Nte: This dcument is fr public release. Restricted phne numbers and emails have been remved. Ebla Virus Disease Prtcl (Versin 2) Department f Health and Wellness
(This page intentinally left blank)
Table f Cntents Purpse...3 Authrity...3 Backgrund...3 Scpe...3 Assumptin...3 Planning Factrs...3 Rles and Respnsibilities...4 Department f Health and Wellness... 4 Medical Officer f Health (MOH)... 4 EHS Prvincial Medical Directr... 4 DHW Duty Officer... 4 Infectin Preventin and Cntrl Nva Sctia... 5 All District Health Authrities/IWK... 5 Capital District Health Authrity... 5 IWK... 5 EHS Operatins... 5 811... 6 Primary Care Physicians and Prviders... 6 CDHA Micrbilgy Lab... 6 Nva Sctia Medical Examiner s Office... 6 Cncept f Operatins...6 Level I: EVD Triage Screening... 7 Level 2: Medical Officer f Health Screening... 7 Level 3: Health Care Screening... 7 Level 4: Deceased Patient... 8 ATTACHMENTS... 12 1
EVD Triage Screening Tl V9... 12 Nva Sctia Infectin Cntrl Guidelines fr Health Care Facilities... 12 NS Ebla Surveillance and Reprting Guidelines... 12 Ebla Virus Public Health Guidelines... 12 PHAC Guidelines fr Handing the Deceased... 12 NS Medical Examiner s Prtcl... 12 Labratry Guidelines... 12 2
Purpse This prtcl serves as the guidance dcument fr the Nva Sctia health system fr planning and respnding t a case f Ebla Virus Disease (EVD). Authrity This prtcl is develped under the authrity f the Deputy Minister, Department f Health and Wellness (DHW). Authrity can als be used under the Nva Sctia Health Prtectin Act as required by the situatin. Backgrund An utbreak f Ebla Virus Disease (EVD) in West Africa has been nging since March 2014, riginating in Guinea, with spread t Liberia, Sierra Lene, with limited travel related cases in the United States. It is imprtant t maintain situatin awareness as the Ebla utbreak unflds. Up-t-date infrmatin n the situatin in Africa and n EVD can be fund at: http://www.phac-aspc.gc.ca/id-mi/vhf-fvh/ebla-prfessinals-prfessinnels-eng.php http://www.wh.int/csr/dn/archive/disease/ebla/en/ Scpe This prtcl is intended t be used as a planning guide fr all cmpnents f the Nva Sctia health system fr EVD Persns Under Investigatin, Prbable Cases, and Cnfirmed Cases. Detailed in this dcument are the assumptins, planning factrs, rles and respnsibilities, and the cncept f peratins. Assumptin The risk t the Nva Sctia health system f encuntering an EVD patient remains lw. Hwever, reasnable and respnsible measures and precautins must be taken t plan fr and respnd t this ptential situatin. Planning Factrs There are several key factrs that serve as the cre planning principles fr this prtcl: 1. All EVD Persns Under Investigatin, Prbable Cases, and Cnfirmed Cases patients will be treated at the Capital District Health Authrity (CDHA) r the IWK (pediatrics). 2. Phlebtmy and labratry fr EVD Persns Under Investigatin, Prbable Cases, and Cnfirmed Cases is nly t be dne at CDHA/IWK. N bld is t is t be drawn in any ther DHAs 3
3. Existing infectin cntrl prtcls in reginal hspitals are apprpriate t manage a patient in islatin until transprt arrangements can be finalized. 4. Any EVD related fatality, including any fatality related t EVD in a health care facility, will be cmanaged with the Nva Sctia Medical Examiner s Office. Educatin and Exercises A critical cmpnent t the health system preparedness is a rbust educatin and exercise prgram in rder t ensure individual staff is familiar with their rle in an EVD respnse. Rles and Respnsibilities Department f Health and Wellness Medical Officer f Health (MOH) Cnduct Level 2: Medical Officer f Health Screening f EVD Persns Under Investigatin, Prbable Cases, and Cnfirmed Cases Initiate and participate in Level 3: Health Care Screening by telecnference Lead utbreak management, case investigatin, and surveillance/epidemilgy Crdinate n behalf f Nva Sctia health system entry f persns under investigatin, prbable cases and cnfirmed cases f EVD with PHAC Quarantine, New Brunswick and Prince Edward Island EHS Prvincial Medical Directr Participate in a Level 3: Health Care Screening by telecnference Prvide guidance and directin n educatin and exercises t prepare and maintain an apprpriate level f pre hspital care readiness DHW Duty Officer Ensure affected DHW leadership is made aware f activatins f the EVD prtcl. Serve as initial pint f cntact fr all DHW branches shuld additinal assistance r cnsultatin is required during the Level 3: Health Care Screening. Nte: DHW Duty Officer activatin cnstitutes a DHW Alert Outlk Cntact Grup ntificatin (senir branch leadership within DHW). The ntificatin shall include but nt be limited t: Lcatin f patient (ie patient frm hme, patient identified thrugh EHS respnse, patient identified at hspital, etc.) Dispsitin f the patient (ie transprted t CDHA/IWK, r kept in islatin at lcatin) Name f MOH leading the EVD prtcl activatin Any specific needs r requests frm DHW utside f the EVD prtcl (Reference: page 23, 25, r 27 f the DHW Duty Officer Manual) 4
Infectin Preventin and Cntrl Nva Sctia Crdinate the Level 1: EVD Screening fr Emergency Departments, EHS Cms Centre, 811 and primary care ffices and clinics Prvide supprt and nging timely cmmunicatin t district infectin preventin and cntrl prgrams and ther health care settings, and prvide subject matter expertise n infectin preventin and cntrl measures/requirements Onging evaluatin/supprt f infectin preventin and cntrl capacity in the system Supprt DHW HEOC Respnse Exercises t test prtcl efficiency and effectiveness Develp and revise IPC EVD guidelines All District Health Authrities/IWK Implement the standardized prvincial EVD Triage Screening Tl Institute and ensure apprpriate infectin preventin and cntrl precautins Upn directin, crdinate the transprtatin f the patient with EHS Implement a rbust, targeted educatin prgram fr apprpriate staff fcusing n mde f transmissin, PPE selectin and dnning & remving f PPE, cleaning and disinfectin Regularly exercise and refine lcal respnse prtcls during heightened activity (nging transmissin risks) Capital District Health Authrity Prvide infectius disease and infectin preventin and cntrl expertise fr Level 3: Health Care Screening by telecnference Be prepared t receive and care fr EVD Persns Under Investigatin, Prbable Cases, and Cnfirmed Cases Participate in a Level 3: Health Care Screening by telecnference IWK Prvide Infectius Disease and Infectin Preventin and Cntrl expertise n the Level 3: Health Care Screening by telecnference Be prepared t receive and care fr EVD Persns Under Investigatin, Prbable Cases, and Cnfirmed Cases Participate in a Level 3: Health Care Screening by telecnference EHS Operatins Implement an EHS Cmmunicatin Centre and On Scene Level 1: EVD Triage Screening Reprt individuals wh screen psitive n the EVD Triage Screening Tl t the Medical Officer f Health Initiate thrugh the EHS Cmmunicatins Centre a Level 3: Health Care Screening by telecnference 5
Participate in a Level 3: Health Care Screening by telecnference Be prepared t transprt an EVD Persns Under Investigatin, Prbable Cases. and Cnfirmed Cases t CDHA r IWK Institute apprpriate infectin preventin and cntrl precautins Implement a rbust, targeted educatin prgram fr apprpriate staff fcusing n mde f transmissin, PPE selectin and dnning & remval f PPE, cleaning & decntaminatin 811 Implement an 811 Level 1: EVD Triage Screening Reprt individuals wh screen psitive n the EVD Triage Screening Tl t the Medical Officer f Health Liaise with EHS Cmmunicatins Centre and 211 fr crdinatin Primary Care Physicians and Prviders Implement an 811 Level 1: EVD Triage Screening Reprt individuals wh screen psitive n the EVD Triage Screening Tl t the Medical Officer f Health Institute apprpriate infectin preventin and cntrl precautins CDHA Micrbilgy Lab Cnduct EVD Persns Under Investigatin, Prbable Cases, and Cnfirmed Cases specimen testing Be prepared t implement the Emergency Respnse Assistance Plan (ERAP) Participate in a Level 3: Health Care Screening by telecnference Institute apprpriate infectin preventin and cntrl precautins Nva Sctia Medical Examiner s Office Prvide crdinatin and equipment fr the cllectin and dispsitin f any EVD fatality including retrieval in any health care facility Prvide directin t funeral hme directrs cncerning the dispsitin f any EVD fatality Cncept f Operatins The EVD prtcl prvides a mechanism fr prmpt assessment, effective cmmunicatin, seamless crdinatin, timeliness in decisin making and an apprpriate level f respnse. A key cmpnent t the EVD preparedness is the targeted cmmunicatin t key stakehlders including universities, cmmunities f interest, and the Nva Sctia health system. As the circumstances change, brader public health messaging will be implemented. Persns entering Nva Sctia frm EVD affected cuntries/regins that d nt have symptms are being infrmed t cntact 811 if they becme symptmatic. The screening prcess is divided int three levels f screening, namely: 6
Level I: EVD Triage Screening The standardized prvincial EVD Triage Screening Tl (Annex A) is designed fr persns wh cntact 811, EHS Cmmunicatins Centre, r present in emergency departments, Cllabrative Emergency Centres (CECs) r primary health care setting (e.g. university health clinics, family practice clinic, etc.) with EVD like symptms. Additinally, PHAC Quarantine, the Canadian Frces, r the New Brunswick and Prince Edward Island Medical Officers f Health may screen a patient that ptentially requires transfer t the Nva Sctia health system. In all circumstances f an EVD Persn Under Investigatin, Prbable Case, r Cnfirmed Cases, the apprpriate Nva Sctia Medical Officer f Health will be cntacted fr further assessment. During business hurs, the lcal MOH is cntacted thrugh the lcal public health ffice (http://nvasctia.ca/dhw/publichealth/cph-cntact-infrmatin.asp). After hurs, the MOH n call is cntacted thrugh QEII Lcating. Level 2: Medical Officer f Health Screening The MOH will crdinate further assessment and decisins regarding patient assessment and dispsitin. Based n the utcme f the MOH review, the decisin will be made t either manage the patient thrugh nrmal plicies and prcedures, r the MOH will cntact the EHS Cmmunicatin Centre t initiate a Level 3: Health Care Screening. Level 3: Health Care Screening A health care screening via telecnference includes the fllwing participants: Medical Officer f Health CDHA and/r IWK Infectius Disease Staff On Call EHS Prvincial Medical Directr Micrbilgist Staff On Call EHS Cmmunicatin Centre Supervisr will remain n the call t crdinate caller participatin and advise n paramedic resurce availability Additinal participants may include: CDHA/IWK Infectin Preventin and Cntrl On Call DHW Duty Officer Infectin Preventin and Cntrl Nva Sctia Based n the utcme f the discussin at the Health Care Screening level, the patient will either be managed thrugh nrmal health system plicies and prcedures r the EHS/CDHA/Micrbilgy EVD plan will be implemented fr transfer t CDHA r the IWK. In the event a caller/patient des nt require EHS transprtatin, whether fr EVD r any ther cnditin, the caller/patient will be cntacted by either the RMOH/MOH n Call r 811. The RMOH/MOH On call will cntact the DHW Duty Officer t infrm them f the event. 7
In the event that a caller/patient requires transprtatin t a health facility fr an EVD r any ther medical reasn, EHS will cntact the caller directly with pre-arrival instructins. Level 4: Deceased Patient The Nva Sctia Medical Examiner s Office must be cntacted t crdinate the dispsitin f EVD patient fatalities, including deaths in health care facilities. 8
The fllwing diagram utlines the Ebla Virus Disease (EVD) Screening Prcess: Level 1: EVD Triage Screening 811 911 DHA/IWK ED Primary Care Prvider PHAC Quarantine Services NB & PEI MOH Cdn Frces EHS Reginal MOH r MOH n Call CMOH r MOH n Call Level 2: Medical Office f Health Screening N Patient Requires Further Investigatin Yes Medical Officer f Health CDHA and/r IWK Infectius Disease Staff On Call EHS Prvincial Medical Directr MOH Micrbilgist Staff On Call Level 3: Health Care Screening EHS Cmmunicatins Centre Cnference Call CDHA and/r IWK Infectin Preventin & Cntrl On Call DHW Duty Officer Reginal r MOH On Call Cntacts Caller r requests 811 t cntact the caller N Yes Decisin t Transprt Medical Officer f Health Infectin Preventin & Cntrl NS (IPCNS) DHW Duty Officer Reginal r MOH On Call Cntacts DHW Duty Officer Determine Mst Apprpriate Destinatin EHS Cntact Caller with Pre Arrival Instructins CDHA Duty Officer IWK Duty Officer Emergent Transfer Emergent Transfer CDHA /IWK Stage at Clsest Apprpriate ED* Urgent Transfer *The staging will nly take place in situatin invlving prhibitive weather r based n medical circumstances in cnsultatin with the ED Level 4: Deceased Patient Deceased Patient NS Medical Examiner s Office Cntacted 9
The DHW Health Services Emergency Management branch is respnsible fr the update f this prtcl. Amendments can be frwarded t the Manager f Planning, Exercises and Training. Peter W. Vaughan, CD, MA, MD, MPH Deputy Minister Nva Sctia Department f Health and Wellness 10
(This page intentinally left blank) 11
ATTACHMENTS EVD Triage Screening Tl V9 Nva Sctia Infectin Cntrl Guidelines fr the Health System NS Ebla Surveillance and Reprting Guidelines Ebla Virus Public Health Guidelines PHAC Guidelines fr Handing the Deceased NS Medical Examiner s Prtcl Labratry Guidelines Nte: Attachments will be circulated as they becme available 12