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Public Health CBRN course

CBRN in Ontario: What’s Out There? Brian Schwartz MD, CCFP(EM), FCFP Scientific Advisor, Emergency Management Unit, MOHLTC. Public Health CBRN course. Goals of Session. Describe the local response to a health emergency Describe the provincial response to a health emergency

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Public Health CBRN course

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  1. CBRN in Ontario:What’s Out There?Brian Schwartz MD, CCFP(EM), FCFPScientific Advisor, Emergency Management Unit, MOHLTC Public Health CBRN course

  2. Goals of Session • Describe the local response to a health emergency • Describe the provincial response to a health emergency • List available provincial resources • Discuss potential roles of public health units & personnel

  3. Outline of session • EMU and its function • Local first response to an incident • Provincial response to an emergency • MOHLTC response to an emergency • Provincial resources: plans, stockpiles and response teams • Role of public health in each

  4. Case 1

  5. Case 1 • An explosion has occurred at the Bloor station in the Toronto subway system • CBRN team is responding due to a phone call to a local TV station from a terrorist group chanting “Death to Canada” and claiming that a radioactive substance has been released

  6. Tokyo: March 20, 1995

  7. Aum Shinrikyo Terrorist Incident • Sarin nerve agent in Tokyo subway station March 20, 1995 • Prior unsuccessful attacks with biological agents, eg. anthrax, botulinum toxin • Prior sarin attack in Matsumoto (1994): • 300 exposed, 56 hospitalizations, 7 deaths • EMS personnel exposed caring for victims

  8. The Patients: Tokyo Sarin attack 1995: • >5000-6000 exposed • 12 deaths: 9 at scene, 1 on arrival at hospital, 2 delayed (hypoxic brain) • 17 patients admitted to ICU • 493 admitted (41 hospitals), most discharged within 48 hours • 3227 presented to EDs (worried well)

  9. Case 2

  10. Case 2 • A tractor trailer carrying chlorine gas cylinders has hit a home and overturned on the Trans-Canada Highway • Several ambulatory patients are appearing at ED complaining of watery eyes and difficulty breathing • Ambulance communications notifies you that at least 30 patients of varying severity are expected to arrive at the local hospital ED in the next hour

  11. Case 3

  12. Case 3 • A nearby power generating station reports a leak of nuclear material • 4 workers are isolated in the facility; internal disaster plan is underway, EMS waiting on-scene • However due to media reports your unit is receiving dozens of calls, and in spite of radio and print requests to “stay in place”, patients from the community are arriving at the ED for “tests” for exposure

  13. Types of Emergencies

  14. 1. Emergency Management Unit (EMU)

  15. Emergency Management Unit (EMU) • Created December 2003 to support emergency management activities within MOHLTC and health care system

  16. EMU Vision • To build and enhance a high performance system of integrated health emergency preparedness and response to keep Ontarians safe

  17. EMU Mission • EMU will collaborate with stakeholders to develop, implement and maintain a comprehensive strategy to prepare for, respond to, and recover from health emergencies of known and unknown origins

  18. Emergency Management Unit Mandate: • Identify and develop the infrastructure required to ensure emergency readiness sustainability • Identify and coordinate the business continuity plan for the ministry

  19. Emergency Management Unit Mandate: • Develop emergency readiness plan(s) and emergency response protocols consistent with Emergency Management Ontario’s expectations & healthcare system needs • Ensure these plans are transparent with clear accountabilities within the health care system and with Ontarians

  20. 2. Local Response

  21. Local Primary CBRN Emergency Responders Prime Agencies: • Hazardous Materials: Fire • Criminal activity: Police • Security threats: RCMP/OPP • Medical issues: EMS

  22. Local Secondary Responders • Hospitals (also “First Receivers”) • Local Public Health Units

  23. Hospital Response to an Emergency

  24. Hospital CBRN Emergency Preparedness Program • Intended to equip hospitals to be First Receiversto: • Those who make their own way to hospital, or • Critically ill patients who need more thorough decontamination i.e.: secondary CBRN response, not duplication of first responder responsibilities

  25. Hospital CBRN Emergency Preparedness ProgramHospital - Designation Process • Level designation based on Geographic distribution: at least one Level One or Two hospital in each LHIN • Hospital capacity to manage emergency victims • Hazard identification and risk assessment • Each site of a hospital corporation to be considered separately if either emergency department or urgent care centre

  26. Hospital CBRN Emergency Preparedness ProgramLevel Designation Levels: • Level 1 100 victims • Level 2 60 victims • Level 3 25 victims • Level 4 10 victims

  27. Hospital CBRN Resources

  28. 1. Decontamination • Decontamination “pop-up” tent • Snap-in shower system and water/air heaters, basic spill control aids • Related decontamination and spill control products

  29. 2. Personal Protective Equipment • Level C apparel (chemical splash suits, cooling vests, boots) • Hand protection (nitrile, butyl, and neoprene gloves) • Respiratory protection (air purifying respirators, N-100 masks)

  30. 3. Radiation Detection Equipment • Portal monitor • Hand-held monitors • Individual dosimeters Used for detection of exposure in incoming patients and monitoring of staff exposure during triage/decontamination procedures

  31. Current Status: 2007 Specialist • 13 hospitals completed training; a total of 182 staff trained to date Operations • >186 sessions confirmed/ completed to date

  32. Secondary Response: Public Health Unit • Program to equip local Public Health Units to collect specimens, provide advice to first responders and communicate risk • Patient care not primary role

  33. Secondary Response: Public Health Unit Roles in preparations & response at municipal level: • Pandemic and other emergency plans • Emergency Operations Centre • IMS roles: • Operations – surveillance, contacts, lab, mass vaccination • Communication • Planning • Other

  34. 3. Provincial Response to an Emergency

  35. 3. Provincial Response to an Emergency Ministry Emergency Response Plan (MERP) • Responsibilities to government/employees • Business continuity • Emergency response

  36. Legislative Framework • Emergency Management and Civil Protection Act • Health Protection & Promotion Act • Other Acts :(Ambulance, Public Hospitals, Long Term Care) • Legislation governing Regulated Health Professionals • Legislation governing Occ Health & Safety • Legislation governing health information

  37. Emergency Management and Civil Protection Act Ministry Standards: • Emergency Management program & coordinator • Emergency Management Committee • Ministry Action Group • Emergency Response Plans • Inter-ministry cooordination

  38. Emergency Management and Civil Protection Act Municipal Standards*: • Emergency Management program & coordinator • Emergency Management Committee • Municipal Emergency Control Group • Emergency Operations Centre • Emergency Response Plans *Public Health Unit involvement

  39. MOHLTC Responsibilities • EM&CP Act has accompanying Order in Council which assigns responsibility for specific types of emergencies to ministries • MOHLTC has been assigned responsibility for: • “Human Health, Disease and Epidemics” • “Health Services During an Emergency”

  40. Government Response to an Emergency EMO: • Overall coordination & management of emergencies in Ontario • Reciprocal notifying arrangements Other Ministries: • Primary responsibility for other types of emergencies, e.g. forest fires, blackouts, food related

  41. Ontario Government Emergency Management Structure (Health) • Provincial Emergency Operations Centre • Provincial Operations Executive Group: • Commissioner of Emergency Management • Chief Information Officer, Emergency Operations and Information Directors • DMs and ADMs as required • CMOH • Director, EMU • Executive Director, CIB

  42. PEOC Response Levels • Routine Monitoring • Enhanced Monitoring • Activation

  43. 4. MOHLTC Response to an Emergency: The Ministry Emergency Response Plan (MERP)

  44. MOHLTC Emergency Management • EMU (Branch within PHD) has primary responsibility for management of health related emergencies • Director reports to CMOH http://www.health.gov.on.ca/english/providers emergencymanagement@moh.gov.on.ca • 416 212-0822 or 1-866-212-2272

  45. Emergency Response in the MOHLTC • EEMC: Executive Emergency Management Committee • PEOC: Provincial Emergency Operations Centre

  46. Executive Emergency Management Committee (EEMC) • Deputy Minister, Chair • CMOH/ADM Public Health Division • Director, Emergency Management Unit • Scientific Advisor, EMU • Chair, PIDAC (as appropriate for bio) • ADMs • MOL representative

  47. Ministry Emergency Operations Centre (MEOC) • EEMC: Executive Emergency Management Committee • PEOC: Provincial Emergency Operations Centre

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