cbrn in ontario: what’s out there? brian schwartz md, ccfp(em), fcfp scientific advisor, emergency...
TRANSCRIPT
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CBRN in Ontario:What’s Out There?
Brian Schwartz MD, CCFP(EM), FCFP
Scientific Advisor, Emergency Management Unit, MOHLTC
Public Health CBRN course
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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
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Outline of session
1. EMU and its function
2. Local first response to an incident
3. Provincial response to an emergency
4. MOHLTC response to an emergency
5. Provincial resources: plans, stockpiles and response teams
6. Role of public health in each
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Case 1
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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
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Tokyo: March 20, 1995
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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
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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)
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Case 2
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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
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Case 3
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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
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Types of Emergencies
Natural Events
Technolo-gical Events
Human-related Events
Hazardous Materials
Hurricane Transport-
related
Bioterrorism Radiation exposure
Ice/ snow storm
Power failure
Suicide bomb
Chemical leak
Flood Water related
Dirty bomb
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Emergency Management Unit (EMU)
• Created December 2003 to support emergency management activities within MOHLTC and health care system
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EMU Vision
• To build and enhance a high performance system of integrated health emergency preparedness and response to keep Ontarians safe
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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
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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
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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
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2. Local Response
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Local Primary CBRN Emergency Responders
Prime Agencies:
• Hazardous Materials: Fire
• Criminal activity: Police
• Security threats: RCMP/OPP
• Medical issues: EMS
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Local Secondary Responders
• Hospitals (also “First Receivers”)
• Local Public Health Units
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Hospital Response to an Emergency
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Hospital CBRN Emergency Preparedness Program
• Intended to equip hospitals to be First Receivers to: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
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Hospital CBRN Emergency Preparedness Program
Hospital - 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
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Hospital CBRN Emergency Preparedness Program
Level Designation
Levels:– Level 1 100 victims– Level 2 60 victims– Level 3 25 victims– Level 4 10 victims
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Hospital CBRN Resources
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1. Decontamination
• Decontamination “pop-up” tent
• Snap-in shower system and water/air heaters, basic spill control aids
• Related decontamination and spill control products
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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)
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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
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Current Status: 2007Specialist• 13 hospitals
completed training; a total of 182 staff trained to date
Operations• >186 sessions
confirmed/ completed to date
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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
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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
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3. Provincial Response to an Emergency
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3. Provincial Response to an Emergency
Ministry Emergency Response Plan (MERP)
1. Responsibilities to government/employees
2. Business continuity
3. Emergency response
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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
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Emergency Management and Civil Protection Act
Ministry Standards:
• Emergency Management program & coordinator
• Emergency Management Committee
• Ministry Action Group
• Emergency Response Plans
• Inter-ministry cooordination
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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
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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”
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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
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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
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PEOC Response Levels
1. Routine Monitoring
2. Enhanced Monitoring
3. Activation
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4. MOHLTC Response to an Emergency:
The Ministry Emergency Response Plan (MERP)
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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
• 416 212-0822 or 1-866-212-2272
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Command
Operations Planning LogisticsFinance and
Administration
Safety Liaison
Communications
Hospitals
LTC Homes
Community
Pre-hospital
24/7 Hotline
Public Health
Data Collection
Technical Expertise
Supplies and Distribution
Business Continuity
Teleconference Mgt.
Human Resources
Finances
Documentation
Laboratories
Liaison
PEOC
Command
Operations Planning LogisticsFinance and
Administration
Safety Liaison
Communications
Hospitals
LTC Homes
Community
Pre-hospital
24/7 Hotline
Public Health
Data Collection
Technical Expertise
Supplies and Distribution
Business Continuity
Teleconference Mgt.
Human Resources
Finances
Documentation
Laboratories
Liaison
PEOCEEMC
Emergency Response in the MOHLTC
• EEMC: Executive Emergency Management Committee
• PEOC: Provincial Emergency Operations Centre
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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
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Command
Operations Planning LogisticsFinance and
Administration
Safety Liaison
Communications
Hospitals
LTC Homes
Community
Pre-hospital
24/7 Hotline
Public Health
Data Collection
Technical Expertise
Supplies and Distribution
Business Continuity
Teleconference Mgt.
Human Resources
Finances
Documentation
Laboratories
Liaison
PEOC
Command
Operations Planning LogisticsFinance and
Administration
Safety Liaison
Communications
Hospitals
LTC Homes
Community
Pre-hospital
24/7 Hotline
Public Health
Data Collection
Technical Expertise
Supplies and Distribution
Business Continuity
Teleconference Mgt.
Human Resources
Finances
Documentation
Laboratories
Liaison
PEOCEEMC
Ministry Emergency Operations Centre (MEOC)
• EEMC: Executive Emergency Management Committee
• PEOC: Provincial Emergency Operations Centre
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MEOC Command
• Command and control function rests with Director, EMU
• Safety
• Liaison (link with command and other organizations including PEOC)
• Communications
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MEOC Operations
• Hospitals
• LTC homes
• Community
• Pre-hospital
• 24/7 hotline
• Public Health
• Laboratories
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MEOC Planning
• Interpretation, dissemination and evaluation of emergency response plans
• Technical expertise: Scientific Response Team (SRT)
• Data collection, analysis and evaluation
• Recommendations to command
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Advisory Bodies: SRT
• Scientific Advisor, Chair
• Technical/scientific experts appropriate to emergency
• In biological emergency, populated by PIDAC members
• Provide evidence/best practice based advice to command
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MOHLTC Graduated Response
1. Routine
2. Enhanced
3. Emergency
4. Recovery
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Public Health Unit Involvement in a Health Emergency
• Operations at local level (testing, biosurveillance)
• Operational support at local level (to first receivers)
• Communications at local level
• Planning at local or provincial level (technical expertise, data collection and analysis)
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Notification Process
/LHINs
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5. Provincial Resources: Plans, Stockpiles and Response Teams
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Provincial Resources: Plans, Stockpiles and Response Teams
Plans:• Ministry Emergency Response Plan
(MERP)• Ontario Health Plan for an Influenza
Pandemic (OHPIP)• Smallpox Plan• Mass Fatality Plan• Provincial Nuclear Emergency Response
Plan (PNERP) + MOH Health Plan
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Provincial Stockpiles
• Hospital contingency stockpiles:– Post SARS supplies– Basic PPE (for 4 weeks for entire province)
• Influenza Pandemic Stockpile (4 weeks of 35% surge):– PPE– Antivirals– Basic vaccination supplies– Antibiotics
• Antidotes for CBRN response teams
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National Stockpiles
• National Emergency Stockpile System: lots of stuff….currently under review
• Antivirals?
• Antibiotics?
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Emergency Response Teams• Ontario Emergency Response Team
(OERT)
• Provincial Emergency Response Team (PERT)
• Chemical Biological Radiological Nuclear Response (CBRN) Teams
• Heavy Urban Search and Rescue (HUSAR) Team
• Emergency Medical Assistance Team (EMAT)
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Emergency Response Teams
Ontario Emergency Response Team (OERT):
• Mutual aid to other provinces
• Coordination of emergency response
• Under direction of EMO
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Provincial Emergency Response Team (PERT):
EMO field staff & others
• Coordinate provincial emergency response
• Provide advice to local officials
• Ensure critical information is exchanged between PEOC and local communities
• Under direction of EMO
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Ontario CBRN Teams
• Ottawa, Toronto and Windsor
• Funded locally
• Fire and Police components have subsidies from OPP and OFM in exchange for support for neighbouring jurisdictions
• Medical direction and oversight from Local Base Hospital
• Public Health input/involvement
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CBRN Teams Stockpiles
• Recent purchase of antidotes for cholinergic agents has been completed to supply the teams and the Ontario Emergency Medical Assistance Team (EMAT)
• Atropine, 2-Pam and Diazepam
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July 2002
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My CBRN Team
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3 CBRN Teams
Windsor Ottawa Toronto
Combined HazMat/CBRN (EMS, fire, police)
CBRNE trained paramedics, fire, police
CBRN trained paramedics, fire, police, PH
70 members 100 members 120 members
Work & exercises with Michigan
No mutual aid agreements
Other GTA teams in progress
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Toronto HUSAR Team
• Emergencies involving collapsed structures, including locating, stabilizing and removing victims
• Firefighters, paramedics and physicians
• Funded nationally and locally: national resource
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Emergency Medical Assistance Team (EMAT)
• EMAT is managed by Ornge (formerly Ontario Air Ambulance), and funded by the EMU, to respond to CBRN emergencies, as well as any infectious disease outbreaks
• Composed of MDs, RNs, RTs, Paramedics and X-Ray Technologists from across the province
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Emergency Medical Assistance Team (EMAT)
• Provides a 56-bed, acute-care field unit in any community with road access in which the local healthcare system is unable to manage a large number of patients due to a health emergency, self-sufficient for 72 hours
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Exercises • Participation in regional exercises with
EMAT and others:2 exercises per yearJune 17, 2005, Windsor: train derailment
with chemical spillOctober 6, 2005, Sudbury: chemical truck
explosion in front of stadium 2006/7: Kingston, Thunder Bay
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EMAT Set-up
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EMAT: Criteria for Deployment
Local hospital and regional acute care resources overwhelmed by emergency, defined by:
• Labour availability inadequate to meet requirements
• >10% over normal sick calls, which compromises the ability to provide acute care services to emergency related patients, and
• Chief Nursing Officer identifies staffing levels as compromising patient/staff safety, and
• Staff unavailable to meet needs of emergency-related patients
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EMAT: Criteria for Deployment
• Local hospital and regional acute care resources physically incapacitated by emergency and unable to care for current and/or anticipated in-hospital acute care patients:– Volume of patients cannot be managed– Patients have been discharged as appropriate
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Federal Health Emergency Response Teams (HERT)
• Teams of 40-60 individuals in 4 centres (Ottawa, Vancouver, Halifax & Winnipeg) to assist in management of health emergency
• Deployed within 24 hours at provincial request
• Self sufficient for up to 72 hours
• Implementation 2007-2008
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Summary
• Provincial & local governments have a mandate to plan for and respond to emergencies
• EMO and EMU take leadership for the province and MOHLTC respectively
• Public Health Units should be a component of local planning
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Summary
Public health personnel are secondary secondary responders with potential roles such as:
• Operational lead in bio emergencies• Communications re public health issues
for any emergency• Operational roles in surveillance,
specimen collection, vaccine/medication distribution
• Technical expertise and data management
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Command
Operations Planning LogisticsFinance and
Administration
Safety Liaison
Communications
Hospitals
LTC Homes
Community
Pre-hospital
24/7 Hotline
Public Health
Data Collection
Technical Expertise
Supplies and Distribution
Business Continuity
Teleconference Mgt.
Human Resources
Finances
Documentation
Laboratories
Liaison
PEOC
Command
Operations Planning LogisticsFinance and
Administration
Safety Liaison
Communications
Hospitals
LTC Homes
Community
Pre-hospital
24/7 Hotline
Public Health
Data Collection
Technical Expertise
Supplies and Distribution
Business Continuity
Teleconference Mgt.
Human Resources
Finances
Documentation
Laboratories
Liaison
PEOCEEMC
Emergency Response: IMS
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Questions/Discussion