HomeMy WebLinkAboutCAO-07-021 - Waterloo Region Community Pandemic Influenza Preparedness Plan~4
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Report To: Finance and Corporate Services Committee
Date of Meeting: Monday, May 7, 2007
Submitted By: Carla Ladd, Chief Administrator
Prepared By: Rob Browning, General Manager, Development and Technical
Services
Ward(s~ Involved: All
Date of Report: April 26, 2007
Report No.: CAO-07-021
Subject: Waterloo Region's Community Pandemic Influenza
Preparedness Plan
RECOMMENDATION:
THAT the City of Kitchener approve Waterloo Region's Community Pandemic Influenza
Preparedness Plan.
And further that the Chief Administrative Officer be authorized to sign the Stakeholder
Acknowledgment and Approval Form on behalf of the City of Kitchener.
EXECUTIVE SUMMARY:
Region of Waterloo Public Health is coordinating the pandemic planning process for Waterloo
Region. Since May 2006, over 100 individuals from over 50 organizations served as members
of working groups (and sub-groups) that developed the various guidelines, tools and strategies
that comprise Waterloo Region's plan -the Community Pandemic Influenza Preparedness
Plan (CPIPP).
The CPIPP is focused on planning for a specific health threat: an influenza pandemic (refer to
Attachment #1 for background information on influenza and pandemic influenza). As such, the
plan is consistent with guidelines and recommendations presented in the federal and provincial
pandemic plans. The CPIPP is an annex to the Region of Waterloo Emergency Response Plan.
Each section of the plan is written so it can stand alone. The CPIPP includes:
Information on influenza and pandemic influenza
Roles and responsibilities of the various levels of government
Waterloo Region's pandemic-specific management structure
Strategies plans} outlining how Public Health will fulfill its key functions and
responsibilities
Information on how health care services will be reorganized and provided
Response tools for the health care sector
Emergency measures to address coordination of services to maintain societal order
How hand what) community support services will be coordinated
Communications plans and strategies
Public Health continues to provide information and support to external organizations/sectors and
the general public. Several resource materials (including a Public Guide to the CPIPP) are
available on Waterloo Region's pandemic-specific website - www.waterlooregionpandemic.ca
or by contacting Public Health directly. Community organizations are also invited to share
resource materials with their clients and stakeholders.
Pandemic planning is an evolving process. The CPIPP will be updated on an ongoing basis. It
is anticipated the next planning stage will commence in September/October 2007. Future
updates will be operational in nature.
REPORT:
According to the Canadian Pandemic Influenza Plan ~CPIP} and Ontario Health Plan for an
Influenza Pandemic ~OHPIP}, local public health authorities and governments are responsible
for planning and coordinating the local response to an influenza pandemic. In Waterloo Region,
Public Health is coordinating the pandemic planning process.
Waterloo Region's pandemic influenza plan is titled, "Community Pandemic Influenza
Preparedness Plan" (CPIPP) ~a copy is distributed with this report}. The CPIPP describes how
Region of Waterloo Public Health, in collaboration with community stakeholders, will respond to
an influenza pandemic. The CPIPP presents guidelines, tools and strategies that will help guide
organizations through the response and recovery phases of a pandemic and who is responsible
for the majority of these tasks.
Planning Process
The CPIPP is being developed in stages. The first stage, which commenced in August 2005
and concluded in April 2006, resulted in the creation of the Community Pandemic Influenza
Preparedness Plan: Strategic Planning Guide and Operational Framework. Community
stakeholders and the Regional Emergency Planning Advisory Committee approved the
framework and Public Health updated the Community Services Committee on this document.
The strategic planning guide and operational framework established goals, assumptions and
principles pertaining to the community response and recovery effort and outlined a process to
further develop Waterloo Region's influenza pandemic plan. A Steering Committee, comprised
of representatives from the health care and emergency response sector and the Region of
Waterloo, guided the development of the CPIPP.
The second planning stage commenced in May 2006 and involved the establishment of a new
Steering Committee and several working groups (and sub-groups). Over 100 individuals from
over 50 organizations served as members of the planning groups prefer to Attachment #2 for a
complete list}. From May to December 2006, the working groups created the preparedness and
response tools, guidelines and strategies that will be used by local governments and
organizations during an influenza pandemic. All of these tools have been reconciled into
Waterloo Region's Community Pandemic Influenza Preparedness Plan.
Overview of Waterloo Region's Community Pandemic Influenza Preparedness Plan -
lmplications for Local Municipalities
2
The CPIPP is focused on planning for a specific health threat: an influenza pandemic. As this
threat will constitute an emergency, Public Health is cooperating with emergency management
specialists. The CPIPP is an annex to the Region of Waterloo Emergency Response Plan, and
is consistent with guidelines and recommendations presented in the federal and provincial
pandemic plans.
To ensure Waterloo Region's efforts are coordinated and effective, the CPIPP presents a
pandemic-specific response (management) structure. During a pandemic, a Regional
Pandemic Control Group (RPCG} will be established. The RPCG will have representation from
all local municipalities and emergency response organizations and will guide and oversee the
broader response and recovery efforts in Waterloo Region. This includes coordination, decision-
making, and communications for functions that are common to all municipalities or regional in
scale. Local municipalities will maintain responsibility for functions that are specific to their
municipality. Several sector-specific coordinating bodies (for the health, community support,
critical infrastructure and communications sectors} will also be established to coordinate
decision-making and the provision of resources for their respective sectors. A Public Health
Support Group comprised of Public Health staff) will be responsible for coordinating Public
Health's response activities. Refer to Attachment #3 for Waterloo Region's pandemic response
structure. Refer to Attachment #4 for a list of RPCG members.
The emergency response sector may need to modify its traditional responses. Given the
expected increase in 9-1-1 calls, emergency responders may not respond as they normally
would. If the pandemic is severe, response times may be delayed. The CPIPP presents the
modified response for this sector and how police, fire and ambulance will coordinate their
services.
The CPIPP also presents a list of critical infrastructure and functions that infrastructure
providers ~e.g., municipalities, hydro) will work to maintain during a pandemic (refer to
Attachment #5). Maintaining infrastructure will be vital to ensure the successful operation of the
health care and related support systems, and to minimize societal disruption. The CPIPP also
contains a draft mutual assistance agreement which outlines the conditions related to the
sharing and provision of personnel, services, equipment or material between organizations.
To the extent possible, each municipality in Waterloo Region will continue to manage their own
critical functions with their staff. Sector coordination will only occur for functions common to all
municipalities, and when a municipality is unable to maintain one of its critical functions and
issues a formal request for assistance from other municipalities in the region. If a municipality is
unable to maintain or operate a critical function, it can request assistance from the Regional
Pandemic Control Group. Once the request is received, the RPCG (or a designated authority}
will decide on an appropriate response.
Collaboration between several organizations ~e.g. police, municipalities, funeral homes,
hospitals) will be required to manage the surge in natural deaths. The CPIPP outlines a strategy
to ensure the proper screening, recognition, reporting and disposition of human remains.
Operational details will be finalized in subsequent planning stages.
Overview of the Remainder of Waterloo Region's Community Pandemic Influenza
Preparedness Plan
The goals of the CPIPP are to reduce morbidity (illness) and mortality death}, and to minimize
societal and economic disruption. The plan also contains a series of planning assumptions and
guiding principles which provide direction to all organizations developing operational and
3
comprehensive pandemic influenza plans. Given the number of ethical dilemmas that will likely
arise during a pandemic, the CPIPP includes an Ethnical Framework for Decision Making as
presented in the OHPIP.
Public Health will be responsible for four key functions:
Surveillance
Public Health Measures
Antiviral Procurement, Distribution and Use
Mass Immunization
The CPIPP highlights the Public Health's primary responsibilities for each function and a
strategy or plan to meet these responsibilities. Through its efforts, Public Health will work to
monitor the progress of the disease and to minimize the burden of illness in the community.
Region of Waterloo Public Health will also operate a general information telephone} line that
residents of Waterloo Region will be able to phone for a basic health screening, to ask
questions and obtain other basic assistance. This phone number will be made available
(through the media) at the start of a pandemic.
As the health care and its related support systems will have difficulty coping with the surge in
demand for service, the current patient flow process for how individuals and families access the
health care and its related support system} will be modified. Following from provincial
guidelines, Influenza Assessment, Treatment and Referral Centres (Flu Centres} will be
established, and all individuals with flu-like symptoms who require care will be required to visit
these centres Winstead of their family physician or the hospital's emergency room} for
assessment, treatment and/or referral. Convalescent Care Centres will also be established.
These centres will support patients who are unable to obtain the care they need at home, but
are not sick enough to be in the hospital.
There will be approximately six to 10 Flu Centres throughout Waterloo Region, primarily in
secondary schools. While initial sites have been selected, their final location will be determined
during the lead up to a pandemic event. The location of these centres will be well advertised
during a pandemic. All centres will be in highly populated areas, on major transportation routes
and will be close to the hospitals. There will be approximately two or three Convalescent Care
Centres in the region; however, their location is undetermined at the present time.
Initial planning details for Flu and Convalescent Care Centres are presented in the CPIPP.
Management and operational details will be finalized in future planning stages.
The CPIPP also addresses services at all three local hospitals. The plan presents a general
overview as to how acute services will be deferred over the course of a pandemic. The plan
also presents a number of operational tools related to the screening and treatment of patients
presenting to acute care facilities during a pandemic. The plans and tools will ensure all three
hospitals are as consistent as possible in their response efforts.
The CPIPP also presents how certain organizations the community support sector (i.e. social
service agencies} will coordinate their planning efforts, including volunteer recruitment. This
sector will work to provide support to individuals and families who would be able to recover from
the flu while staying at home, but do not have the necessary networks to support them during
their illness. Services will only be provided to individuals who are severely ill and if resources
permit.
4
To ensure the successful operation of the health care system several other resources are
included in the CPIPP:
Infection prevention and control guidelines for health care and emergency response
settings
Recommendations for health care and emergency response organizations pertaining to
the stockpiling, distribution and maintenance of equipment and supplies
Guidelines related to health human resources and psychosocial supports for healthcare
workers
The success of all response and recovery tools, guidelines, recommendations and strategies
will depend on effective communications between organizations and in communicating key
messages to the general public. The CPIPP highlights key audiences/stakeholders and how the
dissemination of information will be coordinated. The plan also identifies key messages and
communications vehicles that may be used during a pandemic.
Each chapter in the plan also presents a series of Next Steps. This information will be used to
guide individuals and working in future planning stages as Public Health and its stakeholders
continue to evolve Waterloo Region's Community Pandemic Influenza Preparedness Plan.
Approvals Process for Waterloo Region's Community Pandemic Influenza Preparedness
Plan
In keeping with Public Health's community engagement approach to pandemic planning, all
organizations that have specific roles in implementing the response tools and guidelines during
a pandemic are being asked to endorse Waterloo Region's Community Pandemic Influenza
Preparedness Plan. As part of this endorsement, the administrative head of each organization
is asked to sign a Stakeholder Acknowledgment and Approval Form (refer to Attachment #6).
The approvals process is being carried out in stages. Organizations in the health, community
support and emergency response sectors were asked to indicate their willingness to endorse
the plan via email) by April 13, 2007. All 19 organizations asked to sign the acknowledgement
and approval form provided this confirmation and approved the plan. The official form for
signatures} is currently being circulated.
The Regional Emergency Planning Advisory Committee endorsed the CPIPP on April 5, 2007.
Approval by local municipalities will occur throughout April and May. The regional municipality
and the seven local municipalities will consider/approve the plan over the next few weeks.
Issues Requiring Further Clarification
Throughout the planning process, Public Health collected a list of issues or policy questions that
require clarification from the provincial government. These include, but are not limited to:
Funding (for staffing, equipment and supplies, Flu Centres}
Operational/Management details related to Flu Centres (e.g. liability, insurance, medical
directives, human resources, employee compensation)
The role of primary care providers during a pandemic
Recommendations related to the use of personal protective equipment
Sharing of personal information during an emergency
A draft letter from the Chair of the CPIPP Steering Committee to the Chief Medical Officer of
Health highlighting these issues is presented in Attachment #7.
5
Communication, Public Education and Other Initiatives
Much of the success of the response and recovery efforts will depend on communicating key
messages to the general public. While most information will need to be disseminated leading
up to and during a pandemic, Public Health is continually working to improve its current
communication and public education efforts.
As the CPIPP is over 300 pages and contains detailed information, Public Health developed a
Public Guide to Waterloo Region's Community Pandemic Influenza Preparedness Plan and an
information brochure titled, "Influenza Pandemic -What You Need to Know" copies are
distributed with this report}. The public guide and information brochure highlight key points the
general public should know about the plan and preparedness in general. A clear language
specialist edited the information brochure so it is written at a reading level that is accessible to
the general public.
As Public Health is unable to plan for other organizations, the department continues to provide
information and support to external organizations and sectors. As part of this support, Public
Health produces a newsletter highlighting its pandemic planning initiatives and available
planning resources ~e.g. business continuity tools, fact sheets, provincial updates and
resources}. The newsletter is published four times a year and is distributed to a variety of
stakeholders. All information and documents are available on Waterloo Region's pandemic-
specific website - w.waterlooregionpandemic.ca -which is maintained and updated by
Public Health. Individuals without Internet access are invited to contact Public Health or visit the
Public Health Resource Centre for copies of the material.
Next Steps
The CPIPP hand its related documents and tools} will be reviewed and revised on an ongoing
basis to incorporate provincial updates and directives, and to integrate current knowledge and
best practices. Future edits will be operational in nature. A Steering Committee will continue to
be responsible for directing pandemic planning efforts in Waterloo Region, and it is
recommended the Regional Emergency Planning Advisory Committee review and endorse all
future updates to the plan. Updates on pandemic planning and the CPIPP will be forwarded to
the Community Services Committee on an annual basis.
Region of Waterloo Public Health will continue to support the further development of the CPIPP.
Some of the areas of focus over the next year include:
Work to finalize plans for Influenza Assessment, Treatment and Referral Centres and
Convalescent Care Centres,
Continue to develop surveillance capacity and mass immunization and anti-viral plans,
Continue work on community support efforts, and work with the health care and
municipal sector stakeholders to ensure deferral of services or business continuity plans
are completed.
City of Kitchener staff has already started to detail the city's local pandemic influenza
preparedness plan using the CPIPP as a parent document. City staff will continue to work
cooperatively with staffs of the municipalities within the Region to continually grow the level of
preparedness.
6
FINANCIAL IMPLICATIONS:
Current costs are being absorbed in the approved budget.
Carla Ladd
Chief Administrator
ATTACHMENTS:
Appendices - Waterloo Region's Community Pandemic Influenza Preparedness Plan
Public Guide to Waterloo Region's Community Pandemic Influenza Preparedness
Plan
Influenza Pandemic -What You Need to Know (information brochure)
Attachment #1- Background Information on Influenza and Pandemic Influenza
Attachment #2 - CPIPP Steering Committee, Working Group and Sub-group Members
Attachment #3 - Waterloo Region's Pandemic Response Structure
Attachment #4- Members of the Regional Pandemic Control Group
Attachment #5 -Critical Infrastructure and Functions Providers will work to Maintain during an
Influenza Pande mic
Attachment #6 - Stakeholder Acknowledgment and Approval Form
Attachment #7 -Draft Letter from the CPIPP Steering Committee to the Chief Medical Officer
of Health
Attachment #1-Background Information on Influenza and Pandemic Influenza
Background
Seasonal influenza commonly known as "the flu"} is a contagious virus that circulates on a
yearly basis causing seasonal outbreaks of respiratory illness. Most healthy individuals are able
to recover from the illness, but certain segments of the population -such as the elderly, young
children, and people with certain health conditions -may experience further complications. In
some instances, the disease can be fatal. As a result, influenza is an ongoing public health
threat.
The seasonal influenza viruses are always changing slightly as they exchange parts of their
genetic makeup with other influenza strains. An influenza pandemic for "pandemic"} occurs
when a strain of the flu virus changes in composition, becomes highly contagious, spreads
easily from person to person and moves quickly around the world. Since the population will not
be immune to the new virus, it will affect more people and cause higher rates of morbidity
(illness) and mortality (death}. Public health experts agree that communities should be
prepared for the next pandemic event.
An influenza pandemic would strain health care, community support, municipal and emergency
response resources, and may also result in significant economic and social disruption across
Waterloo Region. A pandemic would challenge our existing systems and institutions because of
increased demand for service coupled with a reduced workforce has a result of illness and family
obligations}. As a result, Region of Waterloo Public Health and its community stakeholders
recognize the benefit of developing mitigation, preparedness, response, and recovery measures
that can be activated before, during, and after an influenza pandemic.
Attachment #2 - CPIPP Steering Committee, Working Group and Sub-Group Members
Steering Committee
Member
Lydia Chudleigh
Dr. Daniel Kollek
Marianne Kraemer
Brenda Lanteigne
Mike Murray
Dr. Liana Nolan*
Karen Quigley-Hobbs**
Mike Schuster
Kelly Smith
Bryan Stortz
Marg Verbeek
Kim Voelker
*Chair **Vice-Chair
Ex officio/ad hoc members
Naideen Bailey
Chris Harold
Matt Saunders
Organization
St. Mary's General Hospital
St. Mary's General Hospital/Grand River Hospital (now resigned)
and Centre for Excellence in Emergency Preparedness
Waterloo Wellington Community Care Access Centre
Grand River Hospital
Region of Waterloo
Region of Waterloo Public Health
Region of Waterloo Public Health
Region of Waterloo Social Services
Waterloo Wellington Community Care Access Centre
Region of Waterloo Corporate Communications
Region of Waterloo Emergency Measures
Waterloo Wellington Community Care Access Centre
Organization
Region of Waterloo Public Health
Region of Waterloo Public Health
Global Consulting
Region of Waterloo Public Health would also like to thank the following individuals for their
contributions to the planning process:
Shannon-Melissa Dunlop St. Mary's General Hospital (now resigned)
Jean-Louis Gaudet Lura Consulting
Pam Hubbard Lura Consulting
Sally Leppard Lura Consulting
Samantha Wilson-Clark Region of Waterloo Public Health (now resigned)
Health Services Working Group
Acute Health Services Sub-group
Member
Lydia Chudleigh**
Terrie Dean
Dr. Daniel Kollek*
Dr. Jonathon Langridge
Brenda Leis
Cheryl Maclnnes
Dr. Liana Nolan
Dr. Linda Pineau
John Prno
John Vanderlaan
Lynn Voelzing
*Chair **Vice-Chair
Organization
St. Mary's General Hospital
Waterloo Wellington Community Care Access Centre
St. Mary's General Hospital/Grand River Hospital know resigned}
and Centre for Excellence in Emergency Preparedness
St. Mary's General Hospital
Grand River Hospital
Cambridge Memorial Hospital
Region of Waterloo Public Health
Grand River Hospital
Emergency Medical Services
Grand River Hospital
St. Mary's General Hospital
Region of Waterloo Public Health would also like to thank the following individual for their
contributions:
Dr. Ron McMillan Cambridge Memorial Hospital know resigned)
Community Health Services Sub-group
Member
Kelly Baechler
Tina Cain
Laura Carlson
Bernadette Grey
Stephen Gross
Brenda Husk
Debbie Kauk
Elizabeth Klassen
Marianne Kraemer*
Toni Lemon
Karen Ostrander
Ellen Otterbein
Kevin Petendra
Karen Quigley-Hobbs
Marlene Raasok
Dr. Janet Samolcyk
Dr. Barbara Schumacher
Dr. Martha Taylor
Dr. Beth Vallieres
Kim Voelker*
Sue Wideman
Kathy Wilkinson
*Co-Chair
Organization
Comcare Health Services
Cambridge Urgent Care Centre
The Sunshine Centre
Lanark Heights Long-Term Care Home
Kitchener Downtown Community Health Centre
Meadowcroft Retirement Home
Comcare Health Services
Waterloo Regional Homes for Mental Health
Waterloo Wellington Community Care Access Centre
Pace Homecare Services
Wilfrid Laurier University
The Westmount Long-Term Care Home (now resigned)
Emergency Medical Services
Region of Waterloo Public Health
Conestoga College
Grandview Family Health Team
University of Waterloo
Family Physician
Cambridge Urgent Care Centre
Waterloo Wellington Community Care Access Centre
Carepartners
St. Luke's Place
Region of Waterloo Public Health would also like to thank the following individuals for their
contributions:
Lydia Chudleigh
Bill Jeffrey
Rosalyn LaRochelle
Steve LaRochelle
Roger Lawler
Cheryl Maclnnes
Mike Murray
Dr. Liana Nolan
John Prno
Tammy Quigley
Ruth Schertzberg
Thomas Schmidt
John Shewchuk
Marg Verbeek
Anne Marie Webster
Arnie Wohlgemut
St. Mary's General Hospital
Conestoga College (now retired)
Woolwich Community Health Centre (now resigned)
Region of Waterloo Social Services
Waterloo Catholic District School Board
Cambridge Memorial Hospital
Region of Waterloo
Region of Waterloo Public Health
Emergency Medical Services
St. Mary's General Hospital
Grand River Hospital
Region of Waterloo Transportation & Environmental Services
Waterloo Catholic District School Board
Region of Waterloo Emergency Measures
St. Louis Parish, Parish Nursing Representative
Waterloo Region District School Board
10
Community Support Working Group
Member Organization
Bianca Bitsakasis-Squires Waterloo Home Support
Wendi Campbell The Food Bank of Waterloo Region
Karen Charles** Canadian Red Cross Society
Janis Doran PATER Program
Jane Hennig Volunteer Action Centre of Kitchener-Waterloo
Jim King City of Cambridge
Joanne Klausnitzer Kitchener-Waterloo Meals on Wheels Incorporated
Marianne Kraemer Waterloo Wellington Community Care Access Centre
Steve LaRochelle Region of Waterloo Social Services
Tony Lea St. John Ambulance
Ron Martens Family & Children's Services of the Waterloo Region
Rob Martin Waterloo Regional Homes for Mental Health
Gwen Page Canadian Mental Health Association know resigned}
Ann Pappert City of Kitchener
Betty Perrin Community Alzheimer Programs
Rev. Christopher Pratt St. John the Evangelist Church
Greg Romanick City of Waterloo
Deb Schlichter House of Friendship
Mike Schuster* Region of Waterloo Social Services
Major Rick Sheasby Salvation Army
John Shewchuk Waterloo Catholic District School Board
Pat Singleton Cambridge Self-Help Food Bank
Ines Sousa-Batista Cambridge Family YMCA Immigrant Services}
Linda Taylor Region of Waterloo Social Services (now resigned}
Anne Marie Webster St. Louis Parish, Parish Nursing Representative
Arnie Wohlgemut Waterloo Region District School Board
Dale Wombwell Salvation Army
*Chair **Vice-Chair
Region of Waterloo Public Health would also like to thank the following individuals for their
contributions:
Deb Bergey Region of Waterloo Social Services
Christina Churchill Independent Living Centre
Dave Cooke City of Cambridge (now resigned)
Jean Cull Family & Children's Services of the Waterloo Region
Jo-Ann Hutchison City of Kitchener
Debbie Kauk Comcare Health Services
Jacki Langlois Volunteer Cambridge (no longer in operation)
Veronica MacDonald Community Care Concepts
Wendy Macintosh City of Waterloo
Monica Morrison Meals on Wheels & Community Home Support
Steve Pawelko Family & Children's Services of the Waterloo Region
Mary Thorpe City of Waterloo
Janet Wall City of Waterloo
Reg Weber City of Cambridge
Deb Young Region of Waterloo Planning, Housing & Community Services
11
Occupational Health & Safety and Human Resources Working Group
Member Organization
Cindy Blair Region of Waterloo Human Resources
Rena Burkholder St. Mary's General Hospital
Katherine Kuhnt Region of Waterloo Public Health
Roger Mayo Emergency Medical Services
Shirley Proctor Grand River Hospital
Anne Rocchi Grand River Hospital
Kelly Smith* Waterloo Wellington Community Care Access Centre
Susan Toth** Cambridge Memorial Hospital
Cathy Vandervoort Cambridge Memorial Hospital
*Chair **Vice-Chair
Region of Waterloo Public Health would also like to thank the following individuals for their
contributions:
Shannon-Melissa Dunlop St. Mary's General Hospital (now resigned}
Randy Esford Grand River Hospital
Andreea Popa St. Mary's General Hospital
Glenn Roach Waterloo Wellington Community Care Access Centre
Penny Smiley Region of Waterloo Human Resources
Equipment and Supplies Working Group
Member Organization
Naideen Bailey Region of Waterloo Public Health
Dave Forbes Cambridge Memorial Hospital
Leah Gibson** Waterloo Wellington Community Care Access Centre
Brenda Lanteigne* Grand River Hospital
Roger Mayo Emergency Medical Services
Vicki Sills St. Mary's General Hospital
Charles Whitlock Region of Waterloo Finance
Debbie Woodhall St. Mary's General Hospital
*Chair **Vice-Chair
Region of Waterloo Public Health would also like to thank the following individual for their
contributions:
Lynn Wilson
Region of Waterloo Finance
Emergency Management Working Group
Member
Marvin Bosetti
Chief Rob Browning
Ron Charie
Susan Duke
Mark Erb
Simon Farbrother
Deputy Chief Mike Mann
Mike Murray*
Dr. Liana Nolan
John Prno
Organization
Township of North Dumfries (now retired)
City of Kitchener/Regional Fire Coordinator
Hydro Coordinator (now retired)
Township of Wellesley
Erb & Good Family Funeral Home Ltd.
City of Waterloo
Waterloo Regional Police Service
Region of Waterloo
Region of Waterloo Public Health
Emergency Medical Services
12
Chief John Ritz Township of Wilmot
Thomas Schmidt Region of Waterloo Transportation & Environmental Services
Mike Schuster Region of Waterloo Social Services
Peter Simmons Township of Woolwich know resigned}
Don Smith** City of Cambridge
Bryan Stortz Region of Waterloo Corporate Communications
Marg Verbeek Region of Waterloo Emergency Measures
Henry Walser Henry Walser Funeral Home Ltd.
*Chair **Vice-Chair
Region of Waterloo Public Health would also like to thank the following individuals for their
contributions:
Chief Terry Allen
Tim Anderson
George Barnes
Wayne Coughlin
Chief John de Hooge
Superintendent Pat Dietrich
Steve Heldman
Rick Kennedy
Ed Kovacs
Rod Kruger
Perry Lee
Victor Leung
Roger Mayo
Randy Miller
Kevin Petendra
Monty Steenson
City of Cambridge
City of Waterloo
City of Cambridge
St. Mary's General Hospital
City of Waterloo
Waterloo Regional Police Service
City of Waterloo
Cambridge Central Ambulance Communications Centre
City of Cambridge
Township of Woolwich
Waterloo Regional Police Service
Cambridge Memorial Hospital
Emergency Medical Services
Township of Woolwich
Emergency Medical Services
Central Ontario Removal Service
Crisis Communications Working Group
Member
Margaret Coleman
Olaf Heinzel
Nancy Hewat
Michael May
Patti McKague
Lu-Ann Procter**
Victoria Raab
Beth Rowland
John Sawicki
Chris Sellers
John Shewchuk
Bryan Stortz*
Michael Strickland
Jacqui Tam
*Chair **Vice-Chair
Organization
Waterloo Region District School Board
Waterloo Regional Police Service
Grand River Hospital
City of Kitchener
City of Waterloo
Region of Waterloo Public Health
St. Mary's General Hospital
Region of Waterloo Corporate Communications
Conestoga College
Cambridge Memorial Hospital
Waterloo Catholic District School Board
Region of Waterloo Corporate Communications
University of Waterloo
Wilfrid Laurier University
Region of Waterloo Public Health would also like to thank the following individual for their
contributions:
Greg Beselaere St. Mary's General Hospital
13
Surveillance, Public Health Measures and Mass Vaccination Working Groups
Region of Waterloo Public Health would also like to thank the following staff for their
contributions to the Surveillance, Public Health Measures and Mass Vaccination chapters:
Naideen Bailey
Jennifer Cutler
Mary Horne
Barbara-May Hutchison
Lesley Rintche
Cathy Tassone
Dr. Hsiu-Li Wang
Samantha Wilson-Clark (now resigned)
Tim Zehr
14
Attachment #3 -Waterloo Region's Pandemic Response Structure
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15
Attachment #4 -Members of the Regional Pandemic Control Group
The Regional Pandemic Control Group will be comprised of persons holding the following
positions, or their appropriate alternates:
Regional Chief Administrative Officer Chair}
Regional Chair
Chief Administrative Officers (or equivalent) of the local municipalities
Heads of Council/Mayors of the local municipalities
Chief of Police
Director of Emergency Medical Services
Regional Fire Coordinator
Chair, Health Sector Control Group
Chair, Critical Infrastructure Control Group
Chair, Community Support Sector Control Group
Chair, Communications Control Group
In addition, the following personnel may be added to the RPCG in a support~ex-officio capacity
as required
Region of Waterloo Manager of Emergency Measures
Fire Chiefs and/or Community Emergency Management Coordinators of the local
municipalities
Region of Waterloo communications officials
Region of Waterloo Public Health officials
Additional personnel called or added to the Regional Pandemic Control Group may include:
Representatives from the School Boards
Representatives from the Universities/Conestoga College
Any other officials, experts or representatives deemed necessary by the Regional
Pandemic Control Group.
16
Attachment #5 -Critical Infrastructure and Functions Providers will work to Maintain
during an Influenza Pandemic
. - ~ -
Water Water Supply* Water Quality
Water Quantity
Regulatory Compliance
Operations and Maintenance
Water Distribution* Operations and Maintenance
Regulatory Compliance
Wastewater Collection* Operations and Maintenance
Pumping Station Function
S ills Res onse
Wastewater Treatment* Treatment
Regulatory Compliance
0 erations and Maintenance
Stormwater* Sills Res onse
Transportation Transit Regular Transit
Operations and Maintenance
Mobilit Plus
Road Infrastructure* Operations and Maintenance
Snow Removal
Traffic Signals
Airport Operations and Maintenance
Air Control
Energy Electrical Supply Distribution
Generation
0 erations and Maintenance
Natural Gas Supply Distribution
Supply
Operations and Maintenance
Vehicle Fuel Supply Distribution
Supply
Waste Waste Management* Refuse Collection
Refuse Disposal
Re ulator Com liance
Other Cemetery/Crematoria
Services
*Functions carried out by multiple municipalities.
1~
Attachment #6 -Stakeholder Acknowledgment and Approval Form
Whereas a Community Pandemic Influenza Preparedness Plan Steering Committee ~"the
Committee"} has been constituted from key stakeholders in Waterloo Region for the purpose of
preparing a community response to the threat of an influenza pandemic;
And Whereas the Committee has prepared a Community Pandemic Influenza Preparedness
Plan ("the Plan"} which follows this Stakeholder Acknowledgement and Approval Form;
By signing this document, each stakeholder acknowledges that their respective organization or
organizational department has been consulted with regard to, and approved, the Plan. Each
stakeholder agrees to collaborate with other community organizations and participate in
Waterloo Region's response and recovery efforts has described in the Plan} to ensure they are
coordinated, effective and transparent.
The signatories are from organizations that have specific roles in implementing the response
tools and guidelines completed in this planning phase. As the planning process evolves and
additional response and recovery strategies are developed in subsequent stages, other
organizations that assume a role in implementing the plan will be asked to sign this stakeholder
acknowledgement and approval form.
Date:
David Brenneman
Chief Administrative Officer, Township of Woolwich
Date:
Karen Charles
Canadian Red Cross Society
Date:
Bonnie Deekon
Executive Director, Cambridge & District Humane Society
Date:
Susan Duke
Chief Administrative Officer/Clerk, Director of Planning, Township of Wellesley
Date:
Julia Dumanian
President & CEO, Cambridge Memorial Hospital
Date:
Linda Fabi
Director of Education, Waterloo Region District School Board
1s
Simon Farbrother
Chief Administrative Officer, City of Waterloo
Date:
Date:
Patrick Gaskin
Acting Chief Executive Officer, Grand River Hospital Corporation
Date:
R. Larry Gravill
Chief of Police, Waterloo Regional Police Service
Date:
Jane Hennig
Executive Director, Volunteer Action Centre of Kitchener-Waterloo
Date:
John Jones
Executive Director, Canadian Mental Health Association, Waterloo Regional Branch
Date:
Joanne Klausnitzer
Executive Director, Kitchener-Waterloo Meals on Wheels Incorporated
Date:
Carla Ladd
Chief Administrative Officer, City of Kitchener
Date:
Roger Lawler
Director of Education, Waterloo Catholic District School Board
Date:
Veronica MacDonald
Executive Director, Community Care Concepts of Woolwich, Wellesley and Wilmot
Date:
Ward McAllister
Manager, Kitchener-Waterloo Humane Society
19
Date:
Rodger Mordue
Acting Administrator/Clerk Treasurer, Township of North Dumfries
Date:
Monica Morrison
Senior Program Manager, Meals on Wheels and Community Home Support
Date:
David Murray
Executive Director, Waterloo Wellington Community Care Access Centre
Date:
Mike Murray
Chief Administrative Officer, Region of Waterloo
Date:
Peter Ringrose
Executive Director, Family & Children's Services of the Waterloo Region
Date:
Katharine Schmidt
Executive Director, The Foodbank of Waterloo Region
Date:
Pat Singleton
Executive Director, Cambridge Self-Help Food Bank
Date:
Don Smith
Chief Administrative Officer, City of Cambridge
Date:
Moira Taylor
President, St. Mary's General Hospital
Date:
Jerry Van Ooteghem
President & CEO, Kitchener-Wilmot Hydro Inc. and Regional Hydro Coordinator
Date:
Grant Whittington
Chief Administrative Officer, Township of Wilmot
Zo
Attachment #7 -
Draft Letter from the CPIPP Steering Committee to the Chief Medical Officer of Health
Dr. George Pasut
A/Chief Medical Officer of Health
80 Grosvenor Street,
11th Floor, Hepburn Block
Toronto, ON M7A 1 R3
Dear Dr. Pasut,
Region of Waterloo Public Health, in collaboration with community stakeholders, is continually
working to develop and improve our local response plans and strategies. This letter is to inform
you of recent activities in Waterloo Region and to forward a list of issues and policy questions
that require clarification from provincial authorities. I understand Ministry staff seeks ongoing
feedback on provincial efforts and I hope you find this information useful.
Over the past two years, Region of Waterloo Public Health collaborated with more than 100
stakeholders from over 50 organizations to develop a pandemic influenza plan for Waterloo
Region. This plan, the Community Pandemic Influenza Preparedness Plan CPIPP), outlines
how organizations and individuals involved in Waterloo Region's emergency response efforts
will respond during a pandemic event. The CPIPP extends beyond the health care sector and
includes guidelines and strategies for the emergency response, community support and
municipal sectors. A copy is enclosed for your perusal.
Throughout the planning process, our stakeholders/planning groups discussed several issues
and policy questions beyond Public Health's jurisdiction. The following are the key issues
Waterloo Region's Community Pandemic Influenza Preparedness Steering Committee would
like the province to address in future iterations of the Ontario Health Plan for an Influenza
Pandemic ~OHPIP} or as soon as possible:
Influenza Assessment, Treatment and Referral Centres (Flu Centres)
The 2006 iteration of the OHPIP recommends that communities establish Influenza
Assessment, Treatment and Referral Centres. While Waterloo Region's CPIPP Steering
Committee is supportive of this recommendation and has developed initial plans for these
centres, there are several issues that are beyond the scope of our planning groups and
mandated public health services in general. Communities will find it difficult to finalize planning
details until provisions are made for the following:
Funding (for equipment, supplies, staffing, facility operations, etc.);
Compensation for Flu Centre staff (particularly if patients do not require health cards to
obtain care);
Insurance requirements and liability concerns;
Medical directives and scope of practice issues (re: Flu Centre staff};
Availability, provision of, and patient payment for pharmaceuticals/antibiotics; and
Antiviral distribution.
Personal Protective Equipment
There is great debate about the appropriate type and use of personal protective equipment
(PPE) and the provision of PPE is consistently raised in our planning forums. Clear guidelines,
21
supported by both the Ministry of Health and Long-Term Care (MOHLTC) and the Ministry of
Labour, are required to address this important issue. The recommendations should consider
best practices for infection control and occupational health & safety, and address the needs for
a variety of settings ~e.g. Flu Centers, hospitals, home visits [by health care and community
support workers], emergency responders and settings where staff or volunteers have close
contact with the public [e.g. shelters, public transit]).
Stockpiling of Equipment and Supplies
The Ontario Health Plan for an Influenza Pandemic recommends health care organizations
stockpile critical equipment and supplies. While the Steering Committee is supportive of the
strategy, it should be accompanied by funding to assist with the acquisition, storage and
distribution of the supplies as the financial and warehousing capacity of the sector is limited.
Stockpiling is also difficult in the absence of clear recommendations regarding personal
protective equipment.
The community support organizations involved in our planning efforts also raised concerns
about the stockpiling of equipment and supplies. While they continue to develop strategies to
eliminate potential employee and volunteer exposure to pandemic influenza, there may be
instances where an employee/volunteer needs to come into close contact with an infected
individual. These organizations, which will be essential to maintain societal order and assist the
health care sector, do not have the capacity or financial means to stockpile the necessary
supplies.
Engagement of Primary Health Care Providers, Physicians and Other Individuals
The role of primary health care providers during an influenza pandemic is unclear. While our
planning groups included representatives from family physicians, urgent care clinics and family
health teams, there is no effective mechanism to engage all primary health care providers. It
would be helpful if the MOHLTC provided reports or updates on their discussions with the
Ontario Medical Association, The College of Family Physicians or any other organization closely
linked with primary care providers. Providing adequate health care during an influenza
pandemic will require extensive coordination and all available resources. Currently, it is
challenging for local planners to engage this important stakeholder. Guidelines outlining or
providing suggestions about their potential role during a pandemic may also be useful.
Updates on discussions with veterinarians, chiropractic, physiotherapist and pharmacist
regulatory bodies (regarding the use of alternate care workers) would also be helpful.
Acute Care
The CPIPP Steering Committee and its Acute Health Services Working Group are supportive of
the critical care triage protocol presented in Chapter 17 of the OHPIP. However, our hospital
representatives indicate they would not be able to follow this protocol given the current
legislation and liability concerns. Will this protocol be legislated?
Our acute sector highlighted the importance of determining compensation guidelines for
physicians who are redeployed to assist with pandemic response efforts. Determining
compensation mechanisms in advance of an event will be essential to ensure their participation.
The acute planning group also raised concerns about access to acute care by patients triaged
from community settings, but do not have a valid health card. Should hospitals provide care?
How will they be compensated? How would physicians bill for the service?
22
In addition, will the MOHLTC fund "closed" hospital beds during a pandemic to increase surge
capacity?
Personal Information and Privacy Legislation
A community's pandemic response and recovery efforts will require unprecedented cooperation
between organizations. To ensure these efforts are effective and coordinated, each organization
may be required to share an individual's personal information. Sharing this information,
however, may not be permitted within current personal information and privacy legislation. Will
special provisions be made during a pandemic? What sort of provisions may be implemented?
Telehealth
The role of Telehealth during a pandemic is unclear. As many public health units plan to operate
a general information/telephone line, it will be essential efforts are not duplicated. Information
provided to the public must also be consistent. It would be helpful to local planners if the role of
Telehealth is clarified.
Community Support Services
While planning for community support services during a pandemic, stakeholders identified
several issues requiring clarification or action:
While effective, the capacity (resources, financial} of community support organizations is
often limited. The ability of these organizations to assist in pandemic response efforts is
dependent on financial compensation for the services. Provisions need to be made for
these supports.
Will the food supply chain be stable during a pandemic? Everyone from farmers to
grocery retailers could be affected, and it will be difficult to support individuals and
families if food is not available. Food provision will be essential to maintain societal
order.
Guidance (re: liability, PPE} pertaining to the use of volunteers in the response effort.
Currently, it is difficult for children's protective service organizations to find appropriate
housing for children in need. If demand for this service increases during a pandemic will
regulations (as per the existing legislation) be relaxed or modified? Will guidelines be
developed to assist these organizations?
How will provincial ministries assist local community support sector organizations during
a pandemic?
Communication
Effective communication during any emergency is vital. During a pandemic it will be essential for
the Provincial Emergency Operations Centre to issue the same clear and consistent directives
to the health care, emergency response, municipal and community support sectors. Doing so
will also work to ensure local efforts across the province are consistent and effective.
Dr. Pasut, Waterloo Region's Community Pandemic Influenza Preparedness Plan Steering
Committee and its planning groups recognize it will be difficult to provide answers to each issue
raised, and understand it may take some time before solutions or consensus is reached. I
appreciate the opportunity to highlight some the current challenges faced by our planning
groups and health unit.
23
On behalf of the Steering Committee I would also like to thank the Ministry of Health and Long-
Term Care (and the Emergency Management Unit in particular) for their ongoing work and
support of local planning efforts. Ontario is a national leader in developing guidelines and
strategies for an influenza pandemic and your Ministry's commitment to protecting the health
and safety of all Ontarians is clearly evident.
I invite you or MOHLTC staff to contact me at nlianaregion.waterloo.on.ca or 519-883-2000
you have any questions or wish to further discuss these issues.
Sincerely,
24
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