EVD Response Preparedness Tool Kit

EVD Response Preparedness Tool Kit

Nova Scotia Department of Health and Wellness

Health Services Emergency Management

October 20, 2014

Note: This document is for public release. Restricted phone numbers and emails have been removed.

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Table of Contents Purpose ......................................................................................................................................................... 3

Acronyms ...................................................................................................................................................... 4

Annex A - Exercise Specification Guidance Document ................................................................................. 5

General Information ................................................................................................................................. 5

Aim ............................................................................................................................................................ 6

Scope ......................................................................................................................................................... 6

Participants ............................................................................................................................................... 6

Planning Team ........................................................................................................................................... 6

Plans .......................................................................................................................................................... 6

Roles and Responsibilities ......................................................................................................................... 7

General Responsibilities ....................................................................................................................... 7

Emergency Preparedness Champions ................................................................................................... 7

Regional Medical Officer of Health ...................................................................................................... 7

Emergency Planner ............................................................................................................................... 7

Infection Prevention and Control .......................................................................................................... 7

Medical Records ................................................................................................................................... 7

Exercise Controller(s) ........................................................................................................................... 7

Time Line ................................................................................................................................................... 8

Objectives ................................................................................................................................................. 8

Common Objectives .............................................................................................................................. 8

Emergency Departments, Collaborative Emergency Centres, PHC Clinics ......................................... 8

Medical Officer of Health On Call (MOH) and /or the Regional Medical Officer of Health (RMOH)8

Infection Prevention and Control and Housekeeping Services ............................................................. 8


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Exercise Script ........................................................................................................................................... 8

Distribution List ........................................................................................................................................ 9

Annex B: EVD Preparedness Checklists ....................................................................................................... 10

Planning and Equipment ......................................................................................................................... 10

Education ................................................................................................................................................ 11

Exercising and Testing ............................................................................................................................. 12


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Purpose

The Ebola Virus Disease (EVD) Response Preparedness Toolkit is designed to help ensure the NS

health system is prepared to respond in the event that a person positively screens for Ebola

Virus Disease (EVD) at an Emergency Department (ED), a Collaborative Emergency Centre (CEC)

or a Primary Health Care Clinic (PHC).

There are four components to EVD preparedness, namely:

- Protocols are developed that detail the response plan for the organization

- Training for health care professionals is conducted to ensure they understand their

individual roles and responsibilities

- Testing of the protocol and practicing of the people

- Revision and re-education of the protocol based on lessons learned

The Ebola Virus Disease (EVD) Response Preparedness Toolkit contains:

- Annex A -Exercise Specification Guidance Document to help test an organization’s plans

and procedures;

- Annex B- EVD Preparedness Checklists to assist organizations measure their level of EVD

preparedness.

Both these documents are designed help organizations achieve the appropriate level of

preparedness for an EVD event.

If you have any questions concerning this document, contact:

Jim MacDougall

Department of Health and Wellness (DHW)

Health Services Emergency Management (HSEM)

Manager Planning Exercises and Training

[email protected]

mailto:[email protected]


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Acronyms The following acronyms are used in both Annexes

Acronym Meaning

CEC Collaborative Emergency Centre

CMOH Chief Medical officer of Health

DHA District Health Authority

DHW Department of Health and Wellness

DRC Democratic Republic of Congo

ED Emergency Department

EHS Emergency Health Services (paramedics)

EVD Ebola Virus Disease

HS Housekeeping Services

HSEM Health Services Emergency Management

IPC Infection Prevention and Control

MOH Medical Officer of Health

PCS (Nursing) Patient Care Services (Nursing)

PHC Primary Health Care

PPE Personal Protective Equipment

PUI Person Under Investigation

RMOH Regional Medical Officer of Health

Sample Exercise Specification

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Annex A - Exercise Specification Guidance Document

General Information

Exercise Walk In is designed to test Emergency Departments’ (ED), Collaborative Emergency

Centres’ (CEC) and Primary Health Care (PHC) clinics’ procedures for identifying (screening),

responding and enacting the notification process to the Regional Medical Officer of Health

(RMOH) for patients that positively screen for Ebola Viral Disease (EVD) .

The purpose for exercising plans and protocols is to test their validity and practicing the

participants. An important component of this work is the use of the tools and procedures for the

response as well as the testing and practice of the communications and decision-making

processes. Exercising can be repeated as often as necessary to ensure a proper EVD response.

The exercise specification envisions a person who is an exercise player (a person playing a role)

along with an exercise controller(s) (who is/are a member of the Exercise Planning Team)

presenting themselves in the ED, CEC, PHC clinic (as determined by the Exercise Planning

Team and with the agreement of the management of the ED, CEC or clinic). The individual will

indicate that this is a test and verbally present symptoms using the script attached to this

document. Based upon the information presented by the exercise player, the EVD procedures

and protocols need to be enacted.

The EVD protocol shall be implemented including the proper internal communications and

infection prevention and control precautions. It is expected that the attending care provider

would contact the RMOH to provide them with the patient’s symptoms and history. The exercise

will end upon the conclusion of the call to the RMOH.

This exercise specification can allow for the temporary isolation of the exercise player, the

practicing of donning and doffing of personal protective equipment and walking through the

proper cleaning and disinfecting of areas where the patient had a physical presence. These are all

potential extensions of this exercise that can be added at the discretion of the Core Planning

Team.

DHAs/IWK Emergency Preparedness Champions are responsible for ensuring EVD readiness in

response to a suspected EVD patient.


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Aim

The aim of this exercise is to practice the ED, CEC or PHC clinic’s ability to:

- Properly triage and screen a potential EVD patients

- Enact the local protocols and procedures

- Implement the DHW EVD Protocol.

Scope

This exercise is designed for the EDs CEC’s and PHC clinics along with the RMOH. It is the

responsibility of the DHAs and RMOHs to work with the PHC providers to ensure

communications and awareness as to how to respond to person the positively screens for EVD as

outlined in the DHW EVD protocol.

Participants

Regional Medical Officer of Health (RMOH)

Emergency Departments (ED)

Collaborative Emergency Centres (CEC)

Infection Prevention and Control (IPC)

Housekeeping Services (HS)

Primary Health Care Providers

Planning Team

VP Champions - Emergency Preparedness

Quality, Patient Safety, Risk Management and Performance & Accountability

Emergency Planner

RMOH

PHC representative

Occupational Health and Safety

Medical Records

Patient Care Services (Nursing)

IPC

ED / CEC representation

HS

Plans

The intent of this section is to identify the written protocols, guidelines, procedures and plans

specific to an EVD response. Included in this documentation are the roles and responsibilities

for staff when encountering a person who positively screens for EVD as outlined in the DHW

EVD Protocol.


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Roles and Responsibilities

General Responsibilities

Each member of the Exercise Planning Team serves as an advisor and makes recommendations

for exercise design during the lessons learned process and enacting the necessary follow up

measures based upon the outcome of the exercises.

Emergency Preparedness Champions

The DHA/IWK Emergency Preparedness Champion is responsible for ensuring the appropriate

preparedness for a potential EVD patient. Planning issues that cannot be resolved by the Core

Planning Team will be brought forward to the Emergency Preparedness Champion for direction

and resolution. The Emergency Preparedness Champion is responsible to inform the DHA/IWK

CEO and Senior Management Team on the preparedness activities and levels.

Regional Medical Officer of Health

The Regional Medical Officers of Health (RMOHs) are responsible for assessing and

determining the need to implement the EVD Protocol. Their participation in the ED, CEC, PHC

clinic EVD response is an essential component of the testing.

Emergency Planner

The Emergency Planner serves as the coordinator of the Core Planning Team.

Infection Prevention and Control

Infection Prevention and Control (IPC) play a critical role in any EVD response. Ensuring the

appropriate safeguards are in place for patient and staff safety is a critical component of the EVD

response. This responsibility is a major component of the EVD response testing.

Medical Records

The Medical Records representative is responsible to guide and help design process to ensure

that patient records are not generated or not retained as a result of the exercise(s).

Exercise Controller(s)

Individuals responsible to ensure the response to the exercise is in accordance with the policies

and procedures and to document exercise findings. The exercise controllers are not to interfere

with the exercise response except to prevent unintended actions that could cause disruption. The

number of exercise controllers shall be determined based on the exercise design. Exercise

controls must be qualified in the areas that they are observing to ensure procedures are being

properly adhered. Exercise controllers have the authority to pause or stop the exercise is an

unsafe situation develops or as determined by real life events.


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Time Line

Date Activity

October __, 2014 Exercise Planning Meeting

October __, 2014 Test 1.

October __, 2014 Exercise Debriefing

October __, 2014 Test 2

October __, 2014 Exercise Debriefing

Objectives

Common Objectives

The exercise player (EVD patient) is appropriately screened as determined by the EVD

Triage Screening Tool.

The appropriate infection prevention and control procedures are implemented

The appropriate organizational EVD and DHW response procedures are implemented.

Emergency Departments, Collaborative Emergency Centres, PHC Clinics

A suspected EVD patient is properly screened

The appropriate isolation procedures for a suspected EVD patient are enacted

Internal notification procedures are implemented

Infection prevention and control measures are adhered to

Housekeeping procedures are practiced or reviewed

The patient’s symptoms and history are communicated to the RMOH

Medical Officer of Health On Call (MOH) and /or the Regional Medical Officer of Health

(RMOH)

Receives information about a person under suspicion from an ED, CEC, or PHC Clinic

Infection Prevention and Control and Housekeeping Services

Proper Infection Prevention and Control measures are followed.

Exercise Script Exercise Player Profile and Initial Complaint


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Male / Female – Age 45 Is a freelance reporter with Reuters Canada News Agency who has just returned from West Africa. The reporter spent time in Freetown Sierra Leone, Guinea and the Democratic Republic of the Congo and was based out of Johannesburg South Africa. They were last in Freetown one week ago. They returned back to Nova Scotia three days ago from Johannesburg via Heathrow Airport in London. They travelled alone. Presenting Symptoms

A splitting headache for the - past 24 hours

A fever that has just come over her very suddenly(39.2C)

Very sore muscles

Feels exhausted Additional Info

Not on any medications.

Divorced with shared custody of 3 kids - sent them to their spouse’s house when the headache got really bad.

http://www.dailymail.co.uk/wires/ap/article-2795442/New-district-Sierra-Leone-gets-

Ebola.html

Distribution List

(Add the appropriate distribution names and contact info)

http://www.dailymail.co.uk/wires/ap/article-2795442/New-district-Sierra-Leone-gets-Ebola.html

http://www.dailymail.co.uk/wires/ap/article-2795442/New-district-Sierra-Leone-gets-Ebola.html

EVD Preparedness Checklist

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Annex B: EVD Preparedness Checklists The following check list is designed to help measure your organizations ability to respond to positive

screen as identified in the EVD Protocol.

Planning and Equipment

# Question Yes No

1. There is a distribution list and process within the organization for relevant programs

and services to receive the DHW EVD Protocol along with any updates.

2. The EVD Triage Screening Tool is in a written format and readily accessible to patient

intake staff within the organization.

3. The organization has a written plan to respond to a person who positively screens

for EVD as identified in the EVD Protocol.

4. The organization response plan includes identified location(s) within the ED, CEC or

PHC were a positive screen can be isolated.

5. The organization response plan includes a control access program to isolated positive

screen’s.

6. The organization response plan includes a process for controlling access to the

positive screen isolation area.

7. The organization response plan includes the identification of the appropriate level of

personal protective equipment (PPE) to be worn by health care workers

8. The organization has the appropriate level of PPE immediately available to staff who

may come into contact with a person who may be considered a positive screen.

9. The organization response plan includes a process for notifying key personal within

the organization including but not limited to, Infection Prevention and Control, the

organization’s Duty Officer, Housekeeping Services, the organization’s CEO and Public

Relations.

10. The organization response plan includes a process for notifying the Regional Medical

Officer of Health (RMOH) or the MOH on Call and the DHW Duty Officer when the

organization is initiating a response to a positive screen.


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11. The organization response plan includes a housekeeping plan to clean and disinfect

areas where the patient has made physical contact and potential droplet contact. This

would include patient rooms, equipment and supplies in the room, or any washrooms

or sinks or surfaces touched by the positive screen. This includes any medical

instruments used in patient assessment or used by the positive screen.

12. The organization response plan includes plans for the proper disposal of waste

materials including PPE, patient meal trays, laundry, and linens, etc.

13. The organization response plan includes an Occupational Health follow up process for

staff that has come into contact with the positive screen.

14. The organization response plan identifies a process to activate a psychosocial plan for

staff as warranted by the situation.

15. The organization response plan identifies processes for staff to follow if they

encounter a potential positive screen at reception or clinic areas.

15. The organization has a response plan for internal and external messaging.

Education

Education is more than circulating an email to staff. This section is intended to ensure that staff

identified in organizational or the DHW EVD Protocol has the knowledge and tools to enact their roles

and responsibilities in a safe manner.

# Question Yes No

1. An education process and program has been established for front line staff to use and

access the EVD Triage Screening Tool.

2. An education process and program has been established for Emergency Physician and

CEC staff to understand their responsibilities as outlined in the DHW EVD protocol.

3. An education process and program has been established for front line staff to use and

access the organization’s individual EVD response plans.

4. An education process and program has been established for front intake staff and

appropriate care providers on the proper selection and donning and proper doffing

techniques for PPE.


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5. An education process has been developed to inform staff of the location of PPE for

positive screen cases.

6. An awareness program has been established to help staff locate appropriate infection

prevention and control guidelines.

7. The organization’s Duty Officers have been informed of their responsibilities as

outlined in the organization’s response plan.

8. The DHAs/IWK have reached out to Primary Care Provides within their area of

responsibility to created awareness of the EVD Protocol and reviewed roles and

responsibilities.

9. An education process and program has been developed for Housekeeping Services for

the proper measures for cleaning and disinfecting areas surface that have come into

contact and areas occupied by a positive screen. This includes processes for proper

waste and linen removal.

10. An education program and process has been established for those persons who have

the responsibility to interact with a positive screen in isolation.

11. An education program and process has been established for those who are

responsible to provide access control to positive screen in an isolation area.

12. An education program a process to provide staff education in reception and clinic

areas the proper procedures for dealing with a potential positive screen.

13. An awareness program has been developed for all DHAs/IWK staff providing them

information on the risks and prevention measures associated with EVD.

Exercising and Testing

The purpose of testing and exercising the plan is to test the written procedures, identify areas for

improving the procedures and practicing the participants in order to the skills and confidence to enact a

proper response.

# Question Yes No

1. An exercise and testing program has been developed for the use of the EVD Triage

Screening Tool in Emergency Departments, CEC’s and PHCs.


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2. An exercise and testing program has been developed for the testing of the

organization’s full EVD Response plan including the activation of the (RMOH).

3. An exercise and testing program has been developed for the staff providing patient

care on the proper selection and donning and proper doffing techniques for PPE.

4. An exercise and testing program has been developed for Housekeeping Services for

the proper measures for cleaning and disinfecting areas surface that have come into

contact and areas occupied by a positive screen.

EVD Response Preparedness Tool Kit

Documents

Transcript of EVD Response Preparedness Tool Kit