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.
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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EVD Response Preparedness Tool Kit
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October 20, 2014
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
EVD Response Preparedness Tool Kit
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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
EVD Response Preparedness Tool Kit
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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
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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.
Sample Exercise Specification
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October 20, 2014
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.
Sample Exercise Specification
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October 20, 2014
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.
Sample Exercise Specification
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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
Sample Exercise Specification
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October 20, 2014
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)
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.