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The Ontario Mass Evacuation Plan is a supporting plan to the Provincial Emergency Response Plan (PERP). For more information on the legislative framework and authorities, see the PERP available on the EMO website. This plan supports the agreement between the Governments of Ontario and Canada (through the Department of Aboriginal Affairs and Northern Development Canada) to provide emergency response support to First Nation communities in the province.
An EMO planning team in consultation with non-governmental organizations, provincial and federal partners developed the plan. This plan is meant to be used to respond to a request for a partial or complete evacuation from one or more communities to one or more host communities.
Provincial coordination will involve the evacuating community, host communities, relevant Ontario ministries, federal departments, non-governmental organizations, and others, as required. This plan is for Ontario’s far north, encompassing municipalities, unorganized territories2 and First Nation communities.
This is an overarching plan for carrying out mass evacuations and as such, many aspects are general in nature4.
The Far North of Ontario spans the width of the province, from Manitoba in the west, to James Bay and Quebec in the east. The far north is subject to several hazards covered under Ontario’s Hazard Identification and Risk Assessment. The geography of the far north may complicate evacuations or efforts to manage or suppress the hazard. Maintain family and community unity, which is integral to maintaining community cohesion and supports. Potential threats to the communities and emergency responders are critical in determining the urgency of the evacuation and for planning resource mobilization.
Real-time threat assessment should be ongoing and coordinated among partners, particularly ministries with relevant OIC responsibilities and the community(ies) at risk.
An OIC ministry or the PEOC may recommend evacuation, or that it is safe to return, based on a real-time threat assessment. The availability, duration, type, and location of host community facilities affect planning for the evacuation. Consideration should be given to maintaining the readiness of host communities for future hosting. Evacuating communities should identify Community Evacuation Liaisons for each host community.
The decision to deploy is typically based on requests from impacted communities, the mandate of the organization deploying staff, and staff member’s level of expertise. Depending on the scale and complexity of the operation, a senior provincial official may be deployed to coordinate the provincial response and to liaise with community and other deployed officials.
Situational awareness requires continuous coordination to help collect, collate, evaluate, and disseminate information.
When planning for the return of evacuees, the number and location of host communities, and the distance to evacuated communities are key planning considerations.
Roles and responsibilities may pertain to transportation hubs, host communities, support from ministries or the federal government, or responsibilities of evacuating communities. Determine the financial and legislative roles and responsibilities for the evacuation and comply with applicable policies, agreements, procedures, etc. Emergency information needs to be coordinated among the affected communities, province, and federal government. Once it has been decided that a community needs complete or partial evacuation, the parties involved must establish who the evacuees are, where the host locations are, and what the means of evacuation will be. Following the judgement of the authorized entity that it is safe for evacuees to return, the order of return and the methods of transportation must be established using an inclusive planning process that involves affected communities, provincial and federal partners, and other partners (i.e. Real-time threat assessment is a critical component of evacuation operations and should be ongoing. All responders involved in managing the hazard or participating in the evacuation must regularly communicate situational awareness information to those conducting real-time threat assessments and must report a changing situation as soon as feasible.
OIC ministries are responsible for assessing the threat for the types of emergencies they have been assigned. EMO is responsible for real-time threat assessments for hazards that have not been assigned to an OIC ministry.
The PEOC is responsible for assessing the threat based on the real-time threat assessment and characteristics of the community(ies) or region under threat. During routine monitoring, the PEOC duty officer performs the function of real-time threat assessment. OIC ministries routinely monitor conditions in the province according to their assigned type of emergency.
Uncertainty in real-time threat assessment is unavoidable, which is why persons with appropriate knowledge of the threat causing the emergency should be involved in the assessment.
During emergencies, the PEOC links with the local community and the OIC ministry acting as provincial lead to coordinate real-time threat assessment information. Emergency managers must understand the makeup of the population who are to be evacuated before they can make key decisions about transportation modes, route selections, hosting destinations, and the many other elements of an evacuation.
Medevac is used for those individuals receiving home care or residing in a health-care facility in the evacuating community that qualify for medical transfer as per the Ambulance Act (evacuation by emergency medical services (EMS) or Ornge). This stage is typically orchestrated through the existing health procedures used in the community. This includes persons with disabilities, seniors, children, pregnant women, and those with medical conditions. Among these, some require attendant care, which means both the caregiver and the Stage 1 evacuee they care for should be on the Stage 1 evacuation list. The designation of evacuees into the different stages will be determined by the First Nation Chief and Council, Head of Council, or appointed person, with the assistance of the on-site health care organization.
Different types of hazards may dictate variations in the criteria for these categories (e.g. The decision to evacuate a community is the responsibility of the First Nation Chief, Head of Council, or appointed person. For First Nations communities, AANDC and PS approve federal assistance to support an evacuation.
The urgency of an evacuation is determined based on the immediacy of the threat to the community (life, safety, health, and welfare), the resilience of the community, and (depending on the nature of the threat) the availability of resources for evacuation or shelter-in-place10. Evacuations may take place prior to (pre-emptive), during, or after an incident has occurred.
Given adequate warning about a hazard, adequate resources, and the likelihood of the threat actually impacting a community, it is advisable to conduct pre-emptive evacuations. If adequate resources are not available to conduct a pre-emptive evacuation, it may still be possible and necessary to carry out an evacuation even while a threat is already affecting a community. If recommending enhanced monitoring or activation of the PEOC, consider what positions must be staffed to conduct the evacuation. Alert PS of the situation and advise them if Government of Canada support may be required to assist. Establish a regular information cycle and contact for evacuating communities, host communities, and other parties assisting with the evacuation. Consider requesting additional host communities stand-by to receive evacuees if the situation appears likely to escalate rapidly. Establish the PEOC Command, and if it is an area or unified command, consider including additional organizations in the command meetings to better inform and coordinate the response.
Determine financial accountabilities in consultation with partners and communicate the information.
Determine at the outset of the operations which organization will be responsible for information management and the manner in which information will be shared. Initiating media contacts or directing the appropriate position to do this according to established plans and procedures (e.g. Adopting an extended operational cycle in which extra positions are staffed beyond the normal working day. Alerting other emergency responders in the province, including non-governmental organizations, that they may be requested to provide assistance.
Marshalling transportation resources, including the recall of deployed resources in preparation for redeployment.
Collecting and analyzing the data necessary to fully understand the potential impact and threat. Weather, resource availability, and the scale of an incident can significantly affect the time required to mobilize resources.
Emergency information is primarily the community’s responsibility, but may be supplemented by the province according to the provisions of the Provincial Emergency Information Plan.
Communications between the field and the PEOC, between the PEOC and partners, and within the PEOC is critical. The PEOC (or other EOC) may request deployments to fulfil specific incident management functions, as needed (e.g.
Where the scale of the incident, evacuation timeline, or availability of staff prevents the physical deployment of staff, relevant incident management functions may be performed remotely using available technology. Information technology in the far north is not universally accessible and may be further compromised by the nature of the emergency. All partners (but with specific reference to PEOC) should recognize the potential limitations to information technology in these regions of the province. The priorities for evacuation will be determined by the Chief and Council (for a First Nation), the Head of Council (for a municipality), or an authorized entity.
Transportation planning for the evacuation will be undertaken by a joint planning team as described in Annex 7. The evacuating community should identify community evacuation liaisons at each of the host community sites to support evacuees. If an evacuation involves a First Nation community, the JEMS Service Level Evacuation Standards provides a sample flight manifest. Service Level Evacuation Standards11 are in place for hosting First Nations community members in the event of an evacuation. Through the PEOC, EMO works with the evacuating First Nation to identify a host community or communities for its evacuees.
The selection and preparation of host facilities should be driven by the needs of the evacuees. Another key consideration is the availability of personnel and other resources to support the host facilities. Potential conflicts with the longer-term use of accommodations in the host community should be considered and mitigated if possible (e.g. The PEOC should begin contingency planning with partners for longer-term evacuations if it appears likely that evacuees will be displaced from their community for longer than the period discussed below. When evacuees are members of a First Nation, the use of any facility that was used as, or could evoke comparisons to, residential schools should be avoided. Communities considering acting as a host community during an evacuation should identify emergency shelter facilities. Short-Term Basic Shelter Services: for a period of 1-14 days, in arenas, gymnasiums, recreation halls, etc. Special Accommodations: to address the requirements of medically vulnerable individuals or those with special needs.
Host communities may be limited in the types of accommodations that they are able to provide. Planning for hosting evacuees builds on information already available (typically from the manifest).
Host communities are responsible for registering evacuees that are entering into their care. Registration records should only be shared with organizations providing services to the evacuees (e.g. Before the return of evacuees, the evacuated community should be in a safe and ready state.
Services have resumed and are sufficient to support returning evacuees – for example, power, water, sanitation, security, food and essential supplies, and medical services. If a community was completely evacuated it may be advisable to begin the return of evacuees with essential workers to restart systems and assess the readiness of the community to receive other returning evacuees. Once approval has been given for all or a part of the population to return home, community leaders, working with community evacuation liaisons, will develop priorities and manifests for the return flights. Ground transportation arrangements may be made by the host community or the provincial government. The evacuated community will take the lead for communicating re-entry procedures, with assistance from partners as required. What media sources can evacuees use for the most up-to-date information on re-entry procedures?
Following a regional evacuation, multiple communities may decide at the same time that they are ready to return evacuees.
The PEOC and partners will commence demobilization as host communities are cleared of evacuees. The Quick Reference Guide is a condensed version of the Ontario Mass Evacuation Plan Part 1: Far North. But VA was not looking for the kind of transportation available at an automobile dealership. The DPU features solid steel construction that Grasso said can withstand winds from a category 3 storm, which can reach 130 mph.
Grasso said that medications can be handed outside through one of the DPU's windows to an area sheltered by the unit's large, retractable awning. The area under the awning contains data and electrical ports and halogen lights to allow the staff to work outside day or night. During a disaster, the DPU would travel with a pickup truck or sport-utility vehicle and a 21-ft drug-delivery trailer that can also be converted to a makeshift pharmacy, if necessary, Grasso said. Grasso said the DPU would be used to provide veterans with some, but not all, of the medications on VA's outpatient formulary. Through a soon-to-be-tested satellite connection to VA's CMOP system, pharmacists in the DPU would access veterans' prescription data during an emergency and supply needed medications onsite. The initial field test of the DPU took place this spring during Operation Double Threat, an emergency-preparedness exercise held in Fort Indiantown Gap, Pennsylvania. To staff the DPU in preparation for the exercise, Grasso said he turned to VA's existing database of emergency-management personnel.
The deployment team for Operation Double Threat included pharmacists and pharmacy technicians who had worked in Houston or New Orleans during the 2005 hurricane season, Grasso said.
Grasso said he is not sure whether he trained the team or the team trained him, but by the end of the exercise he had three pages of ideas for improving the DPU. Grasso said VA pharmacy staff from all over the country have registered for service on the DPU, and about six pharmacists, including himself, have already completed training and can deploy on short notice.
He said future plans for the DPU include a test of the satellite link and the creation of a DPU with a "recreational vehicle footprint" that would not need to be hauled by a truck. VA plans to take the DPU on the road in December for ASHP's Midyear Clinical Meeting in Las Vegas, where the unit will be on display in the exhibit hall. According to VA, the DPU concept arose from departmental recommendations after an assessment of the response to the 2005 hurricane season. ASHP is the national professional organization whose more than 40,000 members include pharmacists, student pharmacists, and pharmacy technicians who serve as patient care providers on healthcare teams in acute and ambulatory settings. ASHP is the national professional organization whose more than 43,000 members include pharmacists, student pharmacists, and pharmacy technicians who serve as patient care providers on healthcare teams in acute and ambulatory settings.


On July 20, 2014, an acutely ill traveler from Liberia arrived at the international airport in Lagos, Nigeria, and was confirmed to have Ebola virus disease (Ebola) after being admitted to a private hospital. Port Health Services conducted early contact tracing at the airport and worked with airlines and partners to ensure notification of the outbreak through International Health Regulations (IHR 2005) mechanisms (3).
As of September 24, 19 laboratory-confirmed Ebola cases and one probable case had been identified (Figure 1). Investigation of the index patient and all exposed contacts required coordination between multiple IMS response teams and across several cities in the course of the response. The threat to Nigeria posed by the arrival in Lagos of a patient acutely ill with Ebola was potentially enormous. Initially, NCDC and the Lagos State Ministry of Health established an Incident Management Center, which served as the overall implementing arm of the national response.
The overall design of the response rested within a senior strategy team made up of the IM, Deputy IM, and primary partner agencies (Doctors Without Borders, the United Nations Children's Fund, the World Health Organization, and CDC). Several issues were observed by the response team during Nigeria's Ebola outbreak that could, in retrospect, have been mitigated through additional preparedness planning for public health emergencies. Onyebuchi Chukwu, MD, Jide Idris, MD, the Ebola EOC response team in Nigeria, Alex-Okoh, MD, Chima Ohuabunwo, MD, Ndadilnasiya Endie Waziri, MD.
The ongoing Ebola virus disease (Ebola) outbreak in West Africa has had an enormous negative impact on civil and public health systems in Liberia, Sierra Leone, and Guinea. Applying lessons from its NCDC and successful polio EOC, Nigeria quickly established a National Ebola EOC after importation of the disease on July 20, 2014. Alternate Text: The figure above is a bar chart showing the number of cases of confirmed (n = 19) and probable (n = 1) Ebola virus disease, by date of illness onset and three-generation spread, in Nigeria during July-August 2014.
Alternate Text: The figure above is a chart showing the organizational structure of the Ebola Response Incident Management Center in Nigeria during July-September 2014. Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S.
This conversion might result in character translation or format errors in the HTML version. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Click on the images below to preview sample floor plan drawings included in the ExampleDrawings.zip file. Editor’s Note: While hospitals near the Atlantic Ocean braced for Hurricane Sandy and prepared to evacuate as necessary, medical centers located inland readied themselves for an influx of patients. A few days before the storm, we sent out notifications to staff to make travel arrangements. The medical center discharged some less-critical patients and opened a few extra wards with 20 to 30 additional adult beds in areas such as an old pediatric intensive care unit and an area of the detox ward that wasn’t being used. Although our computerized prescriber order entry system went down for about six hours, we fared pretty well.
We had no medication issues, but some of the outside pharmacies that [discharged] patients were trying to use had no power, and we weren’t able to call in medications. We had faculty members and students from Long Island University Arnold and Marie Schwartz College of Pharmacy who were based at New York University (NYU) Medical Center come to TBHC while their hospitals and facilities were closed. Being prepared and thinking ahead is great, but sometimes it can only take you so far.  Our institution was extremely prepared for the storm itself and its aftermath, but situations like the gas shortage are hard to plan for.
Residency Match Day 2016 %post_subhead%--> CONGRATULATIONS TO ALL who matched during the first of two residency Matches! Second Chance for Residency Match%post_subhead%--> NEXT TO GRADUATION, Match Day is likely the most anticipated day on the calendars of soon-to-be pharmacy graduates.
Get Connected with ASHP ASHP Connect is the Society's new online community where members connect with each other and share ideas through our discussion board, blogs, social networking tools, RSS feeds, and more. In addition, this plan references the Service Level Evacuation Standards1 developed by the Joint Emergency Management Steering (JEMS) Committee. Updates to the plan will be undertaken as required based on lessons learned from exercises and incident responses.
It is a provincial coordination plan outlining how Ontario would coordinate its response and collaborate with federal and municipal governments, First Nations, non-governmental organizations, and ministry partners. It is not intended for internal evacuations of one part of a community to another part of the same community.
This plan does not replace a community’s own emergency response plans, which should contain provisions for evacuations if they consider evacuations likely. A detailed action plan that addresses the specific scenario, hazard, and threat will still be required.
Evacuations are most frequently caused by forest fires and flooding (most often from spring break-up along the James Bay coast).
Communities in the far north may be located significant distances from communities with road access or from regional centres where services may be available (e.g. Damage to property or the environment may also trigger an evacuation if it poses a risk to the safety, health, and welfare of people. It also dictates what level of activation, and how many and what type of resources will be required for the evacuation. If the evacuation is for one or a few communities, planning may be restricted to movements within the same general geographic area. Therefore, planning should include post-hosting needs, such as financial reconciliation, demobilization support, and reports on issues to be resolved before hosting evacuees in the future.
This allows the incident management team, and all partners, to take informed, effective and consistent actions in a timely manner.
However, as the level of activation increases, the PEOC duty officer transfers this function to a technical specialist or team, if available. These ministries have processes in place for transferring the responsibility for real-time threat assessment to specialists within their ministry when required. All activities and efforts should be focused on moving these people from the at-risk area to places of safety in a timely manner.
This list should contain the names of persons needed to restart systems that must be in place before evacuees can return home (e.g.
If an authorized entity decides on a partial or complete community evacuation, the community should declare an emergency. A pre-emptive evacuation may be undertaken when it is clear that if delayed, conditions (weather or other hazard) would impede evacuation. Evacuations of this nature are done when life safety is at extreme risk and a rescue becomes essential. For example, evacuations of large populations to one or more host communities may require logistics support to secure modes of transportation from a receiving aerodrome or transportation hub to the host community.
Communities are encouraged to make the decision to evacuate as soon as a significant or imminent threat is identified. In widespread evacuations, emergency information may need to be coordinated amongst all involved partners. To assist with streamlining communications, an operational cycle should be established and communicated by the PEOC to partners so they know when they are expected to provide updates on the situation from their perspective. Partners should have back-up technologies available, particularly for their deployed staff.
It is preferable to host community members together, even if it means hosting them farther away from their home community. Evacuation liaisons represent the needs of evacuees when attending meetings with the host community and other agencies. If the information is not collected on the manifest, registration services can collect and provide this more detailed information.
Depending on the scale of the incident, and the numbers and locations of persons to be evacuated, the needs may exceed the capacity of available resources. The Standards provide guidance on allowable expenditures, hosting arrangements, health services, emergency social services, etc. If requested, the PEOC could assist other communities in identifying potential host communities. It is worth noting that community health services and hospitals in the host community may experience an increased demand for their services. Representatives from provincial (through the PEOC) and federal organizations may be available to assist a host community in providing services to evacuees.
It is generally understood that time of year may affect the host community’s ability to provide accommodations during an evacuation. This allows the host community to better coordinate services and seek reimbursement for expenses incurred due to hosting.
The recommendation and the decision to return should be based on the results of the ongoing real-time threat assessment, plus a determination that the home community is ready to support the returning evacuees. This may involve the coordination of an advance team that is given sufficient time and other resources to return the community to a pre-evacuation state. It is critical that at the end of an evacuation, there is a full accounting of the operation in the form of after-action and financial reports.
Grasso joined the Department of Veterans Affairs (VA) as director of Emergency Pharmacy Services in 2005, one of the first tasks assigned to him was to procure a new disaster-response vehicle.
Instead, the department needed a fully functioning mobile pharmacy, with a satellite link to VA's consolidated mail-order pharmacy (CMOP) outpatient formulary database, to provide outpatient services to veterans affected by a hurricane or other disaster. Inside, the unit is divided into five compartments, including pharmacy workspaces for drug preparation and dispensing and an entryway that can be made accessible to patients. This would eliminate the need for most patients to enter the pharmacy, which could pose a security risk.
The DPU's several doors can be written on with a grease pencil to convey important information to patients and staff.
Grasso said VA's seven CMOP sites would also be able to send replacement medications by mail or other carrier service to a patient's temporary address during an emergency.
The disaster scenario included an 8.4-magnitude earthquake affecting the northeastern United States, followed immediately by a pair of category 3 hurricanes that menaced the mid-Atlantic region and the southeastern coast. He also consulted with the department's pharmacy chiefs, who put out a call for volunteers. The rest of the DPU team consisted of pharmacists and pharmacy technicians from the Veterans Integrated Services Network 4 Emergency Medical Response Team, which serves veterans in Pennsylvania, Delaware, and parts of West Virginia, Ohio, New Jersey, and New York. Some suggestions involved structural improvements, such as adding another door and reconfiguring the electrical outlets and adding more storage space.
On July 17, 2014, while under observation in a Monrovia, Liberia, hospital for possible Ebola, the patient developed a fever and, while symptomatic, left the hospital against medical advice.
The EOC case-management team took over management of each laboratory-confirmed or suspected case, triaged potential patients, and decontaminated areas inhabited by them. A total of 894 contacts were identified, and approximately 18,500 face-to-face visits were conducted by contact tracers to assess Ebola symptom development.
The three-generation spread of Ebola (all 19 confirmed and probable cases) to date can be traced to the index case through contact networks (Figure 1). Lagos is Africa's largest city and is also a transit hub for the region with air, land, and sea ports of entry (1).
The initial Incident Management Center was subsequently recast as the national EOC, in line with IMS nomenclature and national structures aimed at emergency response. In October 2012, responding to the declaration by the World Health Organization of polio eradication as a global public health emergency, and to improve its national response, the Government of Nigeria used the IMS to establish a national EOC as part of a new national emergency plan for the global polio eradication initiative (3).
Specifically, the Ebola EOC IM was the polio EOC Deputy IM, and seeded the Ebola EOC with several secretariat and technical staff members from the National Polio EOC. Early in the response, this team mobilized to identify and track the index patient's contacts in the airport and outside Nigeria. This included teams of three social mobilizers who were trained and deployed to conduct house-to-house, in-person visits within specific radii of the homes of the Ebola contacts.
First, financial resources were slow to arrive at the EOC, a delay that threatened to impede the rapid expansion of containment activities across the response.
As of September 24, the Nigeria response had successfully limited the outbreak to 20 laboratory confirmed and probable cases (in two states) with the last cases occurring on August 18 and August 31 in Lagos and Port Harcourt, respectively.
Training and service in public health, Nigeria Field Epidemiology and Laboratory Training, 2008–2014.
Presented at the Risk Mapping for Health Promotion in the Ebola Response Meeting, Lagos, Nigeria, August 4–5, 2014. Six months after the Ebola outbreak was declared: what happens when a deadly virus hits the destitute?
Nigeria's public health system includes a national public health institute (NCDC) and an Emergency Operations Center (EOC) and Incident Management System (IMS), created in 2012 when Nigeria declared polio a public health emergency and restructured its national polio program. I was extremely impressed by the work of our operations leaders as well as our buyer, who placed an order once we knew the storm was coming. Sometimes good planning means telling staff to either come in but not work around the clock, or stagger longer schedules.
This was particularly crucial for medications such as warfarin, where dose changes needed to be made to maintain patient safety. Do you have any words of advice for other pharmacists or pharmacy directors regarding disaster preparedness or functioning during a disaster? As many of the communities in the far north are First Nations, coordination with the federal government is crucial.
Two communities falling within the focus area have road access (Mishkeegogamang and Pickle Lake) and there is a rail link to one municipality (Moosonee). However, the evacuation of multiple communities due to an area-wide emergency is likely to require out-of-area movements for hosting, particularly when the goal is to keep families and communities together. The size and demographics of the population are significant factors in determining how to conduct an evacuation. This would include: scheduling such that staff do not become overly fatigued by the operation and providing as much advance notice of scheduling as is possible given the nature of the incident. In addition, up-to-date contact lists should be maintained by all organizations for use in an emergency. Alternate technologies that may be utilized in an evacuation include satellite phones and amateur radio.
They should also be identified to the host community as resources that may be called upon to assist evacuees. This mitigates the risk of families being separated and makes the return of evacuees less complicated. Evacuation liaisons also assist with creating manifests and determining the order of the return of evacuees in consultation with the Chief, Head of Council, or appointed person from the home community. Once a flight manifest is prepared, it should be sent to the PEOC, which can in turn forward it to other organizations that require the information. Receiving the information in advance can help ensure that needed services are delivered quickly. In this situation, evacuations may need to be prioritized and contingency plans implemented. While the Standards provide guidance on hosting First Nations, they may also be applied to municipal or unorganized territory evacuations as they pertain to hosting arrangements.
While agreements may exist between EMO and a host community, the community retains the option of not hosting during a particular evacuation. Emergency planners should assess proposed facilities based on location, capabilities, capacity, accessibility, and resources, as well as how they would route evacuee traffic. Municipal departments involved in the development of the host facility plan may be able to provide resources to support the set-up and operation of a host facility.
Registration involves creating a municipal record, which is covered under municipal privacy legislation.


Since the degree of damage will likely vary within the affected area, it might be beneficial to initiate a phased re-entry process. In most instances, people are returned in the reverse order of when they were evacuated (i.e.
As with the initial evacuation, numerous resources, especially personnel and transportation related resources will be required to return evacuees to their home community.
It also shows the various partners likely to be involved in an evacuation, broadly reflecting the actions that fall within their jurisdiction. Also inside is a sleeping area with six bunks and a bathroom and shower for VA personnel who would staff the DPU during deployment. Others were related to making the DPU more comfortable for the staff, such as adding a mirror and a place to hang a coat and redirecting the shower head to keep it from spraying into the hallway. The Federal Ministry of Health, with guidance from the Nigeria Centre for Disease Control (NCDC), declared an Ebola emergency.
Despite advice against travel, on July 20 he flew by commercial airline from Monrovia via Accra, Ghana, to Lome, Togo, then changed aircraft, and flew to Lagos. Patients with suspected infection were isolated in the suspected case ward at the Ebola treatment facilities, initially in Lagos and subsequently in Port Harcourt. Persons with suspected Ebola were transported to a suspected case isolation ward by the case management team, and persons who subsequently tested Ebola positive were moved to the confirmed case ward at the same facility in either Lagos or Port Harcourt. The dense population and overburdened infrastructure create an environment where diseases can be easily transmitted and transmission sustained. The EOC expanded its operations to Rivers State when cases emerged there, and oversaw the monitoring of contacts in Enugu State with state health officials as part of the early outbreak response.
The use of IMS through the EOC changed the operational tempo, accountability measures, and programmatic success of the polio program. Critical to demonstrating both national and state commitment, the Deputy IM was a senior member of the Lagos State Ministry of Health (Ebola was imported to Lagos State), with access to human and financial resources within the state health system.
Terms of reference and priority activities were developed by the strategy team to guide each operational team's work; operational teams developed their own staffing, lists of material and financial needs, and a goal-oriented operational plan.
Port Health Service worked with airline and airport authorities and other stakeholders to gather information about contact passengers, decontaminate affected areas of the airport, and send a notice through the World Health Organization-International Health Regulations system to avoid possible spread of the disease.
In response, the team developed a staffing plan for Lagos that included over 150 contact tracers, vehicles, telephones, and mobile data platforms that the contact tracers could use to administer their questionnaires and report contact responses.
For high-density areas, house-to-house teams covered a 500m radius, 1km in medium density areas and 2km for low density (7).
Early activities were funded by the Lagos State government, international partners, and nongovernmental organizations.
Where EOC already exists for other diseases like polio, such structures should be strengthened and used to mount effective responses to new threats like Ebola.
Administration set up command centers manned by departmental leaders, and the hospital provided cots and sleeping arrangements throughout the facility as well as free meals for all staff that were here. We did this willingly in order to provide the same, pre-storm level of care to our patients. My ambulatory care clinic colleagues mentioned that there were scheduling issues for these anticoagulation patients because the clinic had to close for a few days. The majority of the increased patient load came from a nearby nursing home that was evacuated to a shelter in the high school across the street from TBHC. Also, make sure that your employees have a safe way to get to work, and that it’s safe to be there. You can’t check on your property, and you know that you will return home at some point to a mess. This plan supports the activities being undertaken related to mass evacuation planning for ministry and community emergency management programs.
There are two municipalities that fall within the focus area (Moosonee and Pickle Lake) plus more than 30 First Nation communities.
This is facilitated through liaison that may be in place between OIC ministries and federal departments - for example, between the Ministry of Health and Long-Term Care, Health Canada and Local Health Integration Networks (LHIN). Alternatively, the Chief of the First Nation, Head of Council, or an appointed person may decide to conduct a complete or partial evacuation based on an assessment of the threat to area residents.
This approach minimizes potentially having people in harm’s way and enables a more controlled evacuation and optimization of resources. Where possible, identify the positions, rather than individuals who may be involved in the operation. Notwithstanding this recommended practice, a host community’s capacity may be such that it is unable to accommodate an entire community. In the event that the list of potential host communities is insufficient for the size of evacuation pending, the PEOC will solicit additional host communities.
Details on the set-up and operation of the shelter should be provided in the community’s emergency response plan. Each municipality has the responsibility for managing the record in accordance with the applicable legislation and their municipal policies.
The Chief of a First Nation, Head of Council of a municipality, or appointed person, will decide when to allow evacuees to return to the community. Nguku, MBChB5, Sara Beysolow Nyanti, MPA6, Nancy Knight, MD7, Nasir Sani Gwarzo, MD1, Oni Idigbe, PhD8, Abdulsalam Nasidi, MD1, John F. On arrival the afternoon of July 20, he was acutely ill and immediately transported to a private hospital where he was noted to have fever, vomiting, and diarrhea. Four of the cases have been associated with a suspected case in a patient who traveled while ill via commercial aircraft from Lagos to Port Harcourt, Rivers State, and back (Figure 1). Suboptimal infection control practices in health centers lacking necessary equipment and supplies increase the risk for Ebola transmission to health care workers. There was a stated expectation that all partner organizations, donors, and response teams would work through the EOC structure, reporting to an Incident Manager (IM). Indicators and dashboards (electronic displays of high level indicators for each response team monitored at the EOC) were developed to increase accountability of the program staff and spending. Immediately, the EOC developed a functional staff rhythm that facilitated information sharing, team accountability, and resource mobilization while attempting to minimize the distraction of teams from their highest priorities. The Point of Entry team also established entry and exit screening at ports, which is being rolled out at additional ports and will continue for the duration of the regional outbreak to minimize the likelihood of either further importation or exportation of Ebola.
As of September 24, approximately 26,000 households of persons living around Ebola contacts had been reached with house-to-house visits in Lagos and Rivers states. National preparedness efforts should consider how resources can be quickly accessible to fund the early stage of the response.
Suspected cases were confirmed to be Ebola by laboratory testing using RT-PCR to test blood for the presence of Ebola virus.
As of September 24, a total of 894 contacts in three states had been monitored, and 20 confirmed or probable Ebola cases identified, of whom eight died.
The hospital also provided reimbursement for travel, coordinated carpools, and provided car services for the entire week post-hurricane. Normally, we are on high alert with all of the drug shortages going on anyway, so we just ramped it up. Luckily, these issues were short-lived, and our clinics were up and running very soon after the storm. These elderly nursing home patients often needed more advanced medical care than was being provided at the shelter. If they feel safe and taken care of while providing care, that feeling will trickle down to the patients.
Leaders have to account for that toll on the staff and make allowances both during and after the fact to support their staff. It draws linkages to various hazard management plans and procedures developed by ministries. The exact population at any one time is difficult to report as people who are recorded in the census may be away from the community and some who are not recorded may be in the community. Unorganized territories, fly-in lodges and camps, and mining operations also fall into the plan area. The seasonal roads cannot be relied on for evacuation operations given the short and sometimes unpredictable length of time that they are available. Local populations often provide the best information on the threat to their community and the region. Emergency responders may require personal protective equipment, as responder safety will be critical. Where an entire community may not be hosted together in close proximity to the home community, and if the situation allows, the community’s preference should be discussed with the Head of Council, First Nation Chief, or appointed person. The primary reason for returning the most vulnerable people last is to help ensure that support services are in place when they return.
21 million) is a regional hub for economic, industrial, and travel activities (1) and a setting where communicable diseases can be easily spread and transmission sustained. During hospital admission, the patient was queried about Ebola and said he had no known exposure; he was initially treated for presumed malaria.
Additionally, testing for anti-Ebola virus immunoglobulin G, indicating an immune response to Ebola virus, was added to the testing protocol for PCR-negative suspected cases in persons with some symptoms who were epidemiologically linked to subsequent confirmed cases. The isolation and treatment wards were empty, and 891 (all but three) contacts had successfully exited follow up.
After the patient who traveled was discovered, manifests were collected from both flights, and attempts were made to contact passengers to ensure they had not become ill because >21 days had passed since the travel occurred. Contact tracing efforts are burdened by the complex nature of transit, commercial, and public health notification and reporting mechanisms. In turn, the IM would be responsible to deliver accountable and transparent results to the NCDC and the federal Ministry of Health (Figure 2). Through the EOC and the Nigeria Field Epidemiology and Laboratory Training Program (NFELTP) polio activities, state health system strengthening and preparedness was prioritized (4–6). An "Action Tracker" was developed that included specific tasks arising from each meeting, the person responsible, and the due date. Technical partners assigned staff throughout the operational teams in technical advisory roles aimed at building the capacity of the local teams and ensuring quality work. Second, there were discrepancies among the levels of political leadership in fully appreciating the enormous consequences that even a small Ebola outbreak could have on civil institutions such as hospitals, airports, and public gatherings. No new cases had occurred since August 31, suggesting that the Ebola outbreak in Nigeria might have been contained. With no subway service and not enough gas to make it back and forth to the hospital, staying at the hospital was important to guarantee the continuance of pharmacy services. For example, there may be people staying at fly-in lodges that do not report year-round population. Therefore, implementing a rapid response using all available public health assets was the highest priority.
Based on the patient's failure to respond to malaria treatment and his travel from an Ebola-affected country in the region (2), treating physicians suspected Ebola.
When a contact became ill with a suspected case, the contact tracing team gathered data on persons exposed to that contact from the date of symptom onset in the event the suspected case should become laboratory confirmed. The remaining three contacts became ill but tested Ebola negative and were released from the isolation ward in Lagos. The implementation of a rapid response that made use of the available public health assets was the highest priority at the onset of the outbreak, as was organizing the response using proven structures for the delivery of public health in Nigeria.
The IM, responsible for oversight of the response, was selected based on IMS experience and competency rather than rank in government or public service. Targeted education about the urgent need to fund, staff, and supply a response effort was provided to political leadership and should be considered for preparedness efforts elsewhere. Suspected cases were ruled out as confirmed if two consecutive negative RT-PCR tests spaced ?48 hours apart were negative. What made this challenging was the lack of information on these patients—no medical charts, limited information on current medications, etc. Similarly, there may be community events that draw tourist and other visitors to the community. On July 23, the Federal Ministry of Health, with the Lagos State government and international partners, activated an Ebola Incident Management Center as a precursor to the current Emergency Operations Center (EOC) to rapidly respond to this outbreak.
The patient was isolated and tested for Ebola virus infection while local public health authorities were alerted about a suspected case of Ebola. Having the capacity to conduct Ebola laboratory diagnosis in-country at the Lagos University Teaching Hospital facilitated rapid identification of confirmed cases and quick discharge of persons with suspected Ebola who tested Ebola negative. As is standard practice, upon release, the patients who had been suspected cases started a new 21-day follow-up as contacts because of the possibility that they were exposed in the ward.
Overall, no new cases have occurred since August 18 in Lagos and August 31 in Port Harcourt, suggesting that the Ebola outbreak in Nigeria might have been contained (Figure 1). To effectively address Ebola in this complex environment, the response was mounted quickly and used an IMS; both actions are largely credited with helping contain the outbreak early.
Similarly, the Nigerian public did not have specific information about Ebola, and early information provided by the press, in advance of official information from the health authorities, was sometimes inaccurate and created a nationwide scare.
We had to run additional labs, test drug levels, and so on, to see if they had taken medications recently. The index patient died on July 25; as of September 24, there were 19 laboratory-confirmed Ebola cases and one probable case in two states, with 894 contacts identified and followed during the response.
A blood specimen sent to Lagos University Teaching Hospital was confirmed positive for acute Ebola virus infection. In this instance, no one was diagnosed with Ebola while these three contacts were in the ward, thus the likelihood of Ebola exposure was very low, and all three are due to exit follow-up on October 2.
This scare resulted in some persons resorting to extreme and sometimes harmful and ineffective measures to avoid infection such as consuming large quantities of salt water, even in places distant from the outbreak.
Several of them then stayed with us for a few weeks until we could get them into another nursing home. Eleven patients with laboratory-confirmed Ebola had been discharged, an additional patient was diagnosed at convalescent stage, and eight patients had died (seven with confirmed Ebola; one probable).
Both issues could have been addressed through preparedness activities that focused on education and planning, as well as explaining Ebola to the public and describing how to respond should Ebola arrive in Nigeria. The isolation wards were empty, and 891 (all but three) contacts had exited follow-up, with the remainder due to exit on October 2. The Case Management team indicated that early efforts to establish an isolation ward were delayed due to a lack of Nigerian health care workers willing to care for patients with Ebola because of a lack of information and training about how to care for Ebola patients, and because care providers had been disproportionately impacted by Ebola in other affected countries. No new cases had occurred since August 31, suggesting that the Ebola outbreak in Nigeria might be contained.
Preparedness activities should include orientation and training of physicians, nurses, and attendants to safely provide services with attention to infection control procedures and quality Ebola treatment at an appropriately designed facility. The EOC, established quickly and using an Incident Management System (IMS) to coordinate the response and consolidate decision making, is largely credited with helping contain the Nigeria outbreak early. National public health emergency preparedness agencies in the region, including those involved in Ebola responses, should consider including the development of an EOC to improve the ability to rapidly respond to urgent public health threats. The EOC system facilitated improved coordination through the designation of the Management and Coordination Team Lead as the private sector point of contact. The government-led EOC process could define opportunities for partners to place staff strategically in the national and local response efforts and could encourage this through the EOC response teams and management system.
Further, EOC mechanisms should be tested through strategic exercises and use in non-Ebola responses.



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Comments to “Disaster plan pharmacy benefits”

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  2. NURIYEV writes:
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