Canterbury Primary ResponseEarthquakes Sept/Feb/June
Dr Phil SchroederPrimary Care Coordinator
Canterbury Primary Response Group
Kelly RobertsonNurse Leader
Canterbury Primary Response Group
Pre-historic Lessons
Managing It
Emergency Planning: Whole of Health Response
CDHB Operations Team
Primary Care: Canterbury
Primary Response Group
Community and Public Health Secondary Care St John
Canterbury Primary Response Group
Agencies and Funders
• Ministry of Health• Canterbury District Health Board• Hospital & Secondary Care • Community and Public Health • St John• City Council & Civil Defence• Aid Agencies e.g. Red Cross• Mental Health NGOs• Private Hospitals • Hotels• Media & Communications
Primary
• Primary Health Organisations• General Practice• 24HS & After Hours Clinics• Pharmacy• District Nursing + Home Care • Plunket• Maori Community Health• Allied Health Workers• Rest Homes• Radiology & Laboratories
Canterbury: the safest of havens.
Canterbury and NZ 2010 and NZ 2009
Rates Of Inf luenza-like Illness In Canterbury And New Zealand to 30 September 2010
0
50
100
150
200
250
300
7/01
/201
0
7/02
/201
0
7/03
/201
0
7/04
/201
0
7/05
/201
0
7/06
/201
0
7/07
/201
0
7/08
/201
0
7/09
/201
0
7/10
/201
0
7/11
/201
0
7/12
/201
0
Rat
e pe
r 100
,000
pra
ctic
e po
pula
tion Canterbury
NZ 2009NZ 2010
high
moderate to low
September 4th 2010: Magnitude 7.1
• Mass casualties/injuries but no fatalities.
• Building damage Selwyn, Kaiapoi, ChCh and CBD.
• Liquefaction Kaiapoi and ChCh.
• Power out for up to one week.
• Water, Sewage out for several days – months.
Hope for the Best
Plan for the Worst
Lessons September 4th 2010 “7.1” Selwyn Quake
LUCKY?
Emergency Planning
Risk Reductio
n
Readiness
Response
Recovery Relationships
Emergency Planning: Mandate Given 17th February
Health Emergency
Influenza Pandemic
Infectious Outbreak eg. SARS
Non Health Emergency Earthquake Flood or
TsunamiRugby
World Cup
Health Non-Emergency
Measles Outbreak
Noro-virus Community
Outbreak
12:51 22ND FEBRUARY 2011
February 22nd 2011: Magnitude 6.3
• Vertical acceleration quake among highest ever recorded.
• Mass casualties with 181 fatalities.
• Building damage ChCh and in particular CBD with monumental collapse.
• Liquefaction ChCh.
• Power out for up to two months plus.
• Water, Sewage out for months.
Pegasus Health 24Hr Surgery– Staff safety– Patient safety– Building safety– Continuity of services
The Response Phase - Immediate
General Practice– Staff safety– Patient safety– Building safety– Continuity/cessation
of services
The Response Phase - Immediate cont:
Incident Centre coordination
Assessment of GPs and Pharmacy’s ability to provide service
Support for affected services
Staff and practice welfare
The Coordinated Primary Care Response
Response StatusLevel 1 Level 2 Level 3
Score = 4 Score = 2 Score = 0
Building (the building they are working from (rather than their normal place of business
Moderate structural damage to premises, e.g. yellow sticker, co-located with another business or significantly comprised workflow
Minor structural damage to premise that have some impact of workflow
No structural damage – may have cosmetic damage that does not materially impact on business delivery
Services (water, sewer, power, telephone or fax)
One or more services not available for more than 1 business day in the last week
One or more service not available for any part of a business day in the last week
All services available with no interruption to any services in the last week
Staff (both in their employed roles and personal situation
One of more members of the business team significantly impacted by quake (physical injury, loss of family member or friend, displaced form home, significant financial hardship). Staff redundancies likely or made
One of more members of the business team are coping with moderate impact by the quake (significant damage to home, partner redundancy, difficulty maintaining staffing levels, etc)
Members of the business team have been impacted in a limited way by the quake
Income (rest home closure, medical practice relocated, retail sales, reduce consult/script numbers (depopulation)
One or more income streams significantly impacted by the quake (e.g. greater than 20% reduction in income)
One or more income streams moderately impacted by the quake (e.g. 5% to 19% reduction in income)
Income streams impacted in a limited way by the quake (less than 5%)
Practice and Pharmacy Status Definition
Total score across the 4 categories:
Status Score
Green 0 - 1
Amber 2 - 9
Red 10 or more
Practice and Pharmacy Status
Affect on Staff– Personally affected but
continued to work– Affected services
struggling with limited resources
• The clean up• Lack of essential services• Safety of vaccines
Providing Care
– Decreased ability to perform at peak – “earthquake brain”
– Increased risk of misdiagnosis– Coping with own stress with aftershocks in the
work environment – Loss of business due to patients relocating
Providing Care cont…
Affect on Patients– Access to service– Less people presenting but longer consultations
required– Health not priority due to disruption of homes and
livelihood– Relocating – loss of continuity of care
Providing Care cont…
Ongoing………..– Funding options to support patient care– HR support/Pastoral care– Counseling support for staff– Regular communication to General Practice and
Pharmacies– Buddy system– Locum relief
Staff Support
• Co-location
• Relocation
• Insurance Limitations
Issues for Pharmacy - Business Continuity
Issues for Pharmacy - Business Continuity
Wk 1 Wk 2 Wk 30
10
20
30
40
50
60
70
80
90
100
Pharmacies Scripts % comparison 3 weeks post-Quake Green Zone Status
Green 1Green 2Green 3Green 4Green 5Green 6
Issues for Pharmacy - Business Continuity
Wk 1 Wk 2 Wk 30
10
20
30
40
50
60
70
80
90
100
Pharmacies Scripts % comparison 3 weeks post-Quake Rural
Rural 1Rural 2Rural 3Rural 4Rural 5Rural 6Rural 7
Issues for Pharmacy - Business Continuity
Wk 1 Wk 2 Wk 3-100
-80
-60
-40
-20
0
20
Pharmacies Scripts % comparison 3 weeks post-Quake Red Zone Status
Red 1Red 2Red 3Red 4Red 5Red 6
Issues for Pharmacy - Business Continuity
Critical Issues February 2011
General Practice
Comms Building
Pharmacy Comms Building
Day One
District Nursing Building
Primary Coord
Comms Building
Power Computers
Power Stock
Day Three
Cordon Access
Comms Building
Portaloos
Portaloos Stock
Day Six
Cordon Access
Comms
Critical Issues February 2011
General Practice
Comms Building
Pharmacy Comms Building
Day One
District Nursing Building
Primary Coord
Comms Building
Power Computers
Power Stock
Day Three
Cordon Access
Comms Building
Portaloos
Portaloos Stock
Day Six
Cordon Access
Comms
Portaloos
Portaloos
Day Ten
Fuel Staffing
Roles
Critical Issues February 2011
Rural CanterburyDay Three
Situation: Survey 100%
Open.
Problems: 1) Rising numbers displaced
patients and consult rates.
2) Fuel needing
farming coop.3) Resupply medication and courier
issues.
Rural Canterbury
Day OneSituation:
Some Minor Building
Damage. NO Loss Power,
Water, Sewage
Action: Practice
Survey 100% Rural
Practices Open.
Rural Canterbury
Day Six
Situation: Survey 100%
Open.
Problems: 1) Huge
numbers displaced
patients and unprecedented consult rates.
Rural Canterbury
Day Ten
Situation: Survey 100%
Open.
Problems: 1) Ongoing
huge numbers displaced
patients and ongoing high consult rates.
Earthquake Response February 2011
General Practice 33%
Pharmacy 21%
Day One
79%
80%
Day Three
85%
83%
Day Six
96%
94%
Day Ten
Earthquake Response February 2011
Red Practices:
Major Issues
Amber Practices:
Serious Issues
Green Practices:Minor or no issues
7%
34%
59%
Day 15:
103 Open = 96%
1 Relocating
2 Closed
Earthquake Response February 2011
3%
31%
66%
Week 8:
105 Open = 99%
8 Relocated
1 Closed
7%
34%
59%
Day 15 Week 8
Earthquake Response February 2011
17%
34%
49%
Week 83%
31%
66%
General Practice Pharmacy
Canterbury Quakes: Sept, Feb, June
June 13th 2011: Magnitude 5.7 & 6.3
• Some casualties but no fatalities.
• Building damage ChCh & CBD again.
• Liquefaction ChCh.
• Power out for one week plus.
• Water, Sewage out again.
The Gap
What Lessons Are We Learning?
Lesson One:Overall Coordination
Emergency Response
• CIMS – Coordinated Incident Management System
• EOC – Emergency Operations Centre
Emergency Planning: Whole of Health Response
CDHB Operations Team
Primary Care:
Canterbury Primary
Response Group
Community and Public
HealthSecondary
Care St John
Primary Emergency Operations Centre (EOC)
Primary Care Coordinator(s)
CommunicationsPrimary Care Reps :Rural Health Pharmacy
District Nursing EOC Manager
Logistics IntelligenceSector Coordinators Support Human
Resources Finance
Lesson Two:Emergency Timelines
Earthquake Response February 2011Preparing for Further Emergency
First 24 Hours• Institute local response• Contact EOC and provide status
Week One• Centralize Response and deploy resources to greatest
need• Survey Practices/Pharmacies to provide logistic support
Week Two Plus• Recognize areas most needing ongoing intensive input• Design ongoing work-streams or projects
Month Three Plus• Recovery mode: business viability, service viability.
Earthquake Response February 2011
General Practice & Pharmacy
Eastern Suburbs Project
Gastroenteritis Project
Vaccination Project
Practice and Pharmacy
Relocation Project
Practice and Pharmacy Viability
Project
Practice and Pharmacy
Development Project
Human Resource Project
Future PlanningMental Health and
Psycho-social ResponsePreparing for
Further Emergency
Emergency Planning
Response
RecoveryReadiness
Lesson Three:Local Cooperation
Notes:
City Ward Boundaries(Also used by CDEM)
An Example. . . . . .
City Ward
Sectors, Legs and Coordinators
Primary EOC
LEGLEG
LEG
LEG
LEG
City Ward
LEG
Sector Coordinator
Primary EOC
Emergency Planning: Whole of Health Response
Rural Canterbury: 5
Districts
Hospitals & Secondary
Care
Lesson Four:Business Continuity
Business Continuity
Emergency Planning
May 2011 Survey Findings
1) Appreciation for DHB supported free consults and prescriptions.
2) Keen for up to date information and consistent communications.
3) Frustration in achieving and maintaining power, water, sewage services and sense of DHB stockpile required eg. Generators.
4) Remarkable ability to continue to provide care when under duress.
5) Universally felt that everyone would like to be better prepared.
Business Continuity Continuity of Care
Emergency Planning
Lesson Summary:The Circle of Life and
Emergencies
Emergency Planning: Whole of Health Response
(1) Overall
Response
(2) Timeline Progression
(3) Local Response
(4) Business
Continuity
(5) Continuity
of Care
Summary: Whole of Health Response
Canterbury Primary Response Website:www.primaryhealthresponse.org.nz
Logon: Primary Password: Response
Contact Email: [email protected]
