Hauora Tairawhiti Pandemic and Infectious Disease Response …€¦ · In a pandemic or infectious...

Hauora Tairāwhiti

Influenza Pandemic

&

Infectious Disease

Response Plan

2020

Hauora Tairāwhiti Influenza Pandemic & Infectious Disease Response Plan February 2020 2

1. GENERAL INFORMATION ....................................................................................................... 4 Introduction ................................................................................................................................. 4 Influenza ...................................................................................................................................... 4 Characteristics .............................................................................................................................. 4 Characteristics of pandemics ........................................................................................................ 4 If a world‐wide Pandemic was declared, ...................................................................................... 4 Impact on Tairāwhiti .................................................................................................................... 5 Preparing for a pandemic ............................................................................................................. 6 Vaccines ....................................................................................................................................... 6 Drug treatment and anti‐virals ..................................................................................................... 6 Steps to reduce the rate of spread ............................................................................................... 7 Care in the community ................................................................................................................. 7 Care of dependants ...................................................................................................................... 7 Hauora Tairāwhiti Influenza Pandemic & Infectious Disease Response Plan 2020 ........................ 8 Aims and Objectives ..................................................................................................................... 8 Risk Management ........................................................................................................................ 9 Risk Assessment Matrix for pandemic planning ......................................................................... 10 2. Operational Component ....................................................................................................... 11 General Principles ...................................................................................................................... 11 Communication .......................................................................................................................... 11 District ....................................................................................................................................... 12 Civil Defence Emergency Management ...................................................................................... 12 Initial Action & Advice ................................................................................................................ 12 Media Releases .......................................................................................................................... 12 PHASED RESPONSE TO OUTBREAK OF INFECTIOUS DISEASE/PANDEMIC .............. 13 Plan Activation ........................................................................................................................... 14 1. Plan For It ........................................................................................................................ 14 2. Keep It Out....................................................................................................................... 15 3. Stamp It Out .................................................................................................................... 19 4. Manage It ........................................................................................................................ 22 Pandemic Management ............................................................................................................. 22 5. Manage It: Post‐Peak ....................................................................................................... 24 Appendix 1 ................................................................................................................................. 28 CORONAVIRUS 2020 ............................................................................................................. 28 Hauora Tairawhiti Isolation and Quarantine Response ................................................... 28 Hauora Tairawhiti Isolation and Quarantine Procedure.............................................................. 29 Confidential: .............................................................................................................................. 30 If a further clinical setting is required to manage infected patients, consideration will be given to utilising the Chelsea Hospital services. ....................................................................................... 30 Appendix 2 ................................................................................................................................. 31 Appendix 3 ................................................................................................................................. 32 EMERGENCY CHILDCARE RESOURCES ......................................................................................... 32 Appendix 4 ................................................................................................................................. 34 BODY STORAGE .......................................................................................................................... 34 Appendix 5 ................................................................................................................................. 36 REST HOMES .............................................................................................................................. 36 Appendix 5 ................................................................................................................................. 37 HOME CARE SERVICES ................................................................................................................ 37 Appendix 6 ................................................................................................................................. 38


2. Key Guidelines for Hospital Departments ........................................................................... 40 Key Activities for Hospital Departments ..................................................................................... 41 1. Border Control and Quarantine Plan ‐ Port Gisborne ...................................................... 42 Shipping Movement Advice ........................................................................................................ 43 Contacts ..................................................................................................................................... 45


INTRODUCTION

Influenza

Influenza pandemic is one of the more likely events to cause a large‐scale health emergency in New Zealand. Pandemics occurred four to five times in the 20th century, with the major ones reaching New Zealand (in 1918, 1957 and 1968). Recent estimates put mortality from the 1918 influenza pandemic at between 50 ‐ 100 million worldwide. In this country, the 1918 pandemic is estimated to have infected a third to one half of the entire population, causing approximately 8,000 deaths.

Characteristics

Influenza is a highly contagious viral disease of the respiratory tract. It continues to be a major threat to public health worldwide because of its ability to spread rapidly through populations and to cause complications.

Influenza is a significant and under‐recognised cause of mortality in the NZ population, including many cases where influenza contributes to an elderly or chronically ill person’s death.

Influenza is characterised by rapid onset of respiratory and generalised signs and symptoms, including fever, chills, sore throat, headache, dry cough, fatigue and aching. Influenza is easily spread through droplets from an infected person (suspended in the air through coughing or sneezing), being inhaled by another person, or through contact with contaminated objects. The incubation period can range from one to seven days, but is commonly one to three days. Adults are contagious for one to two days before most symptoms start until about day five of the illness. Children generally remain infectious for up to seven days after symptoms start, but may be infectious for up to 21 days.

Characteristics of pandemics

Pandemics are characterised by the global spread of a novel type of virus, and may cause unusually high morbidity and mortality for an extended period. Most people are immunologically naïve to the novel virus and therefore more susceptible to infection. A severe pandemic can overwhelm the resources of a society due to the exceptional number of those affected.

A pandemic entails not only the emergence of a new viral subtype, but also the capacity of that virus to spread efficiently from person to person and cause significant human illness.

If a world‐wide Pandemic was declared, we could expect the following:

Given the high level of global traffic, the pandemic virus may spread rapidly, leaving little or no time to prepare.

1. GENERAL INFORMATION


Vaccines, antiviral agents and antibiotics to treat secondary infections will be in short supply and will be unequally distributed. It will take several months (at least) before any vaccine becomes available.

Medical facilities are likely to be overwhelmed and alternative assessment centres, at the very least, will be required.

Widespread illness may result in sudden and potentially significant shortages of personnel to provide essential community services.

The effect of influenza on individual communities will be relatively prolonged when compared to other natural disasters, as it is expected that outbreaks will reoccur.

Impact on Tairāwhiti

A pandemic will be characterised by a high level of absenteeism in the workforce as people fall ill or stay at home to care for sick relatives. Essential services such as Police, Fire Service, Health and St. John need to be maintained during a pandemic. Other services and supplies including food, water, gas, electricity supplies, educational facilities, postal services and sanitation may also be affected. It is right to assume that normal business activities, regardless of their nature, will suffer during a pandemic.

The Ministry of Health will work with the Prime Minister’s department to minimise social and economic disruption to the greatest extent possible, but all government agencies should factor an incident such as a pandemic in to their emergency planning.

Modelling undertaken by the Ministry of Health (MoH) indicates that 40% of the NZ population will become infected over an 8 week period with a possible case fatality rate of 2%. It is important to note that this modelling is not a prediction or forecast but is designed to provide a structure around which planning can be carried out for a very large event with severe impacts on all aspects of society. The following table is an indication of the impact a pandemic may have on Tairāwhiti:

Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 TOTAL

Illnesses 180 900 4,300 5,800 4,300 1,400 720 360 17,960

Deaths 4 20 90 120 90 30 10 7 371


Preparing for a pandemic

Contingency planning for an event sometime in the future is often difficult to justify, particularly in the face of limited resources and more urgent problems and priorities. However, there are two main reasons to invest in pandemic preparedness:

1. Preparation will mitigate the direct medical and economic effects of a pandemic, by ensuring that adequate measures will be taken and implemented before the pandemic occurs.

2. Preparing for the next (influenza) pandemic will provide benefits now, as improvements in infrastructure can have immediate and lasting benefits, and can also mitigate the effect of other epidemics or infectious disease threats.

A major component of pandemic preparedness is to strengthen the capacity to respond to yearly epidemics of influenza. A surveillance network for human and animal influenza and a targeted influenza vaccination programme are the cornerstones of a national influenza policy.

Ensuring an adequate system for alert, response and disaster management should be the basis of every national pandemic preparedness plan. Depending on the available resources, more specific preparations can be made such as developing specific contingency plans, stockpiling of antivirals, strengthening risk communications, investing in pandemic vaccine research and promoting domestic production of influenza vaccines.

Vaccines

New Zealand does not have the capacity to manufacture vaccines. The first supplies of vaccine against a novel virus are unlikely to be available for at least 4 ‐ 6 months, and possibly even 12 months. By this stage it is likely that New Zealand will have suffered the first pandemic wave. As a result of a high global demand for a vaccine, supplies will be limited. Priority groups for immunisation will be identified early, so that when vaccines become available those people can be immunised rapidly and efficiently. The Ministry of Health will provide the government with recommendations on these priority groups.

Drug treatment and anti‐virals

Many complications from influenza are due to secondary infection with bacterial pathogens. Antibiotics are the preferred treatment for secondary infections, although ineffective in the treatment of uncomplicated influenza.

Anti‐viral drugs can shorten the course of infection if given early in the disease, and can provide short term protection against influenza. During a pandemic (like vaccines) these antivirals will be in short supply and recommendations for their use will be nationally‐directed.


Steps to reduce the rate of spread

Once a novel virus becomes prevalent in NZ, it is unlikely that the spread of the virus can be halted, however there are options to slow transmission that should be considered to slow its advance. These will help reduce pressure on health services over a longer time period and increase the opportunity to protect people, should a vaccine become available. Such measures include :

Recommending that sick people stay at home

Advising the public against unnecessary travel

Utilising the powers of medical officers of health to cancel public events

Closing childcare facilities, schools and tertiary education institutions

Care in the community

Due to the high rates of infection expected during a pandemic, all except the seriously ill will need to be cared for at home. Gisborne Hospitals will prioritise admissions, rationalise services and review staff rosters, however emphasis will be given to out‐of‐hospital care and to saving hospital beds for only the most severe cases.

Care of dependants

During a pandemic it is likely that there will be a number of dependants ‘orphaned’ by the death or hospitalisation of their prime caregiver(s). This will likely result in children requiring care presenting at a hospital or primary care centre.

Note

Once a certain level of efficient transmission is reached, no interventions will halt further spread and priorities need to shift to the reduction of morbidity and mortality i.e. Manage It. Traditional groups at risk from the complications of influenza are persons aged over 65 years, children aged under 1 year and persons of any age with certain underlying chronic health conditions.


Hauora Tairāwhiti Influenza Pandemic & Infectious Disease Response Plan 2020

The Hauora Tairāwhiti Influenza Pandemic & Infectious Disease Response Plan provides a framework for preparation and response by the Tairāwhiti health sector. Planning for pandemics will also strengthen the capacity of the health sector to respond to other adverse events. The planning process is ongoing and the contents of this plan will be updated as required, to reflect advances in the area.

This Plan has been developed within the Ministry of Health national frame work and reflects the structure of the New Zealand Influenza Pandemic Action Plan. It is consistent with but separate from the Tairāwhiti Health Emergency Plan.

The responsibility for implementing the Plan lies with Hauora Tairāwhiti, with support from Tairāwhiti Civil Defence Emergency Management Group and the Emergency Services

Aims and Objectives

The aim of this Plan is to facilitate a co‐ordinated and effective District response in the event of an pandemic, be it influenza or other infectious disease . It provides specific advice and actions, and will also assist other agencies to prepare their own contingency arrangements.

The Plan objectives are to:

provide a plan to ensure rapid, timely and co‐ordinated action, including current and authoritative information for health professionals, the public and media at all stages

specify the roles and responsibilities of Hauora Tairāwhiti, Gisborne Hospital, the Public Health Unit, the Primary Care providers and other key organisations

reduce the morbidity and mortality from the pandemic illness

ensure that essential services are maintained

minimise the social disruption and economic losses that may be associated with a pandemic


Risk Management

The following general areas of risk have been identified and have been included in the pandemic planning tasks:

Identified Risk Mitigation

Unknown characteristics of virus

Not possible to plan for & prepare a specific response because the epidemiology of the virus is not identified.

Prepare a response plan which, although general, adequately covers all reasonable contingencies

Failure of Primary & Secondary Care

Insufficient staff and resources to continue providing GP & Pharmacy services to community

Insufficient staff and resources to continue providing secondary services

GP Plans ‐ Adequate to a point, but not prepared for a full pandemic.

Pharmacy Plans ‐ being addressed by Pharmacy Group

Note : Hauora Tairāwhiti has prepared a Community Based Assessment Centre Plan to assist in mitigating his problem.

Failure of Home Care services ‐

Providers fail to supply contracted services to Home Care clients

Service Providers (Healthcare and TῡrangaHealth) have developed a response. See Hauora Tairāwhiti Pandemic Plan, Appendix 5.

Failure of Community Infrastructure ‐

Fuel, Food, Water, Electricity, Sanitation Services, Law & Order

Considered at CEG, ESCC and Infrastructure meetings. On‐going. To be monitored and managed by Civil Defence.

Shortage of PPE

Security of PPE

Adequate PPE in Hospital Store (MoH funded).

Restricted access to Store enforced.

Failure of Hospital Services ‐

Inadequate admission & discharge protocols; Hospital is overwhelmed due to admission numbers; core business not identified & no plan to sustain it; insufficient staff in key positions with no plan to support or replace them; inadequate training for support & replacement staff; insufficient critical (medical) supplies; insufficient meals provided;

Shortages of antibiotics

Admission and discharge Flowchart developed (App. 8)

Core business to be identified by Management Team, HR issues to be addressed by Manager : People & Development

Supplies ‐ would order on notice; Midland DHB Materials Managers meet 6‐weekly to consider purchase & ‘share’ arrangements (CEO ratified)

Kitchen response ‐ see Hauora Tairawhiti Pandemic Plan, Appendix 6.

Antibiotics ‐ being addressed by PHARMAC in consultation with DHB Pharmacy Managers


Inadequate Communications ‐ with the public, the providers and internal (Hospital)

General confusion even (public) panic, not knowing what the Health response will be, not knowing what their response is supposed to be.

Hospital ‐ staff not knowing what the Hauora Tairāwhiti response will be & how they fit in; not knowing the likely redeployments and requirements of staff; not knowing the risks and mitigations provided

MoH and MOH media releases

Direct contact with Tairāwhiti providers supplying MoH information and assistance with plans

Information to staff:

All staff e‐mail

Social media (under consideration)

Communication Plan, developed by Communications Manager, to fully brief staff

Impact of pandemic on (rural) Māori ‐

Disproportionately affected in previous pandemics; only have access to sparse (likely‐to‐be‐compromised) resources; issues and protocols such as social gathering, tangi, hongi

Meet with Runanga (2)

To be managed by Ngāti Porou Hauora, Tῡranga Health, Te Puni Kokiri and Tῡranganui PHO

Assistance from Peter Brown, Kaiwhakahaere Hauora Māori

Risk Assessment Matrix for pandemic planning

Hazard

Likelihood

1 ‐ 5

Seriousness

1 ‐ 5

Manageability

Y = 1 N = 5

Total

Unknown characteristics of virus 5 4 4 13

Failure of Primary & Secondary Care 5 4 5 13

Failure of Home Care services 4 4 5 13

Impact of pandemic on (rural) Māori 4 4 4 12

Failure of Community Infrastructure 4 4 4 12

Failure of Hospital Services 3 4 4 11

Shortage of PPE 3 4 3 10

Inadequate Communications 3 3 3 9


Introduction

“Operational” means the day‐to‐day activities of putting the Pandemic Plan into practice. Only the key details considered necessary for achieving operational effectiveness (through integration and coordination) have been included in this component.

General Principles Underpinning the Operational Component: These have been identified as follows: The priorities during a Pandemic which has been declared a Health Emergency will be: to ensure correct diagnosis and appropriate treatment for those affected by the

pandemic; to monitor the impact of the pandemic on the health status of the population; to minimise the loss of health status; to minimise the risk of ongoing health concerns; to continue the provision of essential healthcare services; in association with the emergency services, monitor: the effect of the pandemic on essential services; and the economic impact of the pandemic

Communication Effective communication is vital to any action plan and a communications strategy has been developed specifically for responding to a pandemic.

National

During a pandemic the Ministry of Health will manage the communications strategy, with key features including:

The Ministry of Health maintains regular contact with District Health Boards via the Chief Executive, the Medical Officers of Health, the Communications Manager and the Emergency Management Planner

implementing the communications strategy and rapid dissemination of information to the public by the Ministry of Health Communications team

establishing a pandemic national 0800 phone line to provide information to the public. The Ministry of Health has a phone line available for emergencies that can be put into action within a few hours

national advertisements to increase awareness of the national response to the pandemic. Information will be placed on the Ministry of Health website (www.moh.govt.nz) and be available through a range of other media

providing timely surveillance updates and advice to health professionals and the public through the Ministry of Health website www.moh.govt.nz

regular press conferences to ensure accurate and up‐to‐date reports of the status of the pandemic

2. Operational Component


District During a pandemic, the Hauora Tairāwhiti media strategy will be based on timely and appropriate release of national strategies, but will also include:

Daily briefings, twice‐daily if necessary, of :

- Hauora Tairāwhiti clinical, medical and management staff - Primary Care providers, PHOs, NGOs, Service Providers - CEG, Civil Defence Emergency Management Group, Emergency Services (including

Intersectoral Group as required) and other supporting partners - Media, utilising the Hauora Tairāwhiti Communications Manager

Probable use of Healthline (0800 611 116), the 24‐hour health and information advice line, to guide people to the most appropriate form of care for symptoms of influenza.

Civil Defence Emergency Management The Gisborne Civil Defence Emergency Management Group will be an integral part of the Hauora Tairāwhiti pandemic response in Tairāwhiti. Hauora Tairāwhiti will be the lead agency in such an event and rest of the CDEM Group will provide support and coordination assistance to Hauora Tairāwhiti in that role.

In general terms, areas of responsibility will be allocated as follows :

Hauora Tairāwhiti as the Lead Agency will lead and coordinate the initial response to the pandemic for Tairāwhiti and will manage the ‘health response’. This includes the Hospital and all issues relating to health in the community.

The District CDEM EOC will manage and be responsible for the ‘community response’. This includes such areas as monitoring (and managing if necessary) food supplies, fuel supplies, water and waste disposal.

Other agencies from the Intersectoral Group such as Biosecurity (MPI) and NZ Customs Service will be included in the response if required.

Initial Action & Advice Hauora Tairāwhiti will receive advice of a pending pandemic as indicated in the following Plan Activation. This advice will immediately be passed to the CDEM Group, the Coordinating Executive Group (CEG), the Emergency Services and Gisborne District Council for the purpose of those organisations advising their own staff and activating their own Pandemic Plans.

A meeting of the CEG will be called at the earliest available opportunity and all members fully briefed. A regular schedule of briefings will be set to ensure appropriate communications and co‐ordination is maintained.

Media Releases Local media interest will be intense. From the time of receipt of the initial pandemic advice, Hauora Tairāwhiti will be responsible for all initial press releases. As the event unfolds upon Tairāwhiti there will likely be demand for press releases relating to those areas for which CDEM is responsible which will require a sharing of this authority with respect to each others areas of responsibility. This will be a matter for discussion between the CD Controller, the Health Incident Controller and the Medical Officer of Health.


PHASED RESPONSE TO OUTBREAK OF INFECTIOUS DISEASE/PANDEMIC

H A U O R A T A I R A W H I T I

PLAN

FOR IT

* Emergency Management * Public Health Unit (PHU) * Infection Control * Public Information

Management (PIM)

* Pandemic Plans * PHU Response Plans * Infection Control Plans * PIM plans & resources

KEEP

IT OUT

* PHU lead * DHB support * Infection Control

* PIM response * Emergency Management

* Enhanced PHU response * EOC preparation * PIM ‐ activation of prepared

messages & guidelines * Infection Control ‐ activation

of plans

STAMP IT OUT

* DHB Lead * PHU operational

response per PHU Plan * PIM response * Infection Control

* Full activation of DHB & PHU

Pandemic Plans * EOC activation

* Communications Lead ‐ all agencies per PIMS Plan

MANAGE

IT

* DHB Lead * PHU operational response

per PHU Plan * PIM response

* DHB & PHU Plans (continued) * Communications Lead ‐ all

agencies per PIMS Plan

RECOVER FROM IT

* DHB Lead

* PHU operational response per PHU Plan

* PIM response

* DHB & PHU Plans (continued) * Maintain PIM response per DHB

direction


Plan Activation

The Plan will be activated in a phased manner in accordance with the Ministry of Health NZ Influenza Pandemic Plan (2017).

1. Plan For It

Hauora Tairāwhiti Emergency Management planning and preparedness

Key Issues

To strengthen pandemic preparedness at regional and local levels to minimise the risk of transmission to humans and rapidly detect transmission.

Key Actions

establish, revise and exercise Pandemic Plans

prepare for an expansion in demand for key services including ICU/CCU, primary care, ambulance services, laboratory services, 0800 helplines and other services

establish and maintain a Communication Plan and resources for the organisation

train staff and exercise Health and intersectoral plans

maintain stockpiles of critical pandemic supplies e.g. antivirals and antibiotics*

establish and maintain plans and policies for the use of vaccines

Hospital Departments to review Business Continuity & Emergency Response Plans

* Note: All MoH‐issued antibiotics and antivirals have reached their expiry date (see Appendix 1). A MoH Executive Order will be required relating to the use of these expired products.

Hauora Tairāwhiti (Public Health Unit) planning and preparedness

Key Actions

maintain the capability, preparedness and training to mount cluster control operations when required.

identify sources of additional staffing locally from health or non‐health agencies, to enable an intensive cluster control operation to be sustained if required.

monitor the evolving situation overseas

develop key public health messages e.g. the importance of hand‐washing, and cough and sneeze etiquette

identify potentially vulnerable groups and institutional settings in the community

Public Health Interventions: Border

ensure local intersectoral plans are in place maintain the capability, preparedness and training to mount

border control operations when/if required.


If a new strain emerges overseas or there is a resurgence of an existing strain overseas

Consider, as required:

informing key stakeholders

promulgating key messages

informing the public about what the authorities will do in a pandemic

providing travel advice relevant to the threat reviewing and updating key messages and communications

channels

2. Keep It Out

Potential trigger: Community‐level outbreaks overseas through verified human‐to‐human

transmission, significant increase in risk of a pandemic.

Objectives: To prevent or delay the arrival of the pandemic virus into NZ by implementing border management controls, and to prepare for the next phase

Key Decisions

The extent and level of border controls to be implemented will be determined by the actual and potential degree of severity of the pandemic and its ongoing development overseas, and will include iterative consideration of:

preparation by the DHB to establish an Emergency Operations Centre utilising the CIMS structure

moving to positive pratique and travel restrictions

authorising special powers and infectious disease management powers

under the health act 1956 and/or considering the need for an epidemic notice

preparing for a possible release of a pre‐pandemic vaccine, if available

preparing for a possible release of antivirals for use according to policy

commencing vaccination, if a vaccine is available

Key Actions

activate or prepare to activate pandemic plans at short notice when notified by the Ministry of Health

regularly monitor, evaluate and report on the actual and anticipated impact of the pandemic and response activities in individual sectors and report on these activities to the NHCC

activate emergency management organisational structures and the health and disability sector Emergency Management Information System as required

plan for an escalation to the Stamp It Out and Manage It phases, and review recovery plans

prepare for a possible release of pre‐pandemic vaccine if available


Other Cross – Sectoral Actions

Brief staff and key decision‐makers.

Keep up to date with national policy and advice issued by the Ministry of Health.

Lead communications, planning and response within Health and all health agencies and providers.

Maintain coordination with other agencies through established district mechanisms.

Maintain a contact list of other agencies and preferred point of contact

Ensure response staff are given the opportunity for rest and recuperation.


Hauora Tairāwhiti Public Health Unit Keep It Out response

General Response

introduce enhanced staff surveillance and sickness reporting ‐ follow up any influenza‐like illness

review recent surveillance of influenza‐like illness

carry out intensive surveillance through primary health care service providers, Hospital emergency department, infectious disease physicians and laboratories to detect possible imported cases and secondary cases

implement surveillance of influenza‐like illness, viral characteristics, and monitoring of trends in Healthline calls, and prepare to implement sentinel site surveillance (eg, of workforce absence)

monitor the situation overseas

carry out surveillance at the border (port) as required by the Ministry of Health

Border Management

activate coordination mechanisms between border agencies at local levels to ensure planning and programmes are well coordinated

identify and define any areas of concern within which border measures may be applied

alert agencies managing facilities that are to be used for quarantine

require additional declarations from masters of maritime vessels, stating whether anyone has joined the vessel since its last port of call and the place of origin of any such people.

a declaration is required from those vessels that have gone out to sea after receiving pratique and that might have taken crew on board. Compliance with national protocols is required

assess suspect cases at the border (port) using WHO case definitions and travel history, as advised by the Ministry of Health

if a suspect case is reported, arrange for the person to be met and transported to hospital or other designated facility. Ensure the Hospital Emergency Department is advised of the case being transported and that appropriate laboratory testing is undertaken.

quarantine those whose symptoms do not require hospitalisation

if a case is positive for a novel influenza virus (using the polymerase chain reaction (PCR) test), manage other symptomatic people (and other suspected cases) according to set management procedures for suspected cases

prepare and disseminate clinical guidelines, including for the use of personal protective equipment, antivirals and antibiotics, and vaccination procedures (if applicable)

Commence targeted immunisation once vaccine is available


Other Interventions

implement or prepare to implement cluster control activities

renew advice to health care workers to have seasonal vaccination consider requesting establishment of DHB Emergency Operations

Centre

Communications and Health Education

review and update materials for employers, employees and other workplace participants containing key messages for workplaces to help them plan for, prepare for and respond to a pandemic

establish a pandemic website or web page to provide key information for the public and agencies to guide their planning and response

review key messages and promulgate new messages reflecting health action (eg, border controls)

review and increase the frequency of media conference updates (to once or twice daily)

review and update public information in conjunction with all key agencies (ongoing)

regularly review the Public Information Management Strategy, incorporating feedback from talkback monitoring, media monitoring, call centre reports, web monitoring, sector intelligence and other agency intelligence (ongoing)

evaluate and refresh paid media campaigns (ongoing)

introduce as appropriate local helplines as back‐up to the national Healthline, to ensure timely information and advice is provided to the public about the local response, for triage, and to inform members of the public who require information on services to assess influenza‐related symptoms

Coordinate communications to foreign governments on the situation in New Zealand, and advise New Zealanders overseas

Distribute situation reports and intelligence summaries.


3. Stamp It Out

Potential trigger: Novel pandemic virus detected in case(s) in NZ

Objectives: To control and/or eliminate any clusters found in NZ.

Key Decisions

activate the DHB Emergency Operations Centre utilising the CIMS structure when/as appropriate

Prepare authorisation for use of special powers and an epidemic notice, if needed

Consider declaring a state of local emergency under the Civil Defence Emergency Management Act 2002

release antivirals for use according to policy, and monitor antiviral usage

order the pandemic vaccine if available

commence vaccination if and when the vaccine becomes available

release the pre‐pandemic vaccine, if available, under the pre‐pandemic vaccine usage policy

Activate Community Based Assessment Centre(s) if/as appropriate

Maintain actions implemented in the Keep It Out Phase and implement the following actions. Regularly review actions applied to take account of changes in the situation.

Key Actions

review actions and decisions in the context of information provided by the Ministry of Health, and increase the response as necessary and in accordance with Health response plans

prepare to activate business continuity plans, in anticipation of staff or supply chains being disrupted by the pandemic internationally or within New Zealand

prepare for the Manage It phase and review recovery plans

consider a trigger for a shift to the Manage It phase (eg, a 15 percent or higher attack rate or a doubling of the death rate)

release antivirals for use according to policy, and monitor antiviral usage

if appropriate, release pre‐pandemic vaccine under the pre‐pandemic vaccine usage policy

prepare authorisation for use of emergency powers and an epidemic notice, if required

activate DHB EOC utilising CIMS and the health and disability sector Emergency Management Information System (EMIS) as required

Other Cross – Sectoral Actions

Brief staff and key decision‐makers.

Keep up to date with national policy and advice issued by the Ministry of Health.

Lead communications, planning and response within Health and all health agencies and providers.

Maintain coordination with other agencies through established district mechanisms.

Maintain a contact list of other agencies and preferred point of contact

Ensure response staff are given the opportunity for rest and


recuperation.

Communications and Health Education

Implement a multi‐media campaign fronted by a trusted authority figure

covering: - hygiene - social distancing - self‐care and caring for others - staying safe / limiting spread - accessing advice and help - distribute information to Hauora Tairāwhiti staff, health sector

and clients through normal channels

ensure material is customised and uses appropriate channels to reach populations who may be more susceptible such as: - Māori - Pasifika - multi‐cultural/non‐English speaking communities - vulnerable groups, as informed by epidemiological data

distribute situation reports and intelligence summaries

Hauora Tairāwhiti Public Health Unit Stamp It Out response

General Response/ Intelligence

Actions on the identification of a first case will depend on case history. Factors to consider include the following:

if the case has travelled overseas recently (within eight days), increase monitoring

if the case has not travelled overseas within eight days and there has been no animal or bird exposure, assume human‐to‐human transmission within New Zealand

ensure contact‐tracing information informs policy and response

conduct intensive surveillance to detect other cases, possible secondary cases and contacts

carry out intensive surveillance through primary care and the Hospital Emergency Department to detect possible cases and clusters

monitor influenza‐like illness

ensure enhanced laboratory surveillance

carry out surveillance of the spread of influenza through and between districts

monitor the load on and capacity of the health and disability sector

monitor Healthline calls

monitor staff absence through sentinel surveillance in DHBs, schools and other workplaces


Key Actions

review Keep It Out phase actions; implement any outstanding initiatives

carry out contact tracing, voluntary quarantine and the dissemination of advice to contacts on social distancing and symptoms

provide antivirals if available/appropriate

ensure those in voluntary quarantine can access food, medications and treatment for existing conditions, and are referred to welfare agencies for any income support needs

use local contact‐tracing resources produced for emergencies

obtain and train additional staff from outside PHUs to assist with contact‐tracing duties if/as required

monitor contacts’ health while in home quarantine and on antiviral prophylaxis

promote hygiene and social distancing measures

Issue domestic and/or international ‘don’t travel’ advisories

prepare authorisation for use of emergency powers

consider declaring a state of local emergency under the Civil Defence Emergency Management Act 2002, if not already in force

if authorised by the Minister of Health, or if an epidemic notice is in force, or if an emergency has been declared under the Civil Defence Emergency Management Act 2002, consider:: - closing educational facilities in affected area(s) - closing of premises of a stated kind, and/or - forbid people to congregate in outdoor places of amusement or

recreation - isolating or quarantining patients

refer to previously identified potentially vulnerable groups and institutional settings in the community: - maintain communications to enable the targeting of control

interventions, as required

implement intensive, targeted cluster control activities and other programmes in higher risk populations and settings

commence immunisation once vaccine is available

Health Care and Emergency Response

isolate cases for 48 hours and treat according to clinical advice and antiviral policies

use human resource guidelines and policies prepared by DHB human resource manager for major emergencies to implement human resource programmes as required

track all staff contacts of cases and review their health status

report on staff absences to the Ministry of Health to inform national policy

test suspect cases, using the PCR test - test cases in the community or in Hospital when clinically

indicated; - provide information to suspect cases by telephone

liaise with St. John services to provide updated information on


service requirements

consider activating CBACs to support cluster control responses

test cases in the community or in a hospital when clinically indicated; provide information to suspect cases by telephone

Liaise with local ambulance services to provide updated information on service requirements

Consider activating CBACs to support cluster control responses

Consider activating regional response structures

4. Manage It Pandemic Management Potential triggers: - Multiple clusters in New Zealand at separate locations or

clusters spreading out of control. - Logistically impossible to maintain cluster control activities. - Sustained and substantial transmission in the population

Objective - To reduce the impact of pandemic influenza on New Zealand’s population

Key Decisions

release antivirals for use according to policy, and monitor antiviral usage.

order pandemic vaccine, if available

consider the need for an epidemic notice, if one is not already in force, and/or declaring a state of local emergency under the Civil Defence Emergency Management Act 2002, and review their implementation on an ongoing basis.

review the need for containment measures, and implement as necessary.

The application of Manage It phase actions will depend on the epidemiology of the pandemic virus and its spread in different regions. Some districts or regions may remain at the Stamp It Out phase, while others move to the Manage It Phase. Movement from the Manage It phase into the Manage It: Post‐Peak phase may also vary. Targeted Stamp It Out programmes may be maintained in these phases to protect populations at greater risk.

Key Actions

action local plans as necessary or directed, including for primary care, CBACs, hospital services, and antiviral and antibiotic distribution.

increase and support local telephone triage as necessary and possible; monitor demand.

provide relevant and accessible information to higher‐risk populations and settings.

engage with intensivists and monitor ICU capability and capacity.

apply national DHB human resource guidelines and resources locally.

review core competencies required to deliver critical services


under pressure (eg, in an ICU or primary health care) in order to inform any reprioritisation of health resources locally

monitor the impact on critical hospital services;

postpone electives if required/as appropriate and liaise with other DHBs to make best use of available regional resources.

report to the Ministry of Health on service capacity, as required.

comply with any national service or resource priority criteria the Ministry of Health establishes.

liaise with ambulance providers to prioritise the use of this service, if required.

monitor use of DHB personal protective equipment;

where potential shortcomings of PPE are identified, request further allocation from MoH National Reserve Supply.

activate Recovery Plan use framework for Psychosocial Support in emergencies to inform

recovery planning.

Communications and Health education

review the communications strategy, with special reference to audiences and key messages, incorporating feedback from media monitoring and other agencies’ channels and intelligence (ongoing)

evaluate and refresh paid media campaigns and inter‐agency communications and consultation (ongoing)

create and distribute situation reports and intelligence summaries


5. Manage It: Post‐Peak Potential triggers: Wave decreasing, but the possibility of a resurgence or new wave

remains Objective To move towards the restoration of normal services, expediting

recovery, while preparing for a re‐escalation of the response

Key Decisions

Many actions for this phase are common to all pandemics, whether mild or moderate. Additional actions relate to key decisions on:

establishing Recovery Services

implementing vaccination programmes

re‐opening schools

lifting travel restrictions

lifting restrictions on public gatherings

preparing to re‐introduce interventions from earlier phases at short notice, if required, should there be a resurgence or a new wave of the pandemic.

It is likely that actions applied in the Manage It phase will slowly be stood down, and that actions for the Recovery phase will be introduced and strengthened at this point. This phase may occur at different times across the country, reflecting local circumstances. At this stage the maintenance of surveillance and intelligence activities is particularly important in order to obtain early warning of any change in circumstances that requires action. Should there be a resurgence of the pandemic, the actions implemented in previous phases may need to be re‐introduced at short notice.

Key Actions

inform partner agencies of the change in phase.

review actions and decisions, in particular actions relating to key decisions made in earlier phases:

stand down controls and programmes when feasible, noting that they may need to be re‐introduced quickly if there is a resurgence.

debrief staff and agencies, and collate lessons learned in order to better inform planning and future responses.

evaluate the effectiveness of measures used and update plans, guidelines, protocols and algorithms accordingly.

collate report on lessons learned in the health and intersectoral response in order to inform planning and future responses, using an evaluation framework.

collate resources and store material developed in the response for use in future pandemics.

review the ongoing need for an epidemic notice or the activation of special legislative powers.

review the ongoing need for a declaration of a state of local or national emergency under the Civil Defence Emergency Management Act 2002.

review usage of national reserve supplies, and consider re‐ordering supplies.


implement activation of recovery arrangements as required.

prepare to re‐introduce interventions from earlier phases at short notice, if required, should there be a resurgence

review surveillance programmes applied in earlier phases in order to focus activities on early detection of any resurgence.

prepare to return to business as usual

ensure response staff are given the opportunity for rest and recuperation.

maintain appropriate engagement with the Ministry of Health as the lead agency.

keep staff updated of the evolving situation.

use framework for psychosocial support in emergencies (Ministry of Health 2016c) to inform recovery planning.

Communications and Health education

update the public and agencies on any changes to the status of the pandemic (ongoing).

ensure the public and agencies are aware it is possible that the pandemic will resurge or that a second wave will occur, so they remain vigilant.

review the communications strategy, with special reference to audiences and key messages, incorporating feedback from media monitoring and other agencies’ channels and intelligence (ongoing).

evaluate or refresh awareness campaigns (ongoing).

initiate development of a recovery campaign with reference to post‐trauma knowledge and best practice.

disseminate key messages on the post‐peak situation, consistent with communications released by the Ministry of Health.

evaluate and refresh paid media campaigns and inter‐agency communications and consultation (ongoing)

create and distribute situation reports and intelligence summaries


6. Recover From it

Potential trigger Population protected by vaccination or the pandemic has abated in NZ

Objective To expedite the recovery of population health, communities and society where they have been affected by the pandemic, pandemic management measures or disruption to normal services

Key Decisions

Most decisions listed for this phase are common to all pandemics, whether mild or severe, and focus on phasing out programmes introduced in earlier phases, noting that recovery takes time and that some controls and programmes may need to be retained for a period while society gradually returns to normal. In a mild pandemic there may be no need for a specific recovery phase. In more severe pandemics, decisions may need to be made on:

the establishment of recovery offices setting or maintaining national prioritisation criteria for the

distribution and usage of critical goods and services temporarily in short supply

Key Actions

review actions and decisions, and develop phased plans for ceasing programmes introduced in earlier phases, starting or continuing recovery‐specific programmes, and returning to business‐as‐usual activities

give consideration to activating or standing down recovery activities as demanded by the situation

review the ongoing need for an epidemic notice

review the ongoing need for a declaration of a state of local emergency under the Civil Defence Emergency Management Act 2002

review antiviral, antibiotic and other national reserve supply stocks, recall unused supplies to the DHB reserve, and reassess the need to re‐order

deactivate, when appropriate, the DHB Emergency Operations Centre

give consideration to the need to establish or de‐activate operation recovery offices

implement a phased stand‐down of response activities

focus on recovery activities

assess priorities for business resumption

resume business‐as‐usual services gradually

organise debriefings

review the lessons learned

revisit, review and revise plans accordingly move to routine measures as implemented in the Plan For It phase


Public Health

review current surveillance activities and maintain those required during the transition to full recovery (eg, those providing information on health service impact)

monitor the load on and capacity of the local health and disability sector

return to Plan For It activities when recovery is complete


Appendix 1 CORONAVIRUS 2020

Hauora Tairawhiti Isolation and Quarantine Response Situation:

1. All DHB staff will be aware of the coronavirus originating in China that has now spread to a number of other countries.

2. Although the virus has not yet surfaced in NZ, the Ministry of Health has directed that all

DHBs be prepared to deal with such an outbreak. This preparation includes drafting provisions for the isolating or quarantining of patients who are suspected of being infected with the virus. 3.

4. Given the unknowns that currently surround the virus, it is difficult to be completely directive or definitive as to the Hauora Tairawhiti quarantine response, however the purpose of this memorandum is to provide an outline of what our response is likely to be should an outbreak occur.

Definitions of Isolation and Quarantine Isolation: refers to the isolation of a sick person with symptoms. Quarantine: refers to the separation of persons who may be incubating the illness (for example close contacts of cases) but who are not showing symptoms. Quarantine means the person will stay in their designated accommodation and does not leave the building. They cannot leave to shop or visit family and friends. If there is an outside area that cannot be accessed by members of the public, this can be used by people in quarantine. Visitors are not permitted. People going in to quarantine may be able to go outside but not be in close or prolonged contact with others. . Putting people in quarantine, particularly against their will, is a very significant intervention. To make sure people comply, they need to be informed and provided with the most comfortable surroundings possible. Despite measures to improve voluntary compliance, it is likely that some people will resist quarantine, either initially or after a period of time.


Hauora Tairawhiti Isolation and Quarantine Procedure Isolation It is very likely that the DHB response to such a presentation will proceed in stages, as follows: Stage 1 The initial course of action to be taken with a patient who is suspected of being infected with coronavirus and who arrives at Gisborne Hospital is for that patient to be moved to 1 of 4 negative pressure rooms in the Hospital until there is clinical clarity around the virus and that patient. Full infection control procedures will be implemented. A DHB Incident Management Team will be established in the Poutama Room. If the number of presentations exceeds the capacity of the Hospital negative pressure rooms: Stage 2 A sectioned‐off area of one of the Hospital Wards or a full Ward will be created. This would be appropriate for patients considered to be infectious or showing symptoms. This stage would likely involve postponement of elective surgery lists, Outpatients’ clinics etc., managed and directed by the DHB Incident Management Team. Quarantine for contacts of cases This process is for patients not considered to be infectious or showing symptoms, but who still require monitoring, managing or observation. The first option is for people to be quarantined in their own home. If this is not possible i.e. out‐of‐town or international visitors, or it presents a public health risk, consideration will be given to: Vacating and utilising 1 or more of the Hospital flats. Implementation of this stage would allow full utilisation of Hospital security, meals and patient management services. Note: This would require the occupants of 1 or more of the Hospital flats to relocate to the Waikanae Motor Camp motel units for up to 2 weeks (this meets with the approval of Motor Camp management). A review of the occupancy agreement for our current occupants is under review by People & Development, the Chief Financial Officer & Emergency Management (i.e. can we do this?)

5. If the number exceeds the capacity of the Gisborne Hospital site, consideration will be given to accommodating patients in prepared sites such as the Showgrounds Hall. Notes:


1. There is also clear potential for family members of an infected person to be quarantined in

their own homes (should they live locally)

2. If the party(ies) are not from Gisborne i.e. they are visitors/tourists, and they are non‐symptomatic, there is no reason that they cannot proceed to their pre‐arranged accommodation where they can be monitored/managed by Health staff. 6.

3. If the DHB was to arrive at this point (the Showgrounds etc. option) it is very likely that a state of National Emergency would have been declared. Local planning continues should this situation arise.

Confidential: If a further clinical setting is required to manage infected patients, consideration will be given to utilising the Chelsea Hospital services. Note: The possibility of accessing Chelsea Hospital has not been discussed with either

Chelsea Management or DHB Management, nor is there any intention to do so at present. Therefore, any further discussion at this point or release of this issue

would be inappropriate.


Appendix 2

National Reserve PPE Stock held by Hauora Tairawhiti (12/2020)

ITEM QTY ON QTY EXPIRY HAND ISSUED DATE (Y/N)

Mask N95 (22,000) + Surgical (35,700) 55,700 Nil shown

Gowns 11,200 Nil shown

Gloves 82,000 Nil shown

Safeview Glasses 970 Nil shown

Sodium chloride & Glucose IV fluids 729 litres Aug-13

Augmentin Tablets 76,800 Sep-09

Augmentin IV 1880 vials Aug-08

Interlink system Solution Set, Male Luer Adaptor 480 May-16

Precision Glide Needles, 6 mm, 7 mm & 9 mm 7,000 Nov-13

Syringes: 3 ml (1,700), 5 ml (13,00), 10 ml & 20 ml 4,750 Nov-13

Syringes: 10 ml (1,600) & 20 ml (150) Nov-13

Avagard: 500 ml (460 units) 125 ml (160 units) 250 litres

Pharmacy

Amoxycillin Clavulanate 250 mg 1827 units 1,827 units Feb-08

Amoxycillin Clavulanate 500 mg 4200 units 4200 units Sep-09

Amoxycillin Clavulanate 1 gm 52 units 52 units Aug-08

Cephazolin Sodium 1 gm 94 units 94 units Oct-09

Co-Trimoxazole trimethoprim 40 mg 269 units 269 units Oct-08

Co-Trimoxazole trimethoprim 80 mg 37 units 37 units Sep-10

Doxycycline Hydrochloride 52 units 52 units Nov-08

Flucloxacillin Sodium 250 mg 560 units 560 units Jun-08

Flucloxacillin Sodium 500 mg 116 units 116 units Jul-09

Flucloxacillin Sodium 1 g vial 118 units Jan-14

Relenza Dec-12

Tamiflu Aug-11

File Notes

All National Reserve stock items (top section above) have been absorbed in to the Hauora Tairawhiti standard stock system in an endeavour to rotate them through the regular Hospital use system

All pharmacy items with an expiry date have met that mark

Most of the items expired because they are no longer used by Hauora Tairawhiti or were sent to the DHB in completely un‐useable quantities.


Appendix 3 EMERGENCY CHILDCARE RESOURCES General The lead agency for services to children and young people is the Ministry for Vulnerable Children, Oranga Tamariki. It is likely that during the course of an influenza (or infectious disease) pandemic Hauora Tairāwhiti may be seeking to place children in to care (children of patients, orphans etc.). If that situation arises, follow this course of action :

Contact: Ministry for Vulnerable Children Lowe St, Gisborne Manager : DDI ‐(06) 986‐4189, mobile ‐ 029‐986‐4189, fax ‐(06) 863‐2136

If unavailable or cannot assist, contact :

1. Presbyterian Support, child & family services Tairāwhiti 141 Bright Street, Gisborne Manager : Ph. (06) 868‐1399, Fax.(06) 868‐1396

They will:

provide Respite Care (in the home)

provide Foster Care (via Ministry for Vulnerable Children)

provide ‘orphan’ care services & will pick up children from hospital

2. Barnados 25 Ormond Rd, Gisborne Manager : Dianne Saunders DDI. (06) 868‐3601, Ph.(06) 867‐9214 Fax. (06) 867‐8933, Mobile : 027‐610‐0589 [email protected] They:

Do not provide foster care service

Provide Respite Care

Provide Kidstart (early childcare education home‐based)

Provide childcare on Barnados site (part‐funded by Min. Ed)

Provide family support workers

3. Tῡranga Social Services Tuatai Marae, Lytton Rd, Gisborne Manager : Ph. (06) 867‐8890 They:

have limited child care capacity and are dependent upon the Ministry for Vulnerable Children sending cases (and funding) their way


mainly deal with victims of sexual abuse or with children exhibiting abnormal sexual behaviours

are still worth contacting in an emergency


Appendix 4 BODY STORAGE General In the event of a natural disaster, an air/road crash or a pandemic resulting in multiple deaths, Tairāwhiti is ill‐equipped to handle the processing of a large number of bodies in a short space of time:

- Hauora Tairāwhiti no longer has a pathologist - There are no supporting hospitals or pathology services in the Hauora Tairāwhiti area - The body storage facilities at the Hospital Mortuary are not, in their current (day‐to‐day)

format, set up to handle a mass body influx

Refer to Hauora Tairāwhiti Mass Casualty (Death) Plan (copy on Intranet/Emergency Response

If the described event was to occur, the following course of action is recommended :

1. Evans Funeral Service 171 Ormond Rd, Gisborne Ph: (06) 867‐9150 Fax: (06) 868‐5312 [email protected]

In a pandemic or infectious disease situation, EFS will have received prior warning by Hauora Tairāwhiti Emergency Planning.

EFS can obtain MDF caskets from a local joiner 24/7 and a request can be made for them to obtain and deliver them to the Hospital Mortuary.

Prepare the Mortuary to receive a large number of bodies and the appropriate number of temporary caskets from EFS

If the situation is pandemic or infectious diseases, use the advance notice to obtain sufficient body bags

Advise Stores

Request Stores to gather all available body bags within the Hospital (Stores, Wards, ED) and deliver to the Mortuary

Request Stores to arrange immediate delivery of replacement body bags

Notes :

It is possible to store approximately 50 MDF temporary caskets in a chilled area in the Mortuary.

Arrangements will need to be made to transfer the bodies to Auckland or Palmerston North for post mortem ‐ a Police responsibility.

Notes:

1. Refrigerated / frozen food trucks available locally:

- Mainfreight (06) 867‐8509 - Leaderbrand (06) 867‐6231 - Cedenco (06) 869‐0666


2. There will be resistance to providing this form of transport for this purpose as the vehicles will not be allowed to be used for their original purposes post‐pandemic/major disaster

3. If a Certificate as to Cause of Death is issued for the deceased, there is no reason

that a normal burial cannot take place, even if the funeral service is somewhat truncated or even dispensed with by family of the deceased.

4. If the numbers of deceased who have Cause of Death certified appears likely to

overwhelm the system, arrangements can be made for the deceased to be temporarily placed in a local cold storage facility until burial can take place.

5. The modelling figures released by the MoH on a 40% infection rate and 2% case

fatality rate estimate that there could be a total of approximately 370 pandemic‐related deaths over an 8 week period (on top of the ‘usual’ rate of deaths)

If this infection and case fatality rate was to occur, it would very quickly overwhelm local funeral services capacity, even if their own staff were not infected at any stage by the virus (unlikely). If the funeral services were overwhelmed, the Funeral Directors Association of NZ recommends:

The deceased person is taken from place of death to Evans Funeral Services

The deceased is placed in an identifiable body pouch

The deceased is transferred to Taruheru Cemetery for burial

Note: The H1N1 pandemic of 2009 had an infection rate of approximately 15% and a subsequent mortality rate of 0.05%

6. This process would allow for disinterment and funeral service/reburial at a later

(post‐pandemic) stage

7. This ‘non‐funeral/large‐scale burial’ scenario has still to be worked through and ratified with/by Māori, but for rural Māori at least it is possible that individual marae may, once Cause of Death has been formally certified, simply hold their own services and bury the deceased in local authorised urupa/cemeteries


Appendix 5

REST HOMES Gisborne Hospital & Rest Home

beds Dementia Total Beds

Te Wiremu 61 14 75

Dunblane 53 14 67

Leighton House 50 ‐ 50

Beetham Village 37 6 43

Kiri Te Kanawa 81 14 95

282 48 330

The following is a summary of the Rest Home situation in Gisborne :

No facilities have any contingency plans for evacuation to go off‐site. If that had to occur, it would have to be arranged for them, as would transport.

Te Wiremu & Dunblane have good fresh water reserves/storage; Leighton House has limited emergency supplies.

In the event of power failure, Leighton House and Te Wiremu have gas cooking & heating – the other facilities do not have either.

Kiri Te Kanawa is the only Rest Home facility with an on‐site generator. Beetham has a contract (local) for one to be brought in.

All facilities have barely sufficient staff for their day‐to‐day needs. None have staff reserves to call upon during an emergency.

All facilities have Emergency Plans, reviewed annually. The Fire Service regularly test and check the fire and evacuation systems at each facility.

Note : All facilities are aware that Gisborne Hospital is not in a position to assist with accommodation in the event of an evacuation. Similarly, in an influenza pandemic or similar infectious diseases emergency they are all aware that the Gisborne Hospital emergency criteria‐based admission standards would very likely preclude admission of their clients.

***


Appendix 5

HOME CARE SERVICES Gisborne

1. HealthCare NZ ‐ Needs updating

HealthCare have 450 ‐ 480 clients on the Home Care programme at any one time

A lot receive 1 hour per week, some receive up to 42 hours per week

Those with next‐of‐kin would pass to NOK care

They have about 20 High & Complex needs clients

Significant numbers of their clients are +75 years old, although they do have many in the 65 ‐ 75 category

They have a good supply of masks and gloves

If they (in Administration) started getting sick, they have the facility to run this aspect of their organisation remotely ‐ via laptops from their homes

On receipt of advice from Hauora Tairawhiti of a pending pandemic, they would maintain contact with Hauora Tairawhiti in relation to their service provision.

If their Home Care service is compromised, this would be reported to Hauora Tairawhiti who would address this in liaison with the (Gisborne) Civil Defence Emergency Management Group.

Note : All of the HealthCare client details are held in a PC database with minimal manual backup. No onsite generator for electricity backup. HealthCare does have several laptop computers with wireless access which they would endeavour to use for this function however the laptop batteries would have to be recharged via Civil Defence or Health.

2. Tῡranga Health 145 Derby St, Gisborne. Ph. 869‐0457, Fax. 869‐0769. Home Services: Contact :Shirley KEOWN (?) ‐ Manager : Nursing Services After hours 027‐283‐1677 e‐mail : [email protected]

[email protected]

TH have 250 clients on the Home Care programme at any one time

Some have High & Complex needs

Significant numbers of their clients are +75 years old, although they do have many in the 65 – 75 category

They have about 60 staff employed to service the Home Care programme.

They have 5 Registered Nurses involved in this programme

On receipt of advice from Hauora Tairawhiti of a pending pandemic, they would maintain contact with TDH in relation to their service provision.

If their Home Care service is compromised, this would be reported to Hauora Tairawhiti who would address this in liaison with the (Gisborne) Civil Defence Emergency Management Group.

Appendix 6

ADJUST ADMISSION & DISCHARGE PROTOCOLS

Further increase in Admission Rates

BUSINESS AS USUAL (2)

LOSE ELECTIVES

Increase in Admission Rates

BUSINESS ASUSUAL (1)

Or

PLUS

KNOWN LARGE NUMBERS OF SAME INFECTION IN

RATIONING OF CARE

CRITERIA‐BASED ADMISSION

Decision Tree Factors

DECLINE ADMISSION TO PATIENTS OUTSIDE CRITERIA

1ST COME ‐ 1ST

SERVED BASIS OVERLOAD

SHUTDOWN

GISBORNE HOSPITAL ‐ FLOW CHART FOR ADMISSIONS ‐ INFLUENZA OR INFECTIOUS DISEASE

PATIENTS TO HOME CARE

GISBORNE HOSPITAL FULL

CREATE DECISION TREEBased on :

Admission Numbers

Bed Numbers

Staff Numbers

Epidemiology

Survival Probability (Survival Chart)



2. KEY GUIDELINES FOR HOSPITAL DEPARTMENTS

Identify and maintain essential services

Identify non‐essential services and develop processes by which a cessation/reduction of services can take place

Have patient pathways in place for pandemic influenza patients and those with other conditions

Have clear processes in place to treat potentially infected people, wherever they present themselves for assessment, that protect staff and patients

Have clear escalation processes for patients that require hospital care

Have clear infection control practices adapted for individual units

Have clear policies and processes for non‐essential staff and volunteers, to enable them to work in essential areas when required

Develop continuity plans that identify how best the necessary staff resources can be maximised to ensure services are maintained

Stockpile identified supplies that can be used should the supply chain be affected

Provide situation reports for their organisation/unit during a pandemic


Key Activities for Hospital Departments

All Wards & Departments

Activity (as appropriate) By Who

Daily team meetings to cascade information/assess operational needs

Contact Duty Manager for additional back‐up staff

Inform Incident Management Team of any further resource requirements

Cancel non‐urgent appointments and visits

Managers

Cease elective surgery Clinical Director

Implement (with on‐going review) appropriate admission criteria & accelerated discharge procedure

Clinical Director

Close non‐essential departments / services

HR

Redeploy staff to essential services HR

Maximise bed availability by using identified areas for extra beds

Duty Nurse Manager

Maintain levels of essential supplies & equipment

Heads of Department

Apply appropriate infection control measures

All staff

Review any staff who home visit and reallocate tasks. Use telephone assessments if possible

Managers

Security measures reinforced

The Incident Management Team, operating from the Learning Centre Poutama, Maia and Mauri Hiko rooms will provide on‐going management and direction for the

duration of the threat.


1. BORDER CONTROL AND QUARANTINE PLAN ‐ PORT GISBORNE

Situation

There are several viruses currently wide‐spread in certain bird and animal populations that are considered to have pandemic potential, as they may mutate into a virus that is contagious between humans.

In the event of an overseas outbreak of pandemic influenza, New Zealand will put a border management programme into place and the NZ Government will at the time make the final decisions about all aspects of border management response.

Objective

The objective of pandemic control in the maritime border environment is to prevent the entry of pandemic influenza into the wider community while at the same time ensuring minimal disruption to commerce. The following general principles will guide contingency planning in the maritime environment:

Risk assessing all shipping prior to berthing at a NZ port;

Physically clearing all vessels prior to any shore side contact;

Protecting stevedores and other port workers in accordance with best risk management practice;

Isolating and treating on board their vessel any crew or passenger suspected of having an H5N1 infection; and

The guaranteeing of any person needing to come ashore for treatment for suspected H5N1 infection

It should be noted that in the event of a worldwide pandemic outbreak there would likely be a significant disruption to maritime trade caused by illness among port workers and crew. For these reasons the number of arriving vessels may fall significantly.

Response

Border Control will be managed by the NZ Customs Service (the lead agency). They will be

assisted by other agencies such as the Police, MAF, Immigration and the Public Health Unit (Medical Officer of Health).

In the event that human‐to‐human transmission of a pandemic virus is confirmed in another country, advice of this occurrence will be forwarded to the Ministry of Health by the WHO. This advice will be relayed to all Government departments and agencies (Code White) by MoH and will include guidance on exactly what will be required as first mitigation response.

The Health response will be managed by the Medical Officer of Health, Gisborne. On receipt of the WHO/MoH advice, the Medical Officer of Health will direct the following action to be taken in respect of Port Gisborne:


1. The following are to be advised: 1. On‐call Health Protection Officer 2. Eastland Infrastructure Ltd 3. Port Gisborne Manager (Rob Mitchell) 4. Shipping Agent (Kevin Pitcher) 5. Port Gisborne Stevedores (Dave Milner) 6. Establish contact with NZ Customs (details at rear of this Plan)

2. If Port Gisborne is to be closed at this time, this decision will be made at

Government level and will be accompanied by the relevant instructions.

3. The decision not to close Port Gisborne at this time will result in heightened awareness, screening and risk assessment of all vessels until further notice :

In particular of vessels en route to NZ

No vessel will enter port until pratique clearance and does so according to any instructions given

Arriving vessels will receive initial primary screening based on MOH advice

Any arriving crew or passengers with symptoms of pandemic influenza will immediately be identified and isolated ‐ initially on the vessel at anchor

Loading and unloading of vessels will be allowed provided it does not endanger port workers and shore‐side personnel (based on precautionary measures and risk assessment criteria)

Shipping Movement Advice

The Shipping Agents forward to PHU via email documentation relating to the request for pratique 4 – 5 days prior to ETA. In accordance with international obligations they are required to update this information 12 ‐ 24 hours prior to the vessel’s arrival at the pilot

station. The shipping schedule is available on www.eastland.co.nz

This documentation includes the Request for Pratique, Advance Notice of Arrival, Crew List, Voyage Memo and (No) Change of Status. The documentation is considered by the on‐call HPO who, in the absence of good reason to the contrary, will grant pratique (see below).

Pratique

Any vessel that has been at sea for eight days or longer, has not taken anyone on board in that time and has not reported any illness on board should be granted pratique (see Border Response Table).

Note : The majority of vessels arriving at Port Gisborne direct from overseas have sailed from an Asian port (a minimum of 10 days sailing) however on occasion vessels do visit Australian ports before sailing for Gisborne. Advice is to be taken on this aspect from the Shipping Agent and Port

Manager (there will be at least 48 hours’ notice).

Quarantine


There are no quarantine facilities at Port Gisborne and, apart from the Medical Officer of Health, almost no staff available to staff such a facility (if there was one).

Quarantine (if required) at Port Gisborne will primarily be effected by requiring masters to anchor off‐shore and will be managed by the Medical Officer of Health with assistance from NZ Customs and the Shipping Agent.

Any decision to provide shore‐based medical treatment for passengers or crew will be made by the Medical Officer of Health.

Communications

Communications with visiting vessels will be via radio‐telephone, cell phone and/or fax. Contact details for all visiting vessels are held by the Shipping Agent.


Contacts

Eastland Port Carl Magazinovic 027 704 7546 [email protected]

Olsen Shipping Kevin Pitcher (06) 868‐0860 (b) (06) 868‐7973 (a/h) (06) 868‐0861 (fax) 027‐496‐6468 [email protected]

Gisborne Stevedoring Dave Milner (06) 868‐8051 (b) (06) 867‐1756 (a/h) (06) 868‐4145 (fax)

Harbour (for first‐port‐of‐call yachts & private craft) Trevor Mullooly 027‐294‐4773 or 867‐9757 (pvte)

NZ Customs (Napier) Mike Dale, Customs Port Manager, Napier 06‐835‐5799 (b) 029‐245‐5185 [email protected] Daniel McGuire Chief Customs Officer, Napier 06‐835‐5799 (b) 029‐450‐1019 [email protected]

Eastland Infrastructure Ltd ‐ (06) 869‐0700

Health Hauora Tairāwhiti (06) 869‐0500

, Medical Officer (06) 869‐1311 0274‐471‐618 [email protected]

, Medical Officer (06) 869‐1311 027‐215‐4648 [email protected]

, Medical Officer (06) 869‐1311 [email protected]

Steve Hooper, Emergency Management 021‐240‐7571 [email protected] On‐Call Health Protection Officer 0274‐407‐239

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