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Emergency and Pandemic Planning in General Practice/Primary Care
General practice/primary care offers organised episodic and continuous care from clinics embedded in the community. There is variance with regard to size and organisation within practices. Most urban practices are group practices and resources are shared. Most employ practice managers, use computerized patient management systems and have easy access to secondary care facilities. Rural and remote practices can be dependent on just one or two healthcare professionals; others maintain cottage hospitals.
The accepted phases of emergency management are:
- Mitigation (planning to reduce the impact of adverse events)
- Preparedness (holding sufficient goods and services in readiness)
- Response (applying emergency management)
- Recovery (returning services towards normal)
Mitigation
- Give consideration to potential for events that might overwhelm usual resources
- Stay aware of the level of risk for major events such as earthquake, tsunami or infectious disease epidemic, especially H5N1 or other mutant and potentially pandemic influenza
- Have plans to cope with loss of staff and limited or non-supply of usual goods and services for 8 to12 weeks
- Know how to contact goods and services providers or coordinators
- Know the resources and supports available in neighbour practices and how to access Community-Based Assessment Centres (CBAC’s)
- Know lines of communication to Primary Health Organisation, District Health Board and Medical Officer of Health, ambulance and mortuary services
Preparedness
- Hold sufficient human and material resources, together with plans for deployment in case of large scale casualties
- Remember that staff may experience conflict over duty of care to patients and duty of care to their own families
- Provide in-practice education and develop practical skills against epidemic infection, including self-care, diagnosis and notification of cases, containment and clinical care of patients
- Maintain a secure supply of essential medicines including antibiotics, analgesics, intravenous fluids and insulin
- Consider on-site contingencies in case of loss of essential services; telephone, power and water supply services (mobile phone, portable generator, water storage). Remember that public transport may fail and practitioner’s vehicles will need fuel
- In severe situations be ready to put out fires and secure your facility – adequate fire extinguishers and secure storage for medicines, essential equipment, medical records
Response
- In case of an epidemic alert, apply heightened awareness
- Know how you are going to receive and manage patients
- Prevent transmission of infection at the clinic by diversion to a separate area or doing initial assessment at the patient’s home
- Ensure isolation of patients with potentially transmissible disease
- Attend to hand-cleansing, use of face masks, eye protection, gloves and gowns. Attend to safe disposal of contaminated materials and cleansing of equipment and surfaces
- Notify all suspected or presumptive cases to the Medical Officer of Health and stay in touch with the situations of neighbour practices
- Provide for early diagnosis by clinical and laboratory criteria
- Provide early antiviral treatment for cases and for prophylaxis of immediate caregivers - start Oseltamivir within 48hrs
- Provide ongoing supportive care to ill patients with attention to hydration, fever control and treatment of respiratory insufficiency including use of antibiotics for complicating bacterial infection
- Stay in touch with the families of ill patients
- Provide certification as to the fact of death
- Get clear identification of the deceased and arrange for proper disposal of the body
Recovery
- Debrief as soon as possible so that staff can share in expressions of experience that may be helpful to personal and practice recovery
- Assist staff to re-group and re-launch usual general practice
- Be prepared to manage the reality of large scale loss and grieving
- Understand the time-course for recovery of general community and healthcare infrastructures; access to many services will be limited
- Provide for systematic review of patients with chronic conditions that may have deteriorated during the time of emergency
- Review emergency plans and learn from experience
Emergency and Pandemic Planning Documents
To assist in the preparation for, and the mitigation of the effects of a large scale emergency with regards to disruption of supply of goods and services South Link Health, in conjunction with the Ministry of Health through the South Island District Health Boards, is able to provide the emergency and pandemic planning tools below that can be adopted and adapted by each general practice to suit the needs and environment of their practice.
The Emergency Operations Plan has a number of appendices that you will need to complete and populate with data specific to your practice. We encourage you to take the time to complete this exercise. The appendices are generally the parts of the Plan that are subject to change as people change their details (phone number, addresses, etc) and as suppliers and key personnel change.
We also encourage you to institute a process of regular review of these documents to ensure that the Plans are kept up to date and current.
South Link Health hopes that you find this material of benefit, and that it assists you in preparing and giving attention to emergency and pandemic planning. The provision of this documentation meets your requirement to have an Emergency Plan, as part of your Back to Back agreement with your Primary Health Organisation, and also meets the local District Health Board requirement to have a Plan to address pandemic occurrences.
Downloads
SLH-Emergency_Plan_Nov06-formatted.doc
SLH-Plan_Appendices.doc
SLH-Pandemic_plan_Nov06.doc
References
For the latest information South Link Health recommends the following sites for Avian Influenza updates:
www.moh.govt.nz/pandemicinfluenza
www.who.int/topics/avian_influenza/en/
www.cdc.gov/flu/avian/index.htm
Brief to SLH members on Avian Influenza [updated 20/01/06]
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