NOT PROTECTIVELY MARKED. Pandemic Flu Plan. Printed copies must not be considered the definitive version

Transcription

1 Pandemic Flu Plan Printed cpies must nt be cnsidered the definitive versin DOCUMENT CONTROL POLICY NO. Plicy Grup Strategic C-rdinating Grup (SCG) Authr Lucy Denvir Versin n. 1.0 Dr David Breen Reviewer Lucy Denvir Implementatin date May 2014 Scpe NHS Dumfries and Gallway SCG Partners (Applicability) Status Apprved Next review date May 2016 Apprved by SCG Last review date: May 2014 The nly current versin f this plan is n the intranet Page 1 f 58

2 CONTENTS Page GLOSSARY OF ACRONYMS 4 1. INTRODUCTION 1.1 Aim Objectives Scpe 5 2. RESPONSIBILITIES AND ORGANISATIONAL ARRANGEMENTS FOR MANAGING A PANDEMIC 2.1 Gvernance and Ownership Management Structure Majr Emergency Scheme Grups Pandemic Specific Arrangements 8 3. PRINCIPLES OF THE PLAN 3.1 Planning Assumptins Apprach Risk Assessment DETECTION AND ASSESSMENT PHASE 4.1 Key Actins Surveillance, Testing, Diagnsis and Reprting Preventin and Prtectin Service Planning and Cntinuity Cmmunicatin TREATMENT AND ESCALATION PHASE 5.1 Lw Impact Scenari Key Actins Surveillance, Testing, Diagnsis and Reprting Preventin and Prtectin Service Planning and Cntinuity Cmmunicatin Mderate Impact Scenari Key Actins Surveillance, Testing, Diagnsis and Reprting Preventin and Prtectin Service Planning and Cntinuity Cmmunicatin High Impact Scenari Key Actins Surveillance, Testing, Diagnsis and Reprting Preventin and Prtectin Service Planning and Cntinuity Cmmunicatin 31 The nly current versin f this plan is n the intranet Page 2 f 58

3 6. RECOVERY PHASE 6.1 Key Actins Surveillance, Testing, Diagnsis and Reprting Preventin and Prtectin Service Planning and Cntinuity Cmmunicatin PLAN MONITORING AND IMPLEMENTATION 7.1 Dcument Amendment Histry Distributin Assciated Dcuments Educatin and Training 36 APPENDICES APPENDIX 1: APPENDIX 2: APPENDIX 3: APPENDIX 4: APPENDIX 5: APPENDIX 6: APPENDIX 7: APPENDIX 8: APPENDIX 9: APPENDIX 10: APPENDIX 11: APPENDIX 12: APPENDIX 13: PICT mdel agenda Prjected figures fr lw, mderate and high impact scenaris in Dumfries and Gallway WHO Pandemic Alert System Minimum Cre Dataset Algrithm fr management f adults with ILI in primary care Algrithm fr initial management f patients referred t hspital Algrithm fr initial investigatins fr adults referred t hspital Algrithm fr initial assessment and management f children Algrithm fr management f children referred t hspital Pririty Grups fr vaccinatin Pririty NHS Services Cmmunicatins Plan Staff Management The nly current versin f this plan is n the intranet Page 3 f 58

4 GLOSSARY OF ABBREVIATIONS & ACRONYMS BCP D&G DGRI DPH ED EPRT HDU HPS ICT ILI JCVI LHP MES OHS OOHS PGD PIC PICC PICT PPE SCG SGHD Business Cntinuity Plan Dumfries and Gallway Dumfries and Gallway Ryal Infirmary Directr f Public Health Emergency Department Emergency Planning Respnse Team High Dependency Unit Health Prtectin Sctland Infectin Cntrl Team Influenza Like Illness Jint Cmmittee n Vaccinatin and Immunisatin Lcal Heath Partnership Majr Emergency Scheme Occupatinal Health Service Out f Hurs Service Patient Grup Directive Pandemic Influenza C-rdinatr Pandemic Influenza C-rdinating Cmmittee Pandemic Influenza Cntrl Team Persnal Prtective Equipment Strategic C-rdinating Grup Scttish Gvernment Health Department WHO Wrld Health Organisatin The nly current versin f this plan is n the intranet Page 4 f 58

5 1. INTRODUCTION 1.1 AIM T prvide a framewrk fr Dumfries and Gallway s lcal respnse t an influenza pandemic that will minimise the health, scial and ecnmic impact and that reflects the lessns learnt frm the H1N1 pandemic in OBJECTIVES This plan: Sets ut rganisatinal arrangements fr the management f a pandemic in Dumfries and Gallway in line with Majr Emergency Scheme (MES) arrangements. Sets ut the rles and respnsibilities f varius services and multiagency grups thrugh the different phases f a pandemic and the required level f respnse in scenaris f varying impact that may develp. 1.3 SCOPE This plan is fr lcal purpses but is based n, and shuld be read in cnjunctin with, the UK Departments f Health Influenza Pandemic Preparedness Strategy gitalasset/dh_ pdf T avid duplicatin the Plan reflects and refers t mre detailed natinal guidance n specific issues where apprpriate. Further infrmatin can be fund at: The plan is nt a Business Cntinuity Plan (BCP). Each lcal rganisatin and department is expected t develp their wn BCP. Where ther relevant existing lcal plans and strategies are already in place, such as fr mass vaccinatin, infectin cntrl and cmmunicatin, these are referred t but nt cvered in detail in this plan. The nly current versin f this plan is n the intranet Page 5 f 58

6 2. RESPONSIBILITIES AND ORGANISATIONAL ARRANGEMENTS FOR MANAGING A PANDEMIC 2.1 GOVERNANCE AND OWNERSHIP This plan is wned by the Chief Executive f NHS Dumfries and Gallway n behalf f the Strategic Crdinating Grup (SCG). The plan will perate within the verall framewrk f the Dumfries and Gallway Majr Emergency Scheme (MES). 2.2 MANAGEMENT STRUCTURE The management f a Flu Pandemic is a cmbinatin f the generic arrangements f D&G MES and cntingency-specific arrangements fr a flu pandemic. Specifically, in additin t the generic MES arrangements, dealing with a flu pandemic will entail cnstitutin f a Pandemic Influenza Cntrl Team (PICT). The SCG may cnsider establishment f a separate Scientific and Technical Advisry Cell (STAC) but in mst circumstances this functin will be fulfilled thrugh the PICT. The management structure fr an Influenza Pandemic Outbreak in Dumfries and Gallway is shwn diagrammatically belw in Figure 1: Figure 1: Lcal Pandemic Management Structure Dumfries and Gallway Strategic C-rdinating Grup (SCG) (see Sectin 2.3 fr details) Pandemic Influenza Cntrl Team (PICT) Sub-grups will be established as required eg scientific advice, vaccinatin, cmmunicatin, hspital management Tactical Supprt and Functinal Teams (see Sectin 2.3 fr details) The nly current versin f this plan is n the intranet Page 6 f 58

7 2.3 MAJOR EMERGENCY SCHEME GROUPS Strategic C-rdinating Grup (SCG) Remit Fr the general rle f the Strategic C-rdinating Grup and required dcumentatin refer t the D&G MES. The Strategic C-rdinating Grup (SCG) will have verall authrity fr, and will prvide verall directin t, the management f the lcal emergency respnse t a pandemic and its cnsequences. The SCG will set the plicy framewrk fr a cherent clinical and nn-clinical lcal respnse. The SCG will ensure integrated implementatin f arrangements and effective jint wrking acrss MES partner rganisatins. SCG will manage the verall cmmand and cntrl structure including crucial links with the Scttish Gvernment Health Department (SGHD), Health Prtectin Sctland (HPS) and ther relevant natinal level grups and cmmittees established at the time (eg Scttish Pandemic Influenza Crdinating Grup, the Civil Cntingencies Cmmittee, Scttish Emergency C-rdinating Cmmittee). Specific functins f the SCG will include: Agree with HPS and DPH risk assessment and escalatin triggers; Ensure escalatin plicies are clearly defined and cmmunicated t relevant parties; Ensure business capacity plans are available; Clarify which perfrmance targets fr NHS and partner rganisatins can be drpped r mdified; Agree plicy fr the ptimum care f thse affected; Ensure apprpriate facilities fr infectin cntrl; Cmmunicate relevant natinal plicy t lcal Pandemic Influenza Cntrl Team (PICT); Agree a cmmunicatins and media handling strategy cmpatible with MES arrangements. Membership Chief Executive, Dumfries and Gallway Cuncil Chief Executive, NHS Dumfries and Gallway Divisinal Cmmander (Dumfries and Gallway) Plice Sctland Chief Fire Officer, Dumfries and Gallway Fire and Rescue Service Prcuratr Fiscal Scttish Ambulance Service Representative Directr f Public Health Other rganisatins and expertise invited as apprpriate The nly current versin f this plan is n the intranet Page 7 f 58

8 During a flu pandemic the Strategic Crdinating Grup (SCG) will mst likely be chaired by the Chief Executive f NHS Dumfries and Gallway. The chairing f the SCG may pass t ther members particularly in the later recvery phases r if prevailing circumstances make it apprpriate. Tactical Supprt Grup (TSG) Remit Fr the full general functins, respnsibilities and dcumentatin required f the TSG please refer t MES dcumentatin. The TSG prvides multi-agency tactical supprt management within the framewrk f the MES. Functinal Team Managers are called ut t mbilise and c-rdinate the activities f the nn-emergency services. The Functinal teams implement the peratinal supprt fr cnsequence management requirements f the MES. Liaisn Officers within the teams have a full part t play in decisin making Membership The TSG is cmpsed f Functinal Team Managers and Liaisn Officers. The Functinal Team Managers are first line managers cvering fur brad areas: Cmmunicatins; Lgistics; Care fr Peple and Operatins. Any r all f these teams may be frmed accrding t respnse requirements. Membership f these teams cmprises Liaisn Officers drawn frm the Plice, Fire & Rescue Services, Ambulance Service, Maritime and Castguard Agency, NHS Dumfries and Gallway and Armed Frces as apprpriate t the demands f the particular emergency. The Grup is chaired by the Chief Executive f Dumfries and Gallway Cuncil r a nminated Deputy. 2.4 PANDEMIC SPECIFIC ARRANGEMENTS Pandemic Influenza Crdinatr The Pandemic Influenza Crdinatr (PIC) will cnsult with the majr stakehlders f the Flu Pandemic Plan and liaise with NHS and ther rganisatins t ensure that the Plan represents a shared multi-agency respnse in the event f implementatin. The PIC will respnd t SGHD queries regarding the Plan, will participate in the Pandemic Influenza Cntrl Cmmittee (PICC), and will be the named individual fr ensuring that the Plan is kept up t date. The current PIC is: Dr Nigel Calvert, Cnsultant in Public Health Medicine. Ryan Suth, Crichtn Hall, The Crichtn, Dumfries, DG1 4TG Tel nigel.calvert@nhs.net The nly current versin f this plan is n the intranet Page 8 f 58

9 Pandemic influenza Cntrl Cmmittee The PICC will be respnsible fr ensuring the plan is reviewed at the apprpriate pint annually and in year as apprpriate (particularly fllwing exercises and training). The Grup will als take int accunt and cntribute t the Cmmunity Risk Register (maintained by the Fire and Rescue Service n behalf f the SCG). Membership f the PICC will include: Nigel Calvert Cnsultant in Public Health Medicine, NHS Dumfries & Gallway David Gurney - Civil Prtectin Manager, Dumfries and Gallway Cuncil Stephen Hick - SCG Prgramme C-rdinatr David Irving Emergency Planning Officer Pandemic influenza Cntrl Team Remit The PICT will be respnsible fr the day-t-day peratinal management f the Bard level health respnse t the pandemic in liaisn with the SCG and within the framewrk f the MES. This will include n-ging risk assessment and implementing apprpriate and prprtinate respnse at all phases f a pandemic. The PICT will receive strategic instructin frm the SCG and will advise and feed back t them n specific scientific and peratinal issues as they arise. The PICT will be able t c-pt and utilise the full capacity f the MES partners and Tactical Supprt Teams as required. The PICT may decide t establish specific sub-grups t fcus fr example n primary care, hspital care, vaccinatin etc as required. Mre specific functins f the PICT will include: Advise SCG regarding epidemilgy and actual and predicted trends f disease spread Advise SCG regarding lcal health service management and utbreak cntrl measures that are required in line with natinal guidance; Arrange lcal management (diagnsis, investigatin, treatment) f patients with flu-like illness and cnfirmed influenza and its cmplicatins in line with natinal guidance; Ensure ptimum care fr thse affected; Ensure apprpriate facilities fr infectin cntrl; Arrange t have labratries investigate influenza-like illness (ILI), islate strains f influenza and test anti-micrbial susceptibility f secndary bacterial infectins; Arrange a c-rdinated health prtectin respnse in line with natinal guidance; Implement arrangements t cpe with staff absence and increased patient lads; Manage the disruptin caused by influenza n ther NHS services and ther medical cnditins; The nly current versin f this plan is n the intranet Page 9 f 58

10 Implement cntingency staffing arrangements as required; Arrange t prvide anti-viral treatment and t immunise essential staff accrding t natinal guidelines (with Occupatinal Health Service); Implement plans fr emergency mass vaccinatin prgrammes accrding t natinal guidelines (see NHS Dumfries and Gallway Mass Vaccinatin Plan); Estimate requirements fr vaccine and anti-viral drugs; Arrange distributin f vaccine and anti-viral drugs; Ensure vaccine and anti-viral drug administratin t all specified pririty grups accrding t natinal guidelines. Arrange t rutinely reprt all data required by HPS and SGHD n pandemic influenza and it s lcal impact; A mdel agenda fr meetings f the PICT is attached in Appendix 1. Membership The PICT will be led by NHS D&G Chief Operating Officer. Functin and membership f the PICT will be adapted as required during the changing circumstances f a pandemic but the fllwing prvides a guide t cre membership. Hspital management Medical and nursing staff managers Primary care Scttish Ambulance Service NHS 24 and D&G Out-f-Hurs services D&G Cuncil Scial Wrk Health Prtectin (Directrate f Public Health) Infectin Cntrl Team Occupatinal Health Service Pharmacy Micrbilgy labratry HPS Cmmunicatins The nly current versin f this plan is n the intranet Page 10 f 58

11 3. PRINCIPLES OF THE PLAN The verall principles fr this plan are that it will be: Precautinary The plan will reflect the ptential risk based n best infrmatin available. Prprtinate The plan will prvide nly the necessary respnse that apprpriately reflects the risks and circumstances. Adaptable The plan will have capacity built in t be flexible t changing risks and circumstances and scale the respnse up r dwn as required. In particular it will be able t cpe with the full ptential clinical spectrum f influenza severity (see 3.1 belw). 3.1 PLANNING ASSUMPTIONS This plan is based n the fllwing basic planning assumptins: The scpe f any pandemic will be uncertain ie in its speed, duratin, gegraphical spread and severity. The nature f a pandemic means it will have a very high public and media prfile. Influenza pandemic planning in the UK has been based n a reasnable wrst case scenari derived frm experience and analysis f previus 20 th century pandemics. This has indicated that 50% f the ppulatin may be affected ver a 15 week perid. 30% f thse affected may present t primary care, 3% f thse affected may be hspitalised and 2.5% f thse affected may die. This remains an acceptable basic indicatr fr planning. Hwever, as previusly identified, the scpe f any pandemic is highly uncertain and the data n which planning mdel scenaris are cnstructed are als highly unreliable. This plan is designed t be flexible t cpe with a range f circumstances based n lw, mderate and high impact scenaris. It may be that in a future pandemic similar t the 2009 H1N1 picture (ie widespread but in mst cases very mild illness) a decisin will need t be made whether r nt t invke this plan. Central guidance will be fllwed in this situatin. A breakdwn f estimated prjectin figures fr lw, mderate and high impact scenaris f a pandemic in Dumfries and Gallway can be fund in Appendix 2. The prjectins fr high, medium and lw impact scenaris suggest that the peak (week 7) there wuld be 16,500, 8,500, and 3,500 new cases. The nly current versin f this plan is n the intranet Page 11 f 58

12 3.2 APPROACH The apprach t this plan invlves fur key bjectives: Early detectin and assessment Reducing transmissin and prtecting the ppulatin Minimising serius illness and mrtality Prmting resilience The WHO have a six phase trigger and alert system fr pandemic planning at glbal level as depicted belw in Figure 2 (fr further detail see Appendix 3). Figure 2: WHO Pandemic Alert System This tl reflects the glbal system and is nt directly applicable at natinal r lcal level. Hwever, it prvides a useful starting pint fr a phased apprach at lcal level. On declaratin f WHO pandemic Phase 4 (r earlier depending n specific natinal r lcal circumstances) the lcal pandemic respnse will be initiated and wuld cnsist f 3 key phases: 1. Detectin and Assessment 2. Treatment and Escalatin this phase cmmences nce there is evidence f sustained transmissin f the virus in the cmmunity. The respnse is graded t allw flexibility fr a pandemic with Lw, Mderate r High impact 3. Recvery this phase cmmences nce influenza activity is significantly reduced frm its peak r is cnsidered t be within acceptable parameters. The nly current versin f this plan is n the intranet Page 12 f 58

13 Infrmatin and guidance at natinal level will assist in assessing and cntinuusly reviewing the phase and the impact level f the pandemic lcally. 3.3 RISK ASSESSMENT During treatment and escalatin phases it will be vital fr the PICT t cntinuusly review the level f impact f the pandemic lcally in rder t respnd in a precautinary but prprtinate and adaptable manner. It is nt pssible t clearly define what wuld cnstitute a lw, mderate r high impact pandemic. Hwever, Figure 3 prvides a tl t assist risk assessment based n the numbers f peple affected and the severity f the illness / deaths caused. This has been adapted frm the Watt Grup Outbreak Risk Matrix (see ) and the Hspital Infectin Incident Assessment Tl (see ) and is based in principle n a range f evidence frm previus pandemics and epidemic seasns (see and gitalasset/dh_ pdf ). This tl will be used by the PICT n an n-ging basis in cnjunctin with available lcal intelligence, natinal guidance and prfessinal judgement. This will prvide a valuable indicatin and assessment f the risk and impact f a pandemic and s ensure a reasnable, flexible and practicable respnse. The nly current versin f this plan is n the intranet Page 13 f 58

14 Figure 3: Risk Assessment and Mnitring Tl Minr Impact (Scre 1 fr each) Public Health Impact (numbers affected) Attack rate <20% Individual Impact (severity f illness) Case Fatality <0.3% Impact n Services Minimal small increase in staff sickness and increased wrklad in sme areas but manageable Public Anxiety and Cncern Sme public reassurance required but n significant increase in media interest SCORE Medium Impact (Scre 2 fr each) Majr Impact (Scre 3 fr each) Attack rate 20-40% Attack rate >40% Case Fatality % Case Fatality >2.0% Mderate increase in wrklad and staff sickness absence in sme areas requiring sme specific management interventins Majr impact acrss all services requiring widespread implementatin f BCPs Increased public and media anxiety and cncern requiring sme peridic attentin and respnse High level f public and media alarm requiring cntinuus attentin and respnse TOTAL SCORE TOTAL SCORE = 4 6 GREEN FOLLOW PLAN FOR LOW IMPACT SCENARIO TOTAL SCORE = 7 9 AMBER FOLLOW PLAN FOR MODERATE IMPACT SCENARIO TOTAL SCORE = RED FOLLOW PLAN FOR HIGH IMPACT SCENARIO The nly current versin f this plan is n the intranet Page 14 f 58

15 4. DETECTION AND ASSESSMENT PHASE On declaratin f WHO pandemic Phase 4 (r earlier depending n specific natinal r lcal circumstances) the PIC will alert SCG. SCG will review the specific circumstances and decide n the need t establish PICT. In this initial phase the main pririties are: clinical surveillance and intelligence gathering t infrm bth the lcal and natinal respnse; clear cmmunicatin t all relevant persnnel and the public in rder t maximise preparedness. 4.1 KEY ACTIONS 1. Surveillance, Testing, Diagnsis and Treatment Implement enhanced virlgical testing and data cllectin 2. Preventin and Prtectin Implement enhanced infectin cntrl prcedures in healthcare settings Prepare fr anti-viral distributin Prepare fr vaccinatin prgramme 3. Service Planning and Cntinuity Review BCPs urgently Review plans fr enhanced staff sickness absence surveillance 4. Cmmunicatin SCG cnsider need fr Infrmatin Cell and / r Public Infrmatin C-rdinatr and Public Infrmatin Cell Cmmunicate key issues n prgress, preventin and preparatin internally and externally Further guidance n the key actins at Detectin and Assessment Phase under these fur headings is set ut belw. The nly current versin f this plan is n the intranet Page 15 f 58

16 4.2 SURVEILLANCE, TESTING, DIAGNOSIS AND REPORTING PIC will alert lcal clinicians (primary and secndary care) t establish guidelines and practice fr testing f Influenza-Like-Illness (ILI) cases. Patients presenting in primary care (at GP surgery r ut-f-hurs) will be managed as per usual clinical care. Hwever, in additin t usual management nasal and pharyngeal swabs shuld be taken fr virlgy and minimum dataset infrmatin (Appendix 4) cllected and returned. PIC will alert Head f Micrbilgy at DGRI t establish arrangements fr handling influenza specimens. Viral thrat swabs, sputums r nas-pharngeal aspirates shuld be cllected as nrmal and sent t DGRI Micrbilgy Lab fr lcal RT-PCR testing. The Micrbilgy Labratry (DGRI) will frward influenza specimens as necessary fr cnfirmatry testing t the Reginal Virus Labratry (RVL), Glasgw, packaged as per UN 602 Regulatins. The Cnsultant Micrbilgist will arrange urgent transprt if required and liaise with the Directr, RVL, regarding number f specimens and turn-arund times f results. The RVL will perfrm an RT-PCR fr the detectin f influenza virus RNA. An acute and cnvalescent cltted bld sample can be can als be sent, and will be tested by cmplement fixatin test (CFT). PIC will alert Health Intelligence Unit t establish arrangements fr cllecting infrmatin. There will be tw main purpses t data gathering: Identifying epidemilgical and clinical features f the pandemic including numbers affected, speed and gegraphy f spread, severity f illness, risk grups affected. Mnitring the likely impact n services and infrming plans and respnses. The respnsibility fr cllecting, cleaning, cllating and reprting infrmatin relating t the flu pandemic will be the respnsibility f the NHS Dumfries & Gallway Health Intelligence Unit (HI Unit). The staff f the HI Unit will supprt the infrmatin functin f the pandemic management t the exclusin f all ther wrk, as required, but within ffice hurs. Data will be cllected using a minimum cre dataset (Appendix 4). The dataset is likely t be mdified at the time accrding t the specific nature f the pandemic threat and lcal practicalities. This will prvide the basis fr a definitive recrd fr clinical and epidemilgical infrmatin, mnitring and planning thrughut the pandemic. Other surces f infrmatin will als be utilised including the bed management system and death recrds. The HI Unit will endeavur during the detectin and assessment phase t implement an electrnic system fr gathering this infrmatin s that the datasheet can be cmpleted frm a cmputer at any lcatin acrss NHS Dumfries & Gallway. This wuld ptentially enable a wide range f persnnel t generate data thrugh the curse f the pandemic as required eg: The nly current versin f this plan is n the intranet Page 16 f 58

17 General Practitiners Pharmacists Health Visitrs Schl Nurses Cmmunity Nurses Accident & Emergency staff Ambulance staff NHS 24/Out f Hurs service The infrmatin will then be returned via the intranet (HR Net) r t a dedicated bx using MS Infpath and cllated and cleaned at the Health Intelligence Unit. In the circumstances that the electrnic slutin is inperable a paper cpy f the minimum cre dataset shuld be cmpleted with the patient CHI number n each page and faxed t the public health secure fax ( ). Submissins frm such nn-internet rutes will be entered by hand int the database by HI Unit staff. The HI Unit will endeavur t establish a web-based reprting tl allwing any member f the flu pandemic team t access the mst current infrmatin. Where this is nt pssible, regular reprts will be made available as required and prvided t the SCG, and t the PICT nce it is established. Regular reprting culd include: Number f new cases, shwing trend Age prfile Gegraphic breakdwn Breakdwn by GP / LHP CURB 65 utcmes Number f admissins Flu-related deaths 4.3 PREVENTION AND PROTECTION Infectin Cntrl The PIC will alert ICT and heads f service t review and be prepared t implement specific infectin cntrl measures and guidelines. This will include ensuring that all relevant training and supplies f PPE are in place. In this initial phase in all healthcare settings, patients with symptms f pandemic flu shuld be segregated frm nn-influenza patients as rapidly as pssible The Occupatinal Health Service (OHS) will assess any staff with respiratry symptms and supervise and mnitr staff deplyment. OHS will als mnitr sickness absence and prvide psychlgical and scial supprt t staff. Anti-Viral Drugs Anti-viral drugs will nt rutinely be used r available in primary care until a pandemic is established (treatment and escalatin phase). Specific guidance will be issued as t their use at natinal level as the characteristics f the virus The nly current versin f this plan is n the intranet Page 17 f 58

18 are understd. The PIC will be respnsible fr keeping clinicians in primary care updated as guidance becmes available n their apprpriate use. The PIC will als review plans fr anti-viral distributin in preparatin fr mre widespread use. Vaccinatin In this early stage n pandemic specific vaccine will be available. It is likely t be 4 6 mnths frm the emergence f a new virus befre supplies f vaccine wuld enable a ppulatin wide campaign. Sme limited supplies may becme available fr pririty grups sner than this. Estimates f time required t manufacture supplies f the new pandemic flu vaccine fr pririty grups and fr widespread use will be prvided as sn as such infrmatin is available via the JCVI and Health Prtectin Sctland. Guidance will als be issued cncerning wh the pririty grups will be as the characteristics f the virus are identified. This infrmatin will be widely circulated t the general public and the media lcally. The PIC will be respnsible fr reviewing vaccinatin plans including strage, distributin, delivery, pririty grups and mass vaccinatin, in preparatin fr vaccine becming available. 4.4 SERVICE PLANNING AND CONTINUITY During the Detectin and Assessment Phase all Heads f Service will review and update their business cntinuity plans as a matter f urgency. The Occupatinal Health service will review and establish plans fr enhanced surveillance in regard t staff absence. 4.5 COMMUNICATION The SCG will decide n the frmal establishment f an Infrmatin Cell and / r Public infrmatin Cell under MES arrangements. The Public Health Directrate tgether with Cmmunicatins Department will be respnsible fr ensuring and facilitating the apprpriate disseminatin f infrmatin t external and internal audiences n key issues such as: The prgress f the pandemic at internatinal, natinal and lcal level The imprtance f gd respiratry and hand hygiene The establishment f resilience measures such as flu-friends The nly current versin f this plan is n the intranet Page 18 f 58

19 5. TREATMENT AND ESCALATION PHASE The Treatment and Escalatin Phase cmmences nce there is evidence f sustained transmissin f the virus in the cmmunity. SCG will have established the PICT and verall Pandemic Management Structure (see Sectin 2.2) The PICT in cnjunctin with the SCG will determine when the pandemic mves int a treatment and escalatin phase lcally (as determined by natinal guidance and lcal risk assessment). The PICT will be respnsible fr the n-ging risk assessment f the pandemic and whether a Lw, Mderate r High Level respnse is apprpriate (Sectin 3.3). The nly current versin f this plan is n the intranet Page 19 f 58

20 5.1 LOW IMPACT SCENARIO Key Actins 1. Surveillance, Testing, Diagnsis and Treatment Fllw patient management algrithms accrding t natinal guidance Virlgical testing nt nw rutinely required Cntinue data cllectin and reprting 2. Preventin and Prtectin Maintain enhanced infectin cntrl prcedures in healthcare settings and implement islatin and chrting measures (ie infected patients are cared fr tgether in a single unit by the same staff) Implement anti-viral distributin fr treatment and prphylaxis accrding t natinal guidance Prepare fr vaccinatin prgramme and implement priritised rll-ut in accrdance with natinal guidance and availability 3. Service Planning and Cntinuity Enhanced mnitring f capacity in pririty services Enhanced mnitring f staff sickness absence Be prepared t implement BCPs Cnsider ceasing nn-urgent elective activity as a first step 4. Cmmunicatin SCG and PICT review need fr Infrmatin Cell and / r Public Infrmatin Cell Cmmunicate key issues n prgress, preventin, self care, apprpriate use f services, tailred infrmatin fr high risk grups, update n use f anti-virals and vaccine The nly current versin f this plan is n the intranet Page 20 f 58

21 Further guidance n the key actins fr a Lw Impact scenari respnse under these fur headings is set ut belw Surveillance, Testing, Diagnsis and Reprting Even in a lw impact scenari it is imprtant that a clear prcess is established fr testing, diagnsis and apprpriate treatment. It is anticipated that the vast majrity (up t 95%) f flu cases can be managed at hme. Depending n the availability f vaccine and anti-viral drugs, the management will be largely symptmatic. Fr apprpriate triage f patients presenting t GP Practices, Emergency Department triage statins, and ut-f-hurs services, the algrithm in Appendix 5 shuld be fllwed. At this stage taking swabs fr virlgy is n lnger rutinely required. Specific guidance n the use f anti-viral drugs will be given at the time depending n their availability and the nature f the virus. Fr uncmplicated illness in thse peple nt in high-risk grups n antibitics are necessary and hme management is apprpriate. Fr patients with nnsevere pneumnia initial primary care assessment and treatment with antibitics is apprpriate. Fr severe pneumnia, referral t DGRI is indicated. The management and investigatins fr adults referred t hspital are as recmmended in Appendices 6 and 7. The assessment, management and investigatin f children is utlined in Appendices 8 and 9. Nte that all the treatment and diagnsis algrithms referred t abve are likely t be mdified accrding t the specific nature f the pandemic thrugh natinal guidance at the time. The algrithms are taken frm the British Thracic Sciety / British Infectin Sciety / Health Prtectin Agency: Clinical guidelines fr patients with an influenza-like illness during an influenza pandemic and prvide the mst current advice available. Fr mre detail n management f influenza during a pandemic practitiners shuld cnsult these guidelines available at: The CURB65 scre is used in these algrithms as a means t assess severity f individual symptms. This is based n the British Thracic Sciety Cmmunity Acquired Pneumnia Guidelines 2009 ( and is ffered as the best example available f a triage tl. Hwever, it shuld nt replace individual clinical judgement. Minimum dataset frms shuld cntinue t be cmpleted and returned in rder t infrm natinal and lcal risk assessment and decisin making. The nly current versin f this plan is n the intranet Page 21 f 58

22 5.1.3 Preventin and Prtectin Infectin Cntrl Once the treatment and escalatin phase f a pandemic cmmences influenza and nn-influenza patients will be islated r chrted ie cared fr in separate units as far as pssible. This will include, where pssible, different staff caring fr influenza and nn-influenza patients. Lcal guidance n the use f persnal prtective equipment (PPE) and infectin cntrl will be prvided by the ICT and widely issued amngst healthcare practitiners acrss Dumfries and Gallway. Cmprehensive guidance n infectin cntrl aspects is prvided in the Department f Health/Health Prtectin Agency, Pandemic Influenza: guidance fr infectin cntrl in hspitals and primary care settings and Pandemic H1N Influenza: a summary f guidance fr infectin cntrl in health care settings (nw archived at: alasset/dh_ pdf. The principles therein will be fllwed clsely by the Infectin Cntrl Team, the Health Prtectin Team and all healthcare staff in Dumfries and Gallway. The Infectin Cntrl Team and Health Prtectin Team will have jint respnsibility fr ensuring cmpliance with the guidance fr DGRI and fr cmmunity lcatins respectively. They will wrk clsely with the supprt f PICT t ensure guidance is cmplied with acrss NHS D&G. The guidance applies t cmmunity care setting such as care hmes and the HPT will supprt implementatin in these settings. Anti-viral Drugs Once the pandemic is established anti-virals are likely t be the first line f defence until a vaccine is available. Anti-viral drugs will be stred at DGRI Pharmacy and in Cmmunity Pharmacies. They will be used fr treatment as per Appendices 5,6,7,8,9. They may als be used fr prphylaxis in limited and targeted specific circumstances eg fr thse clse cntacts in clinical high risk grups. A widespread husehld prphylaxis apprach will nt be taken. It shuld be nted these algrithms are likely t be mdified thrugh natinal guidance accrding t the nature f the specific pandemic. Vaccinatin At sme pint during the curse f a pandemic limited supplies f vaccine may becme available t pre-determined pririty grups. Advice will be given by WHO thrugh t JCVI n pririty grups at each phase f the pandemic The nly current versin f this plan is n the intranet Page 22 f 58

23 depending n the epidemilgy, clinical features, natural histry and verall risk prfile f the new pandemic and n the availability f vaccine. It is likely that frnt line health and scial care staff and clinical at risk grups wuld be high n the pririty list. The SCG and PICT will fllw this advice as apprpriate t lcal circumstances. Mnitring f vaccine uptake, effectiveness, and side-effects will be recrded using a minimum dataset frm. The public will need t be kept infrmed prmptly and sensitively regarding issues f vaccine availability. Appendix 10 prvides an example f pririty grups fr vaccinatin, accrding t gradually increasing availability f vaccine, alng with a ratinale fr vaccine administratin t this grup and identificatin f wh will be respnsible fr administratin f the vaccine t that grup. The Occupatinal Health Service (OHS) will have respnsibility fr all healthcare staff vaccinatin in a pandemic flu situatin. This table wuld be amended accrding t the natinal guidance at the time Service Planning and Cntinuity During a pandemic f influenza it may be necessary t retract frm nrmal activity t a psitin in which hspital services manage mre respiratry cases at the expense f managing fewer nn-respiratry cases. The first step wuld be t stp all nn-urgent elective activity. In these circumstances nnurgent wuld mean cases such as hernias r hip replacements in which, althugh the cnditin itself may be annying, frustrating, limiting n daily activity and painful, it is nt in any way life-threatening. At lw impact it may nt be necessary t implement such measures. A list f services which wuld remain critical t cntinuing NHS activity and which wuld be priritised can be fund in Appendix 11. There will be enhanced mnitring f capacity in these services in particular and all Heads f Service will be prepared t implement BCPs. OHS will implement enhanced surveillance f staff absence Cmmunicatin The SCG, with advice frm PICT, will review the need fr an Infrmatin Cell and / r Public Infrmatin Cell under MES arrangements. The principles set ut in the Pandemic Flu Cmmunicatins Plan will be adpted and adhered t (Appendix 12). Issues that will be cnsidered fr cmmunicatin with bth internal and external audiences at this time will include: The prgress f the pandemic The imprtance f gd respiratry and hand hygiene Hw t access lcal help apprpriately in rder t minimise the impact n services Self help and care infrmatin Tailred infrmatin fr at risk grups Infrmatin abut anti-virals and vaccinatin as it becmes available The nly current versin f this plan is n the intranet Page 23 f 58

24 5.2 MODERATE IMPACT SCENARIO Key Actins 1. Surveillance, Testing, Diagnsis and Treatment Fllw patient management algrithms which may be mdified accrding t natinal guidance. Cntinue data cllectin and reprting as far as pssible. Cnsider mdificatins t minimum dataset and additinal admin resurce fr HI Unit. 2. Preventin and Prtectin Maintain enhanced infectin cntrl prcedures. Cnsider and prepare fr cntingency measures if required (Sectin 5.3.4). Cntinue anti-viral distributin fr treatment and prphylaxis. Cmmunicate any revised natinal guidance such as pririty grups. Prepare fr vaccinatin prgramme and implement priritised rll-ut in accrdance with natinal guidance and availability 3. Service Planning and Cntinuity Cnsider and implement specific cntingency plans and BCPs where required. Cnsider ceasing further activity in additin t nn-urgent elective cases. 4. Cmmunicatin Establish Infrmatin Cell and / r Public Infrmatin Cell Cntinue t cmmunicate key issues n prgress, preventin, self care, apprpriate use f services, tailred infrmatin fr high risk grups, update n use f anti-virals and vaccine. Als prvide regular cmmunicatin n hw services are cping and being managed. The nly current versin f this plan is n the intranet Page 24 f 58

25 Further guidance n the key actins fr a Mderate Impact scenari respnse under these fur headings is set ut belw Surveillance, Testing, Diagnsis and Reprting As far as pssible patient clinical management shuld cntinue as per natinal and lcal guidance set ut in the algrithms in Appendices 5 9. It is likely these may be mdified at the time depending n the specific nature f the pandemic. Surveillance and reprting shuld als cntinue thrugh the minimum dataset as far as pssible. The nature f infrmatin gathering may be mdified depending n the nature f the pandemic and at this level the PICT and SCG may need t cnsider additinal administrative resurces being allcated t the Health Intelligence Unit t aid data entry and cllectin Preventin and Prtectin Infectin Cntrl Infectin cntrl prcedures shuld be fllwed as set ut previusly in a lw impact scenari. As capacity t maintain islatin r chrting under nrmal service arrangements is exhausted the PICT will make decisins t implement specific measures such as designated ED areas, Wards and Flu Hspitals as set ut in Sectin Anti-viral Drugs Specific guidance will be issued at natinal level regarding the priritisatin and use f anti-virals dependent n the nature f the virus and the availability f stck at the time eg frnt line health and scial care staff and clinical high risk grups may be priritised fr treatment. The PICT will be respnsible fr updating and cmmunicating plicy n an n-ging basis thrughut the pandemic. Vaccinatin In a mderate level pandemic a priritised rll ut f vaccinatin wuld be the mst likely circumstance as previusly utlined in the lw impact scenari Service Planning and Cntinuity If the level f the pandemic lcally is designated by the PICT as Mderate this will alert all heads f service including ED, NHS24 / OOHS, Maternity, Paediatrics, Cmmunity Hspitals, Critical Care, that they shuld review and be prepared t implement their specific business cntinuity and cntingency plans. Further guidance n surge capacity and priritisatin can be fund at Beynd ceasing all nn-urgent elective activity the secnd grup f patients fr whm hspital admissin may need t be curtailed wuld be thse remaining cases, including cases f malignancy, where in the judgement f The nly current versin f this plan is n the intranet Page 25 f 58

26 the clinician cncerned delay f sme weeks wuld nt materially affect the utcme Cmmunicatin In additin t the issues set ut under a lw impact scenari it wuld be imprtant t keep bth internal and external audiences infrmed abut hw services are cping at this level. This is essential in rder t manage bth public expectatin and staff awareness f hw clleagues are being affected. The nly current versin f this plan is n the intranet Page 26 f 58

27 5.3 HIGH IMPACT SCENARIO Key Actins 1. Surveillance, Testing, Diagnsis and Treatment Fllw patient management algrithms mdified accrding t natinal guidance. Cntinue data cllectin and reprting as far as pssible with active participatin f HI Unit staff and additinal admin resurce. 2. Preventin and Prtectin Implement specific cntingency measures (Sectin 5.3.4) in rder t maintain enhanced infectin cntrl prcedures. Cntinue anti-viral distributin fr treatment and prphylaxis using PGDs and in line with any revised natinal guidance in regard t pririty use. Prepare fr mass vaccinatin prgramme in line with Mass Vaccinatin Plan. 3. Service Planning and Cntinuity SCG implement crisis respnse Emergency admissins nly Specific cntingency plans and BCPs implemented Mass Fatality Plan implemented 4. Cmmunicatin MES Infrmatin Cell and / r Public Infrmatin Cell established and cntinue t prvide regular cmmunicatin n all key issues including daily situatin update. Further guidance n the key actins fr a High Impact scenari respnse under these fur headings is set ut belw. The nly current versin f this plan is n the intranet Page 27 f 58

28 5.3.2 Surveillance, Testing, Diagnsis and Reprting Patient clinical management shuld cntinue accrding t algrithms (Appendices 5 9) taking int accunt mdificatins in line with any revised natinal guidance. HI Unit staff will wrk clsely with bed managers t keep an update n hspital admissins as required. HI staff will assist in cllecting infrmatin frm the wards in persn if required and will be clearly identified as part f the flu pandemic team Preventin and Prtectin Infectin Cntrl In rder t maintain apprpriate care, islatin and chrting f influenza patients the cntingency plans set ut in Sectin will be adpted. Anti-viral Drugs In the event f a high impact pandemic Patient Grup Directins which have already been agreed will be implemented. This will facilitate the distributin f Oseltamavir in the peak phase (4-6 weeks) f a flu pandemic frm the fllwing lcatins: GP surgeries OOH services Cmmunity Pharmacies NHS Occupatinal Health Service Algrithms will be mdified t reflect any revised natinal guidance eg limited pririty grups fr treatment. Vaccinatin In the event f a high impact pandemic a mass ppulatin vaccinatin campaign may be required. The NHS Dumfries & Gallway Mass Vaccinatin Plan will be implemented using available Primary Care infrastructure, NHS Occupatinal Health Service, and Health Prtectin Team. The PICT will versee and mnitr the implementatin f the mass vaccinatin prgramme and the PIC will be the named respnsible persn accuntable fr the successful cmpletin f the prgramme. All vaccine will be stred prir t distributin at Pharmacy, DGRI and cld chain will be maintained frm delivery t distributin. The verwhelming majrity f mass vaccinatins fr pandemic flu will be cmpleted by primary care staff (mstly Practice Nurses, Health Visitrs, Cmmunity Nurses and Schl Nurses), wh currently implement the seasnal flu campaign. Additinal nursing staff will be redeplyed and recruited t assist a mass flu vaccinatin prgramme. Vlunteer nurses will The nly current versin f this plan is n the intranet Page 28 f 58

29 als be recruited and trained. It wuld be intended t cmplete a pandemic flu vaccinatin prgramme in tw weeks Service Planning and Cntinuity In a High Impact Scenari the PICT will advise SCG that a High Impact crisis respnse is necessary. This will trigger the fllwing interventins: Admissins It might be necessary t restrict surgery t nly the mst acute emergencies. PICT wuld cnsider the need t prtect surgical capacity by mving remaining surgical emergency beds t the Day Surgery Unit. Deciding n admissin f the remaining emergencies wuld demand a higher level f triage than is presently practised and wuld, therefre, require the presence f the n-call surgical cnsultants, bth general and rthpaedic, in the ED r elsewhere when decisin t admit was being cnsidered. Cmmunity The cmmunity nursing and scial services will be n full alert and are likely t be stretched fr a number f weeks until the pandemic subsides. At this pint thrugh the SCG arrangements additinal vlunteer wrkers will be sught t prvide scial supprt and essential fd items fr elderly r frail cases at hme. Plans t enable Cmmunity Pharmacists and ther cmmunity healthcare prfessinals t respnd t influenza-like illness frm sufferers will be brught int actin in accrdance with the Patient Grup Directins (PGDs) already in place. NHS24 / OOH Liaisn with NHS 24 will ensure that the treatment algrithms and prtcls fr: Triage and management f flu-like illness at hme; Referral t flu hspitals; DGRI referral; Prescriptin f anti-viral agents; Vaccinatin with new pandemic flu vaccine when available; will be fllwed, and apprpriate dcumentatin cmpleted electrnically. Cpies f all data will be made available t the Health Prtectin Unit fr epidemilgical analysis. NHS 24 will take apprpriate planning steps t ensure staffing resilience at all phases f a flu pandemic. There is a separate mre detailed Out-f-Hurs Pandemic Influenza Cntinuity Plan. Scttish Ambulance Service (SAS) Ambulance services are a critical part f the pandemic flu respnse. The Scttish Ambulance Service have their wn Pandemic Outbreak Cntingency Plan which includes: Patient Transprt Service (PTS) will be scaled dwn; Priritisatin f all SAS services; The nly current versin f this plan is n the intranet Page 29 f 58

30 Exceptin reprting will be in place where there are severe delays in call handling r delays in peratinal respnse; Increase in staffing levels will be in place t meet peak demand; Phased implementatin f supprt frm Vluntary Aid Scieties, ther vlunteer grups, mutual r military aid and cmmercial assistance will be in place; Managers are empwered t vary resurce levels t take accunt f high demand; Redeplyment f staff t pririty tasks will be in place. The SAS will be represented n the Strategic Crdinating Grup (SCG) and will be fully engaged with partner agencies n the Pandemic Influenza Cntrl Team (PICT). Flu Wards and Hspitals It is planned t designate Mffat, Annan, Castle Duglas, Thrnhill and part f the Gallway Cmmunity Hspitals as flu hspitals. Existing patients in the designated flu hspitals will be relcated t ther cnvenient and apprpriate facilities. All flu cases with CURB 65 scres (less than) <3 needing admissin will be diverted t these lcatins. T ensure that DGRI and the Gallway Cmmunity Hspital cntinue t functin ptimally, General Practitiners will be asked t refer any ptential r prbable flu cases t the nearest selected flu hspital lcatin. Furthermre a triage admissin will perate at DGRI (Out-f-Hurs Rm A) and the Gallway Cmmunity Hspital, whereby all new admissins will be clinically screened fr flu. Where at all pssible, influenza cases will be managed in flu hspitals. Wards 3 and 6 in DGRI will be the initial flu islatin wards fr extremely ill cases wh need DGRI admissin. Infectin Cntrl Nurses in the acute service will ensure that these arrangements are in place and are cmplied with. Critical care Artificial ventilatin will be in DGRI and will require clinical priritisatin f thse in greatest need and wh are mst likely t benefit. All elective wrk is scaled dwn except urgent cancer wrk. A 24 hur emergency theatre and a weekday 8am-5pm theatre will need t be staffed. Islatin facilities may be rapidly verwhelmed but beds are likely t be limited mre by staff than equipment (ventilatrs etc). Day Stay wuld need t functin as the hspital recvery and pssibly the elective HDU with help frm staff frm SHDU. Staffing ratis will need t be higher than usual t manage a skills shrtage s that trained ICU staff can have a mre supervisry and training rle. Medical HDU and Surgical HDU staff wuld need t triage and prvide nn invasive ventilatin (NIV) when necessary. Further guidance n critical care prvisin during a pandemic can be fund: licyandguidance/dh_ The nly current versin f this plan is n the intranet Page 30 f 58

31 Cntingency plans fr paediatrics, maternity services and ED arrangements will be activated. Fatalities and Mrtuary Facilities In nrmal circumstances the mrtuary at Dumfries and Gallway Ryal Infirmary has the capacity t accmmdate up t 31 bdies, with suitable facilities t supprt pst-mrtem examinatins. In additin, sme undertakers have facilities fr the strage f a limited number f bdies. A High Impact Pandemic may result in the abve arrangements being unable t accmmdate the required demands fr mrtuary and bdy hlding facilities. In the event f any emergency ccurring within the Dumfries and Gallway area requiring mrtuary and bdy hlding facilities greater than nrmal capacity, arrangements are in place thrugh the Majr Emergency Scheme (MES) fr the establishment and management f lcal emergency mrtuaries. The Natinal Emergency Mrtuary Arrangements facilities will nt be able t be invked during a flu pandemic. In the event f a High Impact Pandemic ccurring within Dumfries and Gallway, the fllwing issues, that may require MES Emergency Mrtuary arrangements t vary frm the nrm, will be given apprpriate cnsideratin: Ptential requirement fr additinal lcalised refrigerated facilities fr bdy hlding purpses; Impact f extended timeline between death, certificatin and burial/crematin n mrtuary and bdy hlding arrangements; Unavailability f mutual aid; Limitatin f human resurces acrss all respnder rganisatins; Ptential requirement fr significant additinal family assistance facilities. Staff Management At this level it is likely that staff will als be significantly affected either by sickness themselves r affected by additinal caring requirements fr family members and dependents. A guide t sme key issues in managing staff during such a perid can be fund in Appendix Cmmunicatin The MES Infrmatin Cell and Public Infrmatin Cell will prvide regular cmmunicatin n all key issues previusly identified. At this level a daily situatin update reprt fr all key internal and external audiences will be required. The nly current versin f this plan is n the intranet Page 31 f 58

32 6. RECOVERY PHASE Recvery can be defined as the prcess f restring, rebuilding and rehabilitating individuals, the rganisatin and the wider cmmunity. Based n risk assessment the PICT will advise the SCG when levels activity are reducing t a level that will allw a gradual return t a nrmalisatin f services. The SCG will frmally agree the transitin t recvery phase and the PICT will review its remit and membership t becme the Recvery Wrking Grup (RWG). The RWG will need t cnsider a wide range f issues as determined by the circumstances at the time but these will include thse set ut belw. 6.1 KEY ACTIONS 1. Surveillance, Testing, Diagnsis and Treatment 2. Preventin and Prtectin Public Health (HPT and HPU) will be respnsible fr maintaining surveillance. ICT will maintain apprpriate enhanced infectin cntrl prcedures. HPT will ensure cmpletin f vaccinatin prgramme. 3. Service Planning and Cntinuity OHS will be respnsible fr ensuring the care and well-being f staff affected by the pandemic. Wrkfrce Directrate will be respnsible fr identifying and respnding t lnger term wrkfrce planning issues. Heads f Service will be respnsible fr addressing service backlg issues including estates and facilities management. Finance Directrate will be respnsible fr identifying and reslving issues f exceptinal spend. 4. Cmmunicatin Cmmunicatins Department will be respnsible fr c-rdinating the cmmunicatin f recvery and debriefing activities bth internal and external. Cmmunicatins will als assist in crdinating the prductin f a frmal lessns learnt reprt infrmed by the debriefing. The nly current versin f this plan is n the intranet Page 32 f 58

33 Further guidance n the key actins at Recvery Phase under these fur headings is set ut belw. 6.2 SURVEILLANCE, TESTING, DIAGNOSIS AND REPORTING A heightened level f vigilance will need t be maintained t allw fr early warning f a secnd wave f a pandemic in the cming mnths. Guidance will be issued at natinal level and this will be apprpriately disseminated and implemented lcally. 6.3 PREVENTION AND PROTECTION Maintaining increased vigilance will entail maintenance and early implementatin f enhanced infectin cntrl precautins in healthcare settings in the event f admissins with influenza like illness. The ICT will be respnsible fr advising n this aspect f the recvery phase. The HPT will be respnsible fr ensuring any vaccinatin prgramme is cmpleted and ensuring that uptake f seasnal flu vaccinatin in the fllwing seasn is maximised. 6.4 SERVICE PLANNING AND CONTINUITY In the recvery phase it will be imprtant t ensure that staff are able t return t nrmal patterns f wrking and are encuraged, as service demands allw, t take time ff fr rest and relaxatin. In relatin t wrkfrce planning it will be imprtant t assess the impact f the pandemic acrss the rganisatin. Staff may be suffering frm stress and fatigue. Sme will have suffered bereavement. Particularly in a high impact scenari there will als be cases f severe illness, lng term sickness absence and even deaths amngst the wrkfrce. The OHS and Wrkfrce Directrate will have an imprtant rle t play in caring fr staff affected and planning fr recvery. The RWG will need t address a wide range f service issues. These will include establishing a sustainable plan t recver levels f service acrss the rganisatin and address any backlg r waiting lists in key services. There will als be a need t plan t address any backlg in maintenance f equipment and facilities, recver levels f stcks and supplies and address any budget and financial issues arising frm exceptinal spend required in particular areas. 6.5 COMMUNICATION The RWG will need t address a range f cmmunicatin issues in the recvery phase. It will be imprtant that recvery actins are widely cmmunicated t staff, partner agencies and the public in rder t instil The nly current versin f this plan is n the intranet Page 33 f 58

34 cnfidence and a sense f return t nrmality acrss the cmmunity. There will need t be plans put in place fr debriefing activities. These will need t include all staff invlved but als any vlunteers and ther service prviders. The wider public cmmunity shuld als be prvided with an pprtunity t share experiences and feedback. Depending n the circumstances f a pandemic it may be apprpriate t cnsider memrial activities t acknwledge lsses within the cmmunity r rganisatin. Debriefing activities will need t be sensitive t the circumstances f the pandemic. It may be an pprtunity t celebrate successes in any respnse as well as t acknwledge difficulties. An imprtant aspect f the recvery phase will be t capture all the lessns learnt in a mre frmal reprt that can be shared bth lcally and at natinal level. This will allw fr plans and strategies t be revised and updated. 7. PLAN MONITORING AND IMPLEMENTATION 7.1 DOCUMENT AMENDMENT HISTORY Reviews Date Plan Reviewed March 2012 Next Review Date April 2013 Authr Lucy Denvir Dr Dave Breen Summary f review: The Plan has been extensively revised fllwing wide stakehlder invlvement and cnsultatin and taking int accunt the new UK Influenza Pandemic Preparedness Strategy 2011 and lessns learnt frm H1N1 pandemic Review Grup and Apprval : This Plan was reviewed by the PICC in cnsultatin with the key stakehlders and apprved by the SCG. Amendments Plan / Sectin Date By Whm Summary f Amendment 7.2 DISTRIBUTION This Plan is disseminated thrugh NHS Dumfries and Gallway Intranet as part f the Infectin Cntrl Manual and the Majr Emergency Scheme. This will be the nly place fr access t the mst current and updated versin. The nly current versin f this plan is n the intranet Page 34 f 58

35 7.3 ASSOCIATED DOCUMENTS UK Departments f Health Influenza Pandemic Preparedness Strategy gitalasset/dh_ pdf Department f Health/Health Prtectin Agency: Pandemic Influenza - guidance fr infectin cntrl in hspitals and primary care settings Watt Grup Outbreak Risk Matrix Hspital Infectin Incident Assessment Tl British Thracic Sciety / British Infectin Sciety / Health Prtectin Agency: Clinical guidelines fr patients with an influenza-like illness during an influenza pandemic Department f Health Scientific Summary f Pandemic Influenza and its Mitigatin gitalasset/dh_ pdf ). Further infrmatin can be fund at: Further infrmatin n the D&G Majr Emergency Scheme can be fund at: EDUCATION AND TRAINING Recrd f Previus Training Date Event Descriptin N. Invlved December 2005 Exercise Fever Pitch 100+ December 2007 Exercise Arctic Mnkey 60+ April 2008 Smallpx Mass Vaccinatin Exercise 40+ March 2009 Exercise Quintana R 100+ September 2009 H1N1 Preparedness Tabletp Exercise 10+ June 2011 Exercise LEMA Mass Fatality Tabletp Exercise 30+ The nly current versin f this plan is n the intranet Page 35 f 58

36 Future Training Fllwing apprval this revised plan will be published n the intranet and there will be stakehlder briefings t relevant agencies, departments and staff grups as apprpriate and required. Future Exercises The SCG exercise and training sub-grup will ensure that exercises invlving pandemic flu, and ther scenaris related t cmmunicable disease utbreaks and mass vaccinatin, cntinue t be part f the rlling emergency exercise prgramme. The nly current versin f this plan is n the intranet Page 36 f 58

37 APPENDIX 1: PICT MODEL AGENDA 1 Ntes f Previus Meeting 2 Epidemilgy f Pandemic (Update) and review f Risk Assessment 3 Issues Raised frm SCG 4 Management f Influenza Cases (a) investigatin (b) diagnsis (c) treatment (d) referral (e) ITU/HDU requirements (f) artificial ventilatin facilities 5 Other Clinical Management Issues 6 Bed Management issues 7 Infectin Cntrl 8 Labratry issues 9 Anti-viral distributin and administratin 10 Vaccinatin distributin and administratin 11 Staffing Issues: review and impact cntingency staffing arrangements staff redeplyment 12 Supprt Services Issues 13 Priritisatin f Services 14 Cmmunicatins 15 Reprt t SCG 16 AOCB 17 Date and Time f Next Meeting The nly current versin f this plan is n the intranet Page 37 f 58

38 APPENDIX 2: PROJECTED FIGURES FOR LOW, MODERATE AND HIGH IMPACT SCENARIOS IN DUMFRIES AND GALLOWAY Impact f Pandemic Flu n NHS Dumfries & Gallway general ppulatin. Applying duble the incidence f 1918 pandemic, and higher hspitalisatin and mrtality rates. Dumfries & Regin: Gallway CHP Ppulatin CHI Dec 2011: 155,370 Ttal GPs (@ Oct 2011): 123 Level Clinical Attack Rate: Flu cases seeking cnsultatin w. GP: GP Staff Absence: Hspitalisatin Rate: Mrtality Rate: Lw 10% 5% 10% 0.5% 0.50% Medium 25% 15% 25% 1.5% 1.25% High 50% 30% 50% 3.0% 2.50% HIGH Weekly % f cases in pandemic wave New Clinical Cases Cnsultatins Cnsultatins per GP Excess hspitalisatins Excess deaths Week 1 0.1% Week 2 0.2% Week 3 0.8% Week 4 3.1% 2, Week % 8,214 2, Week % 16,740 5, Week % 16,430 4, Week % 11,082 3, Week 9 9.7% 7,518 2, Week % 5,812 1, Week % 4,030 1, Week % 2, Week % 1, Week % Week % Ttal 100% 77,575 23, ,327 1,939 The nly current versin f this plan is n the intranet Page 38 f 58

39 MED Weekly % f cases in pandemic wave New Clinical Cases Cnsultatins Cnsultatins per GP Excess hspitalisatins Excess deaths Week 1 0.1% Week 2 0.2% Week 3 0.8% Week 4 3.1% 1, Week % 4, Week % 8,370 1, Week % 8,215 1, Week % 5, Week 9 9.7% 3, Week % 2, Week % 2, Week % 1, Week % Week % Week % Ttal 100% 38,788 5, The nly current versin f this plan is n the intranet Page 39 f 58

40 LOW Weekly % f cases in pandemic wave New Clinical Cases Cnsultatins Cnsultatins per GP Excess hspitalisatins Excess deaths Week 1 0.1% Week 2 0.2% Week 3 0.8% Week 4 3.1% Week % 1, Week % 3, Week % 3, Week % 2, Week 9 9.7% 1, Week % 1, Week % Week % Week % Week % Week % Ttal 100% 15, The nly current versin f this plan is n the intranet Page 40 f 58

41 APPENDIX 3: WHO PANDEMIC ALERT SYSTEM Phase 1: N viruses circulating amng animals have been reprted t cause infectins in humans. Phase 2: An animal influenza virus circulating amng dmesticated r wild animals is knwn t have caused infectin in humans, and is therefre cnsidered a ptential pandemic threat. Phase 3: An animal r human-animal influenza reassrtant virus (a cmbinatin f at least tw ther viruses) has caused spradic cases r small clusters f disease in peple, but there haven t been cmmunity-level utbreaks. This limited transmissin means that the virus is nt currently spreading easily enugh amng humans t cause a pandemic. Phase 4: A reassrtant virus is causing cmmunity-level utbreaks, meaning there are sustained disease utbreaks in a cmmunity. This marks a significant upwards shift in the risk fr a pandemic. Hwever, a pandemic isn t necessarily a frgne cnclusin. Phase 5: There is human-t-human spread f the virus int at least tw cuntries in ne WHO regin. Mst cuntries aren t affected at this stage, but declaratin f Phase 5 is a strng signal that a pandemic is imminent. There is little time remaining t finish the rganizatin, cmmunicatin and implementatin f the planned mitigatin measures. Phase 6: In additin t the cuntries affected in Phase 5, there are cmmunity-level utbreaks in at least ne ther cuntry in a different WHO regin. A glbal pandemic is ccurring. The nly current versin f this plan is n the intranet Page 41 f 58

42 APPENDIX 4: NOT PROTECTIVELY MARKED MINIMUM CORE DATASET Please nte this dataset is likely t be mdified accrding t the specific nature f the pandemic. Ntificatin f Suspected Pandemic Influenza Case FORM 1 Patient CHI: Patient D.O.B: Details f staff member cmpleting frm: Centre f wrk: Staff Grup: GP (Which practice/pharmacy/hspital etc?) Pharmacy Cmm. Nursing/H.V. A&E/OOH Hspital Scial Services Other: Patient Details: Date: Time: Name: Address: Full Pstcde: Phne: GP: Please fllw algrithm Symptms: Fever If >38 C <2 days Antiviral given? YES NO + 2 f: Cugh Anrexia (ff fd) Malaise (unwell/exhausted) Cryza (head cld symptms) Chills (cld, shivery) Myalgia (muscle aches/pains) Headache Sre thrat = Influenza-Like Illness (ILI) YES NO stp algrithm (g t Outcme field, ver) The nly current versin f this plan is n the intranet Page 42 f 58