CSA Roundtable: What worked, what didn't during H1N1

Resulting White Paper Shares Insights Into Current Pandemic Preparedness Measures In Canada And What More Should Be Done

TORONTO, June 8 /CNW/ - How did Canada fare during the H1N1 influenza pandemic? What plans worked and what didn't - and why not? What more needs to be done given the threat of future, potentially more serious pandemics? These were some of the questions CSA Standards (CSA) sought to answer when hosting a national Roundtable on Healthcare and Emergency Service Sector Pandemic Preparedness. A comprehensive white paper from the roundtable was released today at the World Conference on Disaster Management.

Roundtable participants concluded that the 2006 Canadian Pandemic Influenza Plan (with updates since) was a positive step toward mitigating serious illness and deaths during the mild H1N1 influenza pandemic outbreak. However, CSA roundtable participants also concluded there were some gaps and inconsistencies in protection during the 2009 H1N1 influenza pandemic, and changes to existing pandemic plans now need to be made in the event of future more moderate or severe influenza pandemics. Roundtable participants included senior representatives from Canada's healthcare and emergency service sectors such as infectious disease, family medicine, first responders, nursing, and hospital/healthcare administration.

"The mildness of the H1N1 pandemic may have given Canadians a false sense of security about the potential devastating impact of future pandemics," said Dr. Allan Holmes, CSA roundtable moderator and pandemic planning expert. "CSA Roundtable participants were unanimous in stressing that 2009 should not be used as the new yardstick for future pandemic preparedness planning. We must remain vigilant in ensuring our pandemic plans continue to evolve as the threat of a more moderate or severe pandemic is always a possibility."

Voices From the H1N1 Pandemic Front Lines: A White Paper on How Canada Could Do Better Next Time, the resulting CSA roundtable white paper released today, outlines constructive recommendations on how Canada's healthcare and emergency service sectors can work more in collaboration with governments and other key decision-makers to improve influenza pandemic preparedness plans going forward. The white paper reinforces that many things went right during the recent H1N1 influenza pandemic but although there were successes, there were also challenges that must be addressed.

"CSA has been involved in the emergency management and healthcare fields for years and we're all about developing standards-based solutions to help protect the health and safety of people," said Doug Morton, director of health and safety, CSA. "Because of the H1N1, we wanted to contribute to the discussion on influenza pandemic preparedness in Canada and hope this white paper will act as a catalyst for improved preparation to protect us from future pandemics. We also thought the timing was perfect in light of the new Federal Emergency Response Plan that is designed to coordinate the federal emergency response efforts for any kind of disaster."

    More Steps to Achieving Protection


CSA roundtable participants felt the Canadian Pandemic Influenza Plan was useful in providing a broad resource for decision-makers, however there were multiple pandemic preparedness plans during the 2009 H1N1 pandemic - federal, provincial, regional, local, institutional and international - and this patchwork system of protection caused tremendous confusion among front-line workers, resulting in an uneven delivery of care. Roundtable participants called for the harmonization of federal and provincial frameworks to create a single pan-Canadian standard approach for pandemic preparedness planning, while preserving flexibility for local level implementation.


In addition, roundtable participants felt the Canadian Influenza Pandemic Plan recognized that unknown factors such as the severity of the illness caused by the pandemic strain and the transmissibility of the virus from person-to-person would impact response measures. But the plan lacked both a severity index for infections and implementation triggers (events or milestones in the epidemic or pandemic process that signal a qualitative change in the situation - such as an elevated and sustained rate of absenteeism in the schools). The severity index and the implementation triggers would better help guide decision-making by provincial and local authorities.

    Personal Protective Equipment and Antivirals

Roundtable participants also felt that influenza pandemic plans must take a multi-faceted approach to protection - including offering protective tactics between: preventing the spread of disease through hand-washing, sneezing into sleeves instead of hands, and staying home if ill; and immunization through a vaccine.

Given that it takes approximately six months to develop a vaccine once the virus is identified, as was the case with the H1N1, roundtable participants felt strongly that more emphasis needs to be put on access to personal protective equipment (such as specialized masks, gowns, and gloves) and antivirals (medications that work by interfering with the ability of the virus to reproduce in the body).

Why both? Because despite the benefits, protective equipment is not foolproof and cannot be solely relied upon before a vaccine is available. Its use requires proper training and fitting, and not all healthcare workers and first responders can be realistically outfitted. Roundtable participants therefore, felt that antivirals were particularly important in the event of a moderate or severe pandemic, and should be available not just for treatment, but also for prophylaxis (prevention). The existing plan does not address pre-exposure prophylaxis for healthcare workers and first responders, no matter how severe the influenza pandemic, and prior to a vaccine being made available. Roundtable participants felt clear guidelines for the preventative use of antivirals - including the identification of "triggers" that would activate the deployment of antiviral stockpiles - are needed.


In addition, CSA roundtable participants identified there was much confusion during the H1N1 about who met the criteria for "priority" access to the vaccine, and who did not. They felt that when healthcare workers and first responders are expected to be on the front lines during an influenza outbreak, they should both be categorized as priority groups. Not only are they at higher risk of getting sick, but the nature of their jobs means they are efficient "spreaders" of disease in the community should they fall ill.


And lastly, CSA roundtable participants felt there is a need for communication improvements among all levels of government, healthcare organizations and the general public, and recommended the creation of an integrated federal/provincial/territorial communications body comprised of medical officers and disaster management experts. This integrated body would enable the various jurisdictions to interpret events unfolding in real-time, to ensure communications is relevant to their region, and to provide "bottom-up" feedback to high-level officials.

In addition, roundtable participants recommended a primary care and emergency service communication network be established to reach those on the frontlines working outside hospital settings (e.g., family physicians, those working in walk-in clinics, home-care and long-term care settings, and first responders).

    About the CSA Roundtable and White Paper

On December 15, 2009, CSA hosted the national Roundtable on Healthcare and Emergency Service Sector Pandemic Preparedness that was moderated by Dr. Allan Holmes, a fellowship-trained emergency physician, president of Global Medical Services, and pandemic advisor to federal and provincial governments and corporations across Canada. This one-day roundtable was possible thanks to arms-length support from Hoffmann-La Roche (Roche Canada).

CSA roundtable Participants included representatives from the following organizations: Association of Medical Microbiology and Infectious Disease Canada; Canadian Association of Emergency Physicians; Canadian Healthcare Association; Canadian Nurses Association; Centre for Excellence in Emergency Preparedness, College of Family Physicians of Canada; Hamilton Health Sciences Centre; National Emergency Nurses Affiliation; Ontario Hospital Association; Ottawa Hospital; and Prince George Fire Fighters Union.

The CSA White Paper, Voices From the H1N1 Pandemic Front Lines: A White Paper on How Canada Could Do Better Next Time, is available online at CSA.ca.

    About CSA

CSA Standards is a leading standards-based solutions organization serving industry, government, consumers and other interested parties in North America and the global marketplace. Focusing on standards and codes development, application products, training, advisory and personnel certification services, the organization aims to enhance public safety, improve quality of life, preserve the environment and facilitate trade. CSA Standards is a division of CSA Group, which also consists of CSA International, which provides testing and certification services for electrical, mechanical, plumbing, gas and a variety of other products; and OnSpeX, a provider of consumer product evaluation, inspection and advisory services for retailers and manufacturers. For more information visit www.csa.ca.


For further information: For further information: Anthony Toderian, Manager, Media Relations, CSA Standards, T: (416) 747-2620, E: anthony.toderian@csagroup.org; Nazia Khan, Environics for CSA Standards, T: (416) 969-2781, E: nkhan@environicspr.com

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