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Brock University
A Discussion Paper On Medical Emergency
Response Planning
Created: April 1, 2007
Brock University’s Medical Emergency Response Plan (MERP), an annex to the
University’s Emergency Response Plan, describes the steps the University will
take to respond effectively to a medical emergency. In particular, the MERP
states how our key administrative areas will respond to the effects of a highly
contagious disease such as pandemic influenza that could affect operations over
a period of time longer than that for which the procedures of the more general
Emergency Response Plan are intended.
This Discussion Paper provides the rationale for the detailed action plans to be
followed by each administrative area and serves to inform the University
community about what decisions will be made, and why, in the event of a medical
emergency such as pandemic influenza.
Summary
Brock University’s Medical Emergency Response Plan will be implemented if and
only if The President of the University, or his designate, chooses to declare a
University medical emergency in response to:
(a) The Niagara Region Medical Officer of Health formally identifying a medical
emergency (such as, but not limited to, pandemic influenza) in the Niagara
Region, or
(b) The Brock University Medical Director, upon consulting with the Director of
Clinical Services and with the Niagara Region Chief Medical Officer of Health,
formally advising the President that our campus is experiencing a medical
situation that requires the Medical Emergency Response Plan to be
implemented.
In the absence of a formal declaration of a Medical Emergency, the operations of
the University will continue under the auspices of approved policies and
procedures as exist at a particular time.
The effect of implementing the Medical Emergency Response Plan will be to:
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1.
2.
3.
4.
5.
Suspend immediately all instruction in all courses
Suspend all student extracurricular activities
Suspend immediately all University-Community activities and events
Evacuate immediately University Residences
Suspend immediately all University Committee activity except the Board
Executive Committee and the MERP Crisis Management Group
6. Maintain the University’s research activities within guidelines provided in
the MERP to facilitate social distancing and infectious disease prevention
7. Maintain University operations in other areas as fully as possible based on
plans implemented in each administrative area of responsibility
When the medical emergency has ended, as determined by a formal
pronouncement from the Niagara Region Chief Medical Officer of Health or on
the formal advice of the Brock University Medical Director, the President of the
University, or his designate, shall announce the resumption of all suspended
activities and each area of campus shall, according to its area-specific plan,
restore its operations to normal conditions as quickly as possible.
NOTE: It is the intention of this plan to include both St Catharines and Hamilton
campuses in its purview. Thus, any decision taken to implement the MERP will
have effect at both campuses simultaneously. It is, in theory, possible that a
declaration of a medical emergency could be made by the Chief Medical Officer
of Health responsible for Hamilton without one being made by the Chief Medical
Officer of Health in Niagara, In such circumstances, unlikely though they might
be, it shall be at the President’s discretion whether to close the Hamilton campus
while not closing the St Catharines campus and to determine the constraints on
university activity that typically involve students, staff, and/or faculty who may be
engaged in activities on both campuses during an affected semester.
Why Has The University Created A Medical Emergency
Response Plan (MERP)?
The potential outbreak of influenza on a global scale and the possible
catastrophic consequences of such a pandemic have been very much in the
public eye since 2005. At that time, international health authorities began
expressing concern that a particular virus that infects domestic poultry and
migratory wild fowl had also infected humans who had come in contact with
diseased birds. The strain of virus, known as H5N1 (for the particular
combination of proteins comprising the coat of the virus), was especially virulent
and a very high percentage of those few human cases reported had died. Further
raising concern was the rapid spread of this “bird flu” from its origins in Asia,
through the Middle and Near East, to Europe.
At the time of the approval of our MERP, the virus was not one for which there
existed evidence for transmission from human to human. There had only ever
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been evidence of the virus being transmitted by direct human contact with the
saliva, nasal secretions, or feces of infected birds. If the virus were to mutate to
become one transmissible from human to human, this would result in the
conditions that typically result in a pandemic spread of a disease. This is what
happened in the global influenza epidemics of 1968, 1957, and 1918 (during
which 20 million people died worldwide).
In the event of pandemic influenza, we would be faced with the introduction of a
new and highly contagious virus that causes serious illness or death and for
which the human population has little or no immunity. Of particular importance to
a University community, the current “bird flu” has, like the Spanish flu of 1918,
been especially deadly to young people, potentially including the age group
typically found on our campuses. Highly virulent influenza is dangerous enough:
to find that we might face the prospect of a strain that preferentially attacks those
who make up the vast majority of our community’s population is especially
sobering and provided a powerful impetus to plan accordingly even though there
was no clear and immediate threat of a pandemic at the time our plan was
created.
Influenza pandemics – worldwide outbreaks – have historically arisen about
every 30 years and occur when all four of the following conditions arise:
1. A new influenza A virus appears and the human population has no or little
immunity, resulting in several, simultaneous epidemics worldwide with
enormous numbers of death and illness.
2. Human-to-human transmission happens easily. With the increase in global
transportation and communications, as well as urbanization and
overcrowded conditions, epidemics of a new influenza virus are likely to
spread quickly around the world.
3. The new virus cause serious clinical illness and death. Outbreaks of
influenza in animals, especially when happening simultaneously with
outbreaks in human, increase the chance of a pandemic, through the
merging of animal and human viruses.
4. The population has little or no immunity to the virus. A vaccine will not be
available at the start of the pandemic as the virus will be new.
Strains of influenza vary over the years due to changing protein structure of the
viral coat, making vaccine production difficult. Attack rates have historically been
about 20 - 40%. Of these, about 50% require outpatient care; about 20% require
inpatient care and 1-5 % die. Considering our Brock numbers of approximately
17,000 students, assuming our campus were to be affected as the more general
population considered by those who model outcomes, our worst case scenario
would be over 4000 ill (1000 in residence), at least 2000 students requiring
formal outpatient care from our campus health services or elsewhere, and as
many as 75 students dying. If the attack rate were half the worst case scenario,
that would mean we would have 2000 Brock students’ sick (500 in residence),
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1000 students requiring formal outpatient care, and still as many as 35-40
deaths.
Influenza virus is contagious 24 hours before symptoms. It is spread by droplet
transmission and its droplets can survive 24 –48 hours on hard surfaces, 12
hours on cloth, paper or tissue and 5 minutes on hands. Incubation is 1-3 days.
Influenza patients are contagious for 7 days, beginning one day before the onset
of symptoms. A specific concern with infections such as “bird flu” is that students
with such cases of influenza could become severely ill within one day and many
students live in close proximity to each other in residence settings. This creates
the possibility of rapid spread. Those with influenza virus when already affected
by other medical conditions may be more susceptible to other illnesses.
Many possible medical emergencies could unfold on our campus, run their
courses, and our responses to them would be a single process of limited
duration, not requiring formal and long term intervention such as anticipated in
the MERP. To reiterate, not all emergencies of a medical nature will
necessitate the implementation of this Medical Emergency Response Plan.
However, it is likely that an infectious disease such as a pandemic influenza
would affect us in waves separated by perhaps 6-9 months. Past experience
suggests that the second (or even a third) wave of such influenza would have
greater impact on public health than the first wave. In our planning, we must be
prepared for the medical impact of such a disease to affect the campus across
more than a single academic year. We must be prepared to learn from
experience and adapt to the lessons that earlier waves of a pandemic would
provide.
Why plan in the absence of a certain threat? The potential numbers alone are
compelling reason to do all that we can do to address the potential problem
before it arrives. We found on a much smaller scale with SARS and later with the
devastating effects of Hurricane Katrina on the city of New Orleans (and its
Universities) that the midst of a crisis or emergency is not the time to be planning
what to do in response. The best time to plant a tree is 20 years ago. The second
best time is now. So, we undertook to create a plan well in advance to deal with
circumstances that we hope do not ever come to pass.
On advice from health authorities internationally (World Health Organization), the
Government of Canada (through the Canadian Public Health Agency), the
Government of Ontario (through its Ministry of Health), and the Region of
Niagara (through the Niagara Region Public Health Department), Brock
University has prepared this plan to allow us to respond as effectively as possible
to a medical emergency including, but not limited to, pandemic influenza.
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What Are The Principles Upon Which The Creation And
Implementation Of Brock’s Medical Emergency
Response Plan Are Built?
The foundation of our Plan is an ethical one. In times of crisis or emergency, it is
imperative to have stated principles that guide the decision making of all those
whose task it will be to steer the University through a medical emergency. During
and after the outbreak of Severe Acute Respiratory Syndrome or “SARS” in
Ontario health care facilities in 2003, the University of Toronto Centre For
Bioethics published a document describing the ethical basis for decision-making
in response to a medical emergency. Brock University has adapted and adopted
their guidelines as the basis for its planning process and for the implementation
of the MERP should it become necessary. Our commitment is to adhere to this
ethical base by enshrining it here to assist with decisions that will have to be
made in the event of a medical emergency.
1. Individual Liberty and the Protection of the Public from Harm
In a medical emergency, restrictions to individual liberty may be necessary to
protect members of the University community from serious medical harm.
However, restrictions to individual liberty should be proportional, necessary and
relevant; should employ the least restrictive means possible; and, should be
applied fairly. Decision makers should weigh the imperative for compliance, and
provide reasons with their decisions to encourage compliance.
2. Stewardship and Accountability
Decisions should be made by people who are credible and accountable as
stewards of the University during a time of crisis. This implies that their decisions
are intended to achieve the best health and academic outcomes given the unique
circumstances of a medical emergency. Those authorized to act on behalf of the
University community during a medical emergency must be able to act in
accordance with the authority they have been given. However, there must be a
process to review decisions (in light of the stewardship mission) when
emergency conditions subside and reflection upon our handling of the medical
emergency is possible.
3. Reciprocity and Professional Responsibility
Measures to protect the public good during a medical emergency are likely to
impose a disproportionate professional burden on a small group of key
individuals. It is also understood that those entrusted with such responsibilities
will have to weigh demands of their professional roles against other competing
obligations to their own health, and to family and friends. Reciprocity requires
that the Brock community support those who face these extraordinary burdens in
protecting our health and well being during a medical emergency and take steps
to minimize their burdens as much as possible.
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4. Privacy
Individuals have a right to privacy. In a medical emergency, however, it may be
necessary to override this right to protect the Brock community from serious
harm. Any such decisions will be taken in accordance with all applicable
legislation governing protection of privacy.
5. Equity
All those who are ill have an equal claim to receive the care they need under
normal conditions. However, during a pandemic or other form of medical
emergency on campus, difficult decisions will need to be made about which
services to maintain and which to defer. Depending on the severity of the medical
emergency, this could limit the provision of emergency or necessary services to
some or all of our community.
6. Trust and Transparency
Decisions should be based on reasons (i.e., evidence, principles, and values)
that stakeholders can agree are relevant to meeting our needs in a medical
emergency. Trust is an essential component of the relationships among all
involved in a medical emergency. Decision makers will be confronted with the
challenge of maintaining stakeholder trust while simultaneously implementing
various control measures during an evolving health crisis. Trust is enhanced by
striving for transparency of process in all respects at all times.
7. Solidarity
A medical emergency at our University may require a new vision of solidarity with
others beyond our own campus. A pandemic or other form of medical emergency
can challenge conventional ideas of autonomy, security, or territoriality. This calls
for collaborative approaches that may require us to set aside our self-interest in
order to work with others .
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Modified from original documentation at
http://www.utoronto.ca/jcb/home/news_pandemic.htm
What Preventative Steps Will We Take As Standard
Procedure That Reflect The Concerns Of The Medical
Community With Respect To Infectious Disease?
In the process of planning for a possible medical emergency, it became clear that
as a campus community we could take four important steps that made good
health sense even if there were no possible medical emergency for which to
plan.
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The most effective way to prevent the spread of infectious disease is to
counteract its mode of transmission. Some diseases are vector-borne
(transmitted by carriers such as mosquitoes or rats). Some are air-borne. And
some, like influenza, are droplet-borne. In the case of droplet-borne transmission,
the best precaution we can all take is hand washing. It is the most powerful tool
in our preventative arsenal to stop the spread of diseases such as influenza.
Though it is not strictly speaking a response to a medical emergency, our
planning process resulted in the development of a proactive commitment to
advocate for proper hand washing as a regular feature of everyone’s day on
campus. Accordingly, hand washing stations installed in key locations on campus
were identified as a vital feature of good campus health and a campaign to
encourage their use (and the use of washroom hand washing facilities) will be
launched at the start of each Fall semester of each academic year as part of the
MERP. The responsibility for this campaign will rest annually with the Office of
University Communications working in collaboration with Student Health Services
and Human Resources who will provide content and advice on dissemination for
greatest impact.
Accompanying a vigorous commitment to hand washing is a second strategy that
we know to be effective in preventing the spread of both air-borne and dropletborne infectious disease. When sick, stay home. Since we cannot facilitate the
spread of disease if we do not come in contact with others, staying away from
others when sick with a disease like influenza is not simply a courtesy. It is social
obligation that is often overshadowed by our commitment to our work. Therefore,
as with the campaign to encourage hand washing, at the start of each Fall
semester of each academic year, we will undertake a campaign to encourage
members of the Brock community to do the right thing and stay home when sick.
Third, every member of the Brock community is encouraged to plan ahead
individually for self and family. The steps we can all take to be ready for any
emergency are simple but ones that few of us typically take the time to address.
A medical emergency checklist that we advise everyone to consider seriously as
his or her personal commitment to preparedness is provided as Appendix 1 of
this document.
Fourth, as an educational institution, knowledge is our mission. Accordingly,
given that an issue such as pandemic influenza is one of interest and
importance, it is appropriate that we ensure that members of our campus
community have access to the best and most recent information about
something that has its origins in academic disciplines in which we have expertise
on our campus. Therefore, via both the Health Services (for students) and
Human Resources (for faculty and staff) web home pages, there will always be a
link to www.brocku.ca/pandemicplan that will be a permanent site to visit to learn
about medical emergency issues of relevance and interest to the campus. This
information will be updated regularly and serve to balance the uncertainty and
fear that can arise when speculation and rumour abound. In this document,
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Appendix 2 presents some basic information about influenza that is of value to
everyone in managing his or her health each year during cold and flu season.
How Will We Monitor The Status Of Campus Health?
The impetus for the development of this plan was the growing concern for a
possible outbreak of pandemic influenza. However, this plan also anticipates
other possible medical emergencies not related to pandemic influenza,
particularly other forms of highly contagious infectious disease. A key element of
our plan is to know when to implement it and that means knowing what levels
and kinds of illness we are experiencing at any given time.
To assist the University’s Medical Director in determining whether to advise the
President to declare a medical emergency and to be able to provide Public
Health officials with accurate information about Brock’s medical circumstances,
the University will engage in an ongoing process of monitoring of illness
among the Brock community. This will be done by:
(a) Regular and ongoing monitoring of clinic visits to Campus Health Services by
our Student Health Services staff, and
(b) Regular and ongoing monitoring of information available from academic and
administrative departments about student, staff, and faculty absence due to
illness.
These sources of data will be assessed regularly, and more frequently as needed
in the event of perceived increased levels of illness on campus, by the Director of
Clinical Services who shall be responsible for interpreting the various sources of
information about campus illness levels. Via the Student Health Services and
Human Resources websites, the University community will be informed of any
significant increases in the level of campus illness. This will allow us to remind
the community of our regular preventative measures and to promote healthy
responses to circumstances in which ill health may be more prevalent.
The University, via the Director of Clinical Services, will maintain regular
communication with Regional and Provincial Public Health officials with respect
to rates of illness at Brock and in Niagara and Ontario. This will allow the
University to ensure that its sense of health and illness on campus is credible
and reliable and that a decision to declare a medical emergency, either by the
University’s Medical Director or Niagara Region Public Health officials, is a
responsible and well-informed one.
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Under What Circumstances Would The Medical
Emergency Response Plan Be Implemented?
The University operates on a daily basis with some of its students, staff, and
faculty ill. At times, rates of illness can be high, particularly when we are in what
is typically called “cold and flu season”. It is not the intent of the MERP to be
implemented under such “normal” circumstances. Nor is it the intent of the MERP
to be implemented on a partial basis to address challenging, but not emergency,
medical conditions. Unless a medical emergency is declared formally as
described in our plan, the University will continue to operate under the auspices
of its approved policies and procedures, even with some of its members sick, and
individual areas of administrative and academic responsibility will maintain as
close to usual operations as possible.
A benefit of engaging in the Medical Emergency Planning process is the
awareness that has developed that each area, academic or administrative, must
have a plan for business continuity whether that be in the face of a formally
declared emergency or not. By virtue of our having contemplated the worst case
scenario, we will have come to understand better the need to be prepared to
manage key aspects of the University’s operations under circumstances in which
leadership structures are jeopardized by illness or absence or for other reasons.
Each area on campus, having planned for how it will deal with the kind of Medical
Emergency envisioned in this document, should also have come to understand
more fully who its key people are, how deep the skills needed extend into the
work force of the area, what the key operational elements are for the area, and
how these will be maintained even under major reductions in human resources.
A medical emergency that requires the implementation of our MERP is different
from campus life affected by normal, or even higher than normal, levels of illness.
Rather than attempt to determine what an emergency is in formulaic terms (e.g.,
when illness levels reach a certain percentage of the student population or the
work force), our MERP establishes the following process whereby a medical
emergency is declared, causing the MERP to be implemented:
The President of the University, or delegate if required, may declare a
medical emergency, thus activating our Medical Emergency Response
Plan, if and only if:
(a) The Niagara Region Medical Officer of Health declares a medical emergency
(such as, but not limited to, pandemic influenza) in the Niagara Region, or
(b) The Brock University Medical Director, upon consulting with the Director of
Clinical Services and with the Niagara Region Chief Medical Officer of Health,
advises the President that our campus is experiencing a medical emergency that
requires this plan to be implemented.
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Our plan entrusts those most able to make the right judgment with respect to a
medical emergency to declare formally that an emergency exists and to
implement our plan.
Who Is Responsible For Implementing Our Medical
Emergency Response Plan?
Immediately upon the declaration of a medical emergency by the President or
delegate, the responsibility for the implementation of the Medical Emergency
Response Plan will be assumed by the Crisis Management Group of the
University as defined in the Emergency Management Plan (EMP). This group
shall add as full members, for the purpose of our response to a medical
emergency, the University’s Medical Director and Director of Clinical Services.
Specifically, that group for the purpose of the MERP shall be comprised of:
The President of the University
The Vice-presidents of the University
The University Medical Director
The Director of Clinical Services, Student Health Services
The Associate Vice-President, Student Services
The Executive Director, Human Resources
The Chief Information Officer
The Director, University Communications
The Executive Director, Facilities Management and the Director, Campus
Security, will attend all meetings of the Crisis Management Group as per the
Crisis Management Group regulations defined in the EMP. Other personnel may
be added by the President in an advisory capacity as required.
The Crisis Management Group shall convene for its first meeting in the Sankey
Chamber and determine at that meeting where and on what schedule future
meetings shall be held during a medical emergency.
Will We Close The University If There Is A Medical
Emergency?
There is a remote possibility that the University could be required to close
entirely. However, it is highly unlikely that any medical emergency, including
pandemic influenza, would result in the complete closure of the University. This
means that, even in the event of a formal declaration of pandemic influenza or
other health-related challenge by the University and/or regional health
authorities, we will not be required to abandon the campus completely and
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enforce a complete suspension of all operations. Our Medical Emergency
Response Plan assumes that, however great the challenge might be medically,
the University will remain open and operational in many, though not necessarily
all, of its functions.
The key element of our plan is to enforce “social distancing”, that is, keeping
people away from each other and out of large (and even medium or small)
groups where infectious disease would more rapidly spread. However, though we
will be obliged to take major steps to create the kind of social distancing that
good public health practice demands, it is still not our intention to plan for
complete University closure.
The implication of taking this stance is that many facets of University operations
would continue, at least at a maintenance level, even amidst a formally declared
medical emergency.
What Will Happen To Teaching and Learning During A
Medical Emergency?
If the University declares a medical emergency, thus implementing the MERP,
there will be an immediate suspension of all instruction in all courses,
undergraduate and graduate. All classes of all kinds (including, lectures,
seminars, labs, workshops, lab meetings for teaching purposes) will be
suspended for the duration of the declared medical emergency. All forms of
assessment, including examinations and submission of essays or projects, are
included in this suspension of activity.
This is a very difficult step for a University to take. Teaching and learning are our
core activities and a primary raison d’etre for any postsecondary institution.
However, having established that our primary concern in this plan is the
protection of the health of our community members, the need to prevent the
spread of infectious disease must take precedence over our academic mission.
The suspension of all instruction applies to all instructors and all students in all
courses. While it might be desirable to attempt to continue instruction using
alternative methods during a medical emergency, such methods would not be
available to all students. If circumstances are sufficiently grave to warrant the
declaration of a medical emergency, it is our belief that in terms of equity and
clarity, it is preferable that we all pull together in a unified response and then
adapt accordingly after the fact as a community rather than attempting piecemeal
solutions that differ, during and after the medical emergency, in their processes,
results, and implications.
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How Will Students Be Affected Academically By A
Suspension Of Instruction During A Medical
Emergency?
The Senate of the University has established 12 weeks, or 36 hours, as the
minimum amount of formal instruction that a student should undertake in order to
be eligible to receive a semester-course academic credit. These required hours
may, in fact, be more in some courses that have laboratories, workshops,
studios, or seminars in addition to three hours of lecture. Whatever the amount of
instructional and assessment time required under normal circumstances, if we
declare a medical emergency, for example under conditions of pandemic
influenza, it will be the case that considerable instructional time may be lost and
that normal assessment procedures (including a normal final examination period)
will be significantly affected.
It is impossible to prepare a precise plan for every possible contingency for a
medical emergency such as pandemic influenza. We cannot know in advance
how many waves of the pandemic might strike Niagara and Brock. We cannot
know how long each wave will last. However, we can state the principles on
which we will base our response to the need to suspend instruction.
1. Fall and Winter semester courses have priority over all other scheduled
activities on campus. All other demands on university physical resources
(such as classrooms, labs, recreational facilities, and residences) will have
lower priority in the aftermath of a medical emergency than the need to
assign time and space to instruction needed to complete as fully as
possible Fall and Winter courses. This means that Spring and Summer
courses will be scheduled only when Fall and Winter semester needs
have been accommodated. It means also that conferences and
community events (e.g., those that typically dominate the summer scene
on campus) will be held only if time and space is available once Fall and
Winter semester course completion needs have been met.
2. The President of the University, acting with the advice of the Vicepresident Academic, the Deans, and the Senate, will determine when
sufficient instruction and assessment time has been provided to declare
that students shall be awarded credits for which they enrolled in a
semester suspended by a medical emergency.
What Will Happen To Students Living In Residence
During A Medical Emergency?
If the University declares a medical emergency, thus implementing the MERP,
we will take immediate steps to suspend our residence operations and require
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students living in residence to leave the campus within 48 hours until such time
as the declaration of the medical emergency is rescinded. The contractual
arrangements made by the University with student residents will reflect the
possibility of this occurring and Residence Services will communicate its
evacuation plans clearly in its orientation program each year.
While the University will not be responsible for the cost of students who are
required to leave the campus, Residence Services will provide assistance and
support in this, including:
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Advising on travel arrangements for students requiring assistance
Providing standard move-out assistance as would normally occur at
the end of the Winter term each year
Collaborating with Student Health Services to provide temporary care
in cases where a student may be too ill to travel immediately
Collaborating with Brock International to provide assistance to
international students whose circumstances may not allow them to
leave Canada and return home for the duration of the medical
emergency
Collaborating with Counseling Services and other relevant areas within
Student Services where necessary to provide assistance to other
students whose circumstances may not allow them to return home for
the duration of the medical emergency
It is possible that the University will need to maintain a small ongoing residence
operation for at least part of a formally declared Medical Emergency. This will
require careful collaboration among Residence Services, Food Services, and
Facilities Management to allow for those who might not be able to depart from
the campus within the 48-hour period envisioned in the MERP. Each of these
areas’ plans will reflect this collaboration.
In the case of pandemic influenza, the University will likely be one of a number of
designated “Flu Centre” sites for the Niagara Region and that makes our duty of
care considerably simpler than if we were to be responsible for our students
ourselves. The resources for such Flu Centres would be provided by the Region,
including health care staff. In the event of a declared medical emergency and
the subsequent evacuation of residences, students who might have already
become too ill to travel would be cared for on campus in its capacity as a Flu
Centre until such time as they were healthy enough to be released.
Nevertheless, the University must still plan for the maintenance of a small
residential facility for students released after treatment and others not able to
travel immediately in the event of a residence evacuation.
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What Will Happen To Student Extracurricular Activities
During A Medical Emergency?
In the event of a medical emergency being declared and the MERP being
implemented, all student extracurricular activities shall be suspended
immediately. This includes intercollegiate athletics, including competitions
hosting Brock athletes at other campuses; campus recreation; any activities
taking place in The Zone and the University Aquatics Centre, as examples, which
shall be closed until the end of the medical emergency; and any other student
activities that require groups to congregate on or off campus under the auspices
of the University.
What Will Happen To Scholarly Research During A
Medical Emergency?
Each researcher will decide if and how he or she will continue to engage in
scholarly activity during a declared medical emergency. However, each member
of the research community must adhere to the requirements governing the
maintenance of research activity on campus as follows.
1. It is highly desirable that faculty research continue as normally as
possible. Where faculty research is primarily an individual enterprise and
not dependent upon specialized University facilities, faculty should work
from off campus as much as possible and minimize time spent on campus
in contact with others.
2. Where faculty research, either individually or in teams, depends upon
specialized University facilities such as laboratories, library, animal care
facilities, or on-campus information technology resources, faculty should
attempt to limit their time spent on campus as much as possible,
recognizing that they will wish to avoid the loss of any time- or
environment-sensitive research enterprises (e.g., biological cultures,
experiments already in progress whose successful completion requires
the maintenance of a previously organized schedule). Faculty conducting
such research and intending to be on campus must inform the Associate
Vice-president Research in writing of their intentions, with copy to the
Dean of the relevant Faculty, explaining the nature of the research that
requires an on-campus presence, and providing an estimate of the
amount of time on campus that is needed to ensure that research in
progress is not lost. The possibility of continuing research in University
facilities assumes safe operating conditions. If these are not present, as
determined by the Associate Vice-president Research in consultation with
the Executive Director of Facilities Management and the Dean of the
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3.
4.
5.
6.
relevant Faculty, even the most important research will have to be
suspended.
The University is home to a broad range of sensitive and expensive
research equipment that requires regular attention if it is to remain
functional. Each researcher, in his or her laboratory environment, will be
responsible for determining whether or not equipment can be maintained
operational or whether, in the face of uncertain working conditions, should
be shut down according to standard operating procedures. Where
research equipment is not the sole responsibility of a single person, user
groups must decide who will take responsibility for such shut down
procedures and take action accordingly. Such decisions must be made
locally by those most able to make them. Where indecision occurs,
Department Chairs and, if necessary, the Dean of the Faculty shall be
responsible for ensuring that the University’s equipment resource is
managed effectively during a Medical Emergency.
The University’s Animal Care Facility is a unique environment with
considerable duty of care as per federal regulations and Brock policies
and procedures. In the event of a Medical Emergency, there must be
provision made for the continuing ethical treatment of all animals under
our care. The University’s Animal Care Committee must have a plan in
place to provide care to animals in its facility in the event that those
normally responsible are unable to work due to illness.
Graduate students, like faculty, often have research projects that should, if
at all possible, be maintained. Therefore, if they choose to do so,
graduates students may attempt to maintain thesis-related research where
possible but do so in a way that minimizes even small groups from
working together in confined laboratory or other research spaces. While
graduate students may, like faculty, attempt to maintain their research
programs under the terms of the Medical Emergency Response Plan,
graduate courses may not continue formally or informally during the
declaration of a medical emergency. Also, while some individual research
activities many continue, research team meetings, workshops, and
gatherings even in small groups that are not vital to the maintenance of a
particular research project must be discontinued for the duration of the
declared emergency. Undergraduate students will not be permitted to be
involved in on-campus research during any period in which instruction has
been suspended since the primary goal is to limit the number of people on
campus and to prevent interactions that might facilitate the spreading of
infectious disease.
When either an internal or external declaration of a medical emergency
(such as pandemic influenza) is made, faculty must postpone immediately
all on-campus human subjects research until such time as the declaration
is rescinded. With the permission of the Vice-president Academic, human
subjects research that takes place in field conditions off campus may be
allowed to continue as long as that research does not take place in an
area in which there has been a declaration of a medical emergency (such
16
as pandemic influenza). For example, if the entire Niagara Region were to
be declared by Niagara Region Public Health as an area in which there
was pandemic influenza, no human subjects research would be permitted
anywhere in the Niagara Region. However, faculty conducting human
subjects research farther afield (perhaps out of the country) where no
such medical emergency exists, would be allowed to pursue those
research activities.
How Will Our Administrative Operations Continue
During A Medical Emergency?
The details of how each administrative and academic area of responsibility will
manage at least maintenance levels of operation are specified in specific
Appendices of the Medical Emergency Response Plan. Each of these plans
adheres to these principles:
1. All meetings of University committees, formal or informal, will be
postponed immediately in the event of an internal or external declaration
of a medical emergency. This includes all meetings, however small, that
require visitors from off campus to come to campus. The only exceptions
to this are the convening of the senior management team, chaired by the
President of the University, to administer the Medical Emergency
Response Plan and the Executive Committee of the Board of Trustees.
2. The first priority of this plan is to safeguard the health of individual
members of our University community. Therefore, it is desirable in each
area of administrative responsibility to maintain operations as fully as
possible but only in ways that emphasize during a declared medical
emergency social distancing and other effective public health practices.
3. Where possible, administrative areas should have methods to maintain
essential operations from off campus locations. A University is a
community and it is not in any way desirable to have the members of that
community dispersed and unable to interact in the usual way that a
collegial and collaborative organization works best. Therefore, these
dispersed operations are not intended in any way to be normal practices
but rather to serve the University’s needs only during a declared medical
emergency.
4. The University remains committed at all times to providing a safe place to
work for all its staff and faculty. The declaration of a medical emergency,
such as pandemic influenza, does not, a priori, mean that the University
has become an unsafe place to work. However, it does mean that the
University must become a place of even higher vigilance around sound
public health practices and even greater commitment to information to all
who will be on campus during the declared emergency.
17
How Will We Communicate With Each Other During A
Medical Emergency?
Daily communication, both within the University and with community members
and partners outside the University, is an essential component of the MERP. To
that end, our entire current communications strategy assumes that externally
provided telecommunications services will remain intact on a day by day basis.
We assume we can rely on standard landline and cell phone networks to provide
us with access to each other and to agencies outside the University. Similarly, we
assume that externally provided internet infrastructure will be available to which
our own servers can connect to provide access to the world at large to send and
receive e-mail and to access public health websites for up to date information.
If these assumptions can be extended into a period of prolonged Medical
Emergency, Information Technology Services will, through its plan, provide
sufficient redundancy in its provision for external connectivity that at least
emergency communications via one provider or another will be maintained at all
times. Included in our communications plan is the adoption of a Blackberry
strategy that will link all of the University’s senior administrators to each other
and to all other Blackberry users worldwide. This particular form of wireless
connectivity will provide a layer of information sharing internally and externally
that will complement standard telephone, e-mail, and web services. The greater
the redundancy in our planning, the greater the likelihood that something at least
resembling normal electronic communications will be possible. Under such
conditions, during a medical emergency, the role of the Manager,
Telecommunications and Network Services will be a key one. Information
Technology Services will ensure in its staffing plan for a medical emergency that
this role will be continuously filled.
In the event of a breakdown in telecommunications systems internally or
externally, or both – a scenario taken seriously by those engaged in Pandemic
Planning – the Crisis Management Team must have a pre-arranged way of
communicating that does not rely on electronic systems. This will inevitably
require face to face meetings and must be set up ahead of time and used
accordingly if the time arises when it is necessary. Similarly, the Office of
University Communications, as part of its area plan, must have a pre-arranged
way of gathering and disseminating information as effectively as possible and ,
particularly, communicating with Public Health authorities on at least a daily
basis.
How Will We Maintain The Physical Resources Of The
18
University During A Medical Emergency?
There is considerable cross training with the current Maintenance and
Operations Staff in Facilities Management, supplemented by lead hands. This
would ensure that day to day supervision could continue in the event of a medical
emergency. Items not considered to be day to day requirements would continue
as possible on a reduced-service basis to allow the focus to be on vital, day to
day operations.
With respect to trades, basic levels of service would be maintained during
staffing shortfalls as long as at least half of the normal staff were available to
work. In some key areas (e.g., control mechanics and refrigeration) staffing levels
are low to begin with so illness in these areas might require supplementation
from outside contractors in order to meet even basis service provision
requirements. Depending on the time of year, certain priorities would have to be
set for safety reasons (e.g., snow plowing in winter). Also, fire safety could
become a critical issue if maintenance became compromised and so resources
would have to be devoted as needed to meet the expectations of the University’s
Fire Plan (e.g., inspection protocols).
What Health Care Services Will Be Available During A
Medical Emergency?
Student Health Services (SHS) already has considerable experience in planning
and implementing a strategy to manage seasonal influenza outbreaks on
campus. This strategy will be expanded in the event of a medical emergency
involving highly contagious infectious disease such as pandemic influenza.
SHS is staffed with many part time staff who have other health related jobs (e.g.,
hospital nurses in critical care). In the case of pandemic influenza, our SHS could
be operating with 30–50 % fewer staff while trying to handle three to four times
the patient load. To combat this primary care challenge, SHS’s plan includes
provision to gain access to those with various health care skill levels who could
contribute to primary care (e.g., Nursing students). Also, SHS will integrate their
operations with the community medical care sites according to provincial
protocols available at the time of a medical emergency. SHS has a good working
relationship with the Niagara Regional Public Health Department as well as the
Niagara Health System and will be in daily contact with these two health care
systems to optimize collective local resources. Maintaining these relationships is
imperative and the University should strive at all times through all of its relevant
officers to ensure the communication regionally is strong and clear.
Student Health Services will modify their procedures during a medical emergency
to ensure optimal care. Waiting room procedures will provide:
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Signage on the door prominently directing students to STOP and
complete their medical information
A hand washing station at the entrance
Kleenex in waiting area and receptacles for their disposal
An area for triage if that becomes necessary
Masks for incoming students
SHS will require patients to provide medical information to assist staff in
identifying influenza-like illness (ILI). Administrative staff will check each patient’s
information and if two or more of the criteria are present in the self report, then
staff will follow the administrative protocol for ILI patients as determined at the
time of the medical emergency by provincial government policy.
SHS is committed to providing medical assessment and education to as many
patients per day as possible. However, they will be limited in their ability to
handle patients requiring further treatment such as IV fluids, oxygen, and
antibiotics. Protocols have been prepared for increasing numbers of ILI patients
presenting to SHS daily. The maximum capacity for such patients would be 15
per day. These protocols are based on droplet precautions, separating ILI and
non ILI patients, appropriate triage, flexibility on operations, selective cancellation
of non essential bookings, protection of medical and administrative staff, use of
ancillary facilities, and recruitment of extra personnel. Significant numbers of
additional people whose level of duties would be based on skills sets, (e.g.,
monitoring of sick patients and residence students: education: preparing self-care
packages: computer help) will be needed and SHS will collaborate with the
Department of Nursing and other units in the Faculty of Applied Health Sciences
to help to fill this need. SHS will also seek out other university responders as
needed.
It is expected that SHS will need to redirect many of their mental health patients
to alternate care (e.g., student counseling).
Due to the magnitude of a medical emergency such as pandemic influenza, care
provided by the medical system outside the University will be primarily home
based care. Therefore, students will be expected to seek care from their family
physicians in their home locations. The evacuation of residences will further
emphasize this approach. For any students requiring care on campus during a
state of medical emergency, SHS will coordinate monitoring and care of these
students in collaboration with other campus services (e.g., Residence and Food
Services).
How Will We Restore Operations When An End To A
Medical Emergency Is Declared?
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There will come a time when the severity of the medical emergency and the
danger posed to the public health of the Brock community will diminish and the
Crisis Management Group will be able to consider a restoration of normal
University life. At that time, upon a pronouncement from the Niagara Region
Chief Medical Officer of Health or on the advice of the Brock University Medical
Director, the President of the University shall announce the resumption of all
suspended activities and each area of campus shall, according to its areaspecific plan, restore its operations to normal conditions as quickly as possible.
This announcement will be transmitted to members of the University community
in as many ways as possible, including an announcement on the University
website home page, a broad based media campaign, and by collaborative efforts
in each area of administrative responsibility to ensure that all members of the
Brock Community are made aware of the change in status of the campus.
There are few upsides to managing through a medical emergency. However, in
the case of an emergency such as pandemic influenza, one thing will be our
advantage. From the time of a formal declaration of a medical emergency, we will
have time, perhaps 6-12 weeks, to refine our strategy for re-opening the
University and restoring operations fully. Much of how we do this will depend on
the time of year and the severity of disruption from which we will have to recover.
It is not that our plan is to avoid up-front responsibility for being ready. It is that
we recognize the opportunity that the emergency itself will offer to think carefully
and with the fullness of all available information to make good decisions that we
cannot make in advance.
How Will We Ensure That We Stay Ready For A Medical
Emergency?
The Medical Emergency Response Planning process is an ongoing aspect of the
University’s administrative readiness to respond to circumstances that could
have a negative impact on our academic mission. It is necessary for the
University to ensure that is stands ready at all times to take action as needed.
The plan, therefore, addresses key elements that, taken collectively, describe our
state of readiness to mitigate the negative effects on our academic mission by a
medical emergency.
Since there is always the possibility of a medical emergency disrupting our
campus, quite apart from the recent focus on pandemic influenza, our plan
includes provision that, each year, the Senior Administrative Council will review
the Medical Emergency Response Plan and determine if it remains effectively in
place and ready for implementation.
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SAC will also communicate each year with the person responsible for each area
of responsibility for which an area-specific appendix is included in the Plan and
require that each area confirm that their area-specific plan remains functional.
As a guideline for this annual review, each area of responsibility will use the
following evaluative framework to determine if the MERP remains viable in each
area of responsibility:
A. Planning, Coordination, and Communication
1. Who comprises your area’s medical emergency response team and what
defined roles and responsibilities for preparedness, response, and recovery
planning does each person have?
2. How does your plan provide for accountability and responsibility as well as
resources for implementing specific components of the plan?
3. What are the meaningful timelines, deliverables, and performance measures
defined by your plan for maintaining operations during a medical emergency in
which widespread illness affects our workforce?
4. How does your plan provide for different outbreak scenarios including
variations in severity of illness, mode of transmission, and rates of infection in the
community.
5. How does your plan address the need for “social distancing” to occur by
providing for clear direction to those working in your area?
6. How does your plan provide for clear and reliable daily communication with al
those who need to hear from you and from whom you need to hear?
(B) Continuity of Operations
7. How does your plan provide for the possibility of the alternative procedures for
operating in the event of disruption of normal operations due to a medical
emergency?
8. How does your plan provide for the continuity of operations with respect to
maintaining essential operations of the university in your area of responsibility?
(C) Infection Control Procedures
9. How does your plan contribute to our need to limit the spread of infectious
22
disease such as influenza on campus?
10. How does your plan address employee absences due to unique to medical
emergencies such as pandemic influenza?
11. How does your plan provide for case identification and the reporting of
information about those in your area who are ill?
12. How does your plan identify the ways in which you might support a surge in
demand for your services and establish steps to have the necessary resources
on hand?
13. How does your plan establish how movement on campus and to and from
campus will take place during a medical emergency such as influenza pandemic
(e.g., with respect to voluntary and mandatory movement restrictions).
(D) Post-emergency Procedures
14. How does your plan provide for a recovery strategy to deal with
consequences of a medical emergency once it is over?
15. How does your plan provide for the resumption of normal operations when
the medical emergency has been declared over?
Each of the areas of responsibility will be evaluated in this way and categorized
as either (A) In Place or (B) In Need of Action. Where an aspect of the plan is
found to be in Need of Action, the Senior Administrative Council will assign one
of its members, or delegate, to take the necessary steps that will allow the item in
question to be re-assessed as being in place.
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Appendix 1
Medical Emergency Planning Checklist
(Updated regularly at www.brocku.ca/pandemicplan)
1. Store a supply of water and food. During a medical emergency like pandemic
influenza, if you cannot get to a store, or if stores are out of supplies, it will be
important for you to have extra supplies on hand. This can be useful in other
types of emergencies, such as power outages and disasters. Calculate how
much your family would need for two weeks and store separately from your
regular food. Here are some suggestions to help you stock emergency supplies:
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Ready-to-eat canned meats, fruits vegetables, soups and fish
Protein or fruit bars
Dry cereal or granola
Peanut butter or nuts
Dried fruit
Crackers
Canned juices
Bottled water (2 liters of water per person per day)
Canned or jarred baby food and formula
Pet food
Skim milk powder and evaporated milk
Prescribed medical supplies such as glucose and blood-pressure monitoring
equipment
Soap and water, or alcohol-based hand wash
Medicines for fever, such as acetaminophen or ibuprofen
Thermometer
Medication to prevent vomiting (e.g. Gravol)
Anti-diarrheal medication (e.g. Imodium, PeptoBismol)
Vitamins
Fluids with electrolytes (e.g. Pedialyte, Sports Drinks)
Cleansing agent/soap
Flashlights
Batteries
Portable radio
Manual can opener
Garbage bags
Tissues, toilet paper, disposable diapers
2. Ask your doctor and insurance company if you can get an extra supply of your
regular prescription drugs.
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3. Have any nonprescription drugs and other health supplies on hand, including
pain relievers, stomach remedies, cough and cold medicines, fluids with
electrolytes, and vitamins.
4. Talk with family members and loved ones about how they would be cared for if
they got sick, or what will be needed to care for them in your home.
5. Volunteer with local groups to prepare and assist with emergency response.
6. Get involved in your community as it works to prepare for an influenza
pandemic.
7. Make list of contact telephone numbers – work, public health, family.
And once you have taken the time to prepare for a medical emergency, teach
your children what to do, too!
Appendix 2
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Medical Emergency Planning Educational Information
(Also found at www.brocku.ca/pandemicplan)
TRUE FLU FACTS
Influenza is serious, acute, respiratory illness that is caused by a virus.
Symptoms may include sudden onset of fever, chills, cough, sore throat,
headache, muscle aches, extreme weakness and fatigue. The cough and fatigue
can persist for several weeks but usually illness lasts from two to seven days.
Some will develop complications and require hospitalization. Every year the flu is
responsible for up to 4500 deaths in Canada.
Influenza is spread by respiratory droplets from infected persons through
coughing, sneezing or talking. It is also spread through direct contact with
surfaces contaminated by the virus, such as keyboards, eating utensils and
unwashed hands.
How Can I Avoid Catching The Flu?
The best way to prevent the seasonal flu is to get a flu vaccination each fall.
Avoid close contact with people who are sick. Stay at home when you are sick so
you can help prevent others from catching your illness. Cover your mouth and
nose with a tissue or sleeve when you cough or sneeze. Wash your hands often
to get rid of the germs your hands collect. Avoid touching your eyes, nose or
mouth, as this is how the influenza virus enters your body.
To minimize your risk of catching the flu:
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Wash your hands after every activity.
Think before you kiss.
Cough or sneeze into your sleeve.
Keep your hands to yourself.
Stay home when you are sick.
Keep your room clean!(door handles, light switches, keyboards, phones)
Don’t share your drink with anyone.
Don’t touch your face with your fingers.
Wash your hands again!
What About A Flu Shot?
26
Who:
All residents of Ontario are encouraged to get the flu vaccine. It is
provided free of charge by the Ontario government to anyone over age 6
months,.
What: The influenza vaccine does not contain live virus so you cannot get the
flu from the flu shot. Protection develops two weeks after receiving the vaccine
and may last for one year. A new vaccine is prepared each year to provide
immunity to the strains of flu expected for the upcoming season. Immunization is
required each year.
Where: Flu immunization is available from community clinics or your family
doctor. Brock provides annual clinics for all students and employees. Students at
Brock can receive a flu shot with an appointment at Student Health Services. ext.
3243
When: Immunization is recommended in October and November each year. In
North America the peak flu season runs from November to March.
What Can Be Done If I Catch The Flu?
Since antibiotics are not effective for infections caused by a virus, there is no
antibiotic treatment for the flu. There are some anti-viral medications, eg Tamiflu.
They are best started within 48 hours of the onset of flu symptoms. Antiviral
medication does not eliminate symptoms but can shorten the course of the
illness.
Keep well hydrated; clear fluids, including chicken soup and fruit juices, are good.
Treat fever with ibuprofen or acetaminophen, not aspirin. Use Gravol for nausea
and Imodium for diarrhea if needed.
Is It A COLD Or Is It FLU?
Signs & Symptoms
COLD
FLU
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Fever, chills
Low fever, if any
Usual; can be a high fever
Headache
Rare
Usual
General aches and pains
Mild, if any
Usual; often severe;
affect the body all over
Fatigue and weakness
Mild if any
Usual, often severe
Runny, stuffy nose
Common
Sometimes
Sneezing
Common
Sometimes
Sore throat
Common
Sometimes
Cough
Mild to moderate;
hacking cough
Common; can become
severe
Onset
Gradual onset
Usually starts
with a scratchy throat
and runny nose
Sudden, usually starts
with a fever, fatigue and
general aches and pains
Severity
Minor infection of
nose and throat
More severe. Quite ill for
3-5 days but may not fully
recover for days or weeks.
may lead to pneumonia,
bacterial infections or
hospitalizations.
If symptoms persist
beyond two weeks.
If you develop shortness
of breath, painful
breathing, earaches,
pain around your
eyes or cheekbones or a
severe sore throat. If you
seem to get better, then
worse again.
.
When to see a Doctor