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Key planning questions
- Who are the key internal constituents that must be involved in the planning process?
- Who are the key external constituents that must be involved in the planning process?
- What other plans exist that need to be coordinated with this plan?
- What are the comprehensive components of a good plan?
- What tools are necessary to help us build the plan?
- How will we vet the plan?
Isolation & Quarantine
Planning Process & Plan Development
Preparing for Plan Development
Planning Assumptions
Planning for the wide range of potential measures that are necessary for isolation and quarantine response is challenging. For example, the length of the isolation and quarantine period will vary depending upon the agent involved, as will the protective measures required for staff interacting with those in quarantine. Focusing too much on the "what-ifs" can slow the planning down. In our planning process, we decided to pick one reasonably "likely scenario," a Toronto-scale SARS outbreak and plan with that specific event in mind, understanding the need for flexibility to address outbreaks of different diseases, different scales, in the context of different disaster situations. This scenario provided a frame of reference within which to begin our planning.
Determining and frequently revisiting the following planning assumptions was a helpful step in understanding which assumptions would or would not work within the planning process. Making our first assumptions allowed us to get to a place where we could adjust our plan. The initial planning assumptions were:
Response Activation. The point at which a Public Health department shifts from "business as usual" to an extraordinary I & Q response will likely be triggered by notification from the Communicable Disease Surveillance staff that they have identified an outbreak of serious concern and need (or will soon need) support to manage the event. Activation may progress incrementally from informal communication to co-location of key leaders, activation of ICS, and the implementation of the agency I & Q Response Plan that will require workforce and staff reassignment.
Community Resiliency. It was important for us to remember that during disasters, communities rally to respond. A good portion of those likely to be isolated or quarantined have the resources and wherewithal to take care of themselves and each other, given timely information and clear guidance. Expect that a subset of persons or households - vulnerable populations - will require the most attention and resources from Public Health and its partners in an I & Q scenario.
Concrete Examples. We turned many planning questions into the following concrete examples to more effectively understand and address the problem at hand, and identify other potential challenges.
Field Response. For planning purposes we initially assumed that Public Health staff would be the only field workers to enter a home for provision of assessment, nursing visits, medical support and delivery of non-medical services and supplies. This is a prime example of an assumption that had to be revisited and changed when it became clear that the need for field workers would surely exceed our own capacity to deliver. The need for other field responders (whether volunteers or staffing from response partners) prompted a wide range of other issues in the areas of training, risk management, personal protective equipment, communications and coordination, etc.
Information Management. We devised a system that first relied on paper (tools, forms, etc.) and Public Health phones and fax for communication between responders. Later we planned to translate our data management to an electronic format. We believe that this approach adds value in two ways. First, in the event that the technology infrastructure is interrupted, a "low-tech" I & Q response can still be mounted. Second, we continue to make significant changes to our systems and processes as the plan evolves. Database development is time-consuming and expensive, and we want to commit appropriate resources once we have finalized our processes.
Planning Process & Plan Development
Preparing for Plan Development
Planning Assumptions
Planning for the wide range of potential measures that are necessary for isolation and quarantine response is challenging. For example, the length of the isolation and quarantine period will vary depending upon the agent involved, as will the protective measures required for staff interacting with those in quarantine. Focusing too much on the "what-ifs" can slow the planning down. In our planning process, we decided to pick one reasonably "likely scenario," a Toronto-scale SARS outbreak and plan with that specific event in mind, understanding the need for flexibility to address outbreaks of different diseases, different scales, in the context of different disaster situations. This scenario provided a frame of reference within which to begin our planning.
Determining and frequently revisiting the following planning assumptions was a helpful step in understanding which assumptions would or would not work within the planning process. Making our first assumptions allowed us to get to a place where we could adjust our plan. The initial planning assumptions were:
- Planning Focus
- Response Activation
- Community Resiliency
- Concrete Examples
- Field Response
- Information Management
Response Activation. The point at which a Public Health department shifts from "business as usual" to an extraordinary I & Q response will likely be triggered by notification from the Communicable Disease Surveillance staff that they have identified an outbreak of serious concern and need (or will soon need) support to manage the event. Activation may progress incrementally from informal communication to co-location of key leaders, activation of ICS, and the implementation of the agency I & Q Response Plan that will require workforce and staff reassignment.
Community Resiliency. It was important for us to remember that during disasters, communities rally to respond. A good portion of those likely to be isolated or quarantined have the resources and wherewithal to take care of themselves and each other, given timely information and clear guidance. Expect that a subset of persons or households - vulnerable populations - will require the most attention and resources from Public Health and its partners in an I & Q scenario.
Concrete Examples. We turned many planning questions into the following concrete examples to more effectively understand and address the problem at hand, and identify other potential challenges.
- We are informed by a hospital that an inpatient is well enough to be discharged and needs to go into isolation at home.
- An inpatient is ready for discharge but shows signs that s/he is not likely to comply with isolation outside the hospital.
- An inpatient needs hospital-level care and isolation but doesn't wish to comply and threatens to leave the hospital against medical advice.
- An ER outpatient (who comes in for emergency care and is not admitted) is identified as a candidate for isolation or quarantine.
- Someone who is quarantined becomes ill with the disease for which she was quarantined.
- Someone in home-based isolation or quarantine deteriorates to the point of needing hospitalization.
- Someone at home needs medical attention for a pre-existing condition (e.g., pregnancy, wound-dressing, kidney dialysis) that is neither emergent nor of hospital-level acuity.
Field Response. For planning purposes we initially assumed that Public Health staff would be the only field workers to enter a home for provision of assessment, nursing visits, medical support and delivery of non-medical services and supplies. This is a prime example of an assumption that had to be revisited and changed when it became clear that the need for field workers would surely exceed our own capacity to deliver. The need for other field responders (whether volunteers or staffing from response partners) prompted a wide range of other issues in the areas of training, risk management, personal protective equipment, communications and coordination, etc.
Information Management. We devised a system that first relied on paper (tools, forms, etc.) and Public Health phones and fax for communication between responders. Later we planned to translate our data management to an electronic format. We believe that this approach adds value in two ways. First, in the event that the technology infrastructure is interrupted, a "low-tech" I & Q response can still be mounted. Second, we continue to make significant changes to our systems and processes as the plan evolves. Database development is time-consuming and expensive, and we want to commit appropriate resources once we have finalized our processes.
