Management and Leadership

Question 1

A local public health unit is assisting one of its community to develop an emergency management plan. Using the emergency management cycle, give an example of public health activity anticipated in each stage.

Answer 1

1) Prevention/Mitigation (any 1 of the following)
- Conduct HIRA to identify hazards in the community that post the greatest risk (probability x severity) e.g. flooding;
- Work with the community to eliminate/reduce the vulnerabilities that contribute to the risks;
- Identify vulnerable populations that might be impacted the most by a particular hazards and create mitigation plans;
- increase public awareness of the risks and public education of preventive strategies
- Advocate development of vaccines of anticipated pandemics
2) Preparedness (any 1 of the following)
- Create ERP/COOP (all hazard and hazard-specific);
- Ensure Mutual Assistance Agreements are in place;
- Conduct training and exercise based on these emergency plans;
- Take inventory of resources required for an effective response;
- Maintain an emergency preparedness stockpile;
3) Response (any 1 of the following)
- Activating ERP/COOP/IMS
- Surveillance (early detection)
- Epi investigation/outbreak control/containment;
- crisis communication;
- pre- or post- exposure prophylaxis distribution e.g. mass immunization;
- Conduct human health risk assessment and make recommendations e.g. evacuation/shelter in place, issuing boiling water advisory
4) Recovery (any 1 of the following)
- Conduct population health assessment post-emergency;
- Communication with public;
- Evidence-based advice to healthcare system, emergency responders and policy makers e.g. discontinue public health measures and allow trades/travels to resume

Question 2

What is an Incident Management System? What are the 5 key functions and top 5 features of IMS?

Answer 2

IMS is a standardized approach to manage an emergency.

Each IMS must have 5 key functions: SFLOP

         - Single Command, 
         - Finance/Admin
         - Logistics
         - Operations
         - Planning

Top Features or Principles

• Unity of Command
• Management by Objectives,
• Integrated Communications,
• Simple & Flexible,
• Scalable & Modular,

-Others: Span of control; Interoperability; Standardization (structures, functions, terminology), Consolidated Incident Action Plan

Question 3

As an AMOH of a local health unit, you have been asked to develop an emergency preparedness plan for one of its community. Describe your initial step in detail.

Answer 3

The initial step is to conduct a Hazard Identification and Risk Assessment (HIRA).

HIRA is a risk assessment tool used to identify hazards (source of danger) that post the greatest risk to a community, both in terms of probability of occurrence and severity of impact.

The steps of HIRA include

• (1) identify hazards;
• (2) assess risk, considering probability of the hazard occurring and its impact, looking at where people and economic activities are;
• (3) Analyze risk by ranking hazards from greatest to least risk and recording in risk assessment grid; and
• (4) monitor and review the HIRA regularly.

Question 4

What is the Emergency Management Framework of Canada?

Answer 4

Canada adopts an all-hazards risk-based approach by addressing vulnerabilities exposed by both natural and human-induced disasters or emergency. This way we can determine the optimal balance and integration of public health measures to address vulnerabilities and risks.

Question 5

Who can declare a state of emergency in your jurisdiction?

Answer 5

Under the Emergency Management and Civil Protection Act, the Premier, Cabinet or the
municipal Head of Council may declare emergency in the province of Ontario.

Question 6

What is an all-hazard approach? And what are the benefits of such approach?

Answer 6

All-hazard approach is a generalized approach for responding to a wide variety of hazards in emergency preparedness regardless of cause.

Benefits:

• improves efficiency by integrating common emergency management elements across all hazard types, which can then be supplemented by hazard-specific sub-components to fill gaps as required; and
• improves the ability of EM activities to address unknown hazards.

Question 7

What is a Emergency Response Plan? List 5 common components of ERP?

Answer 7

ERP defines the initiation and conduction of an emergency response. It also defines how the organization mobilizes to address an emergency (outward-looking).

5 common components:

• Aim of the plan
• Activation and demobilization of the plan
• Notification procedures for internal staff and external partners and stakeholders
• Roles and responsibilities
• Tools, structures and processes to be utilized in an emergency response

Question 8

What is the difference between an ERP and COOP? Name 5 common Wponents of a COOP.

Answer 8

COOP(also known as Business Continuity Plan) defines how organizational interests will be protected and essential operations will be sustained during an emergency. COOP defines how an organization mobilizes to sustain its essential functions during an emergency (inward-looking).

ERP is outward-looking and defines how the organization address and emergency.

Common components of a COOP:

• Background including assumptions underlying the COOP, purpose and scope of COOP
• Triggers for activation and step-down for COOP
• COOP notification procedures of staff
• Description of essential organization functions and identification of required staff and skill sets
• Site vulnerability analysis
• Strategies to reduce the impact of a particular scenario on essential organizational functions including:
• ->Alternative arrangements for work (e.g telework), operating facilities, vendors/suppliers-
• ->Determining how the organization will proceed with non-critical functions during the scenario

Question 9

What is Public Health Emergency of International Concern? Who has the authority to declare it? What are the criteria for a PHEIC?

Answer 9

A) PHEIC is any event that may pose a public health risk to other member states through international spread of disease; AND potentially requires a coordinated international response.

B) World Health Organization under the International Health Regulation (2005) may declare a PHEIC.

C) An event that meets any two of the four following criteria may be a PHEIC and a member state must report to the WHO (RUSS)

i) The public health impact is Serious
ii) The event is Unusual or Unexpected
iii) There is significant risk of international Spread
iv) There is significant risk of international travel or trade Restrictions

Question 10

What diseases must a member state always notify WHO?

Answer 10

• Smallpox
• Wild-type Polio
• New subtypes of human influenza
• SARS

Question 11

Describe an approach to risk assessment of a mass gathering.

Answer 11

Duration of the event
Venue (e.g., indoor vs outdoor)
Type of event (e.g., sports? political? music?)
Season
Density of participants
Country of origin of participants (may have implications for importing disease)

Question 12

Outline the PDSA cycle

Answer 12

Plan- assemble team, define issue, look at alternatives
Do- Implement one of the alternatives on a small scale. Collect data on the outcomes
Study- Evaluate the outcomes of the implementation
Act- Based on findings, decide whether the alternative should be implemented in a more widespread way.

Question 13

What are some of the purposes of Program Evaluation. List 3.

Answer 13

1. To assess progress toward a goal
2. To justify additional funding or resources
3. To identify strengths, weaknesses and areas for improvement
4. To assess for equity of impact
5. To ensure effective programs are maintained
6. To engage stakeholders in CQI

Question 14

List six factors that would make the public perceive a risk as unacceptable, and four factors that would make the public perceive the risk as acceptable (don’t use opposites)

Answer 14

Unacceptable

• impacts children
• harms are not reversible
• impacts future generation
• catastrophic in nature
• Receiving significant media attention
• Unequal distribution of harms

Acceptable

• Familiar
• Naturally occurring
• Risks are well known and clarified
• Exposure is controllable or voluntary

Question 15

Briefly describe the PRECEDE-PROCEED framework.

Answer 15

It is a framework for designing and evaluating programs, most useful for programs targeting health behaviour changes. This framework combines epidemiological, social, behaviour and educational sciences and health administration literature.

PRECEDE refers Predisposing, Reinforcing and Enabling factors as well as Causes in Educational Diagnosis and Evaluation.

PROCEED refers to Policies, Regulatory aspects and Organizational Constructs in Educational and Environmental Development

Question 16

What is stakeholder analysis?
What is the benefit of doing a stakeholder analysis?
List 8 stakeholders that should be included.

Answer 16

Stakeholder analysis is a process of systematically gathering and analyzing qualitative information to determine whose interests should be taken into account when developing and/or implementing a policy.

Stakeholder analysis can prevent potential misunderstandings and/or oppositions to te implementation of a policy or program (WHO)

Associations
Media
Academic
NGOs
Industry
Clients/Community
Healthcare
Unions
Governments
(what is the difference between associations and unions)

Question 17

According to PIPEDA what is personal information?

Answer 17

Factual or subjective information about an identifiable individual. Individuals are considered identifiable if it is reasonable to expect that an individual can be identified from the information (either alone or by combining it with other information)

Examples include:

age, name, ID numbers, income, ethnic origin, or blood type;

opinions, evaluations, comments, social status, or disciplinary actions; and

employee files, credit records, loan records, medical records, existence of a dispute between a consumer and a merchant, intentions (for example, to acquire goods or services, or change jobs).