Ebola: More than an African health crisis

© 2014 Fair Isaac Corporation. Confidential. This presentation is provided for the recipient only and cannot be reproduced or shared without Fair Isaac Corporation’s express consent.

Business Continuity Institute South East of England Forum

Focus on Ebola: More than an African health crisis!

23 January 2015

Agenda

© 2014 Fair Isaac Corporation. Confidential.2

1020 – Welcome from FICO: introduction/administration Brian Kinch1030 – Welcome from BCISEE Chairman Jim Barrow1040 – Medical background to Ebola Danny Showell1110 – NHS planning and continuity precautions Phil Read1140 – Refreshments break1155 – Practical case study Philip Russell1225 – Setting the scene for the exercise Richard Verrinder1230 – Exercise part 11300 – Lunch1330 – Exercise part 21400 – Feedback session and discussion Richard Verrinder1500 - Close

Ebola Viral Disease

Basic facts for business continuity

Danny ShowellConsultant in Public Health Medicine

4

Background

Viral infection

First described: 1976, Ebola river (Democratic Republic Congo)

Sporadic outbreaks in Africa

Largest outbreak started in March 2014

Infection: animal human; then human human

5

Progression

Exposure

Incubation period

Infectious PeriodInfection

Symptomatic Recovery / Death

Time (days)

6

Symptoms

Phase 2 (gastrointestinal phase) • Diarrhoea • Vomiting

Phase 1 (early)• Fever (temperature ≥ 37.50C)• Headaches

• Myalgia (muscle pains)

Phase 3 (recovery or deterioration)• Neurological • Bleeding

7

Transmission

No asymptomatic spread

No small droplet spread (coughs and sneezes)

Direct with bodily fluids of symptomatic person• Vomit, diarrhoea, blood, sputum

No infection through intact skin

8

Control

Medical facilities• Infection control procedures

Contact tracing and monitoring• Twice daily monitoring of temperature

Decontamination of environment• Using appropriate precautions

Summary

Not infectious before symptoms start

Highly infection once symptoms start

Not spread via the airborne route

9

Thank you

10

BCI South East of England (BCISEE)

Ebola EventFriday 23rd January

Phil ReadHead of Emergency Preparedness Resilience & Response (EPRR)

NHS England Essex Area Team (EAST Sub Region)

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12

Content

• How is the Essex NHS preparing for an Ebola case?, and

• How is the Essex NHS preparing for an Ebola outbreak?

• What sensible BC precautions is the NHS taking?

• Healthcare resilience issues to be considered?

• What were the learning points from the ERF exercise/s?

13

Foreword

• (CMO stated for some time) ‘It is expected that we will see a ‘case’ of Ebola in the UK at some time in the future’, no one could be sure…, but….(returning worker from Scotland)

• (Specialists / Microbiologists state) ‘It is not expected that we will see an ‘outbreak’ in the UK at some time in the future’, but no one can be sure….

• The UK (and western world) is different, but we are not complacent…

• There is some intelligence that the ‘outbreak’ in West Africa has peaked/ been contained, but no one can be sure….

• UK planning has focused on initial isolation of a ‘case’ not an ‘outbreak’

• This is different to an ‘seasonal influenza’ epidemic, but has similarities to a ‘pandemic flu’ outbreak’ (not airborne)

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How is the Essex NHS preparing for an Ebola case?

• Wealth of guidance made available via PHE and DH since early 2013 https://www.gov.uk/government/collections/ebola-virus-disease-clinical-management-and-guidance

• All Local Health Resilience Partnerships (LHRP) required to conduct a local OTSE exercise in October 2014

• National safety alerts, including posters, clinical algorithm and clinical setting specific guidance issued (DH CAS system)

• 2 multi agency LRF level exercises conducted, acute trust local exercises conducted and ongoing (Essex Romero 1&2)

• Teams of specialist staff re / trained in FFP3 mask / PPE donning and doffing (high risk undertaking)

• Increase in national (Royal Free lvl 4/ HLIU) and review of local isolation facilities in acute setting, we are assured

• Ambulance Trust HART training and review of conveyance and isolation procedures

Adobe Acrobat Document

https://www.gov.uk/government/collections/ebola-virus-disease-clinical-management-and-guidance




15

How is the Essex NHS preparing for an Ebola outbreak?

• There is no specific guidance on the management of an UK outbreak of Ebola

• Balancing delivery of business as usual with the isolation of number of patients infected / being tested

• Patients require intensive support and care, need/should be in an acute setting should they deteriorate, currently identifying suitable location

• Support to this setting will be fully contained (staffing / transport / equipment / consumables / food / waste, etc)

• Working with all partners to ensure:

• Local infection control procedures are clear, up to date, and consumables available to use (grab boxes all ED Depts)

• Access to microbiologists / national PHE IC specialists 24/7• Business continuity plans are robust (in particular staffing of

specialist functions)• Ensuring LRF multi-agency understanding of principles and

measures to take

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What sensible BC precautions is the NHS taking?

• Identification of signs and symptoms (national clinical algorithm)

• Considering escalation plans should a family / group require isolation

• Re training staff / more staff in FFP3 and PPE donning & doffing

• Reviewed infection control procedures, in particular the disposal of clinical waste

• Consideration to creating local high level isolation units (not ideal)

• Reviewing staffing mutual aid agreements, in particular specialist / critical care staff

• Signs and public information, clear concise and advisory

• Single source of all information

• Returning worker protocols and testing at key UK ports of entry

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Healthcare resilience issues to be considered?

• Safety of staff paramount

• Contact tracing (PHE) timeliness / containment

• Maintaining and protecting high level isolation units

• Deliver business as usual, NHS is under extreme pressure

• Communications & media mgmt critical (prompt / holding statements)

• Maintain a capability to respond to other incidents

• Testing facilities and timeliness of results to inform decision making

• Travelling families / what to do with children, healthcare setting or not?

• How much time / effort and money is required, ongoing assessment

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What were the learning points from the ERF exercise/s?

• Access to information / single source

• Communication portal (Resilience Direct)

• Warning & Informing

• PPE Guidance / Provision

• C3 Trigger points

• Operational Testing / Preparedness

• Ports Preparedness & Response

• NHS Isolation facilities

• Mgmt of minors

• Detaining infected persons

• Contact Tracing process/procedure

• Information to schools and business

• National Policy considerations

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Final Thoughts?

• We are confident / assured of the isolation capabilities of the NHS

• How much time and effort is appropriate for an Ebola outbreak?

• Can we focus on issues to support the delivery of other hazards to save time and avoid duplication?

• We are confident in PHE and Public Health teams to undertake contact tracing and minimise spread

• Early multi agency coordination is absolutely essential

If you have a robust business continuity plan surely you only need some hazard specific tactical guidance…….

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• [email protected]• 0113 82 49021• 07748 321808

Thank you for your time and attention

mailto:[email protected]


Refreshment Break

21


Practical case study

Philip Russell

22


Setting the scene for the exercise

Richard Verrinder

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24 © 2014 Fair Isaac Corporation. Confidential.

► Awareness► External e.g. Social media/Facebook,

etc► Confirm. Heads up► Internal. Procedures► Opportunity

► Staff► Confirm► HR issues. Resource

► Schools► Direct impact► Potential

► Finance► Shares

Exercise Group Output – Group 1 – Sheet 1

► Third Party► Control

► Internal Communications► Knowing lines of communication► LA’s. Public Health► Ownership► Regular updates. Routes► Facts► Counter message

► IMT► Monitor. Helplines

► HR/People► Humiliation► Welfare► Morale. Fear

► Travel► Work► Social► Return to normal


► Education► Own communications► Support professionals

► Trigger Levels► Products► Productivity► Specific for Ebola► Critical activities

► Monitoring Group► Staff refusal► Staff hero► Key person. Provides communications

► BAU► How to return

► Cleaning► Increase. Regardless of science► Toilets?



► How could we learn about this?►Social media: Facebook, Twitter►Local/national radio. LBC – 30 minutes►Phone. Personal contacts – almost immediate►Web/TV/visitors/drivers

► Communications►Internal

►Staff rumour. Unnecessary fear►Reassure staff►Facts about incident

►External►Strategic. Agreed message. PR crisis communications group►Operations. ►Satellite TV►Internet site



Area Issues ActionsFactory operations • Impact production e.g. food perishable

• Inputs disrupted• Outputs: customer experience &

quality

• Internal communications• Leadership/control

Sales • Risk to brand• Customer/consumer perception• Deliver customer expectations

• Science• External communications• Stakeholder crisis

management• Continuing deliveries

Logistics • Should we continue to receive goods in (e.g. catering) and out?

• Staff want to go home (no despatch)

• Escalate to executive• Alternate BCP staff• Internal messaging

HR • Staff need for knowledge• Panic and paranoia• Next day absenteeism

• External medical advisor• Internal communications• Write-off Friday/Monday

Security • Site integrity• HSSE• Target hardening

• Third party provider

• Opportunist


► Assumptions► Smiths live in Lewisham► We: factory in Lewisham► Rapid analysis


► Heightened Alert Level►Escalation arrangements in business varies►Social media monitoring/action►Confidence in information/communications to staff►Advice to first aiders?►COBRA – UK instruction/decision??►Cleaning companies. Training? GDS contractors►LEA. LA advice to business/school workplace►Instruction/LA – cleaners – PPE?►IMT established. Managing worried well►Would have detailed contingency plans►What’s the triggers for “different”



► Heightened Alert Level (cont….)►There will be differences in organisational response

►Policy decisions►Company decision?

►Experience/learning from swine ‘flu. Who in UK?►Union engagement??►Universities. Monitoring of travel. Escalate

► Accept:►There will be different sources of information. Policy decision►Senior leadership to agree trusted information source►Working with stakeholders

►What do we tell them?►What do they need?

► Actions►Will be asked for names for contact tracing►Advice to contaminated persons



► Are HR policies enforceable?►Stay at home?►Pay? Would

► BC plans are robust?►Significant resilience in universities/with some►Does/would Ebola change your absence rate?

► Communications strategy in place►Need to be transparent►Mindful of digital age►Reactive! (Balance). Immediate holding statement

► Caring for loved ones►Organisational capacity►Outsourcing capability

► Shared hygiene information into stakeholders


© 2014 Fair Isaac Corporation. Confidential. This presentation is provided for the recipient only and cannot be reproduced or shared without Fair Isaac Corporation’s express consent.

Business Continuity Institute South East of England Forum

Focus on Ebola: More than an African health crisis!


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