PROVINCIAL PAEDIATRIC PANDEMIC INFLUENZA PLANNING P4

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PROVINCIAL PAEDIATRIC PANDEMIC INFLUENZA
PLANNING(P4)

• Prepared by
• C.Bruce-Barrett Director, Strategic Projects
• Hospital for Sick Children
• June 27, 2006

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Mandate

• To identify gaps propose strategies ensuring a
  coordinated, comprehensive pandemic plan to meet
  the unique special needs of children, youth
  their families in Ontario

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Approach

• P4 Steering Committee
• Existing Pandemic plans
• Literature review
• Paediatric expert consultation
• Issues strategies
• Working groups

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Working Groups

• Communication Education
• Chair, Michael Barrett (London)
• Psychosocial Support Ethics
• Chair, Bev Antle (Toronto)
• Capacity, Supplies Equipment
• Chair, Alison Quigley (Toronto)
• Infection Control Public Health
• Chair, Marina Salvadori (London)
• Medical management Laboratory
• Chair, David Creery (Ottawa)
• Human Resources Support Services
• Chair, Georgina White (Toronto)

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Unique Considerations

• Children are at greater risk of infection
  complications from influenza of spreading the
  virus
• Hospitalization rates similar to the elderly
• Increased morbidity for children lt5 years of age
• More viral shedding
• Poor compliance with infection control practices

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Unique Considerations

• Social, public health other concerns may have
  an impact on services for children
• School day care closures
• Parent/ caretaker illness
• Communal gatherings
• Vaccine refusal

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Unique Considerations

• Influenza manifests differently in children
  will require different treatment
• Symptoms may be more non-specific
• Gastrointestinal symptoms are more likely
• Differentiating between concurrent diseases
  difficult
• Current antivirals are not approved for children
  lt1 yr
• Tamiflu resistance appears more frequently
• Young children require presence of parent/ adult
  at all times
• Surge capacity must accommodate space for parent/
  caregiver child

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Unique Considerations

• Parents reliance on family physicians for
  paediatric care
• Parents/ caregivers will want to speak to family
  MD regarding childs care
• Family physicians will require support to manage
  requests for care during a pandemic

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Strategies

• The health system must
• Communicate effectively with families
• Provide age appropriate information for children
  youth
• Implement infection control consider public
  health measures to reduce the spread of influenza
  among children
• Consider the need for child care services,
  particularly for children of health care workers
• Provide appropriate care for children with
  influenza including care providers, equipment,
  supplies, laboratory support
• Provide psychosocial support for families

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Areas for Development

• Providing paediatric influenza care
• Algorithm guiding decision making as to type of
  care required settings for care delivery
• Paediatric specific protocols, tools databases
• Case definition, identification surveillance
• Contact tracing, reporting monitoring
• Laboratory sampling testing
• Clinical evaluation management guidelines
• Medications (antivirals, antibacterials, vaccines
  etc.)
• Transfers/ Transport between facilities (CCU/
  NICU)
• Admission, management, discharge guidelines

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Areas for Development

• Managing Consent
• Procedures for managing consent associated with
  providing care for children
• Consent to treatment discharge planning for
  hospitalized children if parent/ caregiver is
  unavailable due to illness
• Naming substitute decision makers if parents or
  other family members not available

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Areas for Development

• Physician Support
• Primary care physicians community
  paediatricians
• Provision of tools including triage guidelines,
  care algorithms, staff information
• Access to paediatric advice expertise

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Areas for Development

• Obstetrical Paediatric Care Capacity
• Settings providing these services should
  collaborate on developing
• Regional obstetrical paediatric strategies
  including designation of settings to fulfill
  certain roles responsibilities
• Mutual aid agreements to optimize hospital/
  non-hospital patient management
• Standards governing access to different settings
  types of care (ie. age ceiling for paediatrics
  lt or gt 12)
• An inventory of current surge capacity across
  the system
• Requirements concerning equipment, supplies
  resources
• Plans for use of non-traditional care sites
• Pre-natal antenatal care protocols

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Areas for Development

• Providing Psychosocial Support
• Local pandemic plans will
• Identify psychosocial services resources to
  help children, youth caregivers cope
• Develop strategies to facilitate death rites,
  funeral rituals, grief bereavement within the
  context of a pandemic

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Areas for Development

• Maintaining Education
• Ministries of Health Education working in
  collaboration with school boards to determine
  alternative education strategies during school
  closures

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Conclusions

• Especially challenging
• Unique considerations
• Significant gaps
• Foundation to build from

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Reflections on Planning

• In preparing for battle I have found that plans
  are useless, but planning is indispensable
• Dwight Eisenhower 1890-1969

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