develop communication materials appropriate for use at the border. Governance AHPPC: establish governance arrangements for pandemic influenza and ensure they are consistent with broader emergency arrangements. Legislation: prepare and action any legislative instruments required to support actions. Standby stage Triggers for moving from Preparedness to Standby include: advice received under Surveillance Plan activities of an outbreak overseas of sustained community transmission of a novel virus; or a warning of a potential influenza pandemic received from WHO; or indications received from a jurisdiction that they may seek assistance under the AHMPPI to manage severe seasonal influenza; or an indication from CDNA of a trend in seasonal influenza which may overwhelm state and territory health systems. Standby activities will focus on: preparing to commence enhanced arrangements; identifying and characterising the nature of the disease (commenced in Preparedness); communication measures to raise awareness and confirm governance arrangements; and border activities. In the Standby stage, the following measures could be considered for implementation: Preparing to commence enhanced arrangements Resources (stockpile): check the status of stockpiles and equipment (antivirals, antibiotics, PPE); raise awareness of protocols for access to stockpiles during pandemic; contact warehouses and transport companies to ensure readiness; Australian Government and state and territory governments to liaise concerning stockpiles; assess pre-deployment across states and territories and move stock from National Medical Stockpile (NMS) as appropriate; confirm state and territory delivery sites related to NMS deployment; and pre-deploy PPE to Border Agencies (if undertaking border measures). Resources (HR): consider human resource availability, particularly in highly skilled areas, such as ICU nursing; Clinical care & Public health management: prepare arrangements for triaging in primary care; prepare arrangements for cohorting of patients; prepare arrangements for reducing in non-urgent work – primary and secondary care; prepare arrangements for providing additional support to at risk groups; raise awareness of potential at risk groups; prepare contingency support for home based care; hospitals prepare to review elective procedures;
description). (This will be commenced in the Preparedness or standby stages and will focus here on entry of the disease into Australia and early Australian cases); compare any information about the overall pandemic with seasonal influenza to inform appropriate interventions; refine case definitions as needed; confirm identification of at risk groups; analyse and report Australian data; and maintain case notification system; activate academic studies using enhanced data to test assumptions; monitor sustainability of surveillance systems. Laboratory Capacity: Isolate the virus (if not already undertaken); undertake laboratory testing as required to monitor the pandemic and for individual patient care; develop POC testing to enable timely diagnosis with early discharge, use of antivirals and appropriate cohorting of admitted patients; implement testing protocols to support case management, surveillance needs and to preserve laboratory capacity; and maintain laboratory capacity/capability to detect/test for novel virus. Communications (see Communications Chapter for more detail) Information should be provided as early as possible and acknowledge any associated uncertainty. Sharing information between responders: provide public health management guidance; provide clinical health management guidance (primary care and hospital based); provide advice on antiviral use; share information on the status of disease spread and the current response; raise awareness of at risk groups; provide any information to WHO required under International Health Regulations (IHR) reporting arrangements; and liaise with other international counterparts. Public Communications: coordinate public messaging by convening NHEMRN; and provide information on the status of disease spread and the current response; provide specific information for groups at risk or with specific needs (e.g. CALD, aged care or Aboriginal and Torres Strait Islander people). Monitor feedback and refine communications to address issues and concerns identified; provide media with access to daily updates on the status of disease spread and the current response; provide access to background information; make spokespeople available; respond to media requests; provide advice on: respiratory hygiene and hand-washing; mask wearing (if appropriate); how to find out more information; and hotline details (if any). (Communication measures related directly to infection control and border are included in those sections.) Border measures Communications:
R Key messages communicated to Local Government, NACCHO affiliates and jurisdictional industry peak bodies through identified email contacts for pandemic. S/T HD NACCHO PPM Paid television, radio or print advertisements concerning behaviours to be promoted, such as hygiene practices S/T HD & Department of Health emergency contact numbers R Department of Health contact numbers on the Department of Health website at www.healthemergency.gov.au Department of Health R State and Territory Health Department (S/T HD) contact numbers on relevant health department websites S/T HD R The National Health Services Directory provides information on locating health services Department of Health, S/T HD, GPs, Pharmacies, Hospitals, Primary Health Networks, Local Area Networks Initial and Targeted action Table 7: Methods of sharing information during the initial and targeted action stage. Information about For Method Responsible agency the international situation R Presentation and discussion at AHPPC AHPPC members R International data showing emerging trends shared through existing surveillance systems Department of Health R Situation Reports Department of Health NIR PPM Information for travellers on the smartraveller.gov.au website Department of Health status of the pandemic in Australia R Key messages communicated to Local Government, NACCHO affiliates and jurisdictional industry peak bodies through identified email contacts for pandemic. S/T HD NACCHO R Direction for GPs about the correct sites for information regarding the pandemic including relevant clinical advice and guidance. (http://www.racgp.org.au) RACGP, ACEM, Dept. Health, CDNA, websites of peak bodies PPM Regular media conferences Department of Health/ S/T HD PPM Spokespeople will be available for talk back radio interviews Department of Health/ S/T HD
use of antivirals R Confirmation/identification of at risk groups CDNA R Definition of minimum data set, as outlined in Surveillance Plan CDNA R Clinical management guidelines CDNA R Laboratory Case Definition PHLN R Guidance on The type of clinical specimen required Sample collection guidance Detection methodologies, such as culture, molecular methods such as Polymerase Chain Reaction, molecular characterization (typing and sub-typing methods and serology Quality assurance considerations PHLN R Laboratory Testing Protocols PHLN R Information regarding relevant isolates and sequencing data for test development PHLN R Point of care testing advice CDNA/PHLN R Advice that it is no longer necessary to test all cases PHLN/CDNA R Collation and analysis of jurisdictional data to show emerging trends, as outlined in Surveillance Plan Department of Health R Jurisdictional surveillance data, as outlined in Surveillance Plan S/T HD R Key messages communicated to Local Government, NACCHO affiliates and jurisdictional industry peak bodies through identified email contacts for pandemic. S/T HD NACCHO R Tailoring Infection Control Guidelines to pandemic virus CDNA + additional expertise R Advice regarding the need for additional action specific to institutional settings AHPPC on advice from CDNA, jurisdictions and GP Roundtable, Clinical Stakeholders Forum R Protocol outlining how people identified under exit screening should be managed. AHPPC on advice from CDNA PPM Telephone advice from the Department of Health freecall Public Health Information Line (PHIL) 1800 004 599. PHIL currently operates during business hours. During standby this may vary. Department of Health PPM Health Alert Information lines with capacity to manage inbound and outbound calls. (These can be set up within 2hours) Department of Health PPM Access to information and advice from healthcare professionals through a national call centre. National Health Call Centre Network PPM Regular media conferences Department of Health
Guide to Implementation Table 9: Guide to Implementation for Pharmaceutical measures Measures Preparedness Standby Initial Action Targeted Action: Low CS Targeted Action: Moderate CS Targeted Action: High CS Standdown Practicalities Antivirals: treatment Used for seasonal influenza As for seasonal influenza Treat cases if appropriate Move away from treating mild cases to protecting those at risk of severe outcomes Delivery capacity will become an issue Delivery capacity will become an issue Cases as required by condition Use for all cases Effectiveness strongly dependent on timely delivery and compliance. Risk of stockpile depletion with widespread distribution. Antivirals: post-exposure prophylaxis close contacts, possible at risk contacts, healthcare workers contacts at risk of severe illness close contacts & healthcare workers increasingly as cs rises, contacts at risk of severe illness close contacts, contacts at high risk of severe illness, healthcare workers (depending on exposure risk) Delivery capacity will become an issue Antivirals: pre-exposure prophylaxis HCW (depending on exposure risk) Candidate vaccine If vaccine proves to be effective. Unlikely to offer full protection. Useful if pandemic strain and candidate are same subtype. Possible adverse events. Customised pandemic vaccine At risk groups Not initially available. Access is a key goal of the response
Table 10: Guide to Implementation for Social distancing measures Measures Preparedness Standby Initial Action Targeted Action: Low CS Targeted Action: Moderate CS Targeted Action: High CS Standdown Practicalities Cancel mass gatherings consider High impact on businesses Proactive school closures consider High impact on workplace absenteeism Reactive school closures High impact on workplace absenteeism Workplace closures Substantial costs to businesses and employees; disruption of services and supplies Potential for high costs to employees from lost work days. Home working Not feasible for all Voluntary isolation of cases Disruption to workplaces and the economy Disruption to workplaces and the economy Disruption to workplaces and the economy Household contacts at risk of infection Voluntary quarantine of contacts High impact on workplace absenteeism Benefits and compliance will be highest if disease is severe Impact is dependent on early application Compliance is dependent on information and understanding of patients/contacts. Contact tracing Essential for early surveillance activities Benefits are most likely if disease severity is high. Continue in Targeted Action if CS is high and case identification is effective. Impact depends on early application
healthcare workers national infection control guidelines infection control guidelines Effectiveness dependent on compliance/ correct usage. Contact and droplet precautions plus eye protection. Airborne precautions for aerosol generating procedures. Public messages re: hygiene etc. Used for seasonal influenza Empowers individuals Needs to be in line with seasonal approach Relevant for all levels of transmissibility. Public messages re: situation and response efforts Builds public confidence
Surveillance: Seasonal influenza surveillance Coordinate surveillance of the impact on Australia as a whole Monitor data to identify when seasonal influenza has the potential to overwhelm the capacity of jurisdictional systems to manage the response. The jurisdiction may request assistance through AHPPC and NCC. Consider requests for assistance to respond to a severe season of influenza [AHPPC]. Consider harmonisation of data collection and reporting [ISSWG]. Participate in routine influenza surveillance activities [GPs, Aboriginal Health Workers, EDs]. Surveillance: Pandemic influenza surveillance planning Develop and maintain a national surveillance plan for pandemic influenza. Provide input into development of a national surveillance plan for pandemic influenza. Provide input into development of a national surveillance plan for pandemic influenza [ISSWG/ CDNA]. Consider and endorse a national surveillance plan for pandemic influenza [AHPPC]. Provide input into development of a national surveillance plan for pandemic influenza [through ISSWG]. Surveillance: Pandemic influenza surveillance Monitor and investigate surveillance data for the emergence of potential influenza pandemics. Monitor and investigate surveillance data for the emergence of potential influenza pandemics. Consider and provide advice on surveillance data which may indicate the emergence of an influenza pandemic. Advise AHPPC if the data indicates a level of threat requiring action [CDNA]. Participate in influenza surveillance activities [GPs, Aboriginal Health Workers, EDs].
Health Workforce: GPs Support promotion of feedback of GP Roundtable information regarding primary care into decision making fora. Work with PHN to identify service gaps and vulnerable populations; and to support dissemination of communications and engagement in strategies. Establish clear communication lines with health care providers both a state and local levels. Provide advice on management/treatment strategies and antiviral use. Support data collection and identification of gaps in services and vulnerabilities in patient populations relevant for their region [PHN + AICCHOs]. Establish liaison and clear communication lines with other local health providers (such as pharmacists, community nurses, ambulance, hosp, mental healthcare workers, RACFs.) Advocate for and support the GP profession to plan and prepare for a pandemic, including through the RACGP Disaster Management Network [RACGP, NACCHO]. Health Workforce: Other health practitioners Ensure involvement in planning and design of systems. Ensure involvement in planning and design of systems. Provide advice on management/treatment strategies and antiviral use [CDNA]. Support EDs in planning [relevant professional bodies]. Establish clear communication lines. Health Workforce: Primary healthcare providers Ensure involvement in planning and design of systems to respond to an influenza pandemic. Ensure inclusion of/coordination with S/T HD when working with primary healthcare providers on pandemic issues. Ensure involvement in planning and design of systems to respond to an influenza pandemic. Ensure inclusion of/coordination with Health when working with primary healthcare providers on pandemic issues. Liaise and communicate with primary healthcare providers.
Immunisation: Develop policy, procure vaccines and fund National Immunisation Program (NIP).This includes seasonal influenza vaccination program to support free vaccination for eligible Australians to protect against vaccine preventable diseases and communicate information related to the NIP to the general public and health professionals. Make arrangements with vaccine manufacturers to guarantee pandemic vaccine supply to Australia in the event of a pandemic. Deliver NIP (including seasonal influenza program). Promote vaccination to the community. Educate vaccination services providers about influenza immunisation. Deliver vaccination services as appropriate. Develop policy regarding immunisation during a pandemic or severe seasonal influenza outbreak, such as guidance for communications and coordinate implementation of state/territory immunisation programs. Plan resourcing required to implement use of vaccine [National Immunisation Committee]. Provide technical advice regarding pandemic influenza vaccine immunisation: priority groups; vaccination schedule and suitable vaccine [ATAGI]. Deliver NIP. Provide community education on the seasonal and pandemic immunisation program, led by local public health units [GPs, culturally and linguistically diverse (CALD) community groups, Aboriginal and Torres Strait Islander health sector]. Immunisation: Adverse events following immunisation and antiviral use Monitor the adverse events of antiviral drugs and pandemic vaccines and provide advice on safety of these products [TGA]. Report adverse events following immunisation to the TGA. Consider adverse event profiles and advise on the use of vaccine/antivirals [ATAGI, CDNA]. Report adverse events following immunisation to the state health authority and/or TGA.
Medical Countermeasures Stockpiles: Establish stockpiles Establish and maintain national stockpile – see below. Assess requirement for a jurisdictional stockpile and maintain a stockpile appropriate to this determination. Provide advice regarding inventory of the stockpile, access to and use of stockpile items [AHPPC]. Establish written guidelines on use [CDNA]. Maintain stocks appropriate for infection control [GPs + hospitals + ambulance/ paramedic organisations + AICCHOs + RACFs etc.]. Medical Countermeasures Stockpiles: National Medical Stockpile (NMS) Coordinate development of policy, in consultation with states/territories regarding the inventory and deployment of the NMS (including conduct of any modelling/ research required to inform decisions). Provide guidance on how the NMS can be accessed. Consider measures to strengthen coordination of supply chains. Provide input into the development of policy regarding the inventory and deployment of the NMS. Develop a jurisdictional NMS distribution plan. Provide advice/clear policy regarding the inventory and deployment of the NMS [AHPPC, CDNA, PHLN]. Develop policy on use of pre- and post-exposure prophylaxis for Healthcare Workers [CDNA]. Provide input on needs related to stockpile and the deployment of the stockpile. [e.g. GPs through GP Roundtable, AICCHOs, pharmacists, hospitals through S/T HD]. Antivirals: Consider the effectiveness of antivirals and inform policy on use accordingly. Consider any information provided on the effectiveness of antivirals and inform policy on use accordingly. Comment on the quality of evidence obtained concerning the effectiveness of antivirals [CDNA]. Disseminate in accordance with policy. Support dissemination of national advice on when to use antivirals and who should receive them [hospitals + peak bodies, such as GP organisations, NACCHO, ACEM, RANZCOG, RACGP].
Laboratory: Collaboration Support a collaborative public health laboratory network. Maintain communication with private health laboratory networks [PHLN]. Maintain a public health laboratory network. Maintain communication with private health laboratory networks. Provide leadership and consultation in aspects of public health microbiology and communicable disease control [PHLN]. Provide feedback on service provision. Laboratory: Capacity Build national laboratory capacity through the supply of laboratory equipment, tests and reagents, to meet identified gaps in capacity. Build jurisdictional laboratory capacity through the supply of laboratory equipment, tests and reagents, to meet identified gaps in capacity. Provide strategic advice to the AHPPC to identify gaps and needs in laboratory capacity [PHLN]. Support early detection and laboratory analysis of influenza viruses [labs, NICs, WHOCC]. Laboratory: Regulation Register new pharmaceuticals and vaccines as approved for use in Australia, following assessment of quality, safety and efficacy [TGA].
Public communication: Establish communication protocols for emergencies. Contribute to establishment of communication protocols for emergencies. Ensure effective communication systems and processes are in place. Endorse communication protocols for emergencies [AHPPC]. Contribute to public communication delivery. Support communications to CALD communities. Coordinate information delivery for the ACCHO sector and input feedback to decision making processes [NACCHO]. Establish capacity for sharing information within EDs and local medical officer waiting rooms (paper and television screen savers) [hosp + GPs + PHN] Institutional Settings: Overall Establish standards to promote the safety and security of people in institutional settings. Establish systems to promote the safety and security of people in institutional settings. Consider and endorse standards to promote the safety and security of people in institutional settings [CDNA, AHPPC]. Develop emergency plans for individual institutional settings.
Institutional Settings: Residential Aged Care Facilities Manage a system to promote the safety and security of people in aged care settings. Establish systems to promote the safety and security of people in aged care settings. Respond to outbreaks of influenza with RACF (Public Health Units). Develop policy for Public Health Unit response to RACF influenza outbreaks and develop guidance for RACFs for seasonal influenza outbreak prevention response [CDNA]. Meet Residential Aged Care Accreditation standards. Implement national guidance for RACF for seasonal influenza outbreak prevention and response. Develop and/participate in prevention and treatment response measures [Medication advisory committees in RACFs]. Develop emergency plans for Aboriginal aged care settings [NACCHO to support]. Liaise with S/T public health authorities. International Borders: Border control services Establish arrangements to provide services by Australian Government border agencies and jurisdictional health departments. Participate in arrangements for the provision of services to support border control measures. Make recommendations for use of border security measures. Advise on efficient models to support border control measures [CDNA]. International Borders: Legislative support Develop and maintain legislation to support implementation of measures at Australia’s international borders. Apply powers of appointed human quarantine officers as required. Consider and advise on legislative changes and interaction with S/T public health legislations [Chief Human Quarantine Officers].
International Borders: IHR Maintain IHR core capacities. Maintain National Focal Point (NFP) under IHR. Maintain IHR core capacities. Maintain communications with NFP according to IHR reporting requirements and quarantine service provision agreements. Contribute to IHR core capacities. Contribute to IHR core capacities. International Borders: Australian Medical Assistance Team (AUSMAT) Maintain a system to manage activation and deployment of AUSMAT for international support. Maintain a jurisdictional register of responders (for AUSMAT). Establish and maintain a list of GPs, nurses, paramedics and allied health staff available to support services in areas overwhelmed by the emergency through short term relief [relevant professional bodies, e.g. RACGP Disaster Management Network]. International obligations: Regional support to capacity building (planning) and to response [coordinated by AusAID]. Contribute expertise to regional programs. Technical advice from a range of national health sector bodies may be shared regionally (on request). Contribute expertise to regional programs. Table 20: Roles and responsibilities of the Australian Government, State and Territory Governments and the health sector during the Standby Stage. Standby Roles The Australian Government role is to The State and Territory Governments role is to The joint role of Australian Government and State and Territory Governments is to: The role of other health sector parties is to
Overarching role: Prepare national resources that may be needed to manage the pandemic. Coordinate information gathering and sharing about the virus and the emerging pandemic. Manage international obligations and borders. Prepare jurisdictional resources that may be needed to manage the pandemic. Coordinate communication at state and local levels according to national guidance. Support management of international borders by providing disease control expertise and health care services to ill travellers. Share information on resource availability [AHPPC]. Prepare guidance on case and contact management; chemoprophylaxis and education; vaccination; quarantine/isolation; risk assessment; infection control and use of antivirals [CDNA]. Prepare advice where relevant on interventions outside the health sector, such as social distancing measures [CDNA/ AHPPC]. Prepare organisational personnel and resources for changes in demand and service use that may be required to manage the pandemic. Raise awareness of communication channels [peak bodies].
Surveillance: Domestic surveillance Coordinate collection of jurisdictional data to monitor for the first cases of the new virus. Collect data to monitor for the first cases of the new virus. Share information with the Australian Government (specifics of data sharing arrangements negotiated in Surveillance Plan). Share jurisdictional data with State/Territory Minister and state and local level stakeholders. Interpret surveillance data and provide expert advice on status of pandemic [CDNA]. Develop and update surveillance case definitions. Case definitions will include a probable case, a confirmed case and a contact [CDNA]. Provide other guidance, may include duration of incubation and infectious period, and estimates of infectiousness ® [CDNA]. Establish testing priorities (who should be tested) [CDNA/PHLN] To support detection of the first cases, provide input into state/territory surveillance systems [GPs + hospitals] National Notifiable Disease Surveillance System. [GPs + hospitals + laboratories] To support detection of the first cases, provide input into sentinel systems (e.g. influenza hospitalisations; testing of [participating GPs + hospitals] identification of outbreaks in RACFs [RACFs] and other institutions including schools and childcare centres. Coordinate communication around case incidence and detection across the ACCHO sector [NACCHO].
International Surveillance: Collate and analyse international data to show emerging trends. Share information with the offices of the Minster for Health, Minister for Mental Health and Ageing, decision makers, WHOCC, public health professionals and the public. Share international data with relevant state and territory government agencies and other health sector parties Consider international data and advise on implications for Australia [CDNA]. Share data with healthcare members through representative organisations.
International Surveillance: At risk groups Analyse implications of international surveillance data in terms of at risk groups to inform national level decision making. Reflect the needs of at risk groups in national level decision making. Reflect the needs of at risk groups in jurisdictional level decision making. Identify (confirm) at risk groups [CDNA, possibly with additional expertise]. Establish a national case definition for an individual at risk of complications. Define the minimum data set so agreed parameters are collected across jurisdictions (taking into account jurisdictional capacity). Work in conjunction with other experts to provide tailored guidance for at risk groups (e.g. work with Health Senior Clinical Advisor and Health Quality and Monitoring Branch to develop guidelines for RACFs and childcare centre operators). [CDNA]. Raise awareness of anticipated at risk groups and their needs [peak bodies]. Infection Control: Infection control standards Confirm application of standard infection control standards, or advise of any recommended modifications. Confirm application of standard infection control strategies, or advise of any recommended modifications. Tailor Infection Control Guidelines to the risks relevant to this virus (if required) [CDNA with the support of additional expertise]. Confirm application of standard infection control standards, or advise of any recommended modifications [peak bodies].
Infection Control: PPE Prepare PPE in stockpiles for deployment (if held). Prepared to distribute PPE if made available from stockpiles. Prepared to support appropriate use of PPE as part of coordinated response. Prepare stocks of PPE for use, revise usage practices. Provide information and support education regarding supply of articles such as PPE and hand sanitiser [MTAA]. Health workforce: Ensure health workforce is aware of status of the pandemic, proposed approaches and any public health activities being undertaken during this stage. Ensure health workforce is aware of status of the pandemic, proposed approaches and any public health activities being undertaken during this stage. Ensure health workforce is aware of status of the pandemic, proposed approaches and any public health activities being undertaken during this stage [peak bodies]. Public Health Measures: Coordinate and facilitate preparation of nationally consistent and agreed countermeasures to protect public health. Prepare jurisdictional response activities such as influenza services, assessment & treatment centres, and other wider community interventions. Advise which public health measures should be implemented at this stage [CDNA/ PHLN/ Health]. Share information on resource availability. Consider, select and organise implementation of public health measures appropriate to this stage [AHPPC]. Prepare to participate in public health measures to manage the pandemic, while maintaining business continuity for essential services. Prepare arrangements for triaging [primary care]. Prepare arrangements for cohorting of patients [e.g. GPs (if appropriate), hospitals]. Prepare arrangements for reducing non-urgent work.
Immunisation: Pandemic vaccine program Develop pandemic specific immunisation program delivery strategy. Ensure needs of at risk groups are incorporated. Consider whether to activate existing Deeds for pandemic vaccine supply. Liaise with suppliers to ensure readiness to commence manufacture. Pre-deploy vaccination equipment (if appropriate) Provide input into development of pandemic specific immunisation program. Receive and manage distribution of vaccination equipment. Advise on development of pandemic specific immunisation program, including priority groups. [ATAGI/ NIC]. Immunisation: Candidate vaccines Provide advice on appropriateness of candidate vaccines to current pandemic, and appropriate target groups. [ATAGI + relevant experts]. Decide whether to commence candidate vaccine and which groups will be targeted [AHPPC]. Isolate potential pandemic vaccine viruses [WHOCC]. Antivirals: Monitor international sources for information concerning antiviral resistance. Monitor international sources for information concerning antiviral resistance [CDNA]. Monitor antiviral resistance [WHOCC. NIC].
Surveillance: International Surveillance Collate and analyse international data to show emerging trends. Share information with the offices of the Minster for Health, decision makers, WHOCC, public health professionals and the public. Share international data with relevant state and territory government agencies and other health sector parties. Consider international data and advise on implications for Australia [CDNA]. Share data with healthcare members through representative organisations. Confirm initial cases for WHO [WHOCC].
Surveillance: Escalation to national response Activate and manage National Incident Room. Report issues to the NIR which might foreshadow the requirement for a coordinated response. Escalate measures according to risk assessment appropriate to individual jurisdiction. Consider clinical, laboratory and epidemiological surveillance, resource and political information to determine whether a national response is required (escalate plan) [AHPPC]. Advise on thresholds for escalation [CDNA/PHLN]. Provide input into GP Roundtable. Provide input into clinical expert groups. Provide input through RACGP’s endorsed Disaster Management Network. Provide input through Public Health Medical Officers Network. Representative aged care providers/peak bodies to come together to provide input. Provide input into the Clinical Stakeholders Forum. Infection Control: Infection control standards Maintain appropriate infection control standards. Maintain appropriate infection control standards.
Health Workforce: GPs Seek input from GPs through GP Roundtable and RACGP Disaster Management Network. Ensure input is shared with S/T health departments. Provide GPs with information and seek their input through primary health networks. Provide GPs with information and seek their input through the RACGP Disaster Management Network. Share input received with Australian Government. Support RACFs [GPs, PHN] Support health practitioners as spokespeople by ensuring communication of relevant information [through GP Roundtable, RACGP Disaster Management Network and PHN]. Provide input into GP Roundtable [GPs]. Coordinate input from AICCHOs [NACCHO]. Disseminate information from consultative fora to general public, as appropriate. Communicate access and demand circumstances in EDs (EDs + ACEM). Health Workforce: Primary Health Networks Coordinate linkage of PHN into communication strategies. Communicate with PHN. Collaborate with PHN to fill identified service provision gaps. Support health practitioners as spokespeople by ensuring communication of relevant information [through GP Roundtable, RACGP Disaster Management Network and PHN]. PHN to support data collection and identification of gaps in services, additional resource requirements and vulnerabilities in patient populations relevant for their region [PHN to work together with local AICCHOs and other key groups]. PHN to have dedicated staff and call line to support health practitioners including resource coordination. PHN to liaise with local hospitals/EDs re demand, access and expectations.
Health workforce: Hospitals Consider widening prescription rights for nurses during the emergency, to include antivirals and other key medications. Establish and maintain public hospital system. Support hospitals in coping with increased admissions, increased acuity and access block. Consider opening more beds, cancellation of non-essential procedures. Support hospital systems to maintain essential services. Resuscitate and treat the sickest patients. Disseminate information to the general public [hospitals]. Implement triage, coordinate between services, manage patients and after-hours care [hospitals - EDs particularly central]. Health workforce: Other health practitioners Seek input through professional associations. Liaison with RACFs. Consider widening prescription rights for nurses during the emergency, to include antivirals and other key medications. Liaison with healthcare providers to provide information and seek their input on trends and the effectiveness of approaches. Support health practitioners as spokespeople by ensuring communication of relevant information [through relevant professional associations]. Provide input on the effectiveness of measures and emerging issues through professional associations. Disseminate information to general public. Community nurses, pharmacies and pharmacists will have a key role in information distribution. Public Health Countermeasures Auspice the coordination and facilitation of nationally consistent and agreed countermeasures to protect public health. Coordinate jurisdictional response activities such as influenza services, assessment & treatment centres, and other wider community interventions. Share information on resource availability and coordinate access to resources to maximise the effectiveness of the response [AHPPC]. Deliver pandemic measures as part of coordinated response and/or maintain business continuity for essential services. Telephone support of patients who choose to or are advised to undertake home quarantine, if this measure is recommended.
Antivirals Use national and international antiviral resistance patterns, disease severity data and data on at risk populations to inform policy on NMS. Coordinate administration of antivirals. Use national guidelines and health service capacity assessment to inform policy on jurisdictional stockpile items. Facilitate antiviral resistance testing [PHLN]. Conduct surveillance of antiviral adverse event monitoring [TGA/CDNA]. Provide advice concerning the use and distribution of antivirals [CDNA/ AHPPC]. Provide advice concerning the use of antivirals in infants and children, pregnant and lactating women [CDNA/AHPPC]. Prescribe and deliver antivirals according to NMS and state policy. Conduct resistance tests [WHOCC, NICs]. Provide input into discussions concerning effectiveness, and dissemination of antivirals [GPs, hospitals, pharmacists, WHOCC]. Use existing trial networks/academic collaborations to assemble and analyse evidence concerning current and best practice [academia].
Public communication: Consistent messaging Convey high level messaging to general public [Chief Medical Officer]. Convey high level messaging to general public related to jurisdiction specific measures [Chief Health Officer]. Share information and approaches to coordinate a consistent public message (such as hygiene, PPE) [AHPPC/ CDNA]. Support provision of quality health information. Communicate about risks and encourage behaviours which contribute positively to managing the risk of infection, such as mask wearing or vaccination [public and mental health experts]. Inform general public of high risk destinations if consulted re travel [GPs + travel medicine practitioners]. Public communication: Media engagement Liaise with states and territories re media. Liaise with Australian Government re media. Keep the public and the media informed during national health emergencies by providing consistent and coordinated media and public responses [NHEMRN]. Institutional Settings: Overall Work with state and territory governments to monitor the impact of the pandemic in institutional settings. Investigate and support outbreak management. Disseminate relevant information. Consider the need for additional action specific to institutional settings. Identify the appropriate bodies to undertake provision of this action/advice [AHPPC on advice from CDNA, jurisdictions, the GP Roundtable]. Work with state and territory governments and healthcare providers concerning outbreak management [as relevant].
Institutional Settings: Residential Aged Care Facilities Work with approved providers and regulatory structures of aged care to disseminate relevant tailored information. Liaise with S/T HD units with responsibilities related to the pandemic. Investigate and support outbreak management. Disseminate relevant information. Develop and maintain guidance concerning management of influenza outbreaks in RACFs [CDNA]. Provide additional support relevant to Influenza-like-illness. Distribute information. Liaise with S/T HD public health units, including reporting respiratory outbreaks and risks to residents from outbreaks. Consider advice and adapt practices accordingly [RACFs]. Develop and/participate in prevention and treatment Response measures [Medication advisory committees in RACFs]. Consider use of POC testing for early diagnosis, treatment and cohorting. Institutional Settings: Educational facilities Liaise with Australian Government education authorities. Investigate and support outbreak management. Disseminate relevant information. Liaise with state/ territory government education authorities. Provide advice through WoG processes on social distancing measures relevant to the school environment [CDNA, with other expertise as required]. Provide education on request [GPs, school nurses]. Institutional Settings: Military facilities Investigate and support outbreak management. Disseminate relevant information. Disseminate relevant information. Support outbreak investigation and management. Liaise with Australian Government.
Institutional Settings: Correctional facilities Investigate and support outbreak management. Disseminate relevant information. Liaise with justice bodies on relevant best-practice guidance with respect to control measures [CDNA]. Use knowledge of clients to identify individuals at risk of complications, support surveillance [e.g. GPs, NACCHO]. International borders If recommended, coordinate and implement border agency heightened activities [Health] identification awareness raising. Liaise with airports, airlines, seaports and shipping agencies. Provide officers to participate in implementation of border measures. Contribute expertise to implementation of border activities [e.g. Human Quarantine Officers]. Support implementation of border measures by providing health care to ill travellers identified by border measures. Determine the purpose of border measures under current circumstances and types of border measures to be implemented [AHPPC]. Advise on border related disease management strategies such as allowance of on-travel of identified ill travellers [CDNA]. Work with state and territory governments to manage and treat ill travellers identified at the border. International obligations: International Health Regulations (IHR) Undertake IHR reporting requirements. Maintain core capacities. Report IHR issues within jurisdictions to Australian Government. Contribute to provision of core capacities. Contribute to provision of core capacities. Contribute to provision of core capacities. International obligations: International liaison Communicate with WHO to obtain details regarding disease. Gather information through international relationships at state and territory level.
Standdown of activities Coordinate the development and implementation of an exit strategy to stand down enhanced measures. Consult across the Australian Government concerning scaling back of measures. Manage transition of processes into seasonal arrangements. Implement exit strategy relevant to measures taken on by state and territory government officers and agencies. Consult across jurisdictional government concerning scaling back of measures. Manage transition of services and processes into seasonal arrangements. Determine when to cease or alter enhanced measures [AHPPC]. Provide advice regarding stand-down of measures [CDNA]. Advise on appropriate messaging for responders and public concerning scaling down of measures [AHPPC/ NHEMRN]. Explain reasons for scaling back and how this will happen to practitioners [peak bodies]. Explain reasons for scaling back and how this will happen to public. Support implementation of exit strategy. Manage transition of services into normal arrangements (if altered). Evaluation Evaluate Australian Government pandemic processes. Implement changes as appropriate. Evaluate jurisdictional pandemic processes. Implement changes as appropriate Evaluate committee and governance processes. Implement changes as appropriate. Evaluate organisation/practice/business processes. Implement changes as appropriate