Preventing pandemonium: pandemic preparedness planning and communicable disease outbreak management in a university setting.

• Author: Grundy, Lorie
• Position: Canada

The prospect of a possible influenza pandemic (1) spurred the senior administration at the University of Alberta to commission a Public Health Response Committee [PHRC] (2) to develop a Public Health Response Strategy (Strategy) (3). The PHRC began work in January 2006 to develop a decision-making model, business continuity plan, human resources plan and communications plan that would be operationalized in the event the University faced a major public health event. This article provides an overview of the ongoing development of the Strategy. As well, it describes how a recent outbreak of norovirus in a large student residence enabled the emergency response team to apply and assess the Strategy during an actual public health situation. Key lessons learned relate to the importance of raising awareness and understanding of emergency preparedness and response on campus, crisis communications practices, and adequate provision of resources related to emergency preparedness and response.

Background, Development of Ethical Principles, and Survey of Knowledge and Attitudes

The PHRC is a multi-disciplinary team with 27 representatives composed of students, faculty and staff from key areas of the University, and from external agencies, including the regional health authority for the region (Capital Health) and the Alberta provincial government. In carrying out its mandate, the Committee's priorities include an emphasis on planning for and ensuring, insofar as is possible, the health, safety and security of staff and students, maintaining the essential services of the University, and communicating effectively with stakeholders and partners, including all levels of government.

Governments and institutions, including the University, will be called on to make difficult decisions in the event of a serious public health event such as a flu pandemic. Thus, a key component of the Strategy has been to identify a set of ethical principles to facilitate ethical decision-making in the best interests of the University community, as well as the community at large. The following "NOFLU" ethical principles were drafted after a review of the literature regarding ethics and public health. (4) They have been adopted by the PHRC in its approach to developing the Strategy. NOFLU will guide decision-making in the event of a public health emergency:

1. Need to protect: While there is a need or duty to take steps to protect the community generally (see utilitarianism below), there is also the need or duty to protect those who incur risk for the benefit of the community, to protect vulnerable populations within the community, and to uphold or protect individual rights and freedoms.

2. Openness: Decisions should be made in an open and transparent manner, with clear lines of accountability. Decision-makers should provide information on how decisions are made and on what basis they are made as much as is reasonably possible. The University community (and, where appropriate, the larger community) should be kept informed, and decision-makers should be open to revisiting and revising policies as new information arises.

3. Fairness: The principle of fairness should inform both the process of decision-making and its substantive and procedural outcomes. Decision-making and priority setting should be fair processes and include consultation with stakeholders where appropriate. Outcomes should reflect a fair distribution of the benefits and costs. Procedural fairness carries an obligation to provide protections to those whose rights or liberties are restricted in an attempt to protect the well-being of the community.

4. Least-Restrictive/Proportionate: In the process of decision-making, if there is more than one option that would achieve a particular aim, the least restrictive alternative should be chosen. This does not mean that decision-makers must choose the least restrictive means if it may lack effectiveness compared to other options in a given situation. Rather, the choice must be proportionate. In the absence of full information, decision-making should be taken on a precautionary rather than an evidence-based model.

5. Utilitarianism: Decisions should be made to achieve the greatest benefit to the community.

   Some members of the PHRC also created a survey, which was administered to all students and staff of the University of Alberta (5). Questions were posed around issues such as knowledge of transmission, prevention and treatment of influenza. Opinions were also solicited around matters like willingness and the perceived duty to volunteer during a pandemic, as well as how scarce resources should be allocated. This was done to gather information about knowledge and attitudes in order to assist in planning for education, and the development and implementation of the Strategy.

   University of Alberta Emergency Response Structures

   Within the University's Integrated Emergency Management Program [IEMP], the Emergency Operations Centre [EOC] provides the focal point for leadership, coordination and active support of the emergency site response. In addition to providing critical support, the EOC maintains oversight duties protecting the needs of the University as a whole during an emergency event. Actions taken by the EOC may include determining levels of response plan activation, mobilization of resources, issuance of warnings and directions, provision of aid, coordination of building and facility damage assessment, security/protection of property, and communications. In the event of a flu pandemic or other serious public health emergency, the Strategy provides for the creation of a Public Health Response [PHR] Incident Commander to provide leadership and management of the crisis from within the Emergency Operations Centre (see chart 1). The PHR Incident Commander and the EOC Director are charged with keeping the Crisis Management Team (Provost, President, Vice-Presidents) informed and briefed in order to make critical decisions, give policy direction and interpretation, and provide a spokesperson for media relations during a crisis.

   Key Components of the...