APPENDIX II

LETTER FROM MEDICAL OFFICER OF HEALTH, Toronto

January 29, 2002

Barbara Reynolds
Senate Clerk
Standing Senate Committee on National Security and Defence
Senate of Canada
Parliament Buildings
Ottawa, Ontario
K1A 0A4

Dear Ms. Reynolds:

Re:   Public Health Emergency Preparedness

As Medical Officer of Health for the City of Toronto, I wish to bring to the attention of the Standing Senate Committee on National Security and Defence some of the issues faced by local public health officials in Canada’s largest city.

As you are aware, the response to an emergency of any magnitude begins locally.  Local first responders bear heavy responsibilities as a result of being first on the scene, serving as incident commanders, and being public spokespersons while under intense media scrutiny from the earliest moments onward.  Yet local first responders tend to be on the margins of federal emergency planning, which only takes place in concert with provinces and territories.  Similarly, local emergency plans are developed and tested without the regular inclusion of federal officials, resources or expertise.  As a consequence, our collective ability to prepare for a major emergency in Canada is significantly diminished.  Lack of integration between federal, provincial and local emergency preparedness is a crucial gap that must be addressed, especially in a large urban centre such as Toronto.

Emergency planning has been a provincially mandated responsibility of public health units in Ontario for many years under the Health Protection and Promotion Act and the Emergency Plans Act.  In general, we focus on the prevention and control of situations that could present a health hazard to the general public.  This is accomplished through an extensive network of relationships with other first responders, hospitals, long term care institutions, physicians, laboratories, and community-based health and social service organizations.

In environmental emergencies (including chemical, radiological and nuclear threats), our role is to protect food and water supplies, to assess health risks, and to provide advice to the public to prevent or reduce adverse health impacts.  Operationally, Public Health plays a supporting role to Police, Fire and Ambulance services as well as to the provincial Ministry of the Environment.

By contrast, Public Health is the lead agency for emergencies involving biological agents, as in the investigation and control of outbreaks and epidemics.  In these situations, we conduct disease surveillance among hospitals and laboratories, investigate and counsel cases and contacts, and implement disease control measures such as immunization.  Other first responders usually do not have direct operational responsibilities in these situations.

However, in emergencies involving biological terrorism – whether a series of defined threats or a potentially massive outbreak of unknown origin – Public Health’s lead role to investigate and control the spread of infectious disease can conflict with the operational responsibilities of other first responders.  Recent anthrax-related events have demonstrated a clear need for better co-ordination among local first responders, health service providers at all levels, and various provincial and federal departments in the following areas:

·   sharing plans, resources and intelligence;

·   scenario-based contingency planning;

·   tabletop exercises, training and drills;

·   inventory management, distribution and deployment;

·  criteria and procedures for threat / risk assessment and associated protective measures for workers and the general public.

Generic and scenario-specific protocols are needed that emphasize communication and response coordination across related services.  For example, on-scene investigation and collection of evidence by police services must occur in a manner that enables relevant information to be shared with public health authorities, and vice versa.  This would enable both services to benefit where appropriate from the information and intelligence that has been collected during their respective investigations.  The use of a common planning framework (such as the Incident Command System) would also greatly increase our collective efficiency during the preparation, response and recovery phases of an emergency.

The January 1999 Report of the Special Senate Committee on Security and Intelligence provides an interesting perspective on some of these gaps.  The section on Nuclear, Biological and Chemical Weapons Attacks (p. 47) lacks any reference to public health needs or organizations, and its use of the term “first responders” refers largely to police, fire and ambulance services (p. 48).  The Report’s recommendations pertaining to first responders do also apply to some public health needs, such as those which recommend that the federal government:

·  support the training of first responders across Canada to identify and respond appropriately to a nuclear, biological or chemical attack;

·  ensure that first responders receive the protective and diagnostic equipment they require to respond appropriately to such an attack;

·  establish a national inventory of equipment and other assets available throughout the country to respond to a nuclear, biological or chemical attack;

·  conduct regular joint training exercises among staff from the Department of National defence, the Royal Canadian Mounted Police and first responders throughout the country; and

·  encourage the proliferation of training and equipping of first responders on the National Capital model or some enhanced version.

Unfortunately, from a local perspective it appears that these recommendations have only been partially implemented.  The National Capital First Responders Committee’s plans and policies have not been documented or disseminated in a manner that would enable other municipalities to learn from their experiences.  Despite recent federal and provincial budget announcements for enhanced emergency preparedness, first responders at the local municipal level do not yet have access to sufficient resources, training or in-kind support from any level of government to “ensure” they can respond appropriately to a nuclear, biological or chemical attack.  As well, information sharing across government levels and departments remains very limited.

Greater public health capacity from a national perspective also appears to be needed in areas that include:

·   real-time medical and hospital-based surveillance systems for the early detection of unusual disease patterns;

·   rapid epidemiologic investigation of biological or other incidents in order to assess the human impacts arising from a recognized health hazard and to identify and evaluate the effectiveness of risk reduction measures;

·   laboratory facilities (including containment procedures, reagents and training) for rapid analysis of suspicious packages and samples where high level biohazards are suspected;

·   stockpiles of vaccines, antimicrobials, personal protective equipment and related supplies;

·   regional deployment of the federal inventory of emergency supplies and equipment to support the implementation of contingency plans arising from foreseeable scenarios, e.g. through the development and testing of “push packs”, a concept already used successfully in the U.S.;

·   information and expertise on decontamination procedures, health risk assessments arising from chronic environmental exposures, and other aspects of consequence management;

·   critical incident stress management, risk communication and mental health support for first responders, other exposed individuals and the general public; and

·   review of current federal and provincial legislation to ensure that disease control measures requiring quarantine, the restricted movement of exposed individuals, and/or the designation of public or private buildings for isolation purposes can be undertaken quickly, effectively and with clear legal authority.

While the National Counter Terrorism Plan addresses lead agency roles at the national level as well as federal-provincial relationships, the plan fails to address adequately the role of first responders to terrorist incidents.  National security and emergency preparedness discussions in Canada appear to be dealt with largely through federal/provincial/territorial processes that have no local representatives.  A case in point is a recent national consultation by the federal Solicitor-General to identify needs and gaps in emergency preparedness.  The choice of representatives at these consultations was at the exclusive discretion of each province; Toronto Public Health was informed of this process only by chance and after the final report had been written.

In Canada, a municipal government may request additional assistance to respond in an emergency from their province and then, if needed, from the federal government.  During and between emergencies, the federal government plays a supporting role to provinces and has no direct access to a local municipality except through the respective province.  Reliance on standard federal-provincial arrangements to plan and prepare for emergencies has precluded the development of a national approach that is inclusive of local first responders, including Public Health.  The Canadian system of “bottom-up” response under provincial control stands in contrast to the United States, where emergency response is clearly a top down approach.  The U.S. government provides on site response in the aftermath of an incident as well as training and resources for local emergency preparedness in accordance with national standards.  Clearly a stronger federal role and local presence is required in Canada as well.

Cities hold strategic importance for the country as sites of critical infrastructure, as potential terrorist targets, and as major population centres.  Conversely, cities have the potential to be an invaluable resource to other levels of government and to smaller municipalities.  Strong local capacity to prevent, contain and reduce the impact of an emergency has a direct bearing on the responsibilities and resource implications that would otherwise accrue to the provincial and federal governments.  Major Canadian cities should be included as direct participants in federal emergency planning as a matter of national importance, as our inclusion can no longer be left solely to the discretion of provinces.

In summary, stronger federal support for local first responders, including Public Health, will assist governments at all levels to discharge their responsibilities more effectively and to reduce future costs to Canadians.  Promising efforts are being made by Health Canada and the federal Solicitor General in this regard and should be recognized and supported.  Nonetheless, jurisdictional sensitivities are a heavy obstacle to the proactive sharing of information and resources, even in the current environment of heightened political will among the major players to work co-operatively.  The needs of local first responders, as well as the knowledge and expertise that is resident among them, must receive stronger recognition, and measures to ensure their direct participation in future federal planning activities must be developed.

I hope that this information has been useful and will inform the Committee’s deliberations in a manner that helps to address our needs.  I look forward to your final report.

Yours truly,

Original signed by Dr. Basrur

Dr. Sheela V. Basrur
Medical Officer of Health

cc:     Scott Dudgeon, Executive Director, Toronto District Health Council

APPENDIX III

PEOPLE APPEARING BEFORE THE COMMITEE