Pandemic relief

Tom Imrie
June 09, 2009
By Tom Imrie
The Toronto Police Service (TPS) Occupational Health and Safety Program ensures that all police officers and some civilian staff are trained in managing the risk of communicable disease and appropriate personal protective equipment (PPE).

The Toronto Police Service (TPS) Occupational Health and Safety Program ensures that all police officers and some civilian staff are trained in managing the risk of communicable disease and appropriate personal protective equipment (PPE).

The program provides PPE to every patrol officer and some civilians deemed at risk as a result of their duties, such as court security officers and staff who clean the insides of police vehicles. The equipment includes ‘officer safety kits,’ contained in pouches on an officer’s duty belt, which contain antimicrobial gloves, antiseptic towelettes, saline solution and a one-way CPR air mask.

Higher-level kits are stored in the trunks of patrol vehicles and include enhanced PPE such as N95 masks, protective eye wear, waterless antiseptic hand wash, needle debris containers, Tyvex or similar material coveralls, heavy duty rubber gloves and biohazard storage bags for contaminated clothing. This is considered basic equipment and available to all members who may be exposed to communicable diseases.

The capability to identify which officers are issued enhanced PPE was one benefit of the lessons learned during the SARS epidemic and from events such as anthrax hoaxes.

Through risk assessment, the TPS determined there was a need for officers who may be called to respond to natural or manmade public health emergencies. To prepare, the department trained and equipped specific forensic identification officers in Level 4 Hazmat and issued them positive pressure self-contained breathing apparatus (SCBA) and full coverage, total isolation biohazard containment suits. They were then trained to recognize, assess and control biological hazards.

In a biohazard emergency, whether natural or man made, the officers will mitigate biological hazards through appropriate means (e.g., containment, isolation, decontamination) and then investigate the cause of the event, including packaging and collecting evidence of the offence.

The department has also similarly trained and equipped officers who investigate clandestine drug labs and “hydroponics grow” operations. These officers can be deployed to assist in natural and manmade incidents. They are provided with SCBA, Level 1 Hazmat suits and evidence collection and packaging materials suitable to the risks present. This model has been adopted throughout Canada.

This type of program gave the TPS an advantage during the SARS outbreak. All officers were supplied with PPE and the occupational health and safety unit communicated regularly with them.

“In spite of more than 1,500 documented high-risk contacts,” then chief Julian Fantino wrote, “not one member of the TPS contracted SARS through an occupational exposure.”

Police officers were sent to hospitals in the beginning of the outbreak to secure checkpoints and enforce safety protocols. Once the situation was deemed under control, hospitals employed their own security staffs to carry out those assignments. The TPS also had to re-prioritize calls due to a personnel shortage caused by the quarantining of officers as well as the additional responsibilities they undertook.

“The biggest operational impact of the SARS outbreak on the Toronto Police Service was on its own personnel,” Fantino noted. “More than $560,000 was spent on quarantined members, overtime and call-back expense. More than 15,700 person-hours were dedicated to SARS-related duties.”

Fantino concluded the article by grouping lessons learned into nine categories. Below is a chart developed by PERF that summarizes his analysis. Pandemic planning

Subsequent to the SARS outbreak, the TPS took the lessons learned from its experience and created a draft Public health emergencies/ Pandemic response plan, written with the assistance of several agencies, including the public health department, fire and EMS. TPS also sought guidance and information from provincial and federal agencies to ensure that plan components were within the framework of other governmental and law enforcement partners in the Greater Toronto Area.

Both the occupational health and safety unit and the emergency planning operations section of the public safety unit are responsible for maintaining the plan. The most current draft, used for this case study, was updated on December 15, 2006 and, at the time of this writing, had yet to be approved by the chief and police services board. The plan is divided into five main sections: situation, mission, execution, administration and communications (the last section only provides contact information for PCC staff and is not covered in this case study). Situation

The first section provides a general overview of influenza and the planning being conducted by the World Health Organization, provincial authorities and Toronto Public Health. The impact a pandemic would have on the city is presented, accompanied by a table showing estimated morbidity and mortality range totals (based on 15 and 35 percent infection rates). The section concludes with an explanation of WHO’s pandemic phase designation; at the time this document was prepared, the world was categorized in Phase 3 (pandemic alert), with no or very limited human-to-human transmission of the bird flu. Mission

This section lists the TPS mission statement and mission objectives during a pandemic or other public health emergency:

Provide priority-policing services,

Act as a sentinel agency and share information with health officials,

Provide command and control over policing operations,

Provide personal protective equipment, best health practices and up-to-date health information to TPS,

Provide specially trained and equipped response teams to calls that refer to a person’s sudden death,

Provide alternate staffing models to address personnel shortages,

Assist public health with the safe delivery of vaccines/treatments.

Execution

The bulk of the draft plan is contained in this section, which details when the plan will be activated and procedures that will be followed by police personnel. The pandemic plan can be activated when WHO declares that the phase of alert has reached level 5 (evidence of significant human-to-human transmission) or once TPS has been notified that a pandemic is pending in the area. TPS will be notified by either city or provincial health representatives. Once the police command centre (PCC) is activated, a senior officer will serve as a liaison officer between it and the healthcare divisional operations centre (HDOC). Based on the vetted information provided by this officer, the PCC will be the sole source of health information to TPS.

Typically, the chief of police reports to the city’s emergency operations centre, leaving a deputy chief in charge of the PCC, which will be staffed based on the incident management system organizational chart. The primary operational response is split into two commands – area field and central field – which are led by their respective staff superintendents.

Each TPS unit/division must report twice daily all sick notifications and current daily strength. The PCC will deliver daily situation reports and major event logs and will report all health information and recommendations to front line and support units. Dealing with quarantine, mass deaths and staffing changes

A breakdown of quarantine strategies (for TPS members, community members and prisoners) is also found in this section of the TPS pandemic plan. As previously mentioned, TPS members who are directed to be quarantined – where it is determined to be as a result of occupational contact – will be compensated as if they were “on duty” during their regularly scheduled shifts.

Either a medical officer of health or the TPS medical advisory staff can order a police employee to be quarantined. Members must immediately report this to the occupational health and safety unit, which will determine compensatory next steps with the medical officer of health.

If a member of the public does not comply with a quarantine order, police may be called upon to enforce them. Toronto’s Health Protection and Promotion Act is summarized in this section of the TPS plan and it states, “The police force shall do all things reasonably able… to locate, apprehend and deliver the person in accordance with the order” (p. 16). The plan states that prisoners who show signs of illness (or those arrested under a court order) must be taken to the hospital for admittance. TPS is responsible for guarding these individuals until they can be looked after.

Next, the role of quick response teams in dealing with mass deaths is described. Teams will be available 24/7 to respond to calls (with Toronto EMS) at private residences where a person has died. They will work with EMS to determine if the death was potentially the result of the bird flu, notify the coroner and record the event for police records. (A pandemic- specific field death report that would be completed, along with a sudden death report, was being developed by TPS at the time this document was prepared.)

The plan notes, “These teams shall require a suitable number of rehabilitation breaks due to the stress of wearing personal protective equipment for extended periods of time.”

The next section deals with redeployment and staffing changes as a result of “severe staff shortages.” Staff at the PCC may choose to implement a 12-hour shift schedule to make up for these shortages. Further, all leave may be cancelled and those working in plainclothes or support roles may be redeployed. All training would likely be cancelled and responses to lower-priority calls for service might have to be suspended. Administration

This section of the TPS pandemic plan lists the hours of operation and staffing plan of the police command centre. Currently, the plan calls for – at a minimum – an inspector, civilian planner and uniformed sergeant from the emergency planning operations section. As the incident escalates, the following staffers could be added:

  • One officer from operational services,
  • Two officers from field planning,
  • Two members from occupational health and safety.

Daily situation reports indicating the number of sick members, available on-duty members and a synopsis of challenges encountered during the shift must be submitted to the PCC. The number of sick or absent members will be tracked in order to determine “Hot Spots” of illness within TPS. Conclusion

Toronto was in the early stages of planning for a pandemic when the SARS outbreak took place. Planning resumed at the end of the outbreak and the city incorporated the lessons learned into its pandemic plan. The police service followed suit, emphasizing the following in its draft plan:

  • Training all personnel in daily PPE use and general disease prevention,
  • Employing one person to serve as the liaison between the police and health communities in the event of a public health emergency, working with city emergency management to respond to sudden death calls,
  • Paying quarantined members who had been exposed to a pathogen while on duty as if they were on duty,
  • Incorporating pandemic-specific planning elements into its existing plans.

Future directions

At the time this document was released, the TPS was in the process of:

  • Obtaining approval of the draft plan from senior level officials,
  • Finalizing information on family readiness strategies,
  • Finalizing and obtaining approval on a “Pandemic Field Death Report” form.

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