Joint Regional Meeting Organized by the Sri Lanka Medical Association In Collaboration with University of Huddersfield, UK and
Kalutara Clinical Society, Teaching Hospital, Kalutara “Disaster Preparedness in Hospitals: The Next Wave of Emergency Preparedness in Health Care”
Good afternoon ladies and gentlemen first of all thank you very much giving me this opportunity and Society so during next few me so I will be talking about outbreak response and how clinician can help during the outbreak situation and I’ll be talking about uh practical aspect during the outbreak and uh what
We expect as a consultant in public health from you as a clinician in the P sector during the outbreak scenario and mitigation process so during my presentation I’ll touch upon these three areas mainly first describe what is an outbreak and phases of outbreak and lastly during the
Man I sayal it is not limited to doctors working in the curity SE uh I mean health government Health institution or th kalut but clinician working in the private sector and also General Practitioners can play crucial role in outbreak Management in given scenario so what is an
Outbreak so outbreak can be defined as occurrence of the particular dise the particular disease in excess of what we would normally be expected so I have highlighted few words here excess amount of cases from what we normally be expected in the defined population the Define time frame this is very important
Normally outbreak can be restricted for The Limited jeal song such as small jeal song such asion Phi division or sometimes it will expand or go away from that particular source and spread for the several region District or sometimes process the boundaries and spread several countries at the end can
Spread all over the world all over the globe as you experience du during the co pandemic and duration again it’s vary from disease to disease it will take few days sometimes week some sometimes months or as you sh seen in a CO pandemic we last for more than years or
Sometimes will last for even decades so how we do how do we know whether there’s outbreak or not so normally most of the time we have our uh surveillance disease surveillance data for the most of the disease this is uh d uh cases report over the period of
Time across the year so you can see we we identify the pattern So based on the existing data collected throughout the period we can predict statistically the Baseline the expected level for the given population and given given on the Baseline even up to the Phi level we can
Predict so we know the Baseline if we getting more and more cases we know that there’s a outbreak is going on so then we have to act upon so we can say you can see outbreak dingo outbreak always correlated with two monsoon season we are getting during the year also the outbreak it’s
Not uh we are not uh going to talk about the huge number but sometimes for the some dis even a single case is considered as an outbreak if you consider the malaria we know the malaria has been eliminated uh I think from 2012 and we received the elimination certificate in
2016 so however we continue the uh surveillance system so in that case even a single malaria case is considered as an outbreak you don’t need to have a huge number so if you have a PO case single case is an outbreak and also the disease caused by the unknown agent
Maybe bacteria fungus or virus previously unknown for is also considered as an outbreak and if you have unknown disease privileged unknown disease that is also considered as an outbreak that is a Bas sign information regarding an outbreak and there are three phases there are three phases of
Outbreak so those three pH are inter related interconnected in terms of outbreak management the number one threee outbreak faes which is called as preparedness phace and then the outbreak response phace and the post outbreak pH so if you don’t do the preparedness phas you can’t do your maximum during the
Response phas and also you have to evaluate the situation during the PO out outbreak period and you have to take the corrective measurement during that phas so those are the three phases so each phas you have specific role as a clinician the regarding the prepar place
As you know from the morning we talk about the Readiness and preparedness the time to time we are getting alert from the certain authorities from the local authorities as well as the foreign agencies you have to be vigilant you have to keep your eye open to the those Trend
Impending trend of the outbreak and uh you are getting certain information locally as well as globally and you have to assess Your Capacity this is the period you have to build your capacity within your institution your Readiness need to be enhanced you can conduct your training within the institution and you you
Should have a treatment guideline you can’t take hpet decision during the outbreak therefore you should be ready with the guideline what to do and what not to do right so also you have to ensure the availability of the clinical uh guideline and the medicine other requirement at last most important thing
Is it should be able to coordinate with the relevant authorities so I do believe it’s a high time to have good communication between the Curative sectors and the privative sector in terms of outbreak management because we need your support I think you need our support as well during this phase this is also
Called as a self system capacity building period so the in this space you can prepare your team Your Capacity and enhance your Readiness to counteract with the future outbreak in in so this is based on Research so if you enhance the health system capacity prior to the outbreak you can
Reduce you can reduce the impact of the outbreak this is a normal epidemic curve so if you prepare to the outbreak you can reduce this much of impact so you can reduce a HEC burden and health care cost which is most important current context in our country
If you well prepared you can reduce the cost and burden so this is based on evidence and this is why it is important the preparedness pH of the outbreak so during the response phase the phase number two what can clinician do so normally patient come to you are
The people who are the first line contact with the patient do you have to have a proper assessment actually you have to go back to your medical student period you have to take the proper history examination and investigation when I say history all the component of History are important social history
Family history contact history travel history all those things are very important in outbreak right so then sometimes you need to isolate the patient you have to provide care and treat the and do the proper Examination for certain cases you should do lab laboratory investigation so again based on
Literature and research evidence if you early resp to the case and early response during the outbreak you can prevent this much of potential cases you can PR this much of potential cases if you see early and response early detect the case early and treat the patient early and Report the PA case
All the cases early as possible you can reduce this much of potential cases so see how can we do if you well prepared and act upon as early as possible so therefore start treatment early as possible based on the clinical guide and you can’t do the he thing as I
Mentioned earlier so you have to do you have to abide or adhere to the clinical guideline and important thing is you have to report each and every case that is where you are lucky I think as a clinician you do your maximum actually more than maximum more
Than 100% for the patient you think your duty is to treat and cure the patient but sometimes you forget to always tend to forget to report the case that is most one of the most important component during the outbreak management of course you have to isolate certain cases and
Certain preventive measurement can be started within the institution itself you have to isolate the cases certain cases quarantine the patient and vector control activities can be initiated from the institution itself and prevent contact with the vector especially in terms of when we consider Dy cases and we have practice uh certain
Henic practices within the institution not only that as a treating clinician your responsibility is to educate the patient and empower the patient so during during the outbreak the patient come with the different kind of myths belief and different sort of psychological distress patient answers distress and sometimes uh the uh
Sometimes they forget to add here to the medical advises and do some uncertain unwanted things so then your duty is to educate and empower the public and combating with the Mal uh Mal information misinformation so basically uh outbreak response can be divided into main two arms immediate control measures which
Include treat prophylaxis vaccination and so on and you have to do the pro further investigation so idea is to do the further investigation is to identify techological agent mode of transmission and vehicle of transmission and identify the source source in the field that is the one of the most important thing is out
Management to do that we need information as a public health professional we need information we need person type Place information so while treating the patient we need that kind of information from your side to our side why we need we have to have a proper analysis so person place and time analysis we
Evaluate and we do preventive measurement simultaneous while you are treating the patient within the institution we are taking preventive measurement in the field those aspects are very important in outre prevention so those are this this is the picture of our normal notification uh system this maybe uh
Confusing you so to simplify the thing what you can do now once the patient come to you you treat the patient you say same time you collect data and that collected data need to be sent for the our our PA our system preventive sector so normally we gather information
Simultaneously we do field investigation and corrective measurement at the field level the same time we send information to the National level and National level the information will be analyzed evaluated and they take poliy decision and send back to you so you are initial information is very crucial if you don’t
Take the information and send to the US within the given time frame we can’t take the decision at the field level as well as at the national level so there are common mistake happen during the outbreak so normally we expect you to report or notify the notifiable case on supicious
So by why we need that to provent to prevent further spreading of the disease you have to notify the case on suspicious you don’t need to wait till the confirmation and also incomplete information is another problem legible handwriting and poor quality of the notification system is a
Problem so we can’t identify the patient within the FEI and late notification so most of the time the notification is when the patient is discharg so no point so we have to have information as early as possible to take mitigation action at the field level so therefore notification of all
Suspected notifiable diseases very important T to be done on susp we need quality information to control the corrective measurement at the field level so normally this is the notification form to be honest I hatte it when I was a house officer right but now I realize the import of this
Actually very this is very important to fill this notification form at the at the institutional level and send it to the us as early as possible so what we do at the field level once you send the information to the uh for the preventive sector as preventive sector worker now
We go to the field level nowadays we use the technology use g g system so we are doing mapping so you can see several red dots here and there this is a map of area and which includes several gr division so this is related to the Dy cases now
We once you receive the information we go to the field and we do the corrective measurement at the field level and also we are mapping these things and you can see the S clusters here the one cluster another cluster another cluster what happen if you do if you don’t take
Corrective measurement here the disease will spread further this is not this is at the moment this confined to the this particular Phi or actually division but it spread further so what will happen you will get more and more cases your people will be overburdened there will be more healthare cost for the institution
So that kind of information is very important that this is another example this is for the me so as you know we have meel epidemic during last last year actually the missiles has been eliminated from the Sri Lanka and we received the elimination certificate in 2019 but unforunately due to certain uh
Group of people again the missile reappeared it it uh started in columus CMC area only the single case detected around May last year but within two month it will spread all over the not all over the country basically in the western Province then the Southern and some Spar cases around the country and
Also the jna so once you receive this information from your side we are mapping so we mapping and take decision based on this evidence so we conducted last January we conducted M special vaccination program this decision was taken based on evidence this is called evidence based decision so vaccination program
Conducted only in the western Province and part of the the southern Province only G and M district and then Justa and some part of the kagal district So to that that kind of policy decision we need information so that information coming from should come from
The U so that is why I’m again and again emphasizing so normally what is happen you treat and send information to us if you don’t do that what will happen if you don’t do that the disease will spread all over the place in the field and what what will happen next you
Will get more and more cases you will get more and more complicated cases you have to put more attention on those patient you have to put more money more resources more manpower ultimately your people get a exhausted right then what will happen we are getting more notification at the end our
People also get exhausted so ultimately become vious cycle so after that outbreak is out of control we can’t control outbreak anymore so therefore the initial step during the outbreak is very important and your role is very important little bit of resource mobilization during outbreak actually the out bre is an
Emergency so sudden onet we have limited resources therefore we need your help we need to conduct several vaccination program we have to establish certain uh camps quarantine centers for that you need pral support actually we received during the pandemic so uh in addition to that during next few
Slide I want to talk about few specific diseases starting from the malaria why I’m talking about this is because Sri Lanka is malaria three country at the moment we don’t have endogeneous area within the country however it’s as a clinic treating physician your all needs to take the proper uh involved in the
Surance system why I’m saying this because last year we had a malaria death within the country which occurred in the draining Z of the pH C right so patient had a travel history to the African country but Tean treating physician forgot to ask travel history it’s been treated by the several
General Practitioners but by the time was diagnosis made it was too late a young person passed away due to malaria but I think it’s very important to have a travel social history and contact history you come across the fever patient please ask travel history as this is this is the area especially K
Draing zone is one of the most vulnerable area due to the travel and training and so many people are traveling to the epidemic countri especially Africa for the business purposes so if you come across the patient with the history with history of travel his with the fever always suspect
Malaria so even a single malaria cases and outbreak so then I want to talk about leprosy know that lepr at the moment lepr is an outbreak especially in the cost s starting from Mor then then up to down south so we have excess number of Le cases so when you as a general
Practition the treating the teaching where you if you come across such case if you suspect please refer them to the Dermatological clinics normally for the Le we have collaborative action with the Curative sector and the pr sect normally Dermatological they identify the leprosy case they send information to us so our
Phi and our go to the household level and they visit visited the places and contact facing can be done if you identify the contact then it is easy you to treat the patient at the institutional level it’s kind of collaborative kind of activi so to do that again we need
Datais again the epidemic outbreak this is the estimated number of the TB cases but at the moment we are dealing with t of the outbreak we detected less than expected so there are so many TV cases within the community they are not treated so they are not
Identified so to count the problem we have identified several healthare institution and teaching Hospital C is one of the institution so we expect especially medical officers working in the OPD session if you come across patient uh coming the fever and for for more than two weeks please suspect TB so our
Indicator is you have to send at least 2% of the total op attend to the for the investigation at the moment when I visited last week it around 1.2 or 1.3 so the target is 2% if you come across patient with the for more than two weeks please send the sample please
Uh send patient sample to the for the TB test that’s how we can identify unknown TB taste this is called presumptive TV suspect TV so during next few minutes I will talk about acute injury what do you think about this is not the communicable problem but acute injury itself also
Considered as an outbreak so we need according to your data the dog bites animal bites RPA and domestic of the most prevous however this is severely under reported this is a normal form but it has to be filled by the treating physician at the institutional level these are the information we have
Received so according to the last year last year data uh there’s high amount of faults domestic faults and stuck by other object going increase and why we need this information once you rece weed this information to the medical officer of non-communicable disease we send it to the National level but Sim we take
Mitigation action at the field level so last uh December uh we had six or seven drowning cases around the lagon cultural lagon after weed those information we visited the places and we take multi sector we we took certain action with the several stakeholders in fact police Navy and people from the divisional
Secretary area involved in the process at the moment there are certain steps have been taken and so far we don’t have single case within that Vis so uh those things need to be emphasized so uh in summary I would say the outbreak need to be mitigated with the collaboration to
Action from Curative sector and the preventive sector and your participation is very important your information is very important your time information is very important and we should have a poora to action in future thank you very much