The requirement to respect autonomy - The Royal New Zealand ...

improving performancetamivir but not sufficiently ill to visit the ’FluCentre were recognised as special groups. Systemswere set up so the patient’s usual GP couldeither visit using appropriate personal protectiveequipment, or use a comprehensive telephoneassessment and then arrange an Oseltamivirprescription.CDHB secondary carePandemic plans had anticipated an overloadingof hospital services. Red and green streams wereestablished for admission through the EmergencyDepartment and dedicated ’flu wards wereestablished. A staff ’flu clinic was established andprovided advice, post-exposure prophylaxis andprompt treatment of unwell staff. High risk patientsattending hospital outpatient departmentswere identified and offered prophylaxis.for secondary care patients, with a correspondingrestriction in use of testing in the community.Civil Defence EmergencyManagement / WelfareRegional communication and coordination oflocal authority Civil Defence and EmergencyManagement (CDEM) functions were providedby the Regional Emergency Management Office(EMO), consistent with the National PandemicAction Plan 4 and MCDEM Pandemic PlanningGuide. 8 A website was established for registrationof volunteers and arrangements were madefor volunteer efforts to be co-ordinated by localauthorities with primary care input.The Regional EMO’s Emergency ManagementSurvey provided information on the community’sDespite the considerable impact of the H1N1 09 virus inCanterbury, health care services were not overwhelmed. TheCanterbury H1N1 09 response was based on extensive planningand strong relationships formed well before the pandemicThese measures, the relatively mild nature ofmost cases of H1N1 09 and the diversion ofpatients with influenza-like illness (ILI) to the’Flu Centre meant that most hospital services, includingthe Emergency Department, continued tooperate relatively normally. The notable exceptionwas the Intensive Care Unit, which operated overcapacity for a significant period.LaboratoriesLaboratory services guided clinical and publichealth management of cases and contacts andinformed surveillance. CDHB’s CanterburyHealth Laboratories provided both a local and aregional service. Laboratory staff were closelyinvolved in the development and ongoing reviewof clinical testing guidelines, which were a keytool in management of demand for laboratoryservices. During the ‘manage it’ phase there wasan increasing focus on use of laboratory servicesexperience of both influenza-like illness andinterruption of access to resources. A second surveywas conducted by CPH, and rolling surveyswould have continued if required.Lessons and messagesDespite the considerable impact of the H1N1 09virus in Canterbury, health care services were notoverwhelmed. The Canterbury H1N1 09 responsewas based on extensive planning and strongrelationships formed well before the pandemic. Inparticular, monthly intersectoral pandemic planningmeetings had maintained engagement acrossthe sector, which in turn laid the foundations forrapid response activation and adaptation of existingplans in response to the particular characteristicsof the H1N1 09 pandemic.The CIMS was adopted by both the CDHBco-ordination team and a number of participat-VOLUME 2 • NUMBER 4 • DECEMBER 2010 J OURNAL OF PRIMARY HEALTH CARE 327