DESIGNATED HOSPITAL GUIDE

Transcription

1 DESIGNATED OSPITAL GUIDE

2 i About This Guide The information contained in this Designated ospital Guide is accurate at the time of publication. Please note that some details may change in the period between publication and the TORONTO 2015 Pan Am/Parapan Am Games. This edition of the Designated ospital Guide will be published in electronic form. Welcome Welcome to the TORONTO 2015 Pan Am/Parapan Am Games. This is an exciting time, when sport and health will intersect, bringing this province a legacy of coordination for emergency preparedness and a spirit of medical volunteerism. During the Games, training and competition venues, satellite accommodation and the Athletes Village will span more than 30 venues across 16 municipalities in the Greater Golden orseshoe region of southern Ontario. Our medical services planning has been meticulous and always with a focus on evidence-based athlete care. Our host medical services team will include approximately 2,000 dedicated volunteers from a multitude of professional health care backgrounds who have been selected for their clinical and sport medicine expertise. Our volunteers will be providing comprehensive health care to over 10,000 athletes and officials. The host medical services model has been designed to provide the best possible health care to all athletes, coaches, team officials, technical officials, as well as the Pan American Sports Organization (PASO) and Americas Paralympic Committee (APC)/International Paralympic Committee (IPC) Family, workforce, spectators and members of the local and international media without impacting significantly on the Ontario provincial health care system. This includes an electronic medical record system designed to provide seamless health care between venues and the Polyclinic, partnerships with designated hospitals, municipal ambulance services and medical sponsors. Our inter-professional team will be able to provide appropriate and effective care in a timely manner across our Athletes Village, satellite accommodation and venue footprint. The term designated hospitals stems from the Olympic model where pre-games planning and service agreements provided the foundation for collaborative Games-time health care partnerships. I look forward to working with all of our hospital partners, learning about your unique programs and meeting your dedicated staff. We look forward to meeting and exceeding the high standards of care that have been provided at previous Pan Am and Parapan Am Games. I wish you all a safe, healthy and successful Games. Kind regards, Julia M.K. Alleyne BSc(PT) MD CCFP Dip. Sport Med FACSM MScC FCFPC Chief medical officer, TORONTO 2015 Pan American/Parapan American Games Organizing Committee (TO2015) DESIGNATED OSPITAL GUIDE

3 ii Table of Contents About This Guide...i Welcome...i TO2015 Medical Services...1 Medical Services Vision...1 Medical Services Mission...1 Medical Team Roles and Responsibilities...1 Chief medical officer... 1 Polyclinic manager... 1 Emergency medical manager... 1 Medical venue coordinators... 2 Public health coordinator... 2 TO2015 Medical Services Team Structure...3 Medical Functional Command Centre...4 Available Medical Services...4 Medical clinics... 4 Medical services at the venue... 5 Dental care... 5 Vision care... 5 Pharmacy and prescription medications... 5 Diagnostic imaging... 5 Zone Maps/Games Footprint...5 Operational Dates...5 Polyclinic... 5 Satellite accommodation medical clinics... 6 Games Family hotel... 6 Competition and training dates... 6 ospitals and the Provincial ealth System...6 Trauma ospitals...6 Designated ospital Role...7 Designated hospital services... 7 Daily communication with TO Notification of a hospital visit or admission... 7 Public relations and media... 7 Emergency Services Destination Guidelines...8 TO2015 Medical Insurance Plan...8 Insurance introduction... 8 Persons eligible for coverage under the TO2015 medical insurance plan... 8 Non-members... 8 Identifying a member... 8 Insurance policy provider... 8 DESIGNATED OSPITAL GUIDE

4 iii Policy dates... 9 Insurance policy overview... 9 Common policy inclusions... 9 Common policy exclusions Notification of hospital admission and pre-approval to AIG Billing and Claims Processing Procedures...12 Members Non-members Billing for Canadian residents who are members Consent, Confidentiality and Privacy...12 Consent and information sharing Circle of care Governing law and jurisdiction agreement for physicians Discharge planning Medical transfers Repatriation System-Wide ealth Care Response...14 Mass Casualty Incidents...14 Infection Control Surveillance...15 Awareness of Anti-Doping Protocols...15 Prohibited Substances...15 Medication Use...15 Therapeutic Use Exemptions...16 Before the Games...16 During the Games...16 TO2015 Contact List...16 Frequently Asked Questions...17 Appendix A: Maps Designated ospitals...19 TORONTO 2015 Designated ospitals Pan Am Games West Zone Designated ospitals Pan American Games Downtown/CIBC Pan Am Park Zones Designated ospitals Pan American Games East Zone Designated ospitals Pan American Games North Zone Designated ospitals Pan American Games TORONTO 2015 Designated ospitals Parapan American Games West Zone Designated ospitals Parapan American Games Downtown Zone Designated ospitals Parapan American Games East Zone Designated ospitals Parapan American Games Appendix B: Sports by Designated ospital and Risk...28 DESIGNATED OSPITAL GUIDE

5 iv Appendix C: Trauma ospitals and TO2015 Designated ospitals...31 Trauma hospitals Designated hospitals Appendix D: Sample Games Family Accreditation...32 Pan American/Parapan American identity and accreditation card elements Appendix E: Submitting a Claim to AIG (TO2015 Medical Insurance Plan)...33 Submitting a claim AIG contact information Glossary...35 DESIGNATED OSPITAL GUIDE

6 1 TO2015 Medical Services TORONTO 2015 Pan Am/Parapan Am Games Organizing Committee (TO2015) medical services will be organized under the direction of Dr. Julia Alleyne M.D., the chief medical officer. Medical services during the TORONTO 2015 Pan Am/Parapan Am Games will be provided at all competition and training venues and selected non-competition venues, such as the CIBC Pan Am/Parapan Am Athletes Village, satellite accommodation locations, Games Family hotel, Opening and Closing Ceremonies venues and the Cisco International Broadcast Centre and Main Press Centre. Medical Services Vision The vision of TO2015 medical services is to provide sport-centred, comprehensive, inter-profession health services to athletes and all Games-related sectors in an evidence-informed framework. Medical Services Mission 1. To ensure athletes and Games-related persons have access and priority to appropriate and comprehensive medical services within the Athletes Village, satellite accommodation locations and venues for the assessment and treatment of new and exacerbated health conditions. 2. To ensure communication and collaboration with the Ontario Ministry of ealth and Long-Term Care and its municipal delegates for the appropriate use of essential medical services, emergency management services and public health surveillance. Medical Team Roles and Responsibilities Chief medical officer It is the responsibility of the chief medical officer (CMO) to ensure that TO2015 delivers comprehensive medical services, ambulance and emergency care, infection control and surveillance, and an anti-doping program. Working closely with the federal, provincial and municipal governments, the CMO is tasked with the development and delivery of a complete health care plan for both the TORONTO 2015 Pan Am Games and the TORONTO 2015 Parapan Am Games. The CMO will be the point of contact for the Games organizers (PASO, IPC, TO2015 senior management), provincial medical colleges and associations, medical sponsors, government agencies and regulators, hospitals and Local ealth Integration Networks (LINs), and TO2015 medical volunteers and administrative staff. Polyclinic manager The Polyclinic manager will be responsible for the planning, implementation, staffing and daily operation of the CIBC Pan Am/Parapan Am Athletes Village Polyclinic. The Polyclinic will operate as a Games-time multi-disciplinary health care centre for all accredited Games Family. Services at the Polyclinic will include emergency medicine, family medicine, sports medicine and rehabilitation, specialty physicians, medical imaging, laboratory services, dental care, vision care and pharmacy. Emergency medical manager The emergency medical manager will be responsible for planning, coordinating, implementing and demobilizing emergency medical services (EMS) for the venues, Athletes Village, satellite accommodation and official sites associated with the TORONTO 2015 Pan Am/Parapan American Games and related events. The emergency medical manager will be responsible for contracting and coordinating all the regional EMS/ambulance services into a single comprehensive response plan for every competition and non-competition venue, as well as for ensuring that emergency protocols and disaster plans are complete and implemented. DESIGNATED OSPITAL GUIDE

7 2 Medical venue coordinators The medical venue coordinators will be responsible for the planning, coordination and implementation of medical services for a specified zone of venues. This will include both sport and non-sport venues, and satellite accommodation locations, where medical services will be delivered in a timely manner to all persons involved in the TORONTO 2015 Pan Am/Parapan Am Games and related pre-games events. Public health coordinator During Games time, TO2015 will have public health resources available in the Athletes Village Polyclinic to facilitate service for public health needs across the Games footprint. The public health coordinator will manage the coordination and delivery of projects as identified by Public ealth Ontario, the CMO and the TO2015 medical team across multi-functional areas. Projects will relate to public health surveillance, reportable disease case and outbreak management, and sport-focused infection control procedures. The public health coordinator will act as the point person for communication between TO2015, Public ealth Ontario, the Ministry of ealth and Long-Term Care and all public health units within the Games footprint on infectious disease-related public health matters. DESIGNATED OSPITAL GUIDE

8 3 TO2015 Medical Services Team Structure Chief medical officer Dr. Julia Alleyne Medical venue manager downtown zone Karen Orlando Medical venue coordinator west zone Tricia ayton Medical operations coordinator Courtney Wade Emergency medical manager Steve Urszenyi Volunteer administrator, medical services Natasha Gilbert Anti-doping manager Medical venue coordinator east zone Elwin Lau Medical venue coordinator north zone Brian Bennett Medical venue coordinator CIBC Pan Am Park Leigh Davis Polyclinic assistant Christine Turenko Polyclinic manager Ben Addley Polyclinic Lead medical doctor Lead medical practitioner James Sclater Doping control officer CCES Anti-doping chaperone Lead medical doctor Lead medical practitioner Medical doctor Medical practitioner ealth care administrative assistant Medical doctor Medical practitioner ealth care administrative assistant DESIGNATED OSPITAL GUIDE

9 4 Medical Functional Command Centre The medical Functional Command Centre (MED FCC) is the hub through which all important information must flow to ensure proper communication with all stakeholders during the Games. The MED FCC will be the main point of contact for designated hospitals seeking answers to questions or issues pertaining to insurance, inter-facility patient transfers, communicating with TO2015 for the purpose of providing the organization with critical updates on a patient s condition, and any other issue requiring greater clarity. The MED FCC will also liaise with the TO2015 senior leadership team, under the direction of the chief executive officer, and external partners, including (but not limited to) EMS service providers, medical transportation services, the Ministry of ealth and Long-Term Care and LINs. The MED FCC will be operational during the Games from 07:00 to 21:00, with overnight on-call service. The contact number for the medical Functional Command Centre is fcc.med@toronto2015.org Available Medical Services Medical clinics Medical Services Athletes Village Polyclinic* Satellite Accommodation Games Family Accommodation Venue Medical Clinic Emergency care 24 hr Family practice Limited Specialty services + Laboratory services Limited Medical imaging X-ray, ultrasound, MRI Pharmacy Limited Limited Limited Dental care Vision care Sport medicine & rehabilitation * Emergency care at the Polyclinic will operate 24 hours a day from July 1 to August 17, excluding July 29 to August 1. Regular clinic operational hours will be from 07:00 to 23:00. Clinic open hours will be from 07:00 to 23:00. At satellite and Games Family accommodation, a physician will be on-site on an on call basis from 23:00 to 07:00. + Specialty services may be on-staff, on call, by appointment or available only during specified times and dates, depending on the specific area of expertise. DESIGNATED OSPITAL GUIDE

10 5 Medical services at the venue Medical Services Competition Venue Training Venue Non-Competition Venue On-site ambulance + + Field-of-play medical coverage Physician & rehabilitation services Taping Spectator first aid Tele-medical consultation + Ambulances and paramedics will be on-site at high-risk-sports training venues and during the Opening and Closing Ceremonies. Dental care Any immediate or necessary dental care will be available at the Athletes Village Polyclinic. Severe or emergency cases may be referred to one of the designated hospitals or partner dental clinics. Vision care Any immediate or necessary eye care will be available at the Athletes Village Polyclinic. Severe or emergency cases may be referred to one of the designated hospitals or partner eye-care clinics. Pharmacy and prescription medications Pharmacy services will be available in the Polyclinic to fill prescriptions that are included in the TORONTO 2015 Pharmacy Guide. Medications included in the Pharmacy Guide will be free of charge to all accredited persons when dispensed through the TO2015 pharmacy and medical doctors. Diagnostic imaging Any immediate or necessary imaging, including X-ray, diagnostic ultrasound and MRI, will be available at the Athletes Village Polyclinic. Zone Maps/Games Footprint Included in Appendix A of this guide are maps of each zone, identifying the location of venues and designated hospitals for both the TORONTO 2015 Pan Am Games and TORONTO 2015 Parapan Am Games. Operational Dates The TORONTO 2015 Pan American Games officially open on July 10 and close on July 26, and the TORONTO 2015 Parapan American Games officially open on August 7 and close on August 15. Polyclinic The Polyclinic, located in the CIBC Pan Am/Parapan Am Athletes Village (downtown zone), will be operational from July 1 to August 17, excluding July 29 to August 1. Emergency room care at the Polyclinic will operate 24 hours a day; regular clinic operational hours will be from 07:00 to 23:00 daily. DESIGNATED OSPITAL GUIDE

11 6 Satellite accommodation medical clinics Medical clinics at the satellite accommodation locations will be open from 07:00 to 23:00 daily, with an on-site/on-call medical doctor available from 23:00 to 07:00 daily. Operational dates for the satellite accommodation medical clinics will be as follows: Satellite Accommodation Operational Dates Location Zone Rowing & Canoe/Kayak Sprint Satellite July 5 to 18, 2015 St. Catharines, ON West Accommodation (PVB) Football Satellite Accommodation (PVF) July 5 to 27, 2015 amilton, ON West Shooting & Equestrian Satellite July 5 to 27, 2015 Alliston, ON North Accommodation (PVN) Mountain Bike Satellite Accommodation July 6 to 14, 2015 Barrie, ON North (PV) Canoe/Kayak Slalom Satellite Accommodation (PVM) July 12 to 21, 2015 aliburton, ON North Games Family hotel Pan American Games The Westin arbour Castle (downtown zone) will be the Games Family hotel during the Pan American Games. The medical clinic will be operational July 5 to 27 from 07:00 to 23:00, with an on-site/on-call medical doctor available from 23:00 to 07:00 daily. Parapan American Games The Sheraton Centre Toronto otel (downtown zone) will be the Games Family hotel during the Parapan American Games. Games Family staying at this hotel will have access to the Athletes Village Polyclinic for medical services and on-call advice. Competition and training dates Operational dates for the competition and training venues will be distributed to each of the designated hospitals as a separate document prior to the Games. ospitals may identify which venues are in their area by referring to Appendix A (Zone Maps/Games Footprint) and/or Appendix B (Sports by Designated ospital and Risk). ospitals and the Provincial ealth System A list of trauma hospitals and designated hospitals for the TORONTO 2015 Pan Am/Parapan Am Games can be found in Appendix C. Trauma ospitals The current provincial protocols for CTAS level 1 and 2 will remain intact with the trauma hospitals in our Games territory. These hospitals are: St. Michael s ospital, Toronto Sunnybrook ealth Sciences Centre, Toronto amilton ealth Sciences, amilton general site, amilton All information in this guide is relevant to any patient care provided in the trauma hospitals. DESIGNATED OSPITAL GUIDE

12 7 Designated ospital Role Designated hospital services The role of the designated hospital during the TORONTO 2015 Pan American and Parapan American Games is to provide its services to TO2015 accredited persons who are covered by the TO2015 medical insurance plan ( members ). Services to be provided by the hospital may include, but are not limited to: 1. Emergency room assessment; triage and management. 2. Diagnostic imaging and laboratory investigations. 3. Specialist consultation services. 4. In-patient care and transfer. 5. Surgical services. For clarity, additional services may be required on a case-by-case basis. The hospital is not obligated to provide to members any services other than those that are within their usual services scope. Daily communication with TO2015 The communications protocol will be issued prior to the Games, in conjunction with directives from the LINs and Ministry of ealth. It is anticipated that any designated hospitals with TO2015 member admissions will have a pre-arranged daily conference call with TO2015, compliant with Personal ealth Information Protection Act (PIPA) legislation. Notification of a hospital visit or admission The MED FCC should be notified at the earliest opportunity of any medical encounter with an accredited person with the hospital symbol on their accreditation card. Urgent medical care for life-/limb-threatening conditions will take priority before contacting the MED FCC for any administrative notifications. The number for the MED FCC is Public relations and media All press releases and media requests related to any medical occurrences/injuries during the Games that are referred to the hospital must be pre-approved by TO2015 and the hospital. As relevant and appropriate, other parties such as the National Olympic Committee (NOC)/National Paralympic Committee (NPC), diplomatic mission or police of jurisdiction will also be included in the discussions. The MED FCC must be notified at the earliest opportunity of any press releases and media requests. DESIGNATED OSPITAL GUIDE

13 8 Emergency Services Destination Guidelines TO2015 has engaged with the Ministry of ealth and Long-Term Care and the Regional Base ospital Medical Programs that oversee EMS to create an alternative destination selection pathway for paramedics to use during the Games that will help inform decision-making around the selection of the most appropriate transport destination of ill and/or injured athletes, coaches and other accredited persons covered by the TO2015 medical insurance plan. The goals of these protocols are threefold: 1. To legally establish the Athletes Village Polyclinic as an authorized transport destination for EMS. 2. To stream patients preferentially to either the Polyclinic or the designated hospitals, before using non-designated hospitals. 3. To ensure that special transport consideration guidelines (e.g., trauma patients, STEMI by-pass for myocardial infarction patients, stroke protocols, etc.) are maintained and followed by EMS. Ultimately, the objective of these guidelines is to ensure that a high level of EMS continues to be delivered to various TO2015 client groups, with minimal variance to the emergency medical system s standard operating procedures. TO2015 Medical Insurance Plan Insurance introduction TO2015 has procured in-canada emergency hospital/medical coverage for all accredited athletes, team officials, coaches/support staff, Games Family members, International Federation members and international volunteers participating in the TORONTO 2015 Pan American and Parapan American Games. Persons eligible for coverage under the TO2015 medical insurance plan Persons eligible for coverage under the TO2015 medical insurance plan (members) include, but are not limited to, all accredited individuals attending the Games as an international volunteer, or with their respective NOC/NPC, PASO and the IPC/APC, including athletes, coaches, team officials, support staff and International Federation/Continental Federation members. Non-members Non-members are those persons who are not eligible for coverage under the TO2015 medical insurance plan. Non-members include, but are not limited to, Games spectators, Games workforce, and TO2015 accredited persons not defined in the member categories stated above. Identifying a member All members will have the hospital symbol on their accreditation card located below and to the right of their picture. An example of the accreditation card is provided in Appendix D. The designated hospital may also call the MED FCC to verify or confirm if a TO2015 accredited person is covered under the TO2015 medical insurance plan. If a member is transported or walks into a non-designated hospital for medical services, their medical care will be covered by the TO2015 medical insurance plan. All hospitals may contact the MED FCC to determine insurance processes or medical services. Insurance policy provider The insurance policy provider for the TO2015 medical insurance plan is AIG Insurance Company of Canada (AIG). Contact information for AIG can be found in Appendix E. DESIGNATED OSPITAL GUIDE

14 9 Policy dates Coverage starts on June 29, 2015, at 12:01 am (ET) and expires on August 27, 2015, at 12:01 am (ET). Coverage terminates the earlier of: the date he or she is no longer eligible for coverage, the date the policy is cancelled or expired, or the date he or she leaves Canada. Insurance policy overview Coverage Emergency in-canada medical coverage for the purpose of attending the TORONTO 2015 Pan American and Parapan American Games. Coverage includes hospitalization expenses, medical expenses and emergency ground transportation expenses incurred by reason of sickness or injury of an eligible insured person. Coverage is limited to eligible expenses that are reasonable and customary under government health insurance plans in the geographic area involved for medically necessary treatment or services. Coverage amounts (per eligible person) Coverage is provided in excess of any other government or private health care plans available to an eligible insured person. Emergency medical: Lifetime maximum aggregate: CAD$1,000,000. Emergency dental: Maximum: CAD$10,000. Common policy inclusions ospital, medical and ospital confinement, including semi-private accommodation. therapeutic expenses Emergency transportation: incurred in Canada Ambulance services (ground): CAD$10,000 maximum. Air transportation (pre-approval required): CAD$300,000 maximum. Emergency and therapeutic expenses include: Services of a legally qualified physician or surgeon. Laboratory tests and X-ray examination (diagnostic services). Services of a registered graduate nurse: CAD$15,000 maximum. Qualified anesthetist. Rental of crutches, hospital bed, splints, canes, slings, trusses, braces or other approved prosthetic appliances. Services of a chiropodist, chiropractor, osteopath, physiotherapist, podiatrist, acupuncturist, naturopath or speech therapist, to a maximum of CAD$600 for each practitioner. Expenses for accidental injury to natural, sound teeth, to a maximum of CAD$10,000; CAD$600 for relief of acute dental pain. Out-patient services provided by a hospital. DESIGNATED OSPITAL GUIDE

15 10 Additional benefits Repatriation benefit: In the event of death: maximum of CAD$15,000. Following an emergency evacuation: actual expenses. Travel for up to two immediate family members, to a maximum of CAD$5,000. Rehabilitation benefit: Within two years: maximum of CAD$15,000. Psychiatric/psychological benefit: Maximum of CAD$1,000 outpatient care (maximum of CAD$10,000 if in hospital; maximum of CAD$50,000 for emergency hospitalization). ome alteration and vehicle modification: To a maximum of CAD$15,000. In-hospital benefit: Maximum of CAD$1,500/month up to 12 months. Coma benefit: Six-month wait CAD$1,500 for 100 months, maximum. Emergency medical assistance service included. Common policy exclusions Exclusions include: Pregnancy, miscarriage, voluntary termination of pregnancy, childbirth or its complications. Dental surgery or cosmetic surgery, unless such surgery is a result of a covered injury. Any sickness or injury where, if at the time of the sickness or injury, the insured person is under the influence of drugs, alcohol (blood level in excess of 80 mg of alcohol per 100 ml of blood) or other intoxicant (unless administered on, and in strict accordance with, the advice of a legally qualified physician). Treatment or services that contravene any government health insurance plan (GIP) in Canada. Suicide or any attempt at suicide while sane or insane. Intentionally self-inflicted injury or any attempt at intentionally self-inflicted injury, while sane or insane. Any services or supplies provided by an insured person or an immediate family member of the insured person. DESIGNATED OSPITAL GUIDE

16 11 Exclusions include (cont d): A sickness or injury that, at the time of departure from his/her home country, might reasonably be expected to require an insured person to undergo medical treatment, surgery or hospitalization. Any service, treatment, surgery or stay in hospital not required for the immediate relief of acute pain or suffering or which is not medically necessary. Anticipated medical treatments required on an ongoing basis or for continued stabilization of a medical condition known to the insured person prior to arrival in Canada. AIG Insurance Company of Canada, in consultation with the attending physician, reserves the right to return the patient to his/her home country. If any insured person is (on medical evidence) able to return to his/her home country following the diagnosis of, or the emergency treatment for, a medical condition that requires continuing medical services, treatment or surgery, and the insured elects to have such treatment or services rendered or surgery performed outside of his/her home country, the expense of such continuing medical services, treatment or surgery will not be covered by this plan. If the insured person declines to be transferred or to return to his/her home country when declared medically fit to travel by the medical director, any continuing expenses for such sickness or injury shall not be covered. Translation services of any kind, even when utilized in the delivery of medical services. Organ transplants. Any sickness, injury or medical condition for which a diagnosis need not have been made, where the contract is purchased or the visit is undertaken for the purpose of securing, or with the intent of receiving, medical or hospital services, whether or not such visit is taken on the advice of a physician or surgeon. Notification of hospital admission and pre-approval to AIG To report a hospital admission to AIG, please call AIG services will be available 7 days a week, 24 hours a day. A team of medical professionals will continue to partner with providers until the patient is discharged from hospital. At the time of admission, AIG s office must be immediately notified of any and all treatment, including surgical procedures. Approval of treatment will be required to ensure reimbursement of same. Copies of records will need to accompany all hospital invoicing. DESIGNATED OSPITAL GUIDE

17 12 Billing and Claims Processing Procedures The processes described below apply to hospital, physician and outpatient claims/billing. Members 1. Claims made under the TO2015 medical insurance plan will be made directly to AIG Insurance Company of Canada. Please see Appendix E for AIG s billing and claims processing procedures. The designated hospital will bill AIG directly for services provided to members. 2. In the event that a member elects to receive services that fall outside the TO2015 medical insurance policy, billing will be direct to the member, or as directed by the member. The hospital will be responsible for informing members which services are not provided for under the TO2015 medical insurance policy, after consultation with TO2015 s insurance provider and/or TO2015. In this circumstance, the hospital will establish or follow its usual procedures and policies for determining whether the service will be provided and the process for collecting payment. 3. In some cases, TO2015 may cover the cost of a member s health care service(s) that falls outside the coverage of the TO2015 medical insurance plan. In these instances, the designated hospital will be required to receive prior approval from TO2015 and should bill TO2015 directly. The hospital must contact the TO2015 MED FCC for assistance with this requirement. Non-members Those not covered under the TO2015 medical insurance plan ( non-members ) are asked to have their own insurance for in-canada emergency hospital/medical care. The billing process for these persons should be the same as what the hospital uses with any other visitor to the area. Billing for Canadian residents who are members For Ontario and out-of-province Canadian residents who are members, the hospital will initially bill in accordance with the member s GIP, before billing TO2015 s insurance provider. Consent, Confidentiality and Privacy Consent and information sharing Appropriate consent for care and the exchange of health information will be obtained through TO2015 on an individual basis, in compliance with the ealth Care Consent Act (CCA) and PIPA in order to facilitate timely and appropriate communication within the circle of care to facilitate best patient outcomes. TO2015 protocols and consent forms will be circulated to each designated hospital individually for operational implementation, in conjunction with the hospital s current process for consent and information sharing. Circle of care Circle of care is a term of reference used to describe health information custodians and their authorized agents who are permitted to rely on an individual s implied consent when collecting, using, disclosing or handling personal health information for the purpose of providing direct health care. For the purpose of the Games, the circle of care will be defined as all health care providers involved in the care of a TO2015 accredited individual, starting from initial assessment to the point the patient is discharged from full care. DESIGNATED OSPITAL GUIDE

18 13 This can include the following: Venue medical staff licensed in the province of Ontario (physician, kinesiologist, physiotherapist, nurse, registered massage therapist, chiropractor, athletic therapist, nurse practitioner). NOC/NPC medical staff. Municipal emergency management services. St. John Ambulance. ospital and health care staff involved in patient care in the hospital. TO2015 Polyclinic medical staff. TO2015 pharmacy staff. T02015 laboratory service staff. PIPA defines these health care practitioners and organizations as health information custodians, and personal health information is allowed under the Act to be disclosed between parties, provided it is for the purpose of providing care to an individual. During Games time, TO2015 will obtain expressed consent for information that may be shared with non-medical stakeholders, such as an insurance company or the NOCs or NPCs, where appropriate. If, during a hospital stay, there is uncertainty regarding the source of a health information request, the patient should be consulted first for consent and the MED FCC can be contacted for clarifications and permissions. ospitals are encouraged to maintain their usual consent processes and forms. Governing law and jurisdiction agreement for physicians In accordance with recommendations from the Canadian Medical Protective Association (CMPA), TO2015 is advising that all non-residents who receive health care at our polyclinic, satellite accommodations and venues from our TO2015 Medical Doctors be reasonably requested to sign the expressed consent form consistent with the CMPA s governing law and jurisdiction agreement. This agreement will state that in the case where an individual has a complaint, demand, claim, proceeding or cause of action they wish to pursue in connection with medical or other health care treatment they received during the Games, he/she must file their grievance within the Province of Ontario. As with all consent forms, emergency medical care for patient stabilization precedes the need for consent. The CMPA has advised that medical doctors working within hospitals and clinics outside of the TO2015 medical services should continue to obtain a non-residents signed agreement to the Governing Law and Jurisdiction Form in the usual manner for any non-resident emergency patients. DESIGNATED OSPITAL GUIDE

19 14 Discharge planning To ensure continuity of care, identified TO2015 accredited members who are patients discharged from hospital and requiring ongoing or followup care will have their care coordinated through the TO2015 Polyclinic medical team. Prior to discharge, the designated hospital should contact the TO2015 MED FCC at to ensure the required level of care is available through TO2015 s medical services. As part of the discharge from hospital to the TO2015 medical team, the designated hospital should provide a comprehensive report that, includes: Assessments and/or diagnostic test performed and results reports. Treatments and interventions performed. Surgical and/or operative reports. Current state of the patient s health and capabilities. Complete medications list and other treatment recommendations. Any scheduled followup or consultation appointments. Medical transfers The inter-facility transfer of patients should be conducted as per the hospital s current practices, including the use of private medical transportation services, as appropriate. In the event that a patient requires transfer back to the Athletes Village or any of the five satellite accommodation locations following discharge, the MED FCC must be contacted to assist in facilitating this process through the TO2015 transport services. Repatriation Repatriation of members is included in the TO2015 medical insurance plan. The designated hospital will coordinate this in conjunction with AIG and the MED FCC. System-Wide ealth Care Response TO2015 maintains communications with external partners at the Ministry of ealth and Long-Term Care, hospitals, LINs and EMS services to ensure the appropriate deployment of resources for the Games and to minimize the impact on the provincial health care system. TO2015 accredited persons will not receive queue jumping priority in the provincial health care system. TO2015 accredited persons will be assessed and treated based on the care required, per the hospital s usual procedures and protocols, given the accredited person s medical condition. Mass Casualty Incidents In the event of a mass casualty incident (MCI) at a TORONTO 2015 event, on-scene medical services will provide the initial response. TO2015 and on-scene EMS will immediately engage community emergency response partners. The EMS service of jurisdiction will assume medical incident command and will notify other stakeholders, including the Ministry of ealth and Long-Term Care and LINS. The transport destinations for patients during an MCI will default to a best-case management solution, whereby the Central Ambulance Communications Centres (CACC) will facilitate the appropriate distribution of patients based on current processes that factor in patient acuity and patient loads. DESIGNATED OSPITAL GUIDE

20 15 Infection Control Surveillance While there are no mandatory immunization requirements for travel into Canada as a temporary visitor, TO2015, in consultation with Public ealth Ontario, recommends that travellers have up-to-date vaccinations in accordance with their home country regulations, if applicable, for the following: measles, mumps, rubella tetanus, diphtheria pertussis influenza* *The influenza vaccine, preferably administered at least three weeks before departure (for those from the Southern emisphere only), is recommended. *Immunizations will not be available for vaccination at the Athletes Village and/or venues at Games time. As part of routine practices, all TORONTO 2015 medical clinics will perform screening to identify patients with communicable diseases and to assess the risk of transmission. Subsequent to screening, appropriate interventions and controls will be put into place to treat and/or reduce transmission. While in Ontario, athletes and other accredited individuals who are part of the TORONTO 2015 Pan Am/Parapan Am Games will be subject to the same health legislation as Ontario residents. The ealth Protection and Promotion Act, its Regulations and the Ontario Public ealth Standards are all applicable. This means that health care workers must follow existing reportable disease reporting practices for all accredited individuals during the Games. ospitals will continue to work with Public ealth Ontario through their usual system contact, and the MED FCC will have access to a Gamesembedded Public ealth coordinator. Awareness of Anti-Doping Protocols Prohibited Substances The World Anti-Doping Agency (WADA) 2015 Prohibited List contains the substances and methods prohibited for the TORONTO 2015 Pan American/Parapan American Games. If the 2015 Prohibited List is amended at the time of the Games, the version on the WADA website will be the applicable list, and can be found at wada-ama.org. All athletes and athlete support personnel need to familiarize themselves with the Prohibited List. Medication Use It is the responsibility of the athlete to determine whether a substance that he/she is using or considering using is prohibited. A Global Drug Reference Online (DRO) microsite allows athletes to easily check the status of medication ingredients and brand medications purchased in Canada and the United States. It is available in English, French and Spanish and can be found at toronto2015.globaldro.com. DESIGNATED OSPITAL GUIDE