GUIDANCE DOCUMENT ON THE PREPAREDNESS BY THE AVIATION SECTOR FOR EBOLA PREVENTION AVSEC/FAL Section CASAS IN COLABORATION WITH THE SURINAMESE PUBLIC HEALTH AUTHOIRITY (BOG)
INTRODUCTION Concerning the recent outbreak of the Ebola virus and the effect on the Air Transport sector and Civil Aviation operations, the Civil Aviation Safety Authority Suriname in collaboration with the Public Health Authority (BOG) and the Port Health Committee, hereby are issuing the following guidelines concerning preparedness measures and procedures. In absence of a National Aviation Public Emergency Preparedness Plan, the guidance provided, are measures derived from the ICAO/CAPSCA, WHO guidance documents, during the Alert Green (WHO phase 1 to 3). These guidelines are written to assist all stakeholders, within the air travel process, in taking precautionary (preparedness) measures and developing or adjust their aviation emergency/contingency related plan for any communicable disease, posing a serious health risk. After evaluation, the aviation authorities have established that these guidelines are applicable for airports, airlines, incoming and outgoing passengers, all personnel especially handling agents, aviation security personnel, contracted security personnel, cleaning personnel, ground and cargo handling personnel, catering personnel, ATC, all government agencies at the airport, aviation inspectors, vendors, airport taxi services, visitors and all others. From these guidelines, the following measures and procedures are recommended for immediate implementation. Page 1 of 22
Airport Preparedness 1 1. Establish a clear contact point for policy and operational organization 2. Establish a position with the responsibility for operational implementation and autonomy for rapid policy and decision-making. 3. Establish communication links internally (airline, air traffic management, airport operations, crisis management team, emergency medical services, public health authorities, etc) and externally (media, public) 4. Provide information to passengers (in all terminal buildings, signage, posters, communication system and flyers) and awareness training related to prevention and preparedness to all airport personnel (including all or related airline staff, government entities, vendors, visitors, taxi drivers etc.) in collaboration with the Public Health Authorities (BOG, Ministry of Health) 5. Establish with the Appropriate Public Health authority in consultation with airport management: a. A system of implementing traveler-screening measures as recommended by the WHO, ICAO and the State of Suriname. (See Health questionnaire), as well as a designated location for questioning by health officials. b. Protective measures for all airport personnel, including all airline staff, government entities, vendors, visitors, taxi drivers etc. c. A system to assess travelers who screen positive including: - The designation of an isolation and quarantine area (for aircraft travelers or personnel) - Personal Protective Equipment (PPE) for all at potential risk - Transport to an appropriate medical facility d. Logistics, especially baggage, security, transport, customs and port health formalities for travelers arriving from abroad, for suspected cases and for asymptomatic contacts. 6. Implement Quality Control measures for assuring correct, effective and efficient execution of procedures and measures of allocated tasks throughout the threat period (time frame as advised by WHO) 1 ICAO guidelines for States concerning the management of communicable disease posing a serious public health risk, ICAO template for a national Aviation Public health Emergency Preparedness Plan Page 2 of 22
7. Test, evaluate and adjust if needed all emergency and contingency procedures and measures. 8. Report suspected case(s) to the Port Health Officers immediately 9. Make available PPE to airport personnel when needed 10. Provide training in preparedness and precautionary measures in collaboration with the Public Health Authority and the Ministry of Health to all Airport personnel 11. Provide training to all personnel within the operation on adopted measures and procedures 12. Provide information in collaboration with the Public Health Authority to company doctors for the treatment of suspected ill personnel. The above mentioned points should be part of the public health emergency plan, which is part of The Aerodrome Emergency Plan and the Contingency Plan. 2 Airline preparedness 3 1. Establish a clear contact point for policy and operational organization. 2. Establish a position with the responsibility for operational implementation and autonomy for rapid policy and decision-making. 3. Establish communication links internally (airport, emergency medical services, air traffic management, airline operations, port health authorities etc) and externally (e.g. media, family members, others). 4. Establish general protective guidelines for all airline staff (including, checkin staff, ground handling agents, security staff, maintenance staff, cleaning staff, catering staff etc.) in collaboration with public health authorities. 5. Establish general preparedness guidelines for passenger agents faced with suspected cases and the relevant airline operations (see point 4 ). 6. Cooperate with airport and public health authorities on logistics for dealing with sick traveler(s). 2 Annex 14, Volume 1, 5 th edition, 2009 3 ICAO Guidelines for States concerning the management of communicable disease posing a serious public health risk, ICAO template for a national Aviation Public health Emergency Preparedness Plan Page 3 of 22
7. Advice travelers on the Ebola risk when purchasing tickets and at check-in counters in collaboration with guidance from Public Health Authorities (See Health Questionnaire, flyers, posters etc.). 8. Be advised and take into account the publications from the Ministry of Foreign Affairs on travel ban, as well as guidelines provided by the Public Health Authority and Ministry of Health on authentic health certificates provided by travelers from the affected region (See *Note and appendix IV B) 9. Establish a protective policy for maintenance crew (make available PPE level 4 when needed), cleaning crew and ground handling personnel. 10. Establish protective policy, measures and procedures for cleaning and desinfection of an aircraft having transported a suspected passenger(s) or ill passenger(s) in consultation and collaboration with Public Health Authority and the CASAS Airworthiness section, if needed. 11. Make available for the flight and cabin crew the Universal Precaution Kit/PPE (see document appendix I) 12. Establish protective policy and procedures for cargo and baggage handling (see IHR, 2005, Article 23). 13. Report suspected case(s) to the Public Health Authority immediately. 14. Provide training to all frontline personnel within the operation on adopted operational policy, measures and procedures by the company. 15. Provide training in preparedness and precautionary measures in collaboration with the Public health Authority and the Ministry of Health to all operational Airline personnel. 16. Provide information in collaboration with the public health authority to company doctors for the treatment of suspected ill personnel. Guidelines for a suspected ill person(s) in-flight 4 These actions are subsequent to a suspected case being identified in flight. 4 ICAO Guidelines for States concerning the management of communicable disease posing a serious public health risk, ICAO template for a national Aviation Public health Emergency Preparedness Plan Page 4 of 22
The pilot in command of an aircraft may take emergency measures inflight as may be necessary for the health and safety of passengers and crew on board (Annex 9) 5 1. Establish in collaboration with public health authorities a system to enable cabin crew to identify suspected ill travelers. (See health questionnaire provided by Bureau Public Health and Ministry of health). 2. Establish a system (measures and procedures) to manage suspected ill passenger(s) in-flight (see document appendix IIA). 3. Establish procedures for informing air traffic control in case of a suspected case in-flight ( IHR 2005, art. 28.6, ICAO Annex 9, 8.16 and Annex 9, Appendix 1 and use other forms which are needed (health part General Declaration, Passenger Locater Card See Appendix IIC). 4. Make use of Universal Precaution Kit/PPE 5. The flight crew of an en-route aircraft shall, upon identifying a suspected ill passenger(s), promptly notify the Air Traffic Services with which the pilot is communicating. 6 (For further guidance see document Appendix III and Annex 9, Chapter 1, 8 and Appendix 1). Guidance for ATS is provided in Document Appendix III *Note: All Airlines conducting international air transport, shall follow the guidelines from the State of Suriname concerning the Health Questionnaire to be used at check-in counters, at online check-in and on board (in case of a suspected ill person(s) in flight), even so to include the completed forms in the flight envelope and the handover of these forms to a port health officer on arrival at PBM (See document Appendix on Health Questionnaire). Be advised to include these measures in the training of procedures for check-in, flight and cabin crew and for use on board if needed throughout the threat period. (time frame as advised by WHO, the Suriname Ministry of Health and the Ministry of Foreign Affairs). 5 ICAO template for a national Aviation Public health Emergency Preparedness Plan 6 ICAO template for a national Aviation Public health Emergency Preparedness Plan Page 5 of 22
Procedures and measures to be taken by all Air Transport stakeholders All the procedures and measures mentioned above should be part of the emergency plan of all organizations mentioned in this guidance document, including government agencies (e.g. immigrations, customs, police etc.) in consultation with the relevant airport emergency plan. Airports and Airlines should establish procedures to continue operations, which are included in their respective contingency plan. Be advised to implement Quality Control measures for assuring correct, effective and efficient execution of procedures and measures of allocated tasks throughout the threat period (time frame as advised by WHO). Test, evaluate and adjust if needed, all emergency and contingency procedures and measures. Provide to travelers, all airport personnel, including airline personnel, government agencies, vendors, visitors and all others the basic information on hygiene and sanitization. This in consultation with the Public Health Authority and the Ministry of Health. (See Flyers and Posters). Make available to all personnel the basic protective equipment (gloves, facemasks, hand sanitizers etc.), as well as hand sanitizers for use by passengers and PPE when needed. General guidelines and advice for all categories of personnel, travelers and other stakeholders Be aware of your surroundings Pay close attention to suspected ill person(s) In case of suspected ill person(s) keep a safe distance Wash hands on a frequent and regular basis, use hand sanitizers if necessary Make use of protective equipment when needed and if necessary (facemasks, gloves) Report a suspected case immediately to the port health authorities. Seek immediate medical assistance in case of having been in contact with an Ebola patient or having symptoms as mentioned in appendix IV A. See ICAO Annex 9 and WHO IHR for further guidance (guidelines and forms) Page 6 of 22
Appendix I Annex 6 Operation of Aircraft Part I International Commercial Air Transport Aeroplanes Chapter 6. AEROPLANE INSTRUMENTS, EQUIPMENT AND FLIGHT DOCUMENTS 6.2 All aeroplanes on all flights 6.2.2 An aeroplane shall be equipped with: a) accessible and adequate medical supplies; Recommendation. Medical supplies should comprise: 1) one or more first-aid kits for the use of cabin crew in managing incidents of ill health; and 2) for aeroplanes required to carry cabin crew as part of the operating crew, one universal precaution kit (two for aeroplanes authorized to carry more than 250 passengers) for the use of cabin crew members in managing incidents of ill health associated with a case of suspected communicable disease, or in the case of illness involving contact with body fluids; and 3) for aeroplanes authorized to carry more than 100 passengers, on a sector length of more than two hours, a medical kit, for the use of medical doctors or other qualified persons in treating in-flight medical emergencies. Note. Guidance on the types, number, location and contents of the medical supplies is given in Attachment B. 1. Types 1.1 The different types of medical supplies should be provided as follows: first-aid kit(s) for carriage on all aeroplanes, universal precaution kit(s) for carriage on all aeroplanes that require a cabin crew member, and a medical kit for carriage where the aeroplane is authorized to carry more than 100 passengers on a sector length of more than two hours. Where national regulations allow it, operators may elect to carry the recommended medication in the first-aid kit. Number of first-aid and universal precaution kits 2.1 First-aid kits The number of first-aid kits should be appropriate to the number of passengers which the aeroplane is authorized to carry: Passenger First-aid kits 0 100 1 101 200 2 201 300 3 301 400 4 401 500 5 More than 500 6 2.2 Universal precaution kits For routine operations, one or two universal precaution kits should be carried on aircraft that are required to operate with at least one cabin crew member. Additional kit(s) should be made available at times of increased public health risk, such as during an outbreak of a serious communicable disease having pandemic potential. Such kits may be used to clean up any potentially infectious body contents such as blood, urine, vomit and faeces and to protect the cabin crew members who are assisting potentially infectious cases of suspected communicable disease. Page 8 of 22
3. Location 3.1 First-aid and universal precaution kits should be distributed as evenly as practicable throughout the passenger cabins. They should be readily accessible to cabin crew members. 3.2 The medical kit, when carried, should be stored in an appropriate secure location. Contents The following provides guidance on typical contents of first-aid, universal precaution and medical kits. 4.1.1 First-aid kit: List of contents Antiseptic swabs (10/pack) Bandage: adhesive strips Bandage: gauze 7.5 cm 4.5 m Bandage: triangular; safety pins Dressing: burn 10 cm 10 cm Dressing: compress, sterile 7.5 cm 12 cm Dressing: gauze, sterile 10.4 cm 10.4 cm Tape: adhesive 2.5 cm (roll) Steri-strips (or equivalent adhesive strip) Hand cleanser or cleansing towelettes Pad with shield, or tape, for eye Scissors: 10 cm (if allowed by national regulations) Tape: Adhesive, surgical 1.2 cm 4.6 m Tweezers: splinter Disposable gloves (multiple pairs) Thermometers (non-mercury) Mouth-to-mouth resuscitation mask with one-way valve First-aid manual, current edition Incident record form ICAO/CAPSCA, WHO Guidance on Universal Precaution KIT and PPE Universal precaution kit/contents OF PPE KIT : Dry powder that can convert small liquid spill into a sterile granulated gel Germicidal disinfectant for surface cleaning Skin wipes Face/eye mask (separate or combined) Gloves (disposable) Protective apron 1 pair Tyvek coveralls 1 pair shoe covers 1 plastic apron (in plastic pouch) 4 alcohol wipes 1 PDI sanitary virucidal wipe 1 biohazard bag Page 9 of 22
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Appendix II A ICAO guidelines for states concerning the management of communicable disease posing a serious public health risk In-flight illness Airlines should establish: a) a system enabling cabin crew to identify travelers suspected of having a communicable disease; b) a system of managing travelers who are suspected of having a communicable disease, including: advice from medical ground support (if available) sick traveler relocation, away from other travelers, if possible carriage of appropriate first-aid equipment and supplies, cabin crew training in its use (in accordance with ICAO, Annex 6, 6.2) and general sanitary precautions clean-up of areas occupied by the affected traveler, when necessary reallocation of cabin crew duties use of appropriate personal protective equipment by passenger and crew e.g. masks, gloves disposal of contaminated supplies and equipment personal hygiene measures to reduce risk c) procedures for informing air traffic control that a case of a communicable disease is on board, so that the public health authority at the destination can be advised appropriately in a timely manner (IHR (2005), Article 28.6, ICAO Annex 9, 8.16, and Appendix 1 (Health Part of Aircraft General Declaration)). Note 1. A State may request from an airline information relating to the traveler's destination (so that the passenger can be contacted) and information concerning the traveler's itinerary. When this information is held by the airline, it should comply with such a request in a timely manner, and cooperate fully with public health authorities in providing other relevant information it may hold (IHR (2005) Article 23.1 (a)(i), (ii)). To facilitate the timely release of such information the State should submit a written request, including a reference to the appropriate legislation under which the request is made. Page 14 of 22
Note 2. To assist contact tracing, a passenger locator card (PLC). has been developed. This provides an appropriate method of rapidly collecting traveler contact information: aircraft operators should determine if the PLCs will be kept on board, or at all destination airports. Depending on the specific hazard, the number of PLCs needed may vary, from a few to one for each traveler. The PLC is available at Appendix 1 to this document. The International Air Transport Association, assisted by relevant experts, is evaluating different electronic methods that could facilitate passenger tracing. Page 15 of 22
Appendix II B Annex 9 Page 16 of 22
Appendix II C Annex 9 Page 17 of 22
Appendix III International Civil Aviation Organization Template for a National Aviation Public Health Emergency Preparedness Plan 6.2 PANS-ATM, paragraph 16.6 states: The flight crew of an en-route aircraft shall, upon identifying a suspected case(s) of communicable disease, or other public health risk, on board the aircraft, promptly notify the Air Traffic Service (ATS) unit with which the pilot is communicating, the information listed below: a) aircraft identification; b) departure aerodrome; c) destination aerodrome; d) estimated time of arrival; e) number of persons on board; and f) number of suspected case(s) on board; and g) nature of the public health risk, if known The ATS unit, upon receipt of information from a pilot regarding suspected case(s) of communicable disease, or other public health risk on board the aircraft, shall forward a message as soon as possible to the ATS unit serving the destination/departure, unless procedures exist to notify the appropriate authority designated by the State, and the aircraft operator or its designated representative. When a report of a suspected case(s) of communicable disease, or other public health risk, on board an aircraft is received by an ATS unit serving the destination/departure, from another ATS unit or from an aircraft or an aircraft operator, the unit concerned shall forward a message as soon as possible to the public health authority (PHA) or the appropriate authority designated by the State as well as the aircraft operator or its designated representative, and the aerodrome authority. Note 1. See Annex 9, Chapter 1 (Definitions), Chapter 8, 8.12 and 8.15, and Appendix 1, for relevant additional information related to the subject of communicable disease and public health risk on board an aircraft. Page 18 of 22
Note 2. The PHA is expected to contact the airline representative or operating agency and aerodrome authority, if applicable, for subsequent coordination with the aircraft concerning clinical details and aerodrome preparation. Depending on the communications facilities available to the airline representative or operating agency, it may not be possible to communicate with the aircraft until it is closer to its destination. Apart from the initial notification to the ATS unit whilst en-route, air traffic control communications channels are to be avoided. Note 3. The information to be provided to the departure aerodrome will prevent the potential spread of communicable disease, or other public health risk, through other aircraft departing from the same aerodrome. Note 4. Aeronautical Fixed Telecommunications Network (AFTN) i.e. groundbased telecommunications network (urgency message), telephone, facsimile or other means of communication may be used. In summary: 1. Pilot reports to Air Traffic Services (ATS) 2. ATS reports to destination (and departure) ATS unit 3. Destination ATS unit reports to airport health service provider /public health authority/ any other designated authority for the airport (SOP should reflect which agency will be contacted by ATS) 4. Airport health service provider /public health authority/ any other designated authority for the airport, contacts airline operating agency to obtain further details of illness The specific mechanisms for implementing communications between the competent authority, airline operating agency and airport/aerodrome authority (items 3 and 4 above) should be determined by the State / Administration. An SOP detailing these specific mechanisms should be attached to the emergency preparedness plan. Page 19 of 22
Figure 1: Diagrammatic representation of the mandatory ICAO communication procedure from the affected aircraft in flight to the public health authority at destination. The pilot-in-command notifies the air traffic controller of a public health event, who relays the message to the destination. Additional health related information is obtained via the aircraft operator s agency at destination. Page 20 of 22
Appendix IV A Guidance on example questions which can be included in SOPs of In-check, Flight and Cabin Crew From the WHO Interim Infection Prevention and Control Guidance for Care of Patients with Suspected or Confirmed Filovirus Haemorrhagic Fever in Health- Care Settings, with Focus on Ebola and the Clinical Assessment Form for UN Personnel Exiting Ebola Affected Countries August 2014 TRAVEL HISTORY In the last 3 weeks, has the individual travelled to a specific locality / area that currently has suspect/confirmed Ebola cases? Yes No Unknown If yes or unknown, please specify which Country/City/Region/Town: CURRENT HEALTH STATUS Please check off whichever applies: The individual is currently well, and has no signs or symptoms. The individual is currently unwell, and has signs/symptoms. SIGNS & SYMPTOMS (TO BE COMPLETED IF INDIVIDUAL IS UNWELL) Date of onset of first symptoms (dd/mm/yy): Was onset of symptoms sudden or gradual? Sudden onset Gradual onset Know the symptoms of Ebola virus disease and see a health care provider immediately if symptoms of the disease develop. The symptoms of Ebola virus disease include: Sudden onset of fever, intense weakness, muscle pain, headache and sore throat. This is followed by vomiting, diarrhea, rash, impaired kidney and liver function, and in some cases, both internal and external bleeding. Seek medical attention immediately if a fever and any of the above other symptoms arise during or after travel. Be sure to tell your health care provider that you travelled to a region where Ebola virus disease was present. Page 21 of 22
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