In the event of a public health emergency, the public relies on physicians. Physicians are uniquely positioned to provide care during public health emergencies, and have an ethical duty to provide medical care and/or other physician services. This ethical duty is derived from the values of medical professionalism set out in the Practice Guide – compassion, service, altruism and trustworthiness.

Federal, provincial and local responses to public health emergencies require extensive involvement of physicians. Physicians are integral to an effective response and have always provided medical care and other physician services in times of crisis, often placing themselves at risk of harm, above and beyond routine care provision.

This advice document is intended to help physicians interpret their responsibilities during a public health emergency as set out in the Public Health Emergencies policy and provide guidance around how these obligations may be effectively discharged.

Examples of Public Health Emergencies

Public health emergencies are current or impending situations that constitute a danger of major proportions with the potential to result in serious harm to the health of the public. They can be the result of a multitude of causes.

Examples of situations or conditions which may lead to the declaration of a public health emergency include, but are not limited to, the following:

Forces of Nature	Infectious Disease	Other Health Risk
Flood Hurricane Earthquake Tornado Blizzard Prolonged extreme heat/cold Drought Environmental disaster	Non-seasonal Influenza outbreak (e.g. Swine flu) Severe Acute Respiratory Syndrome (SARS) Pneumonic Plague Ebola Botulism Cholera	Prolonged toxic air Chemical threats Biological threats Contaminated drinking water Bombs and other explosives Nuclear disaster

 

Providing Physician Services in a Public Health Emergency

Physician services include direct medical care, as well as administrative or other indirect activities that support the response effort.  Decisions about what role to undertake during public health emergencies must be made in accordance with the values, principles and duties of medical professionalism.

Some examples of ways that physicians provide direct medical care during public health emergencies include, but are not limited to:

• assessing people for injuries after an earthquake,
• diagnosing and treating infectious diseases,
• triaging people, and
• administering vaccinations.

Some examples of administrative or indirect activities include, but are not limited to:

• providing leadership and guidance on interpreting the information provided by public health and emergency management officials,
• communicating information to current patients and/or members of their community about the nature and severity of the public health emergency, and
• performing administrative roles, such as participating in coordinating patient flow, transfer or discharge of currently hospitalized patients in order to accommodate those affected by the public health emergency.

Additionally, physicians can lend indirect support by responding to the impact of the public health emergency on physician resources. When physician resources are limited it may help if physicians who are not involved in providing direct care temporarily expand the capacity of their current practice. For these physicians, expanding the capacity of their current practice is a way to relieve the pressure that inevitably increases when limited physician resources are directed towards responding to the public health emergency.

Importantly, Ontario’s Good Samaritan legislation offers legal protection to people who give emergency assistance to those who are, or who they believe to be, injured, ill, in peril, or unconscious. Further, the Canadian Medical Protective Association (CMPA) has indicated that it will exercise its discretion to extend assistance to CMPA members who provide medical care during public health emergencies.¹

Documenting Patient Encounters in Public Health Emergencies

As resources may become scarce during public health emergencies, documentation of the facts and circumstances of the patient encounter as well as the rationale for the medical decisions made is recommended, when possible. Document in whatever way possible; if the situation is such that comprehensive charting is not possible, physicians are advised to do the best they can. It is particularly important for physicians temporarily practicing outside of their scope to record this in their documentation of the patient encounter, doing the best that one can.

Planning and Preparation for Public Health Emergencies

It is recommended that physicians prepare for the occurrence of public health emergencies. Physicians are best placed to provide direct medical care during public health emergencies if they maintain their basic and advanced life support skills.

The College recommends that physicians participate in simulation exercises and other emergency planning and preparation activities. For example, mock disaster exercises, public health simulations, developing emergency management plans for practice settings, and/or following hospital/organizational plans. Additionally, physicians are advised to take advantage of training offered for tasks which they may be required to perform during a public health emergency.

Finally, information is available which can assist physicians in being prepared for a public health emergency where they practice and live. Physicians can use the following to prepare for emergency situations:

• federal² and provincial³ legislation;
• emergency management plans developed by federal⁴, provincial⁵ and municipal governments⁶;
• directives from public health agencies; and
• advice provided by the CMPA⁷.

Staying Informed During a Public Health Emergency  

In order for physicians to provide the best possible care, governments and public health authorities are responsible for ensuring that physicians receive timely, accurate and complete information both prior to and during public health emergencies.

In addition to the information provided by authorities, individual practice settings may provide access to additional sources of information during an emergency. This may include, but is not limited to, hospital protocols, directives from community settings where medical services are provided, or organizational plans and/or policies.

Temporary Registration for Physicians from Other Jurisdictions

The College has a registration process in place to provide temporary Certificates of Registration to physicians who are licensed in other jurisdictions during public health emergencies. Contact the Registration department for information: (416) 967-2617 or [email protected]

Obtaining Temporary Hospital Privileges

Decisions regarding hospital privileges are made at the hospital level. Physicians are encouraged to contact hospitals directly to learn about their privileging process.

Compensation for Services Provided During Public Health Emergencies

Governments, public health agencies, and health care institutions are responsible for ensuring resources are in place to facilitate the provision of medical care during public health emergencies. The role of the College is to regulate the practice of medicine to protect and serve the public interest. The College does not make decisions regarding physician compensation, therefore questions about compensation during public health emergencies should be directed to the Ontario Medical Association (OMA) or the Ontario Health Insurance Program (OHIP).  

Postgraduate Trainees and Medical Students

Although still in training, postgraduate trainees are physicians who are regulated by the College, and must follow College policy. The expectations contained in the Public Health Emergencies policy apply to postgraduate trainees. Additionally, the Professional Responsibilities in Postgraduate Medical Education policy clarifies the roles of physicians engaged in postgraduate medical education programs.

Postgraduate trainees must use their best judgement to determine the extent to which they can provide physician services during a public health emergency given their education, training and skillset. They must also adhere to the terms, conditions and limitations of their Postgraduate Education Certificate.

The Council of Ontario Faculties of Medicine has approved guidelines titled “Residents and Public Health Emergency Preparedness Guidelines” that postgraduate trainees may find helpful.

Medical students are not licensed physicians, and must not assume the role of a physician or any other healthcare provider during public health emergencies. Like any other member of the public, medical students may volunteer to assist in ways that are commensurate with their education, training and skillset.

Health Insurance for Physicians during Public Health Emergencies

Providing care during public health emergencies often involves placing oneself at risk for harm, above and beyond routine care provision. Physicians are responsible for ensuring they have appropriate health insurance coverage. The OMA has death and disability insurance available for physicians and their families.  Physicians are advised to contact the OMA for more information about health insurance coverage.⁸

Endnotes

^1. CMPA Public Health Emergencies and Catastrophic Events — https://www.cmpa-acpm.ca/en/membership/protection-for-members/principles-of-assistance/public-health-emergencies-and-catastrophic-events-the-cmpa-will-help

^2. Emergencies Act, R.S.C., 1985, c. 22 (4th Supp.);  Emergency Management Act, S.C. 2007, c. 15;  Quarantine Act, S.C. 2005, c. 20

^3. Health Promotion and Protection Act, R.S.O. 1990, Chapter H.7; Emergency Management and Civil Protection Act R.S.O. 1990, Chapter E.9; Good Samaritan Act, S.O. 2001, Chapter 2

^4. Public Safety Canada: Emergency Management https://www.publicsafety.gc.ca/cnt/mrgnc-mngmnt/index-en.aspx

^5. Ministry of Health Emergency Management Plans and Strategies https://www.ontario.ca/page/ministry-health-emergency-management-plans-and-strategies

^6. Ministry of Municipal Affairs: List of Ontario Municipalities https://www.ontario.ca/page/list-ontario-municipalities#section-3

^7. CMPA: Public Health Emergencies and Catastrophic Events — https://www.cmpa-acpm.ca/en/membership/protection-for-members/principles-of-assistance/public-health-emergencies-and-catastrophic-events-the-cmpa-will-help

^8. OMA Insurance - http://www.omainsurance.com/Pages/default.aspx