Public Health Emergencies


Policy Category: Practice
Under Review: No
Approved by Council: February 2018
Reviewed and Updated: September 2009
College Contact: Physician Advisory Service

Downloadable Version(s): Public Health Emergencies | Public Health Emergencies FAQs


Executive Summary

This policy sets out the College’s expectations for physicians in relation to preparing for and providing physician services during public health emergencies. Key topics and expectations include:

  • Planning and Preparation: It is recommended that physicians prepare for the occurrence of public health emergencies.
  • Staying Informed: Physicians must make reasonable efforts to stay informed during public health emergencies.
  • Providing Physician Services: Physicians must be available to provide medical care and/or other physician services during public health emergencies, and must document patient encounters to the extent to which the specific circumstances allow.
  • Practising Outside of Scope of Practice: If certain criteria are met, as laid out in this policy, physicians may temporarily practice outside of their scope of practice during public health emergencies.

Introduction

In the event of a public health emergency, the public relies on physicians. 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. Providing care during public health emergencies often involves placing oneself at risk for harm, above and beyond routine care provision.

This policy articulates the College’s expectations of physicians and reinforces the profession’s commitment to the public during public health emergencies.

Principles

The key values of professionalism articulated in the College’s Practice Guide – compassion, service, altruism and trustworthiness – form the basis of the expectations set out in this policy.

Physicians embody the values of the profession and uphold the profession’s reputation by:

  1. Providing care for those in need in line with the values of service and altruism.
  2. Collaborating with colleagues, other health professionals, law enforcement, emergency response personnel and others when public health emergencies occur.
  3. Maintaining current knowledge of relevant information available prior to and during public health emergencies.  
  4. Balancing competing professional and personal obligations in accordance with the values, principles and duties of medical professionalism.
  5. Participating in the regulation of the medical profession by complying with the expectations set out in this policy.

Scope

This policy applies to all physicians during public health emergencies, regardless of practice setting or specialty.

Terminology

A public health emergency is a current or impending situation that constitutes a danger of major proportions with the potential to result in serious harm to the health of the public, and is usually caused by forces of nature, a disease or other health risk, an accident or an act whether intentional or otherwise1.

Public health emergencies are declared by governments and public health authorities at the federal, provincial and municipal levels2.

Policy

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.

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.

The expectations of physicians articulated in this policy include physician responsibilities to plan and prepare, to stay informed, to be available to provide physician services, and to only practise outside one’s scope during public health emergencies when specific conditions are met. The policy expectations exist for the duration of the public health emergency.

Planning and Preparation

Simulation exercises and related activities are an important part of emergency preparedness and typically feature as part of planning activities. The College recommends that physicians participate in simulation exercises and other emergency planning and preparation activities3, and take advantage of training offered to them for tasks which they may be required to perform during a public health emergency4.

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 unconscious5. Additionally, the Canadian Medical Protective Association has indicated that it will exercise its discretion to extend assistance to CMPA members who provide medical care during public health emergencies6.

Staying Informed

Physicians are advised to be proactive and inform themselves of the information available which will assist them in being prepared for a public health emergency. Once a public health emergency arises, however, physicians must make reasonable efforts to access relevant information and to stay informed for the duration.

Relevant information can include federal legislation7, provincial legislation8, emergency management plans developed by federal9, provincial10 and municipal governments11, directives from public health agencies, and advice provided by the CMPA12. A physician’s practice setting may afford access to additional sources of information. 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.

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.

Providing Physician Services

In fulfilling their individual commitment to patients, professional commitment to colleagues and collective commitment to the public, physicians must be available to provide physician services during public health emergencies. 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 professionalism13. Considerations for temporarily practising outside of one’s scope of practice during a public health emergency are addressed in the next section.

Physicians providing direct medical care to people in need must do so in accordance with relevant legislation and emergency management plans. Physicians must document these patient encounters to the best of their ability given the circumstances. 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.

There may be reasons related to the physicians’ own health, that of family members or others close to them14 which may place limits on the physicians’ ability to provide direct medical care to people in need during a public health emergency. In those instances, physicians who have a personal health and/or ability limitation must engage in indirect activities that support the response effort during public health emergencies. This can include performing administrative or other support roles. Additionally, physicians can increase capacity in their existing practice to offset the increased strain placed on physician resources during public health emergencies.

Practising Outside of Scope of Practice

In non-emergency situations, there are clear expectations for physicians around scope of practice. A physician must practice only in the areas of medicine in which the physician is educated and experienced.15 If a physician wishes to change their scope of practice the physician must do so in accordance with College policy16.

During public health emergencies, it may be necessary for physicians to temporarily practise outside of their scope. To ensure competence while temporarily practising outside of one’s scope of practice during public health emergencies, physicians are expected to exercise their professional judgement, and work with their colleagues in health care, in determining what appropriate medical care they can provide to persons in need of care, in accordance with relevant legislation and emergency management plans.

Physicians must only practice outside of their scope of practice during disasters and/or public health emergencies if:

  • the medical care needed is urgent;
  • a more skilled physician is not available; and,
  • not providing medical care may result in greater risk or harm to the patient or public than providing it.
  • Once the public health emergency is over, physicians must not practise outside of their scope, unless they elect to change their scope of practice in accordance with College policy17.

Endnotes

1Adapted from Emergency Management and Civil Protection Act, R.S.O. 1990, Chapter E.9

2Public Health in Canada - https://www.canada.ca/en/public-health/corporate/mandate/about-agency/federal-strategy.html

3For example, mock disaster exercises, public health emergency simulations, developing emergency management plans for individual practice settings or following hospital/organizational plans.

4Physicians of all specialties are best placed to provide direct medical care during public health emergencies if they maintain their basic and advanced life support skills.

5Good Samaritan Act,S.O. 2001, Chapter 2

6CMPA 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

7Emergencies Act, R.S.C., 1985, c. 22 (4th Supp.)
Emergency Management Act, S.C. 2007, c. 15
Quarantine Act, S.C. 2005, c. 20

8Health 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

9Public Safety Canada: Emergency Management https://www.publicsafety.gc.ca/cnt/mrgnc-mngmnt/index-en.aspx

10Ministry of Community Safety & Correctional Services: Emergency Response Plans https://www.emergencymanagementontario.ca/english/emcommunity/response_resources/plans/plans.html

11Ministry of Municipal Affairs: List of Ontario Municipalities www.mah.gov.on.ca/page1591.aspx12

12CMPA: 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

13As set out in the Practice Guide

14As defined in the College’s Physician Treatment of Self, Family Members and Others Close to Them policy

15Subsection 2 (5) of Ontario Regulation 865/93 under the Medicine Act, 1991.

16Ensuring Competence: Changing Scope of Practice and/or Re-entering Practice policy

17Ensuring Competence: Changing Scope of Practice and/or Re-entering Practice policy