Report to: Chair and members of the Board of Health
Meeting Date: November 2, 2016
Report Number: BH.01.NOV0216.R20
Prepared by: Jessica Morris, Manager, Health Protection
Shawn Zentner, Manager, Health Protection
Jagjit Singh Bajwa, Public Health Inspector
Approved by: Christopher Beveridge, Director, Health Protection
Submitted by: Dr. Nicola J. Mercer, MD, MBA, MPH, FRCPC
Medical Officer of Health & CEO
It is recommended that the Board of Health:
1. Receive this report for information.
- Mass gatherings of this magnitude have many public health risk impacts that need to be managed and controlled with a coordinated approach.
- Wellington-Dufferin-Guelph Public Health (WDGPH) developed and implemented an internal Integrated Management System (IMS) to plan, prepare and respond to potential public health issues at the International Plowing Match (IPM).
- IPM received approximately 970,000 visitors, including more than 9000 school children.
- WDGPH staff spent 980 hours on IPM-related activities, including food safety, safe water, tobacco control, infection control, rabies control, sewage and waste water disposal.
- There were 76 food vendors, and 136 inspections/re-inspections were completed over the course of the event. The most common infraction was an inadequate handwashing station set-up.
- There were 10 kilometers of installed water distribution lines within the tented city and RV Park. Water sampling occurred at 18 sites that were tested daily for residual chlorine. Daily oversight of drinking water required the monitoring of lab reports and sampling procedures.
- Active surveillance for enteric illness and animal bite incidents was done through daily onsite updates with Emergency Medical Services (EMS).
The 2016 International Plowing Match and Rural Expo (IPM) was held in Minto Township from September 20-24, 2016. The IPM is an annual event organized by the Ontario Plowmen’s Association (OPA) with assistance of a committee made up of local volunteers. Each year the OPA, the parent host of the IPM, partners with a local OPA Branch Association to organize and host the IPM. Plowing Matches have been part of Ontario agricultural history for over 100 years. Match activities included: horse drawn and modern-day plowing contests, artisans’ displays, quilting displays, and much more. Within the IPM, a giant tented city housed approximately 500 exhibitors and vendors selling food, antiques, and showing educational and country lifestyle displays. The IPM also had a Recreational Vehicle (RV) park of approximately 1400 sites.
The IPM was last held in WDGPH near Elora, in Centre Wellington Township, in 2000, and is scheduled to be held in Huron County in 2017. Mass gatherings of this magnitude have many public health risk impacts that need to be managed and controlled with a coordinated approach.
IPM Planning and Preparedness:
Planning for the IPM 2016 started in 2015. The WDGPH working group, composed of Health Protection Division staff, worked with event organizers, coordinators, food vendors, and exhibitors to ensure a safe and successful event. During the event, Public Health Inspectors (PHIs) planned and responded to public health issues on-site.
Public Health planning assumptions included:
- Food/water safety demands will increase
- Temporary increase in population, with daily and overnight visitors
- Health messaging to new visitors to prevent injury/illness (i.e., extreme weather, zoonotic and vectorborne disease risks, handwashing, infection control, and personal safety)
- Expansion of routine practises (i.e., health hazard, animal bite and complaint investigations)
- Enhanced disease surveillance, coupled with accurate reporting and communication
The overall goals of the plan were:
- To enhance public health services to prevent or mitigate potential impacts from the IPM
- To coordinate public health services with other health-sector and community response partners IPM Planning and Preparedness:
- To identify key public health response functions based on prioritized risks, and to clarify responsibilities and capabilities of public health during planning, response, and recovery
- To ensure continuity of time-critical public health services to residents within the impacted areas
- To ensure staffing surge capacity to cope with anticipated demands, and with the coordination with other key community response partners
Public Health Role
Public Health is mandated to ensure food safety, water safety, tobacco control, rabies control, and health hazard complaints are managed and investigated at all special events.1,2,5,7 The Health Protection division formed an IPM internal working committee, based on an Integrated Management Structure (IMS) structure. Each member was assigned a designated role and responsibility in the planning phase, and during the response phase. WDGPH was involved in developing comprehensive, community-based plans which identified local emergency management structures, communication systems, and coordinated local response measures.
There were two community-based planning committees established for the IPM:
1. The IPM Executive Committee (WDGPH ad-hoc member)
2. The IPM Emergency Management Committee (WDGPH member)
WDGPH Internal IPM developed six working groups to assist with the operational planning for this event:
1. Environmental Inspection and Enforcement
2. Environmental Risk Management, and Incident Response
3. Infection Control, Disease Investigation, Surveillance
4. Health Promotion and Communications
5. Emergency Management
6. Logistics/ Resources
1. Environmental Inspection & Enforcement
Responsible for promoting/enforcing Food Safety, Water Safety, and Tobacco Control.
The food safety group pre-screened food vendors prior to the event, inspected vendors during the event, and investigated food-related complaints, and any foodborne illnesses. All the food vendors were inspected and approved prior to serving food to the public.
IPM volunteers served 1840 box lunches to plowmen over the course of the event.
There were 76 food vendors, and 136 inspections/re-inspections were completed over the course of the event. The most common infraction was an inadequate handwashing station set-up.
There were 116 food handlers trained at four food safety workshops, and one full day food handler course, at no cost.
The safe water group worked with IPM planners and the Ontario Clean Water Agency (OCWA) to ensure the water system was in compliance with Regulations to provide potable water throughout the event site and in the RV Park.
Water distribution lines were fed by hauled water in tanker trucks, then pumped into on-site storage tanks, chlorinated, and pressurized.
There were 18 fixed water sampling sites which were tested daily by OCWA and WDGPH for residual chlorine. Samples tested between 1.0-2.0 mg/L of chlorine residual over the five day event.
Multiple water samples were collected and tested in the weeks prior to the event, and a total of 36 bacteriological samples were collected and tested during the event. In total, there was 364 m3 (cubic meters) of water delivered to the IPM site. OCWA repaired 12 distribution line leaks and breaks during the event.
In the weeks before the event, water samples from some distribution lines were contaminated with Escherchia coli and coliform bacteria. The OCWA conducted additional flushing and super chlorination to ensure two clear sets of bacteriological samples were obtained before the event commenced.
The tobacco group promoted and enforced the Smoke-Free Ontario Act (SFOA) throughout the event.
No issues were reported during the event.
2. Environmental Risk Management and Incident Response
Completed pre-site assessment to identify potentially hazardous materials.
Reviewed solid waste disposal plans. There was 31.2 tonnes of waste generated and 7.4 tonnes of recycling generated during the event. No solid waste disposal issues were reported during the event.
Monitored the weather for upcoming adverse weather events and were prepared with related public messaging. No extreme events reported.
Established communication process between Police, and Emergency Medical Services (EMS) to report animal bites and investigate animal bite exposures for rabies control. No animal bite exposures were reported during the event.
Monitored sanitation and pest control of 300 garbage and 300 recyclable receptacles throughout the event. No issues reported during the event.
3. Infection Control, Disease Investigation and Surveillance
Developed a reporting structure with EMS to notify WDGPH staff on-site of any visitors exhibiting signs and symptoms of illness or injury.
Petting Zoos were inspected and it was ensured that infection control practices were being followed (i.e., handwashing stations and signage provided).
The Control of Infectious Diseases (CID) team was engaged in disease surveillance before, during, and after the event. They were on standby to provide assistance with outbreak response, if needed.
4. Safety, Health Promotion, and Communications
Responsible for ensuring that WDGPH staff were easily identified on-site (vests were worn), and had received related health and safety training.
Health Promotion resources were available for distribution (i.e., Petting Zoo Precautions, No Smoking signage).
WDGPH temporary office was located in a trailer on-site. Agency banner was displayed.
Food vendor applications and food safety resources were posted on the WDGPH website with a dedicated IPM 2016 webpage.
Blog: “Greetings from International Plowing Match” was posted on WDGPH website and on social media highlighting the role of public health in ensuring food and water safety at the event.
5. Emergency Management
Responsible for establishing IMS Roles and potentially activating the IMS, in consultation with the Medical Officer of Health (MOH).
There was no need for IMS to be activated during the event since there was no issues reported during the response phase.
Responsible for establishing resources list and setting up a temporary office onsite. Coordinated with Information Technology (IT) to ensure wireless internet service was available on-site.
Managed all financial and human resources matters. During this event, staff worked additional hours (Appendix B) and a business continuity plan was created and followed.
WDGPH used an IMS structure to develop planning and response activities for the multiple facets of the IPM event.
IPM was not an official public health emergency but the adoption of an IMS structure in planning and response helped in the coordinated approach to this large event. WDGPH business continuity was also tested at this time. It served as a training/testing opportunity to build capacity and prepare for an actual large public health emergency.
Ontario Public Health Standards
Food Safety Protocol, 2016
To prevent or reduce the burden of foodborne illness by inspection of food premises, increased public awareness of foodborne illnesses, and educate operators of transient and temporary food premises, including those operating at temporary special events.
The board of health shall conduct surveillance of:
• Suspected and confirmed foodborne illnesses; and
• Food premises in accordance with the Food Safety Protocol, 2016 (or as current) and the Population Health Assessment and Surveillance Protocol, 2016 (or as current).
The board of health shall ensure food handlers in food premises have access to training in safe food-handling practices and principles in accordance with the Food Safety Protocol, 2016 (or as current).
The board of health shall inspect food premises and provide all the components of the Food Safety Program within food premises as defined by the Health Protection and Promotion Act and in accordance with the Food Premises Regulation (O. Reg. 562); the Food Safety Protocol, 2016 (or as current); and all other applicable Acts.
Drinking Water Protocol, 2016
To provide direction in the prevention and reduction of waterborne illness, related to drinking water.
The board of health shall ensure that the medical officer of health or designate is available on a 24/7 basis to receive reports of and respond to:
• Adverse events related to safe water, such as reports of adverse drinking water on drinking-water systems governed under the Health Protection and Promotion Act or the Safe Drinking Water Act;
• Reports of waterborne illnesses or outbreaks;
• Safe water issues arising from floods, fires, power outages, or other situations that may affect water safety; and
• Safe water issues relating to recreational water use including public beaches in accordance with the Health Protection and Promotion Act; the Drinking Water Protocol, 2016 (or as current); the Infectious Diseases Protocol, 2016 (or as current); the Public Health Emergency Preparedness Protocol, 2015 (or as current); and the Recreational Water Protocol, 2016 (or as current).
The board of health shall inform the public about unsafe drinking water conditions and provide the necessary information to respond appropriately in accordance with the Drinking Water Protocol, 2016 (or as current).
Identification, Investigation, and Management of Health Hazards Protocol, 2008
To assist in the prevention and reduction of adverse health outcomes from health hazards in the environment.
The board of health shall implement control measures to prevent or reduce exposure to health hazards in accordance with the Identification, Investigation and Management of Health Hazards Protocol, 2008 (or as current) and the Risk Assessment and Inspection of Facilities Protocol, 2016 (or as current).
Rabies Prevention and Control, 2013
The purpose of this protocol is to prevent a human case of rabies by standardizing animal rabies surveillance and the management of human rabies exposures.
The board of health shall ensure that the medical officer of health or designate is available on a 24/7 basis to receive reports of and respond to suspected rabies exposures in accordance with the Health Protection and Promotion Act; the Public Health Emergency Preparedness Protocol, 2015 (or as current); and the Rabies Prevention and Control Protocol, 2013 (or as current).
WDGPH Strategic Directions
|Health Equity: We will provide programs and services that integrate health equity principles to reduce or eliminate health differences between population groups.||YES|
|Organizational Capacity: We will improve our capacity to effectively deliver public health programs and services.||YES|
|Service Centred Approach: We are committed to providing excellent service to anyone interacting with Public Health.||YES|
|Building Healthy Communities: We will work with communities to support the health and well-being of everyone.||YES|
It was recognized that many volunteers working at the IPM would be involved with food handling (i.e., preparation of boxed lunches for plowmen, tending to various food sampling booths) so it was highly recommended they complete food safety training. This was to help reduce the incidence of foodborne illness at the event.2 Four food safety workshops, and one full-day food handler certification course was offered, over three Saturdays and a couple weeknights in the summer months. The workshops and courses were offered in Clifford, Palmerston, and Harriston, where most of the volunteers for the event resided. The courses were provided free of charge and at flexible times; therefore, most barriers to attendance were removed.
Appendix 1: IPM Planning Committee; Internal, and External Working Groups
Appendix 2: Summary of Staff Hours: Regularly Scheduled and Extended Hours
Data Table of Appendix 2 chart:
|Admin Support||Management||PHIs and IT||All Staff|
|Outside of scheduled hours||0||29||111.5||140.5|
|Normally scheduled hours||12||126.5||701||839.5|
1. Ontario. Ministry of Health and Long-Term Care (2008). Ontario Public Health Standards. [Internet] 2016 [cited 2016 October 5]. Available from: http://www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/d…
2. Ontario. Ministry of Health and Long-Term Care (2016). Food Safety Protocol. [Internet] 2016 [cited 2016 October 5]. Available from: http://www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/d…
3. Health Protection and Promotion Act, R.S.O. 1990. [Internet] 2016 [cited 2016 October 7]. Available from: http://www.elaws.gov.on.ca/html/statutes/english/elaws_statutes_90h07_e.htm
4. Health Protection and Promotion Act. R.R.O. 1990, Ontario Regulation 562 – Food Premises. [Internet] 2016 [cited 2016 October 7]. Available from: https://www.ontario.ca/laws/regulation/900562
5. Health Protection and Promotion Act. R.R.O. 1990, Ontario Regulation 319/08-Small Drinking Water Systems. [Internet] 2016 [cited 2016 October 7]. Available from: https://www.ontario.ca/laws/regulation/080319
6. Ontario. Ministry of Health and Long-Term Care, Public Health Emergency Preparedness Standard and Protocol. [Internet] 2016 [cited 2016 October 7]. Available from: http://www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/d…
7. Ontario. Ministry of Health and Long-Term Care (2013). Rabies Prevention and Control Protocol. [Internet] 2016 [cited 2016 October 5]. Available from: http://www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/d…
8. Ontario. Ministry of Health and Long-Term Care (2016). Risk Assessment and Inspection of Facilities Protocol. [Internet] 2016 [cited 2016 October 7]. Available from: http://www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/d…
9. Smoke-Free Ontario Act, S.O. 1994, C.10. [Internet] 2016 [cited 2016 October 7]. Available from: https://www.ontario.ca/laws/statute/94t10