Manitoba | 40 firefighters head west to battle wildfires

Two Manitoba fire-fighting crews have been deployed to help battle forest fires in the Northwest Territories and British Columbia.

One crew of 20 has been deployed to Kamloops, while a second team of 20 has been sent to Yellowknife.  These initial attack personnel are specially trained ground crews and will be assigned their tasks upon arrival.

One Manitoba air attack officer has just returned from directing water bombers on a fire suppression mission in the Northwest Territories and another air attack officer may soon be sent to perform similar duties.

Manitoba | Summer flood bulletin #25 – July 24 2014

Flood Response

  • The Manitoba government, municipalities and other partners continue to work together on flood recovery efforts in western Manitoba.
  • Early estimates indicate that flood response and repairs will exceed $200 million.  This does not include agricultural losses as they continue to be assessed.
  • The provincial state of emergency continues for areas around the Lake St. Martin Channel and along the lower Assiniboine River including the town and Rural Municipality (RM) of Portage la Prairie and the RMs of St. François Xavier, Headingley, Cartier, Macdonald and Grey.
  • As of July 23, approximately 54 people remain evacuated as a result of summer flooding.
  • As of July 23, Aboriginal Affairs and Northern Development Canada reported a total of
    505 evacuees from First Nation communities affected by all flooding events in 2014.
  • Manitobans affected by flooding can get more information on clean up, mold remediation,
    well-water safety and other issues in After the Flood: What to do when floodwaters recede,which is available at www.gov.mb.ca/flooding.

Assiniboine River – Portage Diversion

  • This morning, flows on the Portage Diversion are approximately 16,250 cfs, reduced to less than half of the 33,000 cfs seen last week during peak flows.
  • Flows on the Assiniboine River dikes between Portage la Prairie and Headingley are 15,000 cfs, down from 18,000 cfs last week.
  • Provincial crews are working with the RM of Portage la Prairie to remove flood protection at the Hoop and Holler Bend and surrounding area.

Lake Manitoba

  • Lake Manitoba is forecast to peak at 814.8 feet by early August.
  • The Lake St. Martin Emergency Outlet Channel is expected to stay open until the spring of 2015 and will help bring the Lake St. Martin water level to approximately 802 ft. by late November 2014.
  • The Fairford River Water Control Structure continues to be operated for the most discharge possible.  Outflows are forecast to reach approximately 15,800 cfs when Lake Manitoba reaches peak levels.
  • Lake Manitoba is currently approximately 1.1 ft. below unregulated levels (the levels that would have occurred with no provincial water control infrastructure) because of high outflows through the Fairford River Water Control Structure.
  • Maps have been prepared for possible flood scenarios on Lake Manitoba and can be found at:  www.gov.mb.ca/mit/floodinfo/floodoutlook/watersheds_data_maps.html.

Disaster Financial Assistance

  • To date, the province has received nearly 600 private applications for Disaster Financial Assistance and another 35 applications from municipalities and other groups.
  • A temporary Disaster Financial Assistance Recovery Office will remain open in Brandon until Friday, July 25 from 8:30 a.m. to 4:30 p.m.  It is located at 1601 Van Horne Ave. E., with access from the south entrance.  Staff will answer inquiries and take applications.
  • Application forms and further details about the disaster financial assistance program are available through the Manitoba Emergency Measures Organization online at www.manitobaemo.ca, or by calling 204‑945‑3050 in Winnipeg or 1-888-267-8298 (toll-free).  Applications are also available at most municipal offices.

Stress and Anxiety Resources

  • The scale and scope of the summer flood is very challenging for affected Manitoba families.  There are resources to help deal with the stress and anxiety that result from crisis situations.
  • Resources are available at www.gov.mb.ca/flooding/managing_stress.html.

Road Information

  • Manitoba Infrastructure and Transportation reports sections of many provincial and municipal roads in western Manitoba have closed or marked with caution due to flooding.
  • There has been considerable damage to bridges and culverts.  Repair work is already underway. More than 30 structures will need to be replaced and another 50 will require repairs.
  • Drivers are reminded to assume bridges may be damaged on all roads.  Reduce speed and restrict weight to 10 tonnes.  Drive with caution and obey road closed signs.
  • For current highway conditions, call 511, visit www.manitoba.ca, www.mb511.ca or follow the Twitter account at www.twitter.com/MBGovRoads.

Up-to-date flood information can be found at www.gov.mb.ca/flooding/, on mobile devices at www.manitoba.ca or on Twitter at www.twitter.com/MBGov.

Newfoundland and Labrador | Govt reaches tentative funding agreement with Community Ambulance Operators Association

The Provincial Government has reached a tentative funding agreement with the Newfoundland and Labrador Community Ambulance Operators Association which represents community-based non-profit ambulance operators across the province.

It includes a total increase in funding of $1.6 million over the term of the agreement and base wage increases for ambulance attendants.

“These operators work in rural parts of our province to help meet the health care needs of our citizens. Our government has demonstrated its commitment to fair negotiations and I am pleased all parties have worked together to reach this tentative funding agreement.”
- The Honourable Charlene Johnson, Minister of Finance and President of Treasury Board

The agreement is valid until April 2017 and includes funding for a $1 per hour base wage increase in each of 2014, 2015, and 2016.

“We are pleased that a tentative agreement has been reached with the association representing community-based operators who play an essential role in the delivery of health care services for the people of our province. This agreement will strengthen road ambulance services in rural parts of Newfoundland and Labrador, provide wage increases to rural paramedics and support operational improvements.”
- The Honourable Clyde Jackman, Minister of Health and Community Services

The tentative agreement outlines funding amounts of approximately $5.4 million in 2014-15, $5.6 million in 2015-16, and $5.8 million in 2016-17, and will be finalized in the coming weeks. The Newfoundland and Labrador Community Ambulance Operators Association represents 22 ambulance operators across the province.

VITAL SIGNS

  • The Provincial Government has reached a tentative funding agreement with the Newfoundland and Labrador Community Ambulance Operators Association.
  • It includes funding for a $1 per hour base wage increase in each of 2014, 2015, and 2016.
  • This tentative agreement will strengthen road ambulance services in rural parts of Newfoundland and Labrador, provide wage increases to rural paramedics and support operational improvements.
  • The agreement is valid until April 2017 and will be finalized in the coming weeks.

NZ | Glass fragments in Actavis brand of oral liquid amoxicillin prompts recall

recallphotos

Glass fragments found in two bottles of the Actavis brand of amoxicillin oral liquid have prompted a recall by the company.

There have been no reports of any harm from the glass being in the bottles. The recall has occurred as a precautionary measure as the glass fragments found in the bottles appear to have been broken off from the lip of the bottle during manufacturing of the product.

Anyone prescribed amoxicillin liquid by their doctor is advised to check if it is the Actavis brand and if it is to stop using it and contact their GP or pharmacist for a replacement. This brand of amoxicillin has only been widely used since the beginning of this month.

Amoxicillin is a frequently prescribed antibiotic and is often used for treatment in children for glue ear, chest, skin and urinary tract infections. It is also used for other less common conditions.

Only the oral liquid Actavis Amoxicillin is affected. The capsule form and other brands of amoxicillin are not affected and alternative antibiotics to amoxicillin are available.

Actavis Amoxicillin oral liquid is packaged in glass bottles and is available in two strengths: 125 mg/5 ml and 250 mg/5 ml.

Medsafe has provided information to health professionals about the recall. Anyone wanting advice is advised to call Healthline 0800 611 116 or Plunketline 0800 933 922.

Products affected

Amoxicillin Actavis Powder for oral suspension (125 mg/5 ml and 250 mg/5 ml).

Key information for consumers and caregivers

  • Do not give any further doses of Amoxicillin Actavis oral liquid.
  • Contact your doctor or pharmacist for further advice. Your doctor may give you an alternative brand of amoxicillin, an alternative antibiotic or alternative treatment.

This recall only applies to the Actavis brand of amoxicillin oral liquid.

Any charge for health services provided as a result of this recall are at the discretion of the GP or pharmacist.

Additional information

How much Actavis brand amoxicillin is on the market: It is estimated that up to 60,000 bottles are in the distribution chain. The bulk of this will be stopped and either held or returned to the distributor.

How much Actavis brand amoxicillin is held by consumers: It is estimated that between 10,000 and 20,000 bottles are likely to have been dispensed to individuals since it became a fully subsidised medicine in NZ on 1 July 2014.

What should people do if they have been prescribed amoxicillin liquid: They should check if it is the Actavis brand. If it is they should stop using it and contact their GP or pharmacist as soon as possible to arrange a replacement. If they are concerned they should contact Healthline 0800 611 116 or Plunketline 0800 933 922. If in doubt talk to your pharmacist or GP.

What is amoxicillin prescribed for: Amoxicillin is a frequently prescribed antibiotic and is often used for treatment in children for glue ear, chest, skin and urinary tract infections. It is also used for other less common conditions.

Are other brands of amoxicillin available: There is a limited supply of alternative brand liquid amoxicillin. There are a number of alternative antibiotics available that are suitable and are Government funded.

What happens if my child misses a dose of medicine before the medicine is able to be replaced: In most cases, a child with a simple infection can miss a single dose of an antibiotic without concern. Anyone concerned or seeking advice should contact their doctor or ring Healthline or Plunketline.

Do I have to pay to see the doctor or to pick up a new medicine from the pharmacist: Any charge for services provided as a result of the recall are at the discretion of the GP or pharmacist. The Ministry expects a significant number of those affected will be under 6 years of age. Both the GP visit and pharmacy prescription charge are fully funded by the Government and there would generally be no charge for this.

Has anyone been harmed as a result of glass in the amoxicillin: There have been no reports of harm.

How did the glass get in the bottles: The bottles are made of glass and in the two cases reported the glass bottles appear to have been broken from the lip of the bottle. As a precautionary measure the bottles have been recalled. Both the company making and distributing the medicine and Medsafe are investigating the cause of the glass being found in the two bottles.

Who found the glass in the bottles and when was it reported: Pharmacists found the glass fragments when they were preparing the oral solution for supply to patients, they alerted the product supplier who in turn alerted Medsafe on the afternoon of 15 July.

Why wasn’t the glass in the bottles found before the bottles were distributed: The glass fragments appear to have been displaced during the manufacturing process of the product. As the bottles are sealed with an aluminium foil cap it is not possible to visually identify damage to the lip of the bottle during or after the manufacturing process. The fragments have been found in the powder contained within two bottles of the product. Visual inspection will not identify glass fragments within this antibiotic powder.

WA | St John boosts medic training to state’s resources sector

Mining, petroleum and industrial companies can bolster their occupational safety and health capability with a new medic training program offered by St John Ambulance Western Australia.

St John launched the Certificate IV in Health Care (Ambulance) this month with the inaugural class of resources workers enrolled in the 10-day course.

Students undertake medical and emergency response scenarios ranging from minor accidents through to mass casualty explosions and other potential serious industrial incidents.

On completing the course, these workers return to their usual job roles backed by the skills to respond in an industrial first aid emergency.

St John Deputy Chief Executive Officer, Anthony Smith, said Certificate IV meets resource sector demand for medics with hands-on, practical training.

“St John has responded to an obvious need in the marketplace for a first-class industrial medic course,” he said.

“For businesses, having a Certificate IV trained worker on site provides a high level of expertise and capability to react in an emergency.

“Medic-trained employees will have an additional valuable skillset to add to their CV in what is becoming a more competitive resources job market.”

According to the WA Department of Mines and Petroleum, in 2012/13 the mining industry had 411 serious injuries which resulted in a worker being off work for two weeks or more.

These incidents require immediate expert medical care that has the best outcome for the patient and results in the quickest return to work.

Certificate IV students commence training with a digital theory component which they complete in their own time and typically takes four to six weeks.

This is followed by a 10-day practical course conducted by St John paramedics. Scenarios are customised for different industries to replicate those which a worker may be faced with on the job.

St John offers industry leading industrial medical services ranging from first aid training through to onsite paramedics.

To register or find out more, visit www.stjohnambulance.com.au or call (08) 9334 1480.

WA | Mom’s first aid training saves boy from lifelong scarring

William Kee of Furnissdale was nearly two years old when he suffered severe burns from a household accident.

His mother, Clare Craggs, had recently completed a first aid course and knew what to do in an emergency.

“When my son was 23 months old he was badly burned by a cup of coffee,” Clare said.

“Following my first aid training, I responded quickly and stripped all his clothes and put him in a cold shower for 20 minutes before taking him to hospital.”

Once in hospital, William was cared for by renowned burns specialist Winthrop Professor Fiona Wood.

In just four months of treatment, he had no visible scars. If it had not been for his mother’s quick thinking, the outcome could have been far worse.

“Fiona Wood told me that if I had not administered first aid, William could have been scarred for life,” Clare said.

Winthrop Professor Wood said: “Twenty minutes of cool clear running water reduces the impact of burn injury in children by 80 per cent, so this first aid message is fundamental not just for parents of children but all members of the community.”

St John Ambulance WA, the state’s leading first aid training, wants to make first aid a part of everyone’s life.

St John First Aid Services and Training General Manager Jane Mahon said: “Providing first aid in a medical emergency can have a huge impact and support the efforts of paramedics and doctors, as we saw with William.”

In 2013/14, St John trained 220,748 people in first aid, including more than 100,000 WA schoolchildren through the First Aid Focus program.

St John has recently launched a tiny tots first aid kit which contains useful items to help parents monitor temperatures, treat minor scratches and to manage unexpected accidents.

For information about first aid training or the tiny tots first aid kit, contact 1300 STJOHN or visit stjohnambulance.com.au

WA | Measles contact at Royal Perth and Bentley Hospitals

The Department of Health is alerting people who were at Royal Perth Hospital (RPH) on July 3 and 6 or at Bentley Hospital on July 2 and 5, that they may have been exposed to measles.

A person who was at RPH and Bentley Hospitals on these days has been confirmed to have measles. If not immune, exposed people who attended the hospitals on these days could develop symptoms of the disease from now until around July 24.

An unimmunised traveller who was infected while holidaying overseas, and who attended the Emergency Department at RPH on June 21 and 24, was the original source of the infection. That person has also spread measles to two family members and another patient attending the Emergency Department at that time.

Contact associated with the most recent case is believed to be limited, but the necessary precautions are being taken by advising known contacts, including both staff and patients.

Measles is highly infectious to non-immune persons and is spread by airborne respiratory droplets. The incubation period is usually 10–14 days but may be up to 18 days. Clinical illness from measles usually begins as fever, cough, runny nose and sneezing and conjunctivitis (red, sore eyes), before the characteristic blotchy red rash appears after about 3 to 4 days. Measles is infectious up to five days before the rash appears, and usually for about 4 days after appearance of the rash.

Measles can be a serious illness, especially in young children and other vulnerable people. Around 50% of cases may require hospitalisation, and complications include pneumonia and encephalitis.

People who have not been vaccinated against measles or have received only one dose of vaccine may still be susceptible to infection. About 99 per cent of people who receive the recommended course of two vaccinations will be immune to measles. People born before 1966 have a high probability of being immune through prior natural infection.

Naturally occurring measles has been eliminated from WA since 1999, but occasional cases and small outbreaks occur associated with tourists or WA residents returning from overseas.

A family of five unimmunised children also recently acquired measles from an unknown source in WA. These incidents are a reminder of the importance for all Western Australians to be fully vaccinated against measles and other infectious diseases, including when travelling overseas.

People who think they may have measles should stay at home and not go to public places. If they need to attend a GP or hospital they should phone ahead so that precautions can be taken to ensure they do not sit in waiting rooms and clinical areas where they may infect other patients and staff.

Further information regarding measles is available at www.public.health.wa.gov.au

WA | 11th case of meningococcal infection

The Department of Health today reported that an elderly person was recently diagnosed with meningococcal disease and is making a good recovery.

Meningococcal disease is an uncommon, life-threatening illness due to a bacterial infection of the blood and/or the membranes that line the spinal cord and brain.

The Department of Health has identified the person’s close contacts and provided them with information, and, where appropriate, antibiotics that minimise the chance that the organism might be passed on to others.

Meningococcal bacteria are carried harmlessly in the back of the nose and throat by about 10–20 per cent of the population at any one time. Very rarely, the bacteria invade the bloodstream and cause serious infections.

Meningococcal bacteria are not easily spread from person-to-person. The bacterium is present in droplets discharged from the nose and throat when coughing or sneezing, but is not spread by saliva and does not survive more than a few seconds in the environment.

Invasive meningococcal infection is most common in babies and young children, older teenagers and young adults, but infection can occur at any age.

Symptoms may include high fever, chills, headache, neck stiffness, nausea and vomiting, drowsiness, confusion, and severe muscle and joint pains. Young children may not complain of symptoms, so fever, pale or blotchy complexion, vomiting, lethargy (blank staring, floppiness, inactivity, hard to wake, or poor feeding) and rash are important signs.

Sometimes—but not always—symptoms may be accompanied by the appearance of a spotty red-purple rash that looks like small bleeding points beneath the skin or bruises.

Although treatable with antibiotics, the infection can progress very rapidly, so it is important that anyone experiencing these symptoms seeks medical attention promptly. With appropriate treatment, most people make a good recovery.

The incidence of meningococcal disease has decreased significantly in WA over the past decade, with around 20 to 25 cases reported each year—down from a peak of 86 cases in 2000.

There were 16 cases notified in 2013, the lowest number recorded in more than 20 years. Eleven cases have been reported to date in 2014.

A vaccine to protect against the C type of meningococcal disease, which in the past was responsible for around 15 per cent of cases in WA, is provided free to children at 12 months of age.

TAS | Public health officials issue measles alert

Measles alert

During July 2014 there have been five confirmed cases of measles diagnosed in Tasmania and two suspected cases. These seven cases comprise three clusters, each of which started with an infection caught outside of Tasmania.

There have been over 250 cases of measles in the mainland states so far this year.

Population Health Services has identified contacts of the recent Tasmanian cases and provided them with advice about measles and, if the timing permitted, measles vaccine or a preventive treatment (immunoglobulin).

Several other illnesses, some linked to known cases, are also under investigation.

It is possible that other people have been exposed to known or as-yet unknown cases of measles, and for this reason we are asking all Tasmanians and their doctors to be alert to the symptoms of this disease.

Measles is highly contagious to people who are not immune, and can be a very serious infection.

 Who is immune to measles and who isn’t?

  • People born before 1966 are probably immune from measles infection during childhood.
  • People born from 1966 onwards are less likely to have had the infection, but will almost certainly be immune if they have had two doses of a measles-containing vaccine.
  • People born from 1966 onwards who have not had measles vaccine, or only had one dose, cannot be sure they are immune. Young and middle aged adults who are uncertain of their immunity should discuss having a booster of a measles vaccine with their General Practitioner.

Most young Tasmanian children will have received their first measles vaccine at 12 months and a second dose at 18 months (or, before July 2013, at 4 – 5 years of age).

 What are the symptoms of measles?

Measles usually starts with a fever, cough, sore red eyes and a runny nose. These start about 10 days after contact with a case, but can occur a few days sooner or later. A blotchy rash firstly on the face and then the body appears several days after the fever. People with measles are usually quite ill.

People who have these symptoms should see a doctor – but it is very important that they call ahead so the clinic can plan to see them without exposing other patients or staff to risk of infection.

People with measles should stay away from school, work and public places until their doctor advises them it is safe for them to resume normal activities.

SA | Colchicine toxicity can be fatal

The South Australian Coroner recently reported on a case of a 76-year-old nursing home resident, who died as a result of colchicine toxicity. The resident received multiple courses of colchicine and at the time of her death, had a potentially lethal blood concentration.

The Coroner found the case illustrated the dangers of colchicine; that its potential lethality is not well understood within the medical community and there are ambiguities in the published dosing guidelines.

There are other case reports in the literature of toxicity and death linked with colchicine.1

Accumulation of colchicine and fatal toxicity

Although colchicine poisoning is relatively uncommon, it is imperative to recognise risk factors and its clinical presentation as it is associated with a high mortality rate.

Accumulation may occur when:

  • multiple courses of colchicine are repeated within a short time frame
  • colchicine is prescribed with a drug that inhibits its metabolism (e.g. clarithromycin)
  • colchicine dose is not adjusted in the elderly, or patients with renal / hepatic impairment

Colchicine should be discontinued immediately if gastrointestinal effects occur (e.g. nausea or diarrhoea). In overdose, colchicine can lead to multiple organ failure.

Indications and dosing information

Colchicine is indicated for the relief of pain early in acute gout, or prophylaxis of recurrent gout including when starting urate lowering therapy. It may also be used for other conditions.

The conservative dosing schedule in the Australian Medicines Handbook (AMH) is recommended.

The Australian product information and Therapeutic Guidelines reflect previously used higher dose regimens.

Recommended dosing in acute gout in adults:

1 mg orally, then 500 micrograms orally 1 hour later. (A maximum 1.5 mg per course)

Do not repeat the course within 3 days. Wait at least 12 hours before resuming prophylactic colchicine.2

Recommended dosing for prophylaxis of gout in adults, including when starting urate lowering treatment:

500micrograms once or twice daily according to response (for further details refer to AMH2)

Dose adjustments are required in the elderly AND in renal and hepatic impairment. Dosing in paediatrics – seek expert advice.

Consider alternative agents

Other short-course pharmacological options for acute gout attacks include:

  • Prednisolone
  • Non-steroidal anti-inflammatory agents

Action required by health professionals

Health care professionals must:

  1. Consider the alternative agents for first-line treatment and prophylaxis of gout.
  2. Be aware of the risks associated with the use of colchicine
  3. Be aware of patient risk factors for colchicine toxicity
  4. Be aware of the inconsistent dosing information for the use of colchicine in the management of acute gout.
  5. Note the conservative dosing schedule in the AMH is recommended.

Action required by SA Health services

Health services should:

  1. Review current practice and ensure recommendations and actions are consistent across all treatment settings.
  2. Ensure that staff are aware of the risks associated with use of colchicine, both short and long-term, and regularly monitor relevant clinical parameters.

Further information

See the full coroner’s report (opens in a new window).

Safety notice

A patient Safety Notice strongly advises the implementation of particular recommendations or solutions to improve quality and safety.

Inform

We recommend you inform:

  • General Managers
  • Pharmacy Directors
  • Medical Directors
  • Clinical Directors
  • Nursing Directors
  • Drug and Therapeutics Committees
  • Medication Safety Committees
  • Safety and Quality Units
  • Clinical Governance

References

  1. Australian Adverse Drug Reactions Bulletin Vol 25, No. 5, Oct 2008
  2. Australian Medicines Handbook 2014 (online). Adelaide: Australian Medicines Handbook Pty Ltd; 2014 January. Available from: http://www.amh.net.au

Be well. Practice big medicine.