International Civil Aviation Organization

International Civil Aviation Organization

Assistance Visit: Not an audit or evaluation Assist State to do a gap analysis on: IHR implementation at PoE (airport) Compliance with ICAO SARPs on Public Health Events

Airport Visit Methodology Visit shall not affect normal operations The visit should demonstrate preparedness in the roles, responsibilities, and procedures in a PHE A suggested format: Scenario of the arrival of an aircraft with a suspected case of infectious disease on board or a scenario where an outbreak of a PHE has occurred in the State in the vicinity of the airport Walkthrough observations and interviews

Airport Assistance Visit (Hong Kong) Evaluation of HKIA

Actual assistance visit is a 2 day affair Day 1: Presentation/s by ICAO AV Team Presentations by host State all stakeholders Discussion on Checklist submitted earlier by host State Review of Documentation Day 2: On site validation of implementation and review of facilities

Visit to Airport Tour of the airport facilities involved in public health emergencies To verify the implementation of the airport public health emergency preparedness plan by the AV team:

International Health Regulations (2005) A global legal framework for public health security IHR (2005) came into force on 15 June 2007* Legally binding for the world s countries that have agreed to follow the same rules to secure international health. Courtesy WHO

Purpose of the IHR (2005) To prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade Article 2 Courtesy WHO

96 Articles Article 14, International Convention on Civil Aviation Basis for action---- Health

Basis for Action - health Article 14, International Convention on Civil Aviation: Each contracting State agrees to take effective measures to prevent the spread by means of air navigation of cholera, typhus (epidemic), smallpox, yellow fever, plague, and such other communicable diseases as the contracting States shall from time to time decide to designate.

Basis for Action - health Article 14, International Convention on Civil Aviation:.and to that end contracting States will keep in close consultation with the agencies concerned with international regulations relating to sanitary measures applicable to aircraft.

Health of passengers and crew = Safety ICAO Assembly Resolution A35-12: Protection of the health of passengers and crews and prevention of the spread of communicable disease through international travel The Assembly:.... Declares that the protection of the health of passengers and crews on international flights is an integral element of safe air travel and that conditions should be in place to ensure its preservation in a timely and cost-effective manner;

18 ICAO Annexes contain SARPs (Standards and Recommended Practices) Annex 1 Personnel Licensing Annex 2 Rules of the Air Annex 3 Meteorological Service for International Air Navigation Annex 4 Aeronautical Charts Annex 5 Units of Measurement to be Used in Air and Ground Operations Annex 6 Operation of Aircraft * Annex 7 Aircraft Nationality and Registration Marks Annex 8 Airworthiness of Aircraft Annex 9 Facilitation * Annex 10 Aeronautical Telecommunications Annex 11 Air Traffic Services Procedures for Air Navigation Services Air Traffic Management (PANS-ATM) * Annex 12 Search and Rescue Annex 13 Aircraft Accident and Incident Investigation Annex 14 Aerodromes * Annex 15 Aeronautical Information Services Annex 16 Environmental Protection Annex 17 Security: Safeguarding International Civil Aviation Against Acts of Unlawful Interference Annex 18 The Safe Transport of Dangerous Goods by Air Annex 19 Safety Management System

Assistance Visit Checklist (http://www.capsca.org/capscarefs.html#stateassistance) After confirmation of Assistance Visit to the State/Airport ICAO CAPSCA Checklist is sent to the State/Airport (Usually to the State Civil Aviation Authority or the State CAPSCA Focal Point Can be from Public Health as well) Ideally 2 months (60 days) before the Assistance Visit. State/Airport will complete the Checklist and send back to ICAO Assistance Visit Team leader Checklist will be discussed with the hosts during the Assistance Visit

Assistance Visit Checklist Components (http://www.capsca.org/capscarefs.html#stateassistance) Grouping of questions in the Checklist Administrative Documentation Emergency Ops Centre Rescue Fire Fighting Services Immigration Customs Cargo & Baggage handlers Air Nav. Service Provider Medical AVSEC Infrastructure Aircraft operators Media

CHECKLIST A. ADMINISTRATIVE Areas 1. Which entity fulfils the function of the Competent Authority (as defined in the WHO International Health Regulations (2005) 2. Is the airport State owned? 3. Is the airport under the administration of the Civil Aviation Authority? 4. Who operates the airport? Specify if there is more than one operator 5. Does the Public Health Authority have designated personnel at the airport? 6. Has the State established a national committee for Public Health Emergency planning? 7. Is the Civil Aviation Authority involved? 8. Is the Public Health Authority involved? 9. If so, under a formal contract/agreement? 10. Are aircraft operators involved? 11. Are the Rescue and Fire Fighting services involved? 12. Is the Air Navigation Services Provider involved? 13. Are the Immigration/Customs Services involved? 14. Are the security services involved? 15. Are private health services involved? 16. Are the service providers involved? (Airlines, 17. Ground Handling Service (GHS), cargo, etc.) 18. Are formal contracts/agreements utilised specifying the involvement of stakeholders? Reference 1. IHR Article 1, Definitions 2. National documentation 3. National documentation 4. National documentation 5. National documentation 6. IHR Annex 1, A, 3 7. ICAO Annex 14, 9.1.1-9.1.3 8. ICAO Annex 14, 9.1.1-9.1.3 9. ICAO Annex 14, 9.1.1-9.1.3 10. ICAO Annex 14, 9.1.1-9.1.3 11. ICAO Annex 14, 9.1.1-9.1.3 12. ICAO Annex 14, 9.1.1-9.1.3 13. ICAO Annex 14, 9.1.1-9.1.3 14. ICAO Annex 14, 9.1.1-9.1.3 15. ICAO Annex 14, 9.1.1-9.1.3 16. ICAO Annex 14, 9.1.1-9.1.3 17. ICAO Annex 14, 9.1.1-9.1.3 18. National documentation

CHECKLIST B. DOCUMENTATION Areas Does the airport have in place a Plan for Public Health Emergencies? Is it part of the Airport Emergency Plan? Is it compatible with the national Aviation Preparedness Plan for Public Health Emergencies? Is it compatible with the National Preparedness Plan for Public Health Emergencies? Has the Airport/Aerodrome Emergency Plan been tested by conducting full-scale exercises and/or table-top exercises? Specify what and when Are the stakeholders familiar with Annex 6, in particular Attachment B (Medical Supplies)? Are the stakeholders familiar with Annex 9, Chap. 8, Appendices 1 (General Declaration) and 13 (Public Health Passenger Locator Card)? Specify (1) who collects the General Declaration and Passenger Location Cards and (2) who processes the information on arrival. Are the stakeholders familiar with Annex 11, in particular Attachment C (Material Relating to Contingency Planning)? Are the stakeholders familiar with Annex 14, Chapter 9 (Aerodrome operational services, equipment and installations) in particular paragraph 9.1 (Aerodrome Emergency Planning)? Are the stakeholders familiar with the International Health Regulations (2005)? Are the stakeholders familiar with ICAO Procedures for Air Navigation Services-Air Traffic Management, Doc. 4444, in particular paragraph 16.6: Notification of suspected communicable diseases on board an aircraft, or other public health risk? Is there a national Preparedness Plan for a Public Health Emergency? Which stakeholders receive training concerning the national Preparedness Plan for a Public Health Emergency (airport personnel, public health authority, etc.)? Is there a National Aviation Preparedness Plan for a Public Health Emergency of International Concern (PHEIC)? Is this Plan part of a National Public Health Emergency Plan? Does the Preparedness Plan include phases as defined by WHO in Pandemic Influenza Preparedness and Response 2009? Is there a National Business Continuity Plan for Public Health Emergencies? Is there an Airport/Aerodrome Operator Business Continuity Plan for Public Health Emergencies? Reference ICAO Annex 14, 9.1.1-9.1.3 ICAO Annex 14, 9.1.1-9.1.3 ICAO Annex 9, 8.16 ICAO web-based Guidelines for States.Section General Preparedness ICAO web-based Guidelines for States.Section General Preparedness ICAO Annex 6, Attachment B ICAO Annex 9, Appendices 1, 13 National documentation ICAO Annex 11, Attachment C ICAO Annex 14, Chapter 9 WHO IHR (2005) ICAO PANS-ATM, Doc 4444 WHO IHR (2005) Article 13 National documentation ICAO Annex 9, 8.16 WHO Pandemic Influenza Preparedness & Response, 2009 National documentation Airport/aerodrome operator documentation

CHECKLIST C. EMERGENCY OPERATION CENTRE (EOC) Areas Reference Is there in place a flow chart to initiate the aviation emergency response plan process? Do Public Health Authority personnel participate in developing the aviation preparedness plan? National documentation ICAO web-based Guidelines for States.Section General Preparedness

CHECKLIST D. RESCUE AND FIRE FIGHTING (RFF) SERVICES Areas Reference Do the RFF Services participate in the development and testing of the Airport Emergency Plan for Public Health emergencies? ICAO web-based Guidelines for States.Section General Preparedness

CHECKLIST E. IMMIGRATION Areas Does the immigration service participate in development and testing of the Airport Emergency Plan for public health emergencies? Are there procedures for handling passengers suspected of being affected by a communicable disease? Are personnel trained about protective measures for handling from suspected passengers? Reference ICAO web-based Guidelines for States.Section General Preparedness Airports Council International (ACI) web-based Guidelines for airport operators.section 6 ACI web-based Guidelines for airport operators.section 6

CHECKLIST F. CUSTOMS Areas Does the customs service participate in development and testing of the airport Emergency Plan for public health emergencies? Are there special procedures for handling luggage from passengers suspected of being affected by a communicable disease? Are customs personnel trained to use appropriate protective measures for handling luggage from suspected passengers? Reference ICAO web-based Guidelines for States.Section General Preparedness IATA web-based Guidelines for aircraft operators Section Air Transport and Communicable Diseases. See Cargo and Baggage Handlers IATA web-based Guidelines for aircraft operators Section Air Transport and Communicable Diseases

CHECKLIST G. CARGO AND BAGGAGE HANDLERS Areas Do personnel handling cargo participate in development and testing of the airport Emergency Plan for public health emergencies? Are relevant personnel trained to use protective measures for handling cargo that may contain infectious substances (ICAO Annex 18 The Safe Transport of Dangerous Good by Air)? Are cargo and baggage handlers trained to use appropriate protective measures for handling luggage from suspected passengers? Reference ICAO web-based Guidelines for States.Section General Preparedness ICAO Technical Instructions for the safe transport of dangerous goods by air, Chapter 6 IATA web-based Guidelines for aircraft operators Section Air Transport and Communicable Diseases

CHECKLIST H. AIR NAVIGATION SERVICE PROVIDER (ANSP) Areas Does the ANSP participate in development and testing of the airport Emergency Plan for public health emergencies? Does the ANSP provide training with the PANS ATM (Doc 4444, paragraph 16.6) procedure for notifying the destination airport of a potential onboard public health emergency? Is a procedure in place for transfer of information from the ANSP to the public health authority, notifying that anticipated arrival of an affected aircraft? Does the ANSP have a contingency plan for managing Public Health Emergencies? Does the ANSP have a Business Continuity Plan for managing Public Health Emergencies? Reference ICAO web-based Guidelines for States.Section General Preparedness PANS-ATM (Doc 4444) National documentation ICAO Annex 11, Attachment C National documentation

CHECKLIST I. MEDICAL SERVICES Areas Is the airport medical service provided by the State or a private enterprise? Has the service provider received training in managing public health emergencies? Has it established a communication process with the Public Health Authority? Has ease of access to the affected aircraft by medical service providers been considered in designating an aircraft parking position? Are medical service providers aware of (1) Notification procedure of a suspected case by the pilot in command (2) Health part of the aircraft general declaration? Is there a procedure enabling the public health authority to communicate with the affected aircraft before landing? Does the service provider participate in the development and testing of the airport emergency plan for public health emergencies? Does it use and process (1) the General Declaration and/or (2) the Public Health Passenger Locator Card? Does it have access to the suspect or affected traveller s assessment area? Does it have procedures for transfer of suspect or affected travellers to specialized evaluation units? Does it have procedures for aircraft disinfection? What disinfectant product(s) is used to disinfect an affected aircraft? What procedure is used? How long does it normally take? Is the service provider aware of relevant aspects of the IHR (2005)? In the case of an affected aircraft carrying a suspected case of a communicable disease, are efforts made to minimize the delay to other travellers and the return to service of the aircraft? Reference National documentation WHO IHR (2005) Annex 1, B National documentation ACI web-based Guidelines for airport operators.section 6 1 - ICAO PANS-ATM 2 -ICAO Annex 9, Appendix 1 WHO technical advice for case management of Influenza A (H1N1) in Air Transport ICAO web-based Guidelines for States.Section General Preparedness National documentation National documentation contract/agreement? WHO IHR (2005) Annex 1, B WHO Guide to Hygiene and Sanitation in Aviation WHO Guide to Hygiene and Sanitation in Aviation WHO Guide to Hygiene and Sanitation in Aviation IHR (2005) ACI web-based Guidelines for airport operators.section 6

CHECKLIST J: SECURITY Areas Does the aviation security (AVSEC) provider participate in the development and testing of the airport emergency plan for public health emergencies? Are there procedures in place for managing aviation security in the designated passenger assessment area for suspect or affected travellers? Are personnel trained in the use of protective measures for managing suspect or affected travellers? Reference ICAO web-based Guidelines for States.Section General Preparedness National documentation ACI web-based Guidelines for airport operators.section 6

CHECKLIST K. INFRASTRUCTURE Areas Are the international passenger flows mixed, on arrival and departure? Is there a designated parking position for an affected aircraft? If so, where is the designated position? Are there provisions for maintaining electricity, water supply, waste disposal, etc. at the aircraft after parking? Does the airport have a designated holding or waiting area for suspect or affected travellers? If so, does the designated area have easy access for passengers (air bridge, ground transportation, etc.)? National documentation Does the designated area have easy access to emergency medical services? Does the designated area have power supply, lighting, air conditioning and adequate services? Is the position of the designated area promulgated to appropriate personnel? Are screening measures available to be rapidly introduced? If so, for: 1- Entry? 2- Exit? 3- Transit? What screening measures are planned to be available? Are facilities available to enable rapid testing of biological specimens? What are they? Reference National documentation ACI web-based Guidelines for airport operators.section 6 National documentation National documentation WHO IHR (2005) Annex 1, B National documentation National documentation National documentation WHO Pandemic Influenza Preparedness & Response, 2009 WHO Pandemic Influenza Preparedness & Response, 2009 National documentation

CHECKLIST L. AIRCRAFT OPERATORS: Areas Do the aircraft operators participate in the development and testing of the airport emergency plan for public health emergencies? Are aircraft operators aware of (1) Notification procedure of a suspected case by the pilot in command (2) Health part of the aircraft general declaration? Are aircraft operators aware of IATA guidelines for: cabin crew; maintenance crew; bird-strike; cleaning crew; passenger agents? Reference ICAO web-based Guidelines for States.Section General Preparedness 1 - ICAO PANS ATM 2 -ICAO Annex 9, Appendix 1 IATA web-based Guidelines for aircraft operators Section Air Transport and Communicable; Diseases

Checklist Media Is there a communications strategy and plan?

CHECKLIST CAPSCA AIRPORT ASSISTANCE VISIT Communication Links Internal Communication Links External Airlines Handling agents Air Traffic Services Local public health agency, local hospital(s) Police, Customs, Immigration, Security Travel agents Airport retailers Information / customer relations services Passengers (before reaching airport and within terminal building) Other airports in same State/Region Other airports outside State/Region Media

CHECKLIST CAPSCA AIRPORT ASSISTANCE VISIT Examples of implementation to be reviewed On the day implementation of preparedness plan Communication links For departing and arriving passengers: Screening methods, Trained personnel, Reliable equipment serviced according to manufacturer s specifications Area for screening Designated areas & facilities for: Review of suspect cases, Possible isolation and quarantine (case assessment), Transport of cases to designated medical facility Use of PPE Baggage, security and customs/immigration clearance Consideration and planning for the possibility of reduced staffing levels at the airport due to sickness absenteeism during a pandemic. Consideration of procedures concerning airspace restriction and/or aircraft diversion when a suspected case of communicable disease is on board an arriving aircraft

Airport facilities to Visit Emergency Operations Centre Passenger screening/assessment locations and facilities Medical Services/Response clinic Immigration & Customs Air Traffic Control Tower Designated aircraft parking position Any other agency / area / facility involved in a public health emergency

Plans and Procedures for Public Health Emergencies in the Aviation Sector WHO International Health Regulations (IHR) 2005 ICAO Annexes 6, 9, 11, 14 & 18 and Doc. 4444 (PANS-ATM) National Public Health Emergency Contingency Plan (PHA) National Aviation Regulations updated with international standards related to public health (CAA) National Aviation Plan for a Public Health Emergency (CAA) Aerodrome Emergency Plan including public health emergencies Air Traffic Services (ATS) contingency plan including public health emergencies ATS Procedures for notification of suspected public health risk on board an aircraft Aircraft Operators Procedures for suspected public health risk on board an aircraft

Documentation National public health emergency preparedness plan Aviation Public Health Emergency Preparedness Plan Airport public health emergency preparedness plan Airport Emergency Procedures Manual Standard Operating Procedures (SOPs) of all stakeholders including the air navigation services provider Public Health Exercises Template for the Health Part of General Declaration? Template Public Health Passenger Locator Card?

Implementation Examples Communication links For departing and arriving passengers: Screening methods, Use of PPE, Trained personnel Designated areas & facilities for: Screening, assessment of suspected cases, Possible isolation and quarantine, Transport of cases to designated medical facility Baggage, security and customs/immigration clearance Consideration and planning for the possibility of reduced staffing levels at the airport due to sickness or other absenteeism during a PHE Procedures concerning arrival and handling of an aircraft when a suspected case of communicable disease is on board

Documents to Review National PHE Plan Aviation part Airport Emergency Plan PHE part ATS Procedures for communication of on-board cases

USOAP Audit - Organization

Air Navigation Service Protocols (2) Does the State ensure that the ATS has established a procedure, upon receipt of information from a pilot regarding a suspected case of communicable disease, to forward a message as soon as possible to: the ATS unit serving the destination/departure if applicable the public health authority (PHA) or the appropriate authority designated by the State the aircraft operator or its designated representative the aerodrome authority? PANS ATM Doc 4444, 16.6.2 & 16.6.3

Guidance for review of question (ATC/Tower) Review procedure and mechanism established to ensure the message is forwarded to the appropriate entities, especially that relating to transfer of information from the destination ATS unit to the public health authority Review the mechanism to ensure the contact details of each entity is up to date and available During industry visit ensure the procedure is known by the staff and contact details of the entities are available

NOTIFICATION OF SUSPECTED COMMUNICABLE DISEASE, OR OTHER PUBLIC HEALTH RISK, ON BOARD AN AIRCRAFT - Aircraft Callsign (ID) - Dep. Aerodrome - Dest. Aerodrome - Est. Time Arrival - Number of persons on board - Number of susp. cases - Nature of public health risk Airport Operator Public Health Authority Other agency(ies) ICAO Aircraft General Declaration - Declaration of Health (ICAO Annex 9, Appendix 1 & IHR (2005) Annex 9) Aircraft Operator (or handling agency) at destination aerodrome Airport Operator Public Health Authority Other agency(ies) Via local procedure (Aerodrome Emergency Plan) Via local procedure (Aerodrome Emergency Plan) Departure Aerodrome TWR ATC Air Traffic Controller Voice or data link e.g. AFTN* Destination Aerodrome TWR ATC *AFTN = Aeronautical Fixed Telecommunication Network

Guidance for review of question (ANS) Review mechanism established to ensure effective implementation Review documented evidence for inclusion of contingency plans in respect of public health emergencies

Guidance for review of question (Tower/ADR) Verify regulations Cross-check with ICAO Annex 14 compliance checklist Review evidence to confirm effective implementation, cooperation and coordination Include emergencies which may occur in the vicinity of an aerodrome Sample aerodrome manual (Airport Emergency Plan PHE part) Review regulation and manuals to ensure inclusion of public health emergencies and coordination with public health services

Guidance for review of question (Aircraft Ops) Review operations inspectors procedures to ensure they check air operators related procedures Sample an air operator procedure to confirm implementation, check if the universal precaution kit is used (not mandatory, recommendation) Check the procedure contains communication between the cabin crew and the flight crew and the transmission, for States where it is required, of a General Declaration form.

Debriefing Results are presented to all the stakeholders Discussion of gap analysis Suggestions for improvement of the preparedness plan Corrective action plan?repeat assistance visit

AV Final Report The results of the assistance visit are provided to the CAA and can only be made public by them. The final report contains the description of the State and airport assistance visit. This will usually comprise but not be limited to the following: documentation exchanged with the CAA authorities; AV Checklist responses by the CAA and stakeholders; list of attendees; agenda; presentations made at the assistance visit meeting; issues discussed during the assistance visit meeting prior to the airport visit list of findings by the assistance visit team; recommended actions, with target completion dates; any other issues raised by the stakeholders.

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