DOCSLIB.ORG

Wait List, Organ Offers and Allocation Policies

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Wait List, Organ Offers and Allocation Policies SECTION: Transplant ID NO.: TP-9-100 PAGE: 1 of 57 ISSUE DATE: February 14, 2019 ISSUE.REVISION: 1.11 REVISION DATE: July 28, 2021 APPROVED BY: Organ Authority POLICIES Wait list, organ offers and allocation Table of Contents 1. Introduction ......................................................................................................................................... 5 1.1 Trillium Gift of Life Network 5 1.2 Transplant System Governance 5 1.3 Allocation Policy Development, Amendment and Evaluation 6 1.4 National Organ Sharing Agreements 6 1.5 National Organ Waitlist Policy – Single Centre Listing 6 1.6 Guide to this Document 6 2. Organ Offers and Acceptance ............................................................................................................... 7 2.1. Organ Offers and Acceptance 7 2.2. Back-Up Candidates 7 2.2.1. Back-Up Candidates (Heart) 7 2.3. Organ Reallocation 7 2.4. Organs For Research 8 3. Kidney & Pancreas Policies ............................................................................................................... 9 3.1. Wait List Requirements and Statuses 9 3.1.1. Dialysis ..................................................................................................................................... 9 3.1.2. Medical Status ......................................................................................................................... 9 3.1.3. Wait List Suspension ............................................................................................................... 9 3.1.4. Serum Testing Requirements and Status ................................................................................ 9 3.1.5. Eligibility for the National Highly Sensitized Patient (HSP) Registry ..................................... 10 3.1.6. Out of Province Transfers ...................................................................................................... 10 3.2. Wait Time 10 3.2.1. Wait Time Calculations .......................................................................................................... 10 3.2.2. Wait Time Reinstatement....................................................................................................... 11 3.3. Allocation 11 3.3.1. Identifying Potential Recipients (Matching) ............................................................................ 11 3.3.2. Local and Provincial/National Allocation ................................................................................ 12 3.3.2.1. Local Allocation ...................................................................................................................... 12 3.3.2.2. Provincial/National Allocation ................................................................................................ 13 3.3.2.3. Allocation of Non-Directed Living Donor and List Exchange Donor Kidneys ........................ 13 3.3.3. Priority Categories for Matched Candidates .......................................................................... 14 3.3.4. Ranking & Allocation Points ................................................................................................... 14 3.4. Kidney Recovery Policies 15 3.4.1. Kidney Pumps ........................................................................................................................ 15 3.4.2. Left versus Right Kidney Allocation ....................................................................................... 15 3.5. Key Definitions 15 3.6. Kidney and Pancreas Policy Appendices 18 Appendix 3A: Virtual Crossmatch (VXM) Rules for Kidney Allocation ................................................ 18 Appendix 3B: Donor Hospital Regions for Local Kidney Allocation .................................................... 19 Appendix 3C: Kidney Allocation Tables .............................................................................................. 24 Table 1. Allocation of Kidneys from Donors < 4 years ........................................................................ 24 Table 2. Allocation of Kidneys from Donors < 35 years ...................................................................... 25 Table 3. Allocation of Kidneys from non-extended criteria donor ≥ 35 (non-ECD) ............................. 27 Table 4. Allocation of Kidneys from extended criteria donors (ECD) ................................................. 28 Table 5. Allocation of Kidneys from anonymous/living exchange (LE) living donors < 35 ................. 29 Table 6. Allocation of Kidneys from anonymous/living exchange (LE) living donors ≥ 35 ................. 29 2 4. Pancreatic Islet Policies .................................................................................................................. 30 4.1. Wait List Requirements and Statuses 30 4.1.1. Medical Status ....................................................................................................................... 30 4.1.2. Wait List Suspension ............................................................................................................. 30 4.1.3. Serum Testing Requirements and Status .............................................................................. 30 4.1.4. Out of Province Transfers ...................................................................................................... 30 4.2. Wait Time 31 4.2.1. Wait Time Calculations .......................................................................................................... 31 4.3. Allocation 31 4.3.1. Identifying Potential Recipients (Matching) ............................................................................ 31 4.3.2. Priority Categories for Matched Candidates .......................................................................... 31 5. Liver and Liver-Bowel Policies ........................................................................................................ 32 5.1. Wait List Requirements and Statuses 32 5.1.1. Medical Status ....................................................................................................................... 32 5.1.2. Wait List Suspension ............................................................................................................. 32 5.1.3. Lab Testing Requirements and Registration Status .............................................................. 32 5.1.4. Out of Province Transfers ...................................................................................................... 33 5.2. Wait Time 33 5.2.1. Wait Time Calculations .......................................................................................................... 33 5.3. Allocation 33 5.3.1. Identifying Potential Recipients (Matching) ............................................................................ 33 5.3.2. Local and Provincial/National Allocation ................................................................................ 34 5.3.2.1. Local Allocation (Locality Rule) .............................................................................................. 34 5.3.2.2. Provincial/National Allocation ................................................................................................ 34 5.3.3. Organ Offer Discussion – New High Status Listings ............................................................. 34 5.3.4. Split Procedures ..................................................................................................................... 35 5.3.5. Priority Categories for Matched Candidates .......................................................................... 35 5.3.6. Additional Ranking and Exception Points .............................................................................. 35 5.3.6.1. Exception Points .................................................................................................................... 35 5.4. Key Definitions 36 5.5. Liver and Liver-Bowel Policy Appendices 37 Appendix 5A: SMC and PELD Calculations ....................................................................................... 37 Appendix 5B: Locality Rule – Defined Donor Hospitals ...................................................................... 38 Appendix 5C: Exception Points ........................................................................................................... 38 6. Small Bowel Policies ........................................................................................................................ 41 6.1. Wait List Requirements and Statuses 41 6.1.1. Medical Status ....................................................................................................................... 41 6.1.2. Wait List Suspension ............................................................................................................. 41 6.1.3. Out of Province Transfers ...................................................................................................... 41 6.2. Wait Time 41 6.2.1. Wait Time Calculations .......................................................................................................... 41 6.3. Allocation 42 6.3.1. Identifying Potential Recipients (Matching) ............................................................................ 42 6.3.2. Priority Categories for Matched Candidates .......................................................................... 42 6.3.3. Additional Ranking ................................................................................................................
Load more

Recommended publications
  • New Bylaw Strives to Unite Community and Students
    $1.00 Your Independent Local News Source Vol 3 No 16 Wednesday, Feb. 13 2008 New bylaw strives to unite community and students By JESSICA VERGE General Sikorski Hall on The Oshawa Express Monday night, the third meeting this year alone on It was a community divided as Oshawa the issue, in an effort to council came down with the final decision on solve student housing prob- student rentals in the citys north end. lems around Durham Landlords, residents and students filled the College and the University audience for a special council meeting at of Ontario Institute of Technology. And after years of home- John Neal owners filing complaints Provincial against rowdy student renters and absentee landlords, and of hard-working, well-behaved students struggling to standout from the stereo- type earned by irresponsible peers and of law- award for abiding landlords trying to provide affordable, safe housing, city council finally reached a res- olution. What were going to see is some structure war vet and some stability in that neighbourhood, says Ward 7 councillor John Neal, who represents An Oshawa the area. senior is Council approved a bylaw to license resi- among a group dential rental units in a section of the city near of citizens to the schools. Most streets bordered by Brittania Photo by Jessica Verge/The Oshawa Express be honoured Avenue to the north, Wilson Road to the east, by the Ormond Drive to the south and the Oshawa province. Creek to west are affected. The bylaw includes Winter wonderland Mieczyslaw regulations that limit the number of bedrooms Oshawa has been hit hard with snow and cold weather these last few weeks as snow covers the Mitch Remembrance Monument in Memorial Park in the downtown core.
    [Show full text]
  • Low Tolerance Long Duration (LTLD) Stroke Demonstration Project
    Low Tolerance Long Duration (LTLD) Stroke Demonstration Project Final Report June 2006 Table of Contents Executive Summary …………………………………………………………………………....….. 3 1.0 Background …………………………………………………………………………...…….. 8 2.0 Approach ……………………………………………………………………………….…… 10 2.1 Scope of Project …………………………………………………………………..….. 10 2.2 Project Goals ……………………………………………………….……………..….. 10 2.3 Data Collection ………………………………………………………………..…...… 11 2.4 Data Analysis …………………………………………………………………..…….. 11 3.0 Project Limitations ……………..……………………………………………………….…... 13 3.1 Admission Issues …………………………………………………………..…………. 13 3.2 Data Indicators/Tools Issues ………………………………………..………………… 13 4.0 Findings ……………………………………………………………..……………..………. 16 4.1 Patient Profile …………………………………………..………………..……….….. 16 4.2 Factors Related to Discharge Destination ………………………………..………….. 21 4.3 Demand and Access ……………………………………………………..…………... 24 5.0 Summary and Recommendations ………………………………………..…………………. 27 6.0 Appendices ………………………………………………..……………………..………… 31 Appendix 1: Members of the LTLD Stroke Demonstration Project Planning Subgroup ..… 31 Appendix 2: LTLD Stroke Rehab Program Description – Bridgepoint Health ……..……… 32 Appendix 3: LTLD Stroke Rehab Program Description – Providence Healthcare ……...… 33 Appendix 4: LTLD Stroke Rehab Program Description – Lakeridge Health …………..….. 34 Appendix 5: LTLD Stroke Rehab Program Description – Castleview Wychwood Towers... 35 Appendix 6: LTLD Stroke Demonstration Project Data Reporting Template ……………... 37 GTA Rehab Network LTLD Stroke Demonstration Project Report,
    [Show full text]
  • University Submission
    Press TAB to move to input areas. Press UP or DOWN ARROW in column A to read throughEnergy the document. Consumption and Greenhouse Gas Emissions Reporting - for 2015 Confirm consecutive 12-mth period (mth-yr to mth-yr) Jan/2015 - Dec/2015 Sector Acute/Chronic Hospital Agency Sub-sector Public Hospital Organization Name Oshawa Lakeridge Health Please fill in the mandatory fields indicated in red, in addition to submitting data on your energy usage. Energy Type and Amount Purchased and Consumed in Natural Units Total (calculated in webform) Electricity Natural Gas Fuel Oil 1 & 2 Fuel Oil 4 & 6 Propane Coal Wood District Heating District Cooling Building / Avg If Yes, enter If Yes, enter GHG Emissions Energy Intensity Operation Operation Name Operation Type Address City Postal Code Total Floor Area Unit hrs/wk Quantity Unit Quantity Unit Quantity Unit Quantity Unit Quantity Unit Quantity Unit Quantity Unit Quantity Unit Renewable? Emission Factor Quantity Unit Renewable? Emission Factor (Kg) (ekWh/sqft) Identifier Comments Stephenson Building Administrative offices and related facilities 2160 Yonge Street Toronto M7A 2G5 135,034.00 Square feet 70 2,181,065.00000 kWh 125,300.00000 Cubic meter 110,000.00000 Litre 23,000.00235 Litre Litre Metric Tonne Metric Tonne 26.73000 Giga Joule No 0.00000 20.50600 KL Chilled Water No 0.00000 max. 255 characters Lakeridge Health Bowmanville Facilities used for hospital purposes 47 Liberty St. S Bowmanville L1C 2N4 155,442.00 Square feet 168 3,027,867.00000 kWh 518,554.00000 Cubic Meter 9,201.00000 Litre
    [Show full text]
  • Whitby Site Steering Committee
    LAKERIDGE HEALTH CORPORATION WHITBY SITE STEERING COMMITTEE Options Study Central East Local Health Integration Network April 24, 2008 Central East Local Health Integration Network Lakeridge Health Corporation: Whitby Site Steering Committee April 24, 2008 TABLE OF CONTENTS Page Executive Summary 1 1.0 Introduction and Background 4 1.1 Lakeridge Health Whitby Fire 4 1.2 Purpose of this Document 6 1.3 Methodology and Process 6 1.4 Scope of Study 8 2.0 Key Issues Identified by Lakeridge Health 9 2.1 General Interim Operating Environments 9 2.2 Lakeridge Health Whitby - Capital 10 2.3 Redevelopment at the Oshawa and Bowmanville Sites 10 3.0 Key Issues Resulting From Site Tours and Key Informant 12 Interviews 3.1 General 12 3.2 Nephrology - LH Oshawa 12 3.3 Geriatric Assessment and Rehabilitation Unit (GARU) (26 beds) 13 and Complex Continuing Care (CCC) Unit (10 beds) - LH Bomanville 3.4 CCC Unit (10 Beds) – 4 Main - LH OSHAWA 13 3.5 CCC Unit (20 Beds) RVHS – Centenary – Margaret Birch Wing 14 3.6 Perceptions – Whitby Situation 14 3.7 Lakeridge Health Development 14 3.8 Other Influencing Factors 15 4.0 Options Considered 16 4.1 Introduction 16 4.2 Dialysis Options 16 4.2.1 Option A: Maintain Dialysis on 6A at the LH OSHAWA 16 site 4.2.2 Option B: Relocate to RVHS (Ajax) or Other Locations 16 – Trailers Options Study ii Central East Local Health Integration Network Lakeridge Health Corporation: Whitby Site Steering Committee April 24, 2008 TABLE OF CONTENTS Page 4.2.3 Option C: Relocate to RHVS (Ajax) – Ambulance 17 Building and Bay 4.2.4
    [Show full text]
  • Psychology Practicum Brochure
    1 Table of Contents I Introduction 3 About Ontario Shores 3 The Town of Whitby 3 Map and Directions to Ontario Shores 4 Parking 4 II Overview of Program 5 Training Philosophy and Goals 5 Structure of the Program 6 Didactic Educational Experiences 7 Supervision and Evaluation 8 Due Process 8 Work Environment 8 Accessibility 8 III Overview of Clinical Rotations 9 1. General Adult Track 9 2. The Forensic Program 10 3. Geriatric and Neuropsychiatry Program 10 4. Outpatient Services 11 5. Adolescents 12 6. Eating Disorder Unit 13 IV Application Process 14 Prerequisites 14 Application Procedure 14 Interview and Selection Procedures 14 Privacy and Application Materials 14 Acceptance and Practicum Checklist 15 V Accreditation 15 VI Psychology Faculty and Supervisors 16 How to Connect with Us 19 2 and Long-Term Care and Local Health Integration Networks (LHINs), and is regulated by the Public I Introduction Hospitals Act, the Mental Health Act and other provincial and federal legislation. About Ontario Shores Ontario Shores Centre for Mental Health Sciences (Ontario Shores) is a leader in mental health care, providing a spectrum of specialized assessment and treatment services for people living with complex and serious mental illness. Exemplary patient care is delivered through safe and evidenced-based approaches where successful outcomes are achieved using best clinical practices and the latest advances in research. Patients benefit from a recovery-oriented environment of care, built on compassion, inspiration and hope. The organization shares its expertise, knowledge and experiences through research, education and The Town of Whitby advocacy initiatives and provides leadership to healthcare provides, community partners, policy Ontario Shores’ main location is situated on the makers and social sectors to strengthen and advance shoreline of Lake Ontario in Whitby, Ontario.
    [Show full text]
  • Lakeridge Health Annual Report 2018/19 Vision Mission
    Lakeridge Health Annual Report 2018/19 Vision Mission We empower One System. people to live their Best Health. best health. Inclusion Compassion Values Innovation Teamwork Joy Contents 2 24 Message from the Reimagining The Future: Chair of the Board of Trustees 2019-2024 Strategic Plan and the President and CEO 25 4 Volunteers and Auxiliaries About Us 28 5 Foundations Lakeridge Health Locations in Durham Region 30 Recognizing Excellence 6 Patient Experiences 34 16 Lakeridge Health By the Numbers Year in Review: Putting People First 35 22 Financials Community Engagement 36 2018/19 Board of Trustees Lakeridge Health Annual Report 2018/19 1 Message from the Chair of the Board of Trustees and the President and CEO It has been an extraordinary year of progress, partnership and engagement for Lakeridge Health. Over the last year, we undertook a historic community consultation, gathering more than 20,000 points of input from the Lakeridge Health team, patients, families, partners, and the community. All of this feedback guided everything we do at Lakeridge Health. In fiscal year 2018/19, we made significant improvements to the patient and family experience, with a special focus on increasing patient satisfaction across all four Lakeridge Health Emergency Departments (EDs). Guided by results of broad-based consultations, we learned what matters most to patients, families, Sharon Cochran, Chair of the Board of Trustees and Matthew Anderson, President and CEO Patient and Family Experience Advisors, and the broader community to understand how to serve people better. This information also informed the development of exciting new innovations to make the ED experience faster and easier to navigate.
    [Show full text]
  • Durham Region Community Resource Guide for Individuals Living with Stroke
    Durham Region Community Resource Guide for Individuals Living with Stroke 1 Durham Region Community Resource Guide: Individuals and their Caregivers Living with Stroke Table of Contents STROKE SERVICES Ambulatory Rehabilitation Centre (ARC) Page 4 District Stroke Centre Page 3 On-Line Resources Pages 5 Stroke Prevention Clinic Page 4 Stroke Survivor and Peer Support Groups Pages 6-7 Central East (CE) LHIN Home and Community Care Pages 8-9 COMMUNITY CARE DURHAM (CCD) Pages 10-12 COMMUNITY SERVICE PROVIDERS Acquired Brain Injury Services Page 13 Advanced, Financial and Long-Term Care Planning Pages 33-34 Community Exercise & Rehabilitation Programs Pages 23-24 Communication Resources and Private Providers Page 15-16 Employment Resources Pages 29-31 Equipment Loan Services Page 21 Equipment Sales and Rental Page 20 Food Services Pages 28-29 General Resources and Information Pages 35-42 Homemaking, Nursing and Support Services Pages 18-19 Housing Resources Pages 31-32 Mental Health Services Page 16-17 Respite Services and Friendly Visiting Programs Page 25 Safety in the Home and Emergency Response Systems Pages 32 Self-Management Program Page 17 Senior Centres Pages 25 Social and Recreational Services Pages 22 Suppliers of Mobility Aids Pages 20-24 Therapy Services Page 14 Transportation and Driving Services Pages 26-28 2 Stroke Services District Stroke Centre Lakeridge Health Oshawa received designation as a District Stroke Centre in 2008. In October of 2015 Lakeridge Health Oshawa obtained Stroke Distinction in Acute Stroke Services and Inpatient Stroke Rehabilitation Services. As a District Stroke Centre we participate in ongoing education/training in stroke care, providing coordinated stroke services based on best practices and evidence for the residents of the Durham Region across the health care continuum.
    [Show full text]
  • Supervised Practice Program in Psychology
    Supervised Practice Program in Psychology 2013 - 2014 Supervised Practice Program in Psychology 2012-2013 Academic Year Table of Contents I Introduction .............................................................................................................................................................. 1 About Ontario Shores .................................................................................................................................................. 1 Mission ............................................................................................................................................................................ 1 Vision ................................................................................................................................................................................ 1 Core Values ..................................................................................................................................................................... 2 Historical Background ................................................................................................................................................... 3 The Town of Whitby .................................................................................................................................................... 6 Map and Directions to Ontario Shores .................................................................................................... 7 II Overview the Program .....................................................................................................................................
    [Show full text]
  • A Simply Senior's Keepsake
    A Simply Senior’s Keepsake Book Ten Friendships, Keeping Active & Inspired Resource Lists by The Whitby Historical Society with grateful acknowledgments to The New Horizons for Seniors The Department of Human Resources and Skills Development Canada ‘A Simply Senior’s Keepsake ...connecting our youth with stories of our Seniors Recipes, Resources andplus Refreshing Ideas Published by: The Whitby Historical Society with grateful acknowledgments to The New Horizons for Seniors The Department of Human Resources and Skills Development Canada Whitby History Museum 123 Brock Street South, Whitby, Ontario Canada L1N 4J9 905 556 9822 www.whitbyhistoricalsociety.com [email protected] [email protected] 2012 © Whitby Historical Society All Rights Reserved Without limiting the rights under copyright reserved above, no part of this publication may be reproduced, stored in, or introduced into a retrieval system, or transmitted in any form or by any means, (electronic, mechanical, photocopying, recording, via internet, or otherwise), without the prior written permission of both the authors and copyright owner, and the publisher of this book, except by a reviewer, who may quote passages in brief. Photographs, diagrams and research material are copyrighted © by the original authors/illustrators named in credits with permission given to WHS for printing/publishing rights. Acknowledgments: Whitby Historical Society Executive and Members Trina Astor-Stewart - Project Coordinator Project Committee Members and Contributors David
    [Show full text]
  • General Orientation Package General Policies
    General Orientation Package General Policies 1. Infection Control: Hand washing is the single most important thing you can do to prevent getting infections. Wash your hands properly and frequently to help prevent the spread of infection. Please access the Public Health Ontario (PHO) Infection Prevention and Control Core Competencies Online Learning Courses, if you have not completed these modules or the equivalent of these modules. If you have any questions or concerns, please contact Infection Control at X3854. http://www.publichealthontario.ca/en/LearningAndDevelopment/OnlineLearning/Infectio usDiseases/IPACCore/Pages/default.aspx 2. Risk Management: Risk management is the responsibility of everyone at Lakeridge Health. Risk is exposure to an untoward event which may cause harm to the patient, staff or corporation. There is a process to manage incidents of risk and error. This process is important to minimize the exposure and harm, to identify opportunities to enhance current processes and practice, and to ensure responsibility and accountability of all. If you are involved in such an incident, discuss with your Faculty/Clinical Instructor or Preceptor. Contact Risk Management at ext. 3207. 3. Occupational Health & Safety: Everyone at Lakeridge Health, including students, need to be vigilant of Occupational Health and Safety hazards. Some of the responsibilities expected of students are to: Report any unsafe conditions to the appropriate supervisors immediately such as wet slippery floors; equipment left in the halls, stairways or walkways; defective equipment; careless handling of equipment; and use and storage of combustible material near open flames; Always be alert to safety issues with wheelchairs, beds, and other equipment used by the patient; Never operate electrical equipment with wet hands; Never place any pressurized containers, needles or glass containers in regular garbage; Use or wear required safety equipment as directed; Report all accidents and potential hazards in your work area to your preceptor immediately.
    [Show full text]
  • LAKERIDGE HEALTH ANNUAL REPORT 2017/18 Z
    LAKERIDGE HEALTH ANNUAL REPORT 2017/18 z Lakeridge Health VISION EXCELLENCE — EVERY MOMENT, EVERY DAY. MISSION WORKING TO PROVIDE EXCELLENT HEALTH CARE CLOSER TO HOME. VALUES COMPASSION COURAGE TRUST INNOVATION 1 MESSAGE FROM THE CHAIR AND CEO Lakeridge Health is on a journey of transformation to become a comprehensive regional system of acute In keeping with this philosophy, over the winter we conducted large-scale consultations with internal and care for Durham Region and beyond. Our aim is to deliver safe, high quality and seamless health care as external stakeholders across Durham Region as part of the Master Planning process. A Master Program and well as an excellent patient experience for all those who come to us for support, compassion and care. Plan is a roadmap for how and where services will be delivered today and for the next 25 years. As Durham Region is one of the fastest-growing and most diverse areas in Ontario, this is a critical piece of work for Over the course of the 2017/18 fiscal year, the organization made significant strides in meeting our the organization. commitment to serve our communities better. Across all Lakeridge Health locations, we delivered on the promise to provide high-quality care closer to home for the more than 650,000 residents of Durham Through this important engagement process, Lakeridge Health received more than 5,000 points Region by changing how we deliver care to improve outcomes and by introducing several new services of feedback and input into what is required for the future. Along with feedback on how to improve across the region.
    [Show full text]
  • Lakeridge Health
    Welcome to Lakeridge Health Bowmanville Ajax Pickering Oshawa Port Perry Whitby A Handbook for All Volunteers, Spiritual and Religious Care Providers and Patient & Family Experience Advisors August 2019 Table of Contents: Welcome Messages ........................................................................................................................ 2 Vision, Mission, Values & Volunteer Resources Team ................................................................... 4 SECTION 1 – GENERAL INFORMATION FOR ALL ...................................................................... 7 SECTION 2 – PRIVACY AND CONFIDENTIALITY ...................................................................... 10 SECTION 3 – ADMINISTRATIVE PROCESSES ......................................................................... 11 Including information on Absenteeism, Dress Code, ID Badges and more SECTION 4 – HEALTH AND SAFETY ......................................................................................... 16 Including information on Scent/Fragrance-Free Hospital, RepairIt, Ergonomics SECTION 5 – HEALTHY WORKPLACE ...................................................................................... 18 Including information on the Code of Conduct, Workplace Violence/Harrassment, Worker Advisory, Wheelchairs SECTION 6 – INFECTION PREVENTION AND CONTROL (IPAC) ............................................ 23 Including information on IPAC, Hand Hygiene and Policies SECTION 7 – EMERGENCY PREPAREDNESS ........................................................................
    [Show full text]