ID 287 Tabletop Exercise

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Vulnerable PopulationsPandemic Influenza
Preparedness Tabletop Exercise
Santa Clara County Public Health Department
June 24, 2008
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What is a tabletop exercise?

• People come together to review and discuss a
  hypothetical emergency situation
• Designed to allow participants to talk through
  plans
• and problems
• NOT designed to measure anyones performance
• Serves as a springboard for further planning and
  more comprehensive exercises

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Exercise roles

• Facilitator
• Provide instructions, tell the story, introduce
  the questions, guide the discussion
• Participants
• Immerse yourself as if the scenario were truly
  occurring in your jurisdiction, using resources
  that are available to you (Emergency Operations
  Plan, policies, procedures,
• references)
• Participate in the group discussions
• Evaluators
• Observe the exercise to evaluate the process

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Ground rules

• Respond as if the scenario is real
• Play the role of your department, agency or
  community throughout the exercise
• Operate within current resource constraints and
  realities

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Objectives
By the end of this exercise, you should be able
to

Describe your individual and your agencys roles
in the response to Pandemic Influenza
Identify at least one gap in your agencys
existing Emergency Operations Plan (EOP)

Contact the appropriate partnering agencies for
assistance

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In the news
Human-to-human transmission of avian influenza
has been reported by the Centers for Disease
Control Prevention (CDC)
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Outbreak
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Today in San Jose...
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DAY 1, 900 a.m. The beginning
A 47-year-old man from San Jose arrives at the
emergency department (ED) at Valley Medical
Center with fever, chills, cough and shortness of
breath
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Patient history

• He is a prominent wildlife photographer who
  returned two days ago with his wife from an
  assignment in Nigeria

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Bad decision
Last night, despite feeling feverish and tired,
he attended an awards banquet with 200 of his
colleagues
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DAY 1, 1200 p.m. At Valley Medical Center

• He is evaluated in the Emergency Dept (ED)
• Chest x-ray reveals pneumonia
• A breathing tube is inserted (intubated) and
  placed on a ventilator due to severe respiratory
  distress
• Just as he is moved to the Intensive Care Unit
  (ICU), his wife begins to complain of similar
  symptoms and registers as a patient in the ED

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DAY 1, 1100 p.m. The wife worsens

• His wifes respiratory status severely
  deteriorates
• She is urgently transferred to the ICU

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DAY 2, 830 a.m. Code blue!

• The photographer suffers a cardiac arrest and
  cannot be revived
• Meanwhile, his wife struggles to stay alive

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DAY 2, 830 a.m. Is something wrong?

• ICU physician concerned based on rapid onset of
  illness and couples travel history to Africa
• Decides to notify the Santa Clara County Public
  Health Department
• Orders an infectious disease (ID) consult

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Break for discussion
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Personal Preparedness

• What steps have you taken to protect you and your
  family for pandemic influenza or other
  disasters/emergencies? Examples
• Prepared emergency pan flu home kit
• Understand how to care for a sick family member
  at home
• Know where to receive accurate information about
  pan flu
• Have you established a plan for childcare if
  schools are closed for
• 4 weeks (moderate) to 12 weeks? (severe pandemic)
• Does your neighborhood have a Community Emergency
  Response Team (CERT), or an active neighborhood
  association with an emergency coordinator?
• Do you know where your vulnerable neighbors
  reside? Has your neighborhood planned how to
  assist them in an emergency?

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Communication
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DAY 2, 200 p.m. Related cases

• Three of the new patients were on the same flight
  as the index (initial) patient and live in the
  surrounding area

Four more patients arrive at Valley Medical
Center with severe flu-like illness
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DAY 2, 330 p.m. In the rest of the world

• A leading medical journal reports human bird flu
  cases in Eastern Europe
• World Health Organization (WHO) reports that
  human-to-human transmission of avian influenza
  has occurred, but remains limited
• WHO increases the pandemic influenza alert phase
  to 4

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WHO Pandemic Flu Phases
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DAY 3, 1200 p.m Confirmation of new pandemic flu
virus
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DAY 3, 330 p.m. Breaking news!
KNTV 11 news reports
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DAY 3, 430 p.m. Public Health Response
A press conference is called by SCC Health
Officer, Dr. Fenstersheib to announce

• schools will be closed effective immediately
• large public gatherings have been cancelled
• all local agencies including hospitals are asked
  to implement their Pandemic Influenza Plans

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Public panic!!!

• CADRE agencies begin receiving concerned calls
  from clients.
• They are worried about getting ill and are asking
  how they can avoid the pandemic virus
• Some are worried about how they are going to
  continue to receive services
• Some clients are afraid to leave their homes
• CADRE Network is activated

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DAY 4, 100 p.m. Valley Medical Center
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Break for discussion
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Agency Preparedness

• At your agency, what measures will you take to
  limit the spread of the virus
• For clients?
• For staff?
• How can your agency disseminate critical
  information to the clients you serve?
• Currently (pre-pandemic)
• During a pandemic
• Have you identified which of your clients are at
  greatest risk of getting ill?

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Detection
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DAY 4 Epidemiological Investigation
Virus sample sent to CAPHD for analysis
Specimen confirmed for pandemic influenza. Sample
is sent to CDC for final confirmation.
Specimen is confirmed as a new pandemic influenza
strain SCCPHD CADPH or notified Local and
State response is taken
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DAY 5, 1000 a.m. The illness spreads

• People who also attended the awards banquet begin
  to seek hospital care
• In addition to the index case, two more patients
  with suspected pandemic influenza have died

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DAY 5, 400 p.m. Hospitals Reach Surge Limit

• Overwhelmed hospitals triage patients as they
  arrive, admitting only the most ill. The vast
  majority must return home to cared for by family
  members

www.sccphd.org/panflu
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Influenza Care Centers Open

• Santa Clara County Health Officer orders the
  first ICC to open. The ICC will receive patients
  that are too sick to be at home, but do not meet
  criteria for hospital admission. Capacity of an
  ICC is 450 patients.

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DAY 6, 300 p.m
Increase to WHO phase 5

• Worldwide
• Cases reported in East Asia, Eastern Europe and,
  most recently, in Africa
• Mortality (death) of patients with pandemic
  influenza in Asia exceeds 5
• WHO declares an increase to pandemic phase 5 for
  influenza

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Break for discussion
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Agency Response

• Does your agency have an emergency operations
  plan?
• Who or how, does your agency activate your
• What are your activation procedures and staffing
  plan for emergency situations?
• What interagency arrangements have been made for
  sharing resources in your community?
• How are you going to provide services to
  home-bound individuals?

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Crisis Long Term Effect
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DAY 7
Breakdown of infrastructure

• Two San Jose pharmacies have experienced
  burglaries, presumably by persons looking for
  Tamiflu
• Law enforcement unable to respond immediately
  because of unprecedented absenteeism among
  officers

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Day 8 Absenteeism Crisis

• Some healthcare workers are afraid to come into
  work
• Essential services such as trash collection,
  utilities repair and public safety agencies are
  reporting up to 30 absenteeism
• Many businesses encourage workers to telecommute
  or work flexible hours

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DAY 14 Update

• Evidence supports person-to-person transmission
• Almost 1,000 suspected cases statewide
• 75 have died, including numerous healthcare
  workers and first responders

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DAY 14
Mass fatality concerns
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DAY 16 Pandemic
declared

• WHO declares an influenza pandemic, phase 6
• In the U.S., public health officials still
  struggling to control the spread of pandemic
  influenza
• Public health system, including hospitals,
  remains overwhelmed

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Emerging economic consequences

• Local businesses are suffering from lack of
  workers and customers
• Poultry consumption down because consumers are
  afraid of getting sick from eating chicken

DAY 20
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DAY 20 Forecasts

• Forecasters predict that epidemic will continue
  for several more months and result in over 1.8
  million deaths nationwide
• Santa Clara County deaths could surpass 36,000
• Estimated nationwide economic impact will exceed
  100 billion

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Break for discussion
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Long Term Planning Response

• Does your agency have a plan for staff absences
  unique to a pandemic?
• Time off/ leave pay to care for family, or when
  employee is home in isolation or quarantine?
• Or return to work policies specific to a
  pandemic?
• Are there any client related supplies that you
  could potentially stockpile to prepare for a
  pandemic?

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End of Pandemic Flu Scenario Thank you!!
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