Pandemic Influenza and Disaster Preparedness

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Pandemic Influenza and Disaster Preparedness

• Marshal Bickert, MPH
• Central Ohio Trauma System

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Todays Presentation

• Potential Pandemic Results
• National, State, Regional Preparedness
• Personal and Agency Preparedness

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What If?
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Central Ohio

• Population 1.9 Million
• 570,000 Sick
• 285,000 Outpatient Visits
• 57,000 Hospitalizations
• 12,700 Deaths
• 4,275 Mechanical Ventilation

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• The 1918 Spanish Influenza epidemic killed, at a
  very, very conservative estimate, 550,000
  Americans in 10 months thats more Americans
  than died in combat in all the wars of the 20th
  century
• Alfred W. Crosby
• Influenza 1918, The American Experience

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• Avian influenza patterns resemble 1918 pandemic,
  WHO study shows
• Jul 3, 2006 (CIDRAP News) The World Health
  Organization (WHO) on Friday published its first
  epidemiologic analysis of all laboratory-confirmed
  cases of H5N1 avian influenza reported to the
  agency between Dec 1, 2003, and Apr 30, 2006.

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What to Expect?

• Large numbers of people will become ill and die.
• There will be significant economic and social
  disruption.
• There will be prolonged disruption of essential
  services including electricity, water, and proper
  sewer functionality.
• Store shelves will remain empty for prolonged
  periods (multiple weeks).
• The healthcare infrastructure WILL BE severely
  strained.

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What does this mean for you?

• Your place of employment may be closed for
  prolonged periods. Due to economic disruptions
  many employers may close permanently.
• Public transportation may not be available.
• Childcare and schools may close for prolonged
  periods.
• You may have to provide basic medical care to
  loved ones.
• All the essential services we take for granted,
  water, police protection, fire/EMS, social
  services, etc. will be severely limited or maybe
  even non-existent.

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What to Expect for Your Practice?

• Exponential growth in demand (direct illness and
  disaster within a disaster)
• Dramatic worker absenteeism (gt40)
• Disruption of supplies and services
• Social distancing requirements
• Disruption of utilities
• Interruption of insurance payments
• Increased security needs

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National Preparedness

• Monitoring disease spread to support rapid
  response
• Developing vaccines and vaccine production
  capacity
• Stockpiling antivirals and other countermeasures
• Coordinating federal, state and local preparation
  
• Enhancing outreach and communications planning

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CDC Planning Assumptions

• Susceptibility to the pandemic influenza virus
  will be universal
• The clinical disease attack rate will be 30 or
  higher during the pandemic
• Illness rates will be highest among school-aged
  children and decline with age
• 20 of working adults will be ill during a
  community outbreak with 40 work absenteeism.

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Central Ohio Trauma System

• Non- Profit- Receives significant funding from
  CMAF
• Established 1998
• Initially established to reduced trauma morbidity
  and mortality in Central Ohio
• 1999 Hospital Disaster Preparedness
• Established RHEP Committee in 2003

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Regional Hospital Emergency Preparedness
Committee (RHEP)

• 24 HRSA Eligible Hospitals in Central Ohio
• 3 Specialty Hospitals
• Local Public Health
• EMA
• Fire/EMS
• Law Enforcement
• Support Agencies

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Current RHEP Structure
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Strategic Emergency Preparedness

• Hazard Analysis
• Scenario-Based Planning
• Development of Task Lists
• Capability Based Planning
• Risk Management
• Continuous Quality Improvement

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Pandemic Influenza Model
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Staffing Shortages

• Internal Factors
• Workplace Acquired Illness
• Morale
• Efficacy
• Fear- Self
• Facility Security

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Extremely High Census
Increased Workforce Demands
Loss of Workforce

• External Factors
• Community Acquired Illness- Self
• Fear- For Family
• Illness Spouse
• Illness Dependents
• Transportation
• Home/Childcare

• Increased Needed Output
• High Acuity Illness
• Diminishing Resources
• PPE Requirements
• Security Measures

Catastrophic Workforce Shortages
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Central Region Staff Survey

• Knowledge- Only 11
• Personal/Family Preparedness- 28
• Spousal Illness Effect- 62 (75)
• Dependent Effect- 90 (65)
• Dependent Care- 25 (60)

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Central Ohio Threats

• Floods
• Terrorism
• Infectious Disease
• Utility Interruptions
• Storms
• Tornadoes
• Dam Inundations
• Rioting
• Hazardous Materials Spills
• Etc, etc, etc,

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• So What do we do now?

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Private Practice Preparedness

• Step 1. Prepare and Protect Your Staff
• Step 2. Stay in Business
• Step 3. Assist in Disaster Response

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Prepare and Protect Your Staff

• No service agency can mount an effective response
  without staff
• How many staff-members/volunteers have the
  following?
• Emergency Supplies Kits including medications
• Family Communications Plans
• Evacuation Kits
• Pet Care Plan

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Personal/ Family Preparedness Ready In 3
Make a Kit Make a Plan Listen
http//www.publichealth.columbus.gov
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Staffing Shortages

• Internal Factors
• Workplace Acquired Illness
• Morale
• Efficacy
• Fear- Self
• Facility Security

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Extremely High Census
Increased Workforce Demands
Loss of Workforce

• External Factors
• Community Acquired Illness- Self
• Fear- For Family
• Illness Spouse
• Illness Dependents
• Transportation
• Home/Childcare

• Increased Needed Output
• High Acuity Illness
• Diminishing Resources
• PPE Requirements
• Security Measures

Catastrophic Workforce Shortages
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Step Two

• Stay in Business!
• Do you have a business continuity of Operations
  Plan?
• Do you know how your office will continue
  operations should it be directly affected by a
  disaster?

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Basic Plan Components

• Medical Emergencies
• Fire
• Evacuation
• Shelter-In-Place (Weather/Chemical)
• Code Adam
• Communications
• Facility Specific (x-ray machines, laboratory
  materials)

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Continuity of Operations Plans (COOP)

• How long will it take you to re-establish
  operations after a large emergency?
• Do you have back-up files and/or IT solutions?
• Do you have an alternate site if your primary
  (normal) area of operations is no longer
  functional?

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Continuity of Operations Plan- Essential (COP-E)

• What are the essential services you must continue
  to provide?
• Have you prioritized these essential services?
• What vulnerabilities exist which would preclude
  you from conducting these essential services?
  Have you mitigated these vulnerabilities?

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Step 3 - Emergency Response

• Potential Community Response Actions
• Integrate into community unified command system
• Assist with Medical Surge Capacity
• Provide Resources
• Disseminate Information
• Assist with Public Health Protective Actions
• Special Needs Sheltering
• Surveillance/Detection/Medical Intelligence

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Integrate into Community Unified Command System

• Establishes a clear chain of command
• Enables effective and efficient resource
  allocation
• Facilitates response information sharing and
  dissemination (Altered Standards of Care and
  Triage/Admission Criteria)

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Columbus and Franklin CountyUnified Incident
Command
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Columbus and Franklin CountyUnified Incident
Command
OPERATIONS SECTION
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Assist with Medical Surge Capacity

• Medical Surge Ability of the community to expand
  medical care capability
• Greatest good for the greatest number
• Provide initial triage and stabilization of
  disaster victims
• Receive overflow of victims from hospitals
• Arrange and coordinate transportation

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Level 2 and 3 SurgeCommand and Control
Community Healthcare Coordination
Altered Standards of Care Coordination
Disaster
Hospital 1
Hospital 2
Private Practice
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Level 3 Surge Community Level
Management
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Provide Resources

• Again, Greatest Good for the Greatest Number
• Make staff and facilities available for medical
  and public health functions
• Close facility and make staff available at other
  locations
• Provide interpreters
• Provide volunteer management technical expertise

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Disseminate Information

• Inward
• Situation Reports (office operational status)
• Resource Needs
• Rumor Control- Report and dispel
• Outward
• Disseminate prevention information
• Inform clients of available resources
• Provide information regarding emergency response
  actions and self treatment options

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Assist with Public Health Protective Actions

• Mass Vaccination Clinics
• Mass Prophylaxis Operations
• Quarantine/Isolation

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Surveillance/Detection/Medical Intelligence

• Surveillance- Early event detection
• Detection- High index of suspicion and report
• Medical Intelligence
• Nature, number, and severity of victims
• Effectiveness of response measures

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Private Practice Preparedness

• Step 1. Prepare and Protect Your Staff
• Step 2. Stay in Business
• Step 3. Assist in Disaster Response

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Finally, Become Preparedness Ambassadors!

• Disseminate preparedness information and promote
  personal, family, and workplace preparedness.
• Determine what services your organization can
  provide during a pandemic.
• Ensure your political leaders are devoting the
  necessary resources for community preparedness.

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Preparedness is no longer optional!

• www.odh.ohio.gov
• www.pandemicflu.gov
• www.ready.gov
• www.cdc.gov/flu/pandemic/

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Summary

• Influenza/Disaster Preparedness
• Federal, State, and Local Preparedness
• Personal, Family, Organizational Preparedness

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The game will go on!

• Marshal Bickert, MPH
• MBickert_at_goodhealthcolumbus.org
• 614-240-7419x4