Anita L. Barkin Dr.P.H., M.S.N., C.R.N.P. November 19, 2014.

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Anita L. Barkin Dr.P.H., M.S.N., C.R.N.P. November 19, 2014

Transcript of Anita L. Barkin Dr.P.H., M.S.N., C.R.N.P. November 19, 2014.

Page 1: Anita L. Barkin Dr.P.H., M.S.N., C.R.N.P. November 19, 2014.

Anita L. Barkin Dr.P.H., M.S.N., C.R.N.P.November 19, 2014

Page 2: Anita L. Barkin Dr.P.H., M.S.N., C.R.N.P. November 19, 2014.

Introduce the emergency response planning concepts related to infectious disease and pandemic.

List key partners –internal and external- in the planning and implementation phases of the infectious disease/pandemic plan.

Review special considerations for smaller nurse-directed clinics with minimal resources.

Page 3: Anita L. Barkin Dr.P.H., M.S.N., C.R.N.P. November 19, 2014.

More effective response to any public health threat/emergency.

Global travel increases speed and opportunity for the spread of disease.

There will be little time to act once the event starts.

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Inclusive, collaborative Plans must be flexible, adaptable,

resilient Plans must be tailored to the particular

type of infectious disease Plans must be tailored to address the

particular needs of institution and available resources

Plans must be tested and rehearsed

Page 5: Anita L. Barkin Dr.P.H., M.S.N., C.R.N.P. November 19, 2014.

Isolation of the sick Quarantine of the exposed Social Distancing

◦ Actions taken to discourage close social contact between individuals

Public education◦ Accurate, clear◦ Consistent with those being given by other

public health authorities

Page 6: Anita L. Barkin Dr.P.H., M.S.N., C.R.N.P. November 19, 2014.

Support the goals of public health by:◦ being knowledgeable about infectious disease

planning guidelines and recommendations.◦ having a plan to isolation the sick/quarantine the

exposed.◦ developing an health education/communication

plan.

To develop a detailed plan for Student Health operations.

To be an active participant in the campus-wide planning process.

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To identify and establish contacts in the local health care community including hospitals, local health departments, emergency response personnel.

To provide sound medical and public health information to the incident commander, key decision makers and the campus community when an event occurs.

Page 8: Anita L. Barkin Dr.P.H., M.S.N., C.R.N.P. November 19, 2014.

Who is responsible for emergency preparedness on your campus?

Does your school have an emergency response plan/template?

Can it be adapted for infectious disease/pandemic planning?

Who do you engage in the conversation on your campus to get emergency planning on the table?

Page 9: Anita L. Barkin Dr.P.H., M.S.N., C.R.N.P. November 19, 2014.

Executive management (President, Provost, Chancellor or designees) Student Health Public Safety Environmental Health & Safety Public Affairs Government Relations Facilities Management Student Affairs (residence life) International Student Services Housing Dining Human Resources Risk Management Telecommunications Information Technology Operations and Finance

Page 10: Anita L. Barkin Dr.P.H., M.S.N., C.R.N.P. November 19, 2014.

Establish relationships with the local public health department and hospital emergency departments.

Create templates for communication. Develop a protocol for screening travelers. Develop protocols for managing a case or cases

(will be tweaked according to the infectious disease)◦ What do you do when a student walks in the door?◦ When and how does a hand off to a medical treatment

center occur?◦ What is your role after the patient is in the hands of

the medical treatment center?◦ What is your role in mitigation strategies?

Page 11: Anita L. Barkin Dr.P.H., M.S.N., C.R.N.P. November 19, 2014.

Health Service Staff education and preparation◦ Engage staff in infectious disease/pandemic

planning and provide exercises and drills to rehearse plan

◦ Provide regular updates for staff on the latest developments regarding emerging threats

◦ Vaccinations◦ Fit testing for N95s◦ Inservices on PPE

Page 12: Anita L. Barkin Dr.P.H., M.S.N., C.R.N.P. November 19, 2014.

Supplies/equipment/services◦ Compile a list◦ Identify vendors/storage◦ Cleaning services, waste removal

Page 13: Anita L. Barkin Dr.P.H., M.S.N., C.R.N.P. November 19, 2014.

Level One – Unit Level Response◦ Student Health can handle situation solely or

with the assistance of a few other departments. Level Two – Small Scale EOC

◦ Case(s) of an infectious disease with high mortality or morbidity that potentially threatens campus health & safety.

Level Three – Full EOC (Pandemic level)◦ Cases of an infectious disease with high mortality

and morbidity that disrupts the conduct of university business.

Page 14: Anita L. Barkin Dr.P.H., M.S.N., C.R.N.P. November 19, 2014.

Can this situation be handled by the Health Service alone?◦ What are the ramifications of a case or cases to

the institution? Human Impact Asset Impact Mission Impact

If not:◦ What aspects of the response can be managed by

Health Services◦ Who are your partners? External? Internal?

Page 15: Anita L. Barkin Dr.P.H., M.S.N., C.R.N.P. November 19, 2014.

Primary duties◦ Care/referral of the ill

How does the student access care? Transportation? ◦ Identification of index case and assessment of

mitigation strategies to limit transmission Patient education/campus education Isolation Surveillance partners

◦ Determine the nature/level of communication to targeted audience(s) Crafted appropriate message(s) in advance of the event

Timing of messages – winter break travel, prior to commencement

Page 16: Anita L. Barkin Dr.P.H., M.S.N., C.R.N.P. November 19, 2014.

University Police or other transportation partner Campus EMS

◦ Coordinate response and provide case reports Student Life

◦ Residential support for the ill Housing and Dining

◦ Special meal accommodations◦ Isolation housing (single room)

Counseling Services◦ For student/friend/family member

Facilities Management◦ Special cleaning requirements

Page 17: Anita L. Barkin Dr.P.H., M.S.N., C.R.N.P. November 19, 2014.

Local Public Health Department Local Hospital Emergency

Department/Urgent Care What are the suggested protocols? Is this a reportable disease? If needed, what assistance can they provide to you?

Page 18: Anita L. Barkin Dr.P.H., M.S.N., C.R.N.P. November 19, 2014.

Case(s) of an infectious disease with high mortality or morbidity that potentially threatens campus health & safety

◦ Greater impact to the university◦ Executive leadership involvement◦ Requires coordination with multiple key

stakeholders◦ Communication/media impact outside of campus

Page 19: Anita L. Barkin Dr.P.H., M.S.N., C.R.N.P. November 19, 2014.

Depends on resources and role of Health Services on the Emergency Response Team

Very limited role:◦ Director/Member of the Emergency Response

team in a consulting capacity Limited role:

◦ Liaison to local health department and other local health care partners

◦ Review communication to the community◦ Health Services provides assessment and referral

Page 20: Anita L. Barkin Dr.P.H., M.S.N., C.R.N.P. November 19, 2014.

Expanded role◦ Health Services director is the Incident

Commander◦ Chief communicator

Creates the communications to campus in collaboration with Media Relations

◦ Organizer Leads the meetings of the Emergency Response

Team

Page 21: Anita L. Barkin Dr.P.H., M.S.N., C.R.N.P. November 19, 2014.

Executive Leadership involvement Internal Communications engaged Establish and communicate a response

protocol for suspected cases Assist in planning/execution of a mass

vaccination clinic, if appropriate

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Communicate early and often Timing of messages Collaborate with media relations Tweak the messages that were crafted in

advance Ensure materials are easy to understand

and culturally appropriate

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Acknowledge responsibility for campus safety. Reassure that the university is taking the

situation seriously. Say what you know, don’t know, what you are

doing to prepare for an event. Include the recommendations/policy on travel

and workplace safety (handwashing, cover your cough).

Offer resources (CDC website, WHO website, HS website).

Establish expectations for further communication updates.

Page 24: Anita L. Barkin Dr.P.H., M.S.N., C.R.N.P. November 19, 2014.

External◦ Maintain communications with local public

health authorities, emergency preparedness groups, hospital systems Identify key contacts Participate in community planning/drills

◦ Benchmark activities/planning of other like colleges and universities

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Housing and Dining◦ Identify additional isolation areas.◦ Assist in relocation of students if necessary.◦ Arrange for meal delivery.

Student Life/Activities◦ Assist with support for students in isolation

housing.◦ Act in a surveillance role.◦ Consider mitigation strategies for student events

(screening participants, hand washing stations). ◦ Consider postponement/cancellation of events.

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Facilities Management◦ Restrict key access to buildings if needed.◦ Initiate decontamination protocols and manage

turnover of isolation housing.◦ Assist with securing/moving additional medical

and cleaning supplies. Environmental Health & Safety

◦ Contract with the hazardous material disposal company for waste disposal and disinfection.

◦ Obtain and distribute PPE

Page 27: Anita L. Barkin Dr.P.H., M.S.N., C.R.N.P. November 19, 2014.

Telecom◦ Additional phone support for Health Services.

Office of International Education◦ Provide guidance regarding international student

issues.◦ Assist in communication of travel advice to

students studying abroad.◦ Identify contacts in host countries regarding

access to health care, travel issues, status of disease in the region.

Page 28: Anita L. Barkin Dr.P.H., M.S.N., C.R.N.P. November 19, 2014.

Campus Police◦ Receive additional PPE training.◦ Implement a dispatch screening protocol.◦ Alert Health Services if encountering individuals

with symptoms consistent with illness.

Human Resources◦ Prepare Call-off and or telecommuting policy for

staff/faculty who are in isolation.◦ Communicate protocols or travel restrictions.◦ Communicate work expectations and leave policies.

Page 29: Anita L. Barkin Dr.P.H., M.S.N., C.R.N.P. November 19, 2014.

Initiate National Incident Management Structure (NIMS)◦ Appoint health of Operations, Liaison, Logistics,

Planning, Safety, Finance and Record Keeper• May have outside agency involvement – City,

State, Federal

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Limited, likely advisory only. Determine staffing, scheduling, hours of

operations needed to support remaining students, if possible. Closure?

May support mass vaccination conducted by public health agency.

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Evaluate the institutional effects of the situation.

Notify Deans and Department Heads of decisions.

Provide oversight for family notifications. Review business continuity plans. Review audiences and content for internal

and external communications. Authorize a temporary suspension of

classes, campus evacuation, closure.

Page 32: Anita L. Barkin Dr.P.H., M.S.N., C.R.N.P. November 19, 2014.

Telecom ◦ Establishing a phone bank.

Student Life/Housing/Dining◦ Support students who cannot go home.

Counseling and Psychological Services◦ Providing teletherapy if possible.

Office of International Education◦ Providing advice to students who are studying

abroad.

Page 33: Anita L. Barkin Dr.P.H., M.S.N., C.R.N.P. November 19, 2014.

Human Resources◦ Identify personnel to staff essential functions.◦ Identify personnel available for telephone support

work. Campus Police

◦ Enforcing public health orders◦ Securing the perimeter of isolation areas.◦ Securing the health care facility.◦ Maintaining civil order and controlling traffic.

Parking◦ Opening gates for evacuation◦ Arranging public transportation options.

Page 34: Anita L. Barkin Dr.P.H., M.S.N., C.R.N.P. November 19, 2014.

20 year old student from China presents to the Health Service with 3 week history of cough, fever, night sweats. His health history indicates that he his last PPD was one year ago. He traveled recently over winter break to see family. He lives in a residence hall.His fever is 100.8, he coughs throughout the exam. Actions:

Instructs the patient to cover his cough and hands him a mask.

The nurse dons an N95 mask as she is concerned about the possibility of TB.Arranges transport to the local emergency room with

a mask on by way of the local ambulance company and informs them of her concerns.

Calls Environmental Health and Safety to clean the room.

Page 35: Anita L. Barkin Dr.P.H., M.S.N., C.R.N.P. November 19, 2014.

Operationalize the response plan when you find out from the local health department that the student is diagnosed with active TB and in isolation in the hospital.

◦ Communication with Health Dept, Student Affairs, Student Life

assist with contact tracing including any student(s) who were in the waiting room at the same time as the ill student.

Targeted communication to the academic dept. or residence hall◦ Assist with arrangements/provide post-exposure testing for

HS staff and others potentially exposed.◦ Collaborate with the Health Dept. to ensure proper follow-

up of contacts. ◦ Monitor student’s return to campus – compliance with

treatment protocol.◦ Advise Dean of Students of the possible impact on

academic progress.

Page 36: Anita L. Barkin Dr.P.H., M.S.N., C.R.N.P. November 19, 2014.

Graduate student arrives from Liberia after spending winter break with family. She follows instructions given in a communication from HS sent to the campus community prior to students returning to campus for the spring term. She monitors her health and takes her temperature twice a day. On the 8th day after her return to the U.S., she notes the onset of fatigue and nausea. She has a low grade temp and calls the Health Service. The student is told to call the local ER to discuss how to approach for care.

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Health Services ◦ Notify response team of the call and need to meet

This will hit media – increased institutional impact◦ Stay in touch with local health care agency for updates◦ Check on PPE supplies◦ Post instructions outside waiting room and on website

regarding the procedure for accessing care◦ Reinforce phone screening with HS staff and Campus

Police dispatch◦ Assist in preparation of communication to campus

community◦ Be the voice of science…be the voice of reason…

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ACHA website◦ www.acha.org/topics/ebola.cfm◦ www.acha.org/Publications/docs/ACHA_Guidelines

_Emergency_Planning_AllHazards_Approach_Feb2011.pdf

CDC http://

wwwnc.cdc.gov/travel/page/advice-for-colleges-universities-and-students-about-ebola-in-west-africa

Medscape◦ EBOLA: CDC Enhanced Guidelines for Wearing PPE

Page 39: Anita L. Barkin Dr.P.H., M.S.N., C.R.N.P. November 19, 2014.

Dr. Margaret ChanDirector-General WHO

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