CDC-INFO National Contact Center H1N1 Response Exercise v. Reality Susan K. Laird, MSN, RN Clinical...
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Transcript of CDC-INFO National Contact Center H1N1 Response Exercise v. Reality Susan K. Laird, MSN, RN Clinical...
CDC-INFO National Contact CenterH1N1 Response
Exercise v. Reality
Susan K. Laird, MSN, RNClinical Director, CDC-INFO
Joint Information Center Team LeadDivision of Community Engagement
Office of the Associate Director for Communication
Centers for Disease Control and Prevention
Special thanks to Marsha Vanderford, PhD, JIC Lead
Stephanie A. Dopson, MSW, MPH, ScD. Candidate, Influenza Coordination Unit
Objectives
At the completion of this workshop, attendees will… have an understanding of how CDC and
CDC-INFO respond to emergencies and coordinate during an event
be aware of CDC resources available to AIRS members in support of state and local activities
Public Health Preparedness and Emergency Response:
How CDC and CDC-INFO activate and mobilize
5
National Strategy for Pandemic Influenza 11/05
Homeland Security Council National Strategy for Pandemic Influenza--Implementation Plan 5/06
HHS Pandemic Influenza Plan 11/05 HHS Implementation Plan 11/06
HHS ESF 8 Playbook CDC-INFO Surge and Scalability
Plan
Planning started years before the H1N1 Pandemic
6
Influenza Pandemic OPLAN
Functional Exercise – Internal, Full Staff31 Jan – 1 Feb 07
(18 Hrs)
AAR
DEOC Working Level Workshop
4 Oct (8 Hrs)AAR
Senior/Division Leader OPLAN
Seminars 28 Sep & 17 Oct
(4 Hrs Each)
AAR
Functional Level Drills
(6 Functional Areas)16 Oct – 1 Dec
(2-4 Hours Each)AAR
Training/Exercise Methods:
Briefings/Seminars
Tabletop Discussion
Workshops and Functional Drills
Functional Exercises
CDC Foundation Tabletop
18 Apr (3-4 Hrs)
AAR
Functional Exercise (Surge)
14-16 Aug 07 (48 Hrs)
AAR
Functional Exercise (Internal/External) 25-27 Apr 07 (48
Hrs)
AAR
Advanced Tabletop: Significant Issue
Forum 8 Dec (4 Hours)
AAR
Section Drills
1-30Nov07 AAR
Intervals, Actions & Triggers TTX
14Nov07
AAR
Lessons Learned Seminar
15Nov07
2008 Influenza Pandemic Exercise Program
CDC Exercises (2006-2007)
7
Influenza Pandemic OPLAN
TTX
CDC / PFO / JFO Role and
Responsibilities July 10, 2008
(4 Hrs) AAR
Limited Full Scale Exercise
(1 State)
Surge/Mitigation
11-13 Mar 2008(48 Hrs)
AAR
Surgeon General’s Flag Retreat
ITA TTX8 Jan 2008(4 Hours) AAR
Limited Full Scale Exercise
Influenza Pandemic Progression from
Acceleration to Peak Transmission
(5 State Participation)
Sep 16-18, 2008
(48-72 Hrs) AAR
2009
Exercise Series
DEOC Section Functional DRILLS
3-14 Nov 2008(4-8 Hours)
AAR
Training/Exercise Methods:
Briefings/Seminars
Tabletop Discussion
Workshops and Functional Drills
Functional Exercises
CDC Exercises (2008)
CDC H1N1 Response
In late March and early April 2009, cases of human infection with a novel H1N1 influenza virus were first reported in Southern California and near Guadalupe County, Texas.
25 percent of the SNS supplies were deployed to all 62 states or project areas.
CDC-developed PCR diagnostic test kits to detect this virus.
Test kits have been distributed to all 50 states, the District of Columbia and Puerto and are being distributed internationally.
April 2009
April 21 – CDC-INFO initiates Log Call for tracking
April 23 – CDC –EOC activated April 24 – Messaging in place at the front of
the IVR redirecting to website April 30 – highest call volume attempted
2009 H1N1 Outbreak Response
Occurred very late in the season Remarkable heterogeneity
across US Affected young people
disproportionately Caused widespread illness;
some severe or fatal Socially disruptive, especially for
schools Tens of thousands of nurses and
other health workers responded worldwide
1111
Key Events
Novel 2009-H1N1 Declarations: USG: Public Health Emergency declared (26 Apr 2009)
Renewed by HHS Secretary Kathleen Sebelius
HHS: Downgraded to Phase 1 – Awareness (9 May 2009) WHO: Pandemic Phase 6 (11 JUN 2009 1600 EDT)
Outbreaks in at least one country in > two WHO regions
USG: National Emergency declared (24 Oct 2009)
To allow Section 1135 [42 USC §1320b–5] waivers to be issued
Response Timeline
Discovery
15 Apr 09to
31 May 09
1 Jun 09to
15 Aug 09
Preparing
S. Hemisphere
16 Aug 09to
4 Oct 09
5 Oct 09to
1 Apr 10
Fall wave
Vaccination
Pre-Pandemic Recovery
Developing Guidance
Sep 8 CDCPosts revised Antiviral drug
guidance
May 6 CDC Posts
Interim guidance
Sep 22 CDC clarificationto reduce burden from
Worried well
13
14
Response—Strategic Goals/ Principles
Reduce illness and death Minimize societal impact Apply greatest effort to interventions with
greatest impact
H1N1 Four Pillars of Action
Surveillance (Situational awareness) Domestic and Global Health care system
Mitigation Vaccination Communication State and Local Support Medical Care and Countermeasures
Examples from the H1N1 Response
Vaccination
CDC has isolated the new H1N1 virus and modified the virus so it can be used to make hundreds of millions of doses of vaccine
Making vaccine is a multiple step process which takes several months to complete
State health departments started ordering Novel H1N1 vaccine on September 30th
Novel H1N1 vaccine was widely available to the public by early December and began to be distributed through retail pharmacy chains
Components of a National Voluntary H1N1 Vaccination Program
Program planning Engaging partners in government (state, tribal, local) and private
sector Financing of program and vaccine administration costs
Implementation and vaccine distribution Assessing how many people receive the vaccine
Communications General public Health professionals
Monitoring vaccine safety Assessing vaccine effectiveness
Communicating Effectively
Continued outreach to: Parents Pregnant Women Child Care Programs Schools, Colleges and
Universities Travelers, Travel Industry Clinicians Laboratorians Businesses, Employers Community and Faith-Based
Organizations Correctional facilities Homeless shelters Migrant farm workers
CDC’s Communication Response: Guiding Risk Communication Principles
Announce early Maintain transparency Do anticipatory guidance
Prepare media and public for change
Acknowledge uncertainties Involve and empower the
public Explain their role in
reducing the impact of the outbreak – communicate calls to action
Effectively utilize partnerships
Communicating Prevention Steps
April 24-Aug 31, 2009:
45 Guidance
Documents
Steps for public,
clinicians, state/local
health departments,
businesses, and
Communities to take
Communicating Guidance Information
Key messages
Talking Points for Media
Partners for messagecoordination
Guidance Documents Fact sheetsCDC-INFO ScriptsPSAsPostersPodcasts/VideocastsHealth AlertsTwitter MessagesListserv content
Foreign LanguageTranslations
Situational Awareness
Clinical/Public Health Guidance, Daily Public UpdatesCDC Emergency Website
News MediaPress conferencesNews releasesInterviewsMedia ToursMedia advisories
15 JIC Teams
(Adaptation/Dissemination (fact sheets, PSA’s, “Tweets”, etc) General PublicAffected CommunitiesVulnerable PopulationsCliniciansState/local PH WorkforceLaboratoriansGlobal Communication CounterpartsPolicy MakersCDC Employees
JIC ChannelsCDC Emergency WebsiteCDC-INFO (English, Spanish, TTY)Health Alert NetworkEpi-XClinician RegistrySocial MediaPartner Distribution Networks
Media Relations
Key Messages
Role of Businesses/Employers in Pandemic Planning and Response
Protect the workforce Encourage ill staff to stay home Do not punish staying home Plan for/support telework Encourage vaccination,
especially of high-risk workers Keep businesses operational
(esp. Critical Infrastructure) Ensure communities continue to
function
Communicating through News Media4/21-6/12 2009
CDC News Media Inquiries 100 per day (range 10-250)
News Briefing Telebriefing Participants (31 briefings) 700 avg. participants per briefing (range 450-2450)
Stories by National Print Media featuring CDC 2,582 (represents actual stories not repeated stories)
CDC Media Web Site Section Views 1,050,342 (25,000 per day)
CDC In-studio interviews 70 national/local interviews (CBS, Fox, CNN, NBC, ABC,
MSNBC, Univision, C-SPAN)
CDC-INFO scripts always in TTY PSA’s in American Sign Language
•H1N1 General messages•Hand hygiene
Targeted Communication to Vulnerable Populations
Deaf and Hard of Hearing
• Collaboration with Partners: ASL PSAs Courtesy of the University of Rochester
• http://www.cde.gov/h1n1flu/deaf.htm
Communicating through Partners
AIRS! American Association on
Intellectual and Developmental Disabilities
Brain Injury Association of America
Florida Association for the Deaf GA Council for the Hearing
Impaired National Institute on Disability
and Rehabilitation Research
March of Dimes Foundation Helen Keller Foundation Lighthouse for the Blind National Council on Disability National Organization on
Disabilities Independent Living Centers Association of University
Centers on Disabilities March of Dimes
Government, NGO, faith-based organizations, and other partners who serve vulnerable populations distribute CDC’s messages.
Example of CDC partners who serve disabled populations:
Pulling Traffic to CDC’s Website April 22, 2009
One fact sheet on H1N1 (swine flu)
6,000 page views July 12, 2009
300 + pages on H1N1 95 million page
views
Social Media Connections Widgets Buttons E- cards Twitter Feeds
Sample of 2009 H1N1 Social Media
Challenges in sharing guidance
Guidance Changed 4/24-7/16 41% (17/41) guidance documents changed
20% (8) changed once 12% (5) changed twice 10% (40) removed and not replaced
Most frequently changed/major changes Case definition Identification of and caring for patients Antiviral guidance School Guidance
Communicating Change: In Practice
Practices for setting expectations for change: Label guidelines “interim” Forecast changes to come in talking points and print
materials
Example:Interim Guidance for Clinicians on the Prevention and
Treatment of Novel Influenza A (H1N1) Influenza Virus Infection in Infants and Children
May 13, 2009 3:30 PM ET This document provides interim guidance for clinicians
who are caring for young children with novel influenza A (H1N1) virus infection. As additional information becomes available, the guidance in this document may be updated.
Communicating Change: Challenges
Rapidly changing guidance 44% of all guidance documents (18/41) changed
between initial release and 7/16/09 17% (3/18) of first week’s guidance changed in the
first week of the response 73% of guidance documents (30/41) first 2-weeks of
response 37% (11/30) of guidance changed once within 2
weeks 10% (3/30) documents changed twice within 2 weeks On a single day (May 1) 4 guidance documents were
revised and reposted.
Implications of Changes
Many revisions— CDC tried to help audiences negotiate changes
Labeled revisions as updates and date stamped them Pushed them to partners through distribution channels
as “updates” However, it was still difficult to tell what was new
One partner—dedicated one full-time person to culling through CDC’s revised guidance and key points daily to figure out what was new.
Lesson Learned: highlight new sections at the top of revisions.
Implications of Change:Potential for Internal Inconsistency is High
Facemask/Respirator Use Posted May 27, 2009
Guidance for Novel H1N1 Flu: Taking Care of a Sick Person
in Your Home
Guidance for Infection Control for Care of Patients with Confirmed or Suspected Novel Influenza A (H1N1): Virus Infection in a Healthcare
Setting
Guidance for Non Pharmaceutical Community Mitigation in Response to Human Infections
with Swine Influenza (H1N1) Virus
Implications of Change: Sometimes public versions/translations were delayed
Key messages
Talking Points for Media
Partners for messagecoordination
Guidance Documents Fact sheetsCDC-INFO scriptsPSAsPostersPodcasts/VideocastsHealth AlertsTwitter MessagesListserv content
Foreign LanguageTranslations
►Lessons Learned: Automated Tracking/Update Systems
Situational Awareness
Clinical/Public Health Guidance, Daily Public UpdatesCDC Emergency Website
News MediaPress conferencesNews releasesInterviewsMedia ToursMedia advisories
15 JIC Teams
(Adaptation/Dissemination (fact sheets, PSA’s, “Tweets”, etc) General PublicAffected CommunitiesVulnerable PopulationsCliniciansState/local PH WorkforceLaboratoriansGlobal Communication CounterpartsPolicy MakersCDC Employees
JIC ChannelsCDC Emergency WebsiteCDC-INFO (English, Spanish, TTY)Health Alert NetworkEpi-XClinician RegistrySocial MediaPartner Distribution Networks
Media Relations
Key Messages
Implications of Change:External Inconsistency
Rapid changes in guidance caught some partners by surprise For example, schools complied with closing,
following release of May 1 School Dismissal Guidance
On May 4, CDC issued changed guidance focused on isolation of ill children, rather than school closings
Lessons learned: Increased collaboration with partners in the development and revision of guidance.
LESSONS LEARNED(AND STILL LEARNING)
Lessons Learned
Possible to rapidly issue and disseminate broad public health guidance
Changes in guidance can be rapidly achieved to meet evolving circumstances
Rapid changes have potential to Threaten internal consistency Surprise and conflict with external partners
Recommendations: Increased collaboration and notification with partners Automated change/content management systems
Guiding Principles
Build and maintain trust and credibility Provide the public with timely, accurate, and
consistent information – and tell them what they can do to help keep themselves and their families safe
Provide partners with information to support their response efforts
Mitigation Strategy
Identify and acknowledge uncertainties Recognize the amount of uncertainty is more
than everyone would like Trust the public to tolerate incomplete and
potentially upsetting information
More Guiding Principles
Anticipate and prepare media and public for changes
Put responses in place rapidly – the phone is going to ring!
Involve and empower the public Explain their role in reducing the impact of
the outbreak – communicate calls to action Share dilemmas and challenges Effectively use partnerships
CDC’s Communication ResponseMajor Challenges
Instant, immense, and ongoing demands for information
Frequent and rapid change Coordination Clearance – assuring scientific accuracy and
consistency Pre-prepared pandemic flu messages and
materials were not easily adapted
Vaccine Issues
Overpromised and underdelivered Concerns about safety – “H1N1 vaccine was
made too fast and too new to be safe” CDC recommendations for priority
vaccination - people didn’t understand reasons
Risk v. benefit perception Characterization of the pandemic H1N1 virus
as “moderate” severity
HOTWASHES AND AFTER ACTIONS
Hotwashes Daily for Exercises
Focus on how to we communicate internally Fix on the fly during events
Staffing up – funding?? Should have initiated the PAT call (Process
Action Team) Putting content in place when there aren’t any
answers yet
AFTER ACTION REVIEW
PURPOSE Conduct a structured, discovery learning
review of critical topics relevant to activities during the H1N1 response and capture lessons learned which will be used to develop a Corrective Action Plan and assign responsibility to individuals or groups with a timeline for completion
AFTER ACTION PROCESS
The AAR is a structured review process that provides immediate feedback for all training/response events and allows participants to discover: What Happened? Why it Happened? How it can be fixed, refined or improved?
AAR RULES OF ENGAGEMENT
Must be a professional discussion – not a critique
Everyone’s opinion is important and everyone participates
We need to be hard on the process, but respectful of each other
Focus on how to do it better next time Take ownership for fixes
AFTER ACTION(HINDSIGHTS ON THE BAD STUFF)
No substantive content in the first few days to couple of weeks while guidance was being developed
CDC-INFO agents were frustrated with not having information to share, especially sensing caller anxiety
Should have instituted PAT calls immediately Insufficient team depth to support sustained
event 24/7/365
HINDSIGHTS - 2
Normal escalation process didn’t work due to program overload
Difficult to decide how to surge up for staffing – volume not predictable in the beginning
Normal process for evaluation difficult to continue as designed for steady state
WHAT WORKED WELL
The CDC-INFO Surge and Scalability Plan and process was practiced and known
CDC.gov website was updated frequently – more than daily
New call flows and escalations were set up to coincide with special teams within EOC
Communication between all CDC-INFO teams was good
Once approval was given from CDC, contact center surge staff was on the floor quickly
WHAT WORKED WELL-2
Podding of surge staff – simplified training processes
Development of email templates to facilitate rapid response to high email volume
Applying Hotwash input/Lessons Learned on a daily basis – identify what isn’t working right away and fix it!
Good tracking and reporting mechanisms in place promptly
WHAT WORKED WELL - 3
CDC-INFO supported several state and local contact centers Provided current, updated scientifically
accurate content on a weekly basis (version control)
Provided several states with detailed reporting with geographic detail
UPDATE
January 12, 2010 – Activated for Haiti Earthquake
May 10, 2010 – Activated for Deepwater Horizon
H1N1 Activation continues
CDC-INFOMAY 2010
H1N1 Inquiries as of 5/18/2010: General Public
Calls 142,248Emails 47,483
Clinicians 23,408 Postal & TTY 16
TOTAL INQUIRIES 213,155