Community PanFlu Planning:

Ancillary Healthcare

Objectives

Facilitate development of your Internal Disaster Plan

Foster discussion among facilities to enhance cohesion during crisis

Encourage “coopetition”.

Why Have a Plan?

Without…CommunicationCoordinationCooperation

You get…ChaosCrisisConfusion

Why Plan? Evidence suggests…

All communities severely impacted >120 casualties = MCI

Without Internal Disaster planning, estimated 40% businesses will fail.

Preparing for a Pandemic in Knoxville

Federal Plan: Local and Self-reliance is keyLocal groups to develop Internal Disaster Plan

SurveillanceCommunicationsInfection ControlOccupational IssuesVaccine/Antiviral accessSupply chain redundancyInteragency cooperation

Family and Individual planning essential

Guidance for PlanningBecause resources will be limited…

Contingency planning should include:

Planning for absenteeism: ~40%Hygiene products and

education in the workplaceSupply shortagesHome offices for critical personnelSick leave policies compatible with state recommendations

The Pandemic Influenza Cycle

Rapid transmission with worldwide outbreaks; multiple waves of disease over a 2 year period.Occurrence of cases outside the usual season.High attack rate for all age groups, with high mortality rates, esp for young adultsCycles 10-40 years. Last pandemic was mild, 1968 (35 years ago)

Will H5N1 become the next pandemic?

Avian Flu not yet Pandemic Flu, but current outbreaks in poultry are largest ever documented.

Impossible to know if or when

If not H5N1, then another will come

The prudent time to plan is now

Assumptions about Disease Transmission

No one immune to virus; 30% of population will become ill

Most will become ill 2 days (range 1-10) after exposure to virus

People may be contagious up to 24 hours before they know they are sick

People are most contagious the first 2 days of illness

Sick children are more contagious than adults

On average, each ill person can infect 2 or 3 others (if no precautions are taken)

Community Disease Control:Early Stage Isolation and Quarantine

Initial Objective: slow spread of disease Isolation vs. QuarantineLegal measures possible but will rely on voluntary cooperation

Once beyond initial cases, shift strategy to “stay home when you are sick”

Community Disease Control:Reducing Social Contact

Canceling large gatherings, mass transit, schools

Decision based on location of flu activity:

Not local: gatherings >10,000 cancelledLocal/neighboring county: >100 cancelled

School closings determined by State Commissioner of Health/Board of Education.

Medical Burden in Knox County2005 Knox County Population est. 396,741

Characteristic

Moderate (0.2%)

Severe (2%)

Illness (30%) 119,000

119,000

Outpatient care

59,500

59,500

Hospitalization

1,190

11,900

ICU (15% hosp pts)

180

1,800

Mechanical ventilators (50% ICU pts)

90

900

Deaths 240

2,380

Establishing a Planning Structure

PanFlu CommitteePanFlu CoordinatorPoint of ContactWritten Plan

Surveillance: Populations Served

Educate staff Signs/symptoms pandemic vs seasonal fluInfection control measuresCommunity response plan

Track patients/staff with panfluHave system in place to report unusual flu-like illness/pan flu to local HD

Surveillance for those at work– Develop screening for employees with flu-like symptoms

Develop sick leave policy specific for panflu

Determine when ill employee may return to work

Internal and External Communication networks

Detailed communications planning needed:Internal- Ensure employees know panflu policy, communications plan, their specific role, esp in surge capacity

External- Point of contact with Health Department

Info via KCHD Broadcast FAX, Email,

website, Media

Coordinate with like organizations

to develop/coordinate emergency plans

Communicate with other facilities affected by yours

Infection Control

Signage to educate personnel and patientsAdequacy of surgical masks for patient contact not involving aerosolization proceduresPossibility of using surgical masks over reusable N95s as well as goggles/face shields for high-risk proceduresEstablishing regularly scheduled environmental cleaning

Vaccine/Antiviral Distribution

Prioritization of personnel : based on level of patient contact

PanFlu Coordinator: to develop and provide list of First and Second tier personnel

Prioritization determined by Feds and may change

Secondary Distribution Center

SNS warehouse SDC Your FacilityHere at KCHD orKCHD off-site warehouse orOther location

Either distribute directly to your staff or have facility point person pick up and administer

Important to be flexible

Surge Capacity:Staffing Shortages

Identify minimum number employees and categories required for essential operationsTemporary helpMOAs with other facilitiesVolunteer Coordinating Center being developed: Non-medical vs Medical

Staffing Shortages andWorkforce Support

Develop strategy for housing staff on-site for prolonged periods if neededStaff encouraged to develop personal family care plans for their absence from home

Planning to be away…Plan for childcare in the event schools close

Arrangements made for eldercare, pet care Discuss/develop plan for employee to work at home if possible

Surge Capacity: Supplies

Estimate needs forconsumable resourcesOne weeks worthPrimary Plan & Contingency Plan

Detailed procedures for supply acquisitionNormal channels exhausted: have a back-up

Have you thought about???

Where are you in developing a plan for your office/business?Triage: patients and employees.What will be your financial viability with a possible 40% absenteeism?Does your family have a plan? Are you prepared with enough water, food, meds?

Have you thought about???

Employees are calling in sick… do you have extra staff to call in??

Employee comes to work but c/o fever and may need to go home. Avian flu or cold?When do you let recovering employee return to work?

Have you though about???

Employees handling money, patient forms… what if they want hand sanitizer, gloves and demand to wear masks?Support services (delivery, suppliers, labs, etc) are not available because of fear of catching disease.Not enough staff to keep store/office open… Can computer records be accessed from another location? What do your patients do?

Have you thought about???Calling on patients to check on their well-being?

Patient emergency calls: how to handle?

Possibility to consolidate services from one or more central locations… work with other professionals to keep one site open?

Have you thought about???

How do you see yourself, if able, offering services to the greater community?Making house calls/volunteer home visits to check on essential patient needs?Offering services through Volunteer Coordination Center?

Have you thought about???

How do you see your professional organization fitting into this equation?Central communications to all professionals? Central location for emergency calls from patients/clients?

Resources

PandemicFlu.govCDC.gov/flu/avianwww.nyhealth.govKnoxcounty.org/healthKnoxpanflu@knoxcounty.org:If you want to be put on “Pandemic alert email” list