1. “ Preparation for the Flu Pandemic, Mobilizing Human Resources” CAPT Lynn A. Slepski, RN, MSN, CCRN Senior Public Health Advisor US Department of Homeland Security 2006 Annual ConferenceAlexandria, Virginia Council on Licensure, Enforcement and Regulation Expect the Unexpected: Are We Clearly Prepared?

2. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Standard Continuity of Operations (COOP) Planning SCALE related –1 Geography –Less than 30 days –Essential functions only –Essential personnel only –Resumption plan Emergency plan that translates to specific situations

3. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia COOP Example—Y2K Major businesses developed a plan Upstream and downstream Wrote Y2K plans into contracts Actually verified/critiqued the plans Result—No issue

4. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Hurricane Katrina 1.5 million people 90,000 square miles Louisiana, Mississippi, and Alabama 770,000 persons displaced 89,000 persons evacuated to make-shift shelters Medical infrastructure sustained extraordinary damage Triggered the largest natural disaster relief and recovery operations in United States history Created an unprecedented demand for relief healthcare services

5. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Katrina Example-Pharmacy Support Original plan –Ring the impact area and prepare to flow support in –LA alone 10 – 12 shelters –Major chains would “adopt” a shelter –Based on census either support from off site OR establish a mobile pharmacy Reality –>200 shelters –Very poor information –Lost time drafting legal language for emergency powers

6. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Pharmacy Response Exercised previous relationships Businesses worked directly w/ the LA Board-practice modifications –Pharmacists could dispense w/o Rx –Any mobile pharmacies could operate without an inspection to operate –Accept any pharmacist license-Immediate reciprocity –Disposal of compromised drugs—hazardous wastes –Remote processing…Pharmacists could enter into a database and begin filling process –Developed a database took all available records

7. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Pandemic Planning Assumptions 40 percent or more of workforce out (Sick, taking care of family or afraid to work) School closures (day care – universities) Supply and delivery chains disrupted Travel delayed or halted; large public gatherings canceled Healthcare system overwhelmed Essential services interrupted Some believe that all rules/regulations will be suspended

8. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Pandemic Challenges Pandemics are different from other types of emergencies There will be no clear beginning and end Almost all locations will be affected simultaneously There will be multiple waves Resources cannot be shifted geographically as in other emergencies Every country will be affected, but countries with better plans will be less vulnerable to terrorism and other threats during a pandemic

9. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia DHS Federal Responsibilities Above and beyond our own continuity planning…. Federal incident management Border control **Maintaining critical infrastructure and key resources (CI/KR) (85% owned privately) –N=17. Examples are food, water, public health, emergency services, energy, transportation –Continuity of operations – essential (COP-E) Catastrophic planning for essential services –Identify in advance where regulatory relief may be helpful

10. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Regulatory Waivers Certain waivers should be considered to ensure that public and private sector responders can react and recover effectively –Pre-identify areas where rules/regulations can be modified or waived temporarily –Weigh risks vs. benefits as entities struggle to maintain response Quality Safety –Don’t want to further compromise vulnerable populations when possible GOAL: Policies in anticipation –What is expected –How laws will be applied and enforced

11. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Public/Private Partnerships US Chamber Trade and Professional Organizations Businesses CI/KR Sectors Advisory Councils Governments and Governmental Agencies

12. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Transportation Issues GOAL: Maintain supply chains Change authorities –Commercial Drivers License (CDL) drive interstate when providing emergency services Decrease restrictions –Drive times, weight restrictions, etc. Licenses, Credentials or Certifications Federal pre-emption of state and locally decided closures to allow movement of critical supplies

13. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Liability Issues GOAL: Liability protection for businesses Medical care, anti-virals and vaccines for side effects and consequences Protective equipment

14. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Sharing of Information GOAL: Continuity of Care Databases Electronic medical records

15. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Personnel Issues GOAL: Protect workers/ maintain operations Fair Labor Standards Act –Time recording, exempt/non-exempt duties, overtime, etc. Confidentiality Requirements –HIPPA, ADA, FMLA Discussions regarding employees or family members Tracking of illness Employer Responses –Benefit documentation (ERISA) response time –Requirements to pay employees w/i a certain period

16. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Scopes of Practice GOAL: Accomplishing the greatest good Healthcare scopes of practice –EMT vs. ACLS Prescription authorities Drug dispensation Identify “able” providers –Who can perform tasks—How to find

17. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Regulatory Requirements GOAL: Protecting the workforce OSHA fit-testing for masks Expedited SAFETY Act application review

18. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Your Role in Pandemic Planning Does your group have a plan? Family? Consider where there may be room for discussion Don’t wait for an invitation to “come to the party” Encourage cross-walking of plans Help identify possible options—be part of a solution

19. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Conclusion Regulatory bodies are key stakeholders Role in both the development and implementation of emergency preparedness plans. Regulatory relief will be necessary –maintain CI/KR –facilitate effective mobilization of resources at a local level Challenge--Consider non-traditional ways of meeting the health and safety needs of the public in a time of crisis.

20. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Speaker Contact Information CAPT Lynn A. Slepski, RN, MSN, CCRN U.S. Department of Homeland Security/Prep Washington, DC 20528 Desk (202) 282-9697 FAX: (202) 282-8191 Lynn.Slepski@dhs.gov