1. Community PanFlu Planning : Healthcare: Acute and Long-term

2. Objectives Facilitate development of your Internal Disaster Plan Foster discussion among facilities to enhance cohesion during crisis Encourage “coopetition”.

3. Why Have a Plan? Without… Communication Coordination Cooperation You get… Chaos Crisis Confusion

4. Why Plan? Evidence suggests… All communities severely impacted >120 casualties = MCI Without Internal Disaster planning, estimated 40% businesses will fail.

5. Preparing for a Pandemic in Knoxville Federal Plan: Local and Self-reliance is key Local groups to develop Internal Disaster Plan Surveillance Communications Infection Control Occupational Issues Vaccine/Antiviral access Supply chain redundancy Interagency cooperation Family and Individual planning essential

6. Guidance for Planning Because resources will be limited… Contingency planning should include: Planning for absenteeism: ~40% Hygiene products and education in the workplace Supply shortages Home offices for critical personnel Sick leave policies compatible with state recommendations

7. 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 adults Cycles 10-40 years. Last pandemic was mild, 1968 (35 years ago)

8. 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

9. 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)

10. Community Disease Control: Early Stage Isolation and Quarantine Initial Objective: slow spread of disease Isolation vs. Quarantine Legal measures possible but will rely on voluntary cooperation Once beyond initial cases, shift strategy to “stay home when you are sick”

11. Community Disease Control: Reducing Social Contact Canceling large gatherings, mass transit, schools Decision based on location of flu activity: Not local: gatherings >10,000 cancelled Local/neighboring county: >100 cancelled School closings determined by State Commissioner of Health/Board of Education.

12. Medical Burden in Knox County 2005 Knox County Population est. 396,741 CharacteristicModerate (0.2%) Severe (2%) Illness (30%) 119,000 Outpatient care 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

13. Establishing a Planning Structure PanFlu Committee PanFlu Coordinator Point of Contact Written Plan

14. Surveillance: Populations Served Educate staff Signs/symptoms pandemic vs seasonal flu Infection control measures Community response plan Track patients/staff with panflu Have system in place to report unusual flu-like illness/pan flu to local HD

15. Have you thought about:Triage? Phone banks: to prioritize patients In-house 211 Establishing boundaries for “non-flu” vs “flu sick” Signage Different areas vs different times Alternate sites In-house: “remote” area not normally intended for triage use Outside of facility: different entrance than regular ER

16. Surveillance for those at work – Develop screening for employees with flu-like symptoms Develop sick leave policy specific for panflu: liberal and non-punitive Determine when ill employee may return to work

17. Have you thought about? In cases of extremely limited resources implementing staff with Influenza-like illness (ILI): Working in non-flu areas Wearing dropcon protection at all times Meticulous attention to hand hygiene Not deployed to high-risk areas

18. 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

19. Infection Control Signage to educate personnel and patients Establishing regularly scheduled environmental cleaning Adequacy: surgical masks for patient contact not involving aerosolization procedures Possibility: surgical masks over reusable N95s + goggles/face shields for high-risk procedures

20. 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

21. Surge Capacity:Staffing Shortages Identify minimum number employees and categories required for essential operations Temporary help MOAs with other facilities Volunteer Coordinating Center being developed: Non-medical vs Medical

22. Volunteer Coordinating Center (VCC) Working with American Red Cross to provide medical and non-medical volunteers. Red Cross: Initial screening and training at various satellite sites. “Triage” volunteers to VCC. Health Dept: Identify volunteers for specific roles. Give volunteers identification. Coordinate and communicate with hospitals.

23. Coordinating Volunteers, cont’ Hospitals/HC facilities to: Identify Volunteer Manager Point of Contact. Communicate to VCC on needs/releases. Develop further training for volunteers specific to your facility. Manage volunteers that they receive.

24. Surge Capacity: Have you thought about? Partnering with Day Cares to utilize their staff in assisting you should their facilities be closed? Partnering with back-up support services (delivery, suppliers, labs, etc)?

25. Have you thought about??? What triggers will you use to activate: Your panflu plan? Closing of non-critical departments? Canceling elective surgery/procedures? Limiting visitors? Closing your facility to new admissions?

26. Surge Capacity: Have you thought about? Handling patients you turn away? What to tell (info packets) about how to care for loved ones? Training for staff to do this? What system you will have in place to accept new patients as beds are freed up?

27. Staffing Shortages and Workforce Support Develop strategy for housing staff on-site for prolonged periods if needed Staff encouraged to develop personal family care plans for their absence from home

28. Workforce Support Psychological and physical strain on personnel responding in emergency situation Psychological stress for families Plan for your staff to have adequate Sleep Food Access to psychological and spiritual support

29. 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

30. Have you thought about? Financial impact of increase in patients but decrease in revenue generating procedures?

31. Have you thought about??? Does your family have a plan? Are you prepared with enough water, food, meds? What will your financial viability be with your possible long-term absence?

32. Surge Capacity: Supplies Estimate needs for consumable resources One weeks worth Primary Plan & Contingency Plan Detailed procedures for supply acquisition Normal channels exhausted: have a back- up

33. Have you thought about??? How do you see yourself, if able, offering services to the greater community? Offering services through Volunteer Coordination Center?

34. Resources PandemicFlu.gov CDC.gov/flu/avian www.nyhealth.gov Knoxcounty.org/health If you want to be put on “Pandemic alert email” list Knoxpanflu@knoxcounty.org: for questions/speaking requests