1. Chapter 11: Nursing in Pandemics and Emergency Preparedness

2. Introduction Humanity has dealt with pandemics throughout the millennia. History tells us that pandemics will occur again. Current history coupled with scientific information and emergency preparedness provide tools to survive a pandemic.

3. Pandemic Pandemic = outbreak of illness that expands to different parts of the globe. Term “pandemic” is from Greek pandemos. – Pan means “all” – Demos means “people” There are examples throughout recorded history.

4. Avian Influenza Virus Avian influenza (bird) flu, called H 5 N 1 Began in Guangdong Province, China in 1996 Crosses species barrier (bird to human, cat to human) Although only hundreds have died, fatality rate among those infected is 60% Possible future pandemic threat

5. An Archetypal 21 st Century Pandemic—H 1 N 1 Influenza Virus (1 of 2) Viral pandemic characteristics – Novel viral strain of illness develops – Population has little or no immunity – Virus moves easily from person to person First 21 st century novel pandemic virus is influenza A (H 1 N 1 ), also known as swine flu.

6. An Archetypal 21 st Century Pandemic—H 1 N 1 Influenza Virus (2 of 2) Influenza virus transmission dynamics – Reservoir is gastrointestinal tract of wild aquatic birds. – Pigs are usually the intermediate host. – Novel virus emerges that can pass from human to human. Antigenic drift versus antigenic shift – Antigenic drift is associated with seasonal epidemics. – Antigenic shift is process by which pandemic viruses arise.

7. WHO Pandemic Phases 1.Virus in animals does not cause human infections. 2.Virus in animals causes human infections. 3.Animal or human– animal influenza resonant virus causes small outbreaks in people. 4.Able to cause community-level outbreaks. 5.Human-to-human spread into at least two countries in one WHO region. 6.Pandemic phase. Criteria defined in phase 5, plus community-level outbreaks in at least one country in a different WHO region.

8. Pandemic Emergency Response and Preparation (1 of 6) Greatest impact is at local level. – Gradual increase of patients to catastrophic levels – Vaccines, antiviral agents, antibiotics potentially in short supply – Medical facilities strained caring for both influenza and noninfluenza patients – Potentially significant shortages of personnel to provide essential community services

9. Pandemic Emergency Response and Preparation (2 of 6) Pandemic preparedness – Must include protocols and stockpiling of supplies. Role of advanced practice nurses – Frontline healthcare workers in direct contact with public – Assist in planning, staffing, services

10. Pandemic Emergency Response and Preparation (3 of 6) Healthcare facilities planning – Flu season stresses an emergency department. – May affect a community and its resources for 6 to 8 weeks. Alternate care sites – For those not needing hospitalization – Should be identified in advance

11. Pandemic Emergency Response and Preparation (4 of 6) Pandemic severity index – Category 1: less than 1 death per 1,000 cases – Category 2: 1 to 5 deaths per 1,000 cases – Category 3: 5 to 10 deaths per 1,000 cases – Category 4: 10 to 20 deaths per 1,000 cases – Category 5: Over 20 deaths per 1,000 cases – Recommendations can be made based on severity.

12. Pandemic Emergency Response and Preparation (5 of 6) Mitigation – Greatest potential for preventing adverse effects is during preimpact phase. – People who are ill, even at the first sign, can be kept from workplace or school. Pre-event planning – Important to identify standards that must be maintained

13. Pandemic Emergency Response and Preparation (6 of 6) Assessing the need – Strain on already overcrowded facilities is immense. – Both sick and concerned individuals must be served. – Software modeling can help estimate impact. Public awareness – When to seek care – Where to seek it – How to protect onself

14. Influenza Pandemic Planning Issues (1 of 2) Not a contained or local event – Therefore less federal, state, and local support is available. Sustained crisis May come and go in waves Prevention options (vaccine) and treatment options (medications) are few and uncertain. Vaccine probably will not be available early in pandemic.

15. Influenza Pandemic Planning Issues (2 of 2) Reaction phase – Phase 4 of WHO pandemic preparedness plan involves rapid containment. Recovery phase – No response to extreme circumstance is complete until the recovery phase. – Includes reestablishing medical and public health infrastructure