1. PANDEMIC PLANNING AT EPHRATA COMMUNITY HOSPITAL
By: Beverly McAllister, MS, MT(ASCP) SC
Laboratory Operations Manager

2. OBJECTIVES: Identify the components of a well-defined Pandemic Plan
Describe the role your facility plays in response to a pandemic
Describe your role as a laboratorian in response to a pandemic

3. Components of a well-defined Pandemic Plan
Pandemic Planning Committee focused on defining a process for the following:
Facility Surveillance for and detection of influenza
Communication processes are adequate and available
Supply management
Surge capacity
Maintaining essential services
Security
Release of information is uniform, coordinated and adequate

4. Pandemic Plan Committee
Direct initiative of Emergency Management Committee
Goal: Develop a Pandemic Influenza Plan
Formed in July 2006
Meet on a monthly basis
Consists of the following members:
COO
VP of Medical Affairs
VP of Physician Practices
Director of Emergency Management Services
Director of Facilities Management
Director of Public Relations
Director of Purchasing Services
Director of Home Care
Director of Pharmacy
Director of Ephrata Medical Equipment

5. Pandemic Plan Committee members cont’d
Infection Control Coordinator
Laboratory Operations Manager
Employee Health Nurse
Nursing Education
Chaplaincy
Director of Emergency Services
Advanced Life Support Unit Manager
Physician Practice Representation

6. What resources have we used to develop the Pandemic Plan?
1. United States Department of Health and Human Services Pandemic Influenza Plan was used as a blueprint for pandemic influenza preparation and response.
2. SCTTF planning resources

7. Ephrata Community Hospital Plan as of 3/10/07 (still in development)
I. Inter-pandemic and Pandemic Alert Periods
1. ECH facility responsibilities
a. ECH will respond to alerts and pandemic related issues through utilization of the EMC, Pandemic Planning Committee and the Hospital Incident Command Structure (HICS)
b. Written Plan includes:
a. disease surveillance
b. facility access
c. occupational health
d. use and administration of vaccines and antiviral drugs
e. surge capacity
f. supply chain and access to critical inventory needs
g. mortuary issues
c. Participation in pandemic influenza response exercises

8. Plan cont’d: Inter-pandemic and Pandemic Alert Periods
B. State and local responsibilities:
1. ECH works within the framework of the SCTTF and through the Hospital Medical Sub-Committee a Regional Hospital Response Plan has been developed.
2. Exercises with local emergency management, local first responders and receivers, regional assets including hospitals and state agencies.
3. Open lines of communication through the use of faxes, direct lines, FREDS, HAN, NEDSS and RODS.
4. Human Relations Department and Employee Health have developed guidelines for any legal issues affecting staff and patient care.

9. Plan cont’d: Inter-pandemic and Pandemic Alert Periods
C. HHS responsibilities
1. ECH response plan is adopted under the guidelines of the US Department oh Health and Human Services and the PA Department of Health (DOH) Pandemic Response Plan
2. ECH will utilize the Department of Homeland Security model protocols for early detection and treatment of influenza among patients and staff; knowing that these protocols can be practiced during routine influenza seasons.

10. II. Pandemic Period
A. If an influenza pandemic begins in another country:
1. ECH facility responsibilities
a. heighten institutional surveillance
b. communicate with key public health,
healthcare and community partners
c. Implement a system of early detection
and treatment of healthcare personnel
who might be infected
d. reinforce infection control procedures
e. accelerate staff training in accordance with the
pandemic influenza education and training

11. Plan cont’d: Pandemic Period- begins in another country
2. State and local responsibilities
a. Working with HHS to provide local
physicians and hospital administrators
with updated information and
guidance as the situation unfolds.

12. Plan cont’d: Pandemic Period- begins in or enters the US
B. If an influenza epidemic begins in or enters the United States
1. ECH facility responsibilities
a. Activate facility pandemic response plan in
accordance with the “Hospital Pandemic Influenza
Triggers”
b. Implement activities to increase capacity,
supplement staff and provide supplies and
equipment
c. Post respiratory/cough etiquette signs
d. Maintain high index of suspicion that patients
presenting with flu-like symptoms have the
pandemic strain

13. Plan cont’d: Pandemic Period- begins in or enters the US
e. Implement infection control practices
f. Rapid communication within and between
healthcare facilities and DOH
g. Implement surge-capacity plans
h. If pandemic strain is detected in local or
community, transmission can be assumed and
hospital would move to the next level of response
2. State and Local Health Responsibilities
a. Provide healthcare facilities with information on
the global, national and local situation
b. Work with HHS to provide guidance on infection
control measures for healthcare and non-
healthcare facilities
c. work with healthcare facilities to address surge
capacity needs

14. Plan cont’d: Pandemic Period- begins in or enters the US
3. HHS Responsibilities a. Assist state and local healthcare and public health
partners on issues related to hospital infection
control, occupational health, antiviral drug use
and clinical management, vaccination and medical
surge capacity.
b. Provide states with materials from the Strategic
National Stockpile for further distribution to
healthcare facilities.

15. III. Pandemic Response
A. Planning for provision of care in the facility
1. Detecting the introduction of Pandemic
Influenza
2. Preventing the spread of Pandemic
3. Managing the impact on facility and staff
4. Expansion of preparedness and response
plans for bioterrorism, SARS and other
infectious diseases to include influenza

16. Pandemic Response cont’d
5. Identify criteria and methods for measuring:
a. Infection control practices
b. Case reporting
c. Patient placement
d. Healthcare workers illness surveillance
6. Review and update inventories of supplies that
will be in high demand during the pandemic
7. Review procedures for receipt, storage, and
distribution of assets received from federal
stockpiles
8. Approach to planning will be consistent with an
“All-Hazards” response

17. Pandemic Response cont’d
B. Planning Process
1. Committee Structure- Define members
2. Planning Resources
a. Pandemic Response Plan DHS
b. SCTTF-Hospital Regional Response
Plan
c. Inter-facility multi-disciplines
d. Outside resources as identified

18. Pandemic Response cont’d
C. Planning Elements
1. Hospital Surveillance
a. Laboratory testing will be consistent
and monitored closely
b. Absenteeism rates will monitored weekly
c. ED visits will be monitored through RODS
and laboratory testing through NEDSS
d. Data to be evaluated includes:
1. admissions
2. discharges/deaths
3. Patient characteristics such as:
age, underlying disease, secondary
complications, illness in healthcare personnel

19. Pandemic Response cont’d
e. Guidelines for distinguishing between
influenza and other respiratory disease
f. Symptoms of Influenza
1. fever
2. headache
3. myalgia
4. prostration
5. coryza
6. sore throat
7. cough

20. Pandemic Response cont’d
2. Hospital Communications
a. External communications outside the facility
will occur through the following contact
individuals: Infection Control Coordinator,
VP of Medical Affairs, Public Relations
b. Internal Communications will occur
through Incident Command
3. Education and Training
a. Hospital Plan and response education
b. Hospital staff guide to the Pandemic
c. Unit specific education
d. Internet Plans

21. Pandemic Response cont’d
D. Triage/Clinical Evaluation/Admission Process
1. Identification of patients w/pandemic flu
2. Separation of pandemic patients
3. Identify type of care needed
4. Identify “triage coordinator” for patient
management
5. Define ED/OP clinical evaluation disposition
procedures
6. Review/streamline admission process
7. Entry “Trigger points” switch from passive
(signs) to active (direct questioning)

22. Pandemic Response cont’d
E. Facility Access
The following criteria and procedures will
be used to limit access if pandemic occurs:
1. Definition of “essential” visitors
2. Protocols for limiting non-essential visitors
3. Criteria or “triggers” for temporary closing
hospital to new admissions/transfers
a. staffing ratios, isolation capacity, risks
to non-influenza patients
b. who makes decision regarding closing/
communication of information
c. consult with state and local health departments on
their role in determining what assistance they offer

23. Pandemic Response cont’d
F. Occupational Health
1. Managing ill workers
a. plan for detecting signs and symptoms
of influenza in healthcare personnel
before reporting to duty
b. policies for managing healthcare workers
with respiratory symptoms
c. Consider assigning staff recovering from
influenza to care for influenza patients
2. Time-off Policies
3. Reassignment of High-Risk Personnel

24. Pandemic Response cont’d
4. Psychosocial health services
5. Influenza vaccination and use of anti-viral drugs
a. Employee annual vaccination program
b. Increased vaccination coverage during
Inter-pandemic period
c. Documentation of vaccination of employees
d. Program established for rapidly vaccinating
or providing antiviral prophylaxis or
treatment to healthcare personnel as
recommended by HHS and PADOH

25. Pandemic Response cont’d
G. Use and Administration of vaccines and
antiviral drugs
1. Pandemic influenza vaccine and
“pre-pandemic” influenza vaccine
a. Interim recommendations
1. Monitor updated HHS information and
recommendations on the development,
distribution, and use of vaccine
2. Work with local and state health depts.
on vaccine distribution plans
3. Have estimated quantities of vaccine needed
4. Develop vaccination prioritization plan
5. Develop Pandemic Influenza Plan

26. Pandemic Response cont’d
H. Surge Capacity
1. Plans to include addressing emergency staffing needs
and increase demand for isolation wards, ICUs,
assisted ventilation services and consumable and
durable supplies
2. FluSurge software
3. Staffing
a. Assign responsibility for assessment and
coordination of staffing during an emergency
through Hospital Incident Command System
b. Estimate minimum number and categories of
personnel needed to care for a single patient or a
small group of patients with influenza on a given
day

27. Pandemic Response cont’d
c. Determine how the hospital will meet staffing needs as
number of patients with pandemic influenza increases
or staff become ill
1. consider patient-care responsibilities to clinical
administrators
2. recruiting retired healthcare personnel
3. Using trainees
4. Using patients’ family members in ancillary
healthcare capacity
d. Collaborate regionally under the regional hospital
response plan

28. Pandemic Response cont’d
e. Increase cross-training of personnel
f. List essential support staff personnel titles
g. PADOH-”emergency staffing crisis”
credentialing
h. Identify insurance and liability issues related
to non-facility staff
i. Use of healthcare providers from other
systems

29. Pandemic Response cont’d
4. Bed Capacity
a. Review and revise admission criteria for times when
bed capacity is limited
b. Polices and procedures for expediting discharge of
patients who do not require on-going care
c. Plan with homecare agencies for follow-up on early
discharges
d. “Triggers” for canceling elective surgical procedures
e. Disposition of those patients requiring emergency
procedures

30. Pandemic Response cont’d
f. Bed tracking through DOH Facility Resource
Emergency Data Systems (FREDS)
g. Hospital licensed bed expansion during the
Pandemic
h. Discussion regarding “Altered Standards of
Care in Mass Casualty Events”
i. Polices and Procedures for shifting patients
between nursing units to free up bed space in
critical care areas and cohorting of patients
j. MOU’s with other healthcare facilities
k. Identification of areas to be vacated for cohorting of
pandemic patients

31. Pandemic Response cont’d
5. Consumable and durable supplies
a. Evaluation of existing system for tracking medical
supplies to detect rapid consumption
b. Consider stockpiling enough consumable resources
such as masks for duration of pandemic event
c. Assess anticipated needs for consumable and
durable resources, and determine trigger point for
ordering extra supplies
d. Anticipate need for antibiotics to treat bacterial
complications of influenza
e. Establish contingency plans for situations in which
primary sources of medical supplies become limited

32. Pandemic Response cont’d
I. Security
1. Healthcare facility plan for additional
security
J. Mortuary Issues
1. Assess current capacity for refrigeration of
deceased persons
2. Discuss mass fatality plans with local and
state health officials and medical examiners
3. Identification of temporary morgue sites
4. Determine scope and volume of supplies
needed to handle the dead.

33. Planning for provision of care in the non-hospital setting
1. Effective Management
a. plan to establish and staff telephone
hotlines
b. develop training modules, protocols,
and algorithms for hotline staff
c. Provide public education materials
d. clinics and offices should have plans that include:
education, staffing, triage, infection control in
waiting rooms, communication with healthcare
partners and public health authorities

34. Planning for provision of care in the non-hospital setting- cont’d
e. communication plan
f. plan for procuring supplies
g. participation in community plan for
distribution of vaccine and antivirals

35. Planning for provision of care in the non-hospital setting- cont’d
a. create planning committee
b. decision making and coordinating
structure
c. How to conduct surveillance for
pandemic influenza in healthcare
personnel and for residential facilities
in population served
d. staff education

36. Planning for provision of care in the non-hospital setting- cont’d
3. Alternative care sites
a. bed capacity and spatial separation of
patients
b. facilities and supplies for hand hygiene
c. lavatory and shower capacity for large
number of patients
d. food service
e. medical service

37. Planning for provision of care in the non-hospital setting- cont’d
f. staffing for patient care and support
services
g. cleaning and disinfection supplies
h. environmental services
i. safety and security

38. RELEASE OF SUPPLIES FROM STRATEGIC NATIONAL STOCKPILE
EPHRATA COMMUNITY HOSPITAL
(EMERGENCY MANAGEMENT COMMITTEE)
COUNTY
(LEMA)
PENNSYLVANIA STATE DEPT. OF HEALTH
(PEMA)
Governor informs PEMA to submit request
Federal and State hold conference call and decide to deploy SNS
FEDERAL
DEPARTMENT OF HEALTH AND HUMAN SERVICES
(FEMA)

39. Role of Laboratorian during a pandemic
Perform necessary tests to determine presence or absence of influenza virus in a patient
Report positive influenza results to Pennsylvania Department of Health via PA-NEDSS reporting system
Report information to infection control coordinator

40. QUESTIONS?
Contact Information:
Phone: