2. Question What was your county doing at the peak H1N1 threat? –Fall, 2009.

3. A Pandemic Tabletop to Exercise the Transitional Paradigm Eric Zgodzinski, MPH, RS Greg Moore, MBA, PMP Toledo-Lucas County Health District –APC Toledo, Ohio

4. Objectives for the TTX 1.To introduce the Transitional Medical Model 2.To explore its integration into individual county disaster plans

5. TTX Format 1.Brief narrative 2.Situation Report (SitRep) or update 3.Discussion of actions by players 4.Questions and clarifications 5.Final discussion

6. Activities that will take place during break-outs: Apply TMM Phase and commence activities accordinglyApply TMM Phase and commence activities accordingly Stakeholder communication:Stakeholder communication: –Public –Neighboring jurisdictions –Response agencies Coordination with RMRS, ODH, CDCCoordination with RMRS, ODH, CDC

7. Be prepared to… Develop and implement plans during the break-outsDevelop and implement plans during the break-outs Document actions takenDocument actions taken Appoint a spokespersonAppoint a spokesperson Present plans to all the attendeesPresent plans to all the attendees Respond to queries by facilitator and other attendeesRespond to queries by facilitator and other attendees

9. In H1N1 Season While the nation has been subjected to over 17,000 deaths from H1N1 and 5.7 million people taken ill, experts agree that it could have been worse. Locally, in NWO, thousands took ill –1 in 5 Americans on average 99% recovered uneventfully. Even seasonal flu has been tamed. –Thank you, H1N1. The Big Question: A Third Wave?

10. There have been unconfirmed reports of major domestic poultry deaths in rural sections of Cuyahoga CountyThere have been unconfirmed reports of major domestic poultry deaths in rural sections of Cuyahoga County

11. Breakout Session What level are you at currently?What level are you at currently? How does your jurisdiction react?How does your jurisdiction react? Change in preparedness & response level?Change in preparedness & response level? What is/are the hospital(s) doing?What is/are the hospital(s) doing? What is public health doing?What is public health doing? What is EMS doing?What is EMS doing? What are the elected officials doing?What are the elected officials doing? Mental health?Mental health? Special needs?Special needs?

13. Associated Press Cuyahoga Co. health officials receive unconfirmed reports of an unusual number of sudden respiratory illness in Parma.Cuyahoga Co. health officials receive unconfirmed reports of an unusual number of sudden respiratory illness in Parma. The ill are being taken to Cleveland hospitals.The ill are being taken to Cleveland hospitals. Cleveland media raise concerns about a third wave of H1N1.Cleveland media raise concerns about a third wave of H1N1.

15. Death in Detroit Death in Detroit Breaking News: Detroit, MI: In a matter of hours, patients are progressing from a Upper Respiratory Infection (URI) to an Acute Respiratory Distress Syndrome (ARDS) and quickly succumb. Family members seem to be falling ill as well. Public health officials are concerned about a new H1N1 variant that is immune to the vaccine.

17. CDC CDC 1000 h press conference: Dr. Frieden states: Were investigating reports from Detroit and the Cleveland area. Nothing has been confirmed at this time…. Yes, we have also heard that some of the patients had already been immunized with both seasonal and H1N1 vaccines in November….

18. The Public Information Officer (PIO) from University of Michigan Hospital in Ann Arbor, confirms that three ICU patients transported yesterday from Windsor, Ontario have died. They were all Influenza Type A positive.

19. Breakout Session What level are you at currently?What level are you at currently? How does your jurisdiction react?How does your jurisdiction react? Change in preparedness & response level?Change in preparedness & response level? What is/are the hospital(s) doing?What is/are the hospital(s) doing? What is public health doing?What is public health doing? What is EMS doing?What is EMS doing? What are the elected officials doing?What are the elected officials doing? Mental health?Mental health? Special needs?Special needs?

21. Detroit hospitals are calling in additional personnel to assist with surgeDetroit hospitals are calling in additional personnel to assist with surge Record numbers of ED visits for ILI affecting mostly the youngRecord numbers of ED visits for ILI affecting mostly the young Increasing numbers of admissions of pregnant womenIncreasing numbers of admissions of pregnant women Rumors of closing the border will impact healthcare commutersRumors of closing the border will impact healthcare commuters

23. 5PM Press Conference Hundreds of suspected/probable cases along the Lake Erie shoreHundreds of suspected/probable cases along the Lake Erie shore 50-60 suspected cases hospitalized in Detroit and Cleveland50-60 suspected cases hospitalized in Detroit and Cleveland –15% in critical condition and 28 reported deaths already28 reported deaths already Preliminary data: H1N1Preliminary data: H1N1 –Probably a mutated version

24. Breakout Session What level are you at currently?What level are you at currently? How does your jurisdiction react?How does your jurisdiction react? Change in preparedness & response level?Change in preparedness & response level? What is/are the hospital(s) doing?What is/are the hospital(s) doing? What is public health doing?What is public health doing? What is EMS doing?What is EMS doing? What are the elected officials doing?What are the elected officials doing? Mental health?Mental health? Special needs?Special needs?

25. Irish Hills, Michigan A professional fishing guide who returned from fishing in Devils Lake two days ago was hospitalized today at Defiance Regional Medical Center for an acute ILI.A professional fishing guide who returned from fishing in Devils Lake two days ago was hospitalized today at Defiance Regional Medical Center for an acute ILI. There is no report of illness in her immediate family.There is no report of illness in her immediate family. Public health officials in Defiance are investigating.Public health officials in Defiance are investigating. Guides family traveling back to Lima areaGuides family traveling back to Lima area

26. Breaking News: Local TV journalists are interrupting American Idol to announce that two flights from Toronto to Columbus International Airport have been quarantined.Breaking News: Local TV journalists are interrupting American Idol to announce that two flights from Toronto to Columbus International Airport have been quarantined. Several passengers are believed to have ILI symptoms.Several passengers are believed to have ILI symptoms. One passenger required resuscitation prior to landing and is enroute to a local hospital.One passenger required resuscitation prior to landing and is enroute to a local hospital.

28. What now? Local hospitals and medical offices are calling local public health for advice on what to do, what to tell patients, and what to tell media. So far, there has been no sudden increase in ILI locally. Routine URIs

29. Breakout Session How does your jurisdiction react?How does your jurisdiction react? Change in preparedness & response level?Change in preparedness & response level? What is/are the hospital(s) doing?What is/are the hospital(s) doing? What is public health doing?What is public health doing? What is EMS doing?What is EMS doing? What are the elected officials doing?What are the elected officials doing? Mental health?Mental health? Special needs?Special needs?

31. Suddenly… EDs are seeing a spike in ILIs.EDs are seeing a spike in ILIs. –Waits are twice baseline –Most are + for Influenza A. Due to M&M seen in Cleveland and Detroit, patients with even minor ILI are being admitted more liberally than before.Due to M&M seen in Cleveland and Detroit, patients with even minor ILI are being admitted more liberally than before.

32. Medical Offices and Clinics Many are not seeing respiratory complaints Patients are being referred to closest ED.

33. Hospital pharmacies are reporting that doctors are prescribing antiviral medications for themselves and familiesHospital pharmacies are reporting that doctors are prescribing antiviral medications for themselves and families Kroger's and Wal-Mart are reportedly running out of cough/cold remedies, hand sanitizer, and masksKroger's and Wal-Mart are reportedly running out of cough/cold remedies, hand sanitizer, and masks NWO

34. 8PM Press Conference –Latest outbreak must be taken seriously Emphasize H1N1 precautionsEmphasize H1N1 precautions –Etiology: Influenza Type A, H1N1-Variant More severe than H1N1 pandemic of this yearMore severe than H1N1 pandemic of this year – Numbers: Thousands with latest flu virusThousands with latest flu virus Scores in critical conditionScores in critical condition 66 dead in Canada66 dead in Canada 34 dead in Detroit and environs34 dead in Detroit and environs 28 dead in Cleveland28 dead in Cleveland

36. Press Conference Press Conference H1N1-Variant Communities to activate fully their Pandemic Flu plansCommunities to activate fully their Pandemic Flu plans –Aggressive social distancing measures Summary of ILI (probable/proven) cases:Summary of ILI (probable/proven) cases: –1,541 hospitalized cases/87 deaths: Ontario –356 hospitalized cases/67 deaths: Michigan –311 hospitalized cases/57 deaths: Ohio SNSSNS –What is available? –Where is it located? –How is it accessed?

37. Current Inventory Status Tamiflu Peramivir Masks –Surgical –Respirators Gloves Vaccines

38. Breakout Session How does your jurisdiction react?How does your jurisdiction react? Change in preparedness & response level?Change in preparedness & response level? What is/are the hospital(s) doing?What is/are the hospital(s) doing? What is public health doing?What is public health doing? What is EMS doing?What is EMS doing? What are the elected officials doing?What are the elected officials doing? Mental health?Mental health? Special needs?Special needs?

40. CDC Breakouts of H1N1-Variant occurring in major metropolitan areas –NY –SF –DC

41. Locally Hospitals are diverting patients –Over-capacity Staff shortages EMS surge protocols Public demanding vaccine

42. Breakout Session How does your jurisdiction react?How does your jurisdiction react? Change in preparedness & response level?Change in preparedness & response level? What is/are the hospital(s) doing?What is/are the hospital(s) doing? What is public health doing?What is public health doing? What is EMS doing?What is EMS doing? What are the elected officials doing?What are the elected officials doing? Mental health?Mental health? Special needs?Special needs?

43. Discussion Discussion