1. When Normal Isn’t Normal: RSV Outbreak in Rural Alaska Sally Abbott, ANP, MSN Hospital Coordinator Public Health Preparedness Program, Anchorage Cathy Wolfe, RN CHC Director of Nursing Samuel Simmonds Memorial Hospital, Barrow Sandra Woods, RN, MS Preparedness Training Coordinator Public Health Nursing, Anchorage

2. North Slope Borough

3. Barrow

4. Alaska and Mainland US Compared

5. Another Comparison of Alaska and US

6. How far do people in your state have to travel to reach pediatric specialty care? A.25 miles or less B.25 to 100 miles C.100-500 miles D.More than 500 miles

7. Summary: Barrow February 21, 2007, Public Health Section of Epidemiology received report that 8 infants with severe RSV were sent on ventilators from Barrow to Anchorage hospitals Between January 28 and March 31, 53 infants were diagnosed; 29 were med-evac’d to Anchorage, 20 required mechanical ventilation Barrow nurses bag vented patients until transported to Anchorage Samuel Simmonds Hospital: 14 licensed beds Barrow Airport Terminal

8. What Is Respiratory Syncytial Virus? Most common cause of serious respiratory infection in infants and young children Spread from respiratory secretions through close contact with infected persons or with contaminated surfaces or objects Illness begins with fever, runny nose, cough, and sometimes wheezing Not reportable in Alaska

9. Is RSV a reportable disease in your state? A.Yes B.No

10. More about RSV Diagnosis can be done by rapid testing but should be confirmed by viral culture and other lab testing Treatment for mild disease: symptomatic, such as acetaminophen for fever Treatment for severe disease: oxygen, mechanical ventilation, other medication http://www.epi.hss.state.ak.us/bulletins/docs/b 2007_13.pdfhttp://www.epi.hss.state.ak.us/bulletins/docs/b 2007_13.pdf

11. Complication: Basketball Tournament in Barrow Happened at height of outbreak Participating communities Bethel Kotzebue Nome Chevak Unalaska Hooper Bay Dillingham

12. Simultaneously...

13. Anchorage Hospitals Providence Alaska Medical Center Alaska Native Medical Center

14. Interagency Partners: Barrow Samuel Simmonds Hospital North Slope Borough Mayor’s Office Emergency Management EMS Fire Chief Health and Social Services North Slope Borough Public Health

15. Interagency Partners: Anchorage Providence Alaska Medical Center Alaska Native Medical Center Alaska Native Tribal Health Consortium Municipality of Anchorage HHS

16. Interagency Partners: State Alaska Division of Public Health Epidemiology Public Health Lab Public Health Nursing Preparedness Program Behavioral Health Public Information EMS Alaska Nurse Alert System

19. Interagency Partners: Federal and Regional CDC Arctic Investigations Alaska Command/Joint Task Force-AK 3 rd Medical Group, Elmendorf AFB Health and Human Services Region X Pacific Northwest Emergency Management Agreement (PNEMA) Arctic Investigations Program Building

20. After Action Review (AAR): What worked No deaths—all patients treated in Anchorage Technical expertise sent to Barrow to assist medical providers Equipment obtained and shared among Anchorage hospitals Partner teleconferences provided accurate information, identified needs and resources Barrow, Alaska

21. AAR: What Worked (cont.) Public information/public education Health Alert Network message sent to providers Alaska Nurse Alert System request sent

22. Recommendations Institutionalize Division of Public Health (DPH) convener role to coordinate partners and share information in timely manner Define PH emergency and triggers to activate response for hospitals & DPH Early dispatch of appropriate physician to rural “hot spot” to provide technical and clinical expertise

23. Does your organization have defined triggers for activation of the Emergency Operation Center? A.Yes B.No

24. More Recommendations Identify and provide additional training in Emergency Operations to Alaska hospitals Develop agreement to facilitate privileging of medical providers in emergencies Build on existing infrastructure to acquire resources, e.g., using traveler respiratory therapists with DPH providing assistance Identify and resolve barriers to activating PNEMA Refine skill sets for Alaska Nurse Alert System

25. More Recommendations (cont.) Include airlines for supply of regional hospitals Identify methods to improve air transport for pediatric patients

26. Final Words Alaska DHSS used this incident as basis for grant from the Office of the Assistant Secretary for Preparedness and Response (ASPR) Partnership. We were 1 of 11 projects that were funded. $742,000 award Develop Just-in-Time training and supply list for non-pediatric hospital Organize technical medical support teams for rural hotspots

27. Questions?