1 preparation and response of the health services to an influenza pandemic

1

PREPARATION AND RESPONSE OF THE HEALTH SERVICES TO AN INFLUENZA PANDEMIC

2

Components to be considered in the Plan

1.- Organization:

Organizational Chart Flows and Coordination Systems Responsible Parties Incorporation of other actors

2.- Functions:

Definition of the functions of each one of the actors in the different phases of the Pandemic

I.- Organization and Functioning

3

Components to consider in the Plan

1.- Outpatient Attention

Number of Establishments

Assignment of available Human Resources

Social, private organizations etc.

Availability of :

Drugs Supplies Equipment

II.- Installed Capacity, Assignment of Resources (1)

4

Components to Consider in the Plan

2.- Hospital Attention Number of establishments (public and private) Number and quality of total available beds (public and private) Number of critical beds available (public and private) Availability of equipment to support critical activity Availability of RRHH to support critical activities Hospital management indicators

Availability: Drugs Supplies Equipment Infection control supplies Personal protection equipment

II.- Installed Capacity, Assignment of Resources (2)

5


1.- Outpatient Care

• Out fitting of additional services• Availability of extra RRHH

2.- Hospital Attention

• Number of possible beds to reconvert

• RRHH that supports the increase in activity

• Installed physical capacity that allows an increase of beds

• Ability to establish strategic reserves (storage and distribution)

III.- Potential Capacity

6


1.- Outpatient Attention

RRHH gap Gap in medical supplies and equipment Valuation of the estimated gaps

2.- Hospital Attention

RRHH gaps

Gaps in supplies and reactives

Gaps in medicines

Gap in equipment that provides support to critical activity

Valuation of the Gaps

IV.- Gap Analysis

7

Model

Outline to create the Health Services Network Capacity Response Plan before an eventual Pandemic

I Interpandemic Period II Pandemic Alert Period III Pandemic Period

8

I.- Interpandemic Period

1.- Formulation of the National Contingency Plan that incorporates the National Health Services Response Capacity during an eventual Influenza Pandemic

a.- Organization and Functioning of the Health Services Network in response to an eventual Pandemic.

2.- Identify the Installed Capacity and the Assignment of Resources of the Health Services Network, outpatient as well as hospitalization.

3.- Identify the Potential Response Capacity of the

Health Services Network.

9

II.- Pandemic Alert Period1.- Theoretical impact of the Pandemic simulation exercise

a.- Establish assumptions under which the simulation exercise is being carried out

2.- Analysis of the gaps between the Installed Capacity and the Potential Capacity from the time of the results of the simulation exercise.

3.- Simulation exercise that allows the evaluation of how the Assistance Network and the structure in command are functioning.

4.- Analysis and evaluation of the response capacity of Bi-national Network Services in frontier scenarios in regions where there is a high exchange among countries.

5.- Preparation and Organization of the Health Services Network in the different periods of the Pandemic.

10

III.- Pandemic Period

Phase 6; Increased and continuous transmission in the

general population (outside the country)

Phase 6; • Increased and continues transmission in the

general population (in the country)

11

Keep up the simulation exercises Evaluate the response capacity of the

Services Network in a Pandemic and each time make the corresponding adjustments.

Implement attention and infection control Protocols

Apply the already established clinical norms for suspicious cases

Make emphasis on the vigilance measures.


Phase 6; Increased and continued Transmission in the general population (outside the country)

12

Activation of the Structure established for this Phase

Application of the norms established for the management of patients and the responsibility of other institutions during this period.

Application of the measures proposed in the Contingency Plan in relation to isolation in specific attention centers and/or others planned for in the Contingency Plan.

Categorize patients and implement the derivation flows of the same in accordance with the established norms.


Phase 6; Increased and continued Transmission in the general population (in the country)

13

PAHO Strategic Plan

Activity2005 2006

November

December

January February

March April

Document Model

Evaluation:DesignRecompilationProcessing

GoodPractices:RecompilationSystematization

Expert’s network:IdentificationInvitationFunctioning

DevelopmentReunion

Regional ReunionBogotá, Colombia

14

PREPARATION AND RESPONSE OF THE HEALTH SERVICES TO AN INFLUENZA PANDEMIC

15


1.- Formulation of the National Contingency Plan that incorporates the National Health Services Response Capacity during an eventual Influenza Pandemic

a.- Organization and Functioning of the Health Services Network in response to an eventual Pandemic.

2.- Identify the Installed Capacity and the Assignment of Resources of the Health Services Network, outpatient as well as hospitalization.

3.- Identify the Potential Response Capacity of the

Health Services Network.

16


Organization and Functioning of the Health Services Network in response to an eventual Pandemic. Organization: There must be an organizational chart that explains the hierarchy at different levels up to the national level. Flow and expedited coordination systems must be established, known and agreed by consensus by the

different parties involved in each one of the Pandemic’s Phases. The parties responsible at different levels must exist in accordance to the organizational chart set out. It must be clear in which Phase of the Pandemic other self managing hierarchical institutions are

incorporated, for example, Private Attention Systems, Armed Forces, Firefighters etc.Duties: The duties of each party must be defined in each distinct Phase of the Pandemic

Outpatient Care Hospital Care Referenced Hospitals Local and Referenced Laboratories Private Attention Armed Forces Firefighters International Organizations (Red Cross, etc.)

1.- Creation of a National Contingency Plan that incorporates the Health Services Network’s Capacity to Respond during an eventual influenza Pandemic

17

a. Outpatient Care

Number of outpatient establishments in the Health Services Network, according to territorial jurisdiction

Staffing of Human Resources Available for outpatient care (doctors, nurses and physiotherapists)

Existence of outpatient personnel that provide respiratory therapy.

Knowledge and/or registration of social and private Organizations that exist, for example: Red Cross, Rotary Clubs, N.G.O’s

Availability of:Drugs, antibiotics, antiviral,

othersSupplies: to control infectionsPersonnel protection equipment

I.- InterpandemicPeriod

2.- Identify the Actual Capacity and the Availability of Resources of the Health Services Network, both outpatient and hospitalization.

18

b.- Hospital Care Number of hospital establishments in the Health Services Network, according

to territorial jurisdiction (if it corresponds) Number of hospital establishments in the Private Care Network Total number of beds available by establishment in the Health Services Network Total number of beds available by establishment in the Private Care Network Total number of critical beds (intermediate and intensive) available in the

Private Care Network Availability of Equipment that supports critical activity in the Health Services

Network establishments Availability of Human Resources to support actual critical activity Actual Hospital Management indicators: occupational indexes, average patient

stays etc. Availability of:

Medications; antivirals, antibiotics and othersSupplies and equipment to control infections

Personnel protection equipment


2.- Identify the Actual Capacity and the Availability of Resources of the Health Services Network, both outpatient and hospitalization.

19

a.- Outpatient Care Ability to outfit additional services in non traditional attention spaces,

examples Community Centers, Schools or other Availability of extra Human Resources, example: Red Cross

personnel, trained volunteers in support assistance, privates etc.

b.- Hospital Care Number of possible beds to be reconverted in the Health Services

Networks’ establishments Availability of Human Resources that support the increase in hospital

activity Installed physical capacity that allows an increase in the number of

hospital beds Ability to establish strategic reserves with respective storage and

distribution mechanisms.


3.- Identify the Potential Response Capacity of the Health Services Network

20

II.- Pandemic Alert Period1.- Theoretical impact of the Pandemic simulation exercise

a.- Establish assumptions under which the simulation exercise is being carried out

2.- Analysis of the gaps between the Installed Capacity and the Potential Capacity from the time of the results of the simulation exercise.

3.- Simulation exercise that allows the evaluation of how the Assistance Network and the structure in charge are functioning.

4.- Analysis and evaluation of the response capacity of Bi-national Network Services in frontier scenarios in regions where there is a high exchange among countries.

5.- Preparation and Organization of the Health Services Network in the different periods of the Pandemic.

21

Establish assumptions under which the simulation exercises are carried out:

General Assumptions Attack Rate (two scenarios) Population to be considered, example, Total Country Population, Population that benefits from the

Public System plus population that benefits form the Private Care System broken down into separate groups etc.

Lethality by group etc Periods and percentages in which consultations and/or hospitalization will take place

Assumptions Outpatient Care Percentage of consultations to be carried out Number of consultations per patient Output of consultations per hour

Hospitalization Assumptions Hospitalization percentages according to groups, older than and younger than 65 years Percentage of patients that will require critical beds Percentage of patients that will require a bed that is less complex than a critical bed Average length of hospitalization of patients in critical beds

II.- Períod ofPandemic Alert

1.- Theoretical impact / simulation exercise of the impact of the disease and the demand on the Pandemic services

22

a.- Outpatient care: Estimated Human Resource gaps according to the simulations Estimated gaps in supplies, medicines and personnel protection equipment Estimate requirements and gaps for antiviral, antibiotics or others Assess estimated gaps: Human Resources, equipment, supplies, antibiotics, antiviral etc. Estimate gaps in requirements that are not outlined in this guide but appeared as a need in the

simulation exercises.

b.- Hospital Care: Estimate gaps in equipment used to support critical activity (fans or others) Estimate gaps in supplies and reactives needed for increased activity Estimate Human Resource gaps that allow for the reconversion of beds and increased activity

in critical units Estimate requirements and gaps for antiviral, antibiotics or others Assess estimated gaps: Human Resources, equipment, supplies, antibiotics, antivirals etc. Estimate gaps in requirements that are not outlined in this guide but appeared as a need in the

simulation exercises.

II.- Pandemic Alert Period

2.- Analysis of the gaps between the Installed Capacity and the Potential Capacity based on simulation exercise results.

23

Evaluate established command structure. Evaluate local, regional and national coordination. Evaluate patient flows according to what has been

established. Evaluate incorporation of other parties in the

established organizational chart. Evaluate cadaver management response. Evaluate coordination between bordering countries.


3.- Simulation exercise that allows the functioning of the Assistance Network and command structure to be evaluated

24

Share among countries the proposed plans

Establish respective coordination between the countries involved

Carry out simulation exercises in conjunction


4.- Analysis and evaluation of the capacity of Binational Network Services to respond to frontier scenarios in Regions with a high interchangeamong countries

25

a .- Period of Pandemic Alert (Phase 3 to 5)

Existence of Guides for the prevention, diagnosis and treatment of the Influenza

Existence of Guides for the control of infections Existence of Guides for the management of cadavers (manipulation,

storage and disposal) Design training of personnel to identify suspicious cases of influenza and

the corresponding flow of consequences. Formulate Protocols that clearly indicate in which stage or at which

moment national organizations and other actors responsible for the creation of non traditional attention scenarios will be incorporated.

Carry out periodic simulation exercises Keep periodic and systematic information on hospital indicators and

outpatient care.


5.- Preparation and Organization of the Health Services Network in the different periods of thePandemic

26

III.- Pandémic Period

Phase 6; Increased and continues transmission in the

general population (outside the country)

Phase 6; Increased and continues transmission in the

general population (in the country)

27

Keep up the simulation exercises Evaluate the response capacity of the

Services Network in a Pandemic and each time make the corresponding adjustments.

Implement attention and infection control Protocols

Apply the already established clinical norms for suspicious cases

Make emphasis on the vigilance measures.


Phase 6; Increased and continued Transmission in the general population (outside the country)

28

Activation of the Structure established for this Phase

Application of the norms established for the management of patients and the responsibility of other institutions during this period.

Application of the measures proposed in the Contingency Plan in relation to isolation in specific attention centers and/or others planned for in the Contingency Plan.

Categorize patients and implement the derivation flows of the same in accordance with the established norms.


Phase 6; Increased and continued Transmission in the general population (in the country)

29

Stragegic PAHO Plan

Actividad2005 2006

November

December

January February

March April

DocumentModel

Evaluation:DesignRecompilationProcessing

Good Practices:RecompilationSystematizaion

Expert’s Network:IdentificationInvitationFunctioning

Meeting development

Regional MeetingBogotá, Colombia

1 preparation and response of the health services to an influenza pandemic

Documents