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Prepare to CarePandemic Planning at Fraser Health

Pandemic Influenza PlanningDecember 10, 2009

Facilitator: Lisa Zetes-Zanatta

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Prepare to Care: Introductions

FHA Pandemic Lady –Lisa Zetes-Zanatta

Roundtable introductions Name

Service

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What is the flu anyway??

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Influenza Virus

Influenza A is subtypedby surface proteins

Hemagglutinin (H) 16 different types

Helps virus enter cells

Neuraminidase (N) 9 different types

Helps virus leave cellto infect others

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Influenza Virus Types

Type A: Infects humans and otheranimals

More severe illness

Causes regular epidemics; can causepandemics

Type B: Infectious only to humans

Causes epidemics, but less severe illness

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Influenza Prevention

Yearly influenza shot

Avoid those who are ill

Wash your hands

Antivirals (in special circumstances)

If you are ill--don’t come to work, covercoughs and sneezes.

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Vaccine Development

Inactivated trivalent vaccine (killed vaccine)

2 A, 1 B

Effectiveness of vaccine depends on “match” between circulatingstrains and those in vaccine

(H3N2)(H1N1)

InfluenzaProtection

A/California/7/2004-like

B/Shanghai/361/2002-like

A/New Caledonia/20/99-like

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Surveillance oncirculating strains

Selection ofspecific strains

Preparationand distributionof virus stock tomanufacturers

Seed poolsinoculated into

eggs

Surveillance oncirculating strains

Selection ofspecific strains

Preparationand distributionof virus stock tomanufacturers

Seed poolsinoculated into

eggs

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Harvest andconcentration

of fluids

Vaccine inactivatedand purified

Vaccine blended,content verified

Packaging, labeling,delivery

May

June

July

August

September

October

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Influenza Pandemic

What is a Pandemic?

Outbreak in wide geographic area (global)

Effects large # of people with seriousillness

Usually a new virus or one whichpopulation has not had exposure in a longtime

May have rapid spread

May occur in waves

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Seasonal VS Pandemic Influenza

Seasonal

Occurs every year

Occurs during winter(usually Dec-Mar)

Most recover in 1-2weeks without tx

Very young, veryold, ill most at riskof serious illness

Pandemic

Occurs infrequently(3 per century)

Occurs any time ofyear

Some may notrecover, even withtx

People of all agesmay be at risk

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Recent Pandemics

Past Pandemics:

1968 Hong Kong Flu (H3N2)

1957 Asian Flu (H2N2)

1918 Spanish Flu (H1N1)

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1918 Pandemic

Worst of past century

Estimated 20-40% of worldpopulation ill

40-50 million people diedworldwide

600,000 or more deaths in US

High mortality in young adults

2020

There aresevere pandemics and mildpandemics

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Infectious Disease Deaths 1900-1996

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H1N1 Human Swine Virus

Swine influenza is caused by type A of thevirus

Transmission can be found through contactwith infected pigs and more recently throughhuman to human contact.

This virus began human to humantransmission in March and Early April inMexico. By late April the spread of the novelstrain was worldwide.

This virus is a novel subtype not previouslydetected in swine or humans

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Are we more or less atrisk today compared to1918?

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Pandemic Planning – Why Plan

Closing of borders, shutting down trade

Closing of schools, events, andbusinesses where large numbers ofpeople congregate

Supply Chain disruption

Health Surges to point of totalcongestion

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Prepare to Care: Ongoing Pandemic Threat:2008/09 Update

As of December 8, 2009:

o 1001 hospitalized human H1N1cases, 47 deaths

o Approx. 90% of cases under 40years old

o Lull in H1N1 activity oversummer, however presence ofvirus did not disappear like theroutine influenza virus

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Prepare to Care: Anticipated Impacts – AcuteCare Sites and Community Programs

System to be extremely taxed

Current service delivery levelswill not be available

Sites and programs will defer anumber of activities on apriority basis

Assessment centres andalternative care sites to operate

Interoperability btw. acute &cmty programs will be essential

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Supply Issues Discussion

Syringes

Surgical Masks / Visors

Laundry

N95’s

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Prepare to Care: Q & A Period

Lisa: lisa.zeteszanatta@fraserhealth.ca

Pandemic

Tabletop Exercise

November 19, 2009

Pandemic Tabletop Exercise

Organizational Background

Business Continuity and Emergency Management areprescribed by Government mandate to the LDB

There has been a Pandemic Plan in place at the LDBsince October 2008

The LDB has been proactive with other types / levels ofemergency management exercises before

Recently two pandemic scenarios were part of the LDB’sEmergency Operations Centre (EOC) exercise

Pandemic Tabletop Exercise

Approach to this Presentation

Follow the “natural phases” of the exercise

Explain lessons learned

Field questions – interactive

Pandemic Tabletop Exercise

Preparing the Exercise

Refresh the Pandemic Plans (+ “lessons learned” from 1st)

“Selling” the exercise to the organization (2nd exercise wasrequested)

Deciding on the exercise format

Preparing a good scenario

Have a knowledgable facilitator

Pandemic Tabletop Exercise

Kicking off the Exercise

Have enough time (2nd exercise was full eight hour day)

Make sure that the EOC team is complete & prepared

Secure undivided attention

Explain the purpose and method

Introduce the scenario

Pandemic Tabletop Exercise

Overcome Hesitation to “Go First”

Good scenario will have a clear “first actor”

Use direct questions to facilitate

Simulate information flow

Avoid speculation / reduce discussion – follow procedure (TOUGH!)

Pandemic Tabletop Exercise

In the thick of the scenario

Keep the communication channels open

Gating criteria / triggers for decision making

Emergency Team members may be missing

Where is your workforce?

External dependencies

Use as much visuals in the plan as possible (flow-charts / diagrams)

It can be overwhelming!

Pandemic Tabletop Exercise

Wind-down

Gauge understanding of “De-escalation” and “Stand-down”

Solicit input on what would represent a “Normalization” of thesituation

Solicit input on “What have we learned today?” (evaluation)

Pandemic Tabletop Exercise

Capture it all

Transfer the scribed notes into electronic format if necessary

Facilitator to review scribed notes and prepare “Lessons Learned”document

Conduct a de-brief with the exercise team and/or have an“Evaluation Form” to understand how useful the exercise was

Pandemic Tabletop Exercise

Evaluation Results

58% + 42%Good + Satisfactory8. Overall Rating

50% + 50%Very realistic + Satisfactory7. Realism of Environment and Conditions

59%Partially6. Did the EOC Procedures Work

83%Good5. Effectiveness of the Scenario

75%Above 64. Number of Issues Needing Explanations

67%Realistic3. Realism of Exercise

75%Comprehensive and easy to understand2. Quality of Instructions

67%Exactly right1. Duration Of Exercise

StatusDominant OpinionEvaluation Element

EOC EXERCISE EVALUATION SCORECARD (Nov 19, 2009)

Pandemic Tabletop Exercise

Top 5 “Lessons Learned”

1. Prepare / publish clear decision making (go / no-go) criteria forEOC activation – speed up activation

2. Clearly spell out the chain of command

3. Clearly assign skill-sets to EOC command structure (NOTseniority or Organizational Hierarchy)

4. Use flow-charts for each EOC section – works better thanchecklists

5. Simplify EOC forms; clarify sign-off responsibilities

Pandemic Tabletop Exercise

Questions?

QUESTIONS?