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Copyright © 2008 Robert Abrams All Rights Reserved

www.watereddowntruth.com


Watered-Down Truth

Presentation by: Robert Abrams

www.watereddowntruth.com© 2008 Robert Abrams All Rights Reserved

. . . Devastating damage expected . . .

Hurricane Katrina . . . a most powerful hurricane with unprecedented strength . . . rivaling the intensity of Hurricane Camille of 1969.

Pre-Katrina Warnings

Watered-Down Truth


Most of the area will be uninhabitable for weeks . . . perhaps longer. At least one half of well constructed homes will have roof and wall failure. All gabled roofs will fail . . . leaving those homes severely damaged or destroyed.

Persons . . . pets . . . and livestock exposed to the winds will face certain death if struck.

Pre-Katrina Warnings

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On Monday, August 29, 2005, 35 people drowned in a one-story nursing home...

Watered-Down Truth


Watered-Down Truth

“As days passed, we would all learn more about the death and destruction caused by, or as a result of, Hurricane Katrina. We would reach agreement as a nation that Katrina was one of the worst disasters we ever faced.”

Excerpt from “Watered-Down Truth”


Trapped in their wheelchairs or on their beds, these 35 nursing home residents were helpless, stationary targets for this powerful surge…

Nursing home owners Salvador and Mabel Mangano, their staff and their ambulatory residents survived.

Excerpt from Introduction to: Watered-Down Truth

Watered-Down Truth


“The last I heard, they were spotted in Natchez, Mississippi. And then recently I was told . . . that the owners are actually trying to leave the country.”

Joe Gallardo, Family Member,Nancy Grace Cable TV Show

Where are the Manganos?According to Whom?

Watered-Down Truth


Rumors on the web and in print alleged that the Manganos abandoned their residents prior to the arrival of Hurricane Katrina – but before they left, they tied their non-ambulatory residents to their beds and wheelchairs and left them to die.

Watered-Down Truth


“My investigation found enough reason to place these individuals under arrest. I think in times of tragedy we have to act immediately to correct a wrong and we did that in this case…”

Manganos Arrested

Attorney General Foti announcing the arrest of Salvador and Mabel Mangano

Watered-Down Truth


“Foti has the legal acumen of an unlit charcoal briquette – and that’s being too hard on charcoal briquettes.”

Manganos’ Counsel Reacts

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James A. Cobb, Jr.Esquire Magazine


Watered-Down Truth

In Louisiana and throughout the country, there was wide public support for Attorney General Foti to CRIMINALLY PROSECUTE the despised nursing home owners.

Nationwide Support for Foti


“I want them to know there are a lot of people devastated by their decision to leave our loved ones in harm’s way.”

“They are guilty, guilty as hell.”

Familial Anger

Yolanda HubertDaughter of Deceased Resident

Zerelda Delotte

Watered-Down Truth


NANCY GRACE . . .

“You know, it’s interesting, Susan. I was reading an AP wire, and it talked about two fishermen. They were making a trip to rescue some of their brothers. They lived off the Gulf of Mexico. They go by St. Rita’s. Susan, they see the oldsters on mattresses, floating up near the ceiling inside the nursing home. So they go back to try to rescue people.”

24/7 Television Coverage and Commentary

Watered-Down Truth


NANCY GRACE . . . (continued)

“Was that the evacuation plan St. Rita’s had in mind, that maybe a fisherman from the Gulf of Mexico might row by and save the oldsters?”

Watered-Down Truth



AARP . . .

“St. Rita’s, the flooded Louisiana nursing home where 34 bodies were discovered –some still slumped in their wheelchairs has become a disturbing symbol of the way older Americans were abandoned, left on their own during the swirling chaos of the Hurricane Katrina disaster.”

Watered-Down Truth



Senator Charles E. Grassley . . .

“As Chairman of the Committee, I request that the Department of Justice and the Office of Inspector General, Department of Health and Human Services, conduct a thorough investigation of the deaths of nursing home residents in the Gulf Coast states, including but not limited to the 34 deaths of residents at St. Rita’s Nursing Home.”

Watered-Down Truth



“Unlike Governor Blanco, President Bush and Mayor Nagin, Sal and Mabel no longer had jobs . . .”

Do-Over

“While these politicians apologized and granted themselves and each other a political do-over, Foti was not prepared to forgive the Manganos and excuse their failure to protect their nursing home residents.”

Excerpts from “Watered-Down Truth”

Watered-Down Truth


• Demonize the Manganos –Guilty by Profession

• Call 40 witnesses, including one resident who was there and several family members.

Prosecution Trial Tactics

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• Present the Manganos as greedy, reckless killers who valued money more than their residents.

• Compare the Manganos’ behavior with other nursing home owners in their parish (county).

Prosecution Trial Tactics

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• The risk of evacuation

• The state of mind of Sal and Mabel Mangano

• The government must issue amandatory evacuation order

Defense Strategy

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• Government incompetence resulted in breached levees and the deadly flooding that killed 1,600 people, including 35 residents of St. Rita’s nursing home

• The Manganos acted in a reasonable and professional manner

Defense Strategy

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What chance do criminal defendants have to compel a sitting governor to testify at their trial?

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Contrasting Styles of Prosecution and Defense

PROSECUTION

• 40 Witnesses

• TheatricsVideos and LocalCelebrities

• Emotion

• Demonize the Manganos

DEFENSE

• 5 Witnesses

• Straight-forward

• Educate Jurors

• Demonize the Government


Paul Knight . . .

“. . . they stuck their heads in the sand, their tails in the air and hoped Mother Nature didn’t kick them in the butt. They gambled as they were want [sic] to do with the lives of 59 people, and 35 of them died because they gambled with their lives .”

Watered-Down Truth

Closing Arguments of the Prosecution


John Reed . . .

“We come to you in the hope that with your verdict you will say to the State of Louisiana that what happened and the way the government handled its responsibility to the homes, to the land, to the security of our people, was not right. And blame cannot be shifted to two ordinary human beings like everybody else doing the best that they could in that time .”

Watered-Down Truth

Closing Arguments of the Defense


John Reed . . . (continued)

“If I had a hope, it would be that by your verdict you would bring the people, who at various times have sat on different sides of this courtroom, together to put this behind us, to say that the time for pointing fingers, the time for laying blame, the time for putting people up and hanging them is passed .”

Watered-Down Truth



Mr. Cobb’s closing arguments were strong and unforgiving against the Prosecution, especially Attorney General Foti.

He told the jury that he was going to be positive – his version of positive . . .

Watered-Down Truth



Watered-Down Truth

P : Pathetic

O :Outrageous

S : Sinful

I : Insulting

T : Tyrannical

I : Illogical

V : Vindictive

E : Evil



Jim Cobb

“And I’m reminded from the Bible that the elders came unto Jesus with a woman accused of adultery and of being unclean. And they approached Jesus saying, ‘Rabbi, she’s accused of adultery and it is the law of Moses saying she should be stoned unto death. What say you, Rabbi?’”[sic]

Watered-Down Truth


Defense Attorneys Go Religious


Jim Cobb . . . (continued)

“For the elders meant to trick and deceive Jesus and embarrass him. For his message of hope was a threat to them. And Jesus, who was sitting on the ground, said without looking up, ‘You say it is the law. It is the law. Let he among you who is without sin pick up and cast the first stone.’”

Watered-Down Truth


Defense Attorneys Go Religious


Robert Habans

“The word ‘scapegoat’ has come to mean a person often innocent who is blamed and punished for the sins and crimes of others. And in Christianity, that same concept has been adopted but with a slightly different spin. It has been used as symbolic of the self-sacrifice of Jesus who takes the sins of humanity on his own head. . . . Having been driven into the wilderness outside the city by the order of the high priests .”

Watered-Down Truth


The Manganos are Scapegoats


Habans then compares Jesus to the Manganos and the jury to the high priests.

Watered-Down Truth



Should You Compare Your Criminal Defendant Clients to Jesus?

Is it appropriate to make such analogies in a courtroom?

Watered-Down Truth


A Quick Verdict

NOT GUILTY!

NOT GUILTY!

NOT GUILTY!

Watered-Down Truth


“The jurors, Sal and Mabel Mangano embraced each other in a way that only survivors with a common enemy can.”

Robert Abrams, AuthorWatered-Down Truth

Hugs and Kisses

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“The jury may not have found them guilty, but our savior says they are. When they face our maker, they’ll have to answer to Him…”

Family MembersCBS News

Case Will Be Decided By A Higher Authority

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Where was Foti during and after the trial?

No more press conferences.

But lots of questions . . .

Cowardly Prosecutor

Watered-Down Truth

?


Why did he refuse to meet with the Manganos before he had them arrested?

When did he charge the Manganos as fugitives when he knew where they were and that they wanted to cooperate with his investigation?

Why did he emphatically state that a mandatory evacuation was issued by St. Bernard Parish, when, in fact, no such order was ever issued?

Questions

Watered-Down Truth


How could he charge the Manganos with having a reckless disregard for the lives of their residents, when they also put their own lives and the lives of their loved ones at risk by remaining in St. Rita’s Nursing Home during the Katrina catastrophe?

Watered-Down Truth

Questions


How could he prosecute the Manganos for negligent homicide and at the same time bring a multi-billion dollar suit against the Army Corps of Engineers for being responsible for the flooding that killed over 1,600 Gulf Coast residents, including the 35 residents of St. Rita’s Nursing Home?

Watered-Down Truth

Questions


Why is it that the Manganos were the only healthcare professionals he prosecuted, even though he claimed that he was investigating many other nursing homes, hospitals and other healthcare providers whose patients died during the hurricane?

Watered-Down Truth

Questions


Was Foti’s decision to charge the Manganos, but not the Lafon Nursing Home owners racially and/or religiously motivated? Was this one of many examples of a Foti practice of selective prosecution?

Watered-Down Truth

Questions


What does the case of The People vs. Mangano tell us about long term care in America?

Is this case an aberration?

Does the truth matter?

Questions to be Answered

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Many lessons can be learned from

disasters like Hurricane Katrina . . .

Watered-Down Truth


Watered-Down Truth

Special considerations for healthcare providers regarding emergency preparedness . . .


Lessons Learned

The Non-Watered-Down Truth

• Don’t be a victim of disaster denial

• Disasters happen – just check out the FEMA website – www.fema.gov

• The government is an important partner in emergency preparedness


Lessons Learned


• Government leaders must be truthful, decisive and available in times of crisis

• There is no place for politics during a serious emergency


Lessons Learned


The media has an important role in emergency preparedness.

However . . .

The media must not view emergencies as a sales opportunity.

Rather, they must view their role as a public service.


Lessons Learned


Often, the best approach is for a healthcare facility to shelter-in-place.

However . . .

Healthcare administrators must be flexible and be prepared to evacuate their facility when necessary!


Lessons Learned


If evacuation is necessary, the facility should consider:

Modes of Transportation

• A contract with a transportation provider does not mean that transportation will be available.


Access

• Is it really possible to navigate the roads?

• Will traffic make an evacuation possible?

Lessons Learned



Does the facility have adequate supplies and equipment?

Lessons Learned



Practice should make for a perfect response to all emergencies.

Applicable laws and regulations require that healthcare facilities hold practice drills.

Regulators must be sure facilities practice in a meaningful and appropriate manner.

Lessons Learned



Facility staff, residents, family members and all other interested parties must be educated about and participate in the facility’s emergency preparedness program.

Lessons Learned



Emergency Communication

• Before

• During

• After

Lessons Learned



The facility leadership maximize communication.

How will you communicate?

• Primary

• Secondary

• Tertiary

Emergency Communication (continued)

Lessons Learned



Communication Priority List(may vary from one facility to another)

• Residents

• Staff/Consultants

• Government Representatives

• Emergency operations officials• Department of Health• Local, state and federal agencies

Lessons Learned




Communication Priority List

• Family Members

• Vendors

• Emergency• Food• Medical

• Pharmacy• Transportation• Water


Lessons Learned



Communication Priority List

• Other Facilities

(especially if evacuation is required)

• Ombudspersons

Lessons Learned




Will the facility be able to properly care for residents with special needs?

Lessons Learned



The facility staff must meet their obligations to their residents, as well as their personal family members and loved ones!

Lessons Learned



Note:

• During Hurricane Katrina, nursing facilities that evacuated made special provisions for the family members of their staff.

• Facilities that sheltered-in-place set up temporary shelters for family members of their staff.

Lessons Learned



A. Location of Special Needs Residents

1. Non-Ambulatory

2. Communication Challenges

a. Non-Verbal

b. Non-English Speaking

3. Dementia Residents

4. Behavioral Residents

5. Infectious Diseases

The following information must be kept current and made available to your “emergency” team:

Lessons Learned



B. Building Construction and Emergency Plans and Documents

1. Any Structural Issues

2. Construction Activities

3. Locations of Exits

Lessons Learned



C. Current list with contact information for all staff and other key members of your community.

The list should include:

1. Home Phone #

2. Cell Phone #

3. Text

4. E-mail

Lessons Learned



D. If you need to pick up staff, a prepared travel plan.

E. List of “Emergency Supervisors,” by location and/or any other organized system.

F. Location of where emergency supplies are prepared and stored.

Lessons Learned



G. How will you protect and preserve medical records and documentation?

H. What is the facility’s obligation to its neighborhood?

Example: Will the facility be a safe place for others to

shelter?

Lessons Learned



I. List of residents who have capacity and a list of those who lack capacity.

Note: Residents with capacity mayrefuse to cooperate with theemergency plan.

Lessons Learned



For a comprehensive list of resources please visit:


Watered-Down Truth


To purchase a copy please visit our website:


A MIGHTY WIND

Starring: Eugene Levy, Fred Willard, Katrina, Rita, Gustav, and Ike

AHCA WebinarA t 2009

A MIGHTY WIND

Starring: Eugene Levy, Fred Willard, Katrina, Rita, Gustav, and Ike

AHCA WebinarA t 2009

Presenter:Joseph DonchessExecutive Director Louisiana Nursing Home Association

Presenter:Presenter:Joseph DonchessJoseph DonchessExecutive Director Louisiana Nursing Home AssociationExecutive Director Louisiana Nursing Home Association

Advance Planning

1. Review and update, if necessary, facility emergency preparedness plan at least once a year before hurricane season.

2. Meet with staff and make assignments of responsibilities.

3. Review emergency preparedness plan with vendors, pharmacist, medical director and physicians

4. Make a list of supplies needed.5. Categorizing residents as Category I

(medically complex) or Category II

Advance Planning

6. Verify agreement with sheltering site (s).7. Verify agreement with transportation service (s).8. Plan for needs of evacuating staff and

accompanying families.9. Attend meetings with local Office of Emergency

Preparedness. Develop a personal, professional relationship with the local director, Police Chief and Fire Chief.

10. Business Interruption Insurance.

Evacuation

1. Go or Stay ???

2.2. Wait for Wait for ‘‘mandatorymandatory’’ evacuation or leave evacuation or leave early? Leaving early means less traffic, early? Leaving early means less traffic, shorter period of time to deal with incontinent shorter period of time to deal with incontinent patients; more reliable cell phone usage.patients; more reliable cell phone usage.

3.3. You may want to evacuate your heavier care You may want to evacuate your heavier care patients early when resources are still patients early when resources are still available, and in adequate numbers.available, and in adequate numbers.

Evacuation

3. Activate Plan• Notify staff, and local OEPs( yours and receiving

parish).• Notify families of decision; order extra meds.• Determine which residents can be discharged to the

care of their family…Notify families for pick up.• Prepare emergency kits and resident baggies.• Place ID bands on residents.• Designate staff member as ‘ first to arrive’ at shelter

to direct set up and activities.• Designate staffer (maintenance worker) to stay at or

near facility in order to assess damage after storm passes and to determine when it can be re-occupied.

Evacuation

3. Activate Plan– Triage residents for bus trip. Load most ambulatory

patients first. They will be on bus for longest time.

– Each bus should have at least two nursing staff, ice chest or refrigerator, emergency medical supplies.

– Do a ‘walk-through’ of facility before leaving.

– Each bus must have enough supplies – wet wipes, diapers, towels, water, Gatorade, sipper cups.

– Patients needing oxygen should be transported by ambulance.

Tips for lining up transportation in advance of a disaster

• Know your residents. Identify their acuity levels. That will help determine the type of transportation you will need.

• Be a partner with the local emergency preparedness department. Once you establish contracts with transportation providers, run those contracts by the department for review. Establish a relationship with a local transportation association.

• Keep costs in mind. Decide what you are willing to spend for an evacuation contract with a transportation company. Talk to statetransportation association about reasonable amounts.

• Consider talking to local churches or schools about using their means of transportation if necessary.

Source: McKnight's interviews with transportation and long-term care experts, 2007

During The Onset (or Aftermath) of an During The Onset (or Aftermath) of an Emergency EventEmergency Event

Goals of Receiving Facilities

1. Mobilize staff to care for incoming evacuees• Staff from evacuating facility will, likely, be few and exhausted.

• Cross Train employees – Housekeepers, laundry, dietary

personnel.

2. Organize community volunteers to ‘welcome’

evacuee residents.

3. Provide a home away from home.

4. Elderly don’t do well.Journal of American Geriatrics Society “Biobehavioral Correlates of Relocation in the Frail Elderly”

Goals of Receiving Facilities

5. Minimize disruption to residents of receiving facility• Maintain their daily regimens and routines as much as possible

6. Notify local Office Of Emergency Preparedness that nursing home evacuees will be arriving – may be a good resource for finding volunteers or responders to help with “offloading”.

7. Local Fire and Emergency Departments will more than likely help to offload residents, if they have the available manpower.

Immediate Challenges of Receiving Facilities

1. Communication• During evacuation trip, communication between

receiving facility and evacuating staff will be sporadic at best (Blackberries are good for emailing).

2. Paperwork of Evacuee Residents• Medication Administration Record• Health and Physical• Admission documentation

• If evacuated facility is damaged, receiving facility may have toadmit evacuee residents.• State Medicaid Agency should be helpful in this process.

Immediate Challenges of Receiving Facilities

3. Physical Plant Preparations• Bedding, supplies, equipment

4. Staff Housing• Children usually accompany evacuating staff

members

5. Verify licenses of incoming staff.

Ongoing Concerns

1. Communications with families, responsible parties (who are likely displaced too).

2. Reconstructing medical records if they were left behind or lost.

3. Cultural and religious differences (Catholic communities moving to Baptist communities)

4. Return transportation – false starts

Ongoing Concerns

5. Publicity

6. Adequate Staffing

a. Agency staffing

b. Overtime

c. Burnout

d. Crisis counselors for staff and residents

e. Morale

Sheltering In Place1. When all other forms of communication were

inoperable, Ham Radios worked. Contact local groups or organizations of Ham Radio Operators to see if they will help.

2. Have Security at facility. If law enforcement or National Guard is not available, hire private security.

3. Make sure emergency generators are operable. Have adequate supply of fuel. Air conditioning is a must in the South. Heat killed most elderly after Hurricane Katrina.

4. Will sheltering facility accept new admissions? Families of elderly living at home will scurry to admit them to a nursing home rather than take them on their own evacuation journey.

78 Hours to Landfall

6 Hours to Landfall

Approximate time of Landfall

Jocelyn Montgomery, RN, PHNCalifornia Association of Health Facilities ‐ Disaster Preparedness Program

NURSING HOMES:PART OF THE SOLUTION IN COMMUNITY PREPAREDNESS

AHCA Webinar, 2009

LONG TERM CARE FACILITY

• Refers to any of a range of institutions that provide health care to people who are unable to manage independently in the community.

www.longtermcareliving.com/glossary

WIDE RANGE OF RECIPIENTS INLONG TERM CARE

• It can include people who are: o pediatric, elderly, in between

o ambulatory

o non ambulatory

o cognitively intact

o cognitively impaired

o minimal assistance

o completely dependant for all activities of daily living

And have special medical and/or behavioral needs

SKILLED NURSING FACILITY DEFINED

“Skilled nursing facility" is defined as an institution(or a distinct part of an institution) which is primarily engaged in providing skilled nursing care and related services for residents who require medical or nursing care, or rehabilitation services for the rehabilitation of injured, disabled, or sick persons, and is not primarily for the care and treatment of mental diseases; …

§§1819(a) and 1919(a) of the Social Security Act

SNAPSHOT OF NATION’S SNFS

• Approximately 16,000 SNFs

• 1,730,000 licensed beds

• 917,000 nursing staff

• 122,400 RNs

• 192,100 LPNs

• 608,900 CNAs

• 12,500 NAs/Orderlies

CDC National Center for Health Statistics 2006/2007 data

SNAPSHOT OF SNF RESIDENTS

• 1,492,200 living in skilled nursing homes on any given day.

• The vast majority of these people are:

• 75 or older

• Female

• Stay less than 3 months

• Disease prevalence high

SNF DISASTER CAPABILITIES

• A critical component of the healthcare system

• Experts in caring for medically fragile populations

• Regulatory oversight

• Bed capacity

• Back up o Powero Medicationso Emergency Supplies

SNF DISASTER NEEDS• More involvement with local planning efforts

• Stronger facility emergency operation plans from the “walls out”

• Assistance to prepare as a partnerin response

SOUTHERN CALIFORNIA 2007

LARGEST EVACUATION (CA HISTORY)

• Approximately 515, 000 people evacuated

• Over 2,200 medical patients evacuated

• 14 Skilled Nursing Facilities

• 5 Intermediate Care Facilities (MR)

• 1 Acute Psychiatric Facility

• 3 General Acute Care Hospitals

HOW DID LTC DO?

No structures lost

No disaster – related deaths

Displace residents received excellent care at other facilities and shelters

Staff reported to work many not knowing whether or not their houses were standing

FIRE STORM “LESSONS LEARNED”

• Coordination special needs response operations, patient and bed tracking.

• Patient identification with critical medical information.

• Staff identification that enable them to cross barriers to return to facilities.

• Plans that adequately address transport and reception of patients to other facilities.

• Criteria for approval to repatriate facility.

PANDEMIC INFLUENZA PREPAREDNESS

• A general lack of preparedness in long term care for pandemic

• Have never been required to provide respirators to workers

• Infectious disease emergencies addressed in emergency operation plans:o Less than 40% had planned for quarantineo Less than 40% had planned for reconfiguring spaceo for wide scale isolationo Less than 30% had planned for storage of remains

TIPS TO AVOID SWINE FLU

TIP # 1

H1N1 PREPAREDNESS

• Robust Infection Control

• Workforce Protection

• Social Distancing Policies

• Excellent Communication and Collaboration with Local Community

CAHF DISASTER PREPAREDNESS PROGRAMhttp://www.cahf.org/public/dpp

• Pandemic Influenza Workbook for Long Term Care

• CAHF’s Model Respiratory Protection Program

• CAHF’s Nursing Home Incident Command System (NHICs)

• READY SET GO Fact Sheets

• Disaster Preparedness Conference for Long Term Care “REALLY READY TOO!”

WE ARE SAFER IF WE WORK TOGETHER!

JOCELYN MONTGOMERY RNDIRECTOR OF CLINICAL AFFAIRS

CALIFORNIA HEALTH CARE [email protected]

Novel H1N1 Influenza A Novel H1N1 Influenza A UpdateUpdate

Janice ZalenSr. Director of Special Programs

American Health Care [email protected]

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Novel HINI Influenza ANovel HINI Influenza A

As of August 21, 2009◦ 7,963 hospitalizations from lab confirmed

H1N1◦ 522 deaths from lab confirmed H1N1◦ More than one million cases (unconfirmed)

What will happen this Fall? Get Ready!!◦ H1N1 will co-circulate with seasonal influenza◦ Will 65+ population continue to be at less

risk than younger age groups?

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Influenza VaccinesInfluenza Vaccines

Initial limited supply of H1N1vaccines targeted to 5 key populations◦ Does NOT include 65+ population◦ Does include healthcare personnel, including

LTC direct care staffCheck in with your public health department NOW

Seasonal influenza vaccines is in good supply and very strongly recommended

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CDC Interim AntiCDC Interim Anti--Viral Medication Viral Medication RecommendationsRecommendations

Those individuals at high risk of serious seasonal flu-related complications are considered high risk of H1N1-related complications◦ Residents of “nursing homes and other chronic-care facilities”

are high-risk for complications of H1N1

Prophylaxis use of antivirals is recommended for people at high risk of serious seasonal flu-related complications who have been in close contact with someone who is ill with H1N1. Health care workers who were in close unprotected contact with persons sick with H1N1 also should be considered for chemoprophylaxis.

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Massive Federal CampaignMassive Federal Campaign

CDC churning out interim guidanceFederal grants to states to plan and prepareInvolvement also of Departments of Homeland Security, Education, Commerce, and LaborWithin Department of Health and Human Services: FDA, CDC, ASPR, CMSGoal: Minimize impact of H1N1

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H1N1 CDC ResourcesH1N1 CDC ResourcesCDC H1N1 Home Page: http://www.cdc.gov/h1n1flu/CDC Guidance for Businesses and Employers http://www.cdc.gov/h1n1flu/business/guidance/Communication Toolkit for Businesses and Employers http://www.cdc.gov/h1n1flu/business/toolkit/Clinical and Public Health Guidance http://www.cdc.gov/h1n1flu/guidance/

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Infection Control and N95 Infection Control and N95 RespiratorsRespirators

Interim guidance on infection control for patients in health care setting http://www.cdc.gov/h1n1flu/guidelines_infection_control.htm◦ All healthcare personnel who enter the rooms of patients

in isolation for swine influenza should wear a fit-tested disposable N95 respirator or equivalent (e.g., powered air purifying respirator)

IOM to make final decision in early SeptemberPlanning for N95 use—AHCA memo: http://www.ahcancal.org/facility_operations/clinical_practice/Pages/SwineFluUpdate14.aspx

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N95 Respirators (N95 Respirators (concon’’dd))

Will N95s be available in the Fall?Will your employees feel more safe?Is a small supply a possibility and will your local public health department help? CMS’ H1N1 Flu -State Survey Agency Guidance http://www.cms.hhs.gov/SurveyCertificationGenInfo/downloads/SCLetter09_36.pdf

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More ResourcesMore Resources

AHCA/NCAL H1N1 site: http://www.ahcancal.org/facility_operations/clinical_practice/Pages/SwineFlu.aspxIncludes CDC twitter and other tweet updatesAHCA summarized updatesLinks to useful resources (including CAHF’sresources) One stop access to U.S. government pandemic information: http://www.flu.gov/

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