pandemic influenza planning - mnp llp · 12 influenza prevention ... concentration of fluids...
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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
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?