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Important Pandemic Flu Information |
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SWINE FLU PREPAREDNESS
The Challenge
What should be done? When should it be done? How much money should be budgeted and committed to the effort? What assistance is required to properly prepare the organization for this potentially devastating disease pandemic?
The objectives of this paper is to:
Raise awareness about impact of pandemic influenza on the health care system
Increase understanding regarding the responsibilities of all participating agencies
Determine whether current plans adequately address anticipated events
Identify gaps in coordination between agencies
Promote advance planning between health departments, hospitals, and other agencies.
The Swine Flu virus is projected by many medical experts to be as fatal as past pandemics. Preventing the spread of the disease will be core to minimizing the losses associated with getting the disease. Closing schools, restricting transportation, canceling meetings, sporting events, public shopping will all be considerations. Working from home, if possible, will be a primary recommendation.
An Swine Flu Pandemic will differ from other forms of disaster losses due to the widespread and potentially devastating outcomes. This pandemic may be virulent for 1.5 years or more. Up to 40% of the population may be affected at a given time. Work absenteeism is expected to be greater than 20%. This high percentage is driven either by fear of being in a group workplace, by being a victim of the disease, or by taking care of a family member who has contracted the disease.
A principal challenge is to respond to this pandemic threat in a proactive, measured fashion utilizing scarce resources to optimal effect, while mitigating loss. With a goal of 'Preparedness without Panic', combined efforts will, in all likelihood, be the performance of generations. It is essential to establish a clear vision of what responses are appropriate, but avoid panic. Hope is not a sufficient strategy. Hope is not a plan.
Below is a listing of conclusions HHS has established for this threat:
1. The H1N1 virus appears to be as deadly as past pandemics.
2. There is no available H1N1-specific vaccine at this time, due to production limitations and uncertainty regarding mutation. That stated, there will not be a vaccine for the first wave of this pandemic disease.
3. Expectations are that 30%, or possibly 90 million people in the US will contract the disease. Forty-five million will seek medical treatment. About 25% will require hospitalization. Lethality rates are currently substantially higher than 50% of those who contract the disease.
Over the course of a pandemic, up to 30% of the local population may become ill and absenteeism is projected to be greater than 25% for a significant period of time. Most people will have a typical course of illness consisting of 3 days of severe febrile illness, followed by a few days of milder symptoms and 1, 2, or more weeks of convalescence. These illnesses will result in a marked surge in demand for outpatient medical services, as well as antiviral medications and over-the-counter remedies. Efforts to protect the population, and thus slow the spread of the disease are paramount. 'Social distancing' is the socially acceptable term for preparedness actions. This may include, but is not limited to the following:
1. Restricting local and distance travel in confined public vehicles.
2. Discouraging assemblies.
a. Business
b. Education at all levels
c. Church
d. Shopping
e. Entertainment
f. Sports
3. Nurture education on prevention
a. Wash and sanitize hands often
b. Avoid public places and assemblies
c. Wear rubber gloves and masks
Health education may reduce the impact on outpatient care providers. The following list of questions at the very least need to be addressed to prepare our communities for the worst case:
Who is leading the public health response and what are the roles and responsibilities of the persons who report to this individual?
What are the key issues the health department needs to address at this point?
Who is the key partner(s) with whom these issues need to be addressed?
What specific assistance will (county/city) need from external agencies/organizations?
What steps are being taken to prepare the provider community and the general public for the events of the next 2-3 months?
What kinds of messages need to be crafted for the public before the outbreak occurs and in response to predictable issues once the outbreak occurs?
How are you working with local media so they will help your efforts?
How is non-English speaking populations being addressed?
What plans do you have in place to step up surveillance activities? Where will additional staff to be needed for extra workload come from?
On what medical care-related areas does public health need to collaborate with the hospitals, emergency rooms and outpatient providers?
What are the plans to vaccinate priority groups after first shipments of vaccine arrive?
Are plans in place for mass vaccination? If so, in what locations and who will staff them?
How do you plan to address anticipated staff shortages in the health department; what essential functions must remain in place? Who decides how limited staff and other resources are allocated?
What essential services must be maintained in the county/city? How will resources be allocated and accounted for in order to maintain these services? Who decides these issues?
What role is public health playing with respect to hospitals and the prospect of facilities being overwhelmed? Are you tracking availability of beds?
How are laboratory services being prioritized to deal with the high demand as well as staff shortages?
You are receiving daily inquiries about the number dying of influenza. How are you responding? How severe is the pandemic in your area and how do you know this?
In anticipation of soon receiving vaccine that will be targeted for health-care workers and first responders, how are you addressing public concerns about lack of vaccine?
Health care workers and first responders express concern about exposure. What advice can be given?
What are your plans to manage the very small supply of antiviral medications received from (state, CDC)?
How will you prioritize who gets antiviral medications, and how will you distribute these medications?
What are the primary responsibilities of 911 dispatch, sheriff, police, and fire departments? What resources will they need?
At what point will you decide whether schools will be closed and whether public gatherings and events will be cancelled? How will you balance school closures with the impact on the workforce when parents stay home with children? Who will be involved in making these decisions?
Hospitals are full, and there are severe staff shortages. The least ill patients are being sent home. Have any plans been made for provision of home health care?
What special issues need to be considered related to various populations such as persons who are geographically isolated, non-English speakers, hearing impaired persons, the elderly, and others with already limited access to healthcare?
How will the deceased be safely and respectfully handled, and how will religious beliefs be addressed?
National recommendations have been issued stating that health-care workers and first responders are the highest priority groups for vaccination when the vaccine first becomes available. As you make plans to begin vaccinating, how are you responding to the angry public that wants vaccine, and in particular to panicked parents?
Because you will not be able to vaccinate every health-care worker and first responder in your jurisdiction, how are you determining which health-care workers are eligible in this first round of vaccination?
Health-care workers are demanding that their family members also receive vaccine. How are you responding to this?
How do you plan to safeguard and monitor your vaccine?
What mental health needs of citizens, health workers, emergency responders, and others must be considered and addressed? How will this be accomplished?
The health care community, both public and private, has been stretched thin responding to the clinical needs. Who will staff the vaccination clinics?
What can be done to alleviate the stress for those who have already been enlisted with other efforts during the past 8 weeks?
Turnout for vaccination is less than expected. What is your communication plan to increase interest in vaccination?
Open alternate or expand current facilities? Will the newly available beds in these facilities meet the need?
Will there be adequate staffing, equipment and services to make the newly available beds usable for patient care?
Will admission criteria be modified?
Will discharge criteria be modified? Cancel elective procedures?
How will changes in standards be addressed from a legal point of view?
What recommendations would you make for establishing priority of access to ICU care and mechanical ventilation? Would such priorities have any meaningful impact on who does or does not receive ICU care?
What problems would be encountered in expanding availability of ICU care and mechanical ventilation?
If you knew with certainty that your community was going to suffer an influenza pandemic with the projected impact, what would be your preparedness recommendations to meet the shortfall in ICU beds? How do these recommendations differ from current preparedness plans?
Will available radiology and laboratory (microbiology and clinical) services be adequate to meet the demand? Will providing service for expanded or ancillary facilities create problems?
Are good data available on the size of the potential pool of various skills that may be available to meet the surge in need?
Will there be authority to waive credentialing requirements for persons with the necessary skills but who are not currently licensed?
Has your jurisdiction looked into legal issues that may affect your ability to use volunteers and other non-credentialed staff?
Is changing nurse/patient ratios a reasonable short-term option?
Who make decision on using volunteers and/or patient family members as care givers?
What is the average daily number of requests for patient transport services in your community? What is the surge capacity? Could the system handle a surge of 30% or more requests on a daily basis during the peak period? How long can this increased level of response be sustained?
Is there a priority system in providing patient transport? Who decides the priority? What criteria are used in making the decision?
Is there a mutual aid agreement if requests for patient transport cannot be met? In your opinion, would this agreement be workable during an influenza pandemic?
What alternative sources could be used for patient transport?
Are there areas that are chronically under-served for which special plans need to be made?
Have plans been made to enhance security in times of emergency?
How many points of entry are there? Do you have security staff to cover all areas?
Will traffic control be a potential problem?
Will parking availability be adequate?
Will security be adequate to protect supplies of critical shortage materials and equipment?
If large numbers of law enforcement personnel are affected, who will provide the necessary services?
Who is responsible for announcing an expedited process of body handling?
How will medical autopsy process be modified by the appropriate medical examiner?
Are resources available to manage bodies that cannot be processed quickly through the hospital, medical examiner, funeral home and burial process?
What authority would suggest an expedited process for funerals and burials?
What authority could process bodies if a regional crematory was not properly disposing of bodies?
Who is responsible for deaths in the home? Are autopsies required, and if so, can a waiver be obtained?
Is the current health care administration system prepared to finance unusual expenses for workup and care of influenza victims?
Is the current health system capable of paying for higher staff costs, overtime, and loss of regular staff?
What resources can be activated to compensate for decreased revenues as the day-to-day patient volume is eliminated?
Given that any existing health care system likely cannot request pre-payment, how will hospitals manage to cover costs until reimbursement occurs?
Is the local system capable of guaranteeing payment to other service and equipment vendors needed to manage the outbreak, even in crisis conditions?
What are the channels and procedures that are currently available for requesting emergency help from state and federal resources?
Who is empowered to request state and federal resources, and to specify what resources are needed?
How would requests for assistance be managed in a metropolitan area that extends over multiple counties in more than one state?
Limiting Organizational Losses
In addition to the aforementioned public health issues, organizations must assess their vulnerabilities to the impact of prolonged mass absenteeism, and act to reduce these effects. This is best achieved by thoroughly understanding each mission critical operational process by mapping each sub-activity, completing and then performing a dependency analysis of each step to fully recognize secondary and tertiary relationships. Increasing stock reserves, cross-training employees for multiple roles, responsibilities and tasks, utilizing video conferencing, and a host of other behavioral or operational modifications may also be required.
Emergency response is complex. Preparations based on the best situation will probably be inadequate. It is much better to prepare for the worst. With anticipated widespread occurrence in all cities, all states, and all countries, resources will be undeniably scarce. The time to prepare is now. |
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