Business Continuity: Developing Emergency Action Trigger Points EATP Based On SMART Principles

1. Business Continuity: Developing Emergency Action Trigger Points (EATP) Based On SMART Principles Johnnie L. Gilpen, Jr. MS, SEM, EMT-T Emergency Preparedness and Response Solutions, LLC

2. Pre - 2009 S-OIV A/ H1N1 Triggers:Did They Work? WHO Pandemic Phases (1-6); US Response Stages (0-6);

3. Pre - 2009 S-OIV A/ H1N1 Triggers:Did They Work? WHO Pandemic Phases (1-6); US Response Stages (0-6); Severity;

4. Pre - 2009 S-OIV A/ H1N1 Triggers:Did They Work? WHO Pandemic Phases (1-6); April 25th : April 27th: WHO confirms �human-to-human of an animal or human-animal influenza reassortment virus able to cause �Community-Level Outbreaks�� Raised Pandemic Alert to PHASE 4 April 29th: WHO confirms �human-to-human spread of the virus into at least countries in one WHO region� Raises Pandemic Alert to PHASE 5 June 11th: WHO confirms Raises Pandemic Alert to PHASE 6 US Pandemic Response Stages (0-6); Severity;

5. Developing Emergency Action Trigger Points That Work! SMART Principle; EATP�s should be: S �Specific; M � Measurable A � Action Oriented R � Realistic T � Time Sensitive

6. Defining a Pandemic Event:Public Misconception In the beginning of the 2009 S-OIV A/H1N1 event, how did the public define a �Pandemic�? Horrific loss of life! Pandemic = Severity = Mass Fatalities; Reality = Currently, the Overall Case-Fatality Rate (CFR) is less than or to that of seasonal influenza.

7. Defining A Pandemic Event: Components of a Pandemic Novel Pathogen; N�ive Population; Susceptible Population; Exposure;

8. Defining A Pandemic Event: BCP Point of View Components of a Pandemic Novel Pathogen; N�ive Population; Susceptible Population; Exposure; IMPACT on the REVENUE STREAM ($$);

9. Defining A Pandemic Event: BCP Point of View Novel Pathogen There is a change in one of the following: Case-Fatality Rate (CFR); Transmission Dynamics; (1) R0:The Basic Reproduction Number The average number of new infections that one cases generates in a susceptible population why they are infectious; R0 is great enough to maintain transmission; Population affected: Seasonal; Very Young (< 24 months) Old (65 >) Current 2009 S-OIV A/H1N1; School Age (SA: 4 � 17 y/o) Young Work Force (YWF: 18 -39 y/o) 1918 Spanish Flu; Work Force (WF: 18 � 65)

10. Defining A Pandemic Event: BCP Point of View N�ive / Susceptible Population (1) Susceptible Population; Change in Immunity; Acquired Infected ? Treated ? Recovered Infected ? Recovered Induced; Vaccinated ? Immune Death; SIR Model (1) (Susceptible � Infectious � Recovered)

11. Defining A Pandemic Event: BCP Point of View Exposure Virus Must Be Present; Sufficient #�s of Contacts with in a Network (population); Change in exposure = Change in local IMPACT; What Changed Here?(2)

12. Defining A Pandemic Event: BCP Point of View IMPACT (3) Business Continuity (BC) focuses on Revenue ($); The PURPOSE of BC is to ensure that the core business functions will continue with minimal or no interruptions; The OBJECTIVE of BC is to ensure that the organization will survive and continue to meet the their operational function (e.g. Make Money, provide services, etc.)

13. Adapting the Business Continuity Objectives with SMART Principles to Pandemic Event Planning First, what is the overall goal of your pandemic program? Public Health Response; or Business Continuity? THERE IS A DIFFERENCE!

14. Public Health vs. Business Continuity? Public Health (Population Level Planning and Response) Focuses on: Containing the event; Decreasing excess Morbidity and Mortality; Does NOT focus on: Business Continuity. Business Continuity (Organizational Level Planning and Response) It is a Severely Reduced Workforce (SRW) Issue! Focuses on: Containing the event; Decreasing excess Morbidity and Mortality in the work place; While maintaining the viability of the organization.

15. Adapting the Business Continuity Objectives with SMART Principles to Pandemic Event Planning (cont.) Use Backwards Planning to Develop Emergency Action Trigger Points (EATP) for YOUR Organization; Remember the OBEJCTIVE of BCP; FOCUS on the SMART Principle; Base Trigger Points on the BCP concept of a Pandemic Event; Differentiate between Corporate and Operational Level Triggers; YOU MUST BE PROACTIVE not REACTIVE!

16. EATP Development Backwards Planning Start with the Worst � Case Scenario

17. EATP Development (cont.) Backwards Planning What is the Worst-Case Scenario for all organizations? Death; CFR similar to that of 1918 Population affected: Wouldn�t matter Public Health Response; Public Opinion and hysteria would force it to be public health �stop loss� event.

18. EATP Development (cont.) Backwards Planning What is the Next Worst-Case Scenario for all organizations? Death CFR similar to that of 1957-68 but less than the 1918 Spanish Flu CFR Population affected: Wouldn�t matter Public Health Response; Public Opinion and hysteria would force it to be public health �stop loss� event.

19. Worst Case Business Continuity Scenario:Employee Absenteeism Primary Employee Absenteeism Employee Absentee because the employee has ILI signs/ symptoms; Average work days missed: Normal Seasonal Flu (4) 3-5 days 2009 S-OIV A/H1N1 Secondary Employee Absenteeism Employee Absentee because another member of their family has ILI signs/ symptoms; Average work days missed: Normal Seasonal Flu (5)(6) 2-3 days 2009 S-OIV A/H1N1

20. EATP Development (cont.) Backwards Planning What is the Worst-Case (SRW) Scenario for all organizations? Primary absenteeism CFR Similar to Seasonal & < 1957-68; Planning Issues: No employee pool to pull from; Alternative work sites May not works to man alternative work stations Loss of specialists

21. EATP Development (cont.) Backwards Planning What is the Worst-Case (SRW) Scenario for all organizations? Secondary absenteeism Associated with primary infection in School Age Children CFR Similar to Seasonal & < 1957-68; Planning Issues: Larger employee replacement pool; Alternative work sites Easier to plan for who may be affected Loss of specialists Can identify those who are most likely to be impacted and can plan accordingly

22. EATP Development (cont.) Backwards Planning What is the Worst-Case (SRW) Scenario for all organizations? Secondary absenteeism Associated with primary infection in Very Young and/ or 65 y/o or older CFR Similar to Seasonal & < 1957-68; Planning Issues: Larger employee replacement pool; Loss of specialists Can identify those who are most likely to be impacted and can plan accordingly

23. EATP Development (cont.) Backwards Planning What is the Worst-Case (Non-Pandemic SRW) Scenario for all organizations? Human � to � Human Transmission with in a specific geographic location i.e. WHO Phase 5 Planning Issues: Executive/ employee education Epidemiological Surveillance and Risk Assessment Site specific Response plan i.e. Employees working in Mexico in March and April of 2009

24. EATP Development (cont.) Backwards Planning What is the Worst-Case (Non-Pandemic SRW) Scenario for all organizations? Increased Human � to � Human Transmission with in a specific geographic location i.e. WHO Phase 4 Planning Issues: Executive/ employee education Epidemiological Surveillance and Risk Assessment Site specific Response plan i.e. Employees working in Southeast Asia where there is H5N1 cases.

25. EATP Development (cont.) Backwards Planning What is the Worst-Case (Non-Pandemic SRW) Scenario for all organizations? Limited Human � to � Human Transmission with in a specific geographic location i.e. WHO Phase 3-4 Epizootic Outbreak (organizational level planning) Planning Issues: Executive/ employee education Epidemiological Surveillance and Risk Assessment Site specific Response plan i.e. Employees working in Southeast Asia where there is H5N1 cases.

26. EATP Development (cont.) Backwards Planning What is the Worst-Case (Non-Pandemic SRW) Scenario for all organizations? Endemic Diseases Seasonal Flu Yellow Fever in South America Malaria H5N1 in SE Asia; Etc. Planning Issues: Executive/ employee education Epidemiological Surveillance and Risk Assessment Epidemic of Seasonal Influenza or other infectious disease can have significant operational level impacts.

27. EATP Development (cont.) Corporate/ Organizational Level Planning Triggers 1- 4 could be grouped together; Primary Planning and Response issues: Education; General educational focus Surveillance; Broad spectrum Vaccination/ Prevention Programs; Broad multi-disease based programs Operational Level Planning All triggers are separate planning documents; Primary Planning and Response issues: Education Geographic specific Surveillance Focus on local media Local PH Departments, schools, employee. Vaccination/ Prevention Programs; Geographic Hazard Specific

28. My Triggers are Not Your Triggers! There is not a 1 size fits all set of EATP�s Each Company, and their respective operational areas must adapt not only the EATP�s but the entire plan to their individual operational characteristics. Never rely on a template!

29. Questions?

30. Thank you for your time! CONTACT INFORMATION Johnnie L. Gilpen, Jr. Email: jgilpen@emprs.org Phone: 405-919-9511