Utilizing Volunteers for Pandemic

1. Utilizing Volunteers for Pandemic Citizen Awareness and Public Outreach Conference September 14, 2006 Rebecca Rogers Gillis Public Heath Preparedness Department for Public Health

2. Topics • Pandemic Influenza • Review definitions • Potential impact • Planning considerations • Volunteer Initiatives for Public Health • MRC • ESAR-VHP • Utilizing Volunteers for Pandemic Influenza • Unit Leaders Should Play a Role in Planning • Potential uses of volunteers Cabinet for Health and Family Services

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4. Influenza • Infection and disease of birds, swine, horses, marine mammals, dogs, and man • Migrating birds and waterfowl are major reservoir for influenza A virus Cabinet for Health and Family Services

5. Definitions . . . • Epidemic: An outbreak of influenza that varies in intensity with more cases than seen normally in a locality • Antigenic “drift”: minor reassortment of virus genes • Epidemics occur every one to three years • Pandemic: Severe outbreak that rapidly progresses to involve all parts of the world • Antigenic “shift”: major reassortment of virus genes to which the overall population has no immunity • Only influenza A viruses cause pandemics • Pandemics occur approximately every 25-30 years Cabinet for Health and Family Services

6. Human Influenza Pandemicsin the 20th Century . . . • The “Spanish” flu of 1918-1920 • At least 20 million deaths world wide • At least 500,000 deaths in the US • Infected 28% of US population • Asian flu of 1957-58 • 70,000 US Dead • Hong Kong flu of 1968-69 • 40,000 US Dead Cabinet for Health and Family Services

7. Avian influenza: a potential pandemic • Infection and disease of birds (migratory birds, waterfowl, and domestic poultry) • Variable effects on birds • Some migratory birds survive/spread virus • Domestic birds often fatal • Possibility for major agricultural impact • KY is 8th largest broiler producer in USA • $600 Million business in KY • second only to horses Cabinet for Health and Family Services

8. H5N1 – the virus in the spotlight ! • Currently isolated from birds in multiple countries in Asia, Eastern Europe, and England • Limited spread to people but high case fatality rate (50%) among known cases • Poor human-to-human transmission, but that could change if virus mutates • Migratory bird surveillance underway along flyways from Asia to North America • To date no H5N1 virus has been isolated from any source (birds or people) in United States Cabinet for Health and Family Services

9. Speculation: Estimated Impact of aFuture Influenza Pandemic in the U.S.* • Deaths: 89,000 - 207,000 • Hospitalizations: 314,000 - 734,000 • Outpatient visits: 18 - 42 million • Additional illnesses: 20 - 47 million • Economic impact: $71.3 - $166.5 billion *Model assumes attack rates of 15-35 % and is based on the 1968 pandemic, and a US population of 290 million persons. Meltzer M, et al. Emerging Infectious Diseases 1999;5:659-671. Cabinet for Health and Family Services

10. Speculation: Estimated Impact of aFuture Influenza Pandemic in Kentucky* • Deaths: 3,000 – 7,000 • Hospitalizations: 9,200 – 21,400 • Outpatient visits: 455,000 – 1.06 million *Model assumes attack rates of 15-35 % and is based on the 1968 pandemic, and a US population of 290 million persons. Meltzer M, et al. Emerging Infectious Diseases 1999;5:659-671. Cabinet for Health and Family Services

11. Challenges of a Pandemic • Rapid Worldwide Spread • Health Care Systems Overloaded • Medical Supplies Inadequate • Economic and Social Disruption • Communications and Information are Critical Components of Pandemic Response Cabinet for Health and Family Services

12. Key Components of Influenza Pandemic Planning • More than a mass vaccination plan • Surveillance and laboratory • Infection control / clinical guidelines • Quarantine / Isolation procedures • Medical surge capacity • Priority groups for available vaccine or antivirals • Personnel / staffing Cabinet for Health and Family Services

13. Disaster Responders Per Capita 1 firefighter for every 265 people 1.1 million firefighters – 750,000 volunteer 1 sworn officer for every 334 people 436,000 sworn law enforcement personnel 291,000 sworn sheriff’s office personnel 1 EMT/paramedic for every 325 people 890,000 all levels of pre-hospital services: basic EMT, intermediate EMT, paramedic 1 public health for every 1,000 in Kentucky Journal of Emergency Medical Services (2004); National Fire Protection Association (2003); National Law Enforcement Officers Memorial Fund (2003) Cabinet for Health and Family Services

14. Medical Reserve Corps • Formed in 2002 in response to President Bush’s call for all Americans to offer volunteer service in their community Purpose • Strengthen communities by forming a team of volunteers with medical backgrounds • Resource in times of community need as well as throughout the year to help local public heath initiatives Cabinet for Health and Family Services

15. What is the typical MRC unit? • There is no "typical" MRC unit. Each unit organizes in response to their area's specific needs • What an MRC looks like depends on: • hazard threats • health concerns • the organization in which the unit is established (health department, faith-based organization, etc.) • The goals are similar Cabinet for Health and Family Services

16. What Do MRC Volunteers Do? • MRC volunteers are incorporated into local community emergency response plans and are activated in response to national/local emergencies Examples • Mass Medication Distribution Plans (Antibiotics) • Large Scale Vaccination Clinics (Smallpox, Influenza) • Special Needs Shelters • Pandemic Influenza Plans Cabinet for Health and Family Services

17. MRC in Kentucky MRC in Kentucky • 18 registered units • 6 units responded during Hurricane Katrina • 13 DHHS (Ashland and Bullitt) • Free local clinic (Paducah-McCracken) • Support ARC mission (Green River) • Staffed DOC (Woodford) • 2 FEMA Disaster Assistance Workers (Woodford) • Disaster pet relief (Woodford) • Nationally, 6,000 MRC volunteers supported efforts • MRC deployed 600 volunteers • Course with Continuing Education • MRC Leader Group Meetings Cabinet for Health and Family Services

18. KENTUCKY Medical Reserve Corps Map Counties with MRC Unit 58 DEPARTMENT FOR PUBLIC HEALTH August 21 , 2006 Cabinet for Health and Family Services

19. Emergency System for the Advance Registration of Volunteer Health Professionals (ESAR-VHP) • HRSA Critical Benchmark #2-4: Surge Capacity • Electronic database of health care personnel who volunteer to provide aid in an emergency • The system will: • Register health professionals • Apply emergency credentialing standards • Allow for the verification of the identify, credentials and qualifications Cabinet for Health and Family Services

20. Implementation Phases • Phase I (Pre-Planning) • Select Name/Logo (KY-HELPS or KHERNLS) • Kentucky Kentucky • Health Health • Emergency Emergency • Listing of Response • Professionals for Network • Surge Listing for Surge • Advisory Group Member Selection • Explore Software/System Options • Obtain Legal Counsel • Select ID Card System • Develop Application • Initial promotion of program with partners Cabinet for Health and Family Services

21. Volunteer Utilization in Pandemic • Unit Leaders Should Play a Role in Planning • Be part of Community Pandemic Preparedness Coordinating Committee • Define unit’s roles and responsibilities in plan • Define legal issues • Train volunteers on ICS/NIMS • Train volunteers on public health preparedness issues including pandemic influenza • Be part of Health Alert Network (HAN) • Encourage volunteer personal and family preparedness • Participate in Exercises Cabinet for Health and Family Services

22. Volunteer Utilization in Pandemic Potential Areas Where Volunteers Could Assist: • Working with identified special needs populations in advance of a pandemic • Mental health support • Surge capacity for a variety of healthcare institutions (including health departments and alternate care facilities) • Distribution of vaccines and/or antivirals, as available • Support community resources such as hotlines and websites to answer questions • Risk communication – helping to spread the word in advance of and during a pandemic (see next slide) Cabinet for Health and Family Services

23. Every Kentuckian can prepare. . . Advice for both seasonal and pandemic influenza • Wash hands frequently • Cough / sneeze into tissue or elbows • Stay home from work / school if sick • Social Distancing: Avoid crowds during outbreaks • Follow public health recommendations for closure of public gatherings Cabinet for Health and Family Services

24. Questions • www.pandemicflu.gov for Pandemic Influenza Information • Visit the MRC website for Planning Guidance for MRC Units • www.medicalreservecorps.gov Rebecca Rogers Gillis Emergency Operations Planning Coordinator Public Health Preparedness Branch Division of Epidemiology and Health Planning Kentucky Department for Public Health 275 East Main Street, HS2EA Frankfort, KY 40621 E-mail: RebeccaL.Gillis@ky.gov Office: 502-564-7243 x 4268 Fax: 502-564-4387 Cabinet for Health and Family Services

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