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Vulnerable Populations Pandemic Influenza Preparedness Tabletop Exercise

Vulnerable Populations Pandemic Influenza Preparedness Tabletop Exercise. Santa Clara County Public Health Department. June 24, 2008. What is a tabletop exercise?. People come together to review and discuss a hypothetical emergency situation

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Vulnerable Populations Pandemic Influenza Preparedness Tabletop Exercise

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  1. Vulnerable PopulationsPandemic Influenza Preparedness Tabletop Exercise Santa Clara County Public Health Department June 24, 2008

  2. What is a tabletop exercise? • People come together to review and discuss a hypothetical emergency situation • Designed to allow participants to talk through plans and problems • NOT designed to measure anyone’s performance • Serves as a springboard for further planning and more comprehensive exercises 1

  3. Exercise roles • Facilitator • Provide instructions, tell the story, introduce the questions, guide the discussion • Participants • Immerse yourself as if the scenario were truly occurring in your jurisdiction, using resources that are available to you (Emergency Operations Plan, policies, procedures, references) • Participate in the group discussions • Evaluators • Observe the exercise to evaluate the process 2

  4. Ground rules • Respond as if the scenario is real • Play the role of your department, agency or community throughout the exercise • Operate within current resource constraints and realities 3

  5. Objectives By the end of this exercise, you should be able to: Describe your individual and your agency’s roles in the response to Pandemic Influenza Identify at least one gap in your agency’s existing Emergency Operations Plan (EOP) Contact the appropriate partnering agencies for assistance 4

  6. In the news… Human-to-human transmission of avian influenza has been reported by the Centers for Disease Control & Prevention (CDC) 5

  7. Outbreak… 6

  8. Today in San Jose... 7

  9. DAY 1, 9:00 a.m. The beginning… A 47-year-old man from San Jose arrives at the emergency department (ED) at Valley Medical Center with fever, chills, cough and shortness of breath 8

  10. Patient history • He is a prominent wildlife photographer who returned two days ago with his wife from an assignment in Nigeria 9

  11. Bad decision… Last night, despite feeling feverish and tired, he attended an awards banquet with 200 of his colleagues 10

  12. DAY 1, 12:00 p.m. At Valley Medical Center • He is evaluated in the Emergency Dept (ED) • Chest x-ray reveals pneumonia • A breathing tube is inserted (intubated) and placed on a ventilator due to severe respiratory distress • Just as he is moved to the Intensive Care Unit (ICU), his wife begins to complain of similar symptoms and registers as a patient in the ED 11

  13. DAY 1, 11:00 p.m. The wife worsens • His wife’s respiratory status severely deteriorates • She is urgently transferred to the ICU 12

  14. DAY 2, 8:30 a.m. Code blue! • The photographer suffers a cardiac arrest and cannot be revived • Meanwhile, his wife struggles to stay alive 13

  15. DAY 2, 8:30 a.m. Is something wrong? • ICU physician concerned based on rapid onset of illness and couple’s travel history to Africa • Decides to notify the Santa Clara County Public Health Department • Orders an infectious disease (ID) consult 14

  16. Break for discussion 15

  17. Personal Preparedness • What steps have you taken to protect you and your family for pandemic influenza or other disasters/emergencies? Examples: • Prepared emergency pan flu home kit • Understand how to care for a sick family member at home • Know where to receive accurate information about pan flu • Have you established a plan for childcare if schools are closed for: • 4 weeks (moderate) to 12 weeks? (severe pandemic) • Does your neighborhood have a Community Emergency Response Team (CERT), or an active neighborhood association with an emergency coordinator? • Do you know where your vulnerable neighbors reside? Has your neighborhood planned how to assist them in an emergency? 16

  18. Communication… 17

  19. DAY 2, 2:00 p.m. Related cases • Three of the new patients were on the same flight as the index (initial) patient and live in the surrounding area Four more patients arrive at Valley Medical Center with severe flu-like illness 18

  20. DAY 2, 3:30 p.m. In the rest of the world… • A leading medical journal reports human bird flu cases in Eastern Europe • World Health Organization (WHO) reports that human-to-human transmission of avian influenza has occurred, but remains limited • WHO increases the pandemic influenza alert phase to 4 19

  21. WHO Pandemic Flu Phases 20

  22. DAY 3, 12:00 p.m Confirmation of new pandemic flu virus 21

  23. DAY 3, 3:30 p.m. Breaking news! KNTV 11 news reports: 22

  24. DAY 3, 4:30 p.m. Public Health Response • schools will be closed effective immediately • large public gatherings have been cancelled • all local agencies including hospitals are asked to implement their Pandemic Influenza Plans A press conference is called by SCC Health Officer, Dr. Fenstersheib to announce: 23

  25. Public panic!!! • CADRE agencies begin receiving concerned calls from clients. • They are worried about getting ill and are asking how they can avoid the pandemic virus • Some are worried about how they are going to continue to receive services • Some clients are afraid to leave their homes • CADRE Network is activated 24

  26. DAY 4, 1:00 p.m. Valley Medical Center 25

  27. Break for discussion 26

  28. Agency Preparedness • At your agency, what measures will you take to limit the spread of the virus • For clients? • For staff? • How can your agency disseminate critical information to the clients you serve? • Currently (pre-pandemic) • During a pandemic • Have you identified which of your clients are at greatest risk of getting ill? 27

  29. Detection… 28

  30. SCC Public Health Dept CA Dept of Public Health Centers for Disease Control DAY 4 Epidemiological Investigation Virus sample sent to CAPHD for analysis Specimen confirmed for pandemic influenza. Sample is sent to CDC for final confirmation. Specimen is confirmed as a new pandemic influenza strain SCCPHD & CADPH or notified Local and State response is taken 29

  31. DAY 5, 10:00 a.m. The illness spreads • People who also attended the awards banquet begin to seek hospital care • In addition to the index case, two more patients with suspected pandemic influenza have died 30

  32. DAY 5, 4:00 p.m.Hospitals Reach Surge Limit Overwhelmed hospitals triage patients as they arrive, admitting only the most ill. The vast majority must return home to cared for by family members www.sccphd.org/panflu 31

  33. Influenza Care Centers Open • Santa Clara County Health Officer orders the first ICC to open. The ICC will receive patients that are too sick to be at home, but do not meet criteria for hospital admission. Capacity of an ICC is 450 patients. 32

  34. DAY 6, 3:00 p.m Increase to WHO phase 5 • Worldwide • Cases reported in East Asia, Eastern Europe and, most recently, in Africa • Mortality (death) of patients with pandemic influenza in Asia exceeds 5% • WHO declares an increase to pandemic phase 5 for influenza 33

  35. Break for discussion 34

  36. Agency Response • Does your agency have an emergency operations plan? • Who or how, does your agency activate your • What are your activation procedures and staffing plan for emergency situations? • What interagency arrangements have been made for sharing resources in your community? • How are you going to provide services to home-bound individuals? 35

  37. Crisis & Long Term Effect 36

  38. DAY 7 Breakdown of infrastructure • Two San Jose pharmacies have experienced burglaries, presumably by persons looking for Tamiflu® • Law enforcement unable to respond immediately because of unprecedented absenteeism among officers 37

  39. Day 8 Absenteeism Crisis • Some healthcare workers are afraid to come into work • Essential services such as trash collection, utilities repair and public safety agencies are reporting up to 30% absenteeism • Many businesses encourage workers to telecommute or work flexible hours 38

  40. DAY 14 Update • Evidence supports person-to-person transmission • Almost 1,000 suspected cases statewide • 75 have died, including numerous healthcare workers and first responders 39

  41. DAY 14 Mass fatality concerns 40

  42. DAY 16 Pandemic declared • WHO declares an influenza pandemic, phase 6 • In the U.S., public health officials still struggling to control the spread of pandemic influenza • Public health system, including hospitals, remains overwhelmed 41

  43. Emerging economic consequences • Local businesses are suffering from lack of workers and customers • Poultry consumption down because consumers are afraid of getting sick from eating chicken DAY 20 42

  44. DAY 20 Forecasts • Forecasters predict that epidemic will continue for several more months and result in over 1.8 million deaths nationwide • Santa Clara County deaths could surpass 36,000 • Estimated nationwide economic impact will exceed $100 billion 43

  45. Break for discussion 44

  46. Long Term Planning & Response • Does your agency have a plan for staff absences unique to a pandemic? • Time off/ leave pay to care for family, or when employee is home in isolation or quarantine? • Or return to work policies specific to a pandemic? • Are there any client related supplies that you could potentially stockpile to prepare for a pandemic? 45

  47. End of Pandemic Flu ScenarioThank you!! 46

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