H1N1 Pandemic Update Section on Emergency Medicine

1. H1N1 Pandemic UpdateSection on Emergency Medicine Steven E. Krug, MD Head, Division of Emergency Medicine Children’s Memorial Hospital Chicago, IL AAP 2009 NCE Washington, DC

3. Spring 2009 – Lessons Learned • Disconnect between federal and local pandemic planning and management recommendations • Variable screening and treatment practices across facilities/practices within local communities • Demand for clinical services by ill and ‘worried well’ patients exceeded capacity • Availability of key medications and supplies limited service delivery and placed patients & staff at risk • Impact of the pandemic on healthcare staff further reduced service capacity at all levels of care • Impact on key safety net services threatened patient care quality and safety

4. Being Aware Being Prepared • Local epidemiology/prevalence of H1N1 • Viral screening/testing • Anti-viral therapy • Treatment and prophylaxis • At-risk populations • Dosing & medication safety concerns • Vaccination • Infection control • N95/PPE use, isolation, furloughs http://aap.org/new/swineflu.htm http://www.cdc.gov/h1n1flu/

5. http://www.aap.org/disasters • Disaster Planning Resources for Pediatricians • Needle: A Disaster Preparedness Plan for Pediatricians • Information on Biological, Chemical, Nuclear & Thermo/Mechanical Agents • Psychosocial and mental health considerations • Influenza • Resources for clinicians • Practice guidance, patient resources, management recommendations • Resources for patient and families • Numerous links • CDC, HHS, NCCD, others

6. Updated Interim Recommendations for the Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season September 22, 2009 2:00 PM ET Updated to include complications and treatment considerations for infants and young children, clarity on underlying conditions that contribute to increased risk for influenza-related complications, and information on anti-viral medication dosing and safety concerns with oral suspensions Interim Guidance on Infection Control Measures for 2009 H1N1 Influenza in Healthcare Settings, Including Protection of Healthcare Personnel October 14, 2009, 2:00 PM ET Updated interim guidance on infection control measures to prevent transmission in healthcare facilities. Emphasizes the ‘hierarchy of controls’ (Elimination of potential exposures, Engineering controls, Administrative controls, Personal protective equipment) as a strategy to protect both staff and patients.

7. October 16, 2009 http://www.cdc.gov/h1n1flu/clinicians/pdf/childalgorithm.pdf

10. AAP DPACDisaster Preparedness Advisory Council • Steven Krug, MD, FAAP - Chairperson • Sarita Chung, MD, FAAP • Daniel Fagbuyi, MD, FAAP • Margaret Fisher, MD, FAAP • Scott Needle, MD, FAAP • David Schonfeld, MD, FAAP • Liaison Members: • DHS/OHA, HHS/ASPR, CDC, NICHD • Laura Aird – AAP Staff

11. Guidelines for Care of Children in the ED Gausche-Hill M, Krug S, and the American Academy of Pediatrics, American College of Emergency Physicians, Emergency Nurses Association Pediatrics - October 2009; 124(4):1233-43. • Recommendations regarding personnel, training, equipment, supplies, medications, support services, quality and process improvement, policies, protocols, and other resources necessary for optimal pediatric emergency care • Updated version of 2001 AAP/ACEP joint policy statement • The presence of MD & RN pediatric coordinators may be the most important factor associated with readiness* • This ADVOCATE could be a community or hospital based pediatrician • Offers recommendations for patient safety & disaster readiness *Gausche-Hill M, et al. Pediatrics 2007; 120(6): 1229-37

12. Children’s Memorial Hospital, Chicago, IL

13. Children’s Memorial Hospital ED Visits

14. New doll available at the American Girl Store: ‘Suzy Swine Flu’….