DEMHS Area 1 Pandemic Influenza Tabletop Exercise June 2, 2009

1. DEMHS Area 1 Pandemic Influenza Tabletop ExerciseJune 2, 2009 Carl Osaki, RS, MSPH Clinical Associate Professor Emeritus School of Public Health University of Washington

2. Today’s Agenda 0900 – 0915: Welcome Purpose/objectives Introductions 0915 – 0945: Overview of legal issues 0945 – 1015: Exercise Instructions & Scenario 1015 – 1215 : Exercise Storyboard 1: Flu outbreak begins in Asia Storyboard 2: Avian flu enters the US Storyboard 3: CT communities respond to pandemic flu

3. Today’s Agenda (cont’d) 1215 – 1300: Lunch 1300 – 1500: Debrief Discussions at each table: -Identify common issues/gaps for each storyboard -Identify common regional themes 1500 – 1600: Summary, next steps, networking 1600: Adjourn

4. Overview/purpose • Identify potential gaps in existing quarantine & isolation plans, procedures and protocols • Identify operational issues in implementing social distancing plans • Validate the ability to provide essential services during a large-scale disease outbreak

5. Exercise Themes • Social Distancing • Quarantine & Isolation (Q & I) • Coordination of response • Management of resources • Risk communication • Legal considerations

6. Terms used today • Tabletop exercise • Scenario to prompt discussion • Isolation • Confinement or separation of infected • Quarantine • Confinement or separation of exposed • Social Distancing • Steps to reduce social contact to prevent the spread of disease (e.g., cancelling events, dismissing schools, separation in lines, telecommuting, flex scheduling, etc)

7. Introductions • At each table: • Name • Organization • Area of responsibility

8. Overview of Legal Issues Marianne Horn, RN, JD CT Department of Public Health

9. Tabletop Instructions • Roles to be played • Learn from this experience • Responding to the scenario • 3 Storyboards • 15 Messages with a question • Focus on policies & plans • 7 minutes per message

10. Tabletop Instructions • Play own role • Respond in real time • Keep notes • Noise control • Breaks • Use of handouts

11. Scenario Assumptions • H5N1 influenza is emerging in SE Asia • Local community preparedness and response/mitigation phases • Governor declares PH emergency when flu hits CT • People are still using H1N1 (Swine Flu) as context for response • Flu hits in fall (Oct-Nov)

12. Questions?

13. Storyboard one “Influenza outbreak begins in Asia”

14. Message 1 • The State Health Commissioner has requested that all local health departments report on the status of Q & I and social distancing policies in their jurisdiction • What is the status of Q & I and social distancing protocols for your department or unit?

15. Message 2 • You have been called to attend a meeting to plan social distancing and Q & I in your community • Who do you see as the primary lead for activating and making decisions about Q & I and social distancing in your community?

16. Message 3 • Some business owners are upset about the loss of business and income which will result from social distancing policies • What steps have been put into place to mitigate the loss of personal or business income resulting from social distancing or Q & I orders?

17. Message 4 • Concern has been raised by EMS, law enforcement, and medical staff about coming into contact with individuals who will be subject to Q & I orders • What are your organization’s plans for worker safety, including personal protective equipment (PPE) and disease hazards training?

18. Message 5 • Schools, businesses, & county government agencies are asked to assist in disease surveillance and monitoring. • What is your organization’s plan for monitoring and reporting illnesses and absenteeism during the outbreak?

19. Storyboard two “Avian Influenza enters the US”

20. Message 6 • Probate court officials have expressed concern about insufficient staff to process appeals to inappropriate or numerous Q & I orders. • What criteria would your organization use to identify and to request a person or group to be quarantined or isolated?

21. Message 7 • Due to the recent H1N1 outbreak, citizens in your community are demanding an immediate response to the threat of pandemic influenza • When should the community be informed about social distancing and Q & I plans and what should the message say?

22. Message 8 • The state Dept of Health has requested local agency assistance in case finding and follow-up • What is the process for requesting or providing resources to state or federal agencies for implementing social distancing policies?

23. Message 9 • The State Commissioner of Education has not yet ordered all schools in CT to be dismissed. Yet absenteeism in one of the schools in your community is over 30%. • What is the plan for notifying the community about cancelling public events and faith-based services; dismissing public and private schools; and prohibiting mass gatherings?

24. Message 10 • Alternate Q and I sites have been identified and are ready to accept sick patients • What procedures are used to notify and assemble medical, law enforcement, and medical transport resources at Q & I sites?

25. Storyboard three “CT communities respond to Pandemic flu”

26. Message 11 • A nurse’s aide at a nursing home has been coughing and sneezing at work. She refuses to leave her job because of loss of income. She speaks very little English and has 5 children at home. • What is the plan for executing, monitoring, and enforcing Q and I orders?

27. Message 12 • A group of 25 tourists from Japan have all come down with flu-like symptoms. They are staying at one of the motels in your community • What measures have been planned for isolating or quarantining potentially infected travelers?

28. Message 13 • Concern has been expressed by some parents about adjusting for make-up days due to prolonged school closures (3 to 5 weeks) • What is the plan to accommodate for the long-term dismissal of schools including continuing education, reopening, parental complaints, and human resource issues?

29. Message 14 • Some home-bound patients are complaining about not receiving continuing medical care services in their homes • What plans are in place to sustain medical care and social services to vulnerable populations (disabled, elderly, non-English speaking, etc) during social distancing?

30. Message 15 • Illnesses have begun to decrease and a few sporadic cases are still being seen • What is the threshold for determining the end of the outbreak and how will communities be instructed to resume normal operations?

31. Debrief • Group discussions – 60 min • Instructions • At your table, record the top 3 issues for each storyboard (10 min/storyboard) • Use your notes sheet • Person at your table will record the issues • At your table, identify a reporter to share your issues with the larger group. • Recording of common regional themes

32. Summary • Next Steps