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Pandemic Influenza: Preparing for the Unthinkable March 13, 2007

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Pandemic Influenza: Preparing for the Unthinkable March 13, 2007

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    1. Pandemic Influenza: Preparing for the Unthinkable March 13, 2007 Charles W. Mackett III, MD, FAAFP Executive Vice Chair, Department of Family Medicine Chair, Medical Advisory Committee Disaster Management Center University of Pittsburgh Medical Center

    2. Pandemic Influenza Bird flu kills in Indonesia and picks up speed across Asia” •The China Post 10 January 2007

    3. Pandemic Influenza Right now, a growing … challenge is overcoming … bird flu fatigue” •Henk Bekedam WHO January 29, 2007

    4. Highly Pathogenic Avian Influenza H5N1 “The most lethal influenza virus we have ever seen” • Robert Webster, St. Jude’s Hosp 2005 H5N1 is a unique and unprecedented threat.H5N1 is a unique and unprecedented threat.

    5. Current Situation H5N1 The First Known Highly Pathogenic Avian Influenza (HPAI) Panzootic Re-emerging Confirmed Human Cases Case Fatality Of ~ 60% No Sustained Human To Human Transmission Recent Family Clusters

    6. Reported Infections in Birds and People: since 2003

    7. Pandemic Influenza Impact on Average U.S. Hospital FluSurge model (CDC) HHS planning assumptions At peak (week 5 of 8) with 25% attack rate Projects pandemic impact on hospitals based on population and number of beds and venitlatorsProjects pandemic impact on hospitals based on population and number of beds and venitlators

    8. Federal Role in Pandemic Response "Any community that fails to prepare with the idea that somehow, in the end, the federal government will be able to rescue them will be tragically wrong." Michael Leavitt, U.S. Secretary of Health and Human Services at Pennsylvania Summit 3/31/06

    9. DoD Preparedness AFI 10-2603 EMERGENCY HEALTH POWERS ON AIR FORCE INSTALLATIONS DoD Influenza Pandemic Preparation and Response Health Policy Guidance (25 Jan 06) Policy for Release of Tamiflu (10 Jan 06) Interim Guidance for Protecting DoD Personnel Involved in (AI) Eradication (21 Mar 06) Pandemic Flu: A Guide for Service Members and Families (3 Jan 07)

    10. UPMC PREPAREDNESS

    13. Mission Statement Prepare UPMC For A Potential Pandemic Flu Disaster By: Protecting & Enabling Staff Addressing Staff Concerns Designing & Implementing Innovative Treatment Making Fiscally Responsible Decisions Acting As A Community & Health Care Leader

    15. UPMC Pandemic Preparedness Stages

    17. Staff Guidance, Support & Utilization Education/Training – What is Avian Flu? Obligation to Work – 40% Absenteeism Protect Staff (Equity) PPE, Rx, Family Protection, Facilities Home (Isolation) Support Supplies, Medications, Telecommuting Communication & Employee Health Emergency Credentialing/Volunteers Cross Functional Training & Utilization

    20. Diagnosis & Treatment Surveillance – Suspect Profile “Griage” – Greet & Triage Cultures – awaiting BSL3 Western PA Specimens/PCR Hospital/Office Isolation -- STOP SPREAD PPE & Masks (N95 for Staff) Medications – Tamiflu 10,000 Courses Prepared to Study Innovative Treatments

    21. Human H5N1

    22. Critical Care Triage – Prioritize ICU Care Reconfigure/Expand ICU & Negative Pressure Beds Ventilators (UPMC – 425) Accelerate Life Cycle Purchase Mask Assisted Ventilation Ramp Up & Augment Critical Care Personnel – Immediate Team

    24. Home Care 3 Level Patient Prioritization Classification High Acuity ? Frequent Visits Medium Acuity ? Decreased Visits Low Acuity ? Telephone Follow-up Health Plan Communication – Reverse 911 RN Advice Line Websites & PrepLink

    25. Business Continuity Issues Equipment & Supplies – Engage Vendors I.T. – Backup & Redundancy Legal Coordinating with County & State Financial Viability – Payers Engaged Ensure Cash Flow Remove Edits & Pre-Authorizations Insurance Behavioral Health – CISM Patients, Families & Staff

    26. Ethical Issues

    27. Ethical Issues Utilitarian vs. Egalitarian Triage Hospital Critical Care Withdraw Life Support Procedural Protections Triage Review Board Common Standard & Community Buy-In

    30. “End Of The Beginning” Department & Business Unit Buy-In Individual Department & Facility Preparations Issues, problems, barriers Corporate Command Center Transformation From Coordination to Command & Control Training & Drills (AHRQ) “2007 Will Be Year of Exercises” (Fauci)

    31. What Can You Do?

    33. “Plans are useless but planning is indispensable” - Dwight David Eisenhower

    36. Questions?

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