Office of Safe and Drug-Free Schools National Conference 2007 Pandemic Influenza Tabletop Exercise

Office of Safe and Drug-Free Schools National Conference 2007Pandemic Influenza Tabletop Exercise Facilitators: Pegi McEvoy, Seattle Public Schools Larry Borland, Douglas County School District August 4, 2007 DRAFT

Content • Exercise Rules • Exercise Objectives • Exercise Schedule • Pandemic Influenza Background Information • Scenario Briefings DRAFT

Exercise Rules • This exercise is conducted in a “non-attributable” environment • Scenario depicts a plausible pandemic influenza event • No trick questions or “hidden” agendas • Players have no previous knowledge of the scenario, and will receive information at the same time • Players will respond using existing plans, procedures and other response resources • Decisions are not precedent-setting and may not reflect your organization’s final position on a given issue DRAFT

Exercise Objectives • Assess school district hazard prevention measures, specifically those addressing infectious threats such as pandemic influenza • Assess school district preparedness • Faculty & staff training in pandemic flu awareness • Coordinate and assess communication plans as an emergency response activity among school districts and emergency response partners DRAFT

Exercise Objectives Con't. • Assess school district’s ability to recover from a pandemic influenza outbreak in order to resume normal activities • Coordinate and assess psychological support services for students and staff DRAFT

Sample Exercise Schedule • 1:00 P.M. Participant Sign-In • 1:30 P.M. Introduction • 1:40 P.M. Exercise Overview • 2:00 P.M. Read Module 1 • 2:10 P.M Module 1 Discussion • 2:30 P.M. Read Module 2 • 2:40 P.M. Module 2 Discussion • 3:20 P.M.Break • 3:30 P.M. Read Module 3 • 3:40 P.M. Module 3 Discussion • 3:50 P.M. Read Module 4 • 4:00 P.M. Module 4 Discussion • 4:20 P.M. Debriefing about Lessons Learned • 5:00 P.M. End of Exercise DRAFT

Pandemic Influenza • Of the few avian influenza viruses that have crossed the species barrier to infect humans • H5N1 has caused the largest number of detected cases of severe disease and death in humans; • H5N1 has potential to cause a pandemic influenza outbreak; • Half of those infected with the virus have died; • Most cases have occurred in previously healthy children and young adults FROM PARTICIPANT MANUAL APPENDIX A – CDC H5N1 FACT SHEET DRAFT

Pandemic Influenza • Symptoms • Typical human influenza-like symptoms • Fever, cough, sore throat and muscle aches • Eye infections, pneumonia and severe respiratory diseases • Severity of symptoms depends on which virus caused the infection FROM PARTICIPANT MANUAL APPENDIX A – CDC H5N1 FACT SHEET DRAFT

Pandemic Influenza • The H5N1 virus is resistant to two antiviral medications commonly used for influenza (amantadine and rimantadine) • Two other antiviral medications, oseltamavir (Tamiflu™) and zanamavir, would probably work to treat influenza caused by H5N1 virus • In April 2007, the Federal Government purchased from Sanofi Pasteur Inc. an H5N1 vaccine for inclusion in the Strategic National Stockpile (SNS) and to be distributed only by public health officials if needed • Other vaccines are being researched and developed FROM PARTICIPANT MANUAL APPENDIX A – CDC H5N1 FACT SHEET DRAFT

World Health Organization (WHO) Phases and Federal Government Response Stages (USG) Participant Manual Appendix D, CDC “Pandemic Influenza Community Mitigation Interim Planning Guide” DRAFT

WHO Phases, United States Government Response Stages (USG) and Pandemic Severity Index (PSI) Participant Manual Appendix D, CDC “Pandemic Influenza Community Mitigation Interim Planning Guide” DRAFT

WHO, USG and PSI • WHO and USG are reporting mechanisms describing the events (i.e., animal cases, human cases, deaths, etc.) • PSI is a planning tool and is based on epidemiologic measurements • Beginning at USG 3, USG & PSI are used together • PSI uses projections to gauge the potential impact and prompts specific community actions

Summary of the Community Mitigation Strategy by Pandemic Severity Participant Manual Appendix D, CDC “Pandemic Influenza Community Mitigation Interim Planning Guide” DRAFT

Scenario Briefing – Module 1May 2010 – July 2010 • Limited number of H5N1 cases in Asia, no human cases in United States • Increasing number of animal cases, very few human cases in Asian countries • Most H5N1 human cases attributed to contact with diseased animals • WHO issues Phase 3 pandemic alert indicating “no or very limited human-human transmission” DRAFT

Scenario Briefing – Module 1May 2010 – July 2010 • Limited number of H5N1 cases in Asia, no human cases in the United States • No cases of infection (in humans and animals) have been identified within the United States • Health and Human Services (HHS) developed Pandemic Influenza Plan • Centers for Disease Control (CDC) developed infection prevention and control measures for the public, school systems, hospitals, etc • United States allocated funding foradditionalvaccine research and development • Increasing media coverage raises public awareness on the threat of pandemic influenza DRAFT

Module 1 Key Discussion Questions • What kind of educational material is available to faculty, staff, students and parents about pandemic influenza? • Does the plan outline the decision-making process, key personnel, and criteria for cancelling classes or closing schools? For example, are decisions made by the education or health agency? At the State or local level? Or, collaboratively? • Has faculty, staff, community and emergency response partners been involved in providing input and feedback for crisis planning for schools? DRAFT

Module 1 Key Discussion Questions (cont.) • Will faculty and staff play a role in the incident command structure once the Incident Command System (ICS) is activated during an emergency? If so, what is the role? • Does the school have plans to acquire and maintain essential supplies, such as disinfectants, face masks, gloves, in the event of a pandemic influenza outbreak? DRAFT

Module 1 Additional Discussion Questions(as time allows) • Is the school district’s current emergency response plan suited for a pandemic influenza outbreak? • Has the State legislature drafted policy providing considerations and accommodations to local school districts in the event of a pandemic flu (i.e., reducing the number of required school days and allowing for additional leave for staff). • Is there a communication plan for keeping the district and schools informed of decisions regarding school scheduling and closures? DRAFT

Module 1 Questions DRAFT

Scenario Briefing – Module 2July 2010 – September 2010 (USG 4) • H5N1 human cases on the rise in Asia, few isolated human cases found in the United States • WHO issues Phase 6 pandemic alert, indicating efficient and sustained human-to-human transmission • Few cases in the United States • Isolated human cases in United States, some fatalities, USG 4 • PSI Standby activities are activated • CDC alerted hospitals, physicians and other healthcare and public health entities to prepare for a potential outbreak within the United States DRAFT

Scenario Briefing – Module 2July 2010 – September 2010 • H5N1 human cases on the rise in Asia, few isolated human cases found in the United States (cont.) • US hospitals see an increase in human cases over the next two months • Most severe cases seen in children and young adults • Virus spread by close-contact • H5N1 threatens school, because students are in close-contact and use the same equipment and facilities DRAFT

Scenario Briefing – Module 2July 2010 – September 2010 • H5N1 human cases on the rise in Asia, few isolated human cases found in the United States (cont.) • During the month of September 2010, the local hospital is treating more and more H5N1 patients • Most patients are children and young adults • On September 20, 2010, CDC confirmed several local media reports that the most recent human H5N1 outbreak occurred inside a high-rise apartment building in (City / District) • PSI moves to Activate • On September 26, 2010 the district cancels all classes and implements alternative teaching and learning activities DRAFT

Module 2 Key Discussion Questions • Does the school system have a surveillance system for absences? If so, is this system linked to the local health department or other health-related entity? • Does the school plan adequately address the maintenance of educational operations in the case of pandemic? If so, what plan is in place for maintaining continuity of instruction (tele-schooling, individual/group mentoring) for students? • What is the school procedure for school closure when a public health emergency has been declared? DRAFT

Module 2 Additional Discussion Questions(as time allows) • To address the fear of a pandemic influenza outbreak, does the school district have the capabilities to provide psychological support for student and faculty/staff when needed? • Does the school have established communication protocols with community and emergency response partners, such as local health departments and media, before and during a public health emergency? DRAFT

Module 2 Additional Discussion Questions (cont.)(as time allows) • What is the school’s plan to communicate with media for latest information dissemination? • What is the school’s plan to communicate with emergency response partners (e.g., public health) during pandemic influenza outbreak during a public health emergency? DRAFT

Scenario Briefing – Module 3October 2010 – December 2010 • Significant H5N1 human-to-human transmission in the United States • Surge in people seeking care for influenza-like illness • Epidemiological studies reveal schools and daycare centers are most vulnerable to outbreaks because people are in close quarters to one another and susceptible to the influenza virus • A pre-established partnership agreement between the district and the local public health agency provides vaccines to educators after the most vulnerable populations are treated.However, the supply is very limited. (It is possible that schools will not be provided any vaccines) • The Federal Government is working with foreign manufacturers to produce more vaccinations • USG 5 and PSI Level 5 moves to Activate DRAFT

Scenario Briefing – Module 3October 2010 – December 2010 • Significant H5N1 human-to-human transmission in the United States (cont.) • Schools in the district remain closed • USG 5 and PSI Level 5 -Activate DRAFT

Module 3 Key Discussion Questions What key procedures are in place to support the continuity of essential school operations, during a long term school closure? The following items should be considered during discussion • Air quality/HVAC system functions • Decontamination • Safe learning environment and alternative teaching and learning methods • Payroll • Line of Succession for all key staff • Collective Bargaining Agreements

Scenario Briefing – Module 4January 2011 • Human H5N1 cases on a steady decline…for now • Human H5N1 cases here in the United States and around the world have leveled off and begin to decline • The vaccine only offers limited protection from and immunity to the H5N1 virus • The Federal Government secured additional vaccinations and began to provide the vaccine to district personnel • Federal Government Response Stage at USG 6-PSI Level moved to Activate • After several months of closure, schools are back in session • Elevated rates of staff and student absenteeism (approximately 1/3) • Alternative learning activities are provided to affected students DRAFT

Scenario Briefing – Module 4January 2011 • Human H5N1 cases on a steady decline… for now… • Seasonal Flu Impact: concurrent epidemic of seasonal flu • Not over: Past experiences with pandemic flu outbreaks show outbreaks can occur in waves • H5N1 resurgence is a realistic threat • Recovery phase with standby community activities in place DRAFT

Module 4 Key Discussion Questions • How much time/school days does the district need to prepare to reopen individual schools within the district? For example, how many days are needed to: • Replenish cleaning and hygiene supplies; • Assess, identify and prioritize the order of individual schools to reopen; • Assess staff capacity, including substitutes (remember, nearby school district will also be recruiting substitutes); • Inform and train staff on health and prevention issues; • Inform parents of school reopening plans and procedures; and • Inform, train and modify learning environment to meet the needs of available staff and healthy students at school alongside alternative strategies addressing those at home. DRAFT

Module 4 Key Discussion Questions • What is the school’s plan to provide psychological support to faculty, staff, students and parents who have been in isolation for three months and are having difficulty re-adjusting to “regular life?” • What is the school’s plan to maintain monitoring for possible resurgence of the virus? DRAFT

Module 4 Additional Discussion Questions(as time allows) • Does the emergency management plan provide protocols standards for decontaminating the buildings and standards providing for a safe and healthy environment? • What kind of resources does a district need in order to rehabilitate the learning environment (i.e., what supplies and tool, how many staff, how many days.) For example, if the school was used as a community facility, such as a makeshift hospital or clinic or vaccine distribution site, what are the procedures for sanitizing the facilities? • Does the district have agreements in place with local and/or State emergency response entities regarding decontamination processes and determinations of safety? DRAFT

Module 4 Additional Discussion Questions (cont.) (as time allows) • Does the plan provide criteria for students and staff re-entering the school community and recontamination prevention programs? For example, those who have been exposed in the last seven days are not permitted to attend school. For those attending school, are there sufficient hand-washing supplies and information awareness campaigns preventing the spread of germs? Are social distancing programs in place? DRAFT

Module 4 Additional Discussion Questions (cont.) (as time allows) • What are the school’s procedures to maintain communication with community and emergency response partners in case H5N1 resurfaces? • What are the school’s efforts to communicate with parents, students and staff about the possibility of H5N1 resurfacing? • What is the school’s plan to provide psychological support for faculty, staff, and students due to influenza related fatalities? DRAFT

Exercise Debriefing Questions • Does the school emergency responseplan adequately address key issues, such as school faculty and staff training in pandemic flu knowledge and handling high morbidity and/or mortality in schools, in dealing with a mass influenza outbreak? • What issues did you identify in the emergency management procedures that could hinder emergency management efforts? • Does the school and district emergency response plan adequately address key issues faced during a long-term school closure, including continuity of instruction, feasibility of feeding students in school meal programs, continuity of business operations (e.g., payroll) and leave policies for teachers? DRAFT

Exercise Debriefing Questions Con't. • Do the school emergency management procedures properly coordinate communication as an emergency response activity among schools, school districts, community and emergency response partners during a pandemic influenza event? In your opinion, what can be done to maintain and coordinate communication during an emergency situation such as the pandemic influenza scenario presented in the exercise? • Does the plan provide adequate resources to the district and schools? Does the plan take into account those resources available regionally? Does the plan outline a process for requesting assisting and resources from local and state partners? • What are the roles and responsibilities of parents throughout the district’s pandemic influenza plan? Do they participate in prevention-mitigation activities? Preparedness? Response? Recovery? Are parents involved in the decision to cancel classes? At what level are they engaged? DRAFT

Exercise Debriefing Questions Con't. • Does the plan provide for adequate psychological support for students, faculty and staff before, during and after a mass influenza outbreak event? If not, what activities and partnerships can the team identify to enhance the mental health of faculty, staff and students? • Overall, is the school capable of effectively and efficiently recovering from a mass influenza outbreak in order to resume a safe learning environment? Can the team identify methods for hastening the disinfectant process? What social distancing strategies can be added? DRAFT

END OF EXERCISE Your input, feedback, questions and other issues identified during the exercise that can help improve school crisis planning. Currently, all events depicted in this exercise are fictional as there is no pandemic influenza outbreak in the United States. The ultimate goal of this exercise is to provide school districts as well as their respective community and emergency response partners an opportunity, through discussion of possible events, to better prepare for a pandemic flu outbreak. DRAFT

Office of Safe and Drug-Free Schools National Conference 2007 Pandemic Influenza Tabletop Exercise