Emergency Response Planning for the Small Health Service

1. Emergency Response Planning for the Small Health Service Anita L. Barkin Dr.P.H., M.S.N., C.R.N.P. November 19, 2014

2. Objectives • Introduce the emergency response planning concepts related to infectious disease and pandemic. • List key partners –internal and external- in the planning and implementation phases of the infectious disease/pandemic plan. • Review special considerations for smaller nurse-directed clinics with minimal resources.

3. Why plan? • More effective response to any public health threat/emergency. • Global travel increases speed and opportunity for the spread of disease. • There will be little time to act once the event starts.

4. Planning • Inclusive, collaborative • Plans must be flexible, adaptable, resilient • Plans must be tailored to the particular type of infectious disease • Plans must be tailored to address the particular needs of institution and available resources • Plans must be tested and rehearsed

5. Goal of Public Health: Slow down spread • Isolation of the sick • Quarantine of the exposed • Social Distancing • Actions taken to discourage close social contact between individuals • Public education • Accurate, clear • Consistent with those being given by other public health authorities

6. Role of Student Health • Support the goals of public health by: • being knowledgeable about infectious disease planning guidelines and recommendations. • having a plan to isolation the sick/quarantine the exposed. • developing an health education/communication plan. • To develop a detailed plan for Student Health operations. • To be an active participant in the campus-wide planning process.

7. Role of Student Health • To identify and establish contacts in the local health care community including hospitals, local health departments, emergency response personnel. • To provide sound medical and public health information to the incident commander, key decision makers and the campus community when an event occurs.

8. Getting Started • Who is responsible for emergency preparedness on your campus? • Does your school have an emergency response plan/template? • Can it be adapted for infectious disease/pandemic planning? • Who do you engage in the conversation on your campus to get emergency planning on the table?

9. Pandemic Planning Committee Members • Executive management (President, Provost, Chancellor or designees) • Student Health • Public Safety • Environmental Health & Safety • Public Affairs • Government Relations • Facilities Management • Student Affairs (residence life) • International Student Services • Housing • Dining • Human Resources • Risk Management • Telecommunications • Information Technology • Operations and Finance

10. Pre-event Planning Phase • Establish relationships with the local public health department and hospital emergency departments. • Create templates for communication. • Develop a protocol for screening travelers. • Develop protocols for managing a case or cases (will be tweaked according to the infectious disease) • What do you do when a student walks in the door? • When and how does a hand off to a medical treatment center occur? • What is your role after the patient is in the hands of the medical treatment center? • What is your role in mitigation strategies?

11. Key Considerations for Student Health Services • HealthServiceStaffeducationandpreparation • Engage staff in infectious disease/pandemic planning and provide exercises and drills to rehearse plan • Provide regular updates for staff on the latest developments regarding emerging threats • Vaccinations • Fit testing for N95s • Inservices on PPE

12. Key Considerations for Student Health Services • Supplies/equipment/services • Compile a list • Identify vendors/storage • Cleaning services, waste removal

13. Levels of Emergency Response • Level One – Unit Level Response • Student Health can handle situation solely or with the assistance of a few other departments. • Level Two – Small Scale EOC • Case(s) of an infectious disease with high mortality or morbidity that potentially threatens campus health & safety. • Level Three – Full EOC (Pandemic level) • Cases of an infectious disease with high mortality and morbidity that disrupts the conduct of university business.

14. Determining the level of response for an infectious disease • Can this situation be handled by the Health Service alone? • What are the ramifications of a case or cases to the institution? • Human Impact • Asset Impact • Mission Impact • If not: • What aspects of the response can be managed by Health Services • Who are your partners? External? Internal?

15. Unit Level Response Health Services Leads and Manages • Primary duties • Care/referral of the ill • How does the student access care? Transportation? • Identification of index case and assessment of mitigation strategies to limit transmission • Patient education/campus education • Isolation • Surveillance partners • Determine the nature/level of communication to targeted audience(s) • Crafted appropriate message(s) in advance of the event • Timing of messages – winter break travel, prior to commencement

16. Unit Level ResponsePossible Internal Partners • University Police or other transportation partner • Campus EMS • Coordinate response and provide case reports • Student Life • Residential support for the ill • Housing and Dining • Special meal accommodations • Isolation housing (single room) • Counseling Services • For student/friend/family member • Facilities Management • Special cleaning requirements

17. Possible External Partners • Local Public Health Department • Local Hospital Emergency Department/Urgent Care • What are the suggested protocols? • Is this a reportable disease? • If needed, what assistance can they provide to you?

18. Small Scale Emergency Response Center • Case(s) of an infectious disease with high mortality or morbidity that potentially threatens campus health & safety • Greater impact to the university • Executive leadership involvement • Requires coordination with multiple key stakeholders • Communication/media impact outside of campus

19. Role of Health Service Director • Depends on resources and role of Health Services on the Emergency Response Team • Very limited role: • Director/Member of the Emergency Response team in a consulting capacity • Limited role: • Liaison to local health department and other local health care partners • Review communication to the community • Health Services provides assessment and referral

20. Role of Health Service Director • Expanded role • Health Services director is the Incident Commander • Chief communicator • Creates the communications to campus in collaboration with Media Relations • Organizer • Leads the meetings of the Emergency Response Team

21. Level 2 Action Plan • Executive Leadership involvement • Internal Communications engaged • Establish and communicate a response protocol for suspected cases • Assist in planning/execution of a mass vaccination clinic, if appropriate

22. Communications • Communicate early and often • Timing of messages • Collaborate with media relations • Tweak the messages that were crafted in advance • Ensure materials are easy to understand and culturally appropriate

23. Content of Communication • Acknowledge responsibility for campus safety. • Reassure that the university is taking the situation seriously. • Say what you know, don’t know, what you are doing to prepare for an event. • Include the recommendations/policy on travel and workplace safety (handwashing, cover your cough). • Offer resources (CDC website, WHO website, HS website). • Establish expectations for further communication updates.

24. Communications • External • Maintain communications with local public health authorities, emergency preparedness groups, hospital systems • Identify key contacts • Participate in community planning/drills • Benchmark activities/planning of other like colleges and universities

25. Internal Partners • Housing and Dining • Identify additional isolation areas. • Assist in relocation of students if necessary. • Arrange for meal delivery. • Student Life/Activities • Assist with support for students in isolation housing. • Act in a surveillance role. • Consider mitigation strategies for student events (screening participants, hand washing stations). • Consider postponement/cancellation of events.

26. Internal Partners • Facilities Management • Restrict key access to buildings if needed. • Initiate decontamination protocols and manage turnover of isolation housing. • Assist with securing/moving additional medical and cleaning supplies. • Environmental Health & Safety • Contract with the hazardous material disposal company for waste disposal and disinfection. • Obtain and distribute PPE

27. Internal Partners • Telecom • Additional phone support for Health Services. • Office of International Education • Provide guidance regarding international student issues. • Assist in communication of travel advice to students studying abroad. • Identify contacts in host countries regarding access to health care, travel issues, status of disease in the region.

28. Internal Partners • Campus Police • Receive additional PPE training. • Implement a dispatch screening protocol. • Alert Health Services if encountering individuals with symptoms consistent with illness. • Human Resources • Prepare Call-off and or telecommuting policy for staff/faculty who are in isolation. • Communicate protocols or travel restrictions. • Communicate work expectations and leave policies.

29. Level 3Full Emergency Operations Center • Initiate National Incident Management Structure (NIMS) • Appoint health of Operations, Liaison, Logistics, Planning, Safety, Finance and Record Keeper • May have outside agency involvement – City, State, Federal

30. Role of the Small Health Service • Limited, likely advisory only. • Determine staffing, scheduling, hours of operations needed to support remaining students, if possible. Closure? • May support mass vaccination conducted by public health agency.

31. Executive Leadership Action Plan • Evaluate the institutional effects of the situation. • Notify Deans and Department Heads of decisions. • Provide oversight for family notifications. • Review business continuity plans. • Review audiences and content for internal and external communications. • Authorize a temporary suspension of classes, campus evacuation, closure.

32. Other Internal Response Partners • Telecom • Establishing a phone bank. • Student Life/Housing/Dining • Support students who cannot go home. • Counseling and Psychological Services • Providing teletherapy if possible. • Office of International Education • Providing advice to students who are studying abroad.

33. Other considerations • Human Resources • Identify personnel to staff essential functions. • Identify personnel available for telephone support work. • Campus Police • Enforcing public health orders • Securing the perimeter of isolation areas. • Securing the health care facility. • Maintaining civil order and controlling traffic. • Parking • Opening gates for evacuation • Arranging public transportation options.

34. Case Study 1: Active Case of TB 20 year old student from China presents to the Health Service with 3 week history of cough, fever, night sweats. His health history indicates that he his last PPD was one year ago. He traveled recently over winter break to see family. He lives in a residence hall. His fever is 100.8, he coughs throughout the exam. Actions: Instructs the patient to cover his cough and hands him a mask. The nurse dons an N95 mask as she is concerned about the possibility of TB. Arranges transport to the local emergency room with a mask on by way of the local ambulance company and informs them of her concerns. Calls Environmental Health and Safety to clean the room.

35. Emergency Response – Level 1 Operationalize the response plan when you find out from the local health department that the student is diagnosed with active TB and in isolation in the hospital. • Communication • with Health Dept, Student Affairs, Student Life • assist with contact tracing including any student(s) who were in the waiting room at the same time as the ill student. • Targeted communication to the academic dept. or residence hall • Assist with arrangements/provide post-exposure testing for HS staff and others potentially exposed. • Collaborate with the Health Dept. to ensure proper follow-up of contacts. • Monitor student’s return to campus – compliance with treatment protocol. • Advise Dean of Students of the possible impact on academic progress.

36. Case Study 2: Ebola Graduate student arrives from Liberia after spending winter break with family. She follows instructions given in a communication from HS sent to the campus community prior to students returning to campus for the spring term. She monitors her health and takes her temperature twice a day. On the 8th day after her return to the U.S., she notes the onset of fatigue and nausea. She has a low grade temp and calls the Health Service. The student is told to call the local ER to discuss how to approach for care.

37. Emergency Response – Level 2 • Health Services • Notify response team of the call and need to meet • This will hit media – increased institutional impact • Stay in touch with local health care agency for updates • Check on PPE supplies • Post instructions outside waiting room and on website regarding the procedure for accessing care • Reinforce phone screening with HS staff and Campus Police dispatch • Assist in preparation of communication to campus community • Be the voice of science…be the voice of reason…

38. Resources • ACHA website • www.acha.org/topics/ebola.cfm • www.acha.org/Publications/docs/ACHA_Guidelines_Emergency_Planning_AllHazards_Approach_Feb2011.pdf • CDC • http://wwwnc.cdc.gov/travel/page/advice-for-colleges-universities-and-students-about-ebola-in-west-africa • Medscape • EBOLA: CDC Enhanced Guidelines for Wearing PPE

39. “Between the extremes of panic and complacency lies the solid ground of vigilance.” Dr. Margaret Chan Director-General WHO

40. Questions