PANDEMIC INFLUENZA ANNEX L

Transcription

1 THE SOUTHERN NEVADA HEALTH DISTRICT EMERGENCY OPERATIONS PLAN PANDEMIC INFLUENZA ANNEX L May Pandemic Influenza Annex L Draft Revisin Date: 10/22/09

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3 L SECTION: ANNEX L TITLE: SIGNATURE PAGE THE UNDERSIGNED STAFF IS IN CONCURRENCE WITH THE RESPONSIBILITIES OF THE FOLLOWING ANNEX TO THE SOUTHERN NEVADA HEALTH DISTRICT EMERGENCY OPERATIONS PLAN. Lawrence Sands, DO, MPH Chief Health Officer Date Jhn Middaugh, MD, Cmmunity Health Directr Date Sctt Weiss, Directr Administrative Services Date Glenn Savage, Directr Envirnmental Health Date Bnnie Srensn, RN, Directr Clinics and Nursing Services Date Stephen Smith, Esq. Attrney fr the District Date 3 Pandemic Influenza Annex L Draft Revisin Date: 10/22/09

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5 L SECTION: ANNEX L TITLE: DISTRIBUTION LIST THE UNDERSIGNED STAFF HAVE RECEIVED A COPY OF THIS DOCUMENT Name Department Date Executive Team SNHD Senir Management Team SNHD ET/SMT SNHD Pandemic Influenza Annex L Draft Revisin Date: 10/22/09

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7 L SECTION: ANNEX L TITLE: DOCUMENT CHANGE RECORD Current New Descriptin f Change Page Date Authr Revisin Revisin N. A B Pandemic phases t WHO Alert All Kay Gdby Phases. Use f Antiviral medicatin. Business Recvery Plan t Cntinuity f Operatins Plan. B C WHO alert phase update. All Kay Gdby 7 Pandemic Influenza Annex L Draft Revisin Date: 10/22/09

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9 L SECTION: ANNEX L TITLE: TABLE OF CONTENTS Sectin Page SIGNATURE PAGE... 3 DISTRIBUTION LIST... 5 DOCUMENT CHANGE RECORD... 7 TABLE OF CONTENTS... 9 PANDEMIC INFLUENZA ANNEX I. PURPOSE II. AUTHORITY III. EXPLANATION OF TERMS A. Acrnyms B. Definitins IV. SITUATION AND ASSUMPTIONS A. Situatin B. Assumptins V. CONCEPT OF OPERATIONS A. General B. Operatinal Guidance C. Activities by Phases f Emergency Management VI. ORGANIZATION AND ASSIGNMENT OF RESPONSIBILITIES A. Organizatin B. Assignment f Respnsibilities C. Task Assignments Cmmand and Cntrl Surveillance Preventin and Cntainment: Implementatin f Cmmunity Level Cntrl Measures Preventin and Cntainment: Use f Antivirals Preventin and Cntainment: Use f Vaccine Emergency Respnse: Health Systems and Critical Infrastructure Cmmunicating with the Public VII. DIRECTION AND CONTROL VIII. READINESS LEVELS IX. ADMINISTRATION AND SUPPORT A. Agreements and Cntracts B. Maintenance and Preservatin f Recrds C. Training D. Pst-Incident and Exercise Review X. ANNEX DEVELOPMENT AND MAINTENANCE A. Annex Develpment B. Review C. Update D. Resurces Pandemic Flu Plan at a Glance Pandemic Influenza Annex L Draft Revisin Date: 10/22/09

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11 SECTION: ANNEX L TITLE: Standards: PANDEMIC INFLUENZA & HIGHLY INFECTIOUS RESPIRATORY DISEASES ANNEX US Natinal Vaccine Prgram Office (NVPO), Natinal Incident Management System (NIMS), Centers fr Disease Cntrl (CDC), and Wrld Health Organizatin (WHO) L I. PURPOSE The purpse f the Pandemic Influenza and Highly Infectius Respiratry Diseases Annex is t prvide a guide fr Suthern Nevada Health District (SNHD) n hw t respnd befre during and after a pandemic situatin. This annex is intended as a cmpanin t the Nevada State Health Divisin Pandemic Influenza Respnse Annex t the State Mass Illness Plan. It is imperative t interpret the SNHD Pandemic Influenza Annex in the cntext f the State plan, alng with the SNHD Emergency Operatins Plan (EOP) and the Mass Prphylaxis Annex (Annex K). The Clark Cunty Office f Emergency Management (CCOEM) is respnsible fr the Clark Cunty EOP, an All-Hazards plan that encmpasses all Cunty agencies. Within this plan, the respnsibilities f SNHD are identified as lead r supprt in an all hazard apprach. The Pandemic Influenza Annex presented here is a part f the CCOEM Emergency Operatins Plan. II. AUTHORITY See the SNHD EOP Sectin I. III. EXPLANATION OF TERMS A. Acrnyms AAR After Actin Reprt ACIP Advisry Cmmittee n Immunizatin Practices APIC Assciatin f Prfessinals in Infectin Cntrl CCOEM Clark Cunty Office f Emergency Management CCSD Clark Cunty Schl District CDC Center fr Disease Cntrl CHO Chief Health Officer COOP Cntinuity f Operatins Plan CRI Cities Readiness Initiative DOC District Operatins Center 11 Pandemic Influenza Annex L Draft Revisin Date: 10/22/09

12 DPCAC Disease Preventin Cntrl Advisry Cmmittee EHD Envirnmental Health Divisin EMS Emergency Medical Services EOC Emergency Operatins Center EOP Emergency Operatins Plan HAN Health Alert Netwrk IC Incident Cmmander ICS Incident Cmmand System ILI Influenza-Like Illness MOU Memrandum f Understanding MRC Medical Reserve Crps NIMS Natinal Incident Management System NPI Nnpharmaceutical Interventins NRP Natinal Respnse Plan NRS Nevada Revised Statutes NSHD Nevada State Health Divisin OOE Office f Epidemilgy OPHP Office f Public Health Preparedness PIO Public Infrmatin Office POD Pint f Distributin PSI Pandemic Severity Index RSS Receive, Stage, and Stre SNHD Suthern Nevada Health District SNPHL Suthern Nevada Public Health Lab SNS Strategic Natinal Stckpile VAERS Vaccine Adverse Event Reprting System WHO Wrld Health Organizatin B. Definitins After Actin Reprt A written summary f the exercise that reflects strengths, weaknesses and areas fr imprvement. Antigenic Shift A sudden, majr change in the antigenic structure f a virus which is usually the result f a genetic mutatin. Disaster An ccurrence f a natural catastrphe, technlgical accident, r humancaused event that has resulted in severe prperty damage, deaths, and/r multiple injuries. District Operatins Center The prtected site frm which the Health District fficials crdinate, mnitr, and direct emergency respnse activities in an emergency. Emergency A cnditin f disaster r f extreme peril t the safety f persns and prperty within the area, caused by such cnditins as air pllutin, fire, fld, hazardus materiel incident, strm, epidemic, rit, drught, sudden and severe energy shrtage, plant r animal infestatins r disease, the Gvernr s warning f an earthquake r vlcanic predictin, r an earthquake r ther cnditins, ther than cnditins resulting frm a labr cntrversy. 12 Pandemic Influenza Annex L Draft Revisin Date: 10/22/09

13 Emergency Operatins Center Specially equipped facilities frm which gvernment fficials exercise directin and cntrl and crdinate necessary resurces in an emergency situatin. First Respnders First respnders in time f disaster, i.e. plice, fire, EMS, Public Health. Immuncmprmised Impaired r weakened immune system due t illness r drugs. Incident An ccurrence r event, either human-caused r thrugh natural phenmena, that requires actin by emergency respnse persnnel t prevent r minimize lss f life r damage t prperty and/r natural resurces. Incident Cmmander The individual respnsible fr the cmmand f all functins at the field respnse level. Incident Cmmand System A natinally used, standardized n-scene emergency management cncept specifically designed t allw its user(s) t adpt an integrated rganizatinal structure equal t the cmplexity and demands f single r multiple incidents, withut being hindered by jurisdictinal bundaries. (See Attachment 7) Influenza-Like Illness An illness that presents with symptms similar t influenza. Medical Reserve Crps A vlunteer rganizatin f Health Care Prfessinals wh strengthen their cmmunities by ffering their expertise thrugh the year as well as during times f cmmunity need. Nnpharmaceutical Interventin Mitigatin measure implemented t reduce the spread f an infectius disease but ne that des nt include pharmaceutical prducts, such as vaccines and medicines. Examples include scial distancing and infectin cntrl measures. Nvel Virus New strain f virus resulting frm antigenic shift. Pandemic Disease Epidemic ver a wide gegraphic area and affecting a large prprtin f the ppulatin. Syndrmic Relating t a grup f symptms that cllectively indicate r characterize a disease. IV. SITUATION AND ASSUMPTIONS A. Situatin Influenza is a highly cntagius viral disease with epidemics f influenza affecting hundreds f thusands f peple nearly every year. The ability fr influenza viruses t drift r frequently make slight structural changes ver time results in the appearance f the different strains that circulate amng the human ppulatin. Vaccines are develped t match the strains expected t circulate each year. 13 Pandemic Influenza Annex L Draft Revisin Date: 10/22/09

14 The ptential fr a pandemic exists if a nvel virus has the ability t spread easily frm persn t persn and can cause serius illness. The Wrld Health Organizatin (WHO) and the US Gvernment have defined phases f a pandemic t assist with the planning and respnse activities. The Wrld Health Organizatin (WHO) develped an alert system ( t help infrm the wrld abut the seriusness f a pandemic. The alert system has six phases, with Phase 1 having the lwest risk f human cases and Phase 6 psing the greatest risk f pandemic. The CDC has develped Interim Pre-pandemic Planning Guidance t help define the severity categry fr pandemic. Fr Categry 1, 2, and 3 pandemics, Alert is declared during U.S. Gvernment Stage 3, with step-wise prgressin by States and regins t Standby based n U.S. Gvernment declaratin f Stage 4 and the identificatin f the first human pandemic influenza case(s) in the United States. Prgressin t Activate by a given State r regin ccurs when that State r regin identifies a cluster f labratry-cnfirmed human pandemic influenza cases, with evidence f cmmunity transmissin in their jurisdictin. 14 Pandemic Influenza Annex L Draft Revisin Date: 10/22/09

15 B. Assumptins The perid f a pandemic influenza utbreak in a cmmunity will likely last frm six t eight weeks. There may be mre than ne wave in a given cmmunity. 15 Pandemic Influenza Annex L Draft Revisin Date: 10/22/09

16 Up t 25-30% f persns may becme ill in a majr pandemic influenza wave. Rates f influenza-related hspitalizatins and deaths may vary substantially. Estimates based n past pandemic influenza events indicate that % f the ppulatin may be hspitalized and % f the ppulatin may die. Influenza viruses are spread frm persn t persn primarily thrugh drplets generated by the cughing and sneezing f infectius persns. The incubatin perid fr influenza is ne t fur days, with an average f tw days. Adults typically are infectius frm the day befre symptms begin thrugh apprximately five days after illness nset. Children can be infectius fr greater than 10 days, and yung children can shed virus fr less than 6 days befre illness nset. Severely immuncmprmised persns can shed virus fr weeks r mnths. Medical care services will likely be severely taxed r verwhelmed. Ten percent r mre f the wrkfrce may be ut f wrk due t illness at the peak f a majr pandemic influenza wave. This estimate includes wrk lss while caring fr ne s self r fr ill family members. The time frm candidate vaccine strain t the prductin f the first vaccine dsage culd be six mnths r mre. Once vaccine is available, it may take five mnths t prduce an adequate supply f vaccine fr the entire US ppulatin (currently prductin capacity is apprximately five millin dses per week). Tw dses f vaccine administered 30 days apart may be required t develp immunity t a nvel virus. The federal gvernment will purchase all influenza vaccine during a pandemic. There is a limited supply f antiviral medicatins. Antiviral distributin t states will ccur thrugh the SNS. Lcal gvernments have the primary respnsibility t prvide public health, mental health and emergency medical services within their jurisdictins. SNHD will fcus n nn-pharmaceutical interventins (NPI) until vaccine is available. State gvernment will augment public health, mental health and emergency medical services that exceed the capabilities f the lcal gvernment. The Natinal Respnse Plan (NRP) will supprt public health and medical activities as required by the State f Nevada in accrdance with pre-established activatin prcedures. Refer t Attachment L-2 fr mre infrmatin regarding Federal and State rles during a pandemic. V. CONCEPT OF OPERATIONS A. General The SNHD will prvide a cnsistent apprach t the effective management f actual r ptential pandemic utbreaks t ensure the health and welfare f the residents f Suthern Nevada perating under the principles and prtcls utlined in the Natinal Incident Management System (NIMS). Prvisins must be made fr the fllwing: 16 Pandemic Influenza Annex L Draft Revisin Date: 10/22/09

17 Establishment f the Disaster Operatins Center (DOC). Crdinating health and medical respnse team effrts. Identificatin, transprtatin, and dispsitin f the deceased. Hlding and treatment areas fr the infected. Islatin and treatment f the infected. Identifying infectius diseases, cntrlling their spread, and reprting their presence t the apprpriate state r federal health authrities. Issuing health advisries t the public n such issues as drinking water precautins, waste dispsal, the need fr immunizatins, and fd prtectin techniques. B. Operatinal Guidance The SNHD will emply the six cmpnents f the NIMS in all peratins, which will prvide a standardized framewrk that facilitates ur peratins in all phases f emergency management. Attachment 7 f the SNHD EOP prvides further details n the NIMS and the Incident Cmmand System (ICS). The SNHD will use its wn resurces, all f which meet the requirements fr resurce management in accrdance with the NIMS, t respnd t emergency situatins, purchasing supplies and equipment if necessary, and request assistance if thse resurces are insufficient r inapprpriate. If additinal resurces are required, the SNHD will request CCOEM t: Summn thse resurces available t us pursuant t MOUs already in place. See Attachment 6 f the EOP fr a cmplete listing f agreements. Summn emergency service resurces that we have cntracted fr. Request assistance frm vlunteer grups active in disasters. Request assistance frm industry r individuals wh have the necessary resurces t deal with the emergency. SNHD will use the guidelines established by the Centers fr Disease Cntrl and Preventin (CDC) fr determining trigger pints fr implementing nnpharmaceutical interventins. A list f trigger pints can be fund in Attachment L-3 f this Annex. C. Activities by Phases f Emergency Management Preventin Give immunizatins. Cnduct specialized training. Cnduct epidemic intelligence, evaluatin, presentatin, and detectin f cmmunicable diseases. Cnduct pandemic awareness prgrams. Preparedness Maintain adequate medical supplies. Review emergency plans. Train and exercise persnnel. 17 Pandemic Influenza Annex L Draft Revisin Date: 10/22/09

18 Respnse Cnduct public infrmatin prgrams regarding persnal health and hygiene. Cnduct disease cntrl peratins. Begin the cllectin f vital statistics. Recvery Cmpile public health reprts fr state and federal fficials. Identify ptential and/r cntinuing hazards affecting public health. Distribute apprpriate guidance fr the preventin f the harmful effects f the pandemic. Cntinue t cllect vital statistics. VI. ORGANIZATION AND ASSIGNMENT OF RESPONSIBILITIES A. Organizatin The nrmal SNHD emergency rganizatin, as described in Sectin V f the SNHD EOP, will plan and carry ut peratins during emergency situatins. B. Assignment f Respnsibilities All departments assigned in this annex t prvide supprt are respnsible fr the fllwing: Designating and training representatives frm their department t include NIMS and ICS training. Ensuring that apprpriate prcedures are maintained. Maintaining current persnnel infrmatin and after-hurs ntificatin prcedures. T ensure that emergency functins are available as needed, SNHD departments have been assigned respnsibility fr specific activities. Thse activities and the assigned departments respnsible fr the activities are summarized belw. C. Task Assignments Cmmand and Cntrl SNHD will take the lead in planning fr a public health respnse t a pandemic. Existing individual cunty agency cmmand systems will be applied t pandemic influenza planning and respnse. These cmmand structures will delineate peratinal pririties within their agencies fr respnse activities befre, during and after a pandemic. SNHD is respnsible fr educating agencies fr preparatin f their departments pandemic respnse plan and ther lcal partners (e.g. McCarran Airprt, Las Vegas Metr Plice Dept., Clark Cunty Fire Dept., Las Vegas Fire Dept., etc.). WHO Phase Pandemic Influenza Annex L Draft Revisin Date: 10/22/09

19 The Chief Health Officer (CHO) r designee will: Prvide the Pandemic Influenza Annex t key plicymakers and ther stakehlders. The Office f Epidemilgy (OOE) will: Crdinate surveillance and epidemilgical investigatin activities including implementing nging influenza surveillance, planning fr pandemic epidemilgical investigatin and crdinating specimen cllectin and testing with the Suthern Nevada Public Health Lab (SNPHL). The Disease Preventin and Cntrl Advisry Cmmittee (DPCAC) will: Define and quantify lcal pririty ppulatin grups t receive vaccine r antiviral medicatins in case f a vaccine shrtage during a pandemic. The Immunizatin Prgram Crdinatr will: Crdinate planning fr the prcurement f vaccines, antivirals and supplies thrugh the Nevada State Health Divisin (NSHD). SNHD will cntinue t wrk with the vaccine distributrs and immunizatin prviders t identify existing vaccine stres in the cunty as well as gaps in the cverage fr pririty ppulatins. This includes netwrking with resrt prperties, hspitals, ambulatry care clinics, lng term care facilities and private vendrs. Crdinate planning, alng with the Office f Public Health Preparedness (OPHP), fr distributin f vaccines, antivirals and supplies. OPHP will: Crdinate planning, alng with the Immunizatin Prgram Crdinatr, fr the distributin f vaccines, antivirals and supplies. Maintain cntact with the Clark Cunty Medical Examiner s Office regarding plans t address mass mrtality events. Review and update the SNHD Pandemic Influenza Annex n an nging basis. Emergency Medical Services (EMS) will: Maintain infrmatin abut the capacity f hspitals and treatment centers thrugh the EM System. The Envirnmental Health Divisin (EHD) will: Crdinate activities related t planning fr the public health respnse t an identificatin f a nvel influenza strain in the animal ppulatin. The Public Infrmatin Office (PIO) will: Crdinate the planning f cmmunicatins activities fr a pandemic respnse and cllabrate with PIO s frm ther respnse agencies. Medical Reserve Crps (MRC) Crdinatr will: Cntinue t recruit medical and supprt vlunteers. Crdinate training fr existing and future vlunteers. 19 Pandemic Influenza Annex L Draft Revisin Date: 10/22/09

20 WHO Phase 4 The CHO r designee will: Initiate and maintain cmmunicatin cnnectivity with lcal, state and natinal cunterparts including CCOEM, State Health Officer, NSHD and the Center fr Disease Cntrl (CDC). The Office f Epidemilgy will: Mnitr the Health Alert Netwrk (HAN) and ther channels f infrmatin and will prvide nging assessments f the situatin t the CHO and ther key SNHD persnnel. Expand and enhance lcal surveillance activities and, if applicable, initiate case tracking activities. Alert the health cmmunity thrugh HAN, prviding an advisry t area hspitals and health care prviders t inquire abut recent travel t affected areas amng patients presenting with severe respiratry illness and t cnsider implementing severe respiratry illness precautins. Crdinate with area hspitals t ensure samples are directed t the crrect labratry fr testing. OPHP will: Ntify the Clark Cunty Schl District (CCSD) and resrt prperties t infrm them abut the pssibility f utilizing cunty schls, large venue and resrt prperties as mass vaccinatin sites in accrdance with memranda f understanding. The Envirnmental Health Divisin (EHD) will: Cnduct evaluatins and prvide guidance and advice t PIO, partners and licensees regarding develpment f EH measures t reduce viral transmissin ptential frm envirnmental surfaces and ther envirnmental means, as well as zntic surces. The Public Infrmatin Office (PIO) will: Crdinate with the Jint Infrmatin Center (JIC) t develp and disseminate apprpriate infrmatin t the public. Activate the Crisis and Emergency Risk Cmmunicatin Annex in the EOP. WHO Phase 5-6 The CHO r designee will: Activate the ICS t: Mnitr and respnd t the results f surveillance and tracking activities. Determine the need fr and scpe f mass vaccinatin activities. Crdinate delivery f vaccine and/r antivirals with NSHD. Carry ut mass vaccinatin activities in accrdance with the Mass Vaccinatin Annex and CRI-SNS Annex. Develp and disseminate apprpriate infrmatin t the public. 20 Pandemic Influenza Annex L Draft Revisin Date: 10/22/09

21 Ensure nging cmmunicatin with lcal, state and federal authrities. Cnsider implementing public health prtective measures fr residents f Suthern Nevada as apprpriate in accrdance with the state statutes listed in Sectin X f the EOP. Cmmunicate the status f the respnse t apprpriate lcal, state and federal authrities. Pst-Pandemic Perid. Surveillance The CHO r designee will: Cnvene relevant parties t debrief frm respnse activities. Cmmunicate the status f the respnse t apprpriate lcal, state and federal authrities. OPHP will: Review and update the Annex based n lessns learned frm respnse activities. There are seven influenza surveillance cmpnents that are designed t prvide a natinal picture f influenza activity. Refer t Attachment L-4 fr a list f these cmpnents. WHO Phase 1-3 The NSHD will: Cnduct passive surveillance f respiratry specimens received by the SNPHL fr viral islatin, and identificatin f influenza type and subtype. Frward psitive cultures t the CDC fr further sub-typing. Cnduct passive surveillance f influenza-like illness (ILI) utbreaks in lng-term care facilities. Receive reprts n the number f patients presenting with ILI and the ttal number f patient visits each week frm a vluntary statewide netwrk f sentinel physicians. The SNHD OOE will: Establish and crdinate the CDC sentinel surveillance system within Clark Cunty Cllabrate with Quest Labratries t establish a system whereby cunts f psitive rapid influenza test and influenza viral cultures are prvided t OOE n a daily basis year rund. Cllabrate with area hspitals t reprt ILI and syndrmic surveillance cunts frm ILI weekly respiratry illness emergency rm visits. WHO Phase 4 21 Pandemic Influenza Annex L Draft Revisin Date: 10/22/09

22 The OOE will: Ensure that all interpandemic influenza surveillance activities are underway regardless f the time f year, enhancing activities as needed based n infrmatin frm HAN alerts, Epi-X alerts, cmmunicatin frm state and federal partners and ther surces and investigating the epidemilgy f early cases thrugh case tracking activities and travel histry. Mnitr the HAN, CDC s Epi-X and ther apprpriate surces fr updates regarding internatinal, federal and state surveillance activities. Mnitr and institute recmmendatins frm CDC fr any additinal surveillance activities that will be undertaken given the specific circumstances. Reprt t state and federal partners abut increased lcal surveillance activities. If necessary, OOE will request additinal resurces fr lcal surveillance and case tracking activities (e.g. CDC Epidemilgical Intelligence Officers, reagents t detect and identify the nvel strain, instructins fr safe handling and testing f a ptential nvel influenza virus). Utilize HAN t ntify area hspitals, physicians, emergency rms and urgent care centers, requesting that they increase labratry diagnsis f influenza fr persns presenting with ILI, especially thse with recent travel histry t regins where the pandemic strain f influenza is circulating r thse with unusual r severe symptms. Crdinate with area hspitals, physicians, emergency rms and urgent care centers t prvide instructins fr directing samples frm patients presenting with severe r unusual ILI t the apprpriate labratry fr testing. Prvide instructins fr the cllectin and safe handling f a ptential nvel influenza virus. Assess, alng with SNPHL, the cmpleteness and timeliness f reprts frm all participating labratries and sentinel prviders. Issue regular alerts regarding surveillance and case tracking activities t the health cmmunity thrugh HAN. The SNPHL will: Cmmunicate with lcal labratries staff regarding the testing and reprting f ILI specimens. Assess, alng with SNHD OOE, the cmpleteness and timeliness f reprts frm all participating labratries and sentinel prviders. The CHO will: Recmmend, in crdinatin with the Reginal CDC Quarantine Officer, quarantine and the need t screen travelers arriving in the area frm affected cuntries. WHO Phase 5-6 The OOE will: Enhance nging surveillance activities t include mnitring and reprting f: Cmmunity health impacts, including deaths and hspitalizatins. 22 Pandemic Influenza Annex L Draft Revisin Date: 10/22/09

23 Pst-Pandemic Perid. Cmmunity impacts, including absenteeism in schls and essential services. Antiviral resistance Vaccine effectiveness. The OOE will: Prepare a detailed summary f the pandemic utilizing surveillance data t evaluate lcal respnse activities. Analysis may include: Severity f influenza utbreaks amng demgraphic grups. Age-specific attack rate. Mrbidity and mrtality. Efficacy f vaccinatin distributin and implementatin f infectin cntrl measures. Preventin and Cntainment: Implementatin f Cmmunity Level Cntrl Measures The gal f cmmunity level cntrl measures is t slw the spread f pandemic influenza as much as pssible and prvide additinal time fr the develpment, manufacture, distributin and administratin f influenza vaccine and antiviral medicatins. Public educatin abut practicing cugh etiquette and prper hand and respiratry hygiene is intended t decrease the prbability that cntact will result in infectin. Activities that include islating suspected cases and quarantining case cntacts, issuing travel advisries and canceling schls and large gatherings, are intended t decrease cntact between infected and uninfected individuals. WHO Phase 1-3 The PIO will: Cnduct nging educatin regarding the imprtance f hand hygiene, cugh etiquette and annual influenza vaccinatin. Maintain templates f dcumentatin needed t enact public health prtective measures including quarantine laws. Maintain cntact infrmatin t cmmunicate infrmatin abut public health prtective measures t area hspitals, CCSD, private schls, parks and recreatin departments, the child day care licensing authrity, hmewners assciatins, chambers f cmmerce, resrt prperties, etc. Develp plans fr cmmunicating infrmatin t the public abut cmmunity level cntrl measures including quarantine. WHO Phase 4 The CHO will: 23 Pandemic Influenza Annex L Draft Revisin Date: 10/22/09

24 Recmmend islatin f persns wh are recent travelers frm affected regins if they have ILI. If influenza is suspected r cnfirmed, SNHD may recmmend islatin at hme r in a hspital until islate sub typing is accmplished. Islatin shuld cntinue fr at least ten days beginning with the first nset f symptms, until viral shedding is n lnger detected, r until the islate is labratry cnfirmed nt t be a nvel influenza A virus. Recmmend quarantine fr case cntacts. Issue an advisry recmmending limiting travel t the affected regin and screening travelers arriving frm the affected regin fr illness cmpatible with influenza. Implement Drplet Precautins fr all persns with suspected r cnfirmed influenza. The virus is present in saliva, nasal secretins and feces. Recmmend that persns wh may be in cntact with ptentially infected animals wear apprpriate persnal prtective equipment and receive an influenza vaccinatin if available. Recmmend that citizens limit travel t destinatins utside f Clark Cunty as well as limit nn-essential travel within Clark Cunty. Recmmend cancellatin f large gatherings depending n the level f persn-t-persn transmissin and effectiveness f current islatin and quarantine prcedures. Based n the epidemilgy f the knwn infected cases, the CHO may cnsider clsure f schls including clleges, universities and clsure f ffice buildings. The PIO will: Increase educatin abut the imprtance f hand hygiene, cugh etiquette and annual influenza vaccinatin. WHO Phase 5-6 The CHO will: Recmmend that all persns wh are ill and their cntacts remain in islatin at hme. Recmmend limitatin r suspensin f large gatherings and recreatin activities. Recmmend the clsure f schls including clleges, universities and clsure f ffice buildings. Recmmend the limitatin f nn-essential wrk activities designated by entity, encuraging telecmmuting when pssible. Recmmend area quarantine. The PIO will: Prepare and disseminate infectin cntrl guidance t health facilities and prviders, schls, childcare centers, etc. Pst-Pandemic Perid. The PIO will: 24 Pandemic Influenza Annex L Draft Revisin Date: 10/22/09

25 Prepare a summary t include descriptin f the cmmunity level cntrl measures t implement. The OOE will: Cnduct an assessment f cmpliance with islatin and quarantine cntrl measures and evaluatin f their efficacy. Preventin and Cntainment: Use f Antivirals Apprpriate use f antivirals fr treatment r prphylaxis f viral respiratry illness r pandemic influenza may ffer a ptentially imprtant strategy t decrease illness cmplicatins and reduce mrtality, thereby minimizing the demands that will be placed n the healthcare system. The SNHD Antiviral Distributin Plan describes hw the SNHD will prepare fr and respnd t an influenza pandemic using antiviral medicatin, including activities arund allcatin, distributin, strage, and mnitring the administratin f the drug. This plan is Appendix A t the: SNHD Pandemic Influenza Plan, Annex L. Tamiflu (Oseltamivir) will likely be the primary antiviral utilized during a pandemic event. Relenza (Zanamivir) will likely be utilized fr Oseltamivir-resistant viruses and fr pregnant wmen. The existing supply and prductin capacity fr antiviral drugs is nt adequate t prvide treatment fr the anticipated number f persns expsed during a pandemic event. Therefre, it is crucial t priritize ppulatin grups t receive antivirals fr therapy during a pandemic event. WHO Phase 1-3 The Public Health Preparedness Planner will: Review CDC guidance defining pririty ppulatins t receive antivirals fr therapy and, where indicated, prphylaxis during a pandemic, befre antivirals and/r vaccine is widely available t all citizens. See Attachment L-5 fr the list f pririty ppulatins adpted by the CDC in July Determine initial estimates f the number f persns within each pririty ppulatin, revising the estimates during an actual event. The initial estimates are included in Attachment L-5. Crdinate amng Assciatin f Prfessinals in Infectin Cntrl (APIC) members t ensure that plans are in place t prvide antiviral therapy within their facilities. Cllabrate with NSHD and ther area jurisdictins t crdinate plans fr the prvisin f antiviral therapy. SNHD will crdinate with healthcare prviders t distribute influenza antiviral therapy t patients acutely ill with influenza within 48 hurs f nset f illness. WHO Phase 4 The Public Health Preparedness Planner will: 25 Pandemic Influenza Annex L Draft Revisin Date: 10/22/09

26 Review and mdify its plan fr the prvisin f antivirals as needed in respnse t the mst current infrmatin received regarding the nvel virus. Such updates may include recmmended target grups and prjected antiviral supply. The SNHD Operatins Sectin will: Ntify the medical cmmunity f the status f antiviral availability and plans t distribute supplies t the established pririty grups. The PIO will: Disseminate antiviral use guidelines t the medical cmmunity. WHO Phase 5-6 The Incident Cmmander will: Cmmunicate with NSHD regarding the availability and, if applicable, the delivery f antivirals thrugh the SNS. The NSHD will: Receive, stage, and stre (RSS) the SNS. Deliver antiviral medicatins t designated lcal RSS site(s). The Public Health Preparedness Planner will: Prvide NSHD with an estimated number f persns within each pririty ppulatin t receive antivirals as well as the ppulatin as a whle. Evaluate antiviral delivery and administratin prcedures and mdify plans as necessary t include the lcal RSS site(s). The SNHD Operatins Sectin will: Crdinate with NSHD and area treatment centers t ensure that antivirals are apprpriately allcated amng treatment centers frm the RSS. Pst-Pandemic Perid. The Operatins Sectin will: Discntinue and dembilize antiviral administratin ensuring that supplies are inventried and returned as apprpriate t the lcal RSS site(s). The Planning Sectin will: Prepare a summary describing and evaluating antiviral delivery and administratin prcedures, and mdify plans as necessary. Preventin and Cntainment: Use f Vaccine Vaccine is the primary cntrl measure during an influenza pandemic. Because current manufacturing prcedures require fur t eight mnths befre large amunts f vaccine are available fr distributin, there culd be a large gap between identificatin f a pandemic strain and availability f vaccine. Further, nce vaccine becmes available, 26 Pandemic Influenza Annex L Draft Revisin Date: 10/22/09

27 prductin capacity may allw fr just ne t tw percent f the ppulatin being vaccinated per week. Therefre, it is necessary t plan fr the allcatin f vaccine based n pririty ppulatin grups. WHO Phase 1-3 SNHD Nursing/PIO will: Initiate and/r cntinue activities t enhance annual influenza vaccinatin cverage levels in traditinal high-risk grups, particularly subgrups in which cverage levels are lw. Activities will be carried ut prir t the beginning f the traditinal influenza seasn each year and will include: Evaluating and implementing epidemic cntrl strategies, e.g. recmmendatins frm NSHD and CDC. Disseminating educatinal materials t area health care prviders including a summary f the mst current influenza vaccine recmmendatins, suggested strategies fr reaching at-risk ppulatins and a list f resurces t help prmte and deliver influenza vaccine t patients. Prviding educatin t area hspital staff abut the imprtance f vaccinating healthcare wrkers and patients with high-risk medical cnditins. Prviding educatin t area nursing hme and assisted living facility staff abut the imprtance f vaccinating persns ver the age f 65. Recmmending that all healthy children ver age 6 mnths receive the apprpriate influenza vaccine and wrk with area pediatricians and schl nurses t peratinalize this recmmendatin. Recmmending that all persns respnsible fr cmmunity safety and security receive annual influenza vaccinatin including emergency medical persnnel, plice and firefighters. Utilizing traditinal and nn-traditinal cmmunicatins channels t educate the general public abut the imprtance f annual influenza vaccinatin. Maintaining current infrmatin abut influenza and influenza vaccinatin n the SNHD website. Infrmatin will be targeted t the healthcare cmmunity and t the general public. Educating lcal businesses abut the imprtance f a vaccinated wrkfrce. Advcating t state and federal partners the develpment f a standardized methd t track and reprt vaccine shipments frm private cmpanies t lcal entities in rder t quickly assess distributin during a vaccine shrtage. Initiate and/r cntinue activities t enhance pneumcccal vaccinatin cverage levels in traditinal high-risk grups t reduce the incidence and severity f secndary bacterial pneumnia. Such activities will ccur in cncert with the activities described in the bullets abve. The Public Health Preparedness Planner will: Review CDC guidance defining pririty ppulatins t receive vaccine fr prphylaxis during a pandemic befre vaccine is widely available t all 27 Pandemic Influenza Annex L Draft Revisin Date: 10/22/09

28 citizens. See Attachment L-6 fr the list f pririty ppulatins adpted by the CDC in July Determine and maintain estimates f the number f persns within each pririty ppulatin, revising the estimates n an annual basis. These estimates are included in Attachment L-6. Review and update the methdlgy within its Mass Vaccinatin Annex (T be develped) and Mass Prphylaxis Annex (Annex K) fr prviding vaccinatin during a pandemic in the event f a severe r mderately severe vaccine shrtage. Review and update its Mass Vaccinatin Annex and Mass Prphylaxis Annex t ensure that it addresses issues relevant t the prvisin f influenza vaccine. This plan includes infrmatin relevant t prviding vaccinatin t the general public nce vaccine becmes widely available, including: Sites t use as mass vaccinatin clinics. Staffing needs and duties. Prtcls fr prper strage f vaccine. Prtcls fr vaccine clinic peratins. Mdel clinic flw design. WHO Phase 4 The Public Health Preparedness Planner will: Review and mdify the Mass Vaccinatin Annex and CRI as needed in respnse t the mst current infrmatin received regarding the nvel virus. Such updates may include recmmended target grups and prjected vaccine supply availability. Assess its human resurces and lgistics capabilities using the staffing calculatr t ensure that apprpriate staff and supplies are available t supprt activities assciated with the prvisin f vaccine at Pints f Distributin centers, if necessary, and if available. If SNHD is unable t staff, resurces will be requested frm CCEOC. A waiver will be requested frm the Gvernr t allw nn licensed persnnel t distribute medicatin. The MRC Crdinatr will: Ntify vlunteer base t be n alert fr the Emergency Ntificatin System call-dwn. WHO Phase 5-6 The Operatins Sectin will: Cmmunicate with the NSHD ffice regarding the availability and delivery f vaccine. Reprt vaccinatin activities t the Operatins Sectin Chief ensuring that supplies are distributed, administered, inventried and returned as apprpriate. The Public Health Preparedness will: 28 Pandemic Influenza Annex L Draft Revisin Date: 10/22/09

29 Prvide NSHD with an estimated number f persns within each pririty ppulatin. Evaluate vaccine delivery and administratin prcedures and mdify plans as necessary. SNHD Nursing will: Prvide vaccine as it is available t pririty grups based n the methdlgy described in Attachment L-6 prir t widespread vaccine availability. Track and mnitr adverse vaccine reactins. SNHD will prvide persns receiving vaccine with infrmatin abut reprting such reactins t nursing. SNHD will reprt (via Adverse Reactin Line: ) any reactins t the CDC Vaccine Adverse Event Reprting System (VAERS). The CHO r designee will: Fully activate mass vaccinatin activities accrding t the Mass Vaccinatin Annex and Mass Prphylaxis Annex upn widespread vaccine availability. The MRC Crdinatr will: Assign vlunteers t tasks/lcatins as they check in and prvide identificatin badges. Pst-Pandemic Perid. The CHO r designee will: Discntinue and dembilize mass vaccinatin activities, ensuring that supplies are inventried and returned as apprpriate fllwing the Mass Vaccinatin Annex. The Planning Sectin will: Prepare a summary describing and evaluating vaccine delivery and administratin prcedures, and will mdify plans as necessary. Emergency Respnse: Health Systems and Critical Infrastructure While the SNHD EOP addresses all hazards, pandemic influenza differs frm many threats. Of great cncern, during a pandemic event is its effect n the capacities f the healthcare system and ther critical cmmunity services. WHO Phase 1-3 The Public Health Preparedness Planner will: Cntinue t wrk with area hspitals t ensure that plicies, plans and prtcls fr mass dispensing fr staff, family members and patients are develped and maintained. 29 Pandemic Influenza Annex L Draft Revisin Date: 10/22/09

30 Cllabrate with such partners as CCOEM and their Advanced Plan within the Mass Casualty Annex, and the City f Las Vegas Fire and Rescue t develp and maintain an inventry f the fllwing resurces: Hspital and lng-term care bed capacity Intensive care unit capacity Ventilatrs (thrugh NHA and City f Las Vegas Fire Dept.) Persnal prtective equipment. Specimen cllectin and transprt materials. Surces f cnsumable medical supplies. Medical persnnel wh may be utilized during an emergency situatin. Pharmacies and pharmacists. Cntingency medical facilities thrugh CCEOC. Mrtuary/funeral services thrugh Crner s ffice. Scial services/mental health services/faith services. Crdinate with CCOEM t estimate the impact f pandemic influenza n healthcare services and critical infrastructure within Clark Cunty. The OOE will: Utilize the CDC FluAid prgram t derive these estimates. WHO Phase 4 The OOE will: Regularly prvide updated infrmatin abut the epidemilgy and transmissin f the nvel virus t the lcal healthcare cmmunity including EMS and hspitals thrugh HAN. The CHO will: Recmmend that EMS and hspitals activate severe respiratry illness prtcls and prvide guidance abut the apprpriate use f persnal prtective equipment thrugh HAN. The IC will: Establish regular cmmunicatin with CCOEM, prviding updated infrmatin abut the epidemilgy and transmissin f the nvel virus. WHO Phase 5-6 The IC will: Request CCOEM t activate the EOC t manage the needs f health, medical and essential service agencies during the pandemic. Designate a liaisn t the EOC t cmmunicate timely and accurate infrmatin abut the epidemilgy f the pandemic and the status f the public health respnse. The OOE will: Cntinually review infrmatin abut the epidemilgy f the pandemic. Based n this data, the OOE will develp and prvide the EOC with 30 Pandemic Influenza Annex L Draft Revisin Date: 10/22/09

31 prtective actin recmmendatins fr the health, medical and essential services sectrs. Pst-Pandemic Perid. The IC will: Participate in recvery and dembilizatin effrts in crdinatin with the EOC. The After Actin Reprting Cmmittee will: Prvide CCOEM with an assessment f the health impact f the pandemic and an evaluatin f the public health respnse. Cmmunicating with the Public Cmmunicating infrmatin t the public abut pandemic influenza will be carried ut accrding t plicies and prcedures described in the SNHD Crisis and Emergency Risk Cmmunicatin Annex. This dcument details the means, rganizatin and prcess by which SNHD PIO will prvide infrmatin and instructins t the public befre, during and after a public health threat r emergency such as pandemic influenza. The PIO will prvide infrmatin regarding the fllwing during a pandemic event: WHO Phase 1-3 Hand and Respiratry hygiene (e.g. regular hand washing, cver yur cugh), self-islatin (e.g. staying hme with flu-like illness), and careseeking fr high-risk adults with flu-like illness (e.g. Call yur physician if... ). Up-t-date web pages n influenza activity, preventin and cntrl. A webpage devted t general influenza infrmatin, avian influenza and pandemic influenza including vaccine availability, updates and preventin infrmatin is available n the SNHD website. WHO Phase 4 The basis f influenza, high-risk ppulatins and recmmended preventive practices. The epidemilgy f the pandemic. The symptms that shuld prmpt seeking medical assistance. Cncepts such as islatin and quarantine. WHO Phase 5-6 The availability f vaccines and antivirals and the ratinale fr prviding medicatin t pririty grups during vaccine and antiviral shrtages. The lcatin and schedule f peratins f mass vaccinatin sites t receive vaccine and/r antivirals. Pst-Pandemic Perid. Crdinate with the CDC, State and Lcal agencies fr apprpriate infrmatin release messages t ensure cnsistency. 31 Pandemic Influenza Annex L Draft Revisin Date: 10/22/09

32 Prmptly respnd t rumrs and inaccurate infrmatin t minimize cncern, scial disruptin and stigmatizatin. Re-release phne bank, web-sites and ther pints f cntact fr the public t address cncerns. Cmmunicate hw peple wh were nt immunized can still d s in the lcal area. The SNHD has a dedicated htline number, (702) 759-INFO (4636). This number can be staffed by vlunteers and can be rlled t an internal phne bank cnsisting f multiple lines t handle a larger vlume f calls. Additinally, if the numbers f calls warrant additinal resurces, the Health District has a cntract with Rcky Muntain Pisn and Drug Center and is able t frward calls t their call center. During this prcess SNHD will furnish Rcky Muntain Call Center persnnel with update FAQs and updated respnse infrmatin as necessary. The Crisis and Emergency Risk Cmmunicatin Annex is maintained by the SNHD PIO. VII. DIRECTION AND CONTROL A. General The CHO is respnsible fr establishing bjectives and plicies fr emergency management and prviding general guidance fr disaster respnse and recvery peratins, all in accrdance with NIMS and ICS. During disasters, he/she may carry ut thse respnsibilities frm the DOC. The Incident Cmmander (IC), assisted by a staff sufficient fr the tasks t be perfrmed, will manage the emergency respnse n-site. B. Line f Successin T ensure cntinuity f activities during threatened r actual disasters, the fllwing line f successin is established fr the CHO: Chief Health Officer Assistant Chief Health Officer Directr f Cmmunity Health Services Manager f OPHP VIII. READINESS LEVELS As intelligence and infrmatin is gathered, a determinatin will be made by the Incident Cmmander regarding the readiness level that the district shuld be perating under t ensure apprpriate respnse. The fllwing activities will be perfrmed fr each readiness level: Level 0 Nrmal cnditins Review and update plans. Review assignment f all persnnel. Crdinate with lcal private industries n related activities. Maintain a list f health and medical resurces. 32 Pandemic Influenza Annex L Draft Revisin Date: 10/22/09

33 Maintain and peridically test equipment. Cnduct apprpriate training, drills and exercises. Develp tentative task assignments and identify ptential resurce shrtfalls. Establish a liaisn with all health and medical facilities. Level 1 Increased Readiness Check readiness f health and medical equipment, supplies and facilities. Crrect any deficiencies in equipment and facilities. Update Emergency Ntificatin System cntact list. Ntify key persnnel f pssible emergency peratins. Review prcedures fr relcating patients and determine the availability f required specialized equipment if evacuatin f health and medical facilities may be required. Level 2 High Readiness Alert persnnel t the pssibility f emergency duty. Place selected persnnel and equipment n standby. Identify persnnel t staff the DOC if activated. Level 3 Maximum Readiness Mbilize health and medical resurces t include persnnel and equipment. Dispatch health and medical representatives t the CCEOC when activated. IX. ADMINISTRATION AND SUPPORT A. Agreements and Cntracts Shuld district resurces prve t be inadequate during an emergency, requests will be made fr assistance frm ther lcal jurisdictins, ther agencies, and industry in accrdance with existing mutual aid agreements and cntracts and thse agreements and cntracts cncluded during the emergency. Such assistance may include equipment, supplies, r persnnel. All agreements will be entered int by authrized fficials and shuld be in writing whenever pssible. Agreements and cntracts shuld identify the lcal fficials authrized t request assistance pursuant t thse dcuments. The agreements and cntracts pertinent t emergency peratins which SNHD is a party t, are summarized in Attachment 6 f the EOP. B. Maintenance and Preservatin f Recrds Maintenance f Recrds Operatinal recrds generated during an event will be cllected and filed in an rderly manner. A recrd f events must be preserved fr use in determining the pssible recvery f emergency peratins expenses, respnse csts, settling claims, assessing the effectiveness f peratins, and updating emergency plans and prcedures. Dcumentatin f Csts All departments and agencies will maintain recrds f persnnel and equipment used and supplies cnsumed during emergency peratins. 33 Pandemic Influenza Annex L Draft Revisin Date: 10/22/09

34 Preservatin f Recrds Vital health & medical recrds shuld be prtected frm the effects f a disaster t the maximum extent pssible. Shuld recrds be damaged during an emergency situatin, prfessinal assistance fr preserving and restring thse recrds shuld be btained as sn as pssible. C. Training It will be the respnsibility f each department head t ensure that persnnel, in accrdance with NIMS and ICS, pssess the level f training, experience, credentialing, currency, physical and medical fitness, r capability fr any psitins they are tasked t fill. D. Pst-Incident and Exercise Review The EOP will remain in peratin until full recvery is achieved as per the Cntinuity f Operatins Plan (COOP). The COOP is activated when necessary as part f the EOP. The CHO is respnsible fr rganizing and cnducting a critique fllwing the cnclusin f a significant emergency event/incident r exercise. The After Actin Reprt (AAR) will entail bth written and verbal input frm all apprpriate participants. An Imprvement Plan will be develped based n the deficiencies identified, and an individual, department, r agency will be assigned respnsibility fr crrecting the deficiency and a due date shall be established fr that actin. X. ANNEX DEVELOPMENT AND MAINTENANCE A. Annex Develpment The SNHD CHO is respnsible fr apprving and prmulgating this annex. B. Review The Plan and its annexes shall be reviewed annually by SNHD Office f Public Health Preparedness (OPHP). The CHO has designated the OPHP Manager t test, review and update this annex at least annually. C. Update This annex will be updated based upn deficiencies identified during actual emergency situatins and exercises and when changes in threat hazards, resurces and capabilities, r district structure ccur. The plan and its annexes must be revised r updated by a frmal change at least annually. Respnsibility fr revising r updating this annex is assigned t the Public Health Preparedness Planner. Revised r updated planning dcuments will be prvided t all departments, agencies, and individuals tasked in thse dcuments. D. Resurces 34 Pandemic Influenza Annex L Draft Revisin Date: 10/22/09