Pandemic/Health Emergency June Pandemic/Health Emergency Annex

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Marilynn Eaton
6 years ago
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1 Annex

2 Table of Contents Introduction and Purpose Page 3 Impact Scenarios Page 3 Activation Triggers Page 4 Planning Assumptions Page 4 Planning, Preparedness and Readiness Page 5 Concept of Operations Page 7 Acronyms Page 10 References/Supporting Information Page 10 Record of Changes Page 11

3 Introduction and Purpose This Annex describes the actions required for the Red Cross to effectively respond to a public health emergency (PHE), including influenza (flu) epidemics or pandemics, while still providing core disaster response services. Included also are assumptions that will affect response capability, expectations of Red Cross activities, and needs generated by the effects of a Public Health Emergency. It applies whether the Public Health Emergency only affects a local area or is nationwide. Impact Scenarios The range of potential impacts from an Avian Flu or other flu pandemic can vary widely, based on the virulence of the specific virus. The range of impacts can be illustrated by examining the impacts within the United States of the last three flu pandemics (1918, 1958 & 1968) 1, Impacts /1968 Illness 90 million 90 million Outpatient care 45 million 45 million Hospitalization 9,900, ,000 ICU 1,485, ,750 Deaths 1,903, ,000 While some of the differences in the number of deaths may be due to advances in medical care, the virulence and ease of transmission of the virus plays a significant role in determining the ultimate impact. According to the Center for Disease Control, the 1918 Spanish Flu spread across the United States in less than 3 weeks. Approximately 30-40% of the population ultimately became infected with the disease. The post-breakout public health response to the pandemic will vary somewhat based on the timing of the development of a vaccine for the virus involved. If no vaccine is available, the outbreak will be more widespread and potentially deadly. Expected public health containment strategies are expected to include the following measures: 1 Source: HHS Pandemic Influenza Plan, page 18

4 Pro-active monitoring Restricting travel and public gatherings in areas with a significant outbreak Mass inoculation (assumes a vaccine is available) Mass distribution of anti-viral drugs Extensive health educational outreach Home quarantine and isolation Group quarantine Activation Triggers This annex will be activated when any one of the following conditions applies: The local Public Health agency announces a current or pending Public Health Emergency. The U.S. Department of Health and Human Services/Centers for Disease Control and Prevention (CDC) announces a current epidemic or pending/current pandemic affecting portions or all of the United States, including U.S. Territories. Indian Health Services announces a current Public Health Emergency for any Tribal Nation in the chapter jurisdiction. Planning Assumptions Public Health Emergencies (PHEs) may be local, regional, nationwide or pandemic. If the Public Health Emergency is a pandemic, it may be characterized by public health authorities as mild, moderate, or severe. The avian flu virus may or may not be the triggering virus. The virulence of the specific virus and related impacts can vary by a factor of 10. Outbreaks will normally peak in fall and winter and run in cycles that will last at least 6-8 weeks. These cycles could last up to a year. The epidemic may unfold gradually or spread rapidly. For a severe pandemic, there will be economic impacts to many communities. Government authorities may use all legal options to minimize the transmission of disease, to include limiting travel, imposing quarantine or isolation, shutting down mass transportation, and banning or limiting public gatherings. Travel restrictions may be implemented either regionally or nationally based on the situation Some Public Health Emergencies will affect regional operations because of high levels of absenteeism, public health recommendations for social distancing, and other threat-specific consequences. Constituent expectations of Red Cross activities and roles will need to be managed. The Red Cross may be asked to perform non-traditional roles. National headquarters will develop additional guidance as needed during the course of the Public Health Emergency.

5 Regional groupings and national headquarters will continue to respond to disasters of all types and sizes. If the Public Health Emergency is nationwide, the regional grouping will need to initiate and sustain disaster responses with few, if any, outside Red Cross resources. For large disasters typically requiring outside resources, there may be major delays in receiving these resources. The travel restrictions may significantly impact the organizations ability to respond to other large natural disasters. Due to travel restrictions and personal concern for safety, service delivery will be more dependent on local chapter volunteers than national DSHR assigned personnel. There may be an increased number of local disasters, such as single and multi-family fires, because more people will be legally or voluntarily quarantined or isolated in their homes. Red Cross volunteers and employees will have the same relative infection rate as the general public, will need to follow precautions from public health agencies, and may not be available to respond to disasters. Red Cross volunteers and employees will also become victims (projected 30-40% of population will become sick). In addition many volunteers will not be willing to participate for fear of being exposed to influenza. Red Cross will not put workers at significant risk and will need to pro-actively provide workers with specific risk and personal safety training. Red Cross will also need to develop special worker health screening criteria to ensure volunteers with highrisk pre-existing conditions are not put in dangerous situations. The regional grouping has active, qualified, Disaster Health Services (HS) and Disaster Mental Health Services (DMH) volunteers, and/or have the ability to recruit them from the community as needed. Service delivery requests will flow to Red Cross at both a national and local level. Quick evaluation of appropriate response will be necessary. The organizations capacity will potentially be overwhelmed by service delivery requests. Red Cross will avoid establishing congregate care shelters in areas where there are active outbreaks. Any food deliveries will be one-way with no feeding equipment being returned. Regular vendors could be incapacitated by effects of the influenza. Additional and atypical resources might be necessary to meet the needs of the community. The regional grouping has the ability to provide public information and educational materials. Security issues could be exacerbated by the impression that Red Cross volunteers and employees have access to or are transporting scarce resources (e.g. vaccines). The region has a Continuity of Operations Plan (COOP) in-place, and can initiate the personnel succession portion of it if needed. Planning, Preparedness and Readiness As outlined in the All Hazards Plan, planning, preparedness and readiness are all very important aspects of disaster response. It is imperative that all parts of the organization be knowledgeable and work to prepare for public health emergencies. A key component

6 is working closely with government partners, most especially public health and emergency management to ensure communication, collaboration, consistent messaging and actions for the safety of Red Cross volunteers, workers and clients. Regional Groupings Identify and plan with local community groups, such as local food banks, their member community agencies that distribute food, and other service providers to prepare to expand their capacity to assemble and distribute food supply kits. If the region has a contract for medical transportation, they must have clarification from Risk Management to carry out this service in a Public Health Emergency. This should be a discussion and an agreement developed during the planning phase. Collaboratively plan with local public health department and emergency management agency to identify appropriate Community Services roles for the Red Cross. Establish response management succession plans and cross-train personnel to ensure the ability to continue to provide Community Services following natural and other disasters (assuming that up to 40% of staff may become ill during a pandemic). In collaboration with the local public health department, identify medically and ethnically appropriate food and other supplies that may need to be distributed to people in home isolation or quarantine. Identify vendors and set up accounts for supplies and services that will be required to establish large food and supply distribution programs. These could include the following: o Truck and Van rental o Food and other supplies o Medical support supplies o Cardboard boxes o Printing services for health educational material o Warehouse and other storage space National Headquarters/Disaster Operations Center Increase the Red Cross stockpile of packaged food. Begin planning with major food vendors and non-governmental partners on how we can collaborate to do large-scale food and supply distribution. Begin discussions with national delivery vendors (FEDEX, UPS, DHL, USPS) to determine how they can potentially assist with distribution of food and supplies.

7 Talk to government partners about the potential for reimbursement for hotel costs if that form of emergency housing instead of shelters is used to limit opportunities for disease transmission. Initiate discussions with government partners about increasing the availability of shelf stable meals such as MRE s (meals ready to eat) in their inventories. Identify and set up accounts with regional vendors for pre-packaged meals. Define the contents and packaging of several versions of a 10-day family supply kit (beyond the current food and feeding support supplies). Continue to develop specific worker safety guidelines, personal protections equipment (PPE) specifications and contagious disease prevention training. Provide guidance on what materials Red Cross will purchase and provide through bulk distribution to people restricted to their homes because of quarantine or isolation versus what we will look to local government to procure. In collaboration with the Centers for Disease Control (CDC) and other federal agencies, determine what medical support supplies may need to be distributed to people in home quarantine or isolation and determine who will provide the materials. Response Concept of Operations Following a nationwide influenza pandemic, local public health departments are expected to request a wide variety of support services from the Red Cross. Mass Care and Individual Assistance response activities will be established following national guidelines, but will be delivered with local resources and adapted to regional situations. Travel restrictions, wide-spread service demand and fear of exposure are expected to significantly limit the ability to deploy out-ofarea DSHR personnel. Considering these issues, chapters need to integrate their pandemic response planning activities with their local and state public health departments. Regional groupings should begin identifying community partners, businesses and other resources to assist in providing the feeding, bulk distribution and other services that will be required. Many of the normal business processes will need to be modified to adapt to providing services during a pandemic. Some of the likely changes include: Use motels and other forms of housing for sheltering instead of congregate care. Increased reliance on packaged meals for feeding. Utilize large feeding support packages (e.g. UGR 7 day food supply for a family) to limit the number of distribution trips.

8 Collaborate with commercial delivery companies and other community agencies (food banks, etc.) to deliver food and supplies. Drop off bulk supplies to points of distribution (e.g. drop off food and supplies to a building, allowing residents to handle internal distribution rather than going door to door). Equip feeding and bulk distribution workers with personal protective equipment and utilize a knock and leave drop off method for home deliveries. Increase collaboration with local public health departments to monitor any congregate care service delivery site established for disasters to ensure people who are actively infected are quickly identified and diverted to limit exposure. Regions If and when a local public health official declares a Public Health Emergencies the Regional Chapter Executive (RCE) will report the emergency and initial assessment information (if known) to their next-level reporting structure as outlined in the Regional Disaster Response Plan. The regional grouping will continue to respond to disasters, and initiate the Five Initial Actions while working within the service delivery parameters identified and the known challenges of the Public Health Emergency. Chief among the challenges will be to provide shelter in response to other disasters while under social distancing recommendations public health authorities. The regional grouping may need to support those needing shelter with either hotel rooms or other means. Payment for these hotel rooms will be a discussion with national headquarters and government partners in order to come to a decision agreed to by all. The regional grouping may also need to recruit additional volunteers and community partners because of the possible lack of trained volunteers during the Public Health Emergency especially during a pandemic. During preparedness for a Public Health Emergency, each regional grouping must identify the partners who will have a role in response to the Public Health Emergency and/or other disasters. A specific Memorandum of Understanding (MOU) for Public Health Emergencies with these agencies is important to ensure agreed upon expectations. Emergency Management Agencies Public Health Agencies Private health providers School Districts VOAD and Community Partners including church groups Local Emergency Planning Committees (LEPC s) Vendors

9 The regional chapter executive will ensure appropriate messaging about the Public Health Emergency and actions that all volunteers and employees should take. The procedures will need to be a high priority at the outset of the Public Health Emergency and continue with updates as more information becomes available. The regional grouping, state Red Cross entity and national headquarters will ensure initial and ongoing contact with government officials to include emergency management and public health authorities. Upon request, the region will maintain contact and as staff emergency operations centers when opened until the Public Health Emergency has been declared to be over. State Response Regional groupings must work together to share information and may share resources if the Public Health Emergency is not widespread. For a pandemic, no disaster volunteers or employees or equipment will move between or to regions in response to the pandemic itself. For major disasters during pandemic situations, the movement of human and material resources will only occur when state public health authorities in the affected area assess the safety of the area for voluntary responders. National Headquarters/Disaster Operations Center Response For national epidemics or pandemics as reported by the Center for Disease Control (CDC) or World Health Organization (WHO), National Headquarters and the Disaster Operations Center will ensure the reporting of this information to all Regional Chapter Executives, regardless of where the Public Health Emergency is happening (i.e. regionally or nationally). Red Cross Senior Leadership will issue specific Public Health Emergency guidance and disseminate it through the National Headquarters Disaster Operations Center. The Disaster Operations Center will continue to support regional groupings to the extent possible while taking into consideration the recommendations of public health authorities. In pandemic conditions, there may be long delays in moving workers and equipment from other parts of the country because of the pandemic s affect on travel and the availability of human and material resources. During a Public Health Emergencies the Red Cross in general WILL: Continue to respond to disasters of all types and sizes, taking into consideration the advice of public health officials related to congregate care facilities (i.e. shelters, service centers). Provide educational materials and logistical support for the provision of pharmaceutical distribution in the community (if requested).

10 Educate the public and distribute information from appropriate government sources about the nature and impact of the event, to include preparedness measures, safety precautions, recommended actions, and sources of assistance. In coordination with other community service providers, support individuals or families isolated or quarantined in their homes with emergency food and supplies in accordance with local community plans. Work to ensure a safe, adequate and available blood supply. Support mass inoculation or anti-viral drug distribution sites through mass care feeding activities. Provide housing and feeding support to members of the general public stranded on the highway when travel restrictions are imposed, in hotels, airports, and train stations. Provide training and other expertise to local government related to opening and operating congregate facilities. Facilitate local government access to vendors for food, water and other supplies by providing referrals. In Public Health Emergencies, the Red Cross generally WILL NOT: Establish shelters or other congregate care facilities when local authorities advise against it, or where the operation of such facilities would enhance the likelihood of disease transmission. Run congregate isolation or quarantine facilities Run respite centers Assume responsibility for the provision of medical care in any facilities, including in special needs shelters, temporary infirmaries, or overflow facilities for hospitals. However, should the need arise, chapters may assist government or other qualified health care providers in recruiting new, medically qualified volunteers from the community to work under the direction and supervision of other agencies. Chapters will provide referrals to these agencies and will not be responsible for verifying certifications and licensure. Purchase, store, or distribute vaccines or medical supplies on behalf of public authorities. Violate worker safety guidelines published by the Occupational Safety and Health Administration (OSHA). Replace lost wages for the public or assume responsibilities for needs arising from economic disruption. Assume responsibility for patient tracking. Conduct death notifications. Provide transportation to medical facilities for anyone demonstrating or reporting the effects of the agent identified as the cause of the Public Health Emergency. If the chapter receives requests to support these types of activities, or other unusual requests, it must contact the Disaster Operations Center prior to making any commitments.

11 Acronyms CDC COOP HHS DFRAP DOC EOC LEPC OSHA PHE SAF VOAD WHO Centers for Disease Control and Prevention Continuity of Operations Plan (Department of) Health and Human Services Disaster Fundraising Action Plan Disaster Operations Center Emergency Operations Center Local Emergency Planning Committee Occupational Safety and Health Administration Public Health Emergency Service to the Armed Forces Voluntary Organizations Active in Disaster World Health Organization References/Supporting information All-Hazards Plan Pandemic Flu Workplace Safety and Health Guidance for Paid and Volunteer Staff CBRNE Annex Link to CDC website Review and Maintenance This Annex will be reviewed and updated on an annual basis. If organization and/or disaster changes occur additional updates will be made.

12 Record of Changes Date of Review Type of Review Comment Reviewer Name

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