Emergency Preparedness at General Mills

Emergency Preparedness at General Mills 2006 Public Health Preparedness: Cross-Borders Issues Roundtable Lessons Learned: Models for Planning and Response Gary Olmstead Products Today 1

General Mills Manufacturing Facilities are Located on Six Continents Emergency Action Plan Required by OSHA 29 CFR 1910.38 Provides general/specific guidelines for: employee/visitor safety evacuation or relocation emergency shutdown of equipment Emergency Incidents Confronting General Mills Medical Fire/explosion Chemical release Weather tornado, hurricane, flood Bomb threat Workplace violence 2

Emergency Management Definitions Emergency Management Identify potential emergencies Prevent problems as much as possible Minimize the consequences by thorough preparation Test the plan periodically Improve continuously 3

Incident Reporting System Corporate 800-800-5050 Facility Emergency Telephone List Emergency Communication Alerts Variety of audible and visual alarms Must practice evacuations Drill on responses COLLABORATIVE PLANNING AND RESPONSE EMERGENCY MEDICAL OUTSIDE RESPONDERS AMBULANCE, POLICE, FIRE FIRE/EXPLOSION CHEMICAL RELEASE WEATHER FIRE, AMBULANCE, POLICE FIRE, AMBULANCE, POLICE, CHEMICAL RESPONSE CONTRACTORS CIVIL DEFENSE, POLICE BOMB THREAT POLICE WORKPLACE VIOLENCE POLICE 4

Strength/Weaknesses of Internal Resources MEDICAL FIRE/EXPLOSION CHEMICAL RELEASE WEATHER BOMB THREAT Trained only in CPR / First Aid Insufficient ability to respond to major fire or explosion Knowledgeable staff, but can t respond off-site Can shelter in place effectively need to monitor government broadcasts No internal capability WORKPLACE VIOLENCE No weapons allowed Advantages/Disadvantages of External Resources in Preparing for and Responding to Emergencies MEDICAL FIRE/EXPLOSION CHEMICAL RELEASE WEATHER BOMB THREAT Expert help but response time may be slow Expert help but lack of knowledge on plant layout and operations Some fire departments are trained, but many will not enter a release area Good advice from weather channels and Civil Defense Expert help but may be delayed responding WORKPLACE VIOLENCE Expert help but may be delayed responding Emergency Planning Internal response 911 system Pull alarms Table top scenarios On site drills 5

National Incident Management System (NIMS) First standardized management approach that unifies federal, state, and local lines of government in the U.S. for incident response Incident Command System command, operations, planning, logistics, finance/administration Standardized interoperable communications systems for incident and information management Preparedness planning, training, etc. DHS s National Response Plan "One team, one goal...a safer, more secure America" The National Response Plan establishes a comprehensive all-hazards approach to enhance the ability of the United States to manage domestic incidents. The plan incorporates best practices and procedures from incident management disciplines homeland security, emergency management, law enforcement, firefighting, public works, public health, responder and recovery worker health and safety, emergency medical services, and the private sector and integrates them into a unified structure. It forms the basis of how the federal government coordinates with state, local, and tribal governments and the private sector during incidents. It establishes protocols to help Save lives and protect the health and safety of the public, responders, and recovery workers; Ensure security of the homeland; Prevent an imminent incident, including acts of terrorism, from occurring; Protect and restore critical infrastructure and key resources; Conduct law enforcement investigations to resolve the incident, apprehend the perpetrators, and collect and preserve evidence for prosecution and/or attribution; Protect property and mitigate damages and impacts to individuals, communities, and the environment; and Facilitate recovery of individuals, families, businesses, governments, and the environment. Avian Influenza A Different Kind of Emergency Only people affected - not equipment or buildings Potential high number of people getting sick and/or dying Exposure may occur off the job and spread through workforce No familiarity with this type of problem Different government agencies taking the lead CDC, WHO, Provincial Ministries of Health 6

Influenza Preparedness at General Mills WHO Classification of Pandemic Phases Phase 1 2 3 4 5 Detail No new influenza virus subtypes have been detected in humans. An influenza virus subtype that has caused human infection may be present in animals. If present in animals, the risk of human infection or disease is considered low. No new influenza virus subtypes have been detected in humans. However, a circulating animal influenza virus subtype poses a substantial risk of human disease. Human infection(s) with a new subtype, but no human-to-human spread, or at most rare instances of spread to a close contact. Small cluster(s) with limited human-to-human transmission but spread is highly localized, suggesting that the virus is not well adapted to humans Larger cluster(s) but human-to-human spread still localized, suggesting that the virus is becoming increasingly better adapted to humans, but may not yet be fully transmissible (substantial pandemic risk). 6 Increased and sustained transmission in general population Avian Flu Human Influenza Pandemic What might happen? In the USA: 20 to 47 million become ill 18 to 42 million outpatient visits, 314,000-734,000 hospitalizations 90,000 to 200,000 deaths Travel will be limited as governments restrict entry. Businesses and schools will close Health care systems will be overwhelmed Essential services may break down as key personnel are infected and others stay home from work 7

H5N1 Influenza Vaccine Present H5N1 vaccine may only prime immune system, likely little actual protection and inadequate stocks Likely would need two doses (novel H type no immune memory) Time lag to produce pandemic vaccine 6 months + Once identified, still unable to manufacture realistic quantities to prevent pandemic Manufactured by a few multinationals national or international pressures may affect distribution Federal Government is stockpiling WHO Situational Assessment as of August 2005 Risk of human influenza pandemic is great The risk will persist over next 1-2 years The evolution of the threat cannot be predicted The early warning systems are weak Preventative intervention is possible, but untested Reduction of morbidity and mortality impeded by inadequate medical supplies Preparation is the best protection A Pandemic Preparedness Plan The Challenge: A pandemic will not be a bomb going off, but will: Evolve over time (days/weeks), and follow WHO phases Require thoughtful and timely triggered responses An Influenza Prevention Plan must address: Leadership, authority and chain of command Triggers that initiate organizational actions Actions that are proven to reduce transmission and illness Communication to all employees Business continuity 8

A Pandemic Preparedness Plan The Plan needs to encompass: Vaccination strategy Company wide flu vaccination (No avian flu vaccine) Health Alerts (employee education) Get vaccinated/don t come to work sick/ Don t panic. Travel and work restrictions (HR policy) Restrict travel or business critical only Respiratory protection practices HEPA and N95 travel respirators Medication strategy Tamiflu, Relenza, Rimantidine Treatment and Prevention of Influenza Treatment: If used within 48 hours of symptoms, reduces Length of illness, Complications (24%), Antibiotic use, no data on changes in contagiousness, (best if =< 6 hours) Tamiflu 75 mg tablet: 1 tablet twice daily for 5 days Relenza - 2 puffs twice daily for 5 days Prophylaxis: About 80 percent effective Currently used for close contacts of H5N1 cases and health care workers. Tamiflu - 1 tablet daily for 1 to 12 weeks Rimantidine 1 tablet (100 mg) twice daily for 14 days or one week after the last reported case Tamiflu cost - $7/tablet Rimantidine - $1.10/tablet Availability of Antivirals? 1. Why: Before pandemic vaccine available, antiviral drugs likely the only influenza-specific medical intervention available 2. When: Pre purchase is the only way to ensure sufficient supplies available Many governments actively stockpiling 3. How: Complex process with multiple issues: Decide amount of medications - treatment vs prophylaxis Confirm availability of product, expiration date Determine if local providers able to manage and prescribe 9

Evacuation of Expatriates In high risk locations, evacuation of personnel may be an option which will require answers to the following: What is the trigger for evacuation? Elective or mandatory? How do you communicate this? Where do they go? HR issues housing, compensation, schooling, etc How long do they stay? When can they return? Emergency Evacuation Issues 1. Based on CDC aviation guidelines, SOS may be capable of medical and mass personnel evacuation, but there may be local and global travel restrictions 2. Destination may likely only be the country of nationality 3. Need multiple approvals: CDC/WHO Governmental Release from hospital Ground transport Receiving country Receiving hospital Over flight clearances Medical Team & crew Portable Isolation Unit FLU Season Communication Influenza is a serious viral disease that can cause fever, cough, sore throat, headache and muscle aches. The flu vaccine is highly effective in preventing influenza, however it does not protect everyone against all viruses that can cause a fever and respiratory symptoms. An influenza epidemic is possible in the United States this year. Please get your vaccine. If you believe you have influenza, seek medical care with your doctor or clinic and follow their instructions regarding treatment. This cough and cold season, employees who are sick with a fever and cough or sore throat, are encouraged to stay at home until 24 hours after the fever has subsided. For questions about when to return to work, contact Health Services at 763-764-3952 to talk with a nurse, physician s assistant or doctor. 10

The 7 Steps of an Effective Pandemic Plan Step 1 Define your team and Chain of Command Step 2 Build a Body of Knowledge to support the basic operational issues related to a pandemic and educate your team Step 3 Define Triggers for when to activate your internal processes, based on WHO pandemic phases Step 4 Evaluate need for Enhanced Resources at high risk and significant business asset locations Step 5 Train personnel beginning at management and high risk locations Step 6 Practice set up pandemic scenarios to test processes, then re-evaluate systems Step 7 Surveillance ensure your team is able to gather and evaluate data, and disseminate a plan in a timely manner GENERAL MILLS INFLUENZA PREVENTION AND TREATMENT PROTOCOL INFLUENZA WORKSITE TRAVEL RESPIRATORY MEDICATION RISK LEVEL PRECAUTIONS RESTRICTIONS PROTECTION STRATEGY Risk Level l No active cases of human influenza On site flu immunizations Employee education (get vaccine, cover your cough, don t come to work sick) Prohibit travel to bird farms and live birds markets unless business critical Masks to International Travelers if requested N-95 Masks required for employees visiting Asian poultry farms/markets All GMI employees vaccinated (H2N2) Tamiflu provided for international business travelers (Use as directed) Risk Level ll Active (H2N2) human influenza ( regular flu morbidity & mortality) Employee education (vaccination reminders, recognition and prevention of influenza) Travel restricted case by case by Health Services to highly affected areas No travel for unvaccinated employees Masks to travelers to areas with active H2N2 if requested Clinic gives masks to symptomatic patients Tamiflu provided for business travelers going to affected areas. (Use as directed for symptoms) Risk Level lll Avian influenza (H5N1) spreading in humans (higher transmissibility and mortality >10%) Employee education Supervisors send employee home for respiratory infections Only business critical travel to affected areas Repatriation arrangements through SOS N-95 Masks worn in public places (airports) HEPA respirators used by clinic, direct contacts, and caregivers Tamiflu (1 twice daily for 5 days) at onset of symptoms Relenza, if resistant strains appear Preventive use for known contacts Risk Level lv Full pandemic, high attack rate, high mortality rate (>30%) Only essential people at worksite Work from home strategy No business travel N-95 Masks provided to employees Clinic, caregivers wear HEPA respirators Probably there will be no medication available by this time Next Steps Influenza preparedness in an ongoing process Start your Get your flu vaccine campaign when supply arrives Review HR policy: Travel restrictions, absentee policy Initiate Don t come to work sick campaign at onset of influenza season Pre-purchase antiviral medications Purchase N 95 dust and travel respirators Train employees on respiratory protection Designate local clinics and check their protocols Monitor illnesses Coordinate the Influenza Strike Force Team 11

Business Continuity Planning Develop plans for operating with a 5%, 25%, and 50% absenteeism rate Prioritize food production to meet public needs Organize incoming supplies and distribution of finished products The Response to Avian Flu This is a very current example of the need for cross-borders collaboration Governments Government agencies National Business Group on Health Regional businesses Trade associations Questions? 12