Prepare to Care Pandemic Planning at Fraser Health Pandemic Influenza Planning December 10, 2009 Facilitator: Lisa Zetes-Zanatta 7
Prepare to Care: Introductions FHA Pandemic Lady Lisa Zetes-Zanatta Roundtable introductions Name Service 8
What is the flu anyway?? 9
Influenza Virus Influenza A is subtyped by surface proteins Hemagglutinin (H) 16 different types Helps virus enter cells Neuraminidase (N) 9 different types Helps virus leave cell to infect others 10
Influenza Virus Types Type A: Infects humans and other animals More severe illness Causes regular epidemics; can cause pandemics Type B: Infectious only to humans Causes epidemics, but less severe illness 11
Influenza Prevention Yearly influenza shot Avoid those who are ill Wash your hands Antivirals (in special circumstances) If you are ill--don t come to work, cover coughs and sneezes. 12
Vaccine Development Inactivated trivalent vaccine (killed vaccine) 2 A, 1 B Effectiveness of vaccine depends on match between circulating strains and those in vaccine A/New Caledonia/20/99-like (H1N1) A/California/7/2004-like (H3N2) Influenza Protection B/Shanghai/361/2002-like 13
Surveillance on circulating strains Surveillance on circulating strains Selection of specific strains Selection of specific strains Preparation and distribution of virus stock to manufacturers Preparation and distribution of virus stock to manufacturers Seed pools inoculated into eggs Seed pools inoculated into eggs 14
May June July Harvest and concentration of fluids Vaccine inactivated and purified August Vaccine blended, content verified September October Packaging, labeling, delivery 15
Influenza Pandemic What is a Pandemic? Outbreak in wide geographic area (global) Effects large # of people with serious illness Usually a new virus or one which population has not had exposure in a long time May have rapid spread May occur in waves 16
Seasonal VS Pandemic Influenza Seasonal Occurs every year Occurs during winter (usually Dec-Mar) Most recover in 1-2 weeks without tx Very young, very old, ill most at risk of serious illness Pandemic Occurs infrequently (3 per century) Occurs any time of year Some may not recover, even with tx People of all ages may be at risk 17
Recent Pandemics Past Pandemics: 1968 Hong Kong Flu (H3N2) 1957 Asian Flu (H2N2) 1918 Spanish Flu (H1N1) 18
1918 Pandemic Worst of past century Estimated 20-40% of world population ill 40-50 million people died worldwide 600,000 or more deaths in US High mortality in young adults 19
There are severe pandemics and mild pandemics 20
Infectious Disease Deaths 1900-1996 21
H1N1 Human Swine Virus Swine influenza is caused by type A of the virus Transmission can be found through contact with infected pigs and more recently through human to human contact. This virus began human to human transmission in March and Early April in Mexico. By late April the spread of the novel strain was worldwide. This virus is a novel subtype not previously detected in swine or humans 22
Are we more or less at risk today compared to 1918? 23
Pandemic Planning Why Plan Closing of borders, shutting down trade Closing of schools, events, and businesses where large numbers of people congregate Supply Chain disruption Health Surges to point of total congestion 24
Prepare to Care: Ongoing Pandemic Threat: 2008/09 Update As of December 8, 2009: o 1001 hospitalized human H1N1 cases, 47 deaths o Approx. 90% of cases under 40 years old o Lull in H1N1 activity over summer, however presence of virus did not disappear like the routine influenza virus 25
Prepare to Care: Anticipated Impacts Acute Care Sites and Community Programs System to be extremely taxed Current service delivery levels will not be available Sites and programs will defer a number of activities on a priority basis Assessment centres and alternative care sites to operate Interoperability btw. acute & cmty programs will be essential 26
Supply Issues Discussion Syringes Surgical Masks / Visors Laundry N95 s 27
Prepare to Care: Q & A Period Lisa: lisa.zeteszanatta@fraserhealth.ca 28
Pandemic Tabletop Exercise November 19, 2009
Organizational Background Business Continuity and Emergency Management are prescribed by Government mandate to the LDB There has been a Pandemic Plan in place at the LDB since October 2008 The LDB has been proactive with other types / levels of emergency management exercises before Recently two pandemic scenarios were part of the LDB s Emergency Operations Centre (EOC) exercise Pandemic Tabletop Exercise
Approach to this Presentation Follow the natural phases of the exercise Explain lessons learned Field questions interactive Pandemic Tabletop Exercise
Preparing the Exercise Refresh the Pandemic Plans (+ lessons learned from 1st) Selling the exercise to the organization (2nd exercise was requested) Deciding on the exercise format Preparing a good scenario Have a knowledgable facilitator Pandemic Tabletop Exercise
Kicking off the Exercise Have enough time (2nd exercise was full eight hour day) Make sure that the EOC team is complete & prepared Secure undivided attention Explain the purpose and method Introduce the scenario Pandemic Tabletop Exercise
Overcome Hesitation to Go First Good scenario will have a clear first actor Use direct questions to facilitate Simulate information flow Avoid speculation / reduce discussion follow procedure (TOUGH!) Pandemic Tabletop Exercise
In the thick of the scenario Keep the communication channels open Gating criteria / triggers for decision making Emergency Team members may be missing Where is your workforce? External dependencies Use as much visuals in the plan as possible (flow-charts / diagrams) It can be overwhelming! Pandemic Tabletop Exercise
Wind-down Gauge understanding of De-escalation and Stand-down Solicit input on what would represent a Normalization of the situation Solicit input on What have we learned today? (evaluation) Pandemic Tabletop Exercise
Capture it all Transfer the scribed notes into electronic format if necessary Facilitator to review scribed notes and prepare Lessons Learned document Conduct a de-brief with the exercise team and/or have an Evaluation Form to understand how useful the exercise was Pandemic Tabletop Exercise
Evaluation Results EOC EXERCISE EVALUATION SCORECARD (Nov 19, 2009) Evaluation Element 1. Duration Of Exercise 2. Quality of Instructions 3. Realism of Exercise 4. Number of Issues Needing Explanations 5. Effectiveness of the Scenario 6. Did the EOC Procedures Work 7. Realism of Environment and Conditions 8. Overall Rating Dominant Opinion Status Exactly right 67% Comprehensive and easy to understand 75% Realistic 67% Above 6 75% Good 83% Partially 59% Very realistic + Satisfactory 50% + 50% Good + Satisfactory 58% + 42% Pandemic Tabletop Exercise
Top 5 Lessons Learned 1. Prepare / publish clear decision making (go / no-go) criteria for EOC activation speed up activation 2. Clearly spell out the chain of command 3. Clearly assign skill-sets to EOC command structure (NOT seniority or Organizational Hierarchy) 4. Use flow-charts for each EOC section works better than checklists 5. Simplify EOC forms; clarify sign-off responsibilities Pandemic Tabletop Exercise
Questions? QUESTIONS? Pandemic Tabletop Exercise