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Pandemic Flu Preparedness and Update

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Title: Pandemic Flu Preparedness and Update


1
Pandemic Flu Preparedness and Update
  • April 30, 2009

2
Todays Presenters
  • Al Cook, CMRP, FAHRMM
  • Chief Resource Director
  • The Regional Medical Center
  • Jeff Wagner, CMRP
  • Vice President
  • MidMichigan Health

3
Pandemic Guidelines
4
Pandemic Guidelines
5
Pandemic Guidelines
6
Pandemic Guidelines
7
Medical Materials Coordinating Group(MMCG)
  • The MMCG is a subgroup of the Healthcare Sector
    Coordinating Council (HSCC), which itself is
    comprised of fifteen owner-operators and
    association members which represent the medical
    products supply chain including manufacturers,
    consolidators, distributors, and maintenance and
    repair.
  • The HSCC and MMCG are recognized by the
    Department of Homeland Security and other federal
    agencies as the initial point of contact within
    healthcares private industry for critical
    infrastructure protection, preparedness, and
    response purposes.

8
Healthcare Sector Coordinating Council
(HSCC) The HSCC is comprised of representatives
and alternates from each sub-council. Issue will
be identified by Subcouncils. Coordination across
Subcouncils and with the GCC will be organized
through the HSCC.

Each sub-council is responsible for organizing
itself Sample Priority Issues for Sub-Councils
Emergency Preparedness, Emergency Response
Vulnerability Assessment / Prioritization
Communication Information Sharing among
members, with HHS and DHS, and with other sectors
Cross-cutting Work Groups will be established to
address priority issues that cut across
sub-councils

Healthcare Personnel Includes Doctors, nurses,
pharmacists, dentists, emergency medicine and
other clinicians and practitioners with direct
involvement in healthcare delivery
Insurers, Payers, HMOs Includes Representatives
of third-party payers for medical treatment and
healthcare delivery including insurance
companies, HMOs and others
  • Information Technology
  • Includes
  • All IT systems, capabilities and networks
    supporting delivery of healthcare services

Laboratories and Blood Includes Laboratories
and lab support services separate from medical
treatment facilities, and companies and
associations from the blood, tissue and organ
industry
Mass Fatality Mgt Services Includes Medical
examiners, coroners, funeral directors,
cremationists, cemeterians, clergy, and
manufacturers and distributors of funeral,
memorial, and cremation supplies
Medical Materials Coordinating Includes Manufact
urers, suppliers, and distributors of medical
supplies and equipment, as well as health care
materials managers
Medical Treatment Includes Hospitals, clinics,
and other organizations/ entities that deliver
medical treatment
Occupational Health Includes Occupational
health physicians and nurses, industrial
hygienists, and other occupational health
professionals
Pharma and Biotech Includes Manufacturers,
suppliers and distributors of generic and branded
pharmaceuticals and biological equipment
Healthcare and Public Health Sector Government
Coordinating Council (GCC)
AHRQ
CMS
FDA
HRSA
IHS/TRIBAL
NIH
SAMHSA
DOD
VA
STATE/LOCAL
CDC
9
Manage the Hype
  • Update 109 p.m. C.D.C. Briefing
  • Dr. Richard Besser, the Acting Director of the
    C.D.C. said that the declaration of a public
    health emergency in the United States on Sunday
    "streamlines the process by which the government
    works." He adds that the government will be
    giving people coming to the U.S. information on
    how to avoid getting sick and "out of an
    abundance of caution" is advising people to forgo
    any non-essential travel to Mexico at this time.

10
Manage the Hype
  • Update 116 p.m. C.D.C. Briefing Dr. Besser
    says that, for people who run businesses or
    schools, it is "time to think about" how they
    might adapt if an outbreak happens on a large
    scale and they have to make things work with
    people working or studying from home. He also
    says that 11 million doses of anti-viral drugs
    from a government stockpile have been sent to
    states with cases of the swine flu, including
    California, Texas and New York.
  • Update 119 p.m. C.D.C. Briefing In response
    to a question from a reporter, Dr. Besser says
    that wearing masks is generally not as useful as
    doing things to prevent disease transmission,
    like washing your hands and forgoing "that little
    kiss of greeting" between people. Dr. Besser
    makes the point that the flu is not transmitted
    by eating pork.
  • Update 121 p.m. C.D.C. Briefing A reporter
    for the Wall Street Journal asks if not having a
    director of Health and Human Services at the
    moment has hurt the government's response to this
    crisis. Dr. Besser says that it has not. He does
    say that a lack of funds for the public health
    system, due to cuts in state budgets, could cause
    problems in the future. He says that "investments
    in preparedness" is what led to this outbreak
    being identified in the United States as quickly
    as it was.

11
Manage the Hype
  • Update 128 p.m. C.D.C. BriefingDr. Besser
    clarifies that the government has only released
    25 of the stockpile of anti-viral drugs so far.
  • Update 135 p.m. C.D.C. BriefingDr. Besser
    says, in response to a question, that the
    decision of the European Union to place a travel
    restriction on people coming to the United States
    is "premature," given that "we only know of 20
    cases" and just one person has been hospitalized
    in the U.S. so far.
  • Update 138 p.m. C.D.C. BriefingA CNN
    reporter asks if Dr. Besser's advice to not kiss
    people as a token of greeting only applies to
    people in areas where the virus has been
    identified. He says that the C.D.C. is not
    calling for "a ban on affection," but suggests
    people in areas where the virus has been
    identified should probably pass on kissing each
    other hello or goodbye for now.

12
Manage the Hype
  • Update 147 p.m. C.D.C. BriefingDr. Besser's
    briefing is over, but a good resource is the
    C.D.C.'s Swine Influenza page on its Web site,
    which has a lot of information about how to spot
    the infection, how to avoid getting it, and
    information on where the 40 confirmed cases in
    the U.S. have been identified. The C.D.C. site
    was updated within the last hour to show that
    cases have been confirmed in the following
    states California (7 cases) Kansas (2 cases)
    New York City (28 cases) Ohio (1 case) Texas (2
    cases).

13
Pandemic Influenza Phases
In nature, influenza viruses circulate
continuously among animals, especially birds.
Even though such viruses might theoretically
develop into pandemic viruses, in Phase 1 no
viruses circulating among animals have been
reported to cause infections in humans. In Phase
2 an animal influenza virus circulating among
domesticated or wild animals is known to have
caused infection in humans, and is therefore
considered a potential pandemic threat. In Phase
3, an animal or human-animal influenza
reassortant virus has caused sporadic cases or
small clusters of disease in people, but has not
resulted in human-to-human transmission
sufficient to sustain community-level outbreaks.
Limited human-to-human transmission may occur
under some circumstances, for example, when there
is close contact between an infected person and
an unprotected caregiver. However, limited
transmission under such restricted circumstances
does not indicate that the virus has gained the
level of transmissibility among humans necessary
to cause a pandemic.
14
Pandemic Influenza Phases
Phase 4 is characterized by verified
human-to-human transmission of an animal or
human-animal influenza reassortant virus able to
cause community-level outbreaks. The ability to
cause sustained disease outbreaks in a community
marks a significant upwards shift in the risk for
a pandemic. Any country that suspects or has
verified such an event should urgently consult
with WHO so that the situation can be jointly
assessed and a decision made by the affected
country if implementation of a rapid pandemic
containment operation is warranted. Phase 4
indicates a significant increase in risk of a
pandemic but does not necessarily mean that a
pandemic is a forgone conclusion.
15
Pandemic Influenza Phases
Phase 5 is characterized by human-to-human spread
of the virus into at least two countries in one
WHO region. While most countries will not be
affected at this stage, the declaration of Phase
5 is a strong signal that a pandemic is imminent
and that the time to finalize the organization,
communication, and implementation of the planned
mitigation measures is short. Phase 6, the
pandemic phase, is characterized by community
level outbreaks in at least one other country in
a different WHO region in addition to the
criteria defined in Phase 5. Designation of this
phase will indicate that a global pandemic is
under way.
16
Pandemic Influenza Phases
During the post-peak period, pandemic disease
levels in most countries with adequate
surveillance will have dropped below peak
observed levels. The post-peak period signifies
that pandemic activity appears to be decreasing
however, it is uncertain if additional waves will
occur and countries will need to be prepared for
a second wave. Previous pandemics have been
characterized by waves of activity spread over
months. Once the level of disease activity drops,
a critical communications task will be to balance
this information with the possibility of another
wave. Pandemic waves can be separated by months
and an immediate at-ease signal may be
premature. In the post-pandemic period,
influenza disease activity will have returned to
levels normally seen for seasonal influenza. It
is expected that the pandemic virus will behave
as a seasonal influenza A virus. At this stage,
it is important to maintain surveillance and
update pandemic preparedness and response plans
accordingly. An intensive phase of recovery and
evaluation may be required.
17
Calculating demand in a pandemic
  • OSHA estimates that for healthcare workers, masks
    will be changed four times per 12 hour shift for
    direct patient care givers. Most healthcare
    workers think this is well underestimated.
  • OSHA also indicates that in Emergency Rooms,
    direct care givers may use as many as one mask
    between each patient and that each person
    visiting the ER should be issued an n-95 to
    prevent transmission.
  • The number is staggering and might indicate that
    in some cases, Materials Managers might be better
    served to seek reusable alternatives.

18
Considerations for meeting demand for PPE
  • Initial volume will not be 100 occupancy but
    will start with a significant surge in daily use
    and crescendo at full census.
  • Heightened awareness should be made for the
    potential of sensitive medical PPE departing with
    the workforce.
  • At the onset, estimates of daily use should be
    calculated and the initial 96 hours of use should
    be brought on site.
  • Work with established suppliers and with the work
    force to establish potential alternatives to
    disposable N-95 face masks. OSHA site offers
    several alternative devices.
  • Assure that the correct type of mask or
    respirator is used in the most appropriate
    instance, e.g. surgical masks used where
    appropriate and disposable N-95s only used where
    essential.

19
Resources
  • http//www.cdc.gov/swineflu/
  • http//www.cdc.gov/swineflu/recommendations.htm
  • http//www.cdc.gov/swineflu/masks.htm
  • http//www.chcoc.gov/Transmittals/TransmittalDetai
    ls.aspx?TransmittalID2227
  • http//www.osha.gov/Publications/3328-05-2007-Engl
    ish.htmlRespiratoryProtectionforPandemicInfluenza

20
Additional Resource
  • AHRMMs Disaster Preparedness Manual for
    Materials Management Professionals is carried in
    the online AHRMM Book Store

21
AHRMMs Disaster Preparedness Manual
  • This book offers sound advice in planning and
    preparing for disaster preparedness. This is the
    time to engage with local, regional, state and
    even federal agencies regarding the plans and
    resources that will be made available to the
    hospital as a result of those plans. No hospital
    will stand alone in any disaster response but
    will stand as a focal point with other local and
    regional agencies to deliver health and public
    health services to their respective communities
    in the most efficient and effective manner.
  • Now is the time for understanding these resources
    and how they will all come together to serve the
    health needs of their communities. Preparation
    and understanding of these integrated response
    efforts will be key elements of hospitals
    disaster response plans.

22
Late Breaking News
  • Current level of influenza pandemic alert raised
    from phase 4 to 5
  • Based on assessment of all available information
    and following several expert consultations, Dr
    Margaret Chan, WHO's Director-General raised the
    current level of influenza pandemic alert from
    phase 4 to 5. She stated that all countries
    should immediately activate their pandemic
    preparedness plans. At this stage, effective and
    essential measures include heightened
    surveillance, early detection and treatment of
    cases, and infection control in all health
    facilities.

23
Questions
24
Speaker Contact Information
  • Al Cook, CMRP, FAHRMM
  • Chief Resource Director
  • The Regional Medical Center
  • Orangeburg, SC
  • 803 395 2651
  • acook_at_regmed.com
  • Jeffrey J. Wagner, CMRP Vice President
    MidMichigan Health Midland, MI
  • 989-839-3821
  • jeff.wagner_at_midmichigan.org
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