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Building healthy communities through

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Title: Building healthy communities through


1
Pandemic InfluenzaWhy Schools Need to Be
Proactive
Diane Hargrove-Roberson, MSW Community Outreach
Program Manager Pandemic Influenza Grant
Building healthy communities through
preparation, prevention and response!
2
Topics of Discussion
  • Influenza
  • Avian Flu
  • Pandemic Flu
  • History, Impact Planning
  • Schools Role
  • Employee Role
  • Resources

3
  • There are only two types of school
    administrators those who have faced a crisis and
    those who are about to!Ron Stephens, Executive
    Director, National School Safety Center

4
What is influenza (flu)?
  • mild to severe respiratory illness of sudden
    onset caused by an influenza virus
  • highly infectious-spreads rapidly from person to
    person
  • some strains more severe than others
  • occurs every year killing 36,000 people in U.S.

5
How does influenza spread?
  • Breathing in droplets
  • produced when infected person talks/coughs/
    sneezes
  • Touching an infected person or surface
  • contaminated with the virus and then touching
    your own or someone elses face

6
Avian Influenza
  • Avian influenza or bird flu is an infection in
    birds caused by a variety of subtype viruses.
  • One such subtype is H5N1.
  • Some strains of H5N1 are highly pathogenic.
  • The severe strain of H5N1 is killing birds in
    Asia and parts of Europe.

7
Avian Influenza cont.
  • The H5N1 strain has sickened about 359 people who
    came in contact with the sick birds in several
    countries 226 people died. (Approximately
    62.9)

As of February 5, 2008
8
359 CASES - 226 DEATHS - 62.9 MORTALITY RATE
9
Will H5N1 become the next pandemic?
  • Avian Flu not yet Pandemic Flu
  • current outbreaks of H5N1 Avian Flu in poultry
    and birds are the largest ever documented
  • Impossible to predict next pandemic flu event
  • If not H5N1, then another
  • Plan now

10
Understanding Pandemic Flu
  • Epidemic serious outbreak in a single community,
    population or region
  • Pandemic an epidemic spreading around the world
    affecting hundreds of thousands of people, across
    many countries
  • Pandemic flu a pandemic that results from an
    influenza virus strain that humans have not been
    previously exposed to

11
Putting Pandemic Flu into Perspective
  • 2001 terrorist attack with anthrax
  • killed five people
  • 2002 outbreak of West Nile Virus
  • killed 284 people nationally in six months
  • 2003 SARS outbreak
  • killed over 800 people world wide
  • froze Asian economies
  • frightened millions of people into wearing masks
    on the streets

12
History of Pandemic Influenza
  • 1968-1969
  • Worldwide 700,000 deaths (34,000 in US)
  • 1957-1958
  • Worldwide 1.5 million deaths (70,000 in US)
  • 1918
  • Worldwide 40-50 million deaths (500,000650,000
    in US)
  • Typical Influenza Season
  • 36,000 deaths in US

13
Caregivers in the Spanish Flu 1918
14
Personal Protective Equipment (1918)
15
Law Enforcement in the 1918 Flu
16
Public Health Measures in 1918Some are unchanged
in 2008
17
Lessons from Past Pandemics
  • Occurs unpredictably, not always in winter
  • Variations in mortality, severity of illness and
    pattern of illness
  • Rapid surge in number of cases over brief period
    of time, often measured in weeks
  • Tend to occur in waves - subsequent waves may be
    more or less severe

18
Pandemic Global Influenza
Outbreak
  • Conditions Supporting Pandemic Influenza
  • 1. New influenza type emerges.
  • (Mutates in human population)
  • 2. Causes serious human illness.
  • 3. Spreads easily from person
  • to person.

19
Currently there is no pandemic influenza in the
world.
  • However, experts from the World Health
    Organization (WHO) and the Centers For Disease
    Control (CDC) believe it is only a matter of time
    before it occurs.

20
Current Status
Interpandemic
Pandemic
Pandemic alert
Phase 4
Larger clusters, localized Limited spread
among humans
Phase 1
Phase 2
Phase 3
Phase 5
Phase 6
No new virus in humans Animal viruses low risk to
humans
No new virus in humans Animal viruses low risk to
humans
New virus in humans Little/no spread among humans
Small clusters, localized Limited spread among
humans
Increased and sustained spread in general human
population
Current status of H5N1
Current H5N1 status
WHO Global Influenza Preparedness Plan, 2005.
Available at http//www.who.int/csr/resources/pub
lications/influenza/GIP_2005_5Eweb.pdf
21
Pandemic Influenza Impacts in Louisiana
  • Estimated Impact in Louisiana
  • 3 Million infected
  • Between 600,000-1.4 million clinically ill
  • Between 300K-700K requiring outpatient care
  • Between 10,000 22,500 hospitalized
  • Between 3,000 6,000 deaths
  • Impact on Infrastructure
  • Significant disruption of transportation,
    commerce, utilities, public safety and
    communications
  • Limited to no assistance from State and Federal
    governments due to nation-wide impact

22
How CCP and DOE are Working Together
  • "Pandemic Influenza Guidance to School Systems
    (working with DOE for three years)
  • Contract with DOE for Pandemic Influenza Planning
  • Statewide School Closure Tabletop
  • Tested states ability to close and reopen
    schools administratively
  • Education and Training with DOE teachers and
    staff

23
Influenza Prevention
  • Vaccination
  • Stay at home when sick
  • Cover your cough
  • Wash hands regularly
  • Avoid touching eyes, nose and mouth
  • Avoid close contact with people who are sick

24
Infection Control - Our Basic Protection
  • Hand Hygiene
  • Wash hands regularly with soap water
  • If no water available 60-95 alcohol-based
    sanitizer
  • Cover your cough strategy
  • Environmental cleaning
  • 110 bleach solution
  • EPA registered disinfectant
  • Gloves surgical masks

25
Hand washing
26
(No Transcript)
27
Available Printed Media Resources
  • Family Readiness Guides (also online)
  • Get Ready, Stay Healthy!
  • Pan Flu Brochure
  • Counter Cards (two-sided card stock)
  • How You Can Be Prepared
  • for a Flu Pandemic
  • Online Fact Sheets www.dhh.louisiana.gov
  • (click pandemic flu information)
  • Pandemic Flu The Facts
  • Pandemics in the United States

28
Increasing Community Awareness
  • How You Can Be Prepared
  • for a Flu Pandemic
  • Individual and Family Guide
  • Spanish, English, Vietnamese
  • versions available
  • Audio version available through
  • the State Library System
  • Braille version - Summer 2008
  • through the State Library System

29
Workforce Support
  • Psychological and physical strain on personnel
    responding in emergency situation
  • Psychological stress for families
  • Plan for staff to have adequate
  • Sleep
  • Food
  • Access to psychological
  • and spiritual support

30
Guidance School Planning
  • Develop alternative procedures for learning in
    event of school closures
  • Develop plan for essential office functions
  • payroll, communication with students, families,
    and staff
  • Infection Control
  • educate practice

31
OPERATIONAL PHASES FOR SCHOOL DISTRICT PANDEMIC
INFLUENZA PLAN
All planning initiatives and tasks identified in the plan are completed by November in anticipation of typical influenza season December to March (Confirmed Human Outbreak Overseas) Phase Yellow initiatives have been confirmed and tested. District is at READY STATUS to implement plan Plan Is Activated
32
What Can You Do Now?
  • Prepare your community become involved in
    disaster training volunteerism.
  • Remember to get enough sleep.
  • Exercise regularly.
  • Prevent the spread of infection wash hands
    regularly, cough/sneeze into tissue, keep your
    hands away from your nose/mouth.
  • Put out cigarettes.
  • Annual flu shots.
  • Nutritious eating.
  • Family plan and kit.
  • Look for information about pandemic flu.
  • Utensils, food and beverages should not be shared.

33
Why We Need To Be Proactive(PREPARATION!)
  • 30-40 student, teacher and staff absences.
  • 30-40 of school bus drivers ill.
  • Interruption of instruction and the instructional
    impact to the students.
  • Use of school buildings as overflow medical
    sites.
  • Maintenance of basic operations for central
    offices/administration.
  • CONTD


34
Why We Need To Proactive Contd
  • Impact on families who will have to provide child
    care if students cant attend school.
  • Impact on employees-loss of time and leave
    closing of schools, taking care of ill spouses
    and children.
  • Emotional responses that students, families and
    staff will be experiencing.

35
Public Health Issues
  • An Influenza pandemic may
  • emerge with little warning.
  • A vaccine will not yet
  • be available.
  • The supply of anti-viral
  • drugs will be limited.

36
Will we need to close schools and for how long?
Severity of the Pandemic will determine a school
closure decision.
37
(No Transcript)
38
P.I.P(Pandemic Influenza Planning)
  • WHERE DO I BEGIN?
  • Form a PIP Committee/Team

39
Planning and CoordinationWhos on the Team?
  • Senior Level Administrator
  • District Representative
  • School Nurse
  • Teachers
  • Health Dept.
  • OEM
  • Guidance / SAC
  • IT / MIS
  • Purchasing / Finance
  • Food Services
  • Facilities
  • PTO
  • Union Representative

40
Considerations for a Pandemic Influenza Plan
  • Surveillance Reporting
  • Prevention Education
  • Communication
  • Continuity of Instruction
  • School Facilities/Infection Control
  • Student Transportation
  • Employee Issues
  • Emotional Preparation

41
Surveillance Reporting
  • Monitoring increases in absenteeism among
    students staff.
  • Documenting and communicating findings to the
    Department of Health and Hospitals (DHH).
  • Evaluating individuals who have symptoms, e.g.
    cough or fever.

42
Surveillance Reporting (Contd)
  • Maintaining disease containment measures
    (isolation quarantine).
  • Maintaining adequate supplies for infection
    control (soap, paper towels, etc.)
  • Participating in any vaccine program implemented
    by DHH.

43
Prevention Education
  • Prevention education for Staff, Students
    Families.
  • Who will be responsible for educating these
    groups about pandemic flu and the preparedness
    plan including individuals for whom English is a
    second language and students with special needs?

44
Prevention Education (contd)
  • District wide awareness program on disease
    prevention infection control.
  • Washing hands often with soap.
  • Alcohol based disposable wipes/hand sanitizers.
  • Respiratory etiquette, e.g. covering mouth and
    nose while sneezing and coughing.

45
Communication
  • Development of consistent clear messages for
    parents, students, staff and the community.
  • Coordinated messages with DHH, parish and state
    agencies.
  • Establishing phone hotlines and websites for
    media, school administrators, teachers, parents
    and others.

46
Communication (contd)
  • Prepare templates for press releases and media
    alerts.
  • Ensure that communications are accessible to the
    visually and hearing impaired and non-English
    speaking communities.

47
Continuity of Instruction
  • Interruption of instruction will impact testing,
    grades, assessments and graduation requirements.
  • Strategies to provide instruction in the face of
    staff absences
  • Restructuring the school calendar and school
    year
  • Deliver only those courses needed for graduation
    and /or core subjects
  • Utilize on-line instruction or other methods

48
School Facilities
  • What if schools are used as overflow medical
    sites? Special
    Considerations
  • Administrators will need authority to restrict
    access to certain areas of the building
  • Special phone lines or communications for
    emergency responders
  • Provide storage space to stock infection control
    and PPE supplies

49
School Facilities (Contd)Special
Considerations
  • Training of school maintenance and custodial
    staff for appropriate cleaning of schools before
    re-occupancy
  • Designate space for public health providers for
    onsite vaccination clinics, medical clinics or
    shelter facilities.

50
Student Transportation
  • Policies and procedures for transporting ill
    students.
  • Maintain current list of contact persons, number
    of buses available, number of drivers available,
    staging areas for buses to transport students or
    adults home.

51
Student Transportation (contd)
  • Training for student transportation staff for
    appropriate cleaning of buses exposed to bodily
    fluids.
  • List of substitute bus drivers.

52
Employee Issues
  • As a result of increased staff absences and the
    length of illnesses in a pandemic, schools will
    need to consider the following
  • Provide identified staff with authority to act
    in the absence of supervisors/senior personnel.
  • Reassess the scope of existing health plans and
    employee assistance programs to deal with the
    physical and emotional trauma of a pandemic.

53
Employee Issues (contd)
  • Reexamine human resource policies. Sick leave and
    attendance policies may not address a major
    employee absence.
  • It may be necessary to develop a policy to
    restrict access to the workplace to prevent
    spread of disease.

54
Emotional Preparation
  • Prepare school counselors to address staff,
    student and family concerns regarding illness and
    death, fear of contagion or transmitting disease,
    quarantine restrictions, etc.
  • Utilize school health professional, local health
    department staff to provide accurate information.
  • Have contingency plans to address school
    counseling shortages that may occur due to
    illness.

55
Crisis Planning The Basic Steps
  • Mitigation/
  • Prevention
  • Preparedness
  • Response
  • Recovery

56
Mitigation/Prevention
Things we can do to reduce or mitigate risk to
health or life caused by a pandemic influenza
outbreak.
57
Preparedness
  • Developing a plan to properly handle a
    pandemic situation prior to its occurrence.

PANDEMIC INFLUENZA PLAN
58
Response
  • Procedural actions and steps to follow during a
    pandemic event.

59
Recovery
  • Restoring the learning and teaching environment
    following a pandemic event.

60
Implementation of the Plan
  • As with ALL emergency response plans- they need
    to be practiced and tested.
  • Participation in a Tabletop Exercise will help to
    strengthen planning efforts.

61
FLOWCHARTS
PANDEMIC INFLUENZA FLOW CHART FOR TEACHERS

Government Response ? Stages PANDEMIC ALERT PERIOD 0-New domestic animal outbreak in at-risk country Suspected human outbreak overseas Measures identified in this column must be accomplished BEFORE November 1, 2007 TYPICAL FLU SEASON IS DECEMBER TO MARCH PANDEMIC ALERT PERIOD (SUBSTANTIAL PANDEMIC RISK) 2.Confirmed human outbreak overseas READY STATUS PANDEMIC PERIOD 3- Widespread human outbreak in multiple locations overseas 4- First human case in North America 5- Spread Throughout United States 6- Recovery preparation for subsequent waves )
Communications Make sure Parent /Guardian contact information is current Keep lines of communications open and frequent to main office regarding current status of Pandemic Confirm contact lists are current/accurate Maintain communications with main office Review with Nurse/Health Services protocols on managing ill children Maintain close contact with parents/guardians providing reassurance for the health and safety of their children Remind parents to keep ill children home
Continuity instruction learning Begin lesson preparation/ homework strategies to assign students if schools were closed due to a pandemic ( 2 weeks up to 12 weeks) Hone lesson preparation / homework activities (District may provide prepackaged activities) Coordinate with District Technology Department for delivery of student assignments and activities.
Prevention Education Central Administration will provide web-based Pandemic Awareness infection control training on District website. Explore this activity. Begin reinforcement of proper hygiene germ control strategies with classroom students (i.e. Hand washing, respiratory etiquette-i.e., cover mouth, using tissues) Post classroom signage that promotes hygiene and respiratory etiquette. HEIGHTENED reinforcement of proper hygiene germ control strategies with classroom students (i.e. Hand washing, respiratory etiquette-i.e., cover mouth, using tissues) Promote vigilant classroom / school hygiene and respiratory etiquette practices and policies. Consider hand washing breaks with students
School Facilities Discuss with custodians the need for ample supply of sanitizers and tissues in the classroom in case of a pandemic event. Ensure classrooms will have an adequate supply of tissues, hand sanitizer wipes, etc. Check and replace supplies as needed
Surveillance Reporting Discuss with Nurse protocol for monitoring ill children. Review with Nurse protocol for monitoring ill children. ( Symptoms of Pandemic Flu) Closely monitor classroom students for illness. Ill children must be identified, reported and mandatory arrangements made for influenza case isolation.
Emotional Preparations Actions Begin discussions with counselors, social workers and psychologists regarding age appropriate strategies for handling children dealing with pandemic associated loss/grief. Review mental health materials and strategies provided by mental health professionals Refer all students in need of professional counseling to appropriate and trained personnel
62
Summary of P.I.P. STEPS
  • Form P.I.P. Committee.
  • Identify Considerations for The Plan. (Core
    Issues)
  • Address Four Stages of Crisis Management
  • Test Evaluate Plan. (Table Top Exercise)
  • Create Final Flow Charts.
    (Roles Responsibilities)

63
  • Information Sources
  • Centers for Disease Control and Prevention,
    Website for Pandemic Influenza Available at
    http//
    www.pandemicflu.gov
  • Emergency Response and Crisis Management
    Technical Assistance Center, ERCM Express Volume
    2, Issue 7, 2006, Schools Respond to Infectious
    Disease Available at www.ercm.org
  • World Health Organization, Current WHO Phase of
    Pandemic Alert,
  • Available at http//www.who.int/csr/disease
    /avian_influenza/phase/en/index.html

64
Get Informed. Be Prepared.
  • State Draft Pandemic Flu Plan
  • http//www.dhh.state.la.us/offices/publications/pu
    bs-145/Pandemic20Influenza20Plan_100906.pdf
  • Family Readiness Guide
  • http//www.dhh.state.la.us/offices/publications/
  • Official Pandemic Flu Web Site
  • http//www.pandemicflu.gov/
  • Centers for Disease Control and Prevention
  • http//www.cdc.gov/flu/pandemicflu/

Even though local, state and federal agencies
have plans to protect the public, you are
responsible for your own safety, even in an
emergency!
65
FOR PANDEMIC INFLUENZA PLAN CONSULTING OR MORE
INFORMATION CONTACT
Diane Hargrove-Roberson, MSW Community Outreach
Program Manager Phone (225) 763-3964 Email
droberso_at_dhh.la.gov
Dr. Frank Welch Medical Director Phone (504)
838-5300 Email fwelch_at_dhh.la.gov
66
QUESTIONS, ISSUES OR CONCERNS?
67
Special Acknowledgements
  • Joshua Wayne, Project Director- Safe School
    Healthy Students
  • Carl Mittelhammer, Emergency Management
    Specialist
  • Bergen County Technical Schools Special
    Services
  • Paramus, New Jersey
  • Public Health Emergency Preparedness Conference
    February 2008, Atlanta, GA
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