Prepare to Care Pandemic Planning at Fraser Health Pandemic - - PowerPoint PPT Presentation

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Prepare to Care

Pandemic Planning at Fraser Health

Pandemic Influenza Planning

December 10, 2009 Facilitator: Lisa Zetes-Zanatta

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Pr Prepare to Ca Care: Introductions

• FHA Pandemic Lady –

Lisa Zetes-Zanatta

• Roundtable introductions
• Name
• Service

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What is the flu anyway??

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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

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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

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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.

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Vaccine Development

• Inactivated trivalent vaccine (killed vaccine)
• 2 A, 1 B
• Effectiveness of vaccine depends on “match” between circulating

strains and those in vaccine

(H3N2) (H1N1) Influenza Protection

A/California/7/2004-like

B/Shanghai/361/2002-like

A/New Caledonia/20/99-like

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Surveillance on circulating strains Selection of specific strains Preparation and distribution

• f virus stock to

manufacturers Seed pools inoculated into eggs Surveillance on circulating strains Selection of specific strains Preparation and distribution

• f virus stock to

manufacturers Seed pools inoculated into eggs

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Harvest and concentration

• f fluids

Vaccine inactivated and purified Vaccine blended, content verified Packaging, labeling, delivery May June July August September October

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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

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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
• ld, ill most at risk
• f 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

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Recent Pandemics

• Past Pandemics:
• 1968 Hong Kong Flu (H3N2)
• 1957 Asian Flu (H2N2)
• 1918 Spanish Flu (H1N1)

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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

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There are severe pandemics and mild pandemics

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Infectious Disease Deaths 1900-1996

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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

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Are we more or less at risk today compared to 1918?

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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

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Pr Prepare to Ca Care: Ongoing Pandemic Threat: 2008/09 Update

• As of December 8, 2009:
• 1001 hospitalized human H1N1

cases, 47 deaths

• Approx. 90% of cases under 40

years old

• Lull in H1N1 activity over

summer, however presence of virus did not disappear like the routine influenza virus

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Pr Prepare to Ca 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

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Supply Issues Discussion

• Syringes
• Surgical Masks / Visors
• Laundry
• N95’s

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Pr Prepare to Ca Care: Q & A Period

Lisa: lisa.zeteszanatta@fraserhealth.ca

Pandemic ic Tabletop Exerc rcis ise

November 19, 2009

Pandemic Tabletop Exercise

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

58% + 42% Good + Satisfactory 8. Overall Rating 50% + 50% Very realistic + Satisfactory 7. Realism of Environment and Conditions 59% Partially 6. Did the EOC Procedures Work 83% Good 5. Effectiveness of the Scenario 75% Above 6 4. Number of Issues Needing Explanations 67% Realistic 3. Realism of Exercise 75% Comprehensive and easy to understand 2. Quality of Instructions 67% Exactly right 1. Duration Of Exercise

Status Dominant Opinion Evaluation Element EOC EXERCISE EVALUATION SCORECARD (Nov 19, 2009)

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?