Avian Influenza and Your Center: An interactive session April 18, 2005 CHCANYS Brooklyn/Queens Kick Off Meeting

2 Interactive Session For this session, we are going to present a moment by moment scenario that will help to introduce some of the concepts of preparedness. Audience members are encouraged to play along…pretend that this is happening at YOUR center. Tell us what your center would do Ask questions Voice concerns Allow for some artificiality of the scenario.

3 Why Avian Influenza? 1.Nuclear Detonation 2.Biological Attack: Aerosolized Anthrax 3.Biological Disease Outbreak: Flu Pandemic 4.Biological Attack: Pneumonic Plague 5.Chemical Attack: Blister Agent 6.Chemical Attack: Toxic Industrial Chemicals 7.Chemical Attack: Nerve Agent 8.Chemical Attack: Chlorine Tank Explosion 9. Natural Disaster: Major Earthquake 10. Natural Disaster: Major Hurricane 11. Radiological Attack: Dirty Bombs 12. Explosive Attacks: Improvised Bombs 13. Biological Attack: Food Contamination 14. Biological Attack: Foot-and- Mouth-Disease 15. Cyber Attack The New York Times; Wednesday, March 16, Nightmares for Disaster Planning

4 Brief Background-Avian Influenza Avian influenza is caused by a bird flu virus. These occur naturally among birds (e.g., chickens, ducks, turkeys) Normally, bird flu does not affect humans; HOWEVER, transmission has occurred in Asia/Southeast Asia causing severe respiratory illness in humans with high death rate. Symptoms of Bird Flu in Humans: Typical flu-like illness (fever, cough, sore throat and muscle aches) to eye infections, pneumonia, severe respiratory diseases and other life threatening complications.

5 Brief Background: Avian Influenza Transmission occurs via contact with infected poultry or contaminated surfaces. Treatment: Currently, there is no vaccine. There are two antiviral drugs used to treat and prophylax for avian influenza.

6 Let’s Start

7 Tuesday Morning Slightly cloudy but pleasant Spring day CHC ED walks into office and turns on computer. There is a high priority from the NYC DOHMH.

ALERT #38: Clusters of severe H5N1 influenza outbreaks with community transmission in Vietnam Please Distribute to All Medical, Pediatric, Family Practice, Laboratory, Critical Care, Pulmonary, Dermatology, Employee Health, and Pharmacy Staff in Your Hospital Dear Colleagues: Clusters of severe H5N1 influenza outbreaks have been identified in southeast Asia. There are currently no cases in the United States. The NYC DOHMH and the federal Centers for Disease Control and Prevention (CDC) have instituted screening of travelers to and from affected countries. A vaccine is in development and will be available in 3-4 months. The NYC DOHMH is requesting heightened surveillance for persons presenting with the following illness: 1. High fever (>38o C or 101.4o F) AND 2. Respiratory signs or symptoms, including cough, shortness of breath or difficulty breathing AND/OR 3. Anyone with these symptoms who has traveled to Vietnam or had contact with someone who is ill and had travelled NYC DOHMH requests immediate reporting of any cases with the above illness and asks health care providers to: Ensure that patients with fever and respiratory symptoms are quickly identified and isolated. Promote respiratory hygiene/cough etiquette and hand washing measures. Consider using rapid influenza diagnostic tests. Use antiviral medications judiciously. Tuesday, 9:00 am The City of New York DEPARTMENT OF HEALTH AND MENTAL HYGIENE Michael R. BloombergThomas R. Frieden, m.d., m.p.h. MayorCommissioner _______________________________________________________________ nyc.gov/health

9 New York City DOHMH Health Alert Infection Control Guidance Suspect and Probable Case Definitions Reporting to DOHMH Patients who meet these criteria should be isolated and evaluated using airborne precautions. Please notify the NYS/NYC immediately so that we can assist with clinical management and laboratory testing. Call the Provider Access Line at NYC DOH1. Tuesday, 9:00 am

10 Public Health Response NYC DOHMH activates their Incident Management System. Enhanced outreach to Hospitals, Community Health Centers Laboratories Vietnamese and Asian communities Teleconference scheduled for hospitals and CHCs at 11 am. Enhanced passive/active surveillance

11 WHAT WOULD YOUR CENTER DO NOW? Response to the Health Alert Activation of Incident Management System (IMS) How do you know when to activate? Partial or full activation? What are your criteria for activating? Notification of Internal Staff Emergency Operations Center

12 NIMS: National Incident Management System System that establishes COMMON language and concepts among all response agencies Incident Management System COMMAND OPERATIONSPLANNING LOGISTICS FINANCE/ADMINISTRATION

13 Back at CHCANYS… Incident Commander – (CHCANYS CEO) Communities Served By CHCANYS Members CHCANYS General Membership (CEO, Medical Directors, EP Coordinators) Planning (EP Medical Director) New York City Department of Health and Mental Hygiene New York City Office of Emergency Management (NYC OEM) New York State Department of Health (NYSDOH) Greater New York Hospital Association (GNYHA) Logistics DirectorOperation DirectorFinance/Administration Director

14 CHCANYS CHCANYS sends out notice to FQHCs: Current information on health alert Teleconference with City at 11am Teleconference with FQHCs and CHCANYS at noon. FQHCs to CHCANYS with questions or issues to bring up with DOHMH

15 Tuesday, 11am Teleconference Call Update of current situation Guidance from DOHMH Identification of cases and reporting Infection Control measures Surgical masks/hand hygiene Guidance from NYS DOH HERDS reporting Guidance from OEM Antiviral supplies Other agencies

16 Tuesday at 11:00 am Back at the CHC… A 55-year-old man and his 31-year-old daughter walk into center. At the registration desk they are coughing and both appear flushed. They also seem somewhat short of breath.

17 Tuesday at 11:00 am As per the center policy and successful internal notification, the two patients are given tissues (or surgical masks) and taken to another room to await examination.

18 WHAT WOULD YOUR CENTER DO NOW? Internal notification Infection Control Measures

19 NIMS: National Incident Management System System that establishes COMMON language and concepts among all response agencies Incident Management System COMMAND OPERATIONSPLANNING LOGISTICS FINANCE/ADMINISTRATION

20 Patient 1 Medical History 55-year-old man Alert, oriented, anxious. Chief complaint: “I can’t sleep at night, I’m coughing too much.” Two-day history of weakness and non- productive cough No other medical history T 100.9, HR 104, RR 28, BP 128/72

21 Patient 2 Medical History 31-year-old daughter Alert, oriented, coughing frequently Chief complaint: “I feel warm, I think I have the flu.” Married with two kids No other medical history T 101, HR 108, RR 28, BP 100/60

22 What else do you want to know? The two patients had recently traveled to Vietnam with their families and had returned on Saturday.

23 WHAT DOES YOUR CENTER DO NOW? External notification Transfer of patient Housekeeping issues

24 NIMS: National Incident Management System System that establishes COMMON language and concepts among all response agencies Incident Management System COMMAND OPERATIONSPLANNING LOGISTICS FINANCE/ADMINISTRATION

25 Tuesday, 11:30am Other patients in the waiting area noticed that the two patients were given tissues (or surgical masks), put in exam rooms and now are being taken away by EMS. Word starts to float among the staff that the “avian flu” is here in the center. Some patients overhear this. On the TV in the waiting area a news reporter announces the imminent danger of the deadly avian flu coming to the US.

26 WHAT WOULD YOUR CENTER DO NOW? Mental Health of Patients Mental Health of Staff

27 Take Home Thoughts When would the current situation trigger your center’s Incident Management System? What internal and external communication needs are required to communicate with your center’s staff? How should the patients waiting to be seen in your center be managed? How would you manage the mental health concerns of your staff?

28 Close Out What CHCANYS has been and will be doing for CHCs in 2005: Three borough wide kick off meetings (Brooklyn/Queens, Bronx, Harlem) Train-the-trainer in fit testing N95 respirators Donning and removing PPE posters Notification Drills via HAN for CHCs Conducting an HVA Developing your IMS Identifying your center’s role during a citywide emergency And more! Stay tuned!

29 Thank you! Questions? Brenda Merritt, MD Emergency Preparedness Medical Director (212) ext. 665 Robyn DiPalma Program Associate (212) ext. 217

30 What is a Tabletop? A verbal “ walkthrough ” of a response to an emergency situation. Designed to elicit dialogue by the participants as they examine and resolve problems based on emergency plans and procedures. A first step towards conducting a partial or full drill.