1. Luke Bowen – Exercise Facilitator
Pan-Flu-Iso Exercise
Module 1
Luke Bowen – Exercise Facilitator
November 9, 2017

2. W E L C O M E Long Term Care Partners Home Care and Hospice
Hospital Partners
Public Health
Emergency Management
EMS
Regional Health Care Coalition
Others E L C O M E

3. E X E
Threat Assessment/Hazard Vulnerability Analysis
Perceived Gap
New CMS Requirements
Desire for Competence & Effectiveness R C I S E O R I G I N

4. MODULE 1 Objectives During the next three hours this exercise;
Will provide the foundation for facilities based exercises in Module 2 of this Situation Manual.
Will engage community partners in an exercise with the Long Term Care Community.
Will assist the LTC Community in meeting their CMS requirements of conducting an exercise testing or validating their Emergency Response Plan.
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5. MODULE 1 Exercise Guidelines
This exercise is a open, low stress environment.
Respond to the scenario using your knowledge of current plans and capabilities.
This exercise is an opportunity to present and discuss multiple options and solutions.
Gaining understanding from community partners and problem solving should be the focus.
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6. First Report
The H3N(X) flu virus has been slowly spreading worldwide from its origin in China. Because this flu was identified late in the vaccine development cycle, this year’s flu vaccine offers no protection against H3N(X). While the symptoms are not severe in younger populations, and these groups are experiencing normal mortality rates, (~0.01% or less) individuals older than 65 are particularly hard hit by a sudden onset of respiratory complications resulting in mortality rates ranging between 2.5% - 3%.
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7. MODULE 1 First Report - Continued
Unlike other influenza strains, contractors of the H3N(X) become contagious about 6 hours after their temperature reaches 100˚F (37.8˚C).
The World Health Organization has declared H3N(X) a pandemic and in the United States the Center for Disease Control (CDC) has implemented its National Pandemic Strategy. The Michigan Department of Health and Human Services (MDHHS) is issuing guidance for Long Term Care Facilities, as well as Assisted Living Facilities, and Senior Citizen apartment complexes in light of the predictable nature of H3N(X).
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8. MODULE 1 First Report - Questions
Is this scenario realistic in Region 2 North?
What are your agencies priorities at this point?
Are there specific policies and/or procedures you would implement at this time?
What notifications, if any, would you make at this time?
What actions would you take to safeguard your residents?
Any additional considerations.
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9. Second Report
As the impact of the flu increases a decision is made to limit its spread by cohorting afflicted patients in facilities by region. The designation of LTC facilities as H3N(X) treatment centers will be coordinated by local public health departments. Healthcare systems that have multiple LTC facilities can designate flu treatment facilities within their system and move affected residents/patients in order to maintain residents/patients within their system.
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10. MODULE 1 Second Report - Continued
If resident/patients cannot be moved prior to entering the contagious phase of their illness they will need to be isolated within their facility until they can be moved. Residents are returned to their facility 24 hours after their flu symptoms have subsided. The action is expected to last about 3 months. During that time your facility will have to limit facility access, monitor residents, staff, and visitors, isolate residents, and track the movement of residents/patients in and out of your facility.
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11. MODULE 1 Second Report - Questions
Will Incident Command be established and maintained throughout the event?
How will you maintain operations if you experience a 30% reduction in staffing?
How will staff and residents be protected?
What tasks could be taken to improve sustainability?
What help would you expect from Emergency Management and Public Health?
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12. Third Report
As H3N(X) progresses Home Health and Hospice agencies experience a gradual, but dramatic, increase in request for service. Hospitals can maintain some of the patients but the majority are sent to available treatment beds or home for treatment or for hospice care. At 4 weeks into the season there is a 50% increase in request for service and a 100% increase at six weeks. This is expected to decrease throughout the balance of the flu season.
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13. MODULE 1 Third Report - Questions
How does your Emergency Plan address a surge in request for service?
Does your organization operate in the Incident Command System during an incident or event?
Does your organization have pre-determined indicators and triggers with regard to Crisis Standards of Care?
Do you have existing Co-operative Agreements with agencies that can support you during an event or incident?
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14. HOT WASH Initial thoughts about Module 1.
What went right in this exercise?
What are some positive take aways?
Areas for improvement.
What should have, or could have been done differently?

15. NEXT STEPS Complete the evaluation form.
Review Module 2 of the Situation Manual to see that it reflects what you plan to test from your Emergency Plan.
Review your objectives to see they are S.M.A.R.T.
Ensure your staff are prepared for the exercise.
Prepare to document the findings of your exercise.
Complete an After Action Report/Improvement Plan.
Any additional considerations.

16. Questions
Hazard Vulnerability Assessment