1. CUPS Health and Education Centre Response to H1N1

2. Who we are Health Education Housing Outreach 140 staff total

3. Health Clinic Health Clinic: – 1800 visits per month – Primary, episodic, crisis based care – Mental Health, Women’s Health, Prenatal Care, Chronic Disease Management, Specialist

4. Family Resource Centre 1000 visits/month Crisis Counselling & Advocacy Goal Setting & Ongoing Support Parenting & Life Skills Low-income Housing Assistance Children’s Programming

5. One World Child Development Centre Early intervention education centre Thriving, instead of surviving Preschool to Kindergarten 60 students

6. Outreach and Housing Other agencies visited by CUPS RNs, NPs and MDs: Hospitals Shelters Detox and Treatment Centres The street (DOAP & Outreach team) 2000 visits/month – the absolute homeless

7. Inner City Agencies: What did we do? Dec 2008 - Pandemic Planning Committee Jan 2009 - Influenza Pandemic Preparedness for Inner city Agencies Feb 2009 - City of Calgary Infectious Disease Management Plan April 2009 - Personal Emergency Preparedness May 2009 - Pandemic Influenza 101

8. CUPS: What did we do? Jun-Aug 2009 set up our emergency structure June 2009 Instructions for staff, Microsan stations July 2009 Patient triage process implemented and inventory organized The ‘Black Book ’

9. PATIENT RECEPTION ?? ASK ?? -cough/cold/fever in last 48hrs? OR Patient looks very unwell/ is coughing MICROSAN HANDS MASK Continue as usual NO 2 nd LPN to Triage need for immediate care ( treatment room) : ILI symptoms : temp/O2 sats/HR Seat pt in reserve seats Notify LPN YES Non urgent URGENT fever> 38 oral Pt to wait in lab chairs Refer MD/NP only Call Agency PRN Pt to wait in reserve seats. Refer to RN, MD, NP MICROSAN

10. Getting ready continued… Sept 2009 Train the Trainer program for managers. Presentation on influenza preparedness given to all staff, by department N 95 masks for medical staff Mandatory staff meeting to present CUPS plan and to address expectations and concerns.

11. How does influenza spread?

12. What was our experience? More staff than patients sick Close to 30% absenteeism at the peak One ICU admission – Camp Bus Driver: resulted in one child treated with Tamiflu. 8-10 patients with ILI symptoms in any one day NP swabs only on those with risk factors or very ill. Aug 2009- First positive H1N1 patient Only 3-4 positive H1N1 patients thereafter H1N1 <10% of all NP swabs No known deaths

13. Immunizations Seasonal flu vaccine was received from AHS on Oct 16/09. Oct 16/09 – Nov 4/09320 given Nov 5/09 – Feb 28/10103 given H1N1 vaccine was received from AHS on Dec 6/09. December/09 109 given January/10 64.5 given February/10 12 given

14. Other clinic actions: CUPS Fluids available for patient distribution. Individual patient teaching on hand washing and use of masks H1N1 Flu talks for clients - LPN H1N1 inservices for staff throughout organization - RN Agencies H1N1 inservices for agencies - RN Patient assessment, and assistance with suspected outbreaks Teaching and advocacy to other agencies on behalf of patients. Community Medicine residents helped agencies develop their pandemic plans Outreach staff transported patients to shelters, hospitals, urgent care centre, hospital pharmacy

15. Patient Reactions to H1N1 Measures Mostly good Receptive to teaching, well informed Barriers: Fluids, Tamiflu Felt hyped by media Started asking for H1N1 shots in October Transportation Addiction, Mental Health Other barriers

16. Tamiflu CUPS received Tamiflu from AHS on Nov 4/09 1 course dispense for an adult in early December Prescriptions written once universal coverage approved Tamiflu prescriptions issued for few staff who became ill

17. Concerns Earlier access to vaccine Immunization for all staff at partner agencies Earlier and easier access Tamiflu Central distribution centre for required supplies Better communication, clear guidelines for who to contact

18. What if things had gotten worse? Phase 1 : described Phase 2 : 2 clinic sites Ill patients Well patients for routine care Phase 3 : Shut down majority of programs, organize 3 teams Team 1: Routine care for prenatal patients at CUPS site women’s clinic. Team 2: Ill patients at CUPS site main clinic, home visits and care by support staff Team 3: Outreach RN/NP/MD/support staff going to shelters for triage and care.

19. If you are sick at home with influenza symptoms, please call CUPS. If sick more than three days please call Health Link: 403-943-LINK