1. New York State Department of Health HANYS' Nursing Home Emergency Preparedness Webconference May 9, 2007

2. Avian Influenza Situation Report Spreading prevalence in migratory birds Continued outbreaks among domestic poultry Mammalian infection (cats, pigs, etc.) lethal Virus is evolving Sporadic human cases (more than 170 reports to date) Most in the young and healthy Case-fatality 50% Rare person-to-person transmission

3. Pandemic Influenza Planning  Supposition: Hospitals will be beyond maximum capacity & staff will be overtaxed  There will have to be decisions made at the state level to alter standards of care

4. Transmission  Typical incubation 2 days Range: 1-4 days  Viral shedding  Can begin 1 day before symptom onset  Peak shedding first 3 days of illness  Subsides usually by 5-7 th day in adults  can be 10+ days in children

5.  Nursing homes should focus planning on enhancing ability to:  accept more fragile, sicker patients from hospitals  retain their residents  surge beyond licensed capacity  How?

6. To be reviewed & reinforced with staff:  Disease prevention strategies  Infection control techniques  Hand washing  Cough etiquette  (include residents!)  Identification of symptoms to:  Promote early detection  Minimize spread

7. What to expect? Staff grief & exhaustion o Admission of sicker residents/patients o Altered standards of care o Retention rather than transfer o Surge o Potential for significant increase in resident mortality Staff should be monitored closely for stress & intervention should be made available as indicated

8. HAN & the Communications Directory are the official NYSDOH directory & alerting system for emergencies

9. Health Alert Network (HAN)  Contains information about disaster preparedness  Contains articles & web site links  Posts current health advisories & alerts  Avian flu  Measles  Lead poisoning  Meningococcal disease  Polio in Minnesota  Rabies in Texas  9/15—to ACFs, Nsg. Homes, LHDs—Bagged fresh spinach  Alert to vets re: psittacosis  HAN library

10. Note: HEALTH NOTIFICATIONS originate from a variety of sources, including:  New York State Department of Health (NYSDOH)  New York City Department of Health and Mental Hygiene (NYCDOHMH)  New York State Office of Homeland Security (NYSOHS)  Centers for Disease Control and Prevention (CDC)

11. HAN Health Notification Viewer SOURCE AUDIENCE TYPE DESCRIPTION DATE POSTED DOCUMENT CREATED DATE RECIPIENTS NYSDOH  ALL USERS E. coli Outbreak Linked to Fresh Spinach: Update #1 Sep 19, 2006 Recipients CDCALL USERSBotulism Toxin Type A associated with bottled carrot juice in FLA and GA Sep 29, 2006 Recipients   Click RECIPIENTS: LHD Commissioners/Directors| NYS| All Hospital CEOs| NYS| All Hospital ICPs| NYS| LHD Dir of Disease Control| NYS| All Hospital ED Directors| NYS| LHD CD Investigative Staff| NYS| Epi Informational List| NYS| Hospital Food Prep| NYS| Hospital Food Directors| NYS| Hospital Risk Management| NYS| LTCF Food Service Directors| NYS| Adult Homes Administrator| NYS| Adult Homes Food Service| NYS| Adult Homes HPN Coordinators| NYS| LTCF Administrators| NYS| LTCF Directors of Nursing| NYS| LTCF Medical Directors| NYS| LTCF ICP| NYS  Click DESRIPTION: Detailed description of alert

12. HPN Communications Directory The purpose of the Communications Directory is to have the most current & accurate contact information available in the event of an emergency

13.  NYSDOH will rely upon this data’s accuracy, which is why your diligence and participation in maintaining current information are vital to the success of the Directory. It is expected that updates will be made on a periodic basis.

14. Section 400.10 HPN Access & Reporting Requirements  HPN accounts  Ensure that sufficient, knowledgeable staff will be available  Maintain & keep current such accounts  At a minimum, 24/7 contacts for emergency communication & alerts must be designated  Sufficient staff users to ensure rapid response to requests for information from NYSDOH and/or LHD  Current & complete updates reflecting changes to general information & personnel role changes as they occur  At a minimum, on a monthly basis

15. Emergency Response Coordinator Individual(s) who serves as coordinator of a facility's emergency operations center What roles should serve? Director, Nursing… Director, Safety/Security… Plant Manager… …Other…

16.  For NYSDOH business hours contact information, call the NYSDOH Regional Office  For non-business hours the NYSDOH contact is the NYSDOH Duty Officer @ 866-881-2809  Contact numbers should be current and available to key staff 24/7

17. Communications Directory Drills Scheduled for June 2007  Roles to be contacted: o Administrator o Designated Pharmacist o Director, Nursing o Director, Patient & Family Services o Director, Safety/Security o Emergency Response Coordinator o HPN Coordinator o HPN Organizational Security Coordinator o Infection Control Practitioner o Medical Director o CHRC AP o 24 hour contact [found in Emergency Contacts (Any Time )]

18. Drill Purpose  Evaluate & ensure accuracy of Communications Directory  Evaluate provider response to NYSDOH notifications to emergency contacts identified in the Communications Directory  NOTE: Continuous non-compliance will result in deficiency citations

19. Collaborate with planning partners  May mean meeting some for the first time  Regional Resource Center (RRC)  LHD (Local/public Health Department)  Office of Emergency Management (OEM)

20. Regional Resource Centers (RRCs) GreeneColumbia

21. HANYS Deliverables 2006 to 2007  Deliverables Tasks to be completed with specific outcomes, timeframes, & target audiences Reporting to NYSDOH

22. Deliverables  Categorize regulatory barriers to emergency preparedness & response  Appoint at least one individual to the OEM link role in the HPN  Ensure that individuals identified in the OEM link role take ICS 100, 200, 700, & 800  Modify &/or provide comments & recommendations to HHS pan flu questionnaire  Work with nursing homes to:  Appoint at least one individual to the Emergency Response Coordinator role in the HPN Communications Directory  Encourage the Emergency Response Coordinator to take ICS 100, 200, 700, & 800 (on line)  Monitor nursing home compliance & report status of ICS training to NYSDOH

23.  Work with DOH to issue a pan flu questionnaire & work with nursing homes to ensure proper completion & timely submission  Ensure that at least one individual identified in the OEM link role participates in quarterly meetings with NYSDOH & disseminates relevant information to nursing homes  Assist nursing homes in entering complete contact information in the Communications Directory, & remind nursing homes to keep information current  Assist NYSDOH in securing timely & complete responses to HERDS surveys issued to nursing homes  Perform outreach to non-members, including posting information on publicly accessible websites

24. Recent events Winter ’07 in Mexico ! Highland, 4/17 Oneida, 3/13

25. Lessons learned  Some HPN data for healthcare facilities remains either incomplete or outdated  This incomplete or outdated information makes it difficult to obtain accurate facility status reports in an emergency  The Incident Command System (ICS) not always followed by all groups, creating back ups  The Regional Office is able to be reached 24/7. Some facilities still do not have the correct numbers.

26. Katharine Logan Health Emergency Preparedness Program NYSDOH Non-acute Care Hedley Park Place 433 River Street Troy, NY 12180-2299 Phone: 518-408-5163 E-mail: KML04@health.state.ny.us