1. Community PanFlu Planning : Ancillary Healthcare

2. Objectives Facilitate development of your Internal Disaster Plan Foster discussion among facilities to enhance cohesion during crisis Encourage “coopetition”.

3. Why Have a Plan? Without… Communication Coordination Cooperation You get… Chaos Crisis Confusion

4. Why Plan? Evidence suggests… All communities severely impacted >120 casualties = MCI Without Internal Disaster planning, estimated 40% businesses will fail.

5. Preparing for a Pandemic in Knoxville Federal Plan: Local and Self-reliance is key Local groups to develop Internal Disaster Plan Surveillance Communications Infection Control Occupational Issues Vaccine/Antiviral access Supply chain redundancy Interagency cooperation Family and Individual planning essential

6. Guidance for Planning Because resources will be limited… Contingency planning should include: Planning for absenteeism: ~40% Hygiene products and education in the workplace Supply shortages Home offices for critical personnel Sick leave policies compatible with state recommendations

7. The Pandemic Influenza Cycle Rapid transmission with worldwide outbreaks; multiple waves of disease over a 2 year period. Occurrence of cases outside the usual season. High attack rate for all age groups, with high mortality rates, esp for young adults Cycles 10-40 years. Last pandemic was mild, 1968 (35 years ago)

8. Will H5N1 become the next pandemic? Avian Flu not yet Pandemic Flu, but current outbreaks in poultry are largest ever documented. Impossible to know if or when If not H5N1, then another will come The prudent time to plan is now

9. Assumptions about Disease Transmission No one immune to virus; 30% of population will become ill Most will become ill 2 days (range 1-10) after exposure to virus People may be contagious up to 24 hours before they know they are sick People are most contagious the first 2 days of illness Sick children are more contagious than adults On average, each ill person can infect 2 or 3 others (if no precautions are taken)

10. Community Disease Control: Early Stage Isolation and Quarantine Initial Objective: slow spread of disease Isolation vs. Quarantine Legal measures possible but will rely on voluntary cooperation Once beyond initial cases, shift strategy to “stay home when you are sick”

11. Community Disease Control: Reducing Social Contact Canceling large gatherings, mass transit, schools Decision based on location of flu activity: Not local: gatherings >10,000 cancelled Local/neighboring county: >100 cancelled School closings determined by State Commissioner of Health/Board of Education.

12. Medical Burden in Knox County 2005 Knox County Population est. 396,741 CharacteristicModerate (0.2%) Severe (2%) Illness (30%) 119,000 Outpatient care 59,500 Hospitalization 1,190 11,900 ICU (15% hosp pts) 180 1,800 Mechanical ventilators (50% ICU pts) 90 900 Deaths 240 2,380

13. Establishing a Planning Structure PanFlu Committee PanFlu Coordinator Point of Contact Written Plan

14. Surveillance: Populations Served Educate staff Signs/symptoms pandemic vs seasonal flu Infection control measures Community response plan Track patients/staff with panflu Have system in place to report unusual flu-like illness/pan flu to local HD

15. Surveillance for those at work – Develop screening for employees with flu-like symptoms Develop sick leave policy specific for panflu Determine when ill employee may return to work

16. Internal and External Communication networks Detailed communications planning needed: Internal- Ensure employees know panflu policy, communications plan, their specific role, esp in surge capacity External- Point of contact with Health Department Info via KCHD Broadcast FAX, Email, website, Media Coordinate with like organizations to develop/coordinate emergency plans Communicate with other facilities affected by yours

17. Infection Control Signage to educate personnel and patients Adequacy of surgical masks for patient contact not involving aerosolization procedures Possibility of using surgical masks over reusable N95s as well as goggles/face shields for high-risk procedures Establishing regularly scheduled environmental cleaning

18. Vaccine/Antiviral Distribution Prioritization of personnel : based on level of patient contact PanFlu Coordinator: to develop and provide list of First and Second tier personnel Prioritization determined by Feds and may change

19. Secondary Distribution Center SNS warehouse  SDC  Your Facility Here at KCHD or KCHD off-site warehouse or Other location Either distribute directly to your staff or have facility point person pick up and administer Important to be flexible

20. Surge Capacity:Staffing Shortages Identify minimum number employees and categories required for essential operations Temporary help MOAs with other facilities Volunteer Coordinating Center being developed: Non-medical vs Medical

21. Staffing Shortages and Workforce Support Develop strategy for housing staff on-site for prolonged periods if needed Staff encouraged to develop personal family care plans for their absence from home

22. Planning to be away… Plan for childcare in the event schools close Arrangements made for eldercare, pet care Discuss/develop plan for employee to work at home if possible

23. Surge Capacity: Supplies Estimate needs for consumable resources One weeks worth Primary Plan & Contingency Plan Detailed procedures for supply acquisition Normal channels exhausted: have a back- up

24. Have you thought about??? Where are you in developing a plan for your office/business? Triage: patients and employees. What will be your financial viability with a possible 40% absenteeism? Does your family have a plan? Are you prepared with enough water, food, meds?

25. Have you thought about??? Employees are calling in sick… do you have extra staff to call in?? Employee comes to work but c/o fever and may need to go home. Avian flu or cold? When do you let recovering employee return to work?

26. Have you though about??? Employees handling money, patient forms… what if they want hand sanitizer, gloves and demand to wear masks? Support services (delivery, suppliers, labs, etc) are not available because of fear of catching disease. Not enough staff to keep store/office open… Can computer records be accessed from another location? What do your patients do?

27. Have you thought about??? Calling on patients to check on their well- being? Patient emergency calls: how to handle? Possibility to consolidate services from one or more central locations… work with other professionals to keep one site open?

28. Have you thought about??? How do you see yourself, if able, offering services to the greater community? Making house calls/volunteer home visits to check on essential patient needs? Offering services through Volunteer Coordination Center?

29. Have you thought about??? How do you see your professional organization fitting into this equation? Central communications to all professionals? Central location for emergency calls from patients/clients?

30. Resources PandemicFlu.gov CDC.gov/flu/avian www.nyhealth.gov Knoxcounty.org/health Knoxpanflu@knoxcounty.org: If you want to be put on “Pandemic alert email” list