2. Avian Flu Pandemic Preparedness David A. Denneno APRN,BC, MSN, MEd, CEN Emergency Preparedness Coordinator Sturdy Memorial Hospital Attleboro, MA

3. The only thing harder to do than get your organization to plan for a disaster is to explain to the public why you didn’t.

4. Avian Flu Key Facts  Influenza A (H5N1) virus is an influenza A virus subtype occurring mainly in birds, is highly contagious among birds, and can be deadly to them  H5N1 virus does not usually infect people, but infections with these viruses have occurred in humans. Most of these cases have resulted from people having direct or close contact with H5N1-infected poultry or H5N1-contaminated surfaces  Influenza viruses have the ability to change. Scientists concerned that H5N1 virus could be able to infect humans and spread easily from one person to another  Pandemic occurrence cannot be predicted  If H5N1 virus were to gain the capacity to spread easily from person to person, an influenza pandemic could begin

5. Pandemic Outbreak Possibilities  At least 2-7 million people worldwide will die (possibly many more)  Tens of millions of people will require medical attention  Healthcare systems may become overwhelmed  Essential services may break down as key personnel are infected  Businesses and schools may close  International travel may be limited as governments restrict entry

6. Pandemic Phases Interpandemic Period Phase 1 No new influenza virus subtypes have been detected in humans. An influenza virus subtype that has caused human infection may be present in animals. If present in animals, the risk of human infections or disease is considered to be low. Phase 2 No new influenza virus subtypes have been detected in humans. However, a circulating animal influenza virus subtype poses a substantial risk of human disease. Pandemic Alert Period Phase 3 Human infection(s) with a new subtype. No human-to-human spread, or at most rare instances of spread to a close contact. Human infection(s) with a new subtype. No human-to-human spread, or at most rare instances of spread to a close contact. Currently at this phase Phase4 Small cluster(s) with limited human-to-human transmission. Spread is highly localized, suggesting that the virus is not well adapted to humans. Phase5 Larger cluster(s) but human-to-human spread still localized, suggesting that the virus is becoming increasingly better adapted to humans, but may not yet be fully transmissible (substantial pandemic risk). Pandemic Period Phase6 Pandemic: increased and sustained transmission in general population.

8. How many vents do you have?

9. Traditional vs Disaster Medicine Traditional Medicine Traditional Medicine Do everything possible for the patient. Do everything possible for the patient. Disaster Medicine Disaster Medicine Do the most for the most. Do the most for the most.

10. HHS Plan

11. Pandemic Influenza Plans HHS Plan HHS Plan National Stockpiles National Stockpiles Massachusetts DPH Plan Massachusetts DPH Plan National Hospital Bio- terrorism Preparedness Program National Hospital Bio- terrorism Preparedness Program

12. HHS Plan The U.S. Department of Health and Human Services recommends that hospitals consider stockpiling enough consumable resources, such as masks and gloves, to last the duration of a pandemic wave, approximately six to eight weeks. It also recommends that hospitals do the following: The U.S. Department of Health and Human Services recommends that hospitals consider stockpiling enough consumable resources, such as masks and gloves, to last the duration of a pandemic wave, approximately six to eight weeks. It also recommends that hospitals do the following: Anticipate the need for supplies and determine trigger points for ordering extra resources Anticipate the need for supplies and determine trigger points for ordering extra resources Estimate the need for respiratory care equipment (including mechanical ventilators), and develop a strategy for acquiring additional equipment, if needed Estimate the need for respiratory care equipment (including mechanical ventilators), and develop a strategy for acquiring additional equipment, if needed Anticipate their need for antibiotics and determine how supplies can be maintained during a pandemic. Anticipate their need for antibiotics and determine how supplies can be maintained during a pandemic.

13. VHA Inc. Survey Depletion of critical supplies within 2 weeks Depletion of critical supplies within 2 weeks Interruptions in Asian manufacturing could impact replenishment options Interruptions in Asian manufacturing could impact replenishment options 60/62% with plans: Not prepared 60/62% with plans: Not prepared 90% inventory last 16 days or < 90% inventory last 16 days or <

14. What do we need?

15. Larry Dooley, Vice President at Novation Hospitals need to take a critical look at their inventory levels. Hospitals need to take a critical look at their inventory levels. Determine whether they need to slowly begin making changes to prepare for the impact of avian flu or some other pandemic Determine whether they need to slowly begin making changes to prepare for the impact of avian flu or some other pandemic Communicate their needs to their supply distribution partners Communicate their needs to their supply distribution partners Network with other hospitals in their community or region Network with other hospitals in their community or region Develop a contingency plan for how they might share supplies or move supplies within a region on a rolling basis Develop a contingency plan for how they might share supplies or move supplies within a region on a rolling basis

16. Sturdy Memorial Hospital Seven Days on Hand 7 DAYS ON HAND updated 3/09/06ItemDailyQtyDaysEachAddTotalBio T Description#use/eaOH/eaOHCostqtyCostInv. Hand soap41528.3325030 Central line KitAK15703A1.51916 * Cadaver BagMI-XD-CBB01300 21 Facial Tissue820936138 * Suct Cathdynd419040.285119185 Suct Cathdydn419024238135 Suct Cathdydn41900412843 Suct TubeK87925030 Suct Collv71-1105392448 D5W 1000ml2B006416233 * D5W 500ml2B0063Q27631 * Lact Ringer2B2324712557 * Saline2B1324552535 110 * TOTAL

17. Sturdy Memorial Hospital Seven Days on Hand 7 DAY ON HAND SURGE ITEMS TotalCurrent Total Itemusage forqtydaysEachqtyTotalBio T Description#1 weekon handOHCostneededCostInv. Mask RespN95630062080 5680 $ Gown Isolation202630050030 5800 $ Glove Small23-93s4600780013 0 $ - Glove Med23-95s20760173005 3460 $ Glove Lg23-97s2500500016 0 $ - TOTAL $

18. Sturdy Memorial Hospital Mask usage predicated on 9 masks/patient/day @ 100 patients or 900 masks/day x 7 days or 6300 masks. Gown usage also predicated on 9 disposable isolation gowns/patient/day @ 100 patients or 900 gowns/day x 7 day or 6300 gowns. Glove usage predicated on current average daily usage plus 20%.