2. Large numbers of ill people seek care; EDs, clinics, and medical offices are crowded; there’s a surge on medical facilities; Delays in seeing a provider; and Potential for delay in antiviral treatment Potential Problems During a Severe Pandemic

3. Long wait times... Reduced access to care and antivirals … Increased risk of illness and death ….

4. Preparing for a Severe Pandemic: Mitigating the Surge on Medical Facilities Drive down transmission of disease and reduce unneeded visits Improve the capacity of medical care systems AND Capability 10: “Medical surge is the ability to provide adequate medical evaluation and care during events that exceed the limits of the normal medical infrastructure of an affected community.” --Public Health Preparedness Capabilities: National Standards for State and Local Planning

5. Develop a coordinated national network of triage lines for use during a severe pandemic to: Improve access to antiviral prescriptions for ill people; Provide an alternative to face-to-face provider encounters; Reduce medical surge; and Increase appropriate use of medical resources. Goals of Flu on Call™

6. How Can We Build on Existing Systems? Health Plan Nurse Advice Lines Hospital Nurse Advice Lines Providers & Clinic Help Lines Other Help Lines Public Health Emergency Help Lines

7. A 2-1-1 Specialist answers “Are you ill or caring for someone who is ill with influenza-like illness?” Caller dials a toll-free number Interactive voice response (IVR) system asks caller to identify his/her state 2-1-1 Specialist provides information directly, or refers caller to public health information (hotline, website) or other community resources “Are you a member of a participating health plan or health system?” 2-1-1 Specialist refers or transfers caller to the appropriate help line. 2-1-1 Specialist transfers caller to a Poison Control Center No Yes No Yes Specialist at Poison Control Center triages caller, recommends where/when to seek face-to-face care, and provides access to antivirals if appropriate. Callers from nonparticipating states are referred to state resources

8. There will be advance notice of impending pandemic before the need to activate Flu on Call™; Medical facilities and clinics will be surged with patients during a severe pandemic, causing delays in treatment; Patients will need a prescription to obtain antiviral medicine during a pandemic; Antivirals from commercial sources may be limited and/or not available --> SNS likely to distribute antivirals; This network can provide accurate information and protocol-driven triage services (integrated telephone platform & common database); State health agencies will determine if this service is available in their state or if the public will be served by another means; and May be used for other public health emergencies. Flu on Call™ Assumptions for Planning

9. Flu on Call™: Public Health Roles and Responsibilities 9 WITH

10. Implementation Considerations for Public Health Expanding scope of professionals that can legally prescribe antivirals during an emergency. Engage health plans and existing health advice lines. Provide participating call centers with pandemic- related information, guidance and situational awareness. Engage the state Poison Control Centers. Engage participating pharmacies. Promote Flu on Call™ to the public. 10

11. Implementation Considerations for Poison Control Centers Expanding scope of professionals that can legally prescribe antivirals during an emergency. Staffing to meet increased demands. Cost of upgrading phone and computer systems. Increased length of calls to adequately assess caller to prescribe antivirals. Maintaining list of referral sources for those without insurance.

12. Potential Benefits of Flu on Call™ Improve access to prescriptions for antiviral medications; Direct ill people to care, if needed; Reduce unnecessary ED, clinic, and provider visits (minimize surge); Provide accurate information to the public (home care; antivirals; infection control at home; when/where to seek care; outbreak information); Reduce transmission of infection in waiting rooms; Reduce misinformation and rumors about pandemic. 12

13. Questions? Thank you! Suzi Silverstein, MA, RD Director, VDH Office of Risk Communication and Education suzi.silverstein@vdh.virginia.gov suzi.silverstein@vdh.virginia.gov