Vulnerable PopulationsPandemic Influenza Preparedness

Tabletop Exercise

Santa Clara County Public Health Department

June 24, 2008

What is a tabletop exercise?

People come together to review and discuss a hypothetical emergency situation

Designed to allow participants to talk through plans and problems

NOT designed to measure anyone’s performance

Serves as a springboard for further planning and more comprehensive exercises

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Exercise roles

Facilitator Provide instructions, tell the story, introduce the

questions, guide the discussion Participants

Immerse yourself as if the scenario were truly occurring in your jurisdiction, using resources that are available to you (Emergency Operations Plan, policies, procedures, references)

Participate in the group discussions Evaluators

Observe the exercise to evaluate the process 2

Ground rules

Respond as if the scenario is real

Play the role of your department, agency or community throughout the exercise

Operate within current resource constraints and realities

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Objectives

By the end of this exercise, you should be able to:

Describe your individual and your agency’s roles in the response to Pandemic Influenza

Identify at least one gap in your agency’s existing Emergency Operations Plan (EOP)

Contact the appropriate partnering agencies for assistance

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In the news…

Human-to-human transmission of avian influenza has been reported by the Centers for Disease Control & Prevention (CDC)

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Outbreak…

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Today in San Jose...

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DAY 1, 9:00 a.m. The beginning…

A 47-year-old man from San Jose A 47-year-old man from San Jose arrives at the emergency department arrives at the emergency department (ED) at Valley Medical Center with (ED) at Valley Medical Center with fever, chills, cough and shortness of fever, chills, cough and shortness of breathbreath

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He is a prominent wildlife photographer who returned two days ago with his wife from an assignment in Nigeria

Patient history

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Bad decision…

Last night, despite feeling feverish and Last night, despite feeling feverish and tired, he attended an awards banquet with tired, he attended an awards banquet with 200 of his colleagues200 of his colleagues

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He is evaluated in the Emergency Dept (ED)

Chest x-ray reveals pneumonia A breathing tube is inserted (intubated)

and placed on a ventilator due to severe respiratory distress

Just as he is moved to the Intensive Care Unit (ICU), his wife begins to complain of similar symptoms and registers as a patient in the ED

DAY 1, 12:00 p.m. At Valley Medical Center

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His wife’s respiratory status severely deteriorates

She is urgently transferred to the ICU

DAY 1, 11:00 p.m. The wife worsens

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The photographer suffers a cardiac arrest and cannot be revived

Meanwhile, his wife struggles to stay alive

DAY 2, 8:30 a.m. Code blue!

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ICU physician concerned based on rapid onset of illness and couple’s travel history to Africa

Decides to notify the Santa Clara County Public Health Department

Orders an infectious disease (ID) consult

DAY 2, 8:30 a.m. Is something wrong?

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Break for discussion

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1. What steps have you taken to protect you and your family for pandemic influenza or other disasters/emergencies? Examples:

Prepared emergency pan flu home kit Understand how to care for a sick family member

at home Know where to receive accurate information about

pan flu2. Have you established a plan for childcare if schools

are closed for: 4 weeks (moderate) to 12 weeks? (severe

pandemic)3. Does your neighborhood have a Community

Emergency Response Team (CERT), or an active neighborhood association with an emergency coordinator?

4. Do you know where your vulnerable neighbors reside? Has your neighborhood planned how to assist them in an emergency?

Personal Preparedness

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Communication…

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DAY 2, 2:00 p.m. Related cases

Four more patients arrive at Valley Medical Center with severe flu-like illness

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A leading medical journal reports human bird flu cases in Eastern Europe

World Health Organization (WHO) reports that human-to-human transmission of avian influenza has occurred, but remains limited

WHO increases the pandemic influenza alert phase to 4

DAY 2, 3:30 p.m.In the rest of the world…

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WHO Pandemic Flu Phases

Inter-pandemic Inter-pandemic phasephase

No new virus in No new virus in animals, no animals, no human caseshuman cases

Low risk of human casesLow risk of human cases 11Higher risk of human casesHigher risk of human cases 22

Pandemic alertPandemic alert

New virus causes New virus causes human caseshuman cases

No or very limited No or very limited human-to-human human-to-human

transmissiontransmission

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Increased human-to-human Increased human-to-human transmissiontransmission

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Significant human-to-human Significant human-to-human transmissiontransmission

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PandemicPandemic Efficient and substained Efficient and substained human-to-human human-to-human

transmissiontransmission

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DAY 3, 12:00 p.m Confirmation of new pandemic flu virus

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DAY 3, 3:30 p.m. Breaking news!

KNTV 11 news reports:

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DAY 3, 4:30 p.m. Public Health Response

schools will be closed effective immediately

large public gatherings have been cancelled

all local agencies including hospitals are asked to implement their Pandemic Influenza Plans

A press conference is called by SCC Health Officer, Dr. Fenstersheib to announce:

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Public panic!!!

CADRE agencies begin receiving concerned calls from clients. They are worried about getting ill and are

asking how they can avoid the pandemic virus Some are worried about how they are going to

continue to receive services Some clients are afraid to leave their homes

CADRE Network is activated

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DAY 4, 1:00 p.m.Valley Medical Center

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Break for discussion

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1. At your agency, what measures will you take to limit the spread of the virus

For clients? For staff?

2. How can your agency disseminate critical information to the clients you serve?

Currently (pre-pandemic) During a pandemic

3. Have you identified which of your clients are at greatest risk of getting ill?

Agency Preparedness

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Detection…

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DAY 4Epidemiological Investigation

Centers for Disease Control

•

•

SCC Public Health Dept CA Dept of Public Health

Virus sample sent to CAPHD for analysis

Specimen confirmed for pandemic influenza.

Sample is sent to CDC for final confirmation.

Specimen is confirmed as a new pandemic influenza strain

SCCPHD & CADPH or notified

Local and State response is taken

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People who also attended the awards banquet begin to seek hospital care

In addition to the index case, two more patients with suspected pandemic influenza have died

DAY 5, 10:00 a.m. The illness spreads

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Overwhelmed hospitals triage patients as they arrive, admitting only the most ill. The vast majority must return home to cared for by family members

DAY 5, 4:00 p.m. Hospitals Reach Surge Limit

www.sccphd.org/panflu 31

Influenza Care Centers Open

Santa Clara County Health Officer orders the first ICC to open. The ICC will receive patients that are too sick to be at home, but do not meet criteria for hospital admission. Capacity of an ICC is 450 patients.

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Worldwide Cases reported in East Asia, Eastern Europe and,

most recently, in Africa Mortality (death) of patients with pandemic

influenza in Asia exceeds 5% WHO declares an increase to pandemic phase 5

for influenza

DAY 6, 3:00 p.m Increase to WHO

phase 5

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Break for discussion

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1. Does your agency have an emergency operations plan?

Who or how, does your agency activate your What are your activation procedures and

staffing plan for emergency situations?

2. What interagency arrangements have been made for sharing resources in your community?

3. How are you going to provide services to home-bound individuals?

Agency Response

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Crisis & Long Term Effect

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Two San Jose pharmacies have experienced burglaries, presumably by persons looking for Tamiflu®

Law enforcement unable to respond immediately because of unprecedented absenteeism among officers

DAY 7 Breakdown of infrastructure

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Some healthcare workers are afraid to come into work

Essential services such as trash collection, utilities repair and public safety agencies are reporting up to 30% absenteeism

Many businesses encourage workers to telecommute or work flexible hours

Day 8 Absenteeism Crisis

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Evidence supports person-to-person transmission

Almost 1,000 suspected cases statewide

75 have died, including numerous healthcare workers and first responders

DAY 14 Update

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DAY 14 Mass fatality concerns

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WHO declares an influenza pandemic, phase 6

In the U.S., public health officials still struggling to control the spread of pandemic influenza

Public health system, including hospitals, remains overwhelmed

DAY 16 Pandemic declared

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Local businesses are suffering from lack of workers and customers

Poultry consumption down because consumers are afraid of getting sick from eating chicken

Emerging economic consequences

DAY 20

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Forecasters predict that epidemic will continue for several more months and result in over 1.8 million deaths nationwide

Santa Clara County deaths could surpass 36,000

Estimated nationwide economic impact will exceed $100 billion

DAY 20 Forecasts

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Break for discussion

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1. Does your agency have a plan for staff absences unique to a pandemic?

Time off/ leave pay to care for family, or when employee is home in isolation or quarantine?

Or return to work policies specific to a pandemic?

2. Are there any client related supplies that you could potentially stockpile to prepare for a pandemic?

Long Term Planning & Response

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End of End of Pandemic Flu Pandemic Flu

ScenarioScenario

Thank you!!Thank you!!

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