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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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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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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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, 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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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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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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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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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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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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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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