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Pandemic Planning

2015 National Campus Safety SummitLas Vegas, Nevada

February 23, 2015

UniversityEmergency

911

Pandemic Planning

2015 National Campus Safety SummitLas Vegas, Nevada

February 23, 20151

Welcome & Introduction

John A. TroccoeEmergency Management ConsultantOffice of Emergency ManagementUniversity of San Francisco Department of Public SafetyDirect: Office: [email protected]

& Principal of:

John A. TroccoeEmergency Management ConsultantOffice of Emergency ManagementUniversity of San Francisco Department of Public SafetyDirect: Office: [email protected]

& Principal of:

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Agenda & Learning Objectives

Purpose

To enable colleges and universities to be prepared tomanage and respond to an influenza pandemic.

Discuss the importance of planning and how to get started. Describe specific areas that should be included in planning. Meeting the health and safety needs of staff & students. Addressing planning issues for the campus-wide response.

Purpose

To enable colleges and universities to be prepared tomanage and respond to an influenza pandemic.

Discuss the importance of planning and how to get started. Describe specific areas that should be included in planning. Meeting the health and safety needs of staff & students. Addressing planning issues for the campus-wide response.

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Agenda & Learning ObjectivesObjectivesA Pandemic Plan outlining the structure and management of the planwill be covered. It will focus on a discussion of six scenario stages (fromPre-event planning, to evidence of increased local human-to-humantransmission, to efficient and sustained local human-to-humantransmission, and to recovery and subsequent waves).A staffing shortage planning tool will be reviewed that will enable eachuniversity’s school and department to assess their critical operations anddecide what actions to take as staff availability declines due to apandemic.And finally, the discussion will briefly cover public health emergenciesinvolving the opening of a Points of Dispensing (POD) site on the campus,in conjunction with local Public Health Departments.

ObjectivesA Pandemic Plan outlining the structure and management of the planwill be covered. It will focus on a discussion of six scenario stages (fromPre-event planning, to evidence of increased local human-to-humantransmission, to efficient and sustained local human-to-humantransmission, and to recovery and subsequent waves).A staffing shortage planning tool will be reviewed that will enable eachuniversity’s school and department to assess their critical operations anddecide what actions to take as staff availability declines due to apandemic.And finally, the discussion will briefly cover public health emergenciesinvolving the opening of a Points of Dispensing (POD) site on the campus,in conjunction with local Public Health Departments.

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Why Plan?

• Business Continuity Plan?

• Emergency Plan?– Pandemic Plan

– Staffing Shortage Plan

• Linked?

• How?

• Business Continuity Plan?

• Emergency Plan?– Pandemic Plan

– Staffing Shortage Plan

• Linked?

• How?

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Why a Pandemic Plan?

• More effective response to anypublic health emergency.

• Pandemics are a part of humanhistory.

• There will be little time to act oncethe event starts.

• More effective response to anypublic health emergency.

• Pandemics are a part of humanhistory.

• There will be little time to act oncethe event starts.

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Seasonal vs Pandemic Flu• Seasonal influenza

– Peaks usuallyDecember thru Marchin North America.

– 36,000deaths/200,000hospitalizations/yr.

– Frail, elderly and veryyoung – U shapeddistribution.

• Pandemic influenza– Rapid, global spread

among humans,– No seasonal

preference.– Comes in waves.– Total duration a year

or more.– Potential millions of

deaths.

• Seasonal influenza– Peaks usually

December thru Marchin North America.

– 36,000deaths/200,000hospitalizations/yr.

– Frail, elderly and veryyoung – U shapeddistribution.

• Pandemic influenza– Rapid, global spread

among humans,– No seasonal

preference.– Comes in waves.– Total duration a year

or more.– Potential millions of

deaths.

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Pandemic Threat Through History• Five in the past century.• Twelve recorded over past 300

years:– Range between events 10-

49 years, average 24.– No predictable pattern.– 1957-58 – reassortment

event.– 1967-68 – reassortment

event.– 1918-20 – mutation event

with markers similar to thosefound in birds.

• Five in the past century.• Twelve recorded over past 300

years:– Range between events 10-

49 years, average 24.– No predictable pattern.– 1957-58 – reassortment

event.– 1967-68 – reassortment

event.– 1918-20 – mutation event

with markers similar to thosefound in birds.

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PandemicsOver the past

100 years

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Pandemic Planning

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Ebola fast facts…• According to the World Health Organization, "there is no specific treatment or

vaccine," and the fatality rate can be up to 90%.• First identified in Africa in 1976.• Named after the Ebola River (where the virus was first recognized) in 1976 (CDC).• Ebola is extremely infectious but not extremely contagious. It is infectious, because an

infinitesimally small amount can cause illness.• Instead, Ebola could be considered moderately contagious, because the virus is not

transmitted through the air. (Most contagious diseases, such as measles or influenza,virus particles are airborne.)

• Humans can be infected by other humans if they come in contact with bodily fluidsfrom an infected person or a contaminated object from an infected person.

• Most likely natural hosts are fruit bats.• Typically, symptoms appear 8-10 days after exposure to the virus, but the incubation

period can span two to 21 days.• Ebola is not transmissible if someone is asymptomatic or once someone has recovered

from it.

• According to the World Health Organization, "there is no specific treatment orvaccine," and the fatality rate can be up to 90%.

• First identified in Africa in 1976.• Named after the Ebola River (where the virus was first recognized) in 1976 (CDC).• Ebola is extremely infectious but not extremely contagious. It is infectious, because an

infinitesimally small amount can cause illness.• Instead, Ebola could be considered moderately contagious, because the virus is not

transmitted through the air. (Most contagious diseases, such as measles or influenza,virus particles are airborne.)

• Humans can be infected by other humans if they come in contact with bodily fluidsfrom an infected person or a contaminated object from an infected person.

• Most likely natural hosts are fruit bats.• Typically, symptoms appear 8-10 days after exposure to the virus, but the incubation

period can span two to 21 days.• Ebola is not transmissible if someone is asymptomatic or once someone has recovered

from it.

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Ebola fast facts…• 2014-2015 West Africa Outbreak:

Cases listed below include confirmed, probable or suspected cases of Ebola as of February 1,2015 (World Health Organization and CDC):

Country Cases Deaths

Guinea 2,975 1,944

Liberia 8,745 3,746

Mali 8 6

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Mali 8 6

Nigeria 20 8

Senegal 1 (origin Guinea) 0

Sierra Leone 10,740 3,276

Spain 1 0

United Kingdom 1 0

United States 4 (2 US,1 Liberia,1 Guinea) 1

TOTALS 22,495 8,981 (40%)

If Ebola Strikes…

Level 1 Go directly toLevel 5of your

Plan

Level 5of your

PlanLevel 1Level 1 GoGo directlydirectly toto

Level 5of your

Plan

Level 5of your

Plan

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Goal of Public Health in a Flu Pandemic:Slow down spread

• Isolation of the sick.• Quarantine of the exposed.• Protective sequestration.

– Isolating a community before illness enters.• Social Distancing.

– Actions taken to discourage close social contactbetween individuals.

• Public education.– Accurate, clear information.– Consistent with those being given by other public

health authorities.

• Isolation of the sick.• Quarantine of the exposed.• Protective sequestration.

– Isolating a community before illness enters.• Social Distancing.

– Actions taken to discourage close social contactbetween individuals.

• Public education.– Accurate, clear information.– Consistent with those being given by other public

health authorities.

What is the role of the Student HealthService in a Flu Pandemic?

• To be knowledgeable about pandemicplanning guidelines andrecommendations.

• To be an active participant in thecampus-wide planning process.

• To develop a detailed plan for StudentHealth operations.

• To be knowledgeable about pandemicplanning guidelines andrecommendations.

• To be an active participant in thecampus-wide planning process.

• To develop a detailed plan for StudentHealth operations.

Role con’t• To identify and establish contacts in the local

health care community including hospitals, localhealth departments, emergency responsepersonnel.

• To provide sound medical and public healthinformation to the incident commander, keydecision makers and the campus community.

• To identify and establish contacts in the localhealth care community including hospitals, localhealth departments, emergency responsepersonnel.

• To provide sound medical and public healthinformation to the incident commander, keydecision makers and the campus community.

Challenges to Planning• Requires multi-faceted, multi-departmental

effort over time.• Deficits in knowledge.

– No case definition.– Gaps in our understanding of viruses.– Gaps in our understanding of which strategies

are most effective.

• Requires multi-faceted, multi-departmentaleffort over time.

• Deficits in knowledge.– No case definition.– Gaps in our understanding of viruses.– Gaps in our understanding of which strategies

are most effective.

Challenges to Planning• Considering the ‘what ifs.’

– we can’t send all students home?– we have students who are ill and the local

health systems are overwhelmed?– we must work with a reduced staff?

• Allocation of resources.– Stockpile goods? How much?– Questions of ethical nature.

• Considering the ‘what ifs.’– we can’t send all students home?– we have students who are ill and the local

health systems are overwhelmed?– we must work with a reduced staff?

• Allocation of resources.– Stockpile goods? How much?– Questions of ethical nature.

Planning in the Present• Based on current knowledge and

understanding.• Inclusive, collaborative.• Plans must be flexible, adaptable, resilient.• Plans must be tailored to the particular type of

institution.• Plans must be tested and rehearsed.

• Based on current knowledge andunderstanding.

• Inclusive, collaborative.• Plans must be flexible, adaptable, resilient.• Plans must be tailored to the particular type of

institution.• Plans must be tested and rehearsed.

Getting Started• Who is responsible for emergency

preparedness on your campus?• Does your school have an emergency

response plan/template?• Can it be adapted for pandemic

planning?• Who do you engage in the conversation

on your campus to get pandemicplanning on the table?

• Who is responsible for emergencypreparedness on your campus?

• Does your school have an emergencyresponse plan/template?

• Can it be adapted for pandemicplanning?

• Who do you engage in the conversationon your campus to get pandemicplanning on the table?

Getting Started con’t• Identify key members of the pandemic

planning committee.– Depth charting

• Identify essential functions and personnel.– Depth charting

• Identify appropriate channels ofcommunication and chain of command.

• Identify the role of student health services.

• Identify key members of the pandemicplanning committee.– Depth charting

• Identify essential functions and personnel.– Depth charting

• Identify appropriate channels ofcommunication and chain of command.

• Identify the role of student health services.

World Health Organization (WHO) –Centers for Disease Control and Prevention (CDC)

– Local Health Departments

•Are the levels the same?•Connected?•Who do you follow?•How do you interpret all stages –phases - levels?

•Are the levels the same?•Connected?•Who do you follow?•How do you interpret all stages –phases - levels?

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Pandemic Flu Prevention & Response Plan

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Levels of Emergency Response

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Pandemic Planning CommitteeMembers

• Executive management (President, Provost, Chancellor ordesignees)

• Student Health• Public Safety• Environmental Health & Safety• Public Affairs• Government Relations• Facilities Management• Student Affairs (residence life)• International Student Services• Housing• Dining• Human Resources• Risk Management• Telecommunications• Information Technology• Operations and Finance

• Executive management (President, Provost, Chancellor ordesignees)

• Student Health• Public Safety• Environmental Health & Safety• Public Affairs• Government Relations• Facilities Management• Student Affairs (residence life)• International Student Services• Housing• Dining• Human Resources• Risk Management• Telecommunications• Information Technology• Operations and Finance

Determine triggers for MovingPlans to Action

• Short window for critical decision making.

• Reducing the number of students on campusmay be best strategy.– Resources/expectations for care/support.

• Once closed…when do you reopen?– 8-12 weeks to avoid resurgence of illness– Define closing – no classes? No research?

Lock down of all buildings?

• Short window for critical decision making.

• Reducing the number of students on campusmay be best strategy.– Resources/expectations for care/support.

• Once closed…when do you reopen?– 8-12 weeks to avoid resurgence of illness– Define closing – no classes? No research?

Lock down of all buildings?

Campus Security• Procedures for securing buildings,

protecting stored supplies.• Communication with local police, fire and

emergency response.• Protocols for transporting sick students.• Fit-test for N95s.• Equip cars with disinfectants, gloves etc.

• Procedures for securing buildings,protecting stored supplies.

• Communication with local police, fire andemergency response.

• Protocols for transporting sick students.• Fit-test for N95s.• Equip cars with disinfectants, gloves etc.

Physical Plant

• Identify On campus quarantine locationsites.

• Contingency plans in case of fuel, waterand energy shortages.– Emergency generators?

• Building ventilations systems.

• Identify On campus quarantine locationsites.

• Contingency plans in case of fuel, waterand energy shortages.– Emergency generators?

• Building ventilations systems.

Human Resources• Identify essential personnel and depth charting.• Call-off guidelines and vacation/sick leave

guidelines.• Return to work guidelines.• Work-at-home guidelines.• Recruitment of volunteers.• Communications for supervisors and campus

work force.

• Identify essential personnel and depth charting.• Call-off guidelines and vacation/sick leave

guidelines.• Return to work guidelines.• Work-at-home guidelines.• Recruitment of volunteers.• Communications for supervisors and campus

work force.

Key Considerations for StudentHealth Services

• Health Service Staff education and preparation.– Engage staff in pandemic planning and provide

exercises and drills to rehearse plan.– Provide regular updates for staff on the latest

developments.– Vaccinations.– Fit testing for N95s.– In-services on PPE.– Encourage staff to make personal emergency plans.– Identify resources for food/on campus shelter.

• Health Service Staff education and preparation.– Engage staff in pandemic planning and provide

exercises and drills to rehearse plan.– Provide regular updates for staff on the latest

developments.– Vaccinations.– Fit testing for N95s.– In-services on PPE.– Encourage staff to make personal emergency plans.– Identify resources for food/on campus shelter.


• Supplies/equipment/services.– Compile a list.– Identify vendors/storage.– Cost estimate for stockpiling/storage.– Negative pressure rooms.– Cleaning services, waste removal.

• Supplies/equipment/services.– Compile a list.– Identify vendors/storage.– Cost estimate for stockpiling/storage.– Negative pressure rooms.– Cleaning services, waste removal.


• Clinical Issues.– Consult with HR regarding use of volunteers.

• List of duties, training plan, telephone triage protocols.– Plans for setting up an infirmary – staffing,

location?– Protocol for monitoring cases in quarantine.– Triage and treatment protocols.– Care of the deceased – morgue/notification of

family.– Plans for mass immunization clinics.– Clinic signage/voice messages.

• Clinical Issues.– Consult with HR regarding use of volunteers.

• List of duties, training plan, telephone triage protocols.– Plans for setting up an infirmary – staffing,

location?– Protocol for monitoring cases in quarantine.– Triage and treatment protocols.– Care of the deceased – morgue/notification of

family.– Plans for mass immunization clinics.– Clinic signage/voice messages.

Communications• Internal

– Whose in charge?– Establish a central reporting plan for monitoring

prevalence of illness, absenteeism, # in isolation andquarantine.

• HR, Campus Police, Residence Life.

– Identify all possible means of communicating tovarious audiences.

• Communication and technology departments.• Communication capabilities, limitations, testing platforms.

• Internal– Whose in charge?– Establish a central reporting plan for monitoring

prevalence of illness, absenteeism, # in isolation andquarantine.

• HR, Campus Police, Residence Life.

– Identify all possible means of communicating tovarious audiences.

• Communication and technology departments.• Communication capabilities, limitations, testing platforms.

Communications con’t

• Provide information to campus communityon status of planning, personal emergencypreparedness, hand-washing.– Communicate early and often.– Collaborate with media relations.– Craft messages in advance.– Ensure materials are easy to understand and

culturally appropriate.

• Provide information to campus communityon status of planning, personal emergencypreparedness, hand-washing.– Communicate early and often.– Collaborate with media relations.– Craft messages in advance.– Ensure materials are easy to understand and

culturally appropriate.

Communications con’t

• External.– Establish and maintain communications with

local public health authorities, emergencypreparedness groups, hospital systems.

• Identify key contacts.• Participate in community planning/drills.

– Benchmark activities/planning of other likecolleges and universities.

• External.– Establish and maintain communications with

local public health authorities, emergencypreparedness groups, hospital systems.

• Identify key contacts.• Participate in community planning/drills.

– Benchmark activities/planning of other likecolleges and universities.

Counseling Services

• Anticipate high need.• 24/7 counseling for staff, faculty, students.• Protocols for providing service via

telephone or internet.

• Anticipate high need.• 24/7 counseling for staff, faculty, students.• Protocols for providing service via

telephone or internet.

Housing Services• Identify rooms and buildings that could be used for

quarantine, isolation and residence for students whocannot go home.

• Develop a procedure for closure and evacuation ofresidence halls.

• Procedures for notifying and relocating students.• Housekeeping staff trained in personal protection and

proper cleaning.• Communication protocols between Housing and

Residence Life.

• Identify rooms and buildings that could be used forquarantine, isolation and residence for students whocannot go home.

• Develop a procedure for closure and evacuation ofresidence halls.

• Procedures for notifying and relocating students.• Housekeeping staff trained in personal protection and

proper cleaning.• Communication protocols between Housing and

Residence Life.

Dining

• Stockpiling and storing non-perishablefood stuffs and fluids.

• Procedures for delivery to residentialareas.

• Volunteer staff.

• Stockpiling and storing non-perishablefood stuffs and fluids.

• Procedures for delivery to residentialareas.

• Volunteer staff.

International students and StudyAbroad

• Plans for communicating with studentsabroad.

• Guidelines for closure of study abroadprograms.

• Procedures for monitoring student travel.• Procedures for communicating to

international students about travel restrictionsand re-entry.

• Plans for communicating with studentsabroad.

• Guidelines for closure of study abroadprograms.

• Procedures for monitoring student travel.• Procedures for communicating to

international students about travel restrictionsand re-entry.

Academic Affairs

• Policies for student absenteeism due toillness/quarantine.

• Alternative procedures for completingcourse work.

• Policies for student absenteeism due toillness/quarantine.

• Alternative procedures for completingcourse work.

Research• Can some research continue?• Plan for maintaining security in labs.• Plan for care of lab animals.• Plan for specimen storage and

managing experiments in progress.

• Can some research continue?• Plan for maintaining security in labs.• Plan for care of lab animals.• Plan for specimen storage and

managing experiments in progress.

Business and Finance

• Procedures for rapid procurement ofgoods.

• Continuation of payroll functions.• Financing and emergency funding

issues.

• Procedures for rapid procurement ofgoods.

• Continuation of payroll functions.• Financing and emergency funding

issues.

Admissions/Financial Aid

• Plan for reviewing applications andrecruiting in absence of face-to-faceinterviews or campus visits.

• Contingency plans for dealing withfinancial aid, withdrawal from school,other factors related to tuition andregistration.

• Plan for reviewing applications andrecruiting in absence of face-to-faceinterviews or campus visits.

• Contingency plans for dealing withfinancial aid, withdrawal from school,other factors related to tuition andregistration.

Recovery• Criteria for calling an end to the crisis and

resuming campus business.• Communication plan for advising students,

staff, faculty of plan to resume business.• Timeline for restorations of operations.• Plan to debrief.• Structure for evaluating the effectiveness of

the emergency response.

• Criteria for calling an end to the crisis andresuming campus business.

• Communication plan for advising students,staff, faculty of plan to resume business.

• Timeline for restorations of operations.• Plan to debrief.• Structure for evaluating the effectiveness of

the emergency response.

Questions

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Staffing Shortage Planning Tool

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Questions

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Points of Dispensing (POD)

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Points of Dispensing (POD) Overview• ‘Open’ Points of Dispensing (POD) - open to the general public.• We will discuss Closed Points of Dispensing (POD)

– Guided by Local Health Departments.– Partnership with local businesses and other organizations.– Quickly deliver antibiotics.– Activated in response to public health emergencies.

• A specific business or organization that has agreed to work with the LocalHealth Department to quickly dispense emergency antibiotics to their staff andfamily members, and in some cases, patients and clients, in response to a large-scale declared public health emergency.

• Only opened in the rare event that the whole population is at great risk ofexposure to an infectious disease or other biological agent and medicationsneed to be taken immediately to prevent severe illness.

• Help decrease the burden of Public PODs in the emergency response.• A Closed POD is “Closed” because it is not open/available to the general public.

They are then “closed” focusing solely on those individuals your organizationwants to protect.

• ‘Open’ Points of Dispensing (POD) - open to the general public.• We will discuss Closed Points of Dispensing (POD)

– Guided by Local Health Departments.– Partnership with local businesses and other organizations.– Quickly deliver antibiotics.– Activated in response to public health emergencies.

• A specific business or organization that has agreed to work with the LocalHealth Department to quickly dispense emergency antibiotics to their staff andfamily members, and in some cases, patients and clients, in response to a large-scale declared public health emergency.

• Only opened in the rare event that the whole population is at great risk ofexposure to an infectious disease or other biological agent and medicationsneed to be taken immediately to prevent severe illness.

• Help decrease the burden of Public PODs in the emergency response.• A Closed POD is “Closed” because it is not open/available to the general public.

They are then “closed” focusing solely on those individuals your organizationwants to protect.

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Points of Dispensing (POD) Overview)• OVERVIEW: How to write and manage a University Points of Dispensing

(POD) Plan in conjunction with the local Public Health department:– What they are?– Policies and Decisions?– How to get Medications?– How they work?– Staff roles.– Training & Checklists.– Documents & Forms.– Reference go to: http://www.closedpodpartners.org/module2.html

(National Association of County & City Health Officials (NACCHO)

• OVERVIEW: How to write and manage a University Points of Dispensing(POD) Plan in conjunction with the local Public Health department:– What they are?– Policies and Decisions?– How to get Medications?– How they work?– Staff roles.– Training & Checklists.– Documents & Forms.– Reference go to: http://www.closedpodpartners.org/module2.html

(National Association of County & City Health Officials (NACCHO)

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Points of Dispensing (POD) Overview

• Plan Table of Contents:1. POD overview2. Response3. EOC activation4. Protocol5. POD operations6. POD organizational chart and staffing needs7. Signage

• Plan Table of Contents:1. POD overview2. Response3. EOC activation4. Protocol5. POD operations6. POD organizational chart and staffing needs7. Signage

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Points of Dispensing (POD) Organization Chart

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Questions

60

Questions & Answers

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