June 2009Emergency Preparedness

“Are you still thinking about me?”

AAR Comments:Which Region had a lot to say?Which Agency had the most to say?What was said:Count by Major Issue - Total: 303 comments Communications 67 comments

Plans 53 CommentsLogistics 50 commentsSurveillance 49 commentsTop 4 items: 171 comments

Sort: Needs Work vs. Positive comment Internal/ External Communications 34 vs. 27Sample Transport 26 vs.9Supplies 3 vs. 2

• SNS Allocations- EMS services have stockpiled PPE for a Pan Flu event and took proactive measures in ordering additional supplies when the epidemic started. However, there may come a time where the demand would exceed the available supply in the private market and EMS has nothing to fall back on. A review of available PPE in the SNS is needed and this supply needs to be shared with all entities. (Hospitals, EMS, Nursing Homes, Etc.)

• During Conference Calls all lines should be muted to eliminate interruptions.

• SNS Allocations- EMS services have stockpiled PPE for a Pan Flu event and took proactive measures in ordering additional supplies when the epidemic started. However, there may come a time where the demand would exceed the available supply in the private market and EMS has nothing to fall back on. A review of available PPE in the SNS is needed and this supply needs to be shared with all entities. (Hospitals, EMS, Nursing Homes, Etc.)

• During Conference Calls all lines should be muted to eliminate interruptions.

EMS EMS

HOSPITALSAntivirals –

• Many questions from facilities on what type and how much antivirals they received and why. No information about amount sent from SNS was available – hospital did not know what to expect and therefore was unable to reconcile with what was delivered.

• Information about limits (can’t open the SNS package until go-ahead given by DHH, etc.) was provided AFTER shipment was received.

• SNS medications were delivered directly to nursing homes. Concerns that no Pharmacist or MD is on site to manage the medication, and that NH is not likely to have a secure location for the medications.

• At hospitals not all pharmacies are open on the weekend. This made it difficult to communicate with the hospitals to expect the National Guard/State Police to show up delivering medications and what to do with them.

• After the antivirals were received some of the expiration dates are soon – June 2009. Need guidance on how to dispose/use. The other items that don’t expire – need guidance on what to do with them.

• SNS Guidance needs to be communicated to physicians. Hospitals do not have a way to get the information out to every doctor – only doctor’s on their medical staff.

• Hospital DRC’s did not get a list of who was receiving the SNS. If the list is shared with the DRC they can review the list to see if anyone was left off of the list in their region.

• Now that the antivirals are not needed, hospitals need to know what to do with it. Need resolution. Hospitals don’t handle open well open ended question for a long time. May be less willing to accept distribution in the future. They need to be able to put it away or someone needs to pick it up.

RECOMMENDATIONS1. Should have gotten information from DRCs or used LHA directory.2. Send out message (ex: 400 licensed beds plus 10%) -You will receive 440 treatment regimens; and provide a

list that includes the quantity and type of drugs when cache is delivered to each facility as well as instructions on how to use and/or dispose of drugs.

3. TBD4. Need to make sure that couriers have this in place at the beginning of an event

Primary Care• Lack of a comprehensive physician networking system• Current efforts are piecemeal resulting in mis-

communication, no communication, inaccurate information, depending on wrong people to get message out

• Website not always up-to-date and required checking 3 different sites instead of one with links to others

• Some regional HAN fax servers had limited volume capability and couldn’t add PCPs

• Lab specimen transport protocol not designed for ease of use by PCPs – designed for rapid transport only

• Not clear who/how to distribute testing kits to small clinics

• Planning Scenario 1: Mild Flu Season

Planning scenario one is based on a projected landfall of a Category 3 or higher hurricane anywhere on the coastline of Louisiana during a mild flu pandemic. A mild flu pandemic is identified as a mid-range pandemic severity index of one to two.

• Planning Assumption: The State of Louisiana will use the H-Hour Timeline to manage the evacuation and sheltering of coastal Louisiana during a mild flu pandemic.

 

• Planning Assumption: A Category 3 Hurricane will necessitate activation of Louisiana’s State Assisted Evacuation Plan.

• Planning Assumption: A mild flu season may require standard infection control procedures ie. Mask be included as part of the standard kit on buses and at all shelters to be used for individuals who have respiratory symptoms such as coughing or sneezing) at parish pick-up points, buses, and shelters.

“Hurri-Flu” Task Force

Mild Severe

• Planning Scenario 2: Severe Pandemic• Planning scenario two is based on a projected landfall of a Category 3 or higher

hurricane anywhere on the coastline of Louisiana during a severe pandemic. A severe pandemic is based on a Severity Index 3 or higher.

 • Planning Assumption:

The following confounding factors should be incorporated into the planning assumptions for a severe index pandemic flu scenario.

• Other states will NOT absorb Louisiana’s residents; hence, LA will have to address “surge-within-borders” evac/shelter plan.

• That out-of-state resources to come into the state and assist LA with support teams will NOT be forthcoming; hence, LA will have to rely on limited organic resources to implement the evac/shelter plan. A COOP Plan should be considered to identify essential services for the evac/shelter plans.

• Up to 40% or more of the population will have flu-like-illness hence it will be difficult to separate out populations. Hygiene and wearing a mask for everyone should be a requirement.

“Hurri-Flu” Task Force

Mild Severe

Anticipated Fall Resurgence

DRAFT MODELS are below for discussion with Parish Directors next week.

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Purpose: The following models were developed to frame levels of expected engagement by other ESF’s.

 

Planning Assumptions: In all models, the need for an incredibly effective communication strategy will be needed.

 

1. Normal Pattern

2. State based Distribution of plentiful vaccine.

3. Limited vaccine

4. In-Extremis Plan (the Pandemic Flu Model)

“I’ll be back!”

Hurricane Preparedness 2009

SHELTERING REGIONS:Region 6, 7 and 8 (and 9)

Confidential Data Enclosed: Not for wide-spread/public

distribution

Special Needs Shelter Network – 2008

Region 1: Evacuation Processing CenterRegion 2: Baton Rouge + federal augmentationRegion 3: Thibodaux Region 4: LafayetteRegion 5: McNeese Region 6: Alexandria + federal augmentationRegion 7: Shreveport/ BossierRegion 8: Monroe + federal augmentationRegion 9: Hammond

77

66

5544

2299

33 11

88

Note: The sequential opening of these shelters is dependent upon need; MSNS shelters – as are all shelters - are not opened concurrently.

Confidential Data Enclosed: Not for wide-spread/public

distribution

Critical Transportation Needs Shelters (CTNS)

77

88

Critical Transportation Needs Shelters (CTNS) - 2009

Primary lead: Department of Social Services

Target: general population based shelters for transportation challenged (shelters which buses will be directed)

Region 7 – five (5) sites in Caddo

Region 8 – two (2) sites in Morehouse

Region 6 – one (1) site in Rapides

66 Current Capacity 2009:8,000 State-operated CTNS3,400 Parish-operated CTNS

Medical Institution Evacuation PlansPRE-STORM EVACUATION

PROCESS

What is the potential throughput?

Regions 4,5: 624 patients

Regions 3,4: 343 patients

Regions 1,3,9: 1063 patients

Number of Parishes: 12Number of Hospitals: 60+

Anticipated Planning Range: low - high

343 - 1063 (reasonable “worst case” planning scenarios)

Abbreviated Timeline Abbreviated Timeline H-hour:• 120: Lean Forward! Email alerts, notifications distributed, communications check

• 72 : Flag goes up! All levels of government (local, state, federal) must watch this storm and be ready to mobilize an AMP. Form 1 is used to identify potential volume of patients so that number of aircraft can be estimated and organized for potential activation.

• 72- 54 Continuous updates to Form 1. Refinement of data as threat becomes more imminent. Based on the direction and threat of the storm, AMP(s) are activated.

• 54: “No-kidding” numbers are ascertained.

• 48: Wheels-up! The first load of patients should be enroute to FCC

• 18: Clearing the Battlefield. A meter-check is determined to see how many patients still require evacuation. This is the last chance to make any corrective actions. SMART listing identified.

• 12: AMPs CLOSED

Hot Topics - 2009

• Triage/ Definition of “special needs”

• Medical Support in CTNS

• Hurri-Flu Task Force