New York State Department of Health

HANYS' Nursing Home Emergency Preparedness Webconference

May 9, 2007

Avian Influenza Situation Report

Spreading prevalence in migratory birds

Continued outbreaks among domestic poultry

Mammalian infection (cats, pigs, etc.) lethal

Virus is evolving

Sporadic human cases (more than 170 reports to date)• Most in the young and healthy • Case-fatality 50%• Rare person-to-person transmission

Pandemic Influenza Planning

Supposition: Hospitals will be beyond maximum capacity & staff will be overtaxed

There will have to be decisions made at the state level to alter standards of care

Transmission

Typical incubation 2 days

Range: 1-4 days

Viral shedding Can begin 1 day before symptom onset Peak shedding first 3 days of illness Subsides usually by 5-7th day in adults

can be 10+ days in children

Nursing homes should focus planning on enhancing ability to: accept more fragile, sicker patients from hospitals retain their residents surge beyond licensed capacity

How?

To be reviewed & reinforced with staff:

Disease prevention strategies Infection control techniques Hand washing Cough etiquette (include residents!) Identification of symptoms to:

Promote early detectionMinimize spread

What to expect?Staff grief & exhaustion

o Admission of sicker residents/patientso Altered standards of careo Retention rather than transfero Surge o Potential for significant increase in resident mortality

Staff should be monitored closely for stress & intervention should be made available as indicated

HAN & the Communications Directory

are the official NYSDOH

directory directory &

alerting system for emergencies

Health Alert Network (HAN)

Contains information about disaster preparedness Contains articles & web site links Posts current health advisories & alerts

Avian flu Measles Lead poisoning Meningococcal disease Polio in Minnesota Rabies in Texas 9/15—to ACFs, Nsg. Homes, LHDs—Bagged fresh spinach Alert to vets re: psittacosis

HAN library

Note: HEALTH NOTIFICATIONS originate from a variety of sources, including:

New York State Department of Health (NYSDOH) New York City Department of Health and Mental Hygiene

(NYCDOHMH) New York State Office of Homeland Security (NYSOHS) Centers for Disease Control and Prevention (CDC)

HAN Health Notification Viewer

SOURCE

AUDIENCE TYPE DESCRIPTION

DATE POSTED

DOCUMENT CREATED DATE

RECIPIENTS

NYSDOH

ALL USERS E. coli Outbreak Linked to Fresh Spinach: Update #1

Sep 19, 2006 Sep 19,2006 Recipients

CDC ALL USERS Botulism Toxin Type A associated with bottled carrot juice in FLA and GA

Sep 29, 2006 Sep 29,2006 Recipients

Click RECIPIENTS: LHD Commissioners/Directors| NYS| All Hospital CEOs| NYS| All Hospital ICPs| NYS| LHD Dir of Disease Control| NYS| All Hospital ED Directors| NYS| LHD CD Investigative Staff| NYS| Epi Informational List| NYS| Hospital Food Prep| NYS| Hospital Food Directors| NYS| Hospital Risk Management| NYS| LTCF Food Service Directors| NYS| Adult Homes Administrator| NYS| Adult Homes Food Service| NYS| Adult Homes HPN Coordinators| NYS| LTCF Administrators| NYS| LTCF Directors of Nursing| NYS| LTCF Medical Directors| NYS| LTCF ICP| NYS

Click DESRIPTION: Detailed description of alert

HPN Communications Directory

The purpose of the Communications Directory is to have the most current & accurate contact information available in the event of an emergency

NYSDOH will rely upon this data’s accuracy, which is why your diligence and participation in maintaining current information are vital to the success of the Directory. It is expected that updates will be made on a periodic basis.

Section 400.10 HPN Access & Reporting Requirements

HPN accounts Ensure that sufficient, knowledgeable staff will be available Maintain & keep current such accounts At a minimum, 24/7 contacts for emergency communication & alerts

must be designated Sufficient staff users to ensure rapid response to requests for

information from NYSDOH and/or LHD Current & complete updates reflecting changes to general

information & personnel role changes as they occur At a minimum, on a monthly basis

Emergency Response Coordinator

Individual(s) who serves as coordinator of a facility's emergency operations center

What roles should serve?Director, Nursing…Director, Safety/Security…Plant Manager……Other…

For NYSDOH business hours contact information, call the NYSDOH Regional Office

For non-business hours the NYSDOH contact is the NYSDOH Duty Officer

@ 866-881-2809

Contact numbers should be current and available to key staff 24/7

Communications Directory DrillsScheduled for June 2007

Roles to be contacted:o Administratoro Designated Pharmacisto Director, Nursingo Director, Patient & Family Serviceso Director, Safety/Securityo Emergency Response Coordinator o HPN Coordinatoro HPN Organizational Security Coordinatoro Infection Control Practitionero Medical Directoro CHRC APo 24 hour contact [found in Emergency Contacts (Any Time)]

Drill Purpose

Evaluate & ensure accuracy of Communications Directory Evaluate provider response to NYSDOH notifications to

emergency contacts identified in the Communications Directory NOTE: Continuous non-compliance will result in deficiency

citations

Collaborate with planning partners

May mean meeting some for the first time Regional Resource Center (RRC) LHD (Local/public Health Department) Office of Emergency Management (OEM)

Regional Resource Centers (RRCs)

Greene Columbia

HANYS Deliverables 2006 to 2007

Deliverables • Tasks to be completed with specific outcomes,

timeframes, & target audiences• Reporting to NYSDOH

Deliverables

Categorize regulatory barriers to emergency preparedness & response

Appoint at least one individual to the OEM link role in the HPN Ensure that individuals identified in the OEM link role take ICS

100, 200, 700, & 800 Modify &/or provide comments & recommendations to HHS pan flu

questionnaire Work with nursing homes to:

Appoint at least one individual to the Emergency Response Coordinator role in the HPN Communications Directory

Encourage the Emergency Response Coordinator to take ICS 100, 200, 700, & 800 (on line)

Monitor nursing home compliance & report status of ICS training to NYSDOH

Work with DOH to issue a pan flu questionnaire & work with nursing homes to ensure proper completion & timely submission

Ensure that at least one individual identified in the OEM link role participates in quarterly meetings with NYSDOH & disseminates relevant information to nursing homes

Assist nursing homes in entering complete contact information in the Communications Directory, & remind nursing homes to keep information current

Assist NYSDOH in securing timely & complete responses to HERDS surveys issued to nursing homes

Perform outreach to non-members, including posting information on publicly accessible websites

Recent events

Winter ’07 in Mexico!

Highland, 4/17

Oneida, 3/13

Lessons learned Some HPN data for healthcare facilities remains either

incomplete or outdated

This incomplete or outdated information makes it difficult to obtain accurate facility status reports in an emergency

The Incident Command System (ICS) not always followed by all groups, creating back ups

The Regional Office is able to be reached 24/7. Some facilities still do not have the correct numbers.

Katharine LoganHealth Emergency Preparedness ProgramNYSDOHNon-acute CareHedley Park Place433 River StreetTroy, NY 12180-2299Phone: 518-408-5163E-mail: KML04@health.state.ny.us