Pandemic Flu Scenario Workshop - ualbanycphp.org · 11 Pandemic Flu Scenario Workshop June 22, 2005...
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Pandemic Flu Scenario Workshop
Pandemic Flu Scenario Workshop
June 22, 2005Albany, New York
June 22, 2005Albany, New York
Regional Resource Center for Emergency & Disaster
Preparedness
Regional Resource Center for Emergency & Disaster
Preparedness
University at AlbanySchool of Public Health
University at AlbanySchool of Public Health
Center for Public Health Preparedness
Center for Public Health Preparedness
Regional Resource Center
Albany Medical Center
Albany Medical Center
Regional Resource Center
Champlain Valley Physicians HospitalChamplain Valley
Physicians Hospital
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PurposePurpose
• To give you an opportunity to review the serious impact of an influenza pandemic on your community, your organization, and your partner organizations.
• To give you an opportunity to review the serious impact of an influenza pandemic on your community, your organization, and your partner organizations.
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Breakout GroupsBreakout Groups
• Crisis & Risk Communication• Surge Capacity Issues• Inter-agency Issues• Resource Distribution• Operational & Implementation Issues
• Crisis & Risk Communication• Surge Capacity Issues• Inter-agency Issues• Resource Distribution• Operational & Implementation Issues
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ObjectivesObjectives• Review the impact of an influenza
pandemic on your community, organization, partner organizations, and professional activities
• Identify problems and potential solutions that are appropriate to the unique conditions of your agency and community
• Share the identified problems and solutions with your peers
• Review the impact of an influenza pandemic on your community, organization, partner organizations, and professional activities
• Identify problems and potential solutions that are appropriate to the unique conditions of your agency and community
• Share the identified problems and solutions with your peers
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AgendaAgenda• Overview• Scenario:
• Module 1• Module 2• Module 3• Module 4
• Summary discussion with all groups (auditorium)
• Overview• Scenario:
• Module 1• Module 2• Module 3• Module 4
• Summary discussion with all groups (auditorium)
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Module FormatModule FormatSituation Update
Pandemic scenario advances.
Situation UpdatePandemic scenario
advances.
Table Discussion(5 min.)
Brainstorm initial responses to question
assigned.
Table Discussion(5 min.)
Brainstorm initial responses to question
assigned.
Report Back & Group Discussion (20 min.)
Each table shares initial responses brainstormed.
Report Back & Group Discussion (20 min.)
Each table shares initial responses brainstormed.
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Ground Rules (1)Ground Rules (1)
• You are playing yourself (but you may need to think outside your usual role).
• You are not making official representation of your agency.
• There are no wrong answers (but there are better ones).
• You are playing yourself (but you may need to think outside your usual role).
• You are not making official representation of your agency.
• There are no wrong answers (but there are better ones).
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Ground Rules (2)Ground Rules (2)
• Assume that the information you are given is accurate.
• Where the information provided is insufficient, do your best to explore all possibilities.
• The facilitators are there to help you. You are not limited to just the facilitator in your room.
• Assume that the information you are given is accurate.
• Where the information provided is insufficient, do your best to explore all possibilities.
• The facilitators are there to help you. You are not limited to just the facilitator in your room.
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BackgroundBackgroundJune 2005June 2005
• The health care and public health community worldwide has been watching and studying the avian influenza A/H5N1 virus that has continued to evolve in southeast Asia.
• The health care and public health community worldwide has been watching and studying the avian influenza A/H5N1 virus that has continued to evolve in southeast Asia.
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BackgroundBackground
• The recent outbreaks that began in December 2004 have resulted in 59 cases and 22 deaths in southeast Asia.
• To date no cases of human-to-human transmission have been confirmed.
• The recent outbreaks that began in December 2004 have resulted in 59 cases and 22 deaths in southeast Asia.
• To date no cases of human-to-human transmission have been confirmed.
Source: WHO. June 16, 2005.Source: WHO. June 16, 2005.
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Pandemic StatusPandemic Status
New Pandemic Phase 3:“Human infection(s) with a new subtype, but no human-to-human spread, or at most rare instances of spread to a close contact.”
New Pandemic Phase 3:“Human infection(s) with a new subtype, but no human-to-human spread, or at most rare instances of spread to a close contact.”
Source: WHO. Global influenza preparedness plan. May 2005.Source: WHO. Global influenza preparedness plan. May 2005.
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Suspicious CaseSuspicious Case
• In Hanoi, Vietnam a worrisome case has come to the attention of the Ministry of Health.
• A migrant worker (identified only as Mr. W.) lies critically ill in an area health center with an influenza-like illness.
• In Hanoi, Vietnam a worrisome case has come to the attention of the Ministry of Health.
• A migrant worker (identified only as Mr. W.) lies critically ill in an area health center with an influenza-like illness.
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InvestigationInvestigation
• Two days ago Mr. W. fell ill on the job at the Hotel Universal.
• According to the investigation, Mr. W. and several others left their home village to return to work in Hanoi, leaving sooner than planned because 4 residents of his village had died.
• The symptoms of the deceased were similar to what a companion suffered from after returning from a 2-day trip to a regional market town.
• Two days ago Mr. W. fell ill on the job at the Hotel Universal.
• According to the investigation, Mr. W. and several others left their home village to return to work in Hanoi, leaving sooner than planned because 4 residents of his village had died.
• The symptoms of the deceased were similar to what a companion suffered from after returning from a 2-day trip to a regional market town.
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Pandemic StatusPandemic Status
New Pandemic Phase 4:“Small cluster(s) with limited human-to-human transmission but spread is highly localized, suggesting that the virus is not well adapted to humans.”
New Pandemic Phase 4:“Small cluster(s) with limited human-to-human transmission but spread is highly localized, suggesting that the virus is not well adapted to humans.”
Source: WHO. Global influenza preparedness plan. May 2005.Source: WHO. Global influenza preparedness plan. May 2005.
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AlertAlert
• The WHO Global Influenza Surveillance Network reports the following on the situation in Vietnam:• Mr. W. has died, along with 8 other
individuals from his village who recently returned to work in Hanoi hotels and private residences.
• Lab tests on collected samples from the victims have isolated a new strain of avian influenza A/H5N1.
• The WHO Global Influenza Surveillance Network reports the following on the situation in Vietnam:• Mr. W. has died, along with 8 other
individuals from his village who recently returned to work in Hanoi hotels and private residences.
• Lab tests on collected samples from the victims have isolated a new strain of avian influenza A/H5N1.
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AlertAlert
• Investigation concludes that human-to-human transmission did occur in these cases.
• The new strain is highly pathogenic.• The new strain can cause primary viral
pneumonia, unlike pneumonia in most influenza patients caused by secondary bacterial infection.
• Investigation concludes that human-to-human transmission did occur in these cases.
• The new strain is highly pathogenic.• The new strain can cause primary viral
pneumonia, unlike pneumonia in most influenza patients caused by secondary bacterial infection.
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OutbreakOutbreak
• Initial investigation in the last 24 hours has revealed 26 other suspected cases in area homes and hospitals.
• Initial investigation in the last 24 hours has revealed 26 other suspected cases in area homes and hospitals.
• Laboratory confirmation of the strain is expected soon.
• Laboratory confirmation of the strain is expected soon.
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Pandemic StatusPandemic Status
New Pandemic Phase 5:“Larger cluster(s) but human-to-human spread still localized, suggesting that the virus is becoming increasingly better adapted to humans, but may not yet be fully transmissible (substantial pandemic risk).
New Pandemic Phase 5:“Larger cluster(s) but human-to-human spread still localized, suggesting that the virus is becoming increasingly better adapted to humans, but may not yet be fully transmissible (substantial pandemic risk).
Source: WHO. Global influenza preparedness plan. May 2005.Source: WHO. Global influenza preparedness plan. May 2005.
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Situation UpdateSituation Update
• With the cases in Vietnam mounting, the neighboring countries of Laos, Thailand, and Cambodia report confirmed and suspect cases of influenza infection by the new strain.
• With the cases in Vietnam mounting, the neighboring countries of Laos, Thailand, and Cambodia report confirmed and suspect cases of influenza infection by the new strain.
• Some cases were quickly traced back to foreign travel and stays at the Hotel Universal in Hanoi.
• Some cases were quickly traced back to foreign travel and stays at the Hotel Universal in Hanoi.
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Situation UpdateSituation Update
• The ministries of health in China, Indonesia and Canada report confirmed cases of infection by the new strain.
• The ministries of health in China, Indonesia and Canada report confirmed cases of infection by the new strain.
• Everywhere, previously unsuspected cases are being investigated retroactively.
• Some cases are in health care workers who probably delivered care to infected travelers.
• Everywhere, previously unsuspected cases are being investigated retroactively.
• Some cases are in health care workers who probably delivered care to infected travelers.
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Pandemic StatusPandemic Status
New Pandemic Phase 6:“Pandemic phase: increased and sustained transmission in general population.”
New Pandemic Phase 6:“Pandemic phase: increased and sustained transmission in general population.”
Source: WHO. Global influenza preparedness plan. May 2005.Source: WHO. Global influenza preparedness plan. May 2005.
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Casualty ReportCasualty ReportJuly 2005July 2005
Module 1Module 1
08Indonesia
29China
3562Vietnam
412Laos
1217Thailand
44Cambodia
16Canada
DeathsCases
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Coming and Going (1)Coming and Going (1)
International air travel:• 2 million passengers per month
arrive on international carriers at NYC airports
• 1,400 passengers per month arrive directly from Canada at Albany International Airport.
International air travel:• 2 million passengers per month
arrive on international carriers at NYC airports
• 1,400 passengers per month arrive directly from Canada at Albany International Airport.
The New York State Thruway serves 230 million vehicles per year.
The New York State Thruway serves 230 million vehicles per year.
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Coming and Going (2)Coming and Going (2)
Daily traffic at the New York -Canadian border:• Train passengers: 200• Pedestrians: 1,800• Bus passengers: 4,655 • Car passengers: 58,074
Daily traffic at the New York -Canadian border:• Train passengers: 200• Pedestrians: 1,800• Bus passengers: 4,655 • Car passengers: 58,074
Source: Bureau of Transportation StatisticsSource: Bureau of Transportation Statistics
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Table Discussion PeriodTable Discussion PeriodModule 1Module 1
• At your table, address at least one question.
• The facilitator and advisors are available to answer any factual questions they can.
• Report back to the group in approximately 5 minutes.
• At your table, address at least one question.
• The facilitator and advisors are available to answer any factual questions they can.
• Report back to the group in approximately 5 minutes.
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Report Back & Group DiscussionReport Back & Group DiscussionModule 1Module 1
• What problems did you identify?• What solutions do you recommend?• What remains unresolved?
• What problems did you identify?• What solutions do you recommend?• What remains unresolved?
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Key ConcernsKey ConcernsModule 1Module 1
• What are three key concerns from this module that should be shared with the other groups?1)
2)
3)
• What are three key concerns from this module that should be shared with the other groups?1)
2)
3)
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Local OutbreakLocal OutbreakAugust 2005August 2005
• During the last week, 42 suspect cases of infection with the novel pandemic strain have been detected in New York State.
• Four cases have been confirmed in your county.
• During the last week, 42 suspect cases of infection with the novel pandemic strain have been detected in New York State.
• Four cases have been confirmed in your county.
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SourceSource
• Investigation reveals that most transmissions occurred at a Fresh Air Fund summer camp session.
• The session was attended by 240 campers from around the region.
• Counselors and staff included local residents as well as college students from foreign summer abroad programs.
• Investigation reveals that most transmissions occurred at a Fresh Air Fund summer camp session.
• The session was attended by 240 campers from around the region.
• Counselors and staff included local residents as well as college students from foreign summer abroad programs.
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SurgeSurge
• Local hospitals are seeing a surge of patients in emergency departments.
• Political and health authorities are bombarded with questions about what to do.
• Local hospitals are seeing a surge of patients in emergency departments.
• Political and health authorities are bombarded with questions about what to do.
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Casualty ReportCasualty ReportAugust 2005August 2005
Module 2Module 2
Canada
New York
U.S.
Global
150670
106420
231750
1,1502,730
Total Deaths to Date
Total Cases to Date
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Table DiscussionTable DiscussionModule 2Module 2
• At your table, address at least one question.
• Report back to the group in approximately 5 minutes.
• At your table, address at least one question.
• Report back to the group in approximately 5 minutes.
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Report Back & Group DiscussionReport Back & Group DiscussionModule 2Module 2
• What problems did you identify?• What solutions do you recommend?• What remains unresolved?
• What problems did you identify?• What solutions do you recommend?• What remains unresolved?
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Key ConcernsKey ConcernsModule 2Module 2
• What are three key concerns from this module that should be shared with the other groups?1)
2)
3)
• What are three key concerns from this module that should be shared with the other groups?1)
2)
3)
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ImpactImpactDecember 2005December 2005
• The pandemic has not been stopped and the impact to date has been enormous…
• The pandemic has not been stopped and the impact to date has been enormous…
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Casualty ReportCasualty ReportModule 3Module 3
December 2005December 2005
19,6801.6 millionCanada
11,400950,000New York
177,60014.8 millionU.S.
7.7 million322 millionGlobal
Total Deaths to Date
Total Cases to Date
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End of First WaveEnd of First Wave
• However, in the northeastern US and most other parts of the country, the rate of new outbreaks has reduced to a fraction of the rate during the peak 3 months ago.
• However, in the northeastern US and most other parts of the country, the rate of new outbreaks has reduced to a fraction of the rate during the peak 3 months ago.
CasesCases
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Vaccine ArrivesVaccine Arrives
• Reaction is mixed• Fear of side effects• Demand greater than supply
• Shortages occur at all levels: International, national, state, local, organization
• Reaction is mixed• Fear of side effects• Demand greater than supply
• Shortages occur at all levels: International, national, state, local, organization
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OverseasOverseas
• Outbreaks continue abroad.• Poor countries on every
continent are experiencing local, savaging outbreaks in remote regions and mega-cities alike.
• Outbreaks continue abroad.• Poor countries on every
continent are experiencing local, savaging outbreaks in remote regions and mega-cities alike.
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PrioritizationPrioritization
• Many advocate prioritizing the military for vaccine, medications, equipment, and medical personnel to maintain national security.
• Many advocate prioritizing the military for vaccine, medications, equipment, and medical personnel to maintain national security.
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Psychosocial ImpactPsychosocial Impact
• After months of steady outbreaks, few lives are untouched by illness, death, bereavement, and stress.
• After months of steady outbreaks, few lives are untouched by illness, death, bereavement, and stress.
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VigilanceVigilance
• Public health authorities stress the need to maintain infection control practices and surveillance.
• Many believe they can relax a bit now that the pandemic has lessened locally.
• History shows that another wave is likely.
• Public health authorities stress the need to maintain infection control practices and surveillance.
• Many believe they can relax a bit now that the pandemic has lessened locally.
• History shows that another wave is likely.
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Political TensionsPolitical Tensions
• Some countries blame each other for not preventing or stopping the pandemic.
• Poor countries make pleas for financial aid and resources.
• Congressional scrutiny is constant.
• Some countries blame each other for not preventing or stopping the pandemic.
• Poor countries make pleas for financial aid and resources.
• Congressional scrutiny is constant.
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Table Discussion PeriodTable Discussion PeriodModule 3Module 3
• At your table, address at least one question.
• Report back to the group in approximately 5 minutes.
• At your table, address at least one question.
• Report back to the group in approximately 5 minutes.
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Report Back & Group DiscussionReport Back & Group DiscussionModule 3Module 3
• What problems did you identify?• What solutions do you recommend?• What remains unresolved?
• What problems did you identify?• What solutions do you recommend?• What remains unresolved?
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Key ConcernsKey ConcernsModule 3Module 3
• What are three key concerns from this module that should be shared with the other groups?1)
2)
3)
• What are three key concerns from this module that should be shared with the other groups?1)
2)
3)
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Second WaveSecond WaveJuly 2006July 2006
• Illness and death rates have crept back up.
• Illness and death rates have crept back up.
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On the MoveOn the Move
• Areas that normally serve only as vacation homes for urban dwellers now see unusually high population levels due to urban “Flu Flight”.
• Areas that normally serve only as vacation homes for urban dwellers now see unusually high population levels due to urban “Flu Flight”.
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OvertimeOvertime
• The staff shortage in healthcare facilities is estimated to be an average of 30%, due to both inability and unwillingness to work.
• Available staff see shifts extended and vacation requests denied.
• Overtime pay and costs reach unprecedented levels.
• The staff shortage in healthcare facilities is estimated to be an average of 30%, due to both inability and unwillingness to work.
• Available staff see shifts extended and vacation requests denied.
• Overtime pay and costs reach unprecedented levels.
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Now HiringNow Hiring
• Demand for able and willing healthcare workers exceeds supply locally and internationally.
• Employers that are able to are offering enormous pay for temporary healthcare workers.
• Demand for able and willing healthcare workers exceeds supply locally and internationally.
• Employers that are able to are offering enormous pay for temporary healthcare workers.
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Surge CapacitySurge Capacity
• Auxiliary hospitals increase in size and number in temporary facilities and structures.
• Auxiliary hospitals increase in size and number in temporary facilities and structures.
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Vaccination CampaignVaccination Campaign
• Immunization levels in the US range from 1% to 25% in different areas.
• Immunization levels in the US range from 1% to 25% in different areas.
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Casualty ReportCasualty ReportModule 4Module 4
39,3601.9 millionCanada
22,8001.9 millionNew York
355,20029.6 millionU.S.
15.5 million644 millionGlobal
Total Deaths to Date
Total Cases to Date
July 2006July 2006
6161
Table Discussion PeriodTable Discussion PeriodModule 4Module 4
• At your table, address at least one question.
• Report back to the group in approximately 5 minutes.
• At your table, address at least one question.
• Report back to the group in approximately 5 minutes.
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Report Back & Group DiscussionReport Back & Group DiscussionModule 4Module 4
• What problems did you identify?• What solutions do you recommend?• What remains unresolved?
• What problems did you identify?• What solutions do you recommend?• What remains unresolved?
6363
Key ConcernsKey ConcernsModule 4Module 4
• What are three key concerns from this module that should be shared with the other groups?1)
2)
3)
• What are three key concerns from this module that should be shared with the other groups?1)
2)
3)
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ConclusionConclusion
• The rate of new infections with the pandemic strain has fallen to levels similar to non-pandemic strains, as have survival rates.
• Vaccine production and delivery continue to climb.
• Thorough evaluation of the response to this pandemic continues.
• The rate of new infections with the pandemic strain has fallen to levels similar to non-pandemic strains, as have survival rates.
• Vaccine production and delivery continue to climb.
• Thorough evaluation of the response to this pandemic continues.
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Casualty ReportCasualty Report
59,0404.9 millionCanada
34,2002.9 millionNY
532,80044 millionU.S.
23.2 million967 millionGlobalTotal DeathsTotal Cases
ConclusionConclusion
December 2006December 2006
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Wrap UpWrap Up
• Discussion• Key concerns• Next: Report back to other groups in the
auditorium
• Discussion• Key concerns• Next: Report back to other groups in the
auditorium
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Acknowledgements (1)Acknowledgements (1)• References & Sources:
• WHO Global Influenza Preparedness Plan
• WHO Checklist for Global Influenza Pandemic Preparedness Planning
• FEMA, HHS: Pandemic Tabletop, 1999.• Exercise guidelines adapted from FEMA
• References & Sources:• WHO Global Influenza Preparedness
Plan• WHO Checklist for Global Influenza
Pandemic Preparedness Planning• FEMA, HHS: Pandemic Tabletop, 1999.
• Exercise guidelines adapted from FEMA
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Acknowledgements (2)Acknowledgements (2)Scenario originally developed for:
Avian Influenza: Preparation and Response Regional Workshop
Rensselaer, NY, June 22, 2005
Presented by:University at Albany Center for Public Health
PreparednessAlbany Medical Center Regional Resource Center
for Bioterrorism and Emergency ResponseChamplain Valley Physicians Hospital Regional
Resource Center
Available at www.UAlbanyCPHP.org
Scenario originally developed for:Avian Influenza: Preparation and Response
Regional WorkshopRensselaer, NY, June 22, 2005
Presented by:University at Albany Center for Public Health
PreparednessAlbany Medical Center Regional Resource Center
for Bioterrorism and Emergency ResponseChamplain Valley Physicians Hospital Regional
Resource Center
Available at www.UAlbanyCPHP.org