Avian Influenza and Your Center:An interactive session

April 18, 2005CHCANYS Brooklyn/Queens Kick Off

Meeting

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Interactive Session

• For this session, we are going to present a moment by moment scenario that will help to introduce some of the concepts of preparedness.

• Audience members are encouraged to play along…pretend that this is happening at YOUR center.

• Tell us what your center would do• Ask questions• Voice concerns

• Allow for some artificiality of the scenario.

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Why Avian Influenza?

1. Nuclear Detonation2. Biological Attack: Aerosolized

Anthrax3. Biological Disease Outbreak:

Flu Pandemic4. Biological Attack: Pneumonic

Plague5. Chemical Attack: Blister Agent6. Chemical Attack: Toxic

Industrial Chemicals7. Chemical Attack: Nerve Agent8. Chemical Attack: Chlorine

Tank Explosion

9. Natural Disaster: Major Earthquake

10. Natural Disaster: Major Hurricane

11. Radiological Attack: Dirty Bombs

12. Explosive Attacks: Improvised Bombs

13. Biological Attack: Food Contamination

14. Biological Attack: Foot-and-Mouth-Disease

15. Cyber Attack

The New York Times; Wednesday, March 16, 200515 Nightmares for Disaster Planning

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Brief Background-Avian Influenza

Avian influenza is caused by a bird flu virus. These occur naturally among birds (e.g., chickens, ducks, turkeys)

Normally, bird flu does not affect humans; HOWEVER, transmission has occurred in Asia/Southeast Asia causing severe respiratory illness in humans with high death rate.

Symptoms of Bird Flu in Humans: Typical flu-like illness (fever, cough, sore throat and muscle aches) to eye infections, pneumonia, severe respiratory diseases and other life threatening complications.

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Brief Background: Avian Influenza

Transmission occurs via contact with infected poultry or

contaminated surfaces.

Treatment: Currently, there is no vaccine. There are two antiviral drugsused to treat and prophylax for avian influenza.

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Let’s Start

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Tuesday Morning

• Slightly cloudy but pleasant Spring day

• CHC ED walks into office and turns on computer.

• There is a high priority email from the NYC DOHMH.

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2005 ALERT #38: Clusters of severe H5N1 influenza outbreaks with community transmission in Vietnam

Please Distribute to All Medical, Pediatric, Family Practice, Laboratory, Critical Care, Pulmonary, Dermatology, Employee Health, and Pharmacy Staff in Your Hospital

Dear Colleagues: Clusters of severe H5N1 influenza outbreaks have been identified in southeast Asia. There are currently no cases in the United States. The NYC DOHMH and the federal Centers for Disease Control and Prevention (CDC) have instituted screening of travelers to and from affected countries. A vaccine is in development and will be available in 3-4 months. The NYC DOHMH is requesting heightened surveillance for persons presenting with the following illness: 1. High fever (>38o C or 101.4o F) AND 2. Respiratory signs or symptoms, including cough, shortness of breath or difficulty breathing AND/OR 3. Anyone with these symptoms who has traveled to Vietnam or had contact with someone who is ill and had travelled NYC DOHMH requests immediate reporting of any cases with the above illness and asks health care providers to:

•Ensure that patients with fever and respiratory symptoms are quickly identified and isolated.

•Promote respiratory hygiene/cough etiquette and hand washing measures.

•Consider using rapid influenza diagnostic tests.

•Use antiviral medications judiciously.  

Tuesday, 9:00 am

The City of New York DEPARTMENT OF HEALTH AND MENTAL HYGIENE

Michael R. Bloomberg Thomas R. Frieden, m.d., m.p.h. Mayor Commissioner _______________________________________________________________

nyc.gov/health

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 New York City DOHMH Health Alert

• Infection Control Guidance

•Suspect and Probable Case Definitions

•Reporting to DOHMH

•Patients who meet these criteria should be isolated and evaluated using airborne precautions. Please notify the NYS/NYC immediately so that we can assist with clinical management and laboratory testing. Call the Provider Access Line at 1-800-NYC DOH1.

Tuesday, 9:00 am

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Public Health Response

• NYC DOHMH activates their Incident Management System.

• Enhanced outreach to • Hospitals, Community Health Centers• Laboratories• Vietnamese and Asian communities

• Teleconference scheduled for hospitals and CHCs at 11 am.

• Enhanced passive/active surveillance

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WHAT WOULD YOUR CENTER DO NOW?

• Response to the Health Alert• Activation of Incident Management System (IMS)

• How do you know when to activate?• Partial or full activation?• What are your criteria for activating?

• Notification of Internal Staff• Emergency Operations Center

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NIMS:National Incident Management System

• System that establishes COMMON language and concepts among all response agencies

• Incident Management System

COMMAND

OPERATIONS PLANNING LOGISTICS FINANCE/ADMINISTRATION

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Back at CHCANYS…

Incident Commander – (CHCANYS CEO)

Communities Served By CHCANYS Members

CHCANYS General Membership (CEO, Medical Directors, EP Coordinators)

Planning (EP Medical Director)

New York City Department of Health and Mental

Hygiene

New York City Office of Emergency Management

(NYC OEM)

New York State Department of Health

(NYSDOH)

Greater New York Hospital Association (GNYHA)

Logistics Director Operation Director Finance/Administration Director

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CHCANYS

• CHCANYS sends out notice to FQHCs:• Current information on health alert• Teleconference with City at 11am• Teleconference with FQHCs and CHCANYS at

noon. • FQHCs to email CHCANYS with questions or

issues to bring up with DOHMH

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Tuesday, 11amTeleconference Call

• Update of current situation• Guidance from DOHMH

• Identification of cases and reporting• Infection Control measures

• Surgical masks/hand hygiene

• Guidance from NYS DOH• HERDS reporting

• Guidance from OEM• Antiviral supplies

• Other agencies

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Tuesday at 11:00 amBack at the CHC…

• A 55-year-old man and his 31-year-old daughter walk into center.

• At the registration desk they are coughing and both appear flushed.

• They also seem somewhat short of breath.

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Tuesday at 11:00 am

• As per the center policy and successful internal notification, the two patients are given tissues (or surgical masks) and taken to another room to await examination.

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WHAT WOULD YOUR CENTER DO NOW?

• Internal notification• Infection Control Measures

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NIMS:National Incident Management System

• System that establishes COMMON language and concepts among all response agencies

• Incident Management System

COMMAND

OPERATIONS PLANNING LOGISTICS FINANCE/ADMINISTRATION

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Patient 1 Medical History

• 55-year-old man• Alert, oriented, anxious.• Chief complaint: “I can’t sleep at night, I’m

coughing too much.”• Two-day history of weakness and non-

productive cough• No other medical history• T 100.9, HR 104, RR 28, BP 128/72

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Patient 2 Medical History

• 31-year-old daughter• Alert, oriented, coughing frequently• Chief complaint: “I feel warm, I think I have

the flu.”• Married with two kids • No other medical history• T 101, HR 108, RR 28, BP 100/60

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What else do you want to know?

• The two patients had recently traveled to Vietnam with their families and had returned on Saturday.

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WHAT DOES YOUR CENTER DO NOW?

• External notification• Transfer of patient• Housekeeping issues

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NIMS:National Incident Management System

• System that establishes COMMON language and concepts among all response agencies

• Incident Management System

COMMAND

OPERATIONS PLANNING LOGISTICS FINANCE/ADMINISTRATION

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Tuesday, 11:30am

• Other patients in the waiting area noticed that the two patients were given tissues (or surgical masks), put in exam rooms and now are being taken away by EMS.

• Word starts to float among the staff that the “avian flu” is here in the center. Some patients overhear this.

• On the TV in the waiting area a news reporter announces the imminent danger of the deadly avian flu coming to the US.

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WHAT WOULD YOUR CENTER DO NOW?

• Mental Health of Patients• Mental Health of Staff

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Take Home Thoughts

• When would the current situation trigger your center’s Incident Management System?

• What internal and external communication needs are required to communicate with your center’s staff?

•How should the patients waiting to be seen in your center be managed?

•How would you manage the mental health concerns of your staff?

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Close Out

• What CHCANYS has been and will be doing for CHCs in 2005:

• Three borough wide kick off meetings (Brooklyn/Queens, Bronx, Harlem)

• Train-the-trainer in fit testing N95 respirators• Donning and removing PPE posters• Notification Drills via HAN for CHCs• Conducting an HVA• Developing your IMS• Identifying your center’s role during a citywide

emergency• And more! Stay tuned!

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Thank you!

Questions?• Brenda Merritt, MDEmergency Preparedness Medical Director(212) 279-9686 ext. 665Bmerritt@chcanys.org

• Robyn DiPalmaProgram Associate(212) 279-9686 ext. 217Rdipalma@chcanys.org

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What is a Tabletop?

• A verbal “walkthrough” of a response to an emergency situation.

• Designed to elicit dialogue by the participants as they examine and resolve problems based on emergency plans and procedures.

• A first step towards conducting a partial or full drill.