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Pandemic Flu Preparedness and Update April 30, 2009

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Pandemic Flu Preparedness and Update. April 30, 2009. Today’s Presenters:. Al Cook, CMRP, FAHRMM Chief Resource Director The Regional Medical Center Jeff Wagner, CMRP Vice President MidMichigan Health. Pandemic Guidelines. Pandemic Guidelines. Pandemic Guidelines. - PowerPoint PPT Presentation

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Page 1: Pandemic Flu Preparedness and Update

Pandemic Flu Preparedness and Update

April 30, 2009

Page 2: Pandemic Flu Preparedness and Update

Today’s Presenters:

Al Cook, CMRP, FAHRMM

Chief Resource Director

The Regional Medical Center

Jeff Wagner, CMRP

Vice President

MidMichigan Health

Page 3: Pandemic Flu Preparedness and Update

Pandemic Guidelines

Stages of Preparedness Level for Materials Managers related to Pandemic Flu Levels (this includes the Avian Flu; a.k.a. H5N1, H5, or bird flu)

  Interpandemic Pandemic Alert Pandemic Postpandemic

Impact

Risk of human infection or disease is considered to

be low

human-to-human spread is still localized, suggesting that

the virus is becoming increasingly better adapted to humans but may not yet be

fully transmissible (substantial pandemic risk)

Increased and sustained transmission in the general

population, likely that 30% or more of population infected

Return to Interpandemic stage

Community

Develop direct communication with

disaster or bio-terrorism coordinator in your facility,

county, or region to ensure duplication of activity is limited or

eliminated

Align planning with clinical leaders and disaster

coordinator(s), prepare for support of satellite treatment centers that may be utilized

to keep flu patients away from medical centers if

possible

Full activation of supply acquisition and distribution related to high volume of flu

patients

De-commission of community services, move back to focus

on main activity centers

Page 4: Pandemic Flu Preparedness and Update

Pandemic Guidelines

Stages of Preparedness Level for Materials Managers related to Pandemic Flu Levels (this includes the Avian Flu; a.k.a. H5N1, H5, or bird flu)

  Interpandemic Pandemic Alert Pandemic Postpandemic

Supplies (see list below)

Maintain normal supply level, stay in close

contact with distribution channel for planning, obtain a copy of the

distributor's disaster plan to ensure supply lines to

the customers, and please

DO NOT HOARD SUPPLIES

Increase in flu patients will place pressure on supplies

within medical facilities, increase supply quantities accordingly, again, please

DO NOT HOARD SUPPLIES

Continue to increase purchases and frequency to handle the increased volume without hoarding, realize that

this may last 4-8 weeks

Supply levels should taper down with decreased patient

activity

Equipment

Ventilator/Respirators and IV Pumps undergo

preventative maintenance checks. Prepare a list of local

medical equipment rental companies and inquire

on availability of specific equipment such as

ventilators/respirators

All ventilators/respirators and IV Pumps ready for service

All available ventilators/respirators and IV Pumps are in active service; maintaining, cleaning, and

turnaround are critical. Rental equipment ordered and in

use.

Disinfecting, repair and maintenance after high

activity

Page 5: Pandemic Flu Preparedness and Update

Pandemic Guidelines

Stages of Preparedness Level for Materials Managers related to Pandemic Flu Levels (this includes the Avian Flu; a.k.a. H5N1, H5, or bird flu)

  Interpandemic Pandemic Alert Pandemic Postpandemic

Staffing

Prepare list of alternate workers in the event of

staff shortages in Materials Management.

Consider cross training of staff. Update phone

records and prepare your protocol for calling in

relief workers

Monitor the need for calling on relief workers

Monitor the need for calling on relief workers

Return staff to normal duties

Funding

Check with local, state and governmental

agencies for funding opportunities. This may

fall under the responsibility of your

facility's disaster coordinator

Focus on supply needs Focus on supply needs

Check with local, state and governmental agencies for funding opportunities. This

may fall under the responsibility of your facility's

disaster coordinator

Page 6: Pandemic Flu Preparedness and Update

Pandemic GuidelinesSupply List

Gloves Exam Suction Catheters

Gowns Isolation Disposable/re-usable Suction Canisters

Masks N95 Oxygen Masks

Masks Procedure Ventilator Tubing

Masks SurgicalRapid Lab Test Kits

Shields Face Respiratory Etiquette signs

Stethoscopes Disposable/re-usable  

Tissues

Goggles Gel Hand Alcohol Based - personal

Blood Pressure Cuffs Disposable/re-usable Wipes Disinfectant for Surfaces

Thermometers Disposable/Re-usable  

Vaccines/anti-viral Medications Morgue Packs

IV Supplies  

Note that quantities should increase based on patient volume changes in most cases, and not by simply increasing by "weeks" or "months" of supplies. This should be managed via close communication with the distributors.

Page 7: Pandemic Flu Preparedness and Update

Medical Materials Coordinating Group(MMCG)

The MMCG is a subgroup of the Healthcare Sector Coordinating Council (HSCC), which itself is comprised of fifteen owner-operators and association members which represent the medical products supply chain – including manufacturers, consolidators, distributors, and maintenance and repair.

The HSCC and MMCG are recognized by the Department of Homeland Security and other federal agencies as the initial point of contact within healthcare’s private industry for critical infrastructure protection, preparedness, and response purposes.

Page 8: Pandemic Flu Preparedness and Update

Healthcare and Public Health Sector Government Coordinating Council (GCC)

Healthcare Personnel

Includes:

Doctors, nurses, pharmacists, dentists, emergency medicine and other clinicians and practitioners with direct involvement in healthcare delivery

Insurers, Payers, HMOs

Includes:

Representatives of third-party payers for medical treatment and healthcare delivery including insurance companies, HMOs and others

Information Technology

Includes:

All IT systems, capabilities and networks supporting delivery of healthcare services

Laboratories and Blood

Includes:

Laboratories and lab support services separate from medical treatment facilities, and companies and associations from the blood, tissue and organ industry

Mass Fatality Mgt Services

Includes:

Medical examiners, coroners, funeral directors, cremationists, cemeterians, clergy, and manufacturers and distributors of funeral, memorial, and cremation supplies

Each sub-council is responsible for organizing itself

Sample Priority Issues for Sub-Councils: Emergency Preparedness, Emergency Response; Vulnerability Assessment / Prioritization; Communication & Information Sharing among members, with HHS and DHS, and with other sectors

Medical Materials

CoordinatingIncludes:

Manufacturers, suppliers, and distributors of medical supplies and equipment, as well as health care materials managers

Medical Treatment

Includes:

Hospitals, clinics, and other organizations/entities that deliver medical treatment

Occupational Health

Includes:

Occupational health physicians and nurses, industrial hygienists, and other occupational health professionals

Pharma and Biotech

Includes:

Manufacturers, suppliers and distributors of generic and branded pharmaceuticals and biological equipment

Cross-cutting Work Groups will be established to address priority issues that cut across sub-councils

Healthcare Sector Coordinating Council (HSCC)

The HSCC is comprised of representatives and alternates from each sub-council. Issue will be identified by Subcouncils. Coordination across Subcouncils and with the GCC will be organized through the HSCC.

AHRQ CMS FDA HRSA IHS/TRIBAL NIH SAMHSA DOD VA STATE/LOCAL CDC

Page 9: Pandemic Flu Preparedness and Update

Pandemic Influenza Phases

In nature, influenza viruses circulate continuously among animals, especially birds. Even though such viruses might theoretically develop into pandemic viruses, in Phase 1 no viruses circulating among animals have been reported to cause infections in humans. In Phase 2 an animal influenza virus circulating among domesticated or wild animals is known to have caused infection in humans, and is therefore considered a potential pandemic threat. In Phase 3, an animal or human-animal influenza reassortant virus has caused sporadic cases or small clusters of disease in people, but has not resulted in human-to-human transmission sufficient to sustain community-level outbreaks. Limited human-to-human transmission may occur under some circumstances, for example, when there is close contact between an infected person and an unprotected caregiver. However, limited transmission under such restricted circumstances does not indicate that the virus has gained the level of transmissibility among humans necessary to cause a pandemic.

Page 10: Pandemic Flu Preparedness and Update

Pandemic Influenza Phases

Phase 4 is characterized by verified human-to-human transmission of an animal or human-animal influenza reassortant virus able to cause “community-level outbreaks.” The ability to cause sustained disease outbreaks in a community marks a significant upwards shift in the risk for a pandemic. Any country that suspects or has verified such an event should urgently consult with WHO so that the situation can be jointly assessed and a decision made by the affected country if implementation of a rapid pandemic containment operation is warranted. Phase 4 indicates a significant increase in risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion.

Page 11: Pandemic Flu Preparedness and Update

Pandemic Influenza Phases

Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short. Phase 6, the pandemic phase, is characterized by community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5. Designation of this phase will indicate that a global pandemic is under way.

Page 12: Pandemic Flu Preparedness and Update

Pandemic Influenza Phases

During the post-peak period, pandemic disease levels in most countries with adequate surveillance will have dropped below peak observed levels. The post-peak period signifies that pandemic activity appears to be decreasing; however, it is uncertain if additional waves will occur and countries will need to be prepared for a second wave. Previous pandemics have been characterized by waves of activity spread over months. Once the level of disease activity drops, a critical communications task will be to balance this information with the possibility of another wave. Pandemic waves can be separated by months and an immediate “at-ease” signal may be premature. In the post-pandemic period, influenza disease activity will have returned to levels normally seen for seasonal influenza. It is expected that the pandemic virus will behave as a seasonal influenza A virus. At this stage, it is important to maintain surveillance and update pandemic preparedness and response plans accordingly. An intensive phase of recovery and evaluation may be required.

Page 13: Pandemic Flu Preparedness and Update

Calculating demand in a pandemic

OSHA estimates that for healthcare workers, masks will be changed four times per 12 hour shift for direct patient care givers. Most healthcare workers think this is well underestimated.

OSHA also indicates that in Emergency Rooms, direct care givers may use as many as one mask between each patient and that each person visiting the ER should be issued an n-95 to prevent transmission.

The number is staggering and might indicate that in some cases, Materials Managers might be better served to seek reusable alternatives.

Page 14: Pandemic Flu Preparedness and Update

Considerations for meeting demand for PPE

Initial volume will not be 100% occupancy but will start with a significant surge in daily use and crescendo at full census.

Heightened awareness should be made for the potential of sensitive medical PPE departing with the workforce.

At the onset, estimates of daily use should be calculated and the initial 96 hours of use should be brought on site.

Work with established suppliers and with the work force to establish potential alternatives to disposable N-95 face masks. OSHA site offers several alternative devices.

Assure that the correct type of mask or respirator is used in the most appropriate instance, e.g.: surgical masks used where appropriate and disposable N-95s only used where essential.

Page 15: Pandemic Flu Preparedness and Update

Resources

http://www.cdc.gov/swineflu/http://www.cdc.gov/swineflu/recommendations.htm

http://www.cdc.gov/swineflu/masks.htm

http://www.chcoc.gov/Transmittals/TransmittalDetails.aspx?TransmittalID=2227

http://www.osha.gov/Publications/3328-05-2007-English.html#RespiratoryProtectionforPandemicInfluenza

Page 16: Pandemic Flu Preparedness and Update

Additional Resource

AHRMM’s Disaster Preparedness Manual for Materials Management Professionals is carried in the online AHRMM Book Store

Page 17: Pandemic Flu Preparedness and Update

AHRMM’s Disaster Preparedness Manual

This book offers sound advice in planning and preparing for disaster preparedness. This is the time to engage with local, regional, state and even federal agencies regarding the plans and resources that will be made available to the hospital as a result of those plans. No hospital will stand alone in any disaster response but will stand as a focal point with other local and regional agencies to deliver health and public health services to their respective communities in the most efficient and effective manner.

Now is the time for understanding these resources and how they will all come together to serve the health needs of their communities. Preparation and understanding of these integrated response efforts will be key elements of hospitals’ disaster response plans.

Page 18: Pandemic Flu Preparedness and Update

Questions

Page 19: Pandemic Flu Preparedness and Update

Speaker Contact Information

Al Cook, CMRP, FAHRMM

Chief Resource Director

The Regional Medical Center

Orangeburg, SC

803 395 2651

[email protected]

Jeffrey J. Wagner, CMRP

Vice President

MidMichigan Health

Midland, MI

989-839-3821

[email protected]