Webcast Outline: April 2, 2008

The following is an outline of the visual presentation made during the April 2 live webcast of discussions to help state planners in the next round of pandemic influenza planning.

Pandemic Intervals, Triggers, and Actions

Approaches to Planning and Response

Pandemic Severity Index

• Determined using:
• • Case-Fatality Ratio
  • Excess Mortality
• PSI characterized as categories
• • For instance, for categories 4 and 5 (CFRs 1-2% and = 2%) all community measures are recommended
• Complete information available at Pandemicflu.gov, “Community Strategy for Pandemic Influenza Mitigation in the US ”

Community Mitigation Interventions

• Home: Cases and Contacts
• • Voluntary Isolation of Cases
  • Voluntary Quarantine of household members in homes with ill persons, use antivirals if feasible
• School: Child Social Distancing
• • Dismissal of students, closure of child care programs
  • Reduce out-of-school contacts & community mixing
• Workplace / Community: Adult Social Distancing
• • Decrease number of social contacts
  • Increase distance between persons
  • Minimize public gatherings
  • Modify workplace schedules

When to Initiate Actions?

• WHO Phases identify global progression of pandemic
• US Government Stages provide more framework for national actions
• Pandemic Intervals
• • New approach to planning to account for:
  • • Asynchrony of pandemic transmission
    • Need for different responses to occur in different places based on local transmission of influenza
  • Identified time intervals that follow an idealized pandemic curve

Intervals, Triggers, Actions

• Pandemic Intervals
• • Initiation
  • Acceleration
  • Peak Transmission
  • Deceleration
  • Resolution
• Definitions and triggers for actions such as implementing CMI are provided

Questions

• intervals@cdc.gov
• • For questions regarding Intervals, Triggers, and Actions approach
• Pandemicflu.gov
• • Community Mitigation Guidance

Uniformed Military Services

The National Guard

• The National Guard is the organized militia reserved to the states by the Constitution of the United States* .
• • It is a Constitutionally unique “dual hatted” organization
  • Since 1636, the Guard has served America as both a wartime force and the first military responders in times of domestic crisis.
  • • Under Command of the Governor thru The Adjutant General
    • May be Federalized by the President to fight wars or quell insurrections
    • Currently there are over 450,000 National Guardsmen
  • Can provide essential domestic support services to the States during disasters
  • • Today there over 7000 guardsmen nationwide providing disaster relief support to the States
    • The National Guard “Essential 10”:
    • • Aviation and Airlift, Communications, Command and Control, Engineering, Logistics, Medical, CBRNE Response, Maintenance, Security,  Transportation

Uniformed Military Services: Specific Considerations during a Pandemic

• Encourage State Emergency Managers and Public Health Officials to:
• • Understand how to efficiently utilize the National Guard (NG) capabilities during all phases of PI planning and response
  • • Clearly codify the responsibilities of the NG in the State plan
    • Establish solid lines of communications in a pre-event environment
    • Cross walk the “NG Essential 10” to the NRF ESF’s
    • Identify critical shortfalls and develop solutions
    • Understand constraints and limitations of the NG response
  • Ensure that All DoD (Active Duty and Reserve), NG members and their beneficiaries, living in the state are accounted for in all phases of planning for:
  • • Antiviral medications, PPE, Healthcare, Social Services, etc.
  • Encourage local public health officials to establish contact with adjacent Federal military base/post Public Health Emergency Officer
  • • Coordinate with the Federal Regional PI Planning Office

National Guard Domestic Support to State: “The Essential 10”

Sustain Transportation Systems:  Operating Objective A.6

Sustain Transportation Systems

3 Goals

1. Keep Goods and People Moving
2. Protect Transportation Workers
3. Protect the Public while using Transportation Systems

Goal 1. Keep Goods and People Moving

• Keep state transportation systems moving
• Keep goods and cargo moving within states and from state to state
• Identify and prioritize essential transportation systems and cargo

Goal 2.  Protect Transportation Workers

• Measures to ensure the safety of transportation workers
• Training and instruction on personal protective equipment, cleaning/sanitizing operations and protocol for potentially sick passengers

Goal 3.  Protect the Public while using Transportation Systems

• Public awareness and education
• Travel advisories
• Public Safety Campaigns

Additional Reference Material

• Transportation Sub-Sector annexes from “Pandemic Influenza Preparedness, Response, and Recovery”           
• • Aviation
  • Highway and Motor Carrier
  • Maritime                      
  • Mass Transit
  • Railroad
• Now available in final draft:   http://www.dot.gov/pandemicflu/

Provide Healthcare and Manage Mass Fatalities

At-Risk Populations

• Definition- Functional Needs
• Planning
• • Locating populations in the community
  • Relationships with advocates
  • Messages from trusted sources

Bed Surge Capacity

• Hospital Available Beds for Emergencies and Disasters (HAvBED)
• • Standard Definitions; Seven types
  • • Available in 24 hours; Available in 72 hours
  • ED Status: Open / Closed / NA
  • Available ventilators
  • http://www.ahrq.gov/prep/havbed/havbed2.htm

Alternate Care Sites

• Expand into Non-Hospital Settings
• • Identify locations
  • Scope of care
  • Staffing
  • Equipment, Supplies, Pharmaceuticals

Personnel Surge Capacity

• Volunteer Registry (ESAR-VHP)
• • Procedures for deploying and tracking
  • • Databases with credentialed personnel
    • Mission definition - Resource types
    • Notification & Fitness for duty
    • Human resources; Legal protections
    • Logistics support
    • Reporting procedures

Scarce Resources

• Ethical Distribution
• • Spectrum of adaptations
  • • Administrative / Clinical changes
  • Maximize resources
  • Clinical care committee
  • Ethical principles and Community norms
  • Transparent decision making
  • http://www.ahrq.gov/research/mce

Fatality Management

• Web-based death certificates
• Procedures for deaths at home
• Public messages for stress management

Healthcare Recovery

• Mechanisms to restore
• • Staffing, equipment, supplies, pharmaceuticals
  • Mental health, substance abuse and other services
• After action reviews and corrective action plans

Department of Veterans Affairs

• Primary function is to provide services to eligible veterans
• Serves as a back up for the Department of Defense
• Has expanded responsibilities under the National Response Framework
• States/territories should include their local VA facilities in the PI planning process

The pandemic influenza planning webinars are brought to you by the U.S. Department of Health and Human Services.