Bioterrorism Preparedness

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Welcome!

• Facility Information/Sign-in Sheet
• Introductions
• Exercise orientation
• Table arrangement
• Narrative, Modules, questions, and briefings
• Breaks
• Lunch at Noon discussion continues
• 100 wrap up next steps
• 130 conclusion

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Introductions

• Name
• Organization
• Agency/Association role in Pandemic Influenza
  preparedness and response

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Packet Contents

• KDHE Kansas Pandemic Influenza Preparedness and
  Response Plan
• Flu Definitions
• Narrative Scenario for Pandemic Influenza
  Exercise
• Exercise Modules 1, 2, and 3, with questions
• Participant evaluation form

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Flu Terms Defined

• Seasonal (or common) flu is a respiratory illness
  that can be transmitted person to person. Most
  people have some immunity, and a vaccine is
  available.
• Avian (or bird) flu is caused by influenza
  viruses that occur naturally among wild birds.
  The H5N1 variant is deadly to domestic fowl and
  can be transmitted from birds to humans. There is
  no human immunity and no vaccine is available.
• Pandemic flu is virulent human flu that causes a
  global outbreak, or pandemic, of serious illness.
  Because there is little natural immunity, the
  disease can spread easily from person to person.
  Currently, there is no pandemic flu.

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Orientation to the Scenario

• Go with it! Dont let artificialities in the
  scenario take away the focus.we are here to
  learn and improve existing procedures
• This is our first influenza exercise, lessons
  learned will be incorporated into future drills
  and exercises
• We will use the results of todays exercise to
  further refine our existing plans and operating
  guides

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Setting the stage..

• Narrative is provided in your folders

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Case Definition

• Documented temperature greater than 100 degrees
  Fahrenheit plus cough and/or sore throat or
  shortness of breath AND EITHER
• 1. History of travel to an affected region
  (including those within the US) within 10 days of
  symptom onset.
• OR
• 2. History of direct contact with an ill
  individual from an affected region (including
  those within the US) within 10 days of symptom
  onset.
• OR
• 3. Having taken one of the flights from Hong
  Kong or Tokyo with infected passengers (CDC has
  supplied airline manifests to affected states).

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Module 1

• CDC released a HAN alert to all state and local
  health departments with a case definition for
  cases of NEW FLU and put all health agencies on
  high alert for influenza pandemic caused by this
  virus.
• By early January 2007-states report an increase
  in Influenza-Like Illness (ILI) with mortality
  rates of up to 5 among young adults (20-30 years
  old).

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Module 1 contd

• July 2007-absolute earliest for the first vaccine
  with expected total 6,000 doses for Kansas and 2
  doses will be needed to produce immunity.
• Mid January 2007-outbreak of unusually severe
  respiratory illness is identified in NE Region of
  Kansas.
• At least 125 cases have occurred in the past
  week, affecting all age groups 20 patients
  required hospitalization, 5 of which have died
  to date.

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Discussion

• More details are provided in your Module 1
  handout
• Discussion questions are also included

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Module 1 Questions

• Who is leading the response?
• What are the roles and responsibilities of your
  staff?
• Describe how Incident Command has been activated
  and how it is being used at this point?
• How was your agency notified and by whom?
• How does your agency receive information and keep
  current on the situation as it unfolds?
• Does your agency have a role at this time?
• Describe the plans and/or SOGs that you use to
  guide your response.

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Module 1 Questions contd

• What kinds of messages need to be crafted for the
  public at this time?
• How is your agency working with the media so that
  they will help you in your efforts?
• How is disease surveillance being conducted at
  this point?
• What steps are being taken to prepare the medical
  community and the the general public for the
  events of the next two to three months?

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Module 2

• Flu reports for the 2006-2007 flu seasons have
  shown in this particular sub-type of flu all over
  the US. Small rural hospitals throughout Kansas
  have diverted patients and large hospitals are
  discharging non-critical patients in order to
  take on the most severe flu cases in their area.
• Neighboring hospitals are at full capacity and
  are unable to accept more patients.
• WHO and CDC have both issued statements
  indicating that there is a pandemic flu.
• The public is growing restless because a flu
  vaccine is not yet available and antiviral
  medication is beginning to run low.
• April 21, 2007 sentinel site and other hospital
  sites in most parts of Kansas are still reporting
  high rates of ILI. Mortality rates for patients
  admitted to hospitals with NEW FLU approaches 5

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Discussion

• More details are provided in your Module 2
  handout
• Discussion questions are also included

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Module 2 Questions

• What plans do you have in place to step up
  surveillance activities?
• On what medical related areas does public health
  need to collaborate with hospitals, emergency
  rooms, out patient providers?
• How will the deceased be safely and respectfully
  handled, and how will religious beliefs be
  addressed?
• What mental health needs of citizens, health
  workers, emergency responders, and others must be
  considered and addressed? How will this be
  accomplished?

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Module 2 Questions contd

• Describe the Health Department Operations
  Center/Local Emergency Operations Center (EOC)
  coordination at this stage.
• What security plans are in place?
• Where will vaccine be distributed when available?
  Who will receive the limited number of doses
  available?
• Does your agency have a Continuity of Operations
  Plan (COOP) that addresses a 30 reduction of the
  workforce due to illness?
• Describe the strategy that will be used to slow
  the spread of the pandemic.

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Module 3

• Mid May, human cases of NEW FLU are still being
  reported in all Kansas regions. Although cases
  are reported in all age groups, adults (20-30
  years old) appear to be the most severely
  affected, and case fatality rates approach 10 in
  that group nationwide. Public unease grows
  because vaccine is not yet available and supplies
  of antiviral drugs are severely limited to some
  private physicians and hospitals. There are
  reports of people taking Oseltamivir (Tamiflu)
  and Relenza (inhalation dosing) as prophylaxis
  but its efficacy is still unknown.

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Module 3 contd

• August 2007-the flu vaccine for NEW FLU sub-type
  of influenza A has been developed and is in
  production. States are receiving flu vaccine in
  sporadic shipments, as supplies are available.
• The public is confused about who will receive
  vaccine first and when. Concerns that crowds
  will overwhelm local health departments in Kansas
  including KDHE and possible violent outbursts are
  possible with rumors of a vaccine shipment being
  hijacked.

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Discussion

• More details are provided in your Module 3
  handout
• Discussion questions are also included

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Module 3 Questions

• Have Plans been made to enhance security in times
  of emergency? How and by whom?
• How is your organization handling the media at
  this time?
• How will you manage the volunteers that want to
  help?
• What can be done to alleviate the stress for
  those who have already been enlisted with other
  efforts during the past 8 weeks?
• Describe how your agency will ensure that the
  needs of your special populations are addressed.

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Hotwash

• Expectations What were they? Were they met?
• Outcomes what do we need to DO now?
• Issues what are areas needing clarification,
  improvement, further discussion?

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Thank you

• Your participation in this exercise has been
  greatly appreciated.
• The After Action Report will be drafted in the
  next few weeks based on comments and written
  evaluations provided today.
• Corrective action plan will be developed
  on__________