Pandemic Influenza TableTop Exercise October 13 2009 THE
Pandemic Influenza: Table-Top Exercise October 13, 2009
THE STORM IS BREWING…
Health Alert Network Advisory #1
Health Alert Network Advisory #1 n An outbreak of severe respiratory illness is identified in a small village in southern China. 25 cases have been reported among all age groups, all patients have had direct contact with poultry. n Viral cultures are positive for type-A influenza virus. n The isolates have been sent to CDC for further characterization.
Discussion Questions: HAN # 1 n Please refer to question list: 1) developing a plan and monitoring
HAN #2
HAN #2 n n Viral cultures from the patients in China tested positive for type-A influenza. The CDC has determined that the isolates are type A H 7 N 3, a subtype that has never before been isolated from humans. Additional cases of H 7 N 3 are now being reported in southern China in patients who have not had any direct contact with poultry The affected villages have been quarantined by the Chinese government.
HAN #2 n n The CDC has dispatched a team of epidemiologists to evaluate the outbreak. All clinicians and state departments of health are alerted for patients with severe respiratory illness and a history of travel to the region of Asia. Isolates of the H 7 N 3 virus are sent to the U. S. Food and Drug Administration (FDA), so that work can begin to produce a reference strain for vaccine production. Influenza vaccine manufacturers estimate initial production will take 4 to 6 months.
HAN # 2 n n The outbreak begins to make headlines in every major newspaper and becomes the lead story on network news. U. S. government officials are briefed on a daily basis as surveillance is intensified throughout Southeast Asia.
Discussion Questions: HAN # 2 n Please refer to question 2: Communications
HAN #3
HAN #3 n Cases of H 7 N 3 are reported in Hong Kong, Singapore, South Korea, and Japan. Transmission from human to human has been documented. n Cases are reported in all age groups, young adults appear to be the most severely affected. n Case-fatality rates are approaching 5%.
HAN #3 n Large numbers of patients are reporting to hospitals, inundating their emergency departments. n Vaccine is not yet available. Supplies of antiviral drugs are severely limited. n The CDC expects cases to begin appearing in the United States.
Discussion Questions: HAN # 3 n Please refer to question #3 Student and personnel health
HAN #4
HAN Alert #4 n n Human cases of the H 7 N 3 virus have been identified in the United States. Los Angeles reports that large numbers of patients have been reporting to their emergency rooms, taxing all local emergency departments. No cases have been reported in New Mexico, but are expected in the next 1 to 2 weeks. State and local agencies are asked to intensify influenza surveillance.
Discussion Questions: HAN #4 n Please refer to questions 4 and 5 Triage Security and Aid
THE STORM HITS
Week One n n n Scenario update: n In New Mexico, the impact has begun to be felt in earnest. There is a noticeable increase in the number of persons presenting to emergency rooms with symptoms consistent with influenza. n Phones at physician offices and the health department begin to ring constantly. More people—the “worried well”—are seeking medical care than actually need it, due to fear about the new strain of virus.
Week One Weekly ncidence Hospital Census Total Hospital Admissions 79 321 400 Intensive Care Unit Admissions 12 35 47 Patients Requiring Ventilators 6 28 34 Deaths 0 10 10 UNMH
Week One n n n City schools are beginning to experience both students and staff out sick. About 10 to 15 percent of their populations are affected. AFD and APD enact their existing emergency plans to assist with staffing shortages in critical areas. A CDC/NIH research team has arrived at UNMH and is requesting access to influenza patients, their records, and laboratory specimens.
Week Two n n Nationwide, accounts of illness are reported by the media. The is a high demand influenza vaccine, but it is not available. Elected officials receive angry phone call from constituents demanding antiviral medication and vaccine. People are demanding answers about why existing antiviral medication is reserved for certain individuals.
Week Two UNMH Weekly Hospital Incidence Census Total Hospital Admissions 132 315 447 Intensive Care Unit Admissions 25 40 65 Patients Requiring Ventilators 13 33 46 0 10 10 Deaths
Week Two n n Traffic in both directions of Lomas Blvd approaching UNMH has increased, causing gridlock at hospital entrances. Large numbers of patients are concentrating in the hallways and waiting rooms to be seen. Wait times are over 8 hours. n n n The UNM campus is experiencing about 20% absenteeism of students. 20% of classes have been cancelled due to professor absences. Facilities management and maintenance at both the hospital and the main campus are experiencing the same absenteeism rate.
Week Two n The hospitals’ four day reserve of disposable durable goods is consumed in 2 days. n At UNMH, the supply of • critical equipment n n n Ventilators monitors etc. • disposable supplies n n n Masks gowns Gloves etc. …may not make it through the week.
Week Two n The City Police Department and Albuquerque Ambulance response times have doubled due to staffing shortages, and the Fire Department response has been systematically reduced, consistent with their “Flu Protocols”. n n The Secretary of the New Mexico Department of Health (NMDOH) has requested, and the Governor has declared a Public Health Emergency. The Secretary of NMDOH is beginning to operate under the Public Health Emergency Response Act (PHERA).
Discussion Questions: Week Two n Please refer to question #7 Prevention of spread of disease
Week Three n n n Scenario update: n Some local pharmacies have run out of antiviral medications Pharmacists are unsure whether they will receive more. n Although the health department has issued guidelines to physicians on antiviral medication use and has emphasized the importance of prioritizing persons with underlying illnesses who have recent onset of influenza symptoms… …anecdotal information suggests that physicians have been prescribing antiviral medications more broadly.
Week Three Weekly Incidence Hospital Census Total 198 317 515 Intensive Care Unit Admissions 39 45 84 Patients Requiring Ventilators 19 38 57 Deaths 16 10 26 UNMH Hospital Admissions
Week Three n n The Mayor of the City of Albuquerque has received a small supply of antiviral medication from the CDC (500 10 -day courses). Public concern over the prioritization of antiviral medications to the police and fire departments is increasing.
Week Three n n n UNMH is experiencing a 20% staff absentee rate. Staff that is available is having difficulties getting to work due to traffic, averaging about 90 additional minutes each way. The ED census has been increased by 100%, and there are consistently 20 admitted patients in the ER waiting for floor beds.
Week Three n n n Patients are getting frustrated with the huge lines, and 25% are leaving without being seen. Some equipment is resupplied. There is conflict with other area hospitals about the receipt of “guaranteed” vendor managed inventory.
Week Three n n n UNM: Main campus also has a 20% absentee rate of staff, and 1/3 of the students have left. There has been a documented cluster of influenza cases in the Laguna / De Vargas dormitories.
Week Three n n n ABQ 911 calls are delayed, and some fire and police calls are not being answered. Some local pharmacies have run out of antivirals, others are extremely low. There was a news report of a pharmacist being beaten up by a crowd demanding antiviral medication.
Discussion Questions: Week Three n Please refer to question #8 Expanding capacity
Week Four n n Albuquerque is overwhelmed by the number of influenza cases. The Office of the Medical Investigator (OMI) has run out of space for bodies, and is requesting refrigerated trucks for storage.
Week Four n n Rough surveillance estimates indicate that 30% of the population is ill with H 7 N 3 influenza. There are students sick with influenza stranded in dormitory rooms with little food.
Week Four UNMH Weekly Hospital Incidenc Census e Total Hospital Admissions 251 315 566 Intensive Care Unit Admissions 51 47 98 Patients Requiring Ventilators 26 40 66 Deaths 26 10 36
Week Four n n n The UNMH ED is packed; there are constantly 30 admitted patients boarding, waiting for beds. 40% staff attrition • Some sick, others caring for ill family members Trash is being picked up every other day.
Week Four n n Central supply reports that medical equipment reserves are only 15% of normal. Only three days of expendable supplies remaining. Previous re-supply orders have been delayed an additional week, and have only been 40% complete when received.
Week Four n n Main campus reports that 4, 000 students are sick with the flu; 75% of classes have been cancelled due to illness or absenteeism. Several academic departments have closed due to illness. n While UNM played host to a Collegiate Invitational Basketball Tournament, several players from Maryland developed the flu, one required a ventilator.
Week Four n n The public safety response has worsened, and the Chief of Police appeared on a local media station to encourage neighborhood watch activity. Hospital infection control has noted an increased rate of decubitus ulcers and nosocomial in hospitalized patients. n A medication error led to the death of a patient on 7 – South. n An increase in medication errors is noted.
Discussion Questions: Week Four n Please refer to question #9 Shortages
Week Five UNMH Weekly Hospital Incidence Census Total Hospital Admissions 251 315 530 Intensive Care Unit Admissions 51 43 94 Patients Requiring Ventilators 26 39 65 Deaths 26 10 36 Recall that these numbers are for UNM, and are a fraction of the Albuquerque and New Mexico impact.
Week Five n n n The NM DOH has received a fragment of the SNS. They called the hospital EOC to arrange delivery. The media has reported that both a student from and an ICU nurse from UNMH died from the flu. There is an outbreak of influenza at the CYFD facility on Edith Blvd. 75 children are ill, two require mechanical ventilation.
Week Five: Discussion Questions n Please refer to questions 10 and 11 Other areas of need The strategic national stockpile
Week Six n n n Grocery stores are suffering shortages of food supplies resulting from ill truckers who usually deliver those supplies. Gasoline prices average $5. 90/gallon. Many stations in Albuquerque have no gas. Some looting has been reported
Week Six UNMH Weekly Hospital Incidence Census Total Hospital Admissions 251 318 569 Intensive Care Unit Admissions 51 52 103 Patients Requiring Ventilators 26 45 71 Deaths 26 10 36
Week Six n n n Many area residents are afraid to venture out for fear of catching the flu. The police department has reported numerous deaths of solitary, elderly people. Hundreds are staying home, and their essential supplies—such as food—are becoming depleted.
Week Six: Discussion Questions n Please refer to question # 12
Week Seven n Hospital staff are exhausted. All those available to provide health care have been brought in. There are no remaining staffing pools. The pharmaceutical companies developing the influenza vaccine are ahead of schedule. They expect the first New Mexico shipment to be delivered in 12 weeks.
Week Seven Weekly ncidence Hospital Census Total Hospital Admissions 132 318 450 Intensive Care Unit Admissions 43 42 85 Patients Requiring Ventilators 21 36 57 Deaths 49 10 59 UNMH
Discussion Questions: Week Seven n Please refer to question #12 Mortuary issues
Week Eight n n The hospital epidemiologist reports that the number of flu patients has declined for 3 consecutive weeks. Anti-viral medication is now becoming available in quantities sufficient for public use.
Week Eight UNMH Weekly Hospital Incidence Census Total Hospital Admissions 132 315 447 Intensive Care Unit Admissions 43 48 91 Patients Requiring Ventilators 21 40 61 Deaths 49 10 59
Week Nine For the first time in several weeks, there were no new cases of influenza reported. n Students are demanding tuition refunds for classes cancelled during the semester.
Week Nine UNMH Weekly Hospital Incidenc Census e Total Hospital Admissions 132 317 449 Intensive Care Unit Admissions 43 49 92 Patients Requiring Ventilators 21 42 63 Deaths 49 10 59
Week Ten n Another week of no new influenza cases.
Week Ten UNMH Weekly Hospital Incidence Census Total Hospital Admissions 132 315 447 Intensive Care Unit Admissions 43 48 91 Patients Requiring Ventilators 21 43 64 Deaths 49 10 59
Discussion Questions: Weeks Nine and Ten n n Please refer to question # 13 After the worst is over
Thank You
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