DEMHS Area 1 Pandemic Influenza Tabletop Exercise

June 2, 2009

Carl Osaki, RS, MSPHClinical Associate Professor Emeritus

School of Public HealthUniversity of Washington

Today’s Agenda0900 – 0915: Welcome

Purpose/objectives

Introductions

0915 – 0945: Overview of legal issues

0945 – 1015: Exercise Instructions & Scenario

1015 – 1215 : Exercise

Storyboard 1: Flu outbreak begins in Asia

Storyboard 2: Avian flu enters the US

Storyboard 3: CT communities respond to pandemic flu

Today’s Agenda (cont’d)

1215 – 1300: Lunch1300 – 1500: Debrief

Discussions at each table: -Identify common issues/gaps for each storyboard-Identify common regional themes

1500 – 1600: Summary, next steps, networking

1600: Adjourn

Overview/purpose

• Identify potential gaps in existing quarantine & isolation plans, procedures and protocols

• Identify operational issues in implementing social distancing plans

• Validate the ability to provide essential services during a large-scale disease outbreak

Exercise Themes

• Social Distancing• Quarantine & Isolation (Q & I)• Coordination of response • Management of resources • Risk communication• Legal considerations

Terms used today• Tabletop exercise

• Scenario to prompt discussion• Isolation

• Confinement or separation of infected• Quarantine

• Confinement or separation of exposed• Social Distancing

• Steps to reduce social contact to prevent the spread of disease (e.g., cancelling events, dismissing schools, separation in lines, telecommuting, flex scheduling, etc)

Introductions

• At each table:• Name• Organization• Area of responsibility

Overview of Legal Issues

Marianne Horn, RN, JD

CT Department of Public Health

Tabletop Instructions

• Roles to be played• Learn from this experience• Responding to the scenario

• 3 Storyboards• 15 Messages with a question

• Focus on policies & plans• 7 minutes per message

Tabletop Instructions

• Play own role• Respond in real time• Keep notes• Noise control• Breaks• Use of handouts

Scenario Assumptions

• H5N1 influenza is emerging in SE Asia• Local community preparedness and

response/mitigation phases• Governor declares PH emergency when

flu hits CT• People are still using H1N1 (Swine Flu) as

context for response• Flu hits in fall (Oct-Nov)

Questions?

Storyboard one

“Influenza outbreak begins in Asia”

Message 1

• The State Health Commissioner has requested that all local health departments report on the status of Q & I and social distancing policies in their jurisdiction

• What is the status of Q & I and social distancing protocols for your department or unit?

Message 2

• You have been called to attend a meeting to plan social distancing and Q & I in your community

• Who do you see as the primary lead for activating and making decisions about Q & I and social distancing in your community?

Message 3

• Some business owners are upset about the loss of business and income which will result from social distancing policies

• What steps have been put into place to mitigate the loss of personal or business income resulting from social distancing or Q & I orders?

Message 4

• Concern has been raised by EMS, law enforcement, and medical staff about coming into contact with individuals who will be subject to Q & I orders

• What are your organization’s plans for worker safety, including personal protective equipment (PPE) and disease hazards training?

Message 5

• Schools, businesses, & county government agencies are asked to assist in disease surveillance and monitoring.

• What is your organization’s plan for monitoring and reporting illnesses and absenteeism during the outbreak?

Storyboard two

“Avian Influenza enters the US”

Message 6

• Probate court officials have expressed concern about insufficient staff to process appeals to inappropriate or numerous Q & I orders.

• What criteria would your organization use to identify and to request a person or group to be quarantined or isolated?

Message 7

• Due to the recent H1N1 outbreak, citizens in your community are demanding an immediate response to the threat of pandemic influenza

• When should the community be informed about social distancing and Q & I plans and what should the message say?

Message 8

• The state Dept of Health has requested local agency assistance in case finding and follow-up

• What is the process for requesting or providing resources to state or federal agencies for implementing social distancing policies?

Message 9• The State Commissioner of

Education has not yet ordered all schools in CT to be dismissed. Yet absenteeism in one of the schools in your community is over 30%.

• What is the plan for notifying the community about cancelling public events and faith-based services; dismissing public and private schools; and prohibiting mass gatherings?

Message 10

• Alternate Q and I sites have been identified and are ready to accept sick patients

• What procedures are used to notify and assemble medical, law enforcement, and medical transport resources at Q & I sites?

Storyboard three

“CT communities respond to Pandemic flu”

Message 11

• A nurse’s aide at a nursing home has been coughing and sneezing at work. She refuses to leave her job because of loss of income. She speaks very little English and has 5 children at home.

• What is the plan for executing, monitoring, and enforcing Q and I orders?

Message 12

• A group of 25 tourists from Japan have all come down with flu-like symptoms. They are staying at one of the motels in your community

• What measures have been planned for isolating or quarantining potentially infected travelers?

Message 13

• Concern has been expressed by some parents about adjusting for make-up days due to prolonged school closures (3 to 5 weeks)

• What is the plan to accommodate for the long-term dismissal of schools including continuing education, reopening, parental complaints, and human resource issues?

Message 14• Some home-bound patients are

complaining about not receiving continuing medical care services in their homes

• What plans are in place to sustain medical care and social services to vulnerable populations (disabled, elderly, non-English speaking, etc) during social distancing?

Message 15

• Illnesses have begun to decrease and a few sporadic cases are still being seen

• What is the threshold for determining the end of the outbreak and how will communities be instructed to resume normal operations?

Debrief• Group discussions – 60 min• Instructions

• At your table, record the top 3 issues for each storyboard (10 min/storyboard)

• Use your notes sheet• Person at your table will record the issues

• At your table, identify a reporter to share your issues with the larger group.

• Recording of common regional themes

Summary

• Next Steps