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bringing care home since 1920 Home Care Alliance of Massachusetts: Table Top Disaster Drill June 24, 2015
Transcript of Home Care Alliance of Massachusetts: Table Top …c.ymcdn.com/sites/ Care Alliance of Massachusetts:...
bringing care home since 1920
Home Care Alliance of Massachusetts:
Table Top Disaster Drill
June 24, 2015
Presenter
Presentation Notes
Lesson Plan: 10:00-10:45 Colleen talks about the manual 10:15- 10:30 purpose of the drill and overview of our ebola drill experience 10:30-11:00 present current MERS info and resources 11:00-11:30 present MERS scenario, assign roles and break out to brainstorm answers to questions (BREAK) 11:30-12:00 groups present their answers and we add ideas from our original drill 12:00 – 12:30 brainstorm home care answers to questions together 12:30 – 1:00 Infection Control – PPE, respirators – videos 1:00 questions, comments
Purpose of a Disaster Drill • Review your existing disaster plan to determine if
there are any potential hazards or vulnerabilities not already identified
• Identify any policies, procedures, needs & issues relating to resources, data, communication, coordination, training
• Gain skills in preparing for & responding to a health-related disaster
• Familiarize players with roles, functions & plans • Promote team building
Presenter
Presentation Notes
From our ppt and page 2-6 in the manual
Steps in a Table Top Drill
• Identify and gather stakeholders • Identify disaster scenario • Discussion of potential issues • Discussion of potential solutions • Update the disaster plan and roles of
each of the stakeholders
Presenter
Presentation Notes
Stakeholders: ask who these might be: medical community (hospitals, MD offices, clinics, SNF, home care agencies) , public safety community (police, fire, ambulance) , funeral directors, town officials (administrators, DPW/waste mgt, Board of Health), school officials (superintendent), state dept of health Disaster scenario: Identify your own disaster scenario from your analysis and identification of your potential hazards and vulnerabilities as discussed in Chpt 2 as well as guidance from the CDC, WHO, state DPH
Ebola Table Top Drill October 29, 2014
Presenter
Presentation Notes
Talk about our drill for Ebola on October 29, 2014 We are not emergency preparedness experts. We are here to share our experience with you with the goal of increasing your awareness of how helpful a drill is determine issues and how to achieve a coordinated response when a disaster does occur. Introduce the next activity – a mock drill for MERS
Middle East Respiratory Syndrome (MERS)
• Viral respiratory illness – MERS-CoV
• First reported in 2012 in Saudi Arabia • Bats and camels implicated in
transmission • May 2015 - Republic of Korea
experiencing the largest outbreak outside of the Arabian Pennisula
Presenter
Presentation Notes
Middle East Respiratory Syndrome Coronavirus (MERS-CoV Retrospective investigation later identified first case in Jordan in April 2012 All cases linked to Arabian Pennisula: Iran, Jordan, Kuwait, Lebanon, Oman, Qatar, Saudi Arabia, United Arab Emirates (UAE), and Yemen Countries with travel-associated MERS cases: Algeria, Austria, China, Egypt, France, Germany, Greece, Italy, Malaysia, Netherlands, Philippines, Republic of Korea, Tunisia, Turkey, United Kingdom (UK), and United States of America (USA). CDC: No recommendations to change travel plans Healthcare workers and patients of healthcare facilities have contracted MERS when sufficient precautions have not been taken
Resource: Rapid Risk Assessment: Middle East Respiratory Syndrome (MERS-CoV). 11, June 2015. European Centre for Disease Prevention and Control. http://ecdc.europa.eu/en/publications/Publications/middle-east-respiratory-syndrome-coronavirus-rapid-risk-assessment-11-June-2015.pdf
Presenter
Presentation Notes
Resource: European Centre for Disease Prevention and Control June 11, 2015: http://ecdc.europa.eu/en/publications/Publications/middle-east-respiratory-syndrome-coronavirus-rapid-risk-assessment-11-June-2015.pdf Only 2 people in the US have ever tested positive - both in May 2014—while more than 500 have tested negative. Two unlinked imported cases of MERS in the United States – one to Indiana, the other to Florida. Both cases were among healthcare providers who lived and worked in Saudi Arabia. Both traveled to the U.S. from Saudi Arabia, where they are believed to have been infected. Both were hospitalized in the U.S. and later discharged after fully recovering. CDC and other public health partners continue to closely monitor the MERS situation. They state that they recognize the potential for MERS-CoV to spread further and cause more cases in the United States and globally
MERS Symptoms
• Wide clinical spectrum: – URI: Fever, chills, non-productive cough, dyspnea,
myalgia, headache, runny nose, sore throat – Nausea/vomiting, diarrhea, abdominal pain – Rapid progression to pneumonia, acute respiratory
failure, multi-organ failure – Atypical: Mild or no symptoms (most likely to recover)
• 35% patients with MERS die – most had an underlying chronic medical conditions
Presenter
Presentation Notes
http://www.cdc.gov/coronavirus/mers/clinical-features.html A wide clinical spectrum of MERS-CoV infection has been reported ranging from asymptomatic infection to acute upper respiratory illness, and rapidly progressive pneumonitis, respiratory failure, septic shock and multi-organ failure resulting in death 3-4/10 people die - Most of the people who died had an underlying medical condition. Pre-existing conditions from reported cases for which we have information have included diabetes; cancer; and chronic lung, heart, and kidney disease. Individuals with weakened immune systems are also at higher risk for getting MERS or having a severe case
MERS Transmission
• Thought to spread via respiratory secretions but not well understood
• All cases have spread through close contact by caring for or living with an infected person
• Any age affected • Incubation period usually 5-6 days
(range 2-14 days)
Presenter
Presentation Notes
DPH says respiratory droplets Healthcare providers should maintain awareness of the need to detect patients who should be evaluated for Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection; this requires clinical judgment as information on modes of transmission of MERS-CoV and clinical presentation of MERS is limited and continues to evolve.
People at Increased Risk
• Recent travelers from the Arabian Peninsula and South Korea
• Close contact with a recent ill traveler from the Arabian Peninsula
• Recently in a Korean healthcare facility • Close contact with confirmed cases • Contact with camels
Prevention and Treatment • Prevention
– No Vaccine – Good hand hygiene – Good respiratory hygiene practices
• Treatment – No specific anti-viral treatment – Symptomatic relief – Vital organ function support for severely ill
Presenter
Presentation Notes
http://www.cdc.gov/coronavirus/mers/clinical-features.html No specific treatment for MERS-CoV infection is currently available. Clinical management includes supportive management of complications and implementation of recommended infection prevention and control measures. Respiratory hygiene practices: cover nose and mouth when coughing or sneezing, throw tissue in trash, avoid touching mucous membranes, avoind personal contact with sick people, clean and disinfect surfaces
Presenter
Presentation Notes
Massachusetts DPH MERS Advisory June 11, 2015 MDPH State Public Health Lab performs diagnostic testing to confirm diagnosis– see MERS-CoV Laboratory FAQs MDPH Report Suspected cases phone line on advisory CDC: Other contacts of the ill person, such as community contacts or contacts on conveyances (e.g., airplane, bus), may be considered for evaluation in consultation with state and local health departments.
Infection Control
• CDC Updated Guidance June 2015 • Source Control: Triage for risk, isolate
those at risk, potentially infected patient wears a face mask
• Standard, contact, and airborne precautions – NIOSH certified N95 respirator
Presenter
Presentation Notes
http://www.cdc.gov/coronavirus/mers/infection-prevention-control.html ensure all persons with symptoms of a respiratory infection adhere to respiratory hygiene and cough etiquette, hand hygiene, and triage procedures throughout the duration of the visit http://www.cdc.gov/coronavirus/mers/infection-prevention-control.html OSHAVideo: https://www.osha.gov/SLTC/respiratoryprotection/training_videos.html https://www.youtube.com/watch?v=ovSLAuY8ib8
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Table Top Drill Objectives • Identify & discuss policy issues that would arise
during a MERS virus outbreak • Identify & understand measures that are
necessary at the local level • Recognize the roles of various public officials &
departments • Illustrate the communication & teamwork needs • Identify gaps in local preparedness policies • Identify additional training needs
Presenter
Presentation Notes
A table top drill is about raising awareness
Overview Exercise • It is late November and flu season is
underway, several MERS cases have been identified in Massachusetts.
Overview Exercise
• To protect public safety, many people who have been in contact with these cases have been have been quarantined.
Overview Exercise • There is a noticeable increase in the number
of persons presenting to ERs and clinics with symptoms consistent with MERS.
• Phones at physician offices and health departments are ringing constantly due to fear about the MERS virus. More people are seeking medical care than actually need it.
Overview Exercise
• DPH reports that one of the patients with MERS is a resident in Your Town.
• The patient had been home for four days before diagnosis with his wife and three children (ages 8, 10 and 14) all of whom attend public school and high school in “Your Town”. The patient’s wife works part-time at a florist shop in “Your Town”.
Role Identification
1. What are the essential services that must be maintained by your entity?
2. What are the key issues affecting your entity and how will they be addressed?
Presenter
Presentation Notes
Groups: Hospitals and emergency rooms MD Offices and urgent care clinics Town administration and local BOH/state DPH School system Emergency services: police, fire, EMTs, ambulance
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Questions Who is leading the public health response? What are the key issues the town health department needs to address at this point? Who are the key partners with whom these issues need to be addressed? What specific assistance will the town need from external organizations?
Presenter
Presentation Notes
Town Issues Who is in charge? Identification of Command, Control & Management procedures. Town administrator?Local officials may be on their own in the first seventy two hours - local & state health departments have primary responsibility for outbreak control. Who: The Town of Norwell BOH Agent would led the response and coordinate efforts with the MA DPH Region 4b staff and Epidemiology staff. Also involved would be the Norwell Emergency Management Team and the VNA BOH Nurses. Roles & Responsibilities: Executive Group – Town Administrator, NFD, NPD, NVNA-Public Health RN. Resources, personnel, situation awareness (public infomration challenges for entire region – prepare “worried well”), Direct active surveillance. Key Issues: Key issue is to identify, isolate and begin tracing early. Follow Ebola protocol (questions to determine risk and the 4 risk categories) and set-up monitoring for symptoms. Educating personnel on PPE prepping/ambulance prep, hazmat protocol and contacting the hospital if/when transporting an MERS risk. Notification & mobilization of necessary staff, resources & availability (who & how) Surveillance & epidemiologic investigation procedures, (contact identification and tracing, recording, reporting), mobilizing laboratory resources, alerting & training health care providers about the identification & reporting of suspected cases. Personal Protective Equipment and decontamination of PPE and transport vehicles. Waste management of PPE, medical supplies and patient-related items that have been contaminated. Adverse event monitoring and treatment protocols, i.e., antibiotics and IV therapy. Key local partners: Board of Health (including VNA), NFD (first responders, decontamination, transport), NPD (security management of the public panic, enforcement of quarantine, identification of need & notification of state & local reinforcements) Local elected officials, health care facilities, laboratory services Area Hospitals Funeral Directors Town BOH Agent, DPH (via Maven) and 24/7 epidemiology line, CDC, Norwell EMO group South Shore Hospital – isolate and contain symptomatic individuals, South Shore Medical Center, Care Well Urgent Care, and area MD Offices need to be ready with questionnaire as well as to isolate and contain patient. Need to be prepared for the “worried well” DPH has made a strong commitment to towns to be a resource (DPH Checklist – continued to be revised). – Contact tracing 4b Medical Reserve Corp - help with contacts, phone tree, communication with “worried well” NVNA – telemonitoring people in their homes, nurses to make visits, communicate and educate Norwell residents regarding Ebola
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Questions What steps should be taken to prepare the community and general public for future events over the next 3 to 4 weeks? What special issues need to be considered related to communicating with various populations such as persons who are geographically isolated, non-English speaking, hearing impaired, and the elderly? How does public health need to collaborate with the hospitals, emergency rooms and outpatient providers?
Presenter
Presentation Notes
Communication Issues Plans for communication with health care providers, the public, the media - who is primary spokesperson? Rapid establishment of hot lines & personnel Identification of public notification channels Preparing Community: Norwell EMO should issue a consistent, collective message (serve as joint information center) to general public for: schools, NVNA, area health care clinics, and physician groups educating people where information is available (NBOM website and NPS website) What kinds of messages need to be crafted for the public in response to predictable issues and questions? A standardized message, linked to all community, medical and special populations should be delivered via TV, radio and social medal by the Norwell Town Administrator Special Issues: Information must be kept succinct and concise. Messages must be multi-lingual and crafter for hearing and vision impaired. The COA can get messages to the elderly. There should also be the ability to have face-to-face communication with individuals and a question forum should be included. Social Media is an option if there is power/electricity. Working with local media? One spokesperson (Town Administrator) who delivers a standardized message via Reverse 911 (Code Red) to get information out to public. Publish phone number for Information Line and, if necessary use the 211 MA resource line. Public Health collaborating with hospitals etc: DPH public announcements (Maven), establishing key contacts for all providers (i.e., town/area physicians, clinics, hospitals, etc.).
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Questions Health care workers and first responders express concern about exposure. What advice can be given? Have any plans been made for provision of food, other basic necessities and health care for people who must limit their exposure to others or who have been quarantined? If necessary, at what point will the decision regarding school closures (for sanitizing, etc.) and cancellation of school and/or public gatherings or events be made?
Presenter
Presentation Notes
Infection Control Issues Training for identified health care staff & other first responders (fire & police) for disease control, use of protective barriers Security procedures for all essential community functions & protection of the public safety and field clinicians. Use common sense, be mindful of the action plan and go slowly. PPE – based on environment there are different levels to use, education in donning and doffing correctly. Quarantined persons Plan: A system is in place for delivering food but education is needed. There is also access to the food pantry.Continuous education needs to be provided on the low risk of contracting Ebola so people delivering food, oil, etc. will understand process and not let fear overtake the situation. School Closures; NPS will defer to other agencies for guidance (public health officials). This decision will be a collaborative one, no single entity will be responsible.
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Questions How will a balance be established when school closures impact the workforce (parents staying home with children)?
How do you plan to address anticipated staff shortages in your organizations?
a) What essential functions must remain in place?
b) Who decides how limited staff and other resources are allocated?
Presenter
Presentation Notes
Staffing Issues Keeping in mind that DPH has warned of a 40% absenteeism rate, health care facilities will prioritize patients and essential functions then determine staffing needs. a) Patient care (essential & triage), Emergency and Public Safety Services, Schools, Public Safety/Public Health/Payroll processing Fire and Police have other resources throughout the State b) Town/agency/organization management. Getting employees to come to work may be an issue. Once staff are at work there won’t be a problem. Panic could spiral with first responders donning PPE. The message and the plan of action needs to be consistent.
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Questions What are the primary responsibilities of 911 dispatch, police and fire departments? What resources will they need? 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?
Presenter
Presentation Notes
Primary Responsilibilities: A standardized approach. When FD and PD are in same building, better communication will be facilitated. A preliminary code to communicate with Police Department so they maintain a 6’ distance from patient and first responders Handling Deceased: Religious beliefs and burial traditions will need guidance from the State regarding safe disposal of remains. There is already CDC guidance available. There is a National Guard unit that is trained to handle deceased remains (epidemic stage). In a pandemic stage, storage of deceased remains could become an issue. Mental Health Needs: Keep fear in check. Educate the public and workers. Institute EAP and peer programs for workers involved.
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Next Steps • Establish a coordinating committee • Establish Roles & Responsibilities (incident
command control & management procedures) • Identify emergency personnel, resource
mobilization and needs • Training-Response Plan • Isolation-Quarantine Procedures • Epidemiologic Investigation • Specimen Collection and transport • Hazmat Providers-Decontamination Procedures • Information Mgt and Communication
Are We Ready? In any disaster or crisis, we find gaps in the best of plans. However, not planning or preparing is not an option when public health and safety is at risk. We have all taken a major step in preparing today by attending this table top disaster drill. We thank everyone for their participation and hope we have provided information and resources to each other that we never have to use.
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N95 Respirator
• https://www.youtube.com/watch?v=Tzpz5fko-fg
References • Centers for Disease Control and Prevention (2015). Middle East Respiratory Syndrome
(MERS). Retrieved from www.cdc.gov/coronavirus/mers
• European Centre for Disease Prevention and Control (2015). Rapid Risk Assessment:
Middle East Respiratory Syndrome (MERS-CoV), 11, June 2015. Retrieved from
http://ecdc.europa.eu/en/publications/Publications/middle-east-respiratory-
syndrome-coronavirus-rapid-risk-assessment-11-June-2015.pdf
• Massachusetts Department of Public health ( 2015). Advisory Middle East Respiratory
Syndrome (MERS) Arabian Peninsula, Republic of Korea , 11, June 2015. Retrieved from
http://www.mass.gov/eohhs/docs/dph/cdc/advisories/mers-advisory.pdf
• RBC Limited, Home Care Alliance of Massachusetts (2014). Home Health Care &
Hospice Emergency Preparedness Workbook Sample Policies and Tools
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