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Pandemic Influenza: Preparing for the Unthinkable March 13, 2007

Pandemic Influenza: Preparing for the Unthinkable March 13, 2007. Charles W. Mackett III, MD, FAAFP Executive Vice Chair, Department of Family Medicine Chair, Medical Advisory Committee Disaster Management Center University of Pittsburgh Medical Center. Pandemic Influenza.

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Pandemic Influenza: Preparing for the Unthinkable March 13, 2007

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  1. Pandemic Influenza: Preparing for the UnthinkableMarch 13, 2007 Charles W. Mackett III, MD, FAAFP Executive Vice Chair, Department of Family Medicine Chair, Medical Advisory Committee Disaster Management Center University of Pittsburgh Medical Center

  2. Pandemic Influenza Bird flu kills in Indonesia and picks up speed across Asia” •The China Post 10 January 2007

  3. Pandemic Influenza Right now, a growing … challenge is overcoming … bird flu fatigue” •Henk Bekedam WHO January 29, 2007

  4. Highly Pathogenic Avian Influenza H5N1 “Bird Flu” “The most lethal influenza virus we have ever seen” • Robert Webster, St. Jude’s Hosp 2005

  5. The First Known Highly Pathogenic Avian Influenza (HPAI) Panzootic Re-emerging Confirmed Human Cases Case Fatality Of ~ 60% No Sustained Human To Human Transmission Recent Family Clusters Current Situation H5N1

  6. Reported Infections in Birds and People:since 2003

  7. Pandemic Influenza Impact on Average U.S. Hospital • FluSurge model (CDC) • HHS planning assumptions • At peak (week 5 of 8) with 25% attack rate

  8. Federal Role in Pandemic Response "Any community that fails to prepare with the idea that somehow, in the end, the federal government will be able to rescue them will be tragically wrong." • Michael Leavitt, U.S. Secretary of Health and Human Services at Pennsylvania Summit3/31/06

  9. DoD Preparedness • AFI 10-2603 EMERGENCY HEALTH POWERS ON AIR FORCE INSTALLATIONS • DoD Influenza Pandemic Preparation and Response Health Policy Guidance (25 Jan 06) • Policy for Release of Tamiflu (10 Jan 06) • Interim Guidance for Protecting DoD Personnel Involved in (AI) Eradication (21 Mar 06) • Pandemic Flu: A Guide for Service Members and Families (3 Jan 07)

  10. UPMC PREPAREDNESS

  11. Mission Statement Prepare UPMC For A Potential Pandemic Flu Disaster By: • Protecting & Enabling Staff • Addressing Staff Concerns • Designing & Implementing Innovative Treatment • Making Fiscally Responsible Decisions • Acting As A Community & Health Care Leader

  12. Motto: “There’s No Chicken Like A Dead Chicken!”

  13. UPMCPandemic Preparedness Stages * These stages are best estimates for planning purposes. They may change over time as events occur and we have more information.

  14. Staff Guidance, Support & Utilization • Education/Training – What is Avian Flu? • Obligation to Work – 40% Absenteeism • Protect Staff (Equity) • PPE, Rx, Family Protection, Facilities • Home (Isolation) Support • Supplies, Medications, Telecommuting • Communication & Employee Health • Emergency Credentialing/Volunteers • Cross Functional Training & Utilization

  15. Diagnosis & Treatment • Surveillance – Suspect Profile • “Griage” – Greet & Triage • Cultures – awaiting BSL3 Western PA • Specimens/PCR • Hospital/Office Isolation -- STOP SPREAD • PPE & Masks (N95 for Staff) • Medications – Tamiflu 10,000 Courses • Prepared to Study Innovative Treatments

  16. Human H5N1

  17. Critical Care • Triage – Prioritize ICU Care • Reconfigure/Expand ICU & Negative Pressure Beds • Ventilators (UPMC – 425) • Accelerate Life Cycle Purchase • Mask Assisted Ventilation • Ramp Up & Augment Critical Care Personnel – Immediate Team

  18. Surge Capacity • Above Normal Surge • Decrease Elective Admissions • “Graceful” Degradation of Services • Reconfigure Beds/HVAC/Negative Pressure • Hospital as ICU • Supranormal Surge • Alternative Sites • On-site Staff Housing • Communication • Equipment & Supplies • Security

  19. Home Care • 3 Level Patient Prioritization Classification • High Acuity → Frequent Visits • Medium Acuity → Decreased Visits • Low Acuity → Telephone Follow-up • Health Plan Communication – Reverse 911 • RN Advice Line • Websites & PrepLink

  20. Business Continuity Issues • Equipment & Supplies – Engage Vendors • I.T. – Backup & Redundancy • Legal • Coordinating with County & State • Financial Viability – Payers Engaged • Ensure Cash Flow • Remove Edits & Pre-Authorizations • Insurance • Behavioral Health – CISM • Patients, Families & Staff

  21. Ethical Issues

  22. Ethical Issues • Utilitarian vs. Egalitarian • Triage • Hospital • Critical Care • Withdraw Life Support • Procedural Protections • Triage Review Board • Common Standard & Community Buy-In

  23. Strategy: UPMC Department and Business Unit Adoption • Many Persons Involved/Planning/Executing • “Chapters” – 32 Core Personnel • Chapters Plus Checklists Distributed • System Wide Preparation - Centralized Control Decentralized Execution - Facility Unique Checklists • Hospital/Department Teams Appointed • Hospital Assessments & Site Visits

  24. Charge to Departments • Department Specific Annexes & Checklists • Faculty & Staff Recall Rosters • Degradation of Services Plans • Survey Faculty & Staff Skills • Pre-designate Immediate Team Members • Coordinate With Hospital Planners

  25. “End Of The Beginning” • Department & Business Unit Buy-In • Individual Department & Facility Preparations • Issues, problems, barriers • Corporate Command Center Transformation • From Coordination to Command & Control • Training & Drills (AHRQ) • “2007 Will Be Year of Exercises” (Fauci)

  26. What Can You Do?

  27. What Can You Do? • DoD & Service Instructions • Develop & Review MTF Specific Plans • Focus Triage, Infection Control, Surge & Degradation of Service Plans • Master Seasonal Flu • Vaccinate All Health Care Workers (ACIP, AAFP, Gerberding) • Respiratory & Hand Hygiene • Donning & Doffing PPE

  28. “Plans are useless but planning is indispensable” - Dwight David Eisenhower

  29. Web Sites/Contacts • www.dod.mil/pandemicflu • www.e-publishing.af.mil/search (keyword 10-2603) • www.pandemicflu.gov • www.osha.gov • Chuck Mackett • mackettcw@upmc.edu • 412-383-2378 • Voicemail 412-383-2311

  30. ARMAGEDDON LITE WHAT? ME WORRY?

  31. Questions?

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