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Join us for a tabletop exercise to review and discuss a hypothetical emergency situation of a pandemic influenza outbreak. This exercise is designed to evaluate processes and serve as a springboard for further planning.
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Pandemic Influenza Tabletop January 8, 2014 Lutheran Medical Center Facilitator: Kelly Keenan, MPH
What is a Tabletop Exercise? • People come together to review and discuss a hypothetical emergency situation. • Designed to allow participants to talk through plans and problems. • NOT designed to measure anyone’s performance, but designed to evaluate processes. • Serves as a springboard for further planning and more comprehensive exercises.
Exercise Format • This tabletop exercise has five modules • Situation overview • Discussion questions • Functional Group • Large Group • At the end of the tabletop exercise, everyone will participate in a debriefing or “hotwash” • Purpose of the hotwash is to capture: • What went well? • What do we need to work on? • What are the next steps? • E.g. Training? A larger exercise? New equipment or new plan creation? • Data gathered during the hotwash should be used to develop the After Action Report and Improvement Plan (AAR/IP)
Exercise Roles • Facilitator • Provide instructions, tell the story, introduce the questions, guide the discussion • Participants • Immerse yourself as if the scenario were truly occurring in your jurisdiction or facility, using resources that are available to you (Emergency Operations Plan, policies, procedures, references) • Participate in the group discussions • Evaluators & Note Takers • Observe the exercise to evaluate the process • Do not participate in the group discussions
Functional Groups • Public health • Hospitals • EMS • Long term care and home health agencies • Community • Emergency Management • Coroners • Behavioral Health • University
Ground Rules • Respond as if the scenario is real. • Don’t “play” the scenario or get stuck in the weeds. • Play the role of your department, agency or community throughout the exercise. • Operate within current resource constraints and realities. • This is a no fault environment, no answers are wrong. • Be respectful of everyone. • Respect everyone’s time, no side bar conversations. • Participate and actively engage in the discussion.
Tabletop Exercise Objectives By the end of this exercise, you should be able to: • Describe your agency’s role in a response to a pandemic influenza outbreak. • Identify at least one gap in your agency’s existing Emergency Operations Plan (EOP). • Articulate the process to contact appropriate partnering agencies during business hours, as well as after hours, for response to a pandemic influenza outbreak.
Introductions • Large Group • Full Name • Title • Agency • Functional Group • Select a speaker • Discuss your objectives for today
Exercise Assumption We are using “Foothills Hospital” for this tabletop. • If you work at a hospital, please assume that “Foothills Hospital” is your hospital. • Everyone else, please assume “Foothills Hospital” is the closest hospital to your agency.
The Beginning A 47-year-old man from Golden, Colorado arrives at the emergency department (ED) at Foothills Hospital with fever, chills, malaise, cough, and shortness of breath.
Patient History • He is a prominent wildlife photographer who returned two days ago with his wife from an assignment in Hong Kong. • Last night, despite feeling feverish and tired, he attended an awards banquet with 200 of his colleagues.
At Foothills Hospital • He is evaluated in the Emergency Department (ED). • A chest x-ray reveals pneumonia. • He is subsequently intubated and placed on a ventilator due to severe respiratory distress. • Just as he is moved to the Intensive Care Unit (ICU), his wife begins to complain of similar symptoms and is admitted as a patient at Foothills Hospital.
The Wife Worsens • His wife’s respiratory status rapidly deteriorates. • She is quickly transferred to the ICU.
Code Blue! • The photographer suffers a cardiac arrest and cannot be revived. • Meanwhile, his wife struggles to stay alive.
Confirmed Cases: 0 Suspected Cases: 2 Fatalities: 1 Is Something Wrong? The Infection Preventionist (IP) is concerned based on rapid onset of illness in both patients. The IP orders an infectious disease (ID) consult.
Confirmed Cases: 0 Suspected Cases: 2 Fatalities: 1 Infectious Disease Consult • The ID specialist interviews the couple’s family. • Learns the husband was assigned to Hong Kong to photograph migratory birds. • Orders specimen collection and a battery of tests.
Confirmed Cases: 0 Suspected Cases: 2 Fatalities: 1 Key Issues • A patient has presented to the local emergency department with unusual symptoms and pneumonia after returning from overseas travel. After suffering cardiac arrest, he passes away. • His wife begins struggling with similar symptoms and is on life support. • ID specialists within the hospital are concerned and begins an investigation.
Confirmed Cases: 0 Suspected Cases: 2 Fatalities: 1 Group Discussion Key Issues • A patient has presented to the local emergency department with unusual symptoms and pneumonia after returning from overseas travel. After suffering cardiac arrest, he passes away. • His wife begins struggling with similar symptoms and is on life support. • ID specialists within the hospital are concerned and begins an investigation. Functional Group Discussion • Discuss the function group questions as a small group • If there is time, discuss the large group questions as a small group
Group Discussion Confirmed Cases: 0 Suspected Cases: 2 Fatalities: 1 Large Group Discussion • At this time, would your agency be aware of the situation? If so, how did you find out about it? • Would your agency want to know that something unusual is happening this early in the incident? • Which agencies should be alerted of the situation at this time? • If you were alerted, what steps would your agency take? • In this situation, is there evidence that something unusual is happening? Questions?
Confirmed Cases: 0 Suspected Cases: 2 Fatalities: 1 Module 2: Communication
Morbidly & Mortality Weekly Report • Lead article in Morbidity and Mortality Weekly Report (MMWR) describes a recent cluster of human avian influenza A (H5N1) cases in Eastern Europe. • New human cases of avian influenza A (H5N1) continue to be reported by World Health Organization (WHO) in South East Asia. • Human-to-human transmission has occurred, but remains limited to household contacts and health care staff caring for confirmed cases. • WHO increase the Global Pandemic Alert Level to the “alert phase”.
WHO’s Global Pandemic Alert Level Confirmed Cases: 0 Suspected Cases: 2 Fatalities: 1
Related Cases? Confirmed Cases: 0 Suspected Cases: 6 Fatalities: 1 • Four more patients arrive at Foothills Hospital with severe influenza-like illness. • One of the new patients mentions they had recently traveled from Hong Kong.
Confirmed Cases: 1 Suspected Cases: 5 Fatalities: 1 Confirmation of H5 influenza • Colorado Department of Public Health and Environment (CDPHE) reference lab reports that original sample from the index case is positive for Avian Influenza A Type H5. • Specimen is sent to CDC for confirmatory testing.
Confirmed Cases: 1 Suspected Cases: 5 Fatalities: 1 Communication • CDPHE notifies Jefferson County Public Health and Foothills Hospital of the laboratory results. • CDPHE and local public health departments notify healthcare providers in the state are notified of the diagnosis using the Health Alert Network. • Suspect cases are to be reported into CEDRS using a newly developed diagnosis called “H5N1”, or reported directly to local public health. • Epidemiological contact tracing begins to identify banquet attendees and flight passengers.
Confirmed Cases: 1 Suspected Cases: 5 Fatalities: 1 Breaking News News stations report: • Possible avian influenza case in Colorado! • Suspected case was on a recent international flight! • Suspected case attended a large public gathering shortly after returning! • We are all at risk of exposure!
Confirmed Cases: 1 Suspected Cases: 5 Fatalities: 1 Public Panic • Government officials and local hospitals receive calls from media outlets around the country. • Jefferson County Public Health and several area hospitals receive calls from panicked citizens. • CO-HELP is activated to address public concerns. • Jefferson County Public Health issues information to the public about proper hygiene during influenza outbreaks.
Confirmed Cases: 1 Suspected Cases: 5 Fatalities: 1 Key Issues • New human cases of avian influenza A (H5N1) continue to be reported by the WHO, a recent cluster of human cases in Eastern Europe and Asia was reported in a large publication. • Human to human transmission has occurred, but remains limited. • CDPHE State Lab has confirmed the index case’s sample was positive for avian influenza type H5, and this sample has been sent to CDC for confirmatory testing. • Healthcare providers in the state are notified of the incident using the Health Alert Network. • The media is reporting this information, which is causing public panic.
Confirmed Cases: 1 Suspected Cases: 5 Fatalities: 1 Group Discussion Key Issues • New human cases of avian influenza A (H5N1) continue to be reported by the WHO, a recent cluster of human cases in Eastern Europe was reported in a large publication. • Human to human transmission has occurred, but remains limited. • CDPHE State Lab has confirmed the index case’s sample was positive for avian influenza type H5, and this sample has been sent to CDC for confirmatory testing. • Healthcare providers in the state are notified of the incident using the Health Alert Network • The media is reporting this information which is causing public panic. Functional Group Discussion • Discuss the function group questions as a small group • If there is time, discuss the large group questions as a small group
Confirmed Cases: 1 Suspected Cases: 5 Fatalities: 1 Group Discussion Large Group Discussion • The notification about the incident will initially be sent out using the Health Alert Network. Does your agency receive these alerts? Who at our agency receives them? What do they do with the information, and who do they share it with? What happens if the Health Alert comes out at night or on the weekend? • What information about the incident would you share with your staff, especially considering the media attention the issue is receiving? Would your agency consider releasing information directly to the media? • How would your agency identify suspected cases? What would you do if you had a suspected case at your facility? • What infection control measures would your agency implement? How would you make those decisions? Questions?
Confirmed Cases: 1 Suspected Cases: 5 Fatalities: 1 Module 3: Outbreak & Investigation
Confirmed Cases: 1 Suspected Cases: 16 Fatalities: 1 Epidemiologic Investigations • CDPHE receives confirmation of positive H5N1 influenza from CDC. • At the request of CDPHE, CDC deploys Epidemic Intelligence Service (EIS) officers to Colorado to help with case investigations. • Suspected cases and their contacts are monitored by the health department, many are placed under quarantine orders.
Confirmed Cases: 1 Suspected Cases: 32 Fatalities: 3 Absenteeism: 3% Illness Spreads • In addition to the index case, two more patients who had contact with the index case have died (suspected H5N1). • Healthcare agencies begin to see increasing numbers of staff calling in sick or not reporting to work. • School District notices a marked decrease in attendance of students. They begin to push messaging to parents that sick students should stay home.
Confirmed Cases: 3 Suspected Cases: 34 Fatalities: 3 Absenteeism: 6% Foothills Hospital • Foothills Hospital admits several more patients with suspected avian influenza, including two of their own healthcare workers. • They begin to see an increase in employee absenteeism. • Other hospitals in Colorado are seeing patients with similar symptoms and reporting those cases to CDPHE using CEDRS. • Hospitals across Colorado are nearing or are at capacity according to EMSystemsHavBedreports.
Confirmed Cases: 6 Suspected Cases: 39 Fatalities: 4 Absenteeism: 9% Worldwide Pandemic Activity • Worldwide • Sporadic cases of severe influenza are reported in East Asia, Eastern Europe and, most recently, in Africa. • Mortality of patients with avian flu in Asia exceeds 50%. • WHO states that it is still at the Alert Phase and requests nations continue to analyze the risk for their population and act accordingly.
Confirmed Cases: 8 Suspected Cases: 43 Fatalities: 5 Absenteeism: 11% Key Issues • CDPHE and CDC confirm cases of H5N1 avian influenza in Colorado; 8 confirmed 43 suspected cases. • The illness is spreading and hospitals are becoming overwhelmed by patients seeking treatment. • Hospitals are running short on critical supplies and also notice a significant impact on staffing due to the illness. • Local health departments are using a large number of staff to conduct case investigations and manage quarantine. • WHO states that it is still at the Alert Phase and requests nations continue to analyze the risk for their population and act accordingly.
Confirmed Cases: 8 Suspected Cases: 43 Fatalities: 5 Absenteeism: 11% Group Discussion Key Issues • CDPHE and CDC confirm cases of H5N1 avian influenza in Colorado; 8 confirmed 43 suspected cases. • The illness is spreading and hospitals are becoming overwhelmed by patients seeking treatment. • Hospitals are running short on critical supplies and also notice a significant impact on staffing due to the illness. • Local health departments are using a large number of staff to conduct case investigations and manage quarantine. • WHO states that it is still at the Alert Phase and requests nations continue to analyze the risk for their population and act accordingly. Functional Group Discussion • Discuss the function group questions as a small group • If there is time, discuss the large group questions as a small group
Confirmed Cases: 8 Suspected Cases: 43 Fatalities: 5 Absenteeism: 11% Group Discussion Large Group Discussion • What are you likely to be worried about at this time – staff shortages or equipment shortages? Why? What would you do to mitigate these concerns? • What are your biggest concerns at this time? What are you doing to mitigate these concerns? If you can’t mitigate these concerns, what will you do? Questions?
Confirmed Cases: 8 Suspected Cases: 43 Fatalities: 5 Absenteeism: 11% Module 4: Crisis
Hospitals Forced to Ration Resources • Regional hospitals report shortage of ventilators, ED beds and ICU beds. • Hospitals triage patients, admitting only the most severe cases. Confirmed Cases: 35 Suspected Cases: 163 Fatalities: 21 Absenteeism: 18%
Confirmed Cases: 35 Suspected Cases: 163 Fatalities: 21 Absenteeism: 18% Controlling Transmission • Public health officials determine most effective control measures. • Pharmaceutical and community containment strategies are evaluated.
