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Tabletop Exercise
HxNx Pandemic Influenza
June 24, 2014
Scope
Focus on the role of your tribal
organization(s) in response to potential
consequences of a severe HxNx pandemic
influenza, as well as the interdisciplinary and
interagency coordination both at the local,
tribal, state, and regional level.
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Core Capabilities
PPD-8/National Preparedness Goal
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PPD-8 calls for development and maintenance of a National Preparedness Goal
defining the core capabilities necessary to prepare for the specific types of
incidents posing the greatest risk to the security of the Nation
States and urban areas use capabilities-based planning to identify a baseline
assessment of their homeland security efforts by comparing their current
capabilities against the Core Capabilities
Core capabilities are essential for the execution of each of the five mission
areas:
– Prevention
– Protection
– Mitigation
– Response
– Recovery
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Core Capabilities
All Mission Areas:
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Planning - Conduct a systematic process engaging the whole community
as appropriate in the development of executable strategic, operational,
and/or community-based approaches to meet defined objectives.
Public Information and Warning - Deliver coordinated, prompt, reliable,
and actionable information to the whole community through the use of clear,
consistent, accessible, and culturally and linguistically appropriate methods
to effectively relay information regarding any threat or hazard and, as
appropriate, the actions being taken and the assistance being made
available.
Operational Coordination - Establish and maintain a unified and
coordinated operational structure and process that appropriately integrates
all critical stakeholders and supports the execution of core capabilities.
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Core Capabilities
Response:
• Infrastructure Systems - Stabilize critical infrastructure functions,
minimize health and safety threats, and efficiently restore and
revitalize systems and services to support a viable, resilient
community.
• Mass Care Services - Provide life-sustaining services to the
affected population with a focus on hydration, feeding, and
sheltering to those who have the most need, as well as support for
reunifying families.
• Situational Assessment - Provide all decision makers with
decision-relevant information regarding the nature and extent of the
hazard, any cascading effects, and the status of the response.
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Core Capabilities
Recovery:
• Economic Recovery - Return economic and business activities
(including food and agriculture) to a healthy state and develop new
business and employment opportunities that result in a sustainable
and economically viable community.
• Health and Social Services - Restore and improve health and
social services networks to promote the resilience, independence,
health (including behavioral health), and well-being of the whole
community.
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Pandemic HxNx Influenza
Background
Background/History on the Threat
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Influenza viruses, especially highly pathogenic avian influenza like H5N1,
are among the most urgent global infectious disease threats.
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The occurrence of pandemics in 1918, 1957, 1968, and 2009 show that
pandemics are inevitable, yet unpredictable events.
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The 2009 H1N1 pandemic occurred against a backdrop of ongoing
pandemic planning efforts by governments and organizations throughout
the world, which included a substantial amount of capacity building and
pandemic response plan development.
•
In fact, many of these activities were initiated because of the recognized
potential for a highly pathogenic avian influenza virus (H5N1) to eventually
develop the capability for sustained human-to-human transmission that
could cause a severe pandemic.
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Background/History on the Threat
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As of August 2014, the World Health Organization (WHO) has reported 664
confirmed cases of HxNx infection, and since 2003, nearly 60% of those
infections have been fatal.
Although the imminent threat of the 2009 H1N1 influenza virus has
subsided, influenza viruses with pandemic potential, including H5N1, H7N9,
and H3N2v, continue to circulate across the globe.
As a result, the threat of a pandemic caused by more pathogenic strains of
influenza remains very significant. In fact, the threat of a more severe
pandemic caused by HxNx or another highly pathogenic strain of influenza
is no less than before the 2009 pandemic.
CDC continues to maintain situational awareness of influenza so that the
United States and other countries can be prepared to respond and
intervene when a novel influenza virus is detected.
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World Health Organization (WHO) Phases
Pandemic Influenza
In response to lessons learned from the 2009
H1N1 pandemic, WHO revised the pandemic
phases. The phases, which are based on
virological, epidemiological, and clinical data, are
to be used for describing the spread of a new
influenza subtype, taking into account the disease
it causes around the world.
•
http://www.who.int/influenza/preparedness/pandemic/influenza_risk_management/en/
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Module 1: Preparedness
Module 1: Scenario
Possible Novel Influenza A Virus in the United States
Alert phase: This is the phase when influenza caused by a
new virus has been identified in humans. Increased
vigilance and careful risk assessment, at local, national and
global levels, are characteristic of this phase. If the risk
assessments indicate that the new virus is not developing
into a pandemic strain, a de-escalation of activities towards
those in the interpandemic phase (the period between
influenza pandemics) may occur.
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Key Issues
• The patients have recently returned from an overseas trip with ILI
• Several of the conference attendees are showing signs of influenzalike illness (ILI), such as coughing, sneezing, fever, and lack of
energy
• One patient is showing rapid progression of illness with severe
symptoms. Two family members now show mild influenza like illness
symptoms
• The middle school reports several cases of ILI from students
• HxNx case confirmed in the U.S.
• CDC EOC is activated
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Discussion Questions - Preparedness
1. What preparedness actions has your tribal nation taken to prepare for a
pandemic influenza response?
2. What information would you need to provide to your partners or
stakeholders on the steps they can take to quickly prepare for a severe
pandemic?
3. What entities will you be coordinating with at this point and who may be
reaching out to you for questions and assistance?
4. What types of guidance will you need and where do you expect that to
come from? How will you share the information with your tribal community?
How/what are you doing to ensure that specific at-risk and vulnerable
populations are reached?
5. How will you prevent illness in your staff and the people you are responsible
for? Operationally, do you have the staff and resources available to respond
for a severe pandemic influenza? If not, how would you obtain these
resources?
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Module 2: Response
Module 2: Scenario
Widespread cases of the HxNx virus in the United States
• Pandemic phase: This is the period of global spread of
human influenza caused by a new virus. Movement
between the interpandemic, alert and pandemic phases
may occur quickly or gradually as indicated by the global
risk assessment, principally based on virological,
epidemiological and clinical data.
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Key Issues
• Public Health Emergency is declared in US
• Community mitigation, such as school closures, measures are
considered
• Worker Safety (e.g., hospital workers, teachers) is threatened
• Possible high rate of employee absenteeism and disruption of
resources/services (e.g., healthcare, power, food services)
• Potential for maximum capacity in hospitals
• Potential immediate shortage of vaccines. Plan for mass
vaccination.
• Shortage of Anti-Viral Drugs
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Discussion Questions - Response
1. What actions are critical during an initial response level, and then at the peak of
response level in your tribal community response plan?
2. What information about self-protection from pandemic influenza needs to be
communicated to your tribal communities? What’s your policy on the closure of
public services/schools or businesses? (Consider authority and responsibilities,
trigger points, duration of closure, plans to re-open, and social consequences of
implementing school/business closures.)
3. Community mitigation measures (e.g., school closures, social distancing) will
increase rates of absenteeism in workplaces. What measures would you take to
ensure the continuity of your operations/services? Do you have leave policies
(e.g., telework) to cope with business closings and at home childcare during a
pandemic?
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Discussion Questions - Response
4. It is likely that medical needs of people will overwhelm existing
healthcare capacities. What measures will you implement in the
community to mitigate surge on the hospital systems (e.g., alternate
care systems, health professional call centers, delivery of only
essential healthcare services)?
5. Discuss capacity to deliver pandemic vaccine in your community.
What are methods to rapidly administer the pandemic vaccination
program that can be initiated and fully implemented once a decision
has been made to distribute pandemic influenza vaccine?
6. What assistance/policy guidance would you need at this stage of
response?
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Module 3: Extended
Response/Recovery
Module 3 Situation Timeline
Transition phase: As the assessed global risk
reduces, de-escalation of global actions may
occur, and reduction in response activities or
movement towards recovery actions by countries
may be appropriate, according to their own risk
assessments.
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Key Issues
 This is a pandemic transition phase
 About 30% of your community population contracted the
virus, and about 20% of cases have been fatal
 How are mass fatalities handled
 Vaccines and anti-viral medications are generally
available, with spot shortages
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Discussion Questions - Extended
Response/Recovery
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2.
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When should the response shift into recovery operations? What actions are
critical at this response level in your tribal community response plan? How
would you prioritize the actions?
What assistance or guidance would you need during the recovery stage?
What steps need to take place in order to rebuild your tribal community, at least
a level of normalcy comparable to pre-incident level, and improved levels?
Would you have adequate supplies/equipment/personnel to rebuild your
community/jurisdiction back to normalcy?
Does your emergency operations plan provide for feedback procedures in order
to record experiences from this response and integrate lessons learned? Who
will lead the after action process and how do you track the progress?
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Participant Questions
Remember a Virus is only a day away from
your door !!!!!
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