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Pandemic Flu Preparedness and Update
April 30, 2009
Today’s Presenters:
 Al Cook, CMRP, FAHRMM
Chief Resource Director
The Regional Medical Center
 Jeff Wagner, CMRP
Vice President
MidMichigan Health
Pandemic Guidelines
Stages of Preparedness Level for Materials Managers related to Pandemic Flu Levels
(this includes the Avian Flu; a.k.a. H5N1, H5, or bird flu)
Interpandemic
Impact
Community
Risk of human infection or
disease is considered to
be low
Develop direct
communication with
disaster or bio-terrorism
coordinator in your facility,
county, or region to
ensure duplication of
activity is limited or
eliminated
Pandemic Alert
Pandemic
Postpandemic
human-to-human spread is
still localized, suggesting that
the virus is becoming
increasingly better adapted to
humans but may not yet be
fully transmissible
(substantial pandemic risk)
Increased and sustained
transmission in the general
population, likely that 30% or
more of population infected
Return to Interpandemic
stage
Align planning with clinical
leaders and disaster
coordinator(s), prepare for
support of satellite treatment
centers that may be utilized
to keep flu patients away
from medical centers if
possible
Full activation of supply
acquisition and distribution
related to high volume of flu
patients
De-commission of community
services, move back to focus
on main activity centers
Pandemic Guidelines
Stages of Preparedness Level for Materials Managers related to Pandemic Flu Levels
(this includes the Avian Flu; a.k.a. H5N1, H5, or bird flu)
Interpandemic
Pandemic Alert
Pandemic
Postpandemic
Supplies
(see list
below)
Maintain normal supply
level, stay in close
contact with distribution
channel for planning,
obtain a copy of the
distributor's disaster plan
to ensure supply lines to
the customers, and
please
DO NOT HOARD
SUPPLIES
Increase in flu patients will
place pressure on supplies
within medical facilities,
increase supply quantities
accordingly, again, please
DO NOT HOARD SUPPLIES
Continue to increase
purchases and frequency to
handle the increased volume
without hoarding, realize that
this may last 4-8 weeks
Supply levels should taper
down with decreased patient
activity
Equipment
Ventilator/Respirators
and IV Pumps undergo
preventative
maintenance checks.
Prepare a list of local
medical equipment rental
companies and inquire
on availability of specific
equipment such as
ventilators/respirators
All ventilators/respirators and
IV Pumps ready for service
All available
ventilators/respirators and IV
Pumps are in active service;
maintaining, cleaning, and
turnaround are critical. Rental
equipment ordered and in
use.
Disinfecting, repair and
maintenance after high
activity
Pandemic Guidelines
Stages of Preparedness Level for Materials Managers related to Pandemic Flu Levels
(this includes the Avian Flu; a.k.a. H5N1, H5, or bird flu)
Interpandemic
Pandemic Alert
Pandemic
Postpandemic
Staffing
Prepare list of alternate
workers in the event of
staff shortages in
Materials Management.
Consider cross training
of staff. Update phone
records and prepare your
protocol for calling in
relief workers
Monitor the need for calling
on relief workers
Monitor the need for calling
on relief workers
Return staff to normal duties
Funding
Check with local, state
and governmental
agencies for funding
opportunities. This may
fall under the
responsibility of your
facility's disaster
coordinator
Focus on supply needs
Check with local, state and
governmental agencies for
funding opportunities. This
may fall under the
responsibility of your facility's
disaster coordinator
Focus on supply needs
Pandemic Guidelines
Supply List
Gloves Exam
Suction Catheters
Gowns Isolation Disposable/re-usable
Suction Canisters
Masks N95
Oxygen Masks
Masks Procedure
Ventilator Tubing
Rapid Lab Test Kits
Masks Surgical
Shields Face
Respiratory Etiquette signs
Stethoscopes Disposable/re-usable
Tissues
Goggles
Gel Hand Alcohol Based - personal
Blood Pressure Cuffs Disposable/re-usable
Wipes Disinfectant for Surfaces
Thermometers Disposable/Re-usable
Vaccines/anti-viral Medications
Morgue Packs
IV Supplies
Note that quantities should increase based on patient volume changes in most cases, and not
by simply increasing by "weeks" or "months" of supplies. This should be managed via close
communication with the distributors.
Medical Materials Coordinating Group
(MMCG)
 The MMCG is a subgroup of the Healthcare Sector
Coordinating Council (HSCC), which itself is comprised
of fifteen owner-operators and association members
which represent the medical products supply chain –
including manufacturers, consolidators, distributors, and
maintenance and repair.
 The HSCC and MMCG are recognized by the Department
of Homeland Security and other federal agencies as the
initial point of contact within healthcare’s private industry
for critical infrastructure protection, preparedness, and
response purposes.
Healthcare Sector Coordinating Council (HSCC)
The HSCC is comprised of representatives and alternates from each subcouncil. Issue will be identified by Subcouncils. Coordination across
Subcouncils and with the GCC will be organized through the HSCC.
Each sub-council is responsible for organizing itself
Sample Priority Issues for Sub-Councils: Emergency Preparedness, Emergency Response; Vulnerability Assessment / Prioritization; Communication & Information
Sharing among members, with HHS and DHS, and with other sectors
Cross-cutting Work Groups will be established to address priority issues that cut across sub-councils
Healthcare
Personnel
Insurers,
Payers, HMOs
Information
Technology
Laboratories
and Blood
Includes:
Includes:
Includes:
Includes:
Includes:
Doctors, nurses,
pharmacists,
dentists,
emergency
medicine and
other clinicians
and practitioners
with direct
involvement in
healthcare
delivery
Representative
s of third-party
payers for
medical
treatment and
healthcare
delivery
including
insurance
companies,
HMOs and
others
All IT systems,
capabilities and
networks
supporting
delivery of
healthcare
services
Laboratories
and lab
support
services
separate from
medical
treatment
facilities, and
companies
and
associations
from the
blood, tissue
and organ
industry
Medical
examiners,
coroners, funeral
directors,
cremationists,
cemeterians,
clergy, and
manufacturers
and distributors
of funeral,
memorial, and
cremation
supplies
AHRQ
CDC
CMS
FDA
HRSA
Mass Fatality
Mgt Services
IHS/TRIBAL
Medical
Materials
Coordinating
Includes:
NIH
Manufacturers,
suppliers, and
distributors of
medical
supplies and
equipment, as
well as health
care materials
managers
SAMHSA
Medical
Treatment
Occupational
Health
Pharma and
Biotech
Includes:
Includes:
Includes:
Hospitals,
clinics, and
other
organizations/
entities that
deliver medical
treatment
Occupational
health
physicians and
nurses,
industrial
hygienists,
and other
occupational
health
professionals
Manufacturers,
suppliers and
distributors of
generic and
branded
pharmaceuticals
and biological
equipment
DOD
Healthcare and Public Health Sector Government Coordinating Council (GCC)
VA
STATE/LOCAL
Manage the Hype
 Update | 1:09 p.m. | C.D.C. Briefing
 Dr. Richard Besser, the Acting Director of the C.D.C. said that the
declaration of a public health emergency in the United States on Sunday
"streamlines the process by which the government works." He adds that the
government will be giving people coming to the U.S. information on how to
avoid getting sick and "out of an abundance of caution" is advising people to
forgo any non-essential travel to Mexico at this time.
Manage the Hype
 Update | 1:16 p.m. | C.D.C. Briefing
Dr. Besser says that, for people who run businesses or schools, it is "time to
think about" how they might adapt if an outbreak happens on a large scale
and they have to make things work with people working or studying from
home. He also says that 11 million doses of anti-viral drugs from a
government stockpile have been sent to states with cases of the swine flu,
including California, Texas and New York.
 Update | 1:19 p.m. | C.D.C. Briefing
In response to a question from a reporter, Dr. Besser says that wearing
masks is generally not as useful as doing things to prevent disease
transmission, like washing your hands and forgoing "that little kiss of
greeting" between people. Dr. Besser makes the point that the flu is not
transmitted by eating pork.
 Update | 1:21 p.m. | C.D.C. Briefing
A reporter for the Wall Street Journal asks if not having a director of Health
and Human Services at the moment has hurt the government's response to
this crisis. Dr. Besser says that it has not. He does say that a lack of funds
for the public health system, due to cuts in state budgets, could cause
problems in the future. He says that "investments in preparedness" is what
led to this outbreak being identified in the United States as quickly as it was.
Manage the Hype
 Update | 1:28 p.m. | C.D.C. Briefing
Dr. Besser clarifies that the government has only released 25% of the
stockpile of anti-viral drugs so far.
 Update | 1:35 p.m. | C.D.C. Briefing
Dr. Besser says, in response to a question, that the decision of the
European Union to place a travel restriction on people coming to the United
States is "premature," given that "we only know of 20 cases" and just one
person has been hospitalized in the U.S. so far.
 Update | 1:38 p.m. | C.D.C. Briefing
A CNN reporter asks if Dr. Besser's advice to not kiss people as a token of
greeting only applies to people in areas where the virus has been identified.
He says that the C.D.C. is not calling for "a ban on affection," but suggests
people in areas where the virus has been identified should probably pass on
kissing each other hello or goodbye for now.
Manage the Hype
 Update | 1:47 p.m. C.D.C. Briefing
Dr. Besser's briefing is over, but a good resource is the
C.D.C.'s Swine Influenza page on its Web site, which has a lot
of information about how to spot the infection, how to avoid
getting it, and information on where the 40 confirmed cases in
the U.S. have been identified. The C.D.C. site was updated
within the last hour to show that cases have been confirmed
in the following states: California (7 cases); Kansas (2 cases);
New York City (28 cases); Ohio (1 case); Texas (2 cases).
Pandemic Influenza Phases
In nature, influenza viruses circulate continuously among animals, especially birds. Even though such
viruses might theoretically develop into pandemic viruses, in Phase 1 no viruses circulating among
animals have been reported to cause infections in humans.
In Phase 2 an animal influenza virus circulating among domesticated or wild animals is known to have
caused infection in humans, and is therefore considered a potential pandemic threat.
In Phase 3, an animal or human-animal influenza reassortant virus has caused sporadic cases or small
clusters of disease in people, but has not resulted in human-to-human transmission sufficient to sustain
community-level outbreaks. Limited human-to-human transmission may occur under some
circumstances, for example, when there is close contact between an infected person and an unprotected
caregiver. However, limited transmission under such restricted circumstances does not indicate that the
virus has gained the level of transmissibility among humans necessary to cause a pandemic.
Pandemic Influenza Phases
Phase 4 is characterized by verified human-to-human transmission of an animal or humananimal influenza reassortant virus able to cause “community-level outbreaks.” The ability to
cause sustained disease outbreaks in a community marks a significant upwards shift in the risk
for a pandemic. Any country that suspects or has verified such an event should urgently
consult with WHO so that the situation can be jointly assessed and a decision made by the
affected country if implementation of a rapid pandemic containment operation is warranted.
Phase 4 indicates a significant increase in risk of a pandemic but does not necessarily mean
that a pandemic is a forgone conclusion.
Pandemic Influenza Phases
Phase 5 is characterized by human-to-human spread of the virus into at least two countries
in one WHO region. While most countries will not be affected at this stage, the declaration of
Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the
organization, communication, and implementation of the planned mitigation measures is short.
Phase 6, the pandemic phase, is characterized by community level outbreaks in at least one
other country in a different WHO region in addition to the criteria defined in Phase 5.
Designation of this phase will indicate that a global pandemic is under way.
Pandemic Influenza Phases
During the post-peak period, pandemic disease levels in most countries with adequate surveillance will
have dropped below peak observed levels. The post-peak period signifies that pandemic activity appears to
be decreasing; however, it is uncertain if additional waves will occur and countries will need to be prepared
for a second wave. Previous pandemics have been characterized by waves of activity spread over months.
Once the level of disease activity drops, a critical communications task will be to balance this information
with the possibility of another wave. Pandemic waves can be separated by months and an immediate “atease” signal may be premature.
In the post-pandemic period, influenza disease activity will have returned to levels normally seen for
seasonal influenza. It is expected that the pandemic virus will behave as a seasonal influenza A virus. At
this stage, it is important to maintain surveillance and update pandemic preparedness and response plans
accordingly. An intensive phase of recovery and evaluation may be required.
Calculating demand in a pandemic
 OSHA estimates that for healthcare workers, masks will
be changed four times per 12 hour shift for direct patient
care givers. Most healthcare workers think this is well
underestimated.
 OSHA also indicates that in Emergency Rooms, direct
care givers may use as many as one mask between each
patient and that each person visiting the ER should be
issued an n-95 to prevent transmission.
 The number is staggering and might indicate that in some
cases, Materials Managers might be better served to seek
reusable alternatives.
Considerations for meeting demand for PPE
 Initial volume will not be 100% occupancy but will start with a
significant surge in daily use and crescendo at full census.
 Heightened awareness should be made for the potential of
sensitive medical PPE departing with the workforce.
 At the onset, estimates of daily use should be calculated and
the initial 96 hours of use should be brought on site.
 Work with established suppliers and with the work force to
establish potential alternatives to disposable N-95 face
masks. OSHA site offers several alternative devices.
 Assure that the correct type of mask or respirator is used in
the most appropriate instance, e.g.: surgical masks used
where appropriate and disposable N-95s only used where
essential.
Resources
http://www.cdc.gov/swineflu/
http://www.cdc.gov/swineflu/recommendations.htm
http://www.cdc.gov/swineflu/masks.htm
http://www.chcoc.gov/Transmittals/TransmittalDetails.
aspx?TransmittalID=2227
http://www.osha.gov/Publications/3328-05-2007English.html#RespiratoryProtectionforPandemicInfl
uenza
Additional Resource
AHRMM’s Disaster
Preparedness Manual for
Materials Management
Professionals is carried in the
online AHRMM Book Store
AHRMM’s Disaster Preparedness Manual
 This book offers sound advice in planning and preparing for
disaster preparedness. This is the time to engage with local,
regional, state and even federal agencies regarding the plans
and resources that will be made available to the hospital as a
result of those plans. No hospital will stand alone in any
disaster response but will stand as a focal point with other
local and regional agencies to deliver health and public health
services to their respective communities in the most efficient
and effective manner.
 Now is the time for understanding these resources and how
they will all come together to serve the health needs of their
communities. Preparation and understanding of these
integrated response efforts will be key elements of hospitals’
disaster response plans.
Late Breaking News
Current level of influenza pandemic alert raised from
phase 4 to 5
Based on assessment of all available information and following several
expert consultations, Dr Margaret Chan, WHO's Director-General
raised the current level of influenza pandemic alert from phase 4 to 5.
She stated that all countries should immediately activate their
pandemic preparedness plans. At this stage, effective and essential
measures include heightened surveillance, early detection and
treatment of cases, and infection control in all health facilities.
Questions
Speaker Contact Information
Al Cook, CMRP, FAHRMM
Chief Resource Director
The Regional Medical Center
Orangeburg, SC
803 395 2651
[email protected]
Jeffrey J. Wagner, CMRP
Vice President
MidMichigan Health
Midland, MI
989-839-3821
[email protected]