Slide 1: Pandemic Response for Rural EMS
Nick Nudell, NREMT-P, CCEMT-P
Slide 2: • Prepared for and presented to EMS providers in Connecticut in 2006. • Data has not been reevaluated for the 2009 Swine outbreak.
Slide 3: Pandemics are not a new threat!
Slide 4: Pandemics Influenza
• Influenza Pandemics are believed to have occurred for at least 300 years at unpredictable intervals.
The 1918 Spanish flu pandemic National Museum of Health and Medicine, Armed Forces Institute of Pathology
Slide 5: 20th Century Influenza Pandemics
• 1918 Spanish Flu A (H1N1) 20-40 mill Deaths 675,000 US Deaths • 1957 Asian Flu A(H2N2) 1-4 mill Deaths 70,000 US Deaths • 1968 Hong Kong Flu A(H3N2) 1-4 mill Deaths 34,000 US Deaths • Swine Flu 1976 emphasized need for pandemic flu planning.
Slide 7: 20th Century Influenza Pandemics
(Cont’d)
• Avian Flu 1997 (AH5N1) “chicken flu” – 18 cases including 6 deaths, more than 1 million chickens were killed in Hong Kong • Avian Flu 2003 (AH5N1) 2 persons with confirmed infection, two deaths. • (H7N7) Over 80 cases of mild disease and 1 death in the Netherlands
Slide 8: CT Avian Industry
Slide 9: CT Avian Industry
• 240 Poultry Farms • 1st in New England for
– Density of Egg Laying Poultry – Chickens Sold – Egg Production and value (per sq/mile)
• 2nd in New England Egg Production with 230 eggs per person/year
Slide 10: Pandemic Influenza
• The nature and severity for the next Pandemic cannot be predicted with any certainty. • Preparedness Planning is imperative to lessen the impact of a Pandemic
Slide 11: Influenza Pandemic Requirements For A Health System
• Adequate staffing
– EMS Providers – Infectious Disease – Health Care Epidemiologists – ED Nursing – Respiratory Therapists – X-Ray techs – Infection Control Professionals – Occupational Health Professionals – Environmental Services Personnel – Clinical Microbiology Technologist
Slide 12: Influenza Pandemic Requirements For Health System (Cont’d)
• Adequate staffing should not be assumed! – Only 32.5% of Florida’s licensed community healthcare providers are willing and able to respond to a high risk event, such as the Avian Flu
(n=2,279, MD- 34.6%, RN-38.4% , RPh17.4%)
Reference - Crane, Jeffrey S. Assessment of the Community Healthcare Providers' Ability and Willingness to Respond to a Bioterrorism Attack in Florida. 1 ed. UMI Publishing, Ann Arbor, MI. 2005. Report located at http://www.jscrane.com/index-7.html
Slide 13: Pandemic Requirements For A Health System
(Cont’d)
• Training
– Initial – Just-in-time
• Protective equipment
– Surgical masks, Disposable long-sleeve gowns and gloves, eye protection – N-95 or PAPRS
• • • • Training Fit testing Battery maintenance Storage
Slide 14: Pandemic Requirements For A Health System
(Cont’d)
• Hand hygiene and cough etiquette
– Signage – Soap, alcohol hand rubs, paper towels, tissue and containers, waste baskets, and surgical masks – Ambulance contamination and decontamination procedures
Slide 15: Pandemic Requirements For A Health System
(Cont’d)
• X-Ray Equipment • Mechanical ventilation
– Transport Ventilators – Respiratory circuits (adult & pediatric) – Oxygen Supply – Scope of Practice – Dedicated facility for disinfecting, cleaning ventilators
Slide 16: Pandemic Requirements For A Health System
(Cont’d)
• Pharmaceuticals and Diagnostic Testing
– Oseltamivir and Amantadine – Influenza and Pneumococcal Vaccine – Rapid Viral Antigen Tests – Respiratory Viral Cultures
Slide 17: Pandemic Requirements For A Health System
(Cont’d)
• Specific resources & destinations for cohorting patients
– Triage – Multi-patient transport – Designated transport units – In-patients Pediatric and Adult
• ICU • Intermediate Care • Wards
Slide 18: Federal Pandemic Influenza Plan
• Pandemic “Influenza Plan” US Department of Health and Human Services released November 2005 • 396 Page Plan with 8 Page Executive Summary
Slide 19: Executive Summary of HHS Pandemic Influenza Plan
• Influenza Pandemic has potential to cause more deaths and illness then any other Public Health Threat • If pandemic occurs with similar virulence of 1918 strain, 1.9 million Americans could die and 10 million could be hospitalized over the pandemic course which may evolve over a year or more.
Slide 20: Executive Summary of HHS Pandemic Influenza Plan
Cont’d • Novel Influenza virus could emerge from anywhere in world at any time • Particular concern is about Avian (H5N1) virus currently circulating in Asia and parts of Europe • Outbreaks of Influenza H5N1 have occurred among poultry in several countries in Asia Since 1997
Slide 21: Avian Influenza In Humans
• More than 100 confirmed cases of Human Infection with Avian Influenza Viruses have been reported since 1997 • Most of these cases are thought to have resulted from direct contact with infected poultry or contaminated surfaces • To date human infections with Avian Influenza a viruses detected since 1997 have not resulted in sustained human to human transmission
Slide 22: Avian Influenza Viruses Infecting Humans
• Hong Kong 2003 one child infected recovered. • New York 2003 One patient recovered. • Canada 2004 Mild eye infection following poultry outbreak. • Thailand and Vietnam 2004 and other parts of Asia in 2004-2005.
Slide 23: Only a matter of… time!
• Sustained Human to Human transmission anywhere in the world will be the triggering event to initiate a Pandemic Response by US
Slide 24: Number of Episodes of Illness, Healthcare Utilization, and Death Associated with Moderate and Severe Pandemic Influenza Scenarios*
Characteristic Illness Outpatient Medical Care Hospitalization ICU Care Mechanical Ventilation Deaths
Moderate (1958/68-like) 100 Million (30%) 50 Million (50%) 865,000 128,750 64,875 209,000
Severe (1918-like) 100 million (30%) 50 Million (50%) 9,900,000 1,485,000 742,500 1,903,000
* Estimates based on extrapolation from past pandemics in the United States. Note that these estimates do not include the potential impact of interventions not available during the 20th century pandemics.
Slide 25: Connecticut
• 2004 Population of 3.5 mill (1.2% of US) • 21% of CT population is “rural”
Characteristic Illness Outpatient Medical Care Hospitalization ICU Care Mechanical Ventilation Deaths Moderate (1958/68-like) 1,050,000 (30%) 525,000 (50%) 110,250 10,090 2,120 1,500 315 750 160 2,450 515 Severe (1918-like) 1,050,000 (30%) 525,000 (50%) 110,250 115,500 24,255 17,325 3,650 8,660 1,850 22,200 4,700
Slide 26: • Past Pandemics have spread worldwide within months • Are expected to spread even more quickly today given modern travel patterns
Slide 27: Rural Connecticut
Slide 29: CT Influenza Pandemic Plan
• Pandemic Period (cases in the U.S.)
– Governor will declare a “Public Health Emergency.” – Governor will work with:
• DPH, • Office of Public Affairs, and • Department of Emergency Management and Homeland Security (DEMHS)
Slide 30: CT Influenza Pandemic Plan
• DPH Emergency Command Center (ECC) and DPH ICS activated. • State Epidemiologist will manage the epidemiologic and immunization in collaboration with local health departments, hospitals and other key response partners. • DPH will provide assistance to the pandemic response as needed:
– – – – – – – – – – Epidemiology Program, Immunizations Program, Environmental Health Section, Health Care Systems Regulation Branch, Laboratory Branch, Local Health Administration Branch, Regulatory Services Branch, Office of Communications, Office of Emergency Medical Services, and Office of Public Health Preparedness (OPHP).
Slide 31: CT Influenza Pandemic Plan
• Each hospital and medical care provider should develop or update its own pandemic response plan to be consistent with the National and CT Pandemic Influenza Response Plans • Each hospital and medical care provider should participate in development of a regional pandemic influenza response plan
Slide 32: CT Influenza Pandemic Plan
• Each hospital and major medical care provider will establish its own EOC and be prepared to participate collaboratively with DPH as needed to:
– collect information to monitor the pandemic, – provide information and respond to patient inquiry, – isolate patients and enforce quarantine of employees and patients as needed, – vaccinate employees and patients and/or – provide antiviral agents to health care providers and patients in accordance with DPH recommendations, and – conduct and enforce other activities as may be declared necessary by the Governor and Commissioner of Public Health.
Slide 33: CT Influenza Pandemic Plan
• Licensed health care workers (DPH 5/03)
– – – – – Physicians Registered Nurses Licensed Practical Nurses Paramedics Emergency Medical Technicians Medical Response Technician (MRT) Emergency Medical Technician (EMT) EMT – Intermediate Paramedic Firefighters (est. from CT Fire Academy) Local Law Enforcement State Law Enforcement Air National Guard (as of 01/23/06) Army National Guard (as of 01/23/06) State Public Health workforce (as of 5/05) Local Public Health workforce (as of 2004) 10,805 40,080 9,640 1,380 8,980 5,871 9,686 843 1,586 21,000 7,522 1,200 1,020 3,212 848 1,802
•
Essential service providers (DPH 1/06)
– – – – – – – – – – –
•
Correctional population
19,216
Slide 34: Need to be actively involved!
• Feb 2006 GAO report identifies lack of transport resources for nursing home evacuations • Planners under/over estimate EMS transport capabilities • PAPRS and decon training/equipment are expensive
Slide 35: Thank you!
Serving EMS, Homeland Security, Public Health and Public Safety Agencies
SafeTech Solutions 110 Peach Street Tinton Falls, NJ 07724 Toll Free (866) 448-1834 Voice (208) 639-1689 Fax (208) 575-2783 http://www.safetechsolutions.us/ nick@safetechsolutions.us
