Breakout Session: Pandemic Influenza Planning and Personal Disaster Preparedness

The breakout session on Pandemic Influenza Planning and Personal Disaster Preparedness focused upon two primary areas of interest: highlighting the important considerations for Centers in the development of their pandemic flu plans and identifying planning measures for persons with disabilities that would serve their needs in the event of a disaster. These topics were selected as result of input gathered from Consortium center staff through a training needs survey instrument. The goals of this track session discussion were to:

• Identify the seriousness of an influenza pandemic and the effects of such an outbreak of the virus on staff and students.
• Identify a list of key challenges as to an influenza pandemic impacting center operations and what is needed to address needs.
• Identify components of clinical management and infection control to be included in an emergency preparedness and response to an influenza pandemic.
• List Center effective practices currently in place relative to developing and implementing a pandemic flu plan.
• Determine considerations for continued partial center operations versus total shutdown of the Center.
• Identify activities to consider in establishing business resumption operations.
• Create continuing education opportunities on infection control practices.
• Develop a framework for personal emergency guidelines for persons with disabilities.
• Identify specific action items to recommend to Center Directors for implementation consideration.

During the pandemic influenza planning and personal disaster preparedness track numerous center medical staff provided education and shared information regarding planning for influenza pandemic. David Berg, Program Manager for the Center for Bioterrorism and Disaster Preparedness, provided technical assistance and participated in the track discussion and planning. Also, Eric Muncert with Saint Francis University's Center Excellence for Remote and Medically Under-served Areas (CERMUSA), the National Telerehabilitation Service System (NTSS), Marcus Haines and Melissa Blum with the Drexel University's National Bioterrorism Civilian Medical Response Center (CIMERC) participated and provided expertise. Representatives from each Center provided input and participated in the discussion. Participant roster included:

• Vickie Lampert, Woodrow Wilson Rehabilitation Center, Virginia
• Brenda Morris, Woodrow Wilson Rehabilitation Center, Virginia
• Barbara Ostvander, Woodrow Wilson Rehabilitation Center, Virginia
• Mike Swinson, Woodrow Wilson Rehabilitation Center, Virginia
• Phyllis Gorsuch, Woodrow Wilson Rehabilitation Center, Virginia
• Brian Clovenger, Carl D. Perkins Comprehensive Rehabilitation Center, Kentucky
• Melissa Adams, Carl D. Perkins Comprehensive Rehabilitation Center, Kentucky
• Patricia Lang, M.D., Hot Springs Rehabilitation Center, Arkansas
• Howard Rutenbert, Facilitator, Hot Springs Rehabilitation Center, Arkansas
• Barbara Roach, Recorder, Hot Springs Rehabilitation Center, Arkansas
• Bruce Brenn, Michigan Career and Technical Institute, Michigan
• Maya Desai, M.D, Workforce and Technology Center, Maryland
• Linda Gibson, Workforce and Technology Center, Maryland
• Bob Kahlert, Workforce and Technology Center, Maryland
• Elizabeth Siskey, Workforce and Technology Center, Maryland
• Ann Reed, Workforce and Technology Center, Maryland
• Duan Huang, M.D., Roosevelt Warm Springs Institute for Rehabilitation, Georgia
• Jay Coughenour, Roosevelt Warm Springs Institute for Rehabilitation, Georgia
• Cathy Harbin, Roosevelt Warm Springs Institute for Rehabilitation, Georgia
• Wilma Lane, Tennessee Rehabilitation Center, Tennessee
• Julia Daff, West Virginia Rehabilitation Center, West Virginia
• Mary Kashhurba, M.D., Hiram E. Andrews Center, Pennsylvania
• Carol Mackel, Hiram E. Andrews Center, Pennsylvania
• Linda Davis, Division of Rehabilitation Services, Maryland
• Eric Muncert, National Telerehabilitation Service System, PA
• Marcus Haines, National Bioterrorism Civilian Medical Response Center, PA
• Melissa Blum, National Bioterrorism Civilian Medical Response Center, PA

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A. Discussion and Highlights

An influenza pandemic was identified as a global outbreak of disease that occurs when a new Influenza A Virus appears or "emerges" in the human population causes serious illness and then spreads easily from person to person worldwide. Participants accepted the fact that experts agree that a pandemic will occur again (as it has three times in the twentieth century), but do not know when it will occur. Highlights of the track discussion and information presented included a set of assumptions and specific recommendations that should guide emergency preparedness planning:

• Each Center needs to establish a pandemic flu plan.
• Ownership of the pandemic flu plan must be accepted by the entire Center - not just medical.
• Each Center's plan should be an educational tool and be written so it can be understood by students and staff.
• Resource materials will need to be developed for staff, clients, and family.
• Partnerships with other organizations and medical providers will be necessary.
• The pandemic flu plan must include addressing security and transportation issues.
• Consideration must be given to the time frame the Center will be self-sufficient.
• Individuals and families should develop their own plans that will "dovetail" with the Center's pandemic flu plan.
• Each Center should establish a relationship with local disaster coordinators and State disaster officials.
• Each Center pandemic flu plan should address Clinical Management/Infection Control, Social Distancing, Isolation and Quarantine, Criteria for Admitting New Students, Continued Partial Operations of the Center, Total Shutdown of the Center, and Resumption of Center Operations.
• Centers, like other organizations, will be vulnerable and decisions will need to be made resolving the operation of the Center based upon the stage of the pandemic. Emphasis will be placed upon limiting the number of illnesses and deaths, preservation of the continuity of essential functions and minimizing disruption to staff, clients, and their families.

B. Challenges Facing Centers in Managing an Influenza Pandemic

Participants identified some critical challenges each Center would face in managing students and continuing Center operations in the event of an influenza pandemic.

• There will be an overwhelming demand for medical services in a pandemic.
• Transportation will be disrupted resulting in limited supplies.
• Staff absenteeism will approach 30%.
• There will be reduced reliability on traditional communication, power and water.
• There will be increased need for outreach to homebound clients.
• Persons will be infectious, but without symptoms and may require quarantine.
• Expect limited assistance from the state and federal government.

C. Effective Practices Currently in Place to Aid Development and Implementation of a Pandemic Flu Plan

Center participants identified examples of current effective practices that are currently in place at consortium centers that will enhance and aid the development and implementation of a Pandemic Flu Plan. These effective practices include:

• A well trained and qualified medical staff.
• Existing crisis management and disaster preparedness plan that should serve as a practical and effective vehicle in which to incorporate a specific center response to pandemic flu.
• Existing disaster response teams designated for other emergency or disaster situations.
• Existing infection control policies and procedures and regular in service training regarding the use of "standard precautions" and infection control principles.

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D. Recommendations

1. Develop a specific and workable Pandemic Flu Plan consistent with each Center's existing disaster plan. The flu plan should include several specific components:

Clinical Management/Infection Control

• Incorporation of selected policies and procedures of the Center's Infection Control Manual to include the following:
  • Adherence to Universal/Standard Precautions, i.e. hand hygiene procedures and use of personal protective equipment (gloves, gowns, and face/eye protection, as necessary)
  • Proper handling of soiled linen and laundry
  • Proper environmental cleaning and disinfection
  • Proper disposal of solid waste
• Inclusion of Droplet Precautions
• Instructions in safe handling and disinfection of equipment
• Address patient placement/room assignment. Patients with like symptoms should be placed in rooms together. Separate waiting areas should be maintained for patients with like symptoms.
• It may become necessary to list appropriate safeguards in the handling and preparation of certain foods, such as poultry.

Social Distancing

All persons must adhere to "social distancing", respiratory hygiene, and cough etiquette. Principles should include, but not limited to:

• Covering the nose/mouth when coughing or sneezing
• Tissues to be available and used to contain respiratory secretions
• Hand hygiene to be performed after contact with respiratory secretions

Isolation and Quarantine

• Quarantine will be utilized to separate individuals exposed to influenza from non-exposed individuals to prevent transmission, should those persons develop illness.
• Quarantine of contacts of flu cases may be beneficial during the earliest phases of a pandemic and in response to an influenza virus that has not achieved the ability to spread easily from person to person.
• During all phases of the pandemic persons ill with influenza will be directed to remain in isolation in either healthcare setting or at home to the fullest extent possible.
• Healthcare providers will implement isolation protocols, to the extent possible, for all patients suspected of being infected with pandemic influenza.

Criteria for Admission

• Consider an initial health assessment upon admission.
Medical Director input is necessary to establish admissions criteria and admission denials during a pandemic.
• Admissions decisions should be based on the acuity of the situation considering factors, such as risk, proximity to emergency medical services, and available supplies.

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Decision Making for Partial Center Operations

• Determination of any patients/clients that cannot be sent home.
• Adequate supplies of food, water, and other supplies.
• Ability to be in a position to triage and assist community persons.
• Resources that Center can provide the community.
• Consider activation of a Crisis Command Center.
• Whether Center is predominantly a school model or if there is a significant medical component will affect the ability to continue operations.
• Established partnerships with healthcare and other organizations.
• Information needs of various audiences, including the public, the media, staff, unions, clients and family, and supplies.
• Determination of what phase of pandemic exist. Phase 3 - human infections are occurring without human-to-human spread. Phase 4 - small clusters of human-to-human transmission. Phase 5 and 6 more advanced stages of infection.

*Phase 3 and 4 may allow partial Center operations. Phase 5 and 6 will likely require total Center shutdown.

Decision Making for Total Shutdown of Center Operations

• Authority to shutdown Center operations: Governor mandate appointing authority, Center Director, and Medical Director joint decision.
• Determination as to when to shutdown Center operations. A directive to shutdown operations will be based largely on information received by federal, state, and local health officials and will include an assessment of the pandemic flu phase the community is in. A decision could be made to close Center operations before the appearance of the flu in the client/student population or even in the community.
• Consider activation of Crisis Command Center.
• Student transportation must be addressed in the Center plan. Medical records may need to accompany patients.
• Notification of client family.
• Establishment of facility security measures during a pandemic.

Decision Making for Resuming Center Operations

• Consider establishing a recovery team to establish priorities, coordinate logistics, evaluate damage, and coordinate notification of clients and staff.
• Maintaining detailed records, including accounting for all damaged-related cost.

2. Implement Immediate Preparedness Activities to Lessen the Spread of Infectious Diseases

• Placement of sanitizers at designated locations.
• When possible, replace hand-operated faucets with hands free faucets and paper towel dispensers.
• Placement of signage at strategic locations on campus reflecting infection control reminders for students, staff, and visitors.
• Increase in service education on infection control practices for all staff and students.
• Implement a comprehensive infection control orientation for all new staff and students.

3. Develop and Implement Personal Emergency Training Guidelines for Persons with Disabilities

• Include an introduction of the importance and necessity of clients preparing for emergencies and disasters.
• Include the importance of creating a Kit/Storage of emergency supplies to include:
• Flashlight and extra batteries
• Battery-powered radio
• First-aid Kit
• Food - 3 day supply
• Water - 1 to 2 gallons
• Instructions for operation of special equipment
• Manual can opener
• Medications
• Instructions in maintaining a file of documents and contacts
• Social Security Card
• Medical History
• Medication list, dosage, schedule, frequency
• Insurance Policies
• Advance Directives
• Local Contacts
• Medical Contacts
• Religious Contacts
• Veterinarian
• Instructions on how to make a plan and test plan
• Plan to shelter-in place
• Plan to get away
• Test plan and make needed revisions
• Implementation of training guidelines: A power point presentation and/or pamphlet can be developed for Center clients and the disability community emphasizing the specific points included in the guidelines under the following headings:
• Introduction - Preparation Makes Sense
• Creating a Kit/Storage of Emergency/Supplies
• Make a Plan
• Test and Revise Your Plan
• Be Informed

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