Question
What was your county doing at the
peak H1N1 threat?
– Fall, 2009.
A Pandemic Tabletop to
Exercise the Transitional
Paradigm
Eric Zgodzinski, MPH, RS
Greg Moore, MBA, PMP
Toledo-Lucas County Health District –APC
Toledo, Ohio
Objectives for the TTX
1. To introduce the Transitional Medical
Model
2. To explore its integration into individual
county disaster plans
TTX Format
1. Brief narrative
2. Situation Report (SitRep) or update
3. Discussion of actions by players
4. Questions and clarifications
5. Final discussion
Activities that will take place
during break-outs:
• Apply TMM Phase and commence
activities accordingly
• Stakeholder communication:
– Public
– Neighboring jurisdictions
– Response agencies
• Coordination with RMRS, ODH, CDC
Be prepared to…
• Develop and implement plans during
the break-outs
• Document actions taken
• Appoint a spokesperson
• Present plans to all the attendees
• Respond to queries by facilitator and
other attendees
In H1N1 Season
• While the nation has been subjected to
over 17,000 deaths from H1N1 and 5.7
million people taken ill, experts agree that
it could have been worse.
• Locally, in NWO, thousands took ill
– 1 in 5 Americans on average
• 99% recovered uneventfully.
• Even seasonal flu has been tamed.
– “Thank you, H1N1.”
• The Big Question: A Third Wave?
• There have been unconfirmed
reports of major domestic poultry
deaths in rural sections of Cuyahoga
County
Breakout Session
• What level are you at currently?
• How does your jurisdiction react?
• Change in preparedness & response level?
• What is/are the hospital(s) doing?
• What is public health doing?
• What is EMS doing?
• What are the elected officials doing?
• Mental health?
• Special needs?
Associated Press
• Cuyahoga Co. health officials receive
unconfirmed reports of an unusual
number of sudden respiratory illness
in Parma.
• The ill are being taken to Cleveland
hospitals.
• Cleveland media raise concerns
about a third wave of H1N1.
Death in Detroit
Breaking News: Detroit, MI:
“In a matter of hours,
patients are progressing from
a Upper Respiratory Infection
(URI) to an Acute Respiratory
Distress Syndrome (ARDS)
and quickly succumb. Family
members seem to be falling ill
as well. Public health officials
are concerned about a new
H1N1 variant that is immune
to the vaccine.”
CDC
CDC 1000 h press conference:
Dr. Frieden states: “We’re investigating
reports from Detroit and the Cleveland area.
Nothing has been confirmed at this time….
Yes, we have also heard that some of the
patients had already been immunized with
both seasonal and H1N1 vaccines in
November….”
• The Public Information Officer (PIO)
from University of Michigan Hospital
in Ann Arbor, confirms that three ICU
patients transported yesterday from
Windsor, Ontario have died. They
were all Influenza Type A positive.
Breakout Session
• What level are you at currently?
• How does your jurisdiction react?
• Change in preparedness & response level?
• What is/are the hospital(s) doing?
• What is public health doing?
• What is EMS doing?
• What are the elected officials doing?
• Mental health?
• Special needs?
• Detroit hospitals are calling in
additional personnel to assist with
surge
• Record numbers of ED visits for ILI
affecting mostly the young
• Increasing numbers of admissions of
pregnant women
• Rumors of “closing the border” will
impact healthcare commuters
5PM Press Conference
• Hundreds of suspected/probable
cases along the Lake Erie shore
• 50-60 suspected cases hospitalized
in Detroit and Cleveland
– 15% in critical condition and
• 28 reported deaths already
• Preliminary data: H1N1
– Probably a mutated version
Breakout Session
• What level are you at currently?
• How does your jurisdiction react?
• Change in preparedness & response level?
• What is/are the hospital(s) doing?
• What is public health doing?
• What is EMS doing?
• What are the elected officials doing?
• Mental health?
• Special needs?
Irish Hills, Michigan
• A professional fishing guide who returned
from fishing in Devil’s Lake two days ago
was hospitalized today at Defiance
Regional Medical Center for an acute ILI.
• There is no report of illness in her
immediate family.
• Public health officials in Defiance are
investigating.
• Guide’s family traveling back to Lima area
• Breaking News: Local TV journalists are
interrupting American Idol to announce that two
flights from Toronto to Columbus International
Airport have been quarantined.
• Several passengers are believed to have ILI
symptoms.
• One passenger required resuscitation prior to
landing and is enroute to a local hospital.
What now?
• Local hospitals and medical offices
are calling local public health for
advice on what to do, what to tell
patients, and what to tell media.
• So far, there has been no sudden
increase in ILI locally.
• Routine URIs
Breakout Session
• How does your jurisdiction react?
• Change in preparedness & response level?
• What is/are the hospital(s) doing?
• What is public health doing?
• What is EMS doing?
• What are the elected officials doing?
• Mental health?
• Special needs?
Suddenly…
• EDs are seeing a spike in ILIs.
– Waits are twice baseline
– Most are + for Influenza A.
• Due to M&M seen in Cleveland and
Detroit, patients with even minor ILI
are being admitted more liberally
than before.
Medical Offices and Clinics
Many are not seeing
respiratory
complaints
Patients are being
referred to closest
ED.
NWO
• Hospital pharmacies are reporting
that doctors are prescribing antiviral
medications for themselves and
families
• Kroger's and Wal-Mart are reportedly
running out of cough/cold remedies,
hand sanitizer, and masks
8PM Press Conference
– Latest outbreak must be taken seriously
• Emphasize H1N1 precautions
– Etiology: Influenza Type A, H1N1-Variant
• More severe than H1N1 pandemic of this
year
– Numbers:
• Thousands with latest flu virus
• Scores in critical condition
• 66 dead in Canada
• 34 dead in Detroit and environs
• 28 dead in Cleveland
Press Conference
H1N1-Variant
• Communities to activate fully their Pandemic Flu
plans
– Aggressive social distancing measures
• Summary of ILI (probable/proven) cases:
– 1,541 hospitalized cases/87 deaths: Ontario
– 356 hospitalized cases/67 deaths: Michigan
– 311 hospitalized cases/57 deaths: Ohio
• SNS
– What is available?
– Where is it located?
– How is it accessed?
Current Inventory Status
• Tamiflu
• Peramivir
• Masks
– Surgical
– Respirators
• Gloves
• Vaccines
Breakout Session
• How does your jurisdiction react?
• Change in preparedness & response level?
• What is/are the hospital(s) doing?
• What is public health doing?
• What is EMS doing?
• What are the elected officials doing?
• Mental health?
• Special needs?
CDC
Breakouts of H1N1-Variant occurring in
major metropolitan areas
– NY
– SF
– DC
Locally
• Hospitals are diverting patients
– Over-capacity
• Staff shortages
• EMS surge protocols
• Public demanding vaccine
Breakout Session
• How does your jurisdiction react?
• Change in preparedness & response level?
• What is/are the hospital(s) doing?
• What is public health doing?
• What is EMS doing?
• What are the elected officials doing?
• Mental health?
• Special needs?
Discussion