Master

Master Breakout Session - Virginia Pandemic Flu Summit - March 23, 2006 CATEGORIES and PRIMARY AGENCY Planning Law Enforcement How do we prepare for something that may last 6 to 18 months ? and Judiciary Federal,State, and Local What can we learn from other disasters ? Personnel When/How would the National Guard be used ? What do Officers need to protect themselves ? Ie Governor's Office gloves,mask Develop policy for who is jailed during this time. Infected jail population Liability umbrella for work outside their normal activities. Need leadership training for quick decision making What policies will be enforced and which waived. How will that affect services When disaster occurs, we are most vulnerable to a terrorist attack. Plan to work with Public Health and EMS providers Train judges and clerks in prevention and decon VDH Identify early those that Decon Training from VDH for in community could help..... Communications Legislation Can we trust the media to provide good Martial Law information Issues around protecting court system, How to handle workers comp/on duty Public notification of related use video for proceedings exposures information Which laws do we enforce and which Testing of personnel to assure they are How do we keep communications open do we waive. not spreading flu? ? Medical treatment to juviniles How to sustain staff during this time What role does Law Enforcement play in public education before Pandemic ? Don't count sick leave during a pandemic situation Use Incident Command Provide counseling for stress injuries to Work with Joint Information center to first responders control message and coordinate efforts and resources. Force Officers to take time off to stay healthy Work with media to control messages Recruitment will be difficult because of Communications between agencies and flu governments. Family preparation/Officers away from home/family sickness Duplicates Medical Training for Officers Staffing Unified Command/Command Structure Vaccine Distribution Isolation and Quarentine Infected people from other states coming to Virginia Medication and treatments to Officers Equipment decontamination Call priorities Increase in crime Equipment and supply shortages Priority for other Public Services Mass fatality management Law Enforcement Isolation and Quarentine Dispensing of Medications/Keeping crowds under control What is Health Departments Plan for flu Vaccine security Priority for Officers to receive flu vaccine Mass burials OCME Law Enforcement Who covers cost of burials for homeless victims ID, Transport, and storage of deceased flu vicitms Page 1 of 25 Local Government Breakout Session - Virginia Pandemic Flu Summit - March 23, 2006 CATEGORIES and PRIMARY AGENCY Local Government Officials Planning What plans should be made to address basics of government - such as elections, meetings of elected officials? Whose job is it to plan for personal protection equipment for the public? What is the local government doing to plan for a loss of 20% to 40% of its work force not showing up for work? Laws What are the laws that impede a response to pandemic flu? What local ordinances should be considered for social distancing? Personnel How will local government maintain operations with significant reductions in work force, in critical areas such as police, fire, water and sewer services? Communications Communications in rural areas requires different means than in urban areas. How will we maintain communications credibility as the messages evolve? Policy Issues Will local government officials set the policies on the prioritization of medicine and vaccine? Who will make the decision to cancel fairs, conferences and conventions? Where will the money come from to pay for the preparedness and response? What is the authority of the local governing body or administrator on issues related to isolation and quarantine? What will be the affect of an economic downturn due to lost tax revenues? Whose role is it to prepare for mortuary affairs? Who will coordinate efforts - within a region - on public messages? How will we address the issue of evacuees coming from an area where pandemic flu may have started? What are the issues involved in force protection? Emergency Managers Health Directors What are the triggers that will cause a local government to declare a state of emergency? Who is tying local, state and business continuity of operations plans together? How will emergency managers and public safety respond when mutual aid may not be available? Are emergency managers considering how to amend emergency operations plans to include planning for pandemic? Who is working with local government emergency managers and local government departments and agencies to plan and prepare for a pandemic? Existing mutual aid agreements Who is preparing personal protection between local governments may not be equipment for employees? able to solve needs; what laws need to be considered in this event? Whose role is to educate the media? Who is responsible for coordination of communications between the local, state and federal governments? Who is preparing to communicate the messages to non-English speaking population? What are the pharmacy laws that impede a response to pandemic flu? Who will be responsible for getting people to come to work during a pandemic? Virginia Department of Emergency Management , Social Services, Private Sector, CDC, Economic Development & Tourism How will social services and private sector and others deal with the loss of personal income due to job loss, or having to stay at home from work? What will be the triggers that cause the Governor to declare a state of emergency? What will recovery look like? What plans need to be made to address the loss of tourists and income from tourism? How can we cross train and identify others with skill and resources to overcome absenteeism? Will it be the local health director who sets policy for the prioritization of medicine and vaccine for treatment? Whose role is it to prepare the public for personal protection equipment? What are the ethical issues related to pan flu decision making, such as, distribution of limited resources, personal protection equipment, etc. Who is addressing the "cry wolf" syndrome; "first it What will be the affect of unemployment was smallpox, then SARS, then anthrax, now pan insurance claims? How will we address supply flu..."? chain issues with distribution centers located in rural areas? Who is responsible for effective public health communications when the message is changing? Page 2 of 25 Healthcare Breakout Session - Virginia Pandemic Flu Summit - March 23, 2006 Communication / Media / Public Education Planning How will ill get guidance on when What if schools closed, etc, to they can return to work? prevent spread of disease? Staffing / Surge Capacity Can we do cross-training (in place, in advance)? Financial Guidance What about concerns about loss of There exists no effective and revenue from decisions such as comprehensive patient tracking suspending elective surgery. system to enable family to locate patient in healthcare system at any point in process including fatality management. Are we developing early risk communication plans? Identify special needs and at risk population and its leaders early. Will we provide education to Needs to be a regional effort. healthcare workers ahead of time? Provide childcare in alternate sites Concerns about the continued cost for healthcare workers of preparedness. Grant funds may have assisted with buying “things” and training, but there are sustainment, planning, and general preparedness costs. Use of non-healthcare workers, or How do we justify stockpiling? alternate use of healthcare What financial reimbursement can workers (e.g., to provide we expect? immunizations or provide traditional field scopes) Confusion on appropriate PPE; conflicting guidelines of when an N-95 is required. This should be clarified with single answer by public health/hospital consensus. Rationing of ventilators, pharmaceuticals requires a consistent policy Have a lead for communication – present one message, not necessarily one source, but provide day-to-day, not just during incident In-House laundry of linens is limited/ outsourcing of laundry and other logistics services to firms that may be at reduced operations due to flu illness will place extra burden on hospitals Provide pet care. Is the commonwealth going to subsidize (staff, supplies) rural areas? If staff may be confined or maintained on-campus for long duration, food and other support functions for sustained operations will be required. Provide a consistent message, Hospital concern that SNS carefully managed, again with a stockpile is not sufficient to meet lead. demand over long period of time Altered standards of care must be Production capacity of supply communicated. chain (medical supplies, equipment, meds, etc) is not adequate to meet extra demand and duration of crisis Clear communication to public Should we put money into a unit from public health/government that has negative airflow for just authority on the most appropriate influenza patients? Should we put action and source of treatment this into future planning? Scheduled communications (e.g., broadcast at a certain time each day) Encourage staff to do personal planning Attempting to prioritize vaccine distribution and anti-virals is inherently unfair and not a viable solution. Emphasis should be on the more practical implementation of high standards for infection control Why can’t there be a template? Surge capacity must be linked to available staff. Staff absenteeism will be caused by: Need to care for ill family members Why aren’t we already hearing from the health dept. how to call at home? Can the federal govt. set up strict guidelines on supply rationing? This concern is over-laid on an already existing nursing shortage and the trend that fewer physicians have association with hospitals for admitting/rounding. Guidelines for vaccine and med distribution need to be consistent NATIONWIDE. Page 3 of 25 Healthcare Breakout Session - Virginia Pandemic Flu Summit - March 23, 2006 Communication / Media / Public Education Generate effective messages to the public to self-treat, stay at home, or access care in outpatient setting. How do we engage citizens and inform them without panic? Staffing / Surge Capacity Provide additional support to hospital staff and their families in terms of available vaccine and treatment medications. N95 vs. surgical mask….where to Utilize hospital RN and other focus resources? clinical staff not presently involved with direct patient care to the maximum extent possible. Public awareness…Can we train How to provide antivirals? Utilize home health resources to the public as in churches, or civil augment hospital staff and/or help defense schools? treat patients at home Stress to the public what they can How can we get another, district Enroll hospital auxiliary do for themselves! or even regional level task force volunteers in staff support together? functions Meet with the media. PSA’s If schools close, how will this Physical limitations on space and NOW…so the public can get used impact workforce availability? equipment to the idea. Can we hold town meetings to Search for more efficient means of Resource sharing- utilize RHCC educate public and local officials? distribution. to maximize resource sharing among region hospitals and collaborate response (see cohorting above) We need a consistent media blitz How do we get the local officialks A surge in patients referred to or from public helath that must start involved? seeking inpatient care will clog up ASAP. the ERs. Celebrities to do messages to the Will we respect historical Triage and refer only most critical public? success?….quarantine---keeping to hospital sick out of community was successful in 1918 Need to have the video on the Pharmacists should be involved in Establish on-campus (but outside web. the planning and education. the hospital) triage areas to assess and re-direct patients to home or alternate treatment areas How can we educate children on Mass casualty…will need Many hospitals have limited the top[ic? refrigerated trucks. Identify cold storage space to stockpile storage facilites. additional supplies Critical to have media give the What about people who die at How would we provide staff to correct message! Keep people at home? Parents will not want the distribute antivirals? home instead of coming to the bodies of their children lying at ED. home! Communications/information Pharmacists should be involved in How would we handle staffing for sharing the planning and education. vaccinations, distribution, and investigation? Education about guidelines, Mass casualty…will need How do we care for healthcare prioritization, etc. refrigerated trucks. Identify cold workers and their families while storage facilites. they need to work? Planning Should we be proactive on physician fit-testing? Financial Guidance Vaccine dissemination Vaccine guidelines (should be mandated by the fed govt) Page 4 of 25 Healthcare Breakout Session - Virginia Pandemic Flu Summit - March 23, 2006 Lead/In Charge Will we have a lead day-to-day, not just during incident? Need to know who that lead is. Mental Health The behavioral health consequences of an extended life threatening circumstance will be significant. The physical an emotional stress on staff, families of staff, and families of patients will impact hospital operations. How will we deal with this? Waive or modify regulations for What about social issues? Mental the duration of the crisis? helath of patients and staff while loved ones ar sick or dying? Legal What about liability issues? Security Medical decisions may cause ethical dilemmas to which the public will react with outrage, even violence. What to do? Standards Of Care Will there be a mechanism to immediately create/amend/suspend regulations and standards? Protection of staff (fit testing, vaccine…) Alter care provided (e.g., d/c elective surgery) and reduce standards of care to free up healthcare workers Is unclear to most participants. Many can articulate jurisdictional EOC to state EOC process, but unsure if that is they way all decisions will be made. Example issues of concern include providing treatment guidance, authorization and establishment of standards of care, and resource allocation. Lead needs to be present for lower level emergencies as well. Examples given include anthrax threat responses, seasonal flu immunization shortages. Allow and legally protect Mental health…Need many Just-In-Time Inventory method providers as standards of care are support groups but won’t be able has drastically reduced stock altered to meet the needs of the to congregate. levels on hand over time crisis Not just altered standards of care, such as in reduced expectations, but different ways of doing things (e.g. different regulations, different work processes) Staffing concerns…Can we make credentialing less cumbersome? Safeguarding extra supplies from Modify the standard of care and theft is an added logistical burden normal processes to meet circumstance. Address liability issues for retired physicians. How are we going to ensure security of vaccine and antivirals while being transported throughout the state? Crowd control outside hopitals, and some places of business will be necessary. Maximize the efficiency of the treatment protocol by selecting the appropriate treatment modality Department of Regulations should expand renewal of licenses. Will those on the frontline have immunity from lawsuits? Modify diversion management and patient referral protocol for duration of crisis Manage in outpatient setting with instruction to return home How will we sustain employee benefits and wages? In a PanFlu surge environment, maintain the highest possible standard of infection control. This should be of the highest priority in terms of treatment process regardless of other compromises made to the standard of treatment Page 5 of 25 Healthcare Breakout Session - Virginia Pandemic Flu Summit - March 23, 2006 Lead/In Charge Legal Mental Health Security Standards Of Care Continued Demand over long duration of Outbreak When do we alter the standards of care? Do we have the support of the legal system? Healthcare needs to realize that we are not going to meet community expectations. Page 6 of 25 Business Breakout Session - Virginia Pandemic Flu Summit - March 23, 2006 Planning Companies, particularly small businesses, cannot accommodate normal operations with significantly reduced staff. Businesses will need to understand they must consider a degradation in service, e.g., curtailment of hours or suspension of operations. USPS should consider reduced delivery schedules (e.g., mail delivery every so many days), particularly in rural areas, where backup personnel may not be able to fill absentee positions. Employers require guidance on sick leave policies, e.g.: > When should a worker stay at home and return to work? > If one person in a residence is ill, should all residents stay home? > Can an employer force an ill worker to stay at home? > Workers may have insufficient leave to cover an extended absence and therefore may return to work inappropriately so as to prevent a lapse in income. > What should be the policy if someone has no sick leave? Paid time off? No pay? Employees who normally travel may be unwilling to do so due to risk: > Efforts should be undertaken to increase the use of VTC/telecommuting where possible. Will this be a problem for IT systems? Telecommunications infrastructure? > Advisories on unsafe or highly infectious areas should be made widely available. Small businesses have no resources to conduct planning/generate plans. Is there a mechanism to post plan templates, hopefully from larger businesses, so smaller businesses can review them and get ideas? Personnel State agencies should be prepared to share personnel across agency lines, if needed to maintain essential services, and to collaborate on leave policies to ensure consistency and commonality. Businesses must identify critical positions needed to maintain minimal operations, and create depth/backup for those positions. Communications What actions should the public take, or not take, when encountering dead birds/fowl? Who will be responsible for collecting and disposing of carcasses? Consider use of retired personnel to supplement work base – a “surge capacity” for absenteeism. This may help achieve depth and meet licensure requirements. The food service industry is a large component of the local tax base. Extraordinary efforts must take place to ensure personnel are educated on safe food practices, infection control measures, etc. There is concern that pandemic influenza State regulation regarding absenteeism from can be transmitted on mail products. Can this work due to flu and when allowed to fire occur, and should mail handling personnel similar to the Medical Leave Act. wear PPE to protect themselves? Legislation Should regulatory standards be weakened to accommodate a smaller and potentially untrained workforce, or should they be tightened to ensure illness does not occur from unsafe practices? Is an employer potentially liable if they permit the Health Department to give vaccines or antivirals to their employees? How will we be advised to handle staff who may become exposed as part of their job; will we keep them at the worksite to spare them exposing their family? Could or should we test employees? If so, with what? Who gets access to the results? Attendees expressed that higher levels of management were generally unaware of pandemic flu concerns as they relate to business, and those attendees do not know how to convey these concerns up the management chain. How does lower level management sell the need for planning to upper management? Businesses request one single source from which to obtain current, reliable, up-to-date information. What is that source? Can there be an electronic bulletin board? Will there be a hotline for people with questions to call (or email)? Interactive website? Retail Merchant Association, Chamber of Commerce Will the state supply procurement laws change to allow for a different set of laws during times of urgency, not emergency. Are there federal programs to compensate me for business losses due to pandemic? Page 7 of 25 Business Breakout Session - Virginia Pandemic Flu Summit - March 23, 2006 Planning Employees will need to receive pay, even if they cannot report to work to pick up their checks. Direct deposit is needed for small businesses, but it is too expensive. Can financial institutions make any provisions and provide assistance for this situation so as to make direct deposit affordable for small businesses? People need to be encouraged to make use of electronic banking. When is it acceptable to degrade services? Personnel Communications Legislation What do we do with an employee who reports to How long is the flu virus viable outside the During a pandemic, will contractual terms still work when he is sick; or we know he has a body? Does ordinary sanitizer kill the virus? apply? Do contracts need to be regnegotiated family member at home sick; even if we told prior to event? them to stay home? How long can we expect someone to be out sick? Will I need to clean or disinfect anything in my business: Pakcages received, work surfaces, vehicles? When is it acceptable to relax regulatory compliance? It may not be possible to conduct required QA oversight, documentation, etc. with reduced staffing. Also, minimum required standards are needed. For example, a restaurant may not have time to deal with a little mold, but food temperature needs to be maintained to ensure food safety. Will borders be closed and supply lines through entry points shutdown due to a pandemic? What should businesses purchase for the protection of their employees? Should they stockpile PPE such as masks, gloves and hand sanitizer? If so, when should they be given to employees and what information is available on their proper use? Can employers mandate that employees receive flu shots? Guidance is needed for Childcare facilities. When should they be closed and when can they remain open? Should businesses providing childcare facilities be encouraged to provide additional space so parents can still report to work if their children are ill, or close them so ill children are forced to stay somewhere else? Can schools be required to remain open so parents who are needed to provide essential services can continue to come to work? Does business insurance cover a pandemic situation? Will insurers adjust premiums down if companies have an emergency response plan that includes a pandemic annex? If a pandemic, what legal responsibilities does a business have to provide a reasonably safe workplace? What are the HIPPA issues involved with identifying and "social distancing" employees. We operate in VA, MD and DC. Will public health agencies have the same message? Are websites used to gather public information equipped to handle the massive surge for information following an outbreak? How can we reduce panic, rumors, and unnecessary absences due to fear vs actual illness? Page 8 of 25 Business Breakout Session - Virginia Pandemic Flu Summit - March 23, 2006 Planning Home delivery services, such as food delivery, may need to expand to accommodate the community’s need for food and pharmaceuticals versus not wanting to expose themselves in stores. How can businesses participate in community wide emergency planning? Who is responsible for ensuring that smaller drinking water systems remain online and distribute safe drinking water. Businesses need to understand they must prepare for the worst case scenario, and with flu, that means to prepare for multiple waves, not just the first. Assistance is needed on crafting personal protective messages for the work place: > Hygiene messages; PPE needed > Basic hygiene supplies, e.g., tissues; alcohol based hand sanitizer; ample waste baskets Do we have employee support systems EAP's) and strategies for sustained behavioral health support of employees Our soscial service systems will be overwhelmed due to increased need for services; where can we go to get additional personnel? Do we need to track those already infected and recovered and do we have a plan to utilize them once they would be considered immune What should we stockpile for our employees? Particularly those in customer service roles. What forecasting models can we use to predict workforce reduction in regional areas? Should we purchase tamiflu now? How/Should we prioritize who gets it in our business? Will businesses be expected to help distribute vaccine and anti-virals? How do we integrate third party management vendors in infrastructure planning? How do we insure IT/Infrastructure security and protect against fraud with a large # telecommuting or remote work force. (HIPPA, GLBA) Are there stages of alert for a pandemic? Here are some available website resources for examples and templates on writing plans: www.OHDEN.net/pandemic www.ready.gov; www.Region.halton.on.ca www.MOH.govt.nz/pandemicinfluenza Personnel Communications Legislation Page 9 of 25 Higher Education Breakout Session - Virginia Pandemic Flu Summit - March 23, 2006 CATEGORIES and PRIMARY AGENCY Planning VDH, DHP and What supplies should be stockpiled in advance and CDC at National how? What should individual institutions do in terms of Level Personnel Communications What can a community reasonably expect of an institution in the case of a pandemic, and visa versa? How can conflicts be resolved if an institution and its community differ in expectations? What guidance does the state have on preparedness and follow-up? Legislation What can be done to expedite the production and dissemination of rapid testing options? OCME ordering, receiving, and warehousing them? What guidance is available for obtaining substitute staff and supplemental resources? What drives the decision to keep a school or college open or closed; and who makes the decision? How should institutional plans further reflect federal and state directives? How is support to be requested and received should mass casualties result? Attorney General's Who provides final guidance on use of N-95s? Office Governor's Office What guidance is available for obtaining substitute staff How will community colleges obtain access to medical care? and supplemental resources? What should be the form and content of our written pan flu plan? Which buildings can be used for quarantine, and how will they be managed and monitored? How can needed partnerships with foundations and affiliated groups be determined and documented? What memos of understanding need to exist re. interface between school clinics and hospital emergency rooms? How can our essential services (infrastructure) be protected and their continuity of operations sustained during an outbreak? How might we enable telecommuting, and tele-educating? All Individuals and Is it possible to reach concensus in advance that students must leave campus whenever classes are Agencies cancelled for an extended period of time? Employers How can existing contracts with vendors be preserved and supplemented? Which personnel and services are considered "essential" ; what are the implications? What work assignments are capable of being re-assigned? Can students be designated as volunteers? What can a community reasonably expect of an institution in the case of a pandemic, and visa versa? How can conflicts be resolved if an institution and its community differ in expectations? What strategies and timelines would work best for communication to and from the school with parents, students, staff, community, and the state? In what ways will we attempt to positively influence student behavior, and with what consequences? Will state law need to require when reporting to work -- or not reporting to work -- is manditory? How can loss of income, customers, and constituents be offset? How will benefits be administered? What role will the state play in limiting international travel during a pandemic? How will the vaccine be acquired and distributed, and for whom it will be required or optional? How can we further access and influence guidelines to be issued by the American College Health Association? Page 10 of 25 Schools Breakout Session - Virginia Pandemic Flu Summit - March 23, 2006 CATEGORIES and PRIMARY AGENCY Planning Policy What criteria will be used to determine when to close VDH and CDC How will schools be utilized in a pandemic? schools? at National If schools are used as emergency centers, what supplies Level would the schools need to have? Who will prepare pandemic flu plan? Need clear guidance for school attendance for sick. How to be sensitive to diverse populations in crisis planning? How is the flu diagnosed? Is there funding/grant available? Who will determine who gets medication/vaccine? Personnel Students How do we know whether we have well or sick children? Will there be cooperation between health department and schools (ie report daily attendance and reasons for absences)? Do schools have the ability to continue educating students when schools are closed by alternative teaching methods? How can schools assist non English speaking families? What will happen when schools close and parents are still working? Communicatons/Education What will schools do to encourage parents to keep children in school as much as possible? How to provide prevention education to teach parents when not to send to school, to teach custodial staff about cleaning, and children about handwashing? How to communicate across the board about preparedness? How to conduct timely and accurate community education? How to manage the media? How would the school nurse deal with children that are sent to the school with the flu? VDEM Who will determine pandemic? How will schools be utilized in a pandemic? How will schools store of food and water if a school is quarantined and kids/staff kept at school? How will schools practice their role in a pandemic flu emergency? How to be sensitive to diverse populations in crisis planning? Will schools have medical supplies in case children can’t go home? How will schools deal with lost instructional time and Will schools make AYP because of attendance rates? maintaining continuity? How to convince the district that a plan is needed? Is there a component to address pandemic flu in crisis plan? What will be the affect of SOL’s on students? Would extended absences be made up? Is there a model crisis plan at state level that includes pandemic flu? What will be the policy for school nurses handling illness? How will schools practice their role in a pandemic flu emergency? How to communicate across the board about preparedness? DOE Do schools have the ability to continue educating students when schools are closed by alternative teaching methods? How to consider needs of seniors – ie. SATs and graduation? How will schools deal with children moving between districts/states? How to educate administrators about disaster plans? How to communicate across the board about preparedness? How to be sensitive to diverse populations in crisis planning? School board Is there a plan for staff reduction due to illness? What will be the absentee policies for students and staff? Is there a plan for staff reduction due to illness? How would the school nurse deal with children that are sent to the school with the flu? Need clear guidance for school attendance for sick. Will “perfect attendance” be reassessed when students not at school until fever free? What will be the affect of SOL’s on students? Would extended absences be made up? Will schools pay full salaries for school staff if schools closed? or district How will schools deal with lost instructional time and maintaining continuity? Is there a component to address pandemic flu in crisis plan? How will schools practice their role in a pandemic flu emergency? How to be sensitive to diverse populations in crisis planning? Will purel gel be installed in classrooms? Is there funding/grant available? Will there be cooperation between health department and schools (ie report daily attendance and reasons for absences)? Do schools have the ability to continue educating students when schools are closed by alternative teaching methods? How to consider needs of seniors – ie. SATs and graduation? Are the administration, staff, students and parents educated about the crisis plan? How to communicate across the board about preparedness? Page 11 of 25 Schools Breakout Session - Virginia Pandemic Flu Summit - March 23, 2006 CATEGORIES and PRIMARY AGENCY Planning Superintendent How will schools continue quality operations when they have sick staff? How will schools continue quality operations when they have sick staff? How will schools practice their role in a pandemic flu emergency? How to be sensitive to diverse populations in crisis planning? How will schools be utilized in a pandemic? How will schools store of food and water if a school is quarantined and kids/staff kept at school? Are there hygiene measures and proper supplies (ie, soap, sanitizer, paper towels, etc)? How to deal with grief issues and loss of life? Who will prepare pandemic flu plan? How will schools practice their role in a pandemic flu emergency? How to be sensitive to diverse populations in crisis planning? How is the flu diagnosed? Will schools have medical supplies in case children can’t go home? Policy What criteria will be used to determine when to close schools? What will be the absentee policies for students and staff? How would the school nurse deal with children that are sent to the school with the flu? Personnel Students Do schools have the ability to continue educating students when schools are closed by alternative teaching methods? What will happen when schools close and parents are still working? Communicatons/Education What will schools do to encourage parents to keep children in school as much as possible? Are the administration, staff, students and parents educated about the crisis plan? How to communicate across the board about preparedness? How to conduct timely and accurate community education? Schools How should schools track of absences for students and staff? How should schools track of absences for students and staff? Do schools have the ability to continue educating students when schools are closed by alternative teaching methods? Who will transport sick children? How to provide prevention education to teach parents when not to send to school, to teach custodial staff about cleaning, and children about handwashing? Whose responsibility is it to educate the parents about the plan? How to communicate across the board about preparedness? Can schools’ websites be used to communicate emergency procedures? How to manage the media? How to educate community in a rural area when there is not a big media market? Federal, State How will schools be utilized in a pandemic? and Local Governments Who pays for the cost incurred for decontamination by outside vendors? Are there hygiene measures and proper supplies (ie, soap, sanitizer, paper towels, etc)? Will food services (free & reduced meals) continue if schools closed? How will schools deal with lost instructional time and maintaining continuity? How will schools practice their role in a pandemic flu emergency? How to be sensitive to diverse populations in crisis planning? Will schools have medical supplies in case children can’t go home? How is the flu diagnosed? Will schools make AYP because of attendance rates? What will be the absentee policies for students and staff? Who will determine who gets medication/vaccine? How to deal with children moving between districts/states? How to communicate across the board about preparedness? Parents Local physcians DSS Who will provide care for students with special needs? Who will transport sick children? Who determines if child is well enough to go to school? Who will provide care for students with special needs? How can schools assist non English speaking families? If schools are used as emergency centers, what supplies How would the school nurse deal with children that are would the schools need to have? sent to the school with the flu? Page 12 of 25 Schools Breakout Session - Virginia Pandemic Flu Summit - March 23, 2006 CATEGORIES and PRIMARY AGENCY Planning Red Cross If schools are used as emergency centers, what supplies Faith based community DMHMRSAS Media Unassigned would the schools need to have? How to deal with grief issues and loss of life? How to deal with grief issues and loss of life? Policy Personnel Students How can schools assist non English speaking families? Communicatons/Education Whose responsibility is it to educate parents about the plan? Can teachers be motivated to volunteer to help if schools Should all siblings of a sick child stay home? Can teachers be motivated to volunteer to help if schools are are closed? closed? Will snow days be used when schools are closed? If schools are opened as medical facilities, who will staff? How do we deal with the workforce not showing up? Are parents notified if a classroom is exposed to flu? Are How will schools deal with the possibility that schools they quarentined? How to educate school staff about pandemic flu before the event? won’t function and that plans may not be followed? Can schools get preauthorization to give children Will school nurses be available to give medications to the Is there a tracking system for flu illnesses? medications? community? Who are the key players during a pandemic flu emergency? When will isolation and quarantine impact schools? What will schools do with immunocompromised students? Are there community resources (such as volunteers) available to help schools? Where does allegiance lie for Medical Reserve Corp members? Does the school have a good relationship with the local health department? Who will pay attention to CDC’s website for case definitions and standards of care? Can schools develop partnerships with workplaces or get community support in the care of a sick child? Will schools educate students about pandemic flu? What can schools do to guarantee low income children have How to convince parents to keep sick children home? meals? Who does communication about absences go to? How can schools ensure culturally sensitive education? How will schools communicate with private physicians? How will children be transported to services? What will happen when schools close and parents are still working? How can we prevent congregation on days out of school? How will students cover the cost of vaccine? Page 13 of 25 EMS Breakout Session - Virginia Pandemic Flu Summit - March 23, 2006 CATEGORIES and PRIMARY AGENCY Planning VDH Pan Who will make certain Fire/EMS personnel are at the top Flu Comm of the inoculation list? - Needs of family? State Plan - Define family Commercial Services - Why weren't they included in the Summit? They must be included in the planning. Interoperability of Plans - Regional Plan - CERT - MMRS - Consolidation Personnel Communications Legislation VDEM Jurisdictional State Local VDH Dept of Ag Fire/Involvement - hospitals and professional health VDH providers are already notified - what about EMS and OEMS Fire? - Planning - training and exercising - Notification Policies and Procedures - Triage - Infection control - sustain? Non Traditional Methods for Work Force Surge Capacity - First Responders/EMS - Personnel - staffing considerations - Equipment Trigger in Standard of Care - Who's the decision maker? Local Agencies Local Facilities Regional and State Facilities Local Page 14 of 25 EMS Breakout Session - Virginia Pandemic Flu Summit - March 23, 2006 CATEGORIES and PRIMARY AGENCY Federal, State Workforce Issues and Local - Accountability - Family Planning Governments Planning Personnel Employment - Prioritization - who do you belong to? - Day Job/Night Job? Education - Public, Public Safety - Families - Education on surge capacity - 1st responders - protocols, what to say to public, where they fit in the ranking of getting vaccines (volunteer vs. pd) - Notification process Crisis Management -Stress management- pre and post incident - Workforce family related death Volunteer Workforce - Availability - Interoperability - Roles and Interaction - CERT / MMRS Communications Communication - Planning - intelligent - Information - Credibility - Flow and Dissemination - Disconnect between VDH/EP&R and Fire/EMS (Particularly in NoVa) Legislation - Rehab - Sheltering of Workforce Who prioritizes FIRE/EMS Mission? - Federal, State, Local Transportation - Alternate sites (non-traditional) - Who do you transport – protocols - Mutual Aid Logistics Support - Re-supply – funding and source - Stockpile vs. manufacturing – local manufacturing of PPE – gloves, masks etc… Who, What, Where and How? - Who's got the money? As hospitals reach capacity what about... - Turn around times - Diversions - How to address Look to military triage as an example of how to handle triage Risk Management - Workman's Comp -Service Degradation -Mass vaccination -30% rule the same for public safety? Liability Infection Control -Standards Change? - If so how? State of Emergency - Local, state and federal Linking 1st Responder - Surge Planning with Hospital and Public Health Federal, State and Local Governments (cont.) Page 15 of 25 Comm & Volunteer Breakout Session - Virginia Pandemic Flu Summit - March 23, 2006 CATEGORIES and PRIMARY AGENCY Planning VDH, DHP and How are we planning for real time CDC at National credentialing of volunteers? Level What steps are being taken for a seamless response? Personnel How will unaffiliated volunteers be integrated into the system? Communications How do we get the mental health message out in appropriate language? Legislation Can we identify specific roles for volunteers and What is our mechanism for delivering timely train for those? and accurate information? How do we coordinate them? What about logistics of supplies - who has How do we avoid double-dipping of volunteers? what, where? How/what should we communicate to the Is it realistic to rely on volunteers - what do we public now? Will there be a plan for the distribution of do when we run out of them? medicine (priority order)? How do we communicate to people that How will we use National Service (AmeriCorps) tough decisions will need to be made? What do we use for a platform for volunteers? planning? How will scientific communitieis get out What specific training do volunteers need? best practices? How can we help disadvantaged groups to prepare now? What are the plans to recruit volunteers for Who will be responsible for the Pan Flu preparedness? hotline? What resources are we offering private MDs to help their patients? How will we make volunteers feel safe? Can we show the Pan Flu video to all middle schoolers in Virginia? How can we use technology to deliver What are we doing about volunteer program care? sustainment? How do we really get communities engaged in planning? Would we use VDEM and rapid assessment teams? What will be done with pets during a pandemic? Who will be coordinating all volunteers resources? How are we planning for real time credentialing of volunteers? What regulations need to be changed in an event? Will we develop standard medical protocols for Health Professionals for the Pan Flu? VDEM What specific mental health training do volunteers need? Will the state activate CERTs and how will they Are we prepared to send out info through the How are we planning for real time be used? emergency broadcast system ? credentialing of volunteers? In pandemic, what training will be expected of volunteers? What language will media materials be in? How do we start to coordinate, consolidate How can we be sure the volunteer resources will and communicate? be used by response agencies? What is our mechanism for delivering timely How do we start to coordinate, consolidate and accurate information? How do we and communicate? coordinate them? How can we avoid Katrina mistakes with beaurocracy? Page 16 of 25 Comm & Volunteer Breakout Session - Virginia Pandemic Flu Summit - March 23, 2006 CATEGORIES and PRIMARY AGENCY Planning Personnel Communications STATE EOC How do we access resources for the infirm How will we use National Service (AmeriCorps) How will we distribute low literacy info to and immobile? volunteers? rural and local communities? What governs leadership roles in chains of How will unaffiliated volunteers be integrated authority? into the system? What is the central message for volunteers to put out to their group members? Legislation Who's in charge of categorizing needs and How can we be sure the volunteer resources will Will there be a structure of chain of resources? be used by response agencies? command to coordinate messages? What about command and control conflicting at all levels? How do we avoid redundancy with agency efforts? Are there any plans to teach nursing care Could ARC coordinate the education of to home family members? volunteer groups? Could ARC coordinate the education of volunteer groups? Can we educate families in personal and family preparedness? What if there is a concurrant disaster sheltering? How do you handle bodies of those who die at home? How do we handle the magnitude of dead bodies? What role will churches play? How do we coordinate all the different volunteer groups? How do we increase the number of volunteers? How will volunteer groups work together? What is the role of volunteers to help homebound and non-medical isolated populations? How can volunteer organizations stay financially viable with increasing demands? How will we make volunteers feel safe? What is our mechanism for delivering timely and accurate information? How do we coordinate them? ARC OCME VOAD Page 17 of 25 Comm & Volunteer Breakout Session - Virginia Pandemic Flu Summit - March 23, 2006 CATEGORIES and PRIMARY AGENCY Attorney General's Office Planning Personnel Who is liable for volunteer groups? Communications Legislation Who is responsible for resolving disputes in communities? What regulations need to be changed in an event? Governor's Office If things are really bad can we expect marshall law to be declared? How can we insure that all areas of the state are included in the planning? What about command and control conflicting at all levels? How do we help governments understand what volunteers can do? Could volunteers be compensated during long term events? How can we pass laws/rules ahead of time to prepare? Can we show the Pan Flu video to all middle How can we pass laws/rules ahead of time to schoolers in Virginia? prepare? How/what should we communicate to the public now? How do we communicate to people that tough decisions will need to be made? Can incentives be provided for businesses and communities to participate in Pan Flu planning? Could there be compensation for volunteers during long term crisis events? How can preparedness planning be integrated into SOLs? What regulations need to be changed in an event? Page 18 of 25 Comm & Volunteer Breakout Session - Virginia Pandemic Flu Summit - March 23, 2006 CATEGORIES and PRIMARY AGENCY Planning Federal, State Do we know and understand each groups roles? and Local Governments How do we make sure all citizens get the help they need? How do we provide resources for homebound population? How can we help disadvantaged groups to prepare now? How do we avoid panic? How do we deal with citizens in rural areas not taking the threat seriously? Who is planning for cultural differences? What plans do governments at all levels have for workng together? How do we overcome the reluctance in communities to convene all the stackholders for a community advisory committee on Pan Flu? How will volunteer responders be Ided? How do we involve employers in the planning process? Have all business completed continuity of business planning to prepare as needed? Dead birds - how will the public handle this? Personnel How will we make volunteers feel safe? What are we doing about volunteer program sustainment? Can communities be divided into sectors for volunteer service? Communications How do we reach and educate those with physical and mental needs? How do we overcome language barriers? Do we know and understand each groups roles? How do we start to coordinate, consolidate and communicate? What is the best way for communities to ID and educate or inform disabled population groups? Will we have necessary resources in our communities for sustainment? How do we get the mental health message out in appropriate language? How can we be sure the volunteer resources will be used by response agencies? How can preparedness planning be integrated into SOLs? Legislation Employers Will health care employees be available to volunteer? Should business be required to complete continuity of business planning to prepare as needed? Game and Fisheries Who will provide hunter education and information on bird handling? Page 19 of 25 Comm & Volunteer Breakout Session - Virginia Pandemic Flu Summit - March 23, 2006 CATEGORIES and PRIMARY AGENCY Planning Personnel All Individuals How do we avoid redundancy with agency How do we keep volunteers and members engaged before an emergency occurs? and Agencies efforts? How do we maintain contact with volunteers over time? How do we help volunteers maintain their skills? Will volunteer actually respond? Is it realistic to rely on volunteers - what do we do when we run out of them? Can we identify specific roles for volunteers and train for those? What are we doing about volunteer program sustainment? How do we avoid double-dipping of volunteers? How will we perform background checks on volunteers? How can we help disadvantaged groups to prepare now? Communications Legislation Page 20 of 25 Planning How do we prepare for something that may last 6 to 18 months ? What can we learn from other disasters ? What do Officers need to protect themselves ? Ie gloves,mask Develop policy for who is jailed during this time. Infected jail population Liability umbrella for work outside their normal activities. Need leadership training for quick decision making What policies will be enforced and which waived. How will that affect services When disaster occurs, we are most vulnerable to a terrorist attack. Plan to work with Public Health and EMS providers Train judges and clerks in prevention and decon Identify early those that in community could help..... Deal with "worried well" from another state if pandemic is not in VA. Cleaning of equipment between shifts Prepare community to be prepared to deal without normal services Personnel When/How would the National Guard be used ? How to handle workers comp/on duty exposures Testing of personnel to assure they are not spreading flu? How to sustain staff during this time Don't count sick leave during a pandemic situation Provide counseling for stress injuries to first responders Force Officers to take time off to stay healthy Recruitment will be difficult because of flu Family preparation/Officers away from home/family sickness Law Enforcement and Judiciary Federal,State, and Local Governor's Office Training from VDH for Decon Isolation and Quarentine Dispensing of Medications/Keeping crowds under control What is Health Departments Plan for flu VDH Law Enforcement Vaccine security Priority for Officers to receive flu vaccine Mass burials Who covers cost of burials for homeless victims ID, Transport, and storage of deceased flu vicitms OCME Law Enforcement Communications Can we trust the media to provide good information Public notification of related information How do we keep communications open ? What role does Law Enforcement play in public education before Pandemic ? Use Incident Command Work with Joint Information center to control message and coordinate efforts and resources. Work with media to control messages Legislation Martial Law Issues around protecting court system, use video for proceedings Duplicates Medical Training for Officers Staffing Unified Command/Command Which laws do we enforce and which do Structure we waive. Vaccine Distribution Medical treatment to juviniles Isolation and Quarentine Infected people from other states coming to Virginia Medication and treatments to Officers Equipment decontamination Communications between agencies and governments. Call priorities Increase in crime Equipment and supply shortages Priority for other Public Services Mass fatality management Management of prisoners in jails and DOC who are sick Assisted Living Breakout Session - Virginia Pandemic Flu Summit - March 23, 2006 CATEGORIES and PRIMARY AGENCY VDH, DHP and CDC at National Level Attorney General's Office Planning Personnel ·Training for staff is needed on infection control, specimen collection (Health Dept) Communications Legislation • Will Good Samaritan laws apply if facilities provide care to non-residents during a pandemic? • Fraudulent claims for care Federal, State and ·Coordination of water, food, power(generators) & Local medical supplies/equipment Governments CSB All Individuals and Agencies Agency Not Specified ·How can we access psychiatric services? • Will regulations change to allow facilities to use nonnursing staff in nursing capacity? (all State agencies) • How will we keep families involved? • What is the availability of transportation of the dead out of the facility when there is no cold storage? • Will resident choice for mortuary services be honored? • Will masks be available? • How can LTC facilities get, on short notice, adequate amounts of medical supplies, equipment and pharmaceuticals? • How will hazardous waste be managed? • How can we procure generators, extra medical medical supplies and medications? – partnerships w/vendors • What are the needed state & local policies that support the coordination of efforts to manage a pandemic? MOUs? • Has Social Services identified licensed and nonlicensed facilities? • How will resident’s rights to medical services and safety be protected? • How will sick and well be segregated? • How will vaccine administration be prioritized? • Who will control and distribute vaccine? • Education and decision making about practices/policies if process is extensive • Will guidance be given to facilities on how to make triage decisions? • Who’s in Charge? • Who does health director contact? • How will guidance on restricting visitation & quarantine of new admissions be communicated to facilities? • How do you keep the well population healthy? • How do you communicate the need for social • Is there physician support for medical management of • Importance of handwashing residents? • How will vaccine availability and priority be • Who writes medical orders for residents? communicated? • What is the role of health departments in sending statistics to facilities? • Accurate and consistent messages • Fear, rumors among residents • Communication technology and information • How will coordination take place between Veterans Administration, state and contract nursing homes? • Information is needed in a usable format. • Adequate staffing: medical, direct care, food service • Ability to get staff on short notice • What do we do about health care providers abandoning their patients? • Who will do fit testing for N95 masks? • Will we have the ability & resources to care for residents/patients who would normally be sent to hospitals? • How will consent for treatment be handled if no guardian is available? • Will Medicare/Medicaid regulations on documentation be flexible during a pandemic? • How does a facility protect itself against law suits when large numbers of deaths occur from a pandemic? Page 24 of 25 Assisted Living Breakout Session - Virginia Pandemic Flu Summit - March 23, 2006 CATEGORIES and PRIMARY AGENCY Planning • How do we make sure our facilities/services (nursing homes, asst. living, home care, continuing care retirement comm., hospice) are not overlooked, especially for release of vaccine or antivirals? • How do we triage and transfer patients to hospitals and readmit them to LTC during a pandemic? • Facilities may be closed to admissions • What isolation & infection control measures will the patients accept & adhere to? • Building structure/layout is not conducive to isolation • Nursing homes should have standardized plans throughout the state • Staff needs & staff’s family needs (urban vs. rural) – transportation, medication, housing, food • Security is needed for non-hospital medical facilities • What should facility plans include? • What plans do facilities have in place? • Do disaster plans need to change to reflect priority for pandemic flu planning? • Staying current with planning and preparation with turn over of staff • Where will money come from for planning/training/supplies for assisted living facilities? • LTC needs to be in regional coordination • Development of quick test for facilities to determine H5N1 strain. Personnel Communications • How will information be distributed in rural areas? • Will large print/Braille information be available? • How will HD and facilities communicate regarding symptoms? • Central office want statistics immediately and regularly • How will we confirm H5N1 as apposed to other strains? Legislation VDEM STATE EOC ARC OCME VOAD Governor's Office Employers Game and Fisheries Page 25 of 25