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									  New York State
Department of Health

HANYS' Nursing Home Emergency
  Preparedness Webconference

         May 9, 2007
Avian Influenza Situation Report
 Spreading prevalence in migratory birds

 Continued outbreaks among domestic poultry

 Mammalian infection (cats, pigs, etc.) lethal

 Virus is evolving

 Sporadic human cases (more than 170 reports to
     • Most in the young and healthy
     • Case-fatality 50%
     • Rare person-to-person transmission
Pandemic Influenza Planning

   Supposition: Hospitals will be beyond maximum capacity & staff will be
   There will have to be decisions made at the state level to alter
    standards of care

   Typical incubation
       2 days
       Range: 1-4 days

   Viral shedding
      Can begin 1 day before symptom onset
      Peak shedding first 3 days of illness
      Subsides usually by 5-7th day in adults
           can be 10+ days in children
 Nursing homes should focus planning on enhancing ability to:
        accept more fragile, sicker patients from hospitals

        retain their residents

        surge beyond licensed capacity

 How?
To be reviewed & reinforced with staff:

 Disease prevention strategies
 Infection control techniques
 Hand washing
 Cough etiquette
 (include residents!)
 Identification of symptoms to:
            Promote early detection
            Minimize spread
What to expect?
Staff grief & exhaustion

o Admission of sicker residents/patients
o Altered standards of care
o Retention rather than transfer
o Surge
o Potential for significant increase in resident mortality

Staff should be monitored closely for stress &
  intervention should be made available as
HAN & the Communications Directory

       are the official NYSDOH
              alerting system
              for emergencies
       Health Alert Network
   Contains information about disaster preparedness
   Contains articles & web site links
   Posts current health advisories & alerts
            Avian flu
            Lead poisoning
            Meningococcal disease
            Polio in Minnesota
            Rabies in Texas
            9/15—to ACFs, Nsg. Homes, LHDs—Bagged fresh
            Alert to vets re: psittacosis

   HAN library
from a variety of sources, including:

 New York State Department of Health (NYSDOH)
 New York City Department of Health and Mental Hygiene
 New York State Office of Homeland Security (NYSOHS)
 Centers for Disease Control and Prevention (CDC)
            HAN Health Notification Viewer
            AUDIENCE                              DATE           DOCUMENT
     SOURCE TYPE            DESCRIPTION           POSTED         CREATED      RECIPIENTS

     NYSDOH ALL USERS       E. coli Outbreak      Sep 19, 2006 Sep 19,2006 Recipients
     ,                      Linked to Fresh
                            Spinach: Update #1

     CDC       ALL USERS    Botulism Toxin Type A Sep 29, 2006 Sep 29,2006 Recipients
                            associated with
                            bottled carrot juice in
                            FLA and GA

   , Click RECIPIENTS: LHD Commissioners/Directors| NYS| All Hospital CEOs| NYS| All
    Hospital ICPs| NYS| LHD Dir of Disease Control| NYS| All Hospital ED Directors| NYS| LHD
    CD Investigative Staff| NYS| Epi Informational List| NYS| Hospital Food Prep| NYS| Hospital
    Food Directors| NYS| Hospital Risk Management| NYS| LTCF Food Service Directors| NYS|
    Adult Homes Administrator| NYS| Adult Homes Food Service| NYS| Adult Homes HPN
    Coordinators| NYS| LTCF Administrators| NYS| LTCF Directors of Nursing| NYS| LTCF
    Medical Directors| NYS| LTCF ICP| NYS
   Click DESRIPTION: Detailed description of alert
HPN Communications Directory

The purpose of the Communications Directory is to have
  the most current & accurate contact information
  available in the event of an emergency
NYSDOH will rely upon this data’s accuracy, which is
why your diligence and participation in maintaining current
information are vital to the success of the Directory. It is
expected that updates will be made on a periodic basis.
    Section 400.10 HPN Access & Reporting
   HPN accounts
   Ensure that sufficient, knowledgeable staff will be available
   Maintain & keep current such accounts
   At a minimum, 24/7 contacts for emergency communication & alerts
    must be designated
   Sufficient staff users to ensure rapid response to requests for
    information from NYSDOH and/or LHD
   Current & complete updates reflecting changes to general
    information & personnel role changes as they occur
   At a minimum, on a monthly basis
Emergency Response Coordinator

Individual(s) who serves as coordinator of a facility's emergency
   operations center

What roles should serve?
Director, Nursing…
Director, Safety/Security…
Plant Manager…
   For NYSDOH business hours contact information, call the
         NYSDOH Regional Office
      For non-business hours the NYSDOH contact is the
                         NYSDOH Duty Officer
                                  @ 866-881-2809

   Contact numbers should be current and available to key staff 24/7
     Communications Directory Drills
                 Scheduled for June 2007

   Roles to be contacted:
          o Administrator

          o Designated Pharmacist

          o Director, Nursing

          o Director, Patient & Family Services

          o Director, Safety/Security

          o Emergency Response Coordinator

          o HPN Coordinator

          o HPN Organizational Security Coordinator

          o Infection Control Practitioner

          o Medical Director

          o CHRC AP

          o 24 hour contact [found in Emergency Contacts (Any Time)]
Drill Purpose

 Evaluate & ensure accuracy of Communications Directory
 Evaluate provider response to NYSDOH notifications to
  emergency contacts identified in the Communications Directory
 NOTE: Continuous non-compliance will result in deficiency
Collaborate with planning partners

   May mean meeting some for the first time
         Regional Resource Center (RRC)

         LHD (Local/public Health Department)

         Office of Emergency Management (OEM)
Regional Resource
Centers (RRCs)

                    Greene   Columbia
HANYS Deliverables 2006 to 2007

 Deliverables
  •   Tasks to be completed with specific outcomes,
      timeframes, & target audiences
  •   Reporting to NYSDOH
 Categorize regulatory barriers to emergency preparedness &
 Appoint at least one individual to the OEM link role in the HPN
 Ensure that individuals identified in the OEM link role take ICS
  100, 200, 700, & 800
 Modify &/or provide comments & recommendations to HHS pan flu
 Work with nursing homes to:
        Appoint at least one individual to the Emergency Response
         Coordinator role in the HPN Communications Directory
        Encourage the Emergency Response Coordinator to take
         ICS 100, 200, 700, & 800 (on line)
 Monitor nursing home compliance & report status of ICS training to
   Work with DOH to issue a pan flu questionnaire & work with
    nursing homes to ensure proper completion & timely submission
   Ensure that at least one individual identified in the OEM
    link role participates in quarterly meetings with NYSDOH &
    disseminates relevant information to nursing homes
   Assist nursing homes in entering complete contact information in
    the Communications Directory, & remind nursing homes to keep
    information current
   Assist NYSDOH in securing timely & complete responses to
    HERDS surveys issued to nursing homes
   Perform outreach to non-members, including posting information
    on publicly accessible websites
Recent events

                , 4/17

                           ’07 in
       Lessons learned
   Some HPN data for healthcare facilities remains either
    incomplete or outdated

   This incomplete or outdated information makes it difficult to
    obtain accurate facility status reports in an emergency

   The Incident Command System (ICS) not always followed by
    all groups, creating back ups

   The Regional Office is able to be reached 24/7. Some facilities
    still do not have the correct numbers.
Katharine Logan
Health Emergency Preparedness Program
Non-acute Care
Hedley Park Place
433 River Street
Troy, NY 12180-2299
Phone: 518-408-5163

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