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					Departmental Response

GHA intends to use an ―all hazards‖ incident command structure for responding to pandemic influenza and
will incorporate the relevant aspects of communicable disease control. Preparations by departments will
escalate should Pandemic Phase 5 and 6 evolve. To succeed, preparedness demands involvement and
support from all, ranging from CEO‘s to frontline workers and their families.
Departmental responsibilities will include, but not be limited to:

Materials Management
 Supplies / vendor supply availability.
    Plans for obtaining limited resources have been discussed with local and regional vendors.
    Constant assessment of the supply chain is taking place to ensure no challenges have arisen.
    Target all possible second and third order effects, such as „who supplies the suppliers‟ and identify
       their potential weaknesses.
    Regional stockpile may offer additional supplies.
    Reviewing & updating inventory is taking place for supplies that will be in high demand during
       a pandemic.
        PPE/Full face masks/ N-95 disposables ( 2 per day / health care worker for approx. 30
         days) / tissues/ soap/ hand gel sanitizer/Personal hygiene supplies / Antimicrobial
         soap/Clorox bleach/ Disinfectants/ emergency water/ Syringes/ alcohol preps/waterless
        hygiene products/ beds /thermometer covers/ Band-Aids /Laundry detergent/ cleaning
        solutions/paper products/ Morgue packs

Resident Services
 Restrict gatherings/ social distancing encouraged. Cancel group activities.
 Stop volunteer & children‘s visits to facility.
 Post visual alerts/ air info updates on Senior TV ( admin/nrsg to provide info)
 Arrange room set up for mass inoculations when vaccine/antivirals are available.
 Arranges for ―community shop‖ when possible at stores.
 Ask residents to limit unnecessary travel or trips.
 Determine need to establish ‗pet-care‘ area.
 Recruit community in house volunteers ( retired nurses, physicians).
 Work with IL residents about personal plans, contact information, and encourage at least a 72-
   hour supply of needed items to have on hand.
    Power point slides and handouts developed to educate residents, families and staff on
       preparedness plans.
 Assists nursing/ dietary departments with duties.

Transportation
 For those essential workers without options or for those who rely solely on public transportation,
   establish a means of dedicated transportation to/from work while maintaining necessary infection
   control processes ( social distancing/ surface cleaning)
    In house volunteers/ community vehicle use.
    Drive routes to homes of staff have been updated

Dining Services
 Adjust menu ( cold platter vs. hot items) box lunch packaging for delivery.
 Communication with vendors. ( second & third vendors)
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     Confirmation has been received from PFG Virginia Foodservices that GHA has selected
          option2 of the 2007 disaster plan. PFG has received a copy of our emergency menu and an
          emergency order.
     The order is coded and kept on file in their offices and electronically on office computers.
     In the event of an emergency, order will be shipped to our facility on the next delivery day.
     In the event of a system failure in the Richmond Va. Distribution center, they can use one of
          their other distribution centers to fill the order.
   Use of military ready packs from stockpile if available.
   14 day supplies are on hand/ use of rotation system
   Storage areas for supplies & water have been determined.
   Stagger lunch/ dinner serve times for residents & staff.
   Close salad & buffet self serve bars.
   Use of white gloves for table servers.
   Use disposable salt/pepper packets, etc.
   Pedestal hand sanitizer dispensers placed at entrance‘s to dining areas for residents.
   Temporary close HCU dining rooms & serve meals on units in rooms.
   Determine a strategy to feed workers who might remain on site.
   Cross training of staff for other duties.
     In progress. Dept. reports progress at Quality Improvement meetings.
   Responsibility for the coordination of staffing & assignment changes during an emergency is
    assigned to the supervisor/ manager on duty.

Home Care
 Anyone having symptoms will notify the Home Care Office Manger of symptoms. The HCOM
  will notify GHA Infection Control Nurse of symptoms and the location the person had most
  recently worked.
 Home Care staff will be assigned to limit crossing between facilities.
 Home Care staff will contact residents prior to visit to determine whether anyone is having
  influenza-like illnesses.
 Home Care services will be reassigned according to Home Care practice using the tier priority
  system.
   Level A: residents who live independently will be last to have services discontinued.
      Consideration being given to their ability to maintain functioning in an independent living
      area, coordination with the interdisciplinary team will assist in relocating if necessary.
   Level B; residents who live in Assisted Living or Health Care will have services discontinued
      and coordination with AL and HCU to maintain continuity of services needed.
   Level C; residents who have Home Care socialization services will have services
      discontinued.
   Home Care Coordinator will maintain a list of residents who are deemed unsafe to leave
      unattended or if services discontinued would not be able to maintain ADL‟s.
   Home Care staff who are not providing Level A services will be available to nursing for
      assignments.

Hospice
 Agreements are in place with vendors supplying medications, oxygen and equipment for delivery
   and replenishments.
 On admission to hospice, patients and caregivers are asked about emergency preparedness plans.
 Hospice nurse will review medication, equipment and supplies needed for each hospice patient
   and obtain adequate levels for each person.
 Hospice nurses will prioritize needs of patients.                                        12


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   Hospice staff will contact patient/family prior to home visit to determine whether anyone is
    having an influenza-like illness.
   Hospice staff will limit crossing between the 2 facilities.

Information Technology
 Develop and maintain infrastructure ( dedicated websites, faxes, hotlines, internet servers, system
    backups, computers, cell phones, radios) for communicating status.
     To date, 80% of essential personnel have remote access availability.
     Technology is periodically tested and integrated into overall future planning operations.
 Provide communications/IT infrastructures as needed to support telecommuting /remote access.
 Procure additional redundancies for communications, to include alternate cell phone
    services and blackberry services.
   Familiarize key personnel with available communications, resources and gaps.

Beauty Salon
 Cancel appointments when necessary. Limit number of people in salon at one time.
 Arrange room appointments for those residents on isolation at end of day.
 Should salon be closed periodically, post a notice to residents.
 Staff to assist other departments as needed.
 Responsibility for the coordination of staffing during an emergency –manager.

Fitness Center
 Wipe down with disinfectant all equipment ( beginning & end of shift ).
 Provide sanitizing wipes for residents use to wipe down machines between workouts.
 Outbreak of virus may require pool & center to be closed. Post notice to residents.

Nursing
               Priority order for staffing is HCU /HG dementia unit , AL, Clinic.
   Provide an aggressive annual vaccination program/ nurses to assist for crowd control/paperwork
     Vaccinations for IL, AL, HCU residents, families, volunteers, contract workers, takes place
         annually. Staff is offered at no cost, the vaccine and all are encouraged to become immunized.
     Staff needed for mass inoculation is approximately 3 nurses and 2 assistants.
   If vaccine is classified as experimental and has not been approved by FDA yet, consents are
    available with information.
   A contact for obtaining influenza vaccine / antiviral prophylaxis has been identified.
    Pharmacy Supplier/ DOH
     If coming from the National Stockpile, DOH will deliver our supply from the drop off point
       to GHA. (This eliminates the security need in transporting the vaccine).
   A priority list ( based on HHS guidance for use of vaccine and antivirals in a pandemic
          when in short supply) and estimated number of residents and personnel who would
           be targeted for influenza vaccination has been developed.
             1. Number of first priority personnel_____131____
             2. Number of second priority personnel __110____
             3. Number of remaining personnel______ 110____
             4. Number of first priority residents 120_
             5. Number of second priority resident 380_
     Vaccine/antivirals will be kept locked in the GHA Pharmacy. The Pharmacist will limit the
       distribution of the vaccine to the DON, ADON or IC nurse.
   System for rapidly delivering vaccine or antivirals has been developed & tested.            13

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       On a moments notice, GHA can begin mass inoculations. Minimum supplies of 1,000
          syringes/ alcohol preps and sharps containers are kept in stock/ in house by the IC nurse.
     Restricts new admissions
     Expedite discharge of residents to IL/Home.
       Provide education to resident, family on respiratory etiquette, hand hygiene at discharge.
     Discourage unnecessary appointments
     Droplet Precautions/ Standard Precautions / PPE use
     N-95 particulate mask use.
       Meeting with 3M rep/ Materials Management and IC nurse for education training on fit
          testing.
       Seminar calendar received from 3M on fit testing education training.
       Fit testing policy incorporated into annual education training.
       Use N-95 mask for resident if transport is necessary. Notify the receiving facility that a
          possible pan flu patient is being transferred to them.
     Close dining rooms/ serve residents in room
     Treat roommates as ―exposed cohorts‖ Do not change rooms.
     Cross Train Staff Positions
       MDS-has DON, ADON and 2 backup nurses identified
     Assign responsibility for the coordination of staffing during an emergency.
       Staffing coordinator /IT to arrange emergency measure for at home work.
       Staffing coordinator could arrange staff schedules from home. DON, ADON can input
          payroll.
     Screen residents returning from hospital stay, outpatient, or family visit.
       Prior to returning from hospital/ visit---check symptoms.
       Develop an assessment checklist for staff to consistently follow
     Provide housekeepers with room #‘s whose occupants are ill.
       Daily phone alerts & updates to ES desk will be made by shift Supervisor/ Clinic using the
          Nursing Notification System.
     Special needs ( clinical, dialysis appointments, tube feedings, oxygen, etc.)
       Unit nurses check supply levels, appointments every day.
     Altered Standards of Care Practices approved by the Board of Health
       Regional offices provide guidance to state agencies ( waivers, suspensions).
           Staff educator to inservice/ update staff if practices are in effect.
           http://www.ahrq.gov/research/altstand/index.html

 Clinic
 Passive Monitoring Independent Living:
   In definition, a resident in Independent Living is asked to perform self assessment at least
      twice daily and to contact the Clinic if respiratory symptoms and/or fever occur. This
      requires minimal resources and places few constraints on individual movement. Clinic staff
      would receive any calls for symptoms and plan for the rapid isolation of the person
      developing symptoms. This plan includes partnering with family members who could possibly
      be a source for assistance. Restrictions may be voluntary or legally mandated;
      Confinement may be in their home or on the HCU.

    Pharmacy
     Stocks supplies/ OTC medications, pain relievers, sundries, etc.
     Serves as a secure source for handling/ storage of vaccine/ antivirals.
     Develop a strategy for ensuring uninterrupted provision of medicines to residents who might not
      be able to (or should not) travel.                                                        14

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   IV fluids/IV equipment

Employee Health
 Monitor/ track ill staff. Effective communication with off-site and ill employees.
 Ensure the use of appropriate PPE while at work for all staff.
 Symptomatic personnel should be sent home until they are physically able to return to duty.
   Screened by the Employee Health Nurse or supervisor prior to start of shift. (SAMPLE
     SCREEN ATTACHED)
   A hotline will be set up for communication to the employee health nurse for notification
    of symptoms.
   A log of health care workers who have recovered from pan flu ( confirmed or probable)
    will be kept.

Human Resources
   Establish policies for absences & sick leave and when ill staff that is no longer infectious may
    return to work. (Ensure ill staff remain at home 48 hours s/p symptoms cease.)
     Sick pay will be provided and extended to those employees who are scheduled to work but do
                not meet the health surveillance criteria determined by the employee health nurse. All
                holiday and vacation time will be suspended under these conditions, and rules will be
                in effect to handle overtime pay and use of benefit time.
   Work issues relating to illness, sick pay, staff rotation, shift coverage, overtime pay, use
    of benefit time, transportation, and use of cell phones has been addressed in policy.
     See above bulleted item. Staff rotation and shift coverage shall be provided by department
        heads. HR will act as the command station to handle work issues and compensation
        questions.
   Cancel all orientation classes, employee meetings
   Develop a strategy for accommodating & supporting staff that have child or eldercare
    responsibilities.
     Staff are tasked to develop emergency care arrangements, in advance, for child or eldercare
        issues.
   Existing or new policies regarding employee failure to respond/ job abandonment must
    be appropriate and clearly communicated
     Essential employees that are scheduled to report to work are expected to do so, and
             essential staff that are not scheduled are expected to contact HR and find out
             what is needed of them. If a staff member can not legitimately get to work, special
             dispensation may be allowed. If an employee simply chooses not to come in, they
             are subject to the rules and regulations of GHI and will be dealt with
             accordingly. ( please refer to the inclement weather policy).
   Updating emergency contact information, address & phone numbers has been completed.
   Training & education on Pandemic Influenza Response Plan will be incorporated into the
    annual employee/ new orientation schedule.
   Stress management techniques for staff ( EAP Program) are communicated to employees
    at orientation and annually. Inserts into the Team Update and paycheck stuffers also are
    used.
   Provide staff with facility ID cards that identify them as an essential employee in a health
    care facility.
     “Essential” employees, identified by their department heads, will have a second
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     badge ( to be attached to the original badge) showing their „essential‟ status. This is
       to roll out in the fall of 2007.
   Arranges places of rest & meals for workers for prolonged periods of time has been
    developed.
     HR action item.
   Multi-state licensure issued to nursing personnel.
     Consult with the state health department on plans for rapidly credentialing healthcare
    professionals during a pandemic. When an emergency staffing crisis can be declared and
    identified, emergency laws would allow personnel with out-of-state licenses to work.

Staff Education
 Distribute materials in paycheck stuffers, newsletters, about pandemic signs/symptoms, how its
    spread, ways to protect yourself, family preparedness plans, and how to care for ill persons at
    home. ( Available in different languages).
 Use of posters, Senior TV, huddle demonstrations to inform staff & residents of basic infection
    control measures.
 Post visual alerts at entrance to restrict ill visitors.
 Education Inservices to residents/ staff . (respiratory hygiene/ cough etiquette, hand washing,
    standard/ droplet precautions, influenza complications, fit testing of respirators.)
     3M Corporation provides a “Train the Trainer” video for respirator use once fit testing is
      complete.
 Develop a strategy for ―just in time‖ training of non-clinical staff who might be asked to assist
    clinical personnel ( bathing, monitoring of vital signs, distribute food trays, transport residents).
 Assist with visual & verbal screening of persons at the entrance to the community.
 Assist nursing department staff

Housekeeping
 Use cleaning recommendations as provided by HHS.
 Clean and disinfect all resident rooms at least once a day.
 Frequently touched areas daily wipe downs using disinfectant.
 Clean ill resident rooms last. ( Nursing to provide info daily)
 Reduction in routine schedule cleaning.
 Disposable tissue dispensers placed in common areas
 Keep gel hand sanitizers available in all public areas.
 Assign responsibility for the coordination of staffing during an emergency.

Laundry
 Staff MUST wear n-95 surgical masks and other PPE when handling laundry.
 Floor washers and dryers will be used. Eliminate as much outside laundering as possible.
 Sorting and separation of laundry is not necessary.

QI/IC
    Training plan on pandemics has been developed and education will begin shortly.
    A system is in place for monitoring for nosocomial transmission of pandemic. This is
    implemented and tested by monitoring for non-pandemic influenza seasonally.
   Aggressive annual fall influenza/pneumo program.
   Monitor flu/ pneumo vaccine status for all admissions to GHA.
   Coordinates with external organizations.
   Maintains communications with other neighboring facilities & facilities in the mutual assistance
    agreement                                                                                    16

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   Provide estimates of the quantities of vaccine needed
   Is notified by DOH for amount availability, pick up or delivery of vaccine/antivrials.
   Point of contact to maximize communication between GHA and public health system.
   Increase surveillance for respiratory disease among residents.
   Notify the local health department if a case is suspected.
     A link has been established with the District Epidemiologist, the Emergency Planning
        Coordinator and the assistant Emergency Planning Coordinator for the city of Alexandria.
     QI/IC nurse participates in the Va. Medical Reserve Corp.(Alexandria).
     QI/IC nurse is a member of the Mayor of Alexandria‟s Pandemic Working Group.
   Delivers Vaccine /antiviral to storage area. ( Pharmacy) count as a narcotic.
   Provide rapid vaccination/ antiviral prophylaxis to healthcare personnel as recommended.
   Monitors updated HHS information & recommendations.
   Provides communication feedback with DON/ Med. Director/ Admin as necessary.
   Information is provided from a reliable source. WHO/ CDC/ DOH.
   Submits EPI form to DOH on any respiratory illnesses.
   Collects data for EPI curve, visual tracking of clusters & facility attack rate.
   Monitoring/surveillance/ track ill residents-quarantine if necessary.
   Monitors maintenance/ housekeeping departments for proper Isolation precautions.
   Provides internal Investigation Summary post outbreak.
   Monitor information sources for any updates on next pandemic wave.

Plant Operations
 Emergency Communications/ revise as necessary
 Prioritize operational impacts.
 Review all equipment standard maintenance and repair schedules.
 Oversees community security for intruders/ thefts.
 Provides security measures for transport of vaccine antivirals ( if necessary)
    Understanding at this point is that DOH will provide „drop off‟ to our community.
 Ensure all company vehicles are kept in good repair and gas tanks full.
 Maintains current key contacts / vendor numbers.
 Use of ham radio/ portable 800 MH radios by department.
 Review procedures for receipt, storage and distribution of assets received from federal stockpiles.
 Plan an alternate dumpsite for trash hauls.
 Determine the scope & volume of supplies (e.g. body bags) needed to handle an increased
   number of deceased persons.
    Supply sources for post mortem care has been identified as County Coroner, and the
       Mount Castle-McCormick, Demaine, or Evert Wheatley Funeral Homes
 Temp morgue set up ( Game Room/ or locked off bathrooms on G1) as outlined in Bioterrorism
   Plan if no refrigeration available.
 Assign responsibility for the coordination of staffing during an emergency.
 If water supply is interrupted:
    Fill buckets with pool water ( places buckets on each level) for fire use.
    Fill buckets with pool water for scheduled „commode flushes‟.
    Placement of kitty litter & liners for commode use in designated bathrooms.
    Initiate fire watch procedures.

Social Work/ Chaplaincy
 In advance, alert families & residents to PI plan, preparedness, exercises, and encourage family
   support. Include a possibility of evacuation.
    This is being done at Care Plan meetings, emails, Town Hall meetings, Gazette Articles and
       brief Senior TV announcements. ( info provided)                                         17

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   Assist to keep calm if schools, restaurants, theaters, etc. face mandatory closings
   Will keep all POA‘s HCU/AL residents email/phone #‘s updated ( info provided)
   Will provide updated information to POA‘s, HCU/ AL residents.
   Provide psychological support to residents/ staff. Reinforce that support resources will be offered
    to staff for an extended time period after the pandemic crisis has resolved.
     Reinforce to HCU their value and importance to the community.
     Maintain tie with MRC volunteer for psychological first aid.
   Encourage social distancing if services are held.
     Adjust communion distribution methods.
     Sign of peace options (omit handshaking).
   Coordination of assistance from residents. Nurses, physicians, typists, telephone operators, etc.
    for assist in department.

Front Desk
 Display signage regarding alert & post updates ( info provided)
 Enforce restrictions by verbally and visually screen visitors for respiratory symptoms.
 Location point of a chalkboard to determine day to day what personnel are on-site and
    where they are located in the facility.
   Forward any inquiries to the appropriate spokesperson.
   Checks visitors for identification.
   Central point for staff bed availability.

Administration/ Administrator of Record
   Sets authorities for activating and terminating the company‘s response plan.
   Communication updates to residents/ staff
     First communication is critical
              Go public quickly
              Say what you know, what you don‟t know and what you‟re doing.
              Keep talking. Communicate often. Promise and deliver timely, regular updates.
              Be clear, (no jargon) and consistent.
              Despite the urge to say such things as, “stay calm…don‟t panic. I want to reassure
                 you…” don‟t say them. Instead be reassuring and calm.
              Recognize that even though the risk may be small, people will be frightened
              Explain that the information may change when you know more
   Identify key topics for ongoing communications ( staffing needs, bed capacity, durable and
    consumable medical supplies & equipment and device needs and supplies of influenza &
    antivirals).
   Provided staffing surge capacity numbers daily.
   Assign responsibility for the coordination of staffing during an emergency.
   Key personnel will provide in writing, ‗just in time‘ cross training instructions on
    essential tasks. Identify and train essential staff needed to carry on the organization‘s work.
    Include back up plans, cross training,
     One to one meetings have been completed for direct reports. Task assigned was to
            familiarize each person with duties of each director.
     Create a list of non-essential positions that can be re-assigned to support critical services
   Maintains contact with facilities ( Mutual Assistance Agreement) as possible sources to
    accept non-influenza residents in order to free up bed space.
     Areas of facility that could be used for expanded bed space:
       Auditorium, Game Room, Anne Lee Room, Crystal Room                                           18

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   Determines if all visitors are totally restricted from the facility.
   Provide a telephone number where persons can call for information.
   Have staff work from home when possible or stagger shifts.
   Identify insurance & liability issues related to the pandemic.
   When appropriate, include basic information about pan flu in public meetings ( sermons, classes,
    trainings, small groups meetings, announcements).
   Postpones/ cancels gatherings for meetings ( conference calls).
   Identify areas of the facility that could be vacated for use in housing staff.
   Use Flu Surge Software available from the CDC to estimate bed capacity.
                 ( http://www.cdc.gov/flu/flusurge.htm)

Staff
GHA will clarify expectations with every staff before any disaster strikes. Staff is aware of
what GHA expects and what the implications of certain choices will be.
   Encourage employees to have alternate means and routes for getting to and from work.
   Self monitoring for flu like symptoms prior to coming to work.
   MUST use PPE and Standard, Droplet or Isolation precautions when applicable.
   Provide updated contact information to Human Resources.
   Staff are expected to develop their own disaster plan to take into consideration care for
    children, parents or others dependent on them. ( including pets).
   Staff is encouraged to pack a disaster ‗go bag‘ with all the clothes and supplies needed if
    called to work in an emergency. Education on how to build a kit is found at
    www.72hours.org.
   Are aware of the need to carry a picture ID and identification as a healthcare employee
    for GHA.
   Are aware of stress management techniques and available resources

IL Residents
   Encouraged to practice good respiratory hygiene/cough etiquette and social distancing.
   Are encouraged to wash their hands frequently and to use the hand gel sanitizers in
    common areas throughout the building.
   Are encouraged to keep a supply of non-perishable food, water on hand for at least 3
    days. Non-perishable foods should not need water to reconstitute or for use.
   Are encouraged to keep routine medications for and supplies on hand to cover 30 days.
   Are encouraged to keep a first aid kit, paper products, a flashlight, radio, batteries and
    hand gel sanitizers in supply.
   Are encouraged to keep vaccinations status up to date. Tetanus, pneumo and the annual
    influenza vaccine ( when applicable).
   Masks use ( by choice/ optional when well ) . Obtain education on how to use them
    and encourage articipation in fit testing..
   Advised to keep bathtub full of water in case of water shut offs.
   Advised to store water in plastic or glass containers with a tight fitting screw on cap. ( Do
    not use milk containers even when cleaned).
   Encouraged to volunteer to assist in departments ( typing, copying, helping with the
    education, assist with helping well residents with meals, etc.) Social Worker will be point
    person for contact.
   Are informed of stress management techniques and resources available to them.              19

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T Y --THE INVITE

MORE COMFORATBLE DEVELOPING PLANS AND POLICIES.

TIME/CLOCK.

CHALLENGED WITH TAKING CARE OF PROBABLY THE MOST
VULNERABLE SEGMENT OF OUR POPULATION.

CONTINUITY OF OPERATIONS IS ESSENTIAL.

P-A-N-I-C

MRC/ MAYOR‘S PANDEMIC WORKING GROUP ( REPRESENT LTC)
PARTICIPATION-- BETTER UNDERSTANDING OF PUBLIC HEALTH
PLANS AND TO HAVE OUR RESIDENTS & STAFF SUPPORT THESE
EFFORTS.


OUR PLAN IS NOT A POLICY. ( POLICIES WILL ATTACH TO THE
PLAN).


PAMDEMIC INFLUENZA REPONSE PLAN OBJECTIVES
  1. CREATE A MULTIDISCIPLINARY PLANNING TEAM.
  2. IDENTIFY HAZARDS SPECIFIC TO THE FACILITY.
  3. DETERMINE PROTECTIVE ACTIONS.
  4. IDENTIFY RESOURCES AND CAPABILITIES.
  5. ESTABLISH LIASON WITH LOCAL HEALTH DEPARTMENT AND
     PARTICIPATE IN LOCAL AND/OR REGIONAL EMERGENCY
     PREPAREDNESS GROUPS.
  6. BUILD THE PLAN—LIVING DOCUMENT.
  7. COMMUNUCATE THE PLAN—EDUCATE, DRILL, AND
     EXERCISE THE PLAN. UNCOVER WEAKNESSES.
  8. REVIEW & REVISE THE PLAN AS NEEDED.


POTENTIAL LOSS OF 25% OF STAFF.
     10% ILL; 10% CARING FOR ILL FAMILY; 5% ‗WORRIED WELL‘.

EACH DEPARTMENTS INVOLVEMENT IS CRITICAL.

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3/29/06; Reviewed 6/25/07
       BEGAN AT OUR MONTHLY QI MEETINGS.


KEY POINTS OF THE PLAN:
     CIRCUMSTANCES UNDER WHICH IT IS ACTIVATED
     ORGANIZATIONAL STRUCTURE THAT WILL BE USED
     RESPONSIBILITIES OF KEY PERSONNEL HAVE BEEN DESCRIBED




AT EVERY LEVEL, FROM THE PRESIDENT ON DOWN TO LOCAL
HEALTH DISTRICTS, PANDEMIC PLANNING TAKES TIME AND
RESOURCES.


PREPARATION CAN BE COSTLY AND COMPLICATED.



THINK OF PANDEMIC PLANNING THE WAY YOU THINK OF CAR
INSURANCE. YOU MUST HAVE IT, BUT HOPE YOU NEVER HAVE TI
USE IT.




C:\Docstoc\Working\pdf\a001fdae-0195-4896-902e-6c17832535d0.doc
3/29/06; Reviewed 6/25/07