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  • Moderator: See “Primary Care Center Generic Question Database” for additional questions. You may choose to use any of the questions from the database on this slide.


  • 1. Avian Influenza and Your Center: An interactive session April 18, 2005 CHCANYS Brooklyn/Queens Kick Off Meeting
  • 2. Interactive Session
    • For this session, we are going to present a moment by moment scenario that will help to introduce some of the concepts of preparedness.
    • Audience members are encouraged to play along…pretend that this is happening at YOUR center.
      • Tell us what your center would do
      • Ask questions
      • Voice concerns
    • Allow for some artificiality of the scenario.
  • 3. Why Avian Influenza?
    • Nuclear Detonation
    • Biological Attack: Aerosolized Anthrax
    • Biological Disease Outbreak: Flu Pandemic
    • Biological Attack: Pneumonic Plague
    • Chemical Attack: Blister Agent
    • Chemical Attack: Toxic Industrial Chemicals
    • Chemical Attack: Nerve Agent
    • Chemical Attack: Chlorine Tank Explosion
    • Natural Disaster: Major Earthquake
    • Natural Disaster: Major Hurricane
    • Radiological Attack: Dirty Bombs
    • Explosive Attacks: Improvised Bombs
    • Biological Attack: Food Contamination
    • Biological Attack: Foot-and-Mouth-Disease
    • Cyber Attack
    The New York Times; Wednesday, March 16, 2005 15 Nightmares for Disaster Planning
  • 4. Brief Background-Avian Influenza Avian influenza is caused by a bird flu virus. These occur naturally among birds (e.g., chickens, ducks, turkeys) Normally, bird flu does not affect humans; HOWEVER, transmission has occurred in Asia/Southeast Asia causing severe respiratory illness in humans with high death rate. Symptoms of Bird Flu in Humans: Typical flu-like illness (fever, cough, sore throat and muscle aches) to eye infections, pneumonia, severe respiratory diseases and other life threatening complications.
  • 5. Brief Background: Avian Influenza Transmission occurs via contact with infected poultry or contaminated surfaces. Treatment: Currently, there is no vaccine. There are two antiviral drugs used to treat and prophylax for avian influenza.
  • 6. Let’s Start
  • 7. Tuesday Morning
    • Slightly cloudy but pleasant Spring day
    • CHC ED walks into office and turns on computer.
    • There is a high priority email from the NYC DOHMH.
  • 8.
    • 2005 ALERT #38: Clusters of severe H5N1 influenza outbreaks with community transmission in Vietnam
    • Please Distribute to All Medical, Pediatric, Family Practice, Laboratory, Critical Care, Pulmonary, Dermatology, Employee Health, and Pharmacy Staff in Your Hospital
    • Dear Colleagues:  
    • Clusters of severe H5N1 influenza outbreaks have been identified in southeast Asia. There are currently no cases in the United States. The NYC DOHMH and the federal Centers for Disease Control and Prevention (CDC) have instituted screening of travelers to and from affected countries. A vaccine is in development and will be available in 3-4 months. The NYC DOHMH is requesting heightened surveillance for persons presenting with the following illness:
    • 1. High fever (>38o C or 101.4o F) AND
    • 2. Respiratory signs or symptoms, including cough, shortness of breath or difficulty breathing AND/OR
    • 3 . Anyone with these symptoms who has traveled to Vietnam or had contact with someone who is ill and had travelled
    • NYC DOHMH requests immediate reporting of any cases with the above illness and asks health care providers to:
      • Ensure that patients with fever and respiratory symptoms are quickly identified and isolated.
      • Promote respiratory hygiene/cough etiquette and hand washing measures.
      • Consider using rapid influenza diagnostic tests.
      • Use antiviral medications judiciously.
    Tuesday, 9:00 am
      • The City of New York
        • Michael R. Bloomberg Thomas R. Frieden, m.d., m.p.h.
          • Mayor Commissioner
    • _______________________________________________________________
    • nyc.gov/health
  • 9. Tuesday, 9:00 am
      • Infection Control Guidance
      • Suspect and Probable Case Definitions
      • Reporting to DOHMH
      • Patients who meet these criteria should be isolated and evaluated using airborne precautions. Please notify the NYS/NYC immediately so that we can assist with clinical management and laboratory testing. Call the Provider Access Line at 1-800-NYC DOH1.
      New York City DOHMH Health Alert
  • 10. Public Health Response
    • NYC DOHMH activates their Incident Management System.
    • Enhanced outreach to
      • Hospitals, Community Health Centers
      • Laboratories
      • Vietnamese and Asian communities
    • Teleconference scheduled for hospitals and CHCs at 11 am.
    • Enhanced passive/active surveillance
    • Response to the Health Alert
    • Activation of Incident Management System (IMS)
      • How do you know when to activate?
      • Partial or full activation?
      • What are your criteria for activating?
    • Notification of Internal Staff
    • Emergency Operations Center
  • 12. NIMS: National Incident Management System
    • System that establishes COMMON language and concepts among all response agencies
    • Incident Management System
  • 13. Back at CHCANYS… Incident Commander – (CHCANYS CEO) Communities Served By CHCANYS Members CHCANYS General Membership (CEO, Medical Directors, EP Coordinators) Planning (EP Medical Director) New York City Department of Health and Mental Hygiene New York City Office of Emergency Management (NYC OEM) New York State Department of Health (NYSDOH) Greater New York Hospital Association (GNYHA) Logistics Director Operation Director Finance/Administration Director
  • 14. CHCANYS
    • CHCANYS sends out notice to FQHCs:
      • Current information on health alert
      • Teleconference with City at 11am
      • Teleconference with FQHCs and CHCANYS at noon.
      • FQHCs to email CHCANYS with questions or issues to bring up with DOHMH
  • 15. Tuesday, 11am Teleconference Call
    • Update of current situation
    • Guidance from DOHMH
      • Identification of cases and reporting
      • Infection Control measures
        • Surgical masks/hand hygiene
    • Guidance from NYS DOH
      • HERDS reporting
    • Guidance from OEM
      • Antiviral supplies
    • Other agencies
  • 16. Tuesday at 11:00 am Back at the CHC…
    • A 55-year-old man and his 31-year-old daughter walk into center.
    • At the registration desk they are coughing and both appear flushed.
    • They also seem somewhat short of breath.
  • 17. Tuesday at 11:00 am
    • As per the center policy and successful internal notification, the two patients are given tissues (or surgical masks) and taken to another room to await examination.
    • Internal notification
    • Infection Control Measures
  • 19. NIMS: National Incident Management System
    • System that establishes COMMON language and concepts among all response agencies
    • Incident Management System
  • 20. Patient 1 Medical History
    • 55-year-old man
    • Alert, oriented, anxious.
    • Chief complaint: “I can’t sleep at night, I’m coughing too much.”
    • Two-day history of weakness and non-productive cough
    • No other medical history
    • T 100.9, HR 104, RR 28, BP 128/72
  • 21. Patient 2 Medical History
    • 31-year-old daughter
    • Alert, oriented, coughing frequently
    • Chief complaint: “I feel warm, I think I have the flu.”
    • Married with two kids
    • No other medical history
    • T 101, HR 108, RR 28, BP 100/60
  • 22. What else do you want to know?
    • The two patients had recently traveled to Vietnam with their families and had returned on Saturday.
    • External notification
    • Transfer of patient
    • Housekeeping issues
  • 24. NIMS: National Incident Management System
    • System that establishes COMMON language and concepts among all response agencies
    • Incident Management System
  • 25. Tuesday, 11:30am
    • Other patients in the waiting area noticed that the two patients were given tissues (or surgical masks), put in exam rooms and now are being taken away by EMS.
    • Word starts to float among the staff that the “avian flu” is here in the center. Some patients overhear this.
    • On the TV in the waiting area a news reporter announces the imminent danger of the deadly avian flu coming to the US.
    • Mental Health of Patients
    • Mental Health of Staff
  • 27. Take Home Thoughts
    • When would the current situation trigger your center’s Incident Management System?
    • What internal and external communication needs are required to communicate with your center’s staff?
    • How should the patients waiting to be seen in your center be managed?
    • How would you manage the mental health concerns of your staff?
  • 28. Close Out
    • What CHCANYS has been and will be doing for CHCs in 2005:
      • Three borough wide kick off meetings (Brooklyn/Queens, Bronx, Harlem)
      • Train-the-trainer in fit testing N95 respirators
      • Donning and removing PPE posters
      • Notification Drills via HAN for CHCs
      • Conducting an HVA
      • Developing your IMS
      • Identifying your center’s role during a citywide emergency
      • And more! Stay tuned!
  • 29. Thank you!
    • Questions?
    • Brenda Merritt, MD
    • Emergency Preparedness Medical Director
    • (212) 279-9686 ext. 665
    • [email_address]
    • Robyn DiPalma
    • Program Associate
    • (212) 279-9686 ext. 217
    • [email_address]
  • 30. What is a Tabletop?
    • A verbal “walkthrough” of a response to an emergency situation.
    • Designed to elicit dialogue by the participants as they examine and resolve problems based on emergency plans and procedures.
    • A first step towards conducting a partial or full drill.