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Critical Care Network:  Pandemic Influenza Planning - Perspectives for Critical Care
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Critical Care Network: Pandemic Influenza Planning - Perspectives for Critical Care


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  • Stats verified after the event – during the outbreak numbers were reported verbally through teleconferences – there was no opportunity to systematically assess the profiles of these patients, the utilization of antiviral regimes, their responses to therapies, outcomes or dispositions.
  • Transcript

    • 1. Pandemic Influenza Planning –Perspectives for Critical Care Dr Kelly Barnard Health Authorities Division
    • 2. Why we need to plan • Influenza pandemics represent global emergencies with catastrophic impact. • Pandemics have been documented every ten to forty years dating back to the 1600s, and likely long before that - three during the last century alone. • In 1918 /1919 over 20 million people died worldwide. • “The last pandemic occurred in 1968. Experts agree – we are overdue for another.” Dr. Perry Kendall 2005 • In 2009 H1N1….Operational Monitoring, Health Authorities Division 2
    • 3. Hospitalizations – 1032Deaths – 55Peak Hosp demand – Oct / Nov
    • 4. Age Distribution
    • 5. Age Distribution BC pH1N1 case fatality rate ~0.006%
    • 6. Some lessons learned from H1N1— Clinical care: Enhance the bridge between primary care, public health and clinical health professionals in future emergency / outbreak response planning efforts— Refine acute care and critical care surge planning— Need to have real time information to guide clinical response Human resources :Develop plans and guidelines to ensure highest and best use of scarce health sector resources Public health: Surveillance/ antivirals/ immmunizations Logistics: Standardization – of supply items, priorities, planning, forecasting and SC approach
    • 7. Lessons in Clinical Care Antivirals can play a role in mitigating morbidity but risk of resistance is real. Need to study this with each new pandemic. Administrative data can be used in real time to track utilization – physician visits / medication use Active surveillance needed for Hospitalizations / ICU beds / staffing levels. Active surveillance needed to guide clinical care Many of the assumptions that underlie the logistics planning require adjustment with real time information about severity
    • 8. Health Impacts of Next Pandemics Assumptions: The majority of the population (over 50% - 70%) will be infected over the course of the pandemic 15%-35% clinically ill over the course of the pandemic and of these:  most of cases occur first wave (plan for 25% CAR in peak 6 wks)  50% will not require clinical care  up to 50% will seek outpatient care  1 % will be hospitalized PHAC - U.S. Meltzer Model adapted  0.4 % will die 9
    • 9. Health Impacts of Next Pandemic in BCAssumptions(without any Vaccines or Rx interventions)  Infected Up to 3,000,000  Clinically ill 635,000 – 1,400,000  See HC provider 317,500 – 740,000  Hospitalized 8,000 – 19,000  Die 2,500 – 5,900  Economic effects – KPMG 2006 BC study –  1.9 – 4.4 % dec GPP 10
    • 10. Outcome assumptions with No Interventions PopulationClinically Ill (CAR (100%)= 35%)Outpatient care Infected(50% of CAR) (70%)Hospitalized(1% of CAR)Fatal cases(0.4% of CAR) 11
    • 11. The Pandemic Influenza Operational Planning Project - A group of coordinated projects covering a wide range of topics including:  Communications and Education Planning Assumptions  Family Physician Communication Legislation and Regulatory Changes  First Nations/Small and Remote Operational Governance Structure Communities Information Management  Laboratory Plan Logistics and Provincial Stockpile  Surveillance Plan Mass Fatality Management  Self Care Guide Maintenance Plan  Antiviral Distribution Human Resources – Gap Analysis  Vaccine Storage, dist, and security Human Resources – Scope of Practice  Testing Guidelines Provincial Ethics Framework  Physician Infection Control Ventilator Allocation Guidelines  Home and Community Care Acute Care Surge Plan  Antibiotic Therapy Immunization Response Plan  Psychosocial Plan for HCW Updated PPE Recommendations  Community Psychosocial Plan Operational Monitoring, Health Authorities Division 12
    • 12. Questions??Operational Monitoring, Health Authorities Division 13