Subject: Incident Action Planning: Pandemic Flu

Insert Clinic Logo EMERGENCY OPERATIONS PLAN RESPONSE SUBJECT: INCIDENT ACTION PLANNING: PANDEMIC FLU POLICY NO.: 4.12

POLICY: The CLINIC will establish a procedure for addressing an outbreak of pandemic flu.

Summary of WHO Global Pandemic Phases (WHO Global Influenza Preparedness Plan)

Interpandemic Period Phase 1. No new influenza virus subtypes have been detected in humans. An influenza virus subtype that has caused human infection may be present in animals. If present in animals, the risk of human infection or disease is considered to be low.

Phase 2. No new influenza virus subtypes have been detected in humans. However, a circulating animal influenza virus subtype poses a substantial risk of human disease.

Pandemic Alert Period Phase 3. Human infection(s) with a new subtype but no human-to-human spread or at most rare instances of spread to a close contact.

Phase 4. Small cluster(s) with limited human-to-human transmission but spread is highly localized, suggesting that the virus is not well adapted to humans.

Phase 5. Larger cluster(s) but human-to-human spread is still localized, suggesting that the virus is becoming increasingly better adapted to humans but may not yet be fully transmissible (substantial pandemic risk).

Pandemic Period Phase 6. Pandemic phase: increased and sustained transmission in the general population.

Postpandemic Period Return to the Interpandemic Period (Phase 1)

PROCEDURES: 1. All Officers and Section Chiefs will respond in accordance with Job Action Sheet responsibilities. In addition, the ICS team members will perform the following responsibilities: a. Incident Commander will: i. Obtain and communicate data regarding the pandemic flu phase, and assign a staff member to be responsible for acquiring and maintaining updated versions of pandemic influenza plans from the United States Department of Health and Human Services, the California Department of Health Services, and Los Angeles County Department of Health Services. ii. Estimate the minimum number and categories of personnel necessary to keep the Clinic open. b. The Logistics Section Chief will: i. Ensure employee contact information is current and includes office, home, pager, and cellular telephone numbers and office and home email addresses. ii. Ensure lines of succession are established for critical leadership positions at least two persons deep. iii. Create and update contact information for emergency response agencies, resource vendors, partner and support organizations, and others who may be involved in the response to pandemic influenza. iv. Work with the Clinic’s Human Resources Department to: 1. Establish employee compensation and sick-leave absences unique to a pandemic influenza (e.g. non-punitive, liberal leave, leave for family care). 2. Establish procedures for when a previously ill person is no longer infectious and can return to work after illness and when symptomatic employees can work at the clinic and in what capacities. 3. Identify flexible worksite (e.g. telecommuting) options for employees not required to work onsite and flexible work hours (e.g. staggered shifts). 4. Establish procedures for employees who have been exposed to pandemic influenza, are suspected to be ill, or become ill at the worksite (e.g. infection control response, immediate mandatory sick leave) and for evaluating symptomatic personnel before they report for duty and tested during a non-pandemic influenza period. 5. Establishing procedures for the management of personnel who are at increased risk for influenza complications (e.g., pregnant women, immunocompromised healthcare workers) by placing them on administrative leave or altering their work location. 6. Establish a plan for managing a staffing shortage within the organization due to illness in personnel or their family members have been addressed. 7. Ensure a specific waiting room location has been designated for patients with symptoms of influenza that is segregated from other patients awaiting care. 8. Maintain inventory of Personal Protective Equipment (PPE), immunizations and pharmaceuticals to the levels possible. 9. Estimate anticipated consumable resource needs (e.g., masks, gloves, hand hygiene products, medical supplies). c. The Operations Section Chief will: i. Ensure surgical masks are distributed to symptomatic patients who are able to wear them (adult and pediatric sizes should be available), and provide facial tissues, receptacles for their disposal and hand hygiene materials in waiting areas and examination rooms. ii. Designate separate examination rooms for evaluation of patients with symptoms of influenza, if patients with influenza will be evaluated in the same location as patients without an influenza-like illness. d. The Public Information Officer will: i. Ensure that a Respiratory Hygiene/Cough Etiquette is in place (see www.cdc.gov/flu/professionals/infectioncontrol/resphygiene.ht m). ii. Signage (language appropriate) directing patients and those accompanying them to notify reception personnel if they have symptoms of pandemic influenza has been posted. iii. Signage (language appropriate) on Respiratory Hygiene/Cough Etiquette instructing symptomatic persons to use tissues to cover their cough to contain respiratory secretions and perform hand hygiene has been posted. e. The Medical/Technical Specialist-Medical will: i. Ensure that personnel to use Standard (www.cdc.gov/ncidod/dhqp/gl_isolation_standard.html) and Droplet Precautions (i.e., N-95 mask for close contact) (www.cdc.gov/ncidod/dhqp/gl_isolation_droplet.html) with symptomatic patients. ii. If necessary, establish a system for phone (and e-mail, where appropriate) triage of patients to determine who requires a medical evaluation, to limit office visits to those that are medically necessary. iii. If necessary, manage patient care at the height of the pandemic by including the following possibilities: 1. Temporarily canceling non-essential medical visits (e.g., annual physicals). 2. Designating separate blocks of time for non-influenza and influenza-related patient care. iv. Monitor the use and availability of pandemic influenza vaccines and antiviral medications that have been identified (www.hhs.gov/pandemicflu/plan/sup6.html). v. Estimate the number of personnel and patients who would be targeted as first and second priority for receipt of pandemic influenza vaccine or antiviral prophylaxis, based on HHS guidance for use. (see www.dhhs.gov/nvpo/pandemicplan/annex6.pdf).