I've just came across this document from another site and have begun reading it....hat-tip, Marina, PFI
National Strategic Plan for EmergencyDepartment Management of Outbreaks of Novel H1N1 Influenza
Vulnerability
Population. No area of the United States would be
spared from the spread of novel H1N1. Although the
weather may affect transmission rates, no emergency
department is exempt from the risks of an outbreak.
If the transmission rates double from the spring 2009,
over 30,000 cases can be expected over the fall and early
winter. Emergency departments could see 150% of normal
volume of respiratory complaints. This may even be true in
communities where the novel H1N1 virus is not yet widely
present due to increased levels of concern by the public
regarding any respiratory related illness.
Critical Infrastructure. The ability of some critical
infrastructures to continue normal operations depends
largely on the attendance of its workforce. Others may
have plans and procedures in place for tele-work or social
distancing. The nation?s just-in-time supply chain could
experience delays in supplying goods and services, and
businesses who cannot survive operational interruptions
may expand inventories of supplies.
Hospitals are no exception to this. Pharmacies may
not be able to get additional supplies from distributors
or sources higher in the chain, domestic and foreign.
Supplies of personal protective equipment ( PPE) and
other supplies may require stockpiling, and food services
could encounter supply problems due to production and
delivery. The workforce may be depleted due to infection,
fears of coming to work in an infectious environment, or
the need to care for children out of school or other family
members. Medical care is highly labor intensive; thus,
service delivery is expected to be exquisitely sensitive to
the ratio of service demand to workforce supply.
Consequence. The consequences to society will
vary with the severity of the illness (transmission and
virulence), the degree to which the population is prepared
and resilient (vaccinated, compliant with community
mitigation strategies, and educated about the threat), and
whether business and industry can sustain productivity
during a pandemic. An outbreak with the severity of
the 1918 pandemic can be a nation-changing event with
massive mortality in young people who are economically
responsible for young families and, in large part, for our
nation?s defense.
Lesser-severity outbreaks can result in temporary
disruptions in the flow of goods and services, and would
likely cause further stresses on an over-burdened health
care system. Certain medical services would be delayed or
unavailable, potentially causing secondary morbidity and
mortality to those unaffected by influenza.
A mild outbreak or no change from baseline
seasonal influenza will undoubtedly result in charges
of over-reaction and fear mongering, which could have
detrimental effects on future compliance with public
health measures, future influenza immunization initiatives
and compliance with a response to public health
emergencies.
There are consequences to planning, including financial
investment and diversion of human resources, and
consequences to the lack of planning should the threat
become reality. In either case, a prudent assessment of risk
is vital and prudent planning in response to that risk is
necessary to avoid victimization.
Response to the Threat
The American College of Emergency Physicians
(ACEP) supports comprehensive response planning by
its members and their institutions. ACEP will work with
its corresponding professional associations (e.g. nurses,
prehospital professional, EMS medical directors, hospitals,
public health associations) to implement the actions and
satisfy the requirements of the planning process. ACEP
will seek support as necessary on behalf of its members
from federal government entities responsible for surge
medical response capabilities.3 ACEP state chapters
should seek the involvement of their state health directors.
Members should involve local emergency managers,
political leaders and local health directors.
This is starts on page 5.
[This scenario is a notional planning scenario based on
available information, within which are certain assumptions
that may change as information becomes more precise. It is
meant to be challenging and realistic, but is not predictive.]
The first cases of novel H1N1 reappear in an
unspecified area of the nation in late September. Early
cases are not recognized as influenza, and will be treated
conservatively, affording the opportunity for transmission
to schoolmates and family.
The vaccine for the novel H1N1 will not be ready for
distribution in large volumes until late October. Vaccine
for the novel H1N1 may require two injections, at least two
weeks apart, to stimulate immunity. Immunity will not
be sufficient to protect subjects from infection until two
weeks after the second injection.
Local officials will be hesitant to implement community
mitigation strategies early in an outbreak, especially school
closure so close to the beginning of the school year. The
media will continue to fuel the public sentiment that
health officials over-reacted to the spring wave and are
doing likewise to the fall cases. There will be political
pressure to keep schools open because of large numbers
of workers without ?time off? benefits to care for their
children. The Federal government will not have solutions
in place, such as emergency wage replacement, to mitigate
that pressure. Because of economic pressures and high
value placed on jobs in a weakened economy, workers will
continue to work when sick, exacerbating transmission in
the most contagious stage of their illness.
After a few weeks of the fall wave, the prevalence
in affected parts of the country will increase. The first
few deaths will be reported, some in young individuals.
Emergency departments will begin to see large volumes of
people who are not ill with the flu but are concerned that they or their children ?might have it.? They are requesting
screening and prescriptions for antivirals. Emergency
departments will experience a 150% increase in chief
complaints with respiratory symptoms.
By mid-October, 15,000 cases will be reported across
the country, with hot spots in urban areas that have not
employed community mitigation strategies. The highest
prevalence will be among children and young adults,
but during this wave, there will be a 5-fold increase in
mortality, with 250 deaths by late-October, mostly in
school-age children and those in late teens.
The CDC will document the increased virulence, and
communities will begin to close schools. Health guidance
will be provided encouraging those with fever, cold
symptoms, sore throat or respiratory symptoms to remain
at home and wear masks in public, and to go to their
doctor or the emergency department if acutely ill. This
will be concurrent with fall allergy season, when a large
proportion of people report nasal symptoms in a normal
year, and many of those will normally have sore throat
and cough. The highest concentration of people who have
no doctor or health coverage is the same population at
greatest risk for becoming ill with novel H1N1: children
and young adults.
Even though the prevalence of illness is less than 2%,
some public officials may discourage the use of public
transportation or participating in other close gatherings.
There will be increased demand on emergency medical
services for transport of patients to the hospital who would
normally see a doctor via public transportation.
As the prevalence of disease increases, deaths of
children will be in the news regardless of the case fatality
rate, and concerned parents will want their children
checked if they have any related symptoms. Primary
care providers who may have the capacity to see only a
few extra people per day, will be overbooked and will be
referring patients to the emergency department.
National Strategic Plan for EmergencyDepartment Management of Outbreaks of Novel H1N1 Influenza
Vulnerability
Population. No area of the United States would be
spared from the spread of novel H1N1. Although the
weather may affect transmission rates, no emergency
department is exempt from the risks of an outbreak.
If the transmission rates double from the spring 2009,
over 30,000 cases can be expected over the fall and early
winter. Emergency departments could see 150% of normal
volume of respiratory complaints. This may even be true in
communities where the novel H1N1 virus is not yet widely
present due to increased levels of concern by the public
regarding any respiratory related illness.
Critical Infrastructure. The ability of some critical
infrastructures to continue normal operations depends
largely on the attendance of its workforce. Others may
have plans and procedures in place for tele-work or social
distancing. The nation?s just-in-time supply chain could
experience delays in supplying goods and services, and
businesses who cannot survive operational interruptions
may expand inventories of supplies.
Hospitals are no exception to this. Pharmacies may
not be able to get additional supplies from distributors
or sources higher in the chain, domestic and foreign.
Supplies of personal protective equipment ( PPE) and
other supplies may require stockpiling, and food services
could encounter supply problems due to production and
delivery. The workforce may be depleted due to infection,
fears of coming to work in an infectious environment, or
the need to care for children out of school or other family
members. Medical care is highly labor intensive; thus,
service delivery is expected to be exquisitely sensitive to
the ratio of service demand to workforce supply.
Consequence. The consequences to society will
vary with the severity of the illness (transmission and
virulence), the degree to which the population is prepared
and resilient (vaccinated, compliant with community
mitigation strategies, and educated about the threat), and
whether business and industry can sustain productivity
during a pandemic. An outbreak with the severity of
the 1918 pandemic can be a nation-changing event with
massive mortality in young people who are economically
responsible for young families and, in large part, for our
nation?s defense.
Lesser-severity outbreaks can result in temporary
disruptions in the flow of goods and services, and would
likely cause further stresses on an over-burdened health
care system. Certain medical services would be delayed or
unavailable, potentially causing secondary morbidity and
mortality to those unaffected by influenza.
A mild outbreak or no change from baseline
seasonal influenza will undoubtedly result in charges
of over-reaction and fear mongering, which could have
detrimental effects on future compliance with public
health measures, future influenza immunization initiatives
and compliance with a response to public health
emergencies.
There are consequences to planning, including financial
investment and diversion of human resources, and
consequences to the lack of planning should the threat
become reality. In either case, a prudent assessment of risk
is vital and prudent planning in response to that risk is
necessary to avoid victimization.
Response to the Threat
The American College of Emergency Physicians
(ACEP) supports comprehensive response planning by
its members and their institutions. ACEP will work with
its corresponding professional associations (e.g. nurses,
prehospital professional, EMS medical directors, hospitals,
public health associations) to implement the actions and
satisfy the requirements of the planning process. ACEP
will seek support as necessary on behalf of its members
from federal government entities responsible for surge
medical response capabilities.3 ACEP state chapters
should seek the involvement of their state health directors.
Members should involve local emergency managers,
political leaders and local health directors.
This is starts on page 5.
[This scenario is a notional planning scenario based on
available information, within which are certain assumptions
that may change as information becomes more precise. It is
meant to be challenging and realistic, but is not predictive.]
The first cases of novel H1N1 reappear in an
unspecified area of the nation in late September. Early
cases are not recognized as influenza, and will be treated
conservatively, affording the opportunity for transmission
to schoolmates and family.
The vaccine for the novel H1N1 will not be ready for
distribution in large volumes until late October. Vaccine
for the novel H1N1 may require two injections, at least two
weeks apart, to stimulate immunity. Immunity will not
be sufficient to protect subjects from infection until two
weeks after the second injection.
Local officials will be hesitant to implement community
mitigation strategies early in an outbreak, especially school
closure so close to the beginning of the school year. The
media will continue to fuel the public sentiment that
health officials over-reacted to the spring wave and are
doing likewise to the fall cases. There will be political
pressure to keep schools open because of large numbers
of workers without ?time off? benefits to care for their
children. The Federal government will not have solutions
in place, such as emergency wage replacement, to mitigate
that pressure. Because of economic pressures and high
value placed on jobs in a weakened economy, workers will
continue to work when sick, exacerbating transmission in
the most contagious stage of their illness.
After a few weeks of the fall wave, the prevalence
in affected parts of the country will increase. The first
few deaths will be reported, some in young individuals.
Emergency departments will begin to see large volumes of
people who are not ill with the flu but are concerned that they or their children ?might have it.? They are requesting
screening and prescriptions for antivirals. Emergency
departments will experience a 150% increase in chief
complaints with respiratory symptoms.
By mid-October, 15,000 cases will be reported across
the country, with hot spots in urban areas that have not
employed community mitigation strategies. The highest
prevalence will be among children and young adults,
but during this wave, there will be a 5-fold increase in
mortality, with 250 deaths by late-October, mostly in
school-age children and those in late teens.
The CDC will document the increased virulence, and
communities will begin to close schools. Health guidance
will be provided encouraging those with fever, cold
symptoms, sore throat or respiratory symptoms to remain
at home and wear masks in public, and to go to their
doctor or the emergency department if acutely ill. This
will be concurrent with fall allergy season, when a large
proportion of people report nasal symptoms in a normal
year, and many of those will normally have sore throat
and cough. The highest concentration of people who have
no doctor or health coverage is the same population at
greatest risk for becoming ill with novel H1N1: children
and young adults.
Even though the prevalence of illness is less than 2%,
some public officials may discourage the use of public
transportation or participating in other close gatherings.
There will be increased demand on emergency medical
services for transport of patients to the hospital who would
normally see a doctor via public transportation.
As the prevalence of disease increases, deaths of
children will be in the news regardless of the case fatality
rate, and concerned parents will want their children
checked if they have any related symptoms. Primary
care providers who may have the capacity to see only a
few extra people per day, will be overbooked and will be
referring patients to the emergency department.