Community Pandemic Flu Plan Assignment

Flu Man GroupPhil AndersonJoshua Rose

Becci SchmitzStephanie Sue Sillito

Sai Xiong

Flu Kit

Supply Estimated Cost in USD

Medical SuppliesThermometer $9.95Pain Reliever/ Fever Reducer $5.95Cold Packs (24 pack) $20.00DecongestantExplore FFP 2 (20 pack) – masks $6.95Anti-diarrhea Meds $4.00Prescription Medications (8 week supply) variable

- this includes any prescription medications that an individual is currently taking, such as hypertension medications, birth control pills,

antidepressants, diabetes medications…(this will be different for every person and should be the responsibility of each individual to assure that proper stocks of their medications are available in their home)

If available (very unlikely that these will be available): Tamiflu (H5N1 strain) variableRelenza/Amantadine (standard flu strains) variableQuick Vue Influenza Test Kit $25.00

- to make sure you don’t use your Tamiflu unless youabsolutely have to $45.00

Other ItemsRadio (Battery Operated/ Wind Up) $29.95Batteries (24 pack) $10.00Disinfectant (wipes, hand sanitizer etc.) $3.95Towels, Rags N/APaper Towels, Toilet Paper, Feminine Hygiene Products N/AContainers for contaminated articles N/AClean Clothes N/ACash ($500+) N/ANutritional Supplements (i.e. Centrum) $8.95Flashlight N/ADuct tape N/A

Food/Water55 gallon water storage x 2 $85.90Water purification tablets (50pack) $3.95Total Cereal x 50 $247.50Canned Goods variable

- vegetables: corn green beans asparagus carrots spinach peas potatoes/sweet potatoes

- fruit: peaches pineapple mandarins/oranges fruit cocktail pears

- soup non condensed soups would be preferable because the water

needed to make condensed soup may be contaminated soups with meat in them such as beef or chicken soups would

be a good source of protein soups with vegetables in them should be purchased to help

fulfill one’s daily vegetable requirements- meats

tuna chicken salmon

Nutrition Bars x 5 $94.75Dried Fruit variable

cranberries bananas prunes raisins

Total Estimated Costs (8 week isolation) $601.80

Note: The supplies with the N/A under the estimated costs column are things that most people already have in their homes. If a person is lacking in any of those supplies he/she should make sure to stock up on them.

Note: The list of foods under canned goods and dried fruits is only a suggestion. A person may purchase any canned goods and dried

fruit that they desire but they must ensure that the foods they do buy add up to a well balanced diet.

Emergency Workforce Team Plan

Development of an emergency management team in the event of a pandemic is a high priority that must be accomplished BEFORE any outbreak occurs. This team may include individuals already employed by the city for similar duties or may include new individuals that may be hired for the strict purpose of dispatching and coordinating the team.

The team should consist of five parts:

- Fire Dept / EMT- Police- Hazmat - Coordinating team- Laboratory

The five parts of the emergency response team (ERT) are explained as follows:

1. Fire Dept/ EMT

The duties of the fire dept/ EMTs are to provide safe transport of individuals showing symptoms of infection to a proper healthcare facility. The fire dept is to assess immediate danger and provide support for EMTs. Their duties will be similar to their current operation.

2. Police

The police are to provide safe passage of EMTs to a healthcare facility and prevent violence or altercations that may arise as a result of intense situations. The police are also to assist hazmat in quarantining infected households or businesses and preventing the possible contamination of bystanders and other civilians. Their duties will include their current operational procedures.

3. Hazmat

Hazmat is to assess the situation of reported infections by: a) creating a secure and quarantined area of the reported infection location, b) performing immediate scans and tests of the areas in which the infected individual was located, c) collecting samples and sending them off to be tested for possible influenza presence. After test samples are taken the hazmat team is responsible for fully quarantining and disinfecting the immediate area. The quarantine is to be assisted by local or state police and fire dept personnel.

4. Coordination Team

The coordination team is to consist of a panel of local and state healthcare officials, city council members and an epidemiology/pandemic expert. The purpose of the team is to develop strategies for the following:

i. Quarantine proceduresii. Emergency response procedureiii. Hospital and Clinic procedure *iv. Treatment options and procedure **v. Disposal and sanitation of medical waste and personal propertyvi. Burial and body disposal procedurevii. Direction of human services for children and elderlyviii. Transportation and city wide quarantine effortsix. Access and shipment control of flu vaccine and specialty medical

supplies

* hospital administration will retain their current duties and have control of their healthcare facilities ** Discussed in conjunction with the hospital administration and lead attending physician

The Role of the Media

The main purpose of the media, prior to the flu pandemic, is to inform the public about the necessary preparations one should make. The media (television, news papers, radio etc.) should provide people with a list of supplies (including quantities) that the public should have stocked in their homes. The media should also provide the people with information about the flu (how the virus is spread, who is most susceptible, what can one do to avoid contracting the flu) without causing the population to panic.

During the pandemic, the media needs to notify the public about which cities/states are affected, especially if the outbreak is occurring in neighboring communities. Death tolls and number of new flu cases should be reported on a daily basis so as to inform the public of the seriousness of the pandemic.

At this point, television stations and news paper rooms may no longer be in operation, thus the main source of information will probably be the radio. A cell-phone-a-thon should also be set up so that cell phone users could call an information hotline and hear recorded updates of the flu pandemic.

The media should inform the public about appropriate quarantining procedures as well as protocols for dealing with the dead. One should be informed about what to do if one falls ill, or if one’s friend or family member becomes infected.

The media shall be solely a means to educating the community. It should not sensationalize the flu pandemic in any way. The members of the community need to be educated and prepared for the pandemic, not terrified. The media should refrain from spreading fear throughout the community to avoid a Y2K type frenzy.

Community Communication (e.g. moving goods and services)

During a pandemic, critical supplies shall be transported by the National Guard in order to ensure safe arrival of the goods. If large quantities of supplies need to be moved, firefighters shall be called to aid in the transport, a few police officers shall be asked to accompany the firefighters to protect the goods and keep order.

Critical supplies include:

- food- water and water filtration products- gasoline- flu drugs and vaccines- medical supplies (IV’s, masks, gloves etc.)

Quarantine measures/Prevention/Travel/Crime Prevention

During a pandemic, individuals residing in Oshkosh (except for essential workers such as doctors, nurses, policemen, firemen, grocery store workers, etc.) will have to stay in their homes until the pandemic subsides. Individuals from neighboring towns in Winnebago County shall be prevented from entering Oshkosh. Only those individuals involved in the transport of critical supplies, i.e. the National Guard, shall be allowed in or out of the city.

The police shall enforce the quarantine with the aid of the military. Anyone who shows signs of being sick during a pandemic shall be asked to stay home, unless they become critically ill, in which case they will be permitted to go to the hospital.

During a pandemic, businesses may become vulnerable to security issues, but because individuals are required to stay in their homes, (except essential workers) the police shall be arresting anyone who is caught wondering the street. This should help to protect businesses to some degree. Unfortunately, for the most part, businesses shall be responsible for ensuring their own security (security systems, gates, deadbolts etc.)

Public Gatherings

In the event of a flu pandemic, all public gatherings shall be prohibited. Schools will be closed. No church services shall be performed in a public setting. If church leaders (priests, pastors etc.) choose to do so, they may give religious talks over the radio once a week. Each religious denomination shall be entitled to no more than one hour of airtime per week should they choose to use this resource. The rest of the air time shall be reserved for the news and updates about the pandemic. Public libraries as well as movie theatres shall be shut down until the pandemic subsides. If people choose to hold public gatherings during the pandemic, they will be fined and sent back home. If they resist, all persons instigating conflict shall be forced into confinement (i.e. jail) until law enforcement officers feel that the persons in question have calmed down and will no longer pose a threat to themselves or others.

Fines:

1st offense - $1502nd offense - $3003rd offense – an individual shall be put in jail for one week4th offense – the individual shall remain in jail until the pandemic subsides

Hospitals

Mercy Medical Center500 S. Oakwood RdOshkosh, WI 54904(920) 223-2000

Mercy Medical Center shall be used for flu patients. All inpatients shall be isolated on the top floor. The rest of the floors in the hospitals will be used to care for flu victims. According to the affinity health website, www.affinityhealth.org , Mercy Medical possesses 157 patient beds. Once the hospital beds are all in use, patients shall be put on couches, mattresses on the floor etc., until there is no more room left. (See floor map attached at the end of the flu plan)

Aurora Medical Center855 North Westhaven DriveOshkosh, WI 54904(920) 456-6000

Aurora Medical Center shall remain open for the public’s non-flu related emergencies as well as for the isolation of flu victims. On the first floor, the ICU and Diagnostic Imaging rooms shall be used for non-flu hospital patients. The surgery, physical therapy, medical oncology, and dialysis wards shall be reserved for flu patients. The first floor also possesses a pharmacy which shall be guarded by two police officers round the clock. All three inpatient units (two on the second floor, and one on the third) will continue to be used for patients already residing in the hospital. On the second floor, the cardiopulmonary services ward shall be used for flu patients, and, on the third floor, the labor and delivery ward, pediatric unit, and the OBGYN clinic shall also be used for flu patients. All physician offices, as well as the conference center shall be used for patient overflow. (See floor map attached at the end of flu plan)

Resources of Aurora Medical Center

Beds       Medical/Surgical         48 ICU Beds                         12 Pediatric Beds                        6 ED beds                      13

Ventialtors                        7 (6 can be used for pediatric patients)

Current isolation capacity                 ED Bay                        1         ED Triage            1         Adult med/surg           3         Ped's                       2       ICU                      1

Decontamination                2 fixed rooms

Information on Aurora Medical Center Resources obtained from:

Frances R. Finley, DHA, FACHEAdministrator(920) 456-7606

Alternatives to Hospitals

Once both hospitals are full, aurora and affinity healthcare clinics shall open their doors to the sick. A list of clinics is provided on a different sheet of paper. A list of clinics in neighboring cities is also provided.

Once the clinics are full, local high schools will serve as an alternative Isolation Hospital.

North High School West High School1100 W. Smith Ave 375 N Eagle StOshkosh, Wi 54901 Oshkosh, Wi 54902Phone: (920) 424-7000 Phone: (920) 424-4090

Equipment to Supply Makeshift Clinics & Its personnel

Equipment used in temporary isolation sites would be similar to that in an ordinary hospital. Many modern machines and life support systems used in hospitals today are designed for transfer to and from various sites.

Oxygen: Most hospitals have a large oxygen supply system located in the basement or on the roof that distributes oxygen to the rooms through interconnected pipes in the walls. Obviously this isn’t practical in an off site location. So oxygen supplies would need to be provided in liquid O2 tanks. Along with the tanks, oxygen regulators should be used to regulate the outflow. Optional biofilters are available for the regulators to allow for sterile feed. Standard flow tubes and delivery masks will also be a requirement.

Cots/Beds: Using hospital grade beds is very unlikely in a temporary isolation site due to the cost of the beds, size, and availability. However, camping cots and makeshift beds (i.e tables w/ sleeping bags, household mattresses, etc) can suffice. Sheets and pillows will be needed as well.

Plastic Wrap/Tarps: Since makeshift isolation wards are crude places for containing microbes and viruses, sealing off patients is important. Plastic wrap, while crude, can provide a good barrier for a short period around a patient. Taping plastic wrap to the ceiling and walls around a patient’s bed can create a small “bubble” in which most of the air exhaled will be trapped or prevented from dispersing in large areas.

Standard Medical Supplies: As with any hospital or clinic, standard medical supplies (i.e. antibiotics, surgical tools, blood pressure machines/cuffs, stethoscopes, ventilators, etc) will be needed. Since many of the makeshift places can be set up in local clinics and immediate care facilities, those should not be a problem. Other supplies can be obtained from the university, schools, and stores.

Since much of the effects of influenza are untreatable except without antivirals, rest and ventilation, the best thing to do is, prevent secondary infection, contamination, and suffering.

Any staff needed to run a makeshift isolation center is the same as a regular hospital. At least one physician should be present, but if not available, a well trained RN should be the lead healthcare provider. CNAs should run the routine checkups and treatments.

Since the makeshift locations are not as well designed as an ordinary hospital, at least one armed guard should be posted at each clinic to prevent riot, theft or panic.

Pharmacies/Health Plans

Many individuals require medications every day, unfortunately, during a pandemic, pharmaceuticals may be in short supply due to the fact that most of them are not manufactured in the United States of America. This will place the burden of divvying out medications on local pharmacies (such as Walgreen’s, Morton’s, Wal-Mart Pharmacy). During a situation like this, pharmacies should run on a first come first serve basis and they should be guarded 24/7 by the National Guard to prevent rioting. Pharmacies may substitute some medications for others with similar effects if they run out of one medication (such as blood pressure medications that may be necessary for a person’s survival). Antibiotics should be used sparingly and those that are terminally ill or very old should not receive medicines that would better serve the young and healthy.

Many health plans will not pay for medications purchased from other countries, therefore making the individual responsible for financing his or her own medicinal needs. The WHO, NIH and CDC should coordinate together to decide how much of each medicines should be stockpiled and preserved for a national crisis should a pandemic occur. Many countries will be on their own if a pandemic occurs, but if these countries so desire, they may ship drugs to the US. The import laws regarding medicinal drugs should be bent during the pandemic so as to ensure that adequate drugs are being supplied to communities. The movement of medicines such as Tami flu should be the responsibility of the National Guard to ensure its safe transport and arrival.

Some groups of people in the community may be ignored. These groups are considered high risk groups and will not likely get the drugs they depend on for a normal lifestyle once the pharmacies run out.

High Risk Groups Include:

- immuno-suppressed : such as HIV patients, individuals who have had organ transplants or who have autoimmune diseases and are on immune suppressing medications

- the elderly- young children- special needs communities :. those with mental retardation or physical disabilities

Tami flu and other anti-influenza drugs will be reserved for those that are at a higher risk for infection such as healthy individuals between the ages of 17 and 35 years of age. Winnebago county as well as other communities should start stockpiling Tami flu and other anti-influenza drugs. Although there is no proof any of these drugs will work for the Avian Flu, these drugs are the only defense we currently have. These anti-influenza drugs should be dispensed immediately when medical professionals and personnel assisting in the crisis begin to show signs of the flu.

Discrimination on who shall receive these medications may create tension in the community. This could anger the public and cause rioting as well as looting thus the medications and pharmacies should be guarded 24/7 by the National Guard.

Long-term care (nursing homes, and elderly living alone)

Recipients of antiviral drugs shall include (in order of priority):

- people who work in essential occupations:

healthcare workers: doctors, nurses, physician assistants, nurse practitioners, CNA’s

city servants : firefighters, police, EMTs, HAZMAT army: National Guard

- only individuals between the ages of 17 and 35 who have severe cases of the flu shall be treated with antiviral medications because they are the most vulnerable

Antiviral medications shall under no circumstance be used to prevent additional cases of the flu because individuals would have to take antivirals until the pandemic was over. This would take away medications that should be used to treat the sick.Individuals in long-term care facilities shall continue to receive care from such facilities, but they shall not receive special treatment in regards to the pandemic. Antiviral medications shall be reserved solely for young adults who are more susceptible to the virus. The elderly who live on their own or in small group homes shall be the responsibility of their family members. Those without family members shall be on their own. Unfortunately, resources during a pandemic will be very limited and checks on the

elderly will not be a possibility. The majority of the efforts will be in preventing further spread of the disease and treating sick individuals between 17 and 35.

Vaccines

Vaccine Recipients:

1. Doctors2. Nurses/Nurse Practitioners3. Community/Pandemic City Board Members4. City Servants (firefighters, police, EMTs, Hazmat)

- Only city servants over the age of 17 and under the age of 35 will receive the vaccine. Since this is the most vulnerable age group, priority is given to

them.5. Essential workers between the ages of 17 and 35, such as gas station attendants, grocery store clerk, etc.6. All remaining vaccine will be administered to anyone under 35 years and over 17 years because they are the individuals who are most at risk. This will be done on a first come first serve basis.7. Elderly and intensive care patients will receive vaccinations only if additional vaccines are available.

City Issues

Employees Critical to Maintaining the City

- healthcare workers- firemen/policemen- army- grocery workers- gas station employees- water treatment plan employees- garbage collection employees- Wisconsin public works employees

The impact of a pandemic on local business will be devastating. All non essential businesses shall be forced to shut down until the ban on public gatherings as well as the quarantine is lifted. There are no immediate sick leave policies in place for individual businesses. Each business shall decide their own sick leave policies until bans on public gatherings and quarantines are imposed on the city of Oshkosh.

Essential Businesses Include:

- healthcare facilities- pharmacies- grocery stores- gas stations- water treatment plants- garbage collection agencies- mortuaries

The city will not provide infection-control supplies to the general public because Oshkosh will not be able to handle the financial burden of doing so during a crisis, and mass distribution of supplies would pose a problem (people’s skills and time will mostly be required in healthcare, and maintenance of order in the city). Each individual is responsible for obtaining their own infection control supplies such as tissues, masks, gloves, etc. The city will provide general information about the flu, proper cough etiquette and glove disposal in the form of pamphlets.

Sewage Treatment Plant

According to Melvin Keifer, manager at the Oshkosh sewage treatment plant, the plant will not shut down during an emergency. Even if electricity were to go out, there are enough generators on site to provide the energy required to properly filter the water. The Oshkosh plant also has a half a years worth of chlorine (18 tons) which will maintain the quality of Oshkosh’s water supply provided that the pandemic in Oshkosh does not exceed six months. Keifer said that if a pandemic were to exceed six months, it was highly unlikely that, during these months, the sewage treatment plant would not receive more chlorine.

Melvin KeiferSewage Treatment Plant Manager(920) 232-5325

Funeral Homes

Oshkosh  

Konrad-Behlman Funeral Homes Ltd 402 Waugoo Ave

Oshkosh Wisconsin 54901

Phone: (920) 231-1510

Fiss & Bills Funeral Home 130 Church Ave

Oshkosh Wisconsin 54901

Phone: (920) 235-1170 Seefeld Family Of Funeral Chapels

300 N Eagle St Oshkosh

Wisconsin 54902 Phone: (920) 236-7750

Seefeld Family Of Funeral Chapels 1025 Oregon St

Oshkosh Wisconsin 54902

Phone: (920) 236-7750 Poklasny Funeral Home

870 W South Park Ave Oshkosh

Wisconsin 54902 Phone: (920) 235-1170

Konrad-Behlman Funeral Homes Ltd 100 Lake Pointe Dr

Oshkosh Wisconsin 54904

Phone: (920) 231-1510

Online Funeral Guide DirectoryUSAfuneralhomesonline.comhttp://www.usafuneralhomesonline.com/funeral-homes-by-state/wisconsin-funeral-homes/wisconsin-funeral-directors07.html

During a pandemic, bodies will be stored in hospitals and mortuaries until the maximum storage capacity is reached. If there is no longer any room to store the bodies, they shall be brought to an abandoned barn/building in the country and burnt. Cremation shall be mandatory to keep the streets free of corpses and prevent the spread of the flu or other diseases.

Winnebago County Health Department’s Board of Health and the Oshkosh Board of Health Role

Oshkosh Members for the Board of Health.Dr. Barbara Strand – Chair, Affinity Medical GroupJamie Bonell, CFNP, APNP, Aurora Medical GroupBurk Tower - Council RepresentativeChristine Kniep, UW-ExtensionSusan Panek, United WayStan Kline- AlternateMardell Sowers – Alternate

Winnebago County Health Department’s Board of HealthChair – Stephan RankinVice-Chair – James KoziczkowskiTom LaFuzeDenise McHughJoanne SievertSteve ArneDr. Joseph BachmanNancy BarkerNurse Coordinator – Kathy HanlonSanitation – Kris MurphyFinancial Advisor - Tom Geske

They are currently working on a flu plan though no date has been posted on their website as to when they will next update for it will be but the last update was 2/14/06. Information has been posted though on government, WHO, CDC, Individual, and business plans.

http://www.ci.oshkosh.wi.us/Health/Health.htmhttp://www.ci.oshkosh.wi.us/Health/Bioterrorism.htm

Aurora Medical Center Floor Plan

Mercy Medical Floor Plan