Having spent the last 18 years of my career preparing for a pandemic at the various levels and organizations, I wanted to take a moment to pause and reflect on where we were, where we are now, and what did we learn. This series will encompass my experiences in a major metro area on the east coast as well as my work in the Midwest.

I began my work in public health and medical preparedness in 2002, when we realized after the 9/11 attacks that we were woefully unprepared as a nation for a public health emergency of any kind. The Anthrax attacks of that year proved to us that we were vulnerable to a bioterrorism attack and did not have the systems or infrastructure in place to respond to be able to save the lives of our American citizens.

Our initial focus was on preparing for a bioterrorist attack, as this was the current hot button and area of concern. Grants were written, moneys allocated, and guidelines provided to develop public health emergency response plans at regional and state levels. What became readily apparent in my home state in the Midwest, was that we did not have plans in place or preparedness for any type of emergency where public health would need to respond, be it a natural disaster or a bioterrorist attack. So while the initial moneys focused on bioterrorism, some forward thinking planners and administrators took the opportunity to develop systems for response that would work in any type of emergency that impacted the health of the public. This shift in mindset was not an easy one.

Our technical challenges at that time seem almost comical today. The advances in technology have allowed us to do things we only dreamed of at that time. Communication is, and always has been, the most challenging part of any emergency. Simple things such as communication to all of the healthcare providers in the community and efficient ways to do that were some initial challenges. Today these challenges have evolved to not, is there a system that can help me to communicate, but to which system do I choose, how is this system integrated into the community/state systems, administration of the system, and buy in of key stakeholders to support the system and provide the desired data and information when it is truly needed.

In our next article, we will look at the administrative challenges faced when preparing for this pandemic.

On December 27, 2013, the Center for Medicare/Medicaid Services published a proposed rule that strengthens emergency preparedness regulations for 17 different healthcare provider types to include hospitals and long term care facilities. The changes have been proposed as the existing CMS regulations pertaining to emergency preparedness have been found to be lacking in sufficient depth to ensure healthcare facilities are actually prepared when disaster strikes. This rule is rumored to be released as a “final rule” with unknown modifications in the first quarter of 2016.

The proposed rule is based on the four foundations of risk assessment and planning, policy and procedure, communication planning, and training and testing. For those facilities who are Joint Commission accredited, the changes (save a few) should not be terribly burdensome, but those who are going from the old CMS requirements to the revised ones, will have quite a bit of work to do.

The challenge will be to build an effective emergency preparedness program, rather than to just check off a few requirements and call it good. Building a program takes time and energy and most importantly focus, direction, and teamwork. Emergency preparedness is a “team sport”, not to be undertaken by one person, but as a team; a team of the leadership in the facility who all have a part to play if preparedness is to be achieved.

Some tips for those who would be starting at square two (you all have at least some sort of plan to start with);

1. Create an emergency preparedness team comprised of your leadership who is led by, or at least accountable to, the facility administrator. Meet every two weeks. Pass out parts of the plan to be worked on and brought back to the committee for review and approval. Stay focused and motivated. It could take a year to get this thing done.

2. Don’t recreate the wheel. There have been lots of smart people working on templates and tools for the last many years. A few internet searches and you can find some great work out there. Fill in the blanks and add to as necessary. Your plan does not have to be long to be effective, just make sure they key points are there and your plan is workable and effective.

3. Join your local or regional healthcare coalition. They are your partners in crime. Folks that you need to have relationships with at the local and regional level. They are your conduit to resources when you need them, communication systems, information during events, and a way to satisfy your community exercise requirement. Healthcare coalitions are forming partnerships now and would love for you to be a part of that.

Preparedness is not a sprint, it is a marathon. If it were easy, everyone would have accomplished it. It is a challenge in our already busy worlds and schedules, but when the time comes and you need your plan, it will certainly be worth every bit of time and effort invested.

Ebola is the hot topic of the week, likely to be a hot topic for quite some time. Confusion abounds with conflicting messages being shown on tv and other news media outlets regarding the personal protective equipment required to protect our health care workers. As two nurses who cared for the first Ebola death in the US fall ill, news media are condeming our hospitals for not being prepared. While hospitals prepare for disasters of all types, this is an infectious disease outbreak with serious implications and complications, and potentially an extended duration. The graphic nature of the symptoms of the illness combined with a high fatality rate, make this an illness noone wants to catch. So as hysteria abounds, hospitals must evaluate the evidence, guidance, and throw in some common sense to determine their readiness for such a patient. The CDC has been very proactive in issuing guidance for hsoptials and health care workers on screening, testing, case definitions, personal protective equipment, and notification procedures. Local and state public heatlh are geared up to conduct investigations and contact tracing of potential cases and exposed persons. The issue at hand seems to be how do we protect our public health and hospital workers from being contaminated and coming down with the illness. While CDC guidelines call for modest PPE, television shots clearly show a higher level of protection worn by the CDC. Confusion is understandable. Hospitals must evaluate the evdience and determine the risk to their workers, while being vigilant to detect any possible cases who might walk in their doors at any time. Prudent actions - train  your intake personnel on screening of all patients for symptoms and travel history; evaluate your personal protective equipment inventory along with negative pressure capability; determine your policy on PPE utilizing your resources and CDC guildelines; review or create an infectious disease plan that outlines what your actions will be for potential cases; conduct tabletop and functional exercises to test out your plan, identifying gaps, weaknesses, and additional resource needs; communicate frequently with your staff your levels of preparedness and plan should your get an ebola patient.

The Zika Virus is the latest public health crisis that has women of child bearing age terrified across the globe. Zika virus infection during pregnancy has been linked to adverse outcomes including pregnancy loss and microcephaly, absent or poorly developed brain structures, defects of the eye and impaired growth in fetuses and infants. This virus has been brought to the US thus far by travellers but with mosquito season upon us, it will likely spread to the continental US as well. As with many diseases of public health consequence, good mosquito control is key to the reduction of mosquitos who are the primary vector of this disease. Standing water is required for mosquito breeding. Be sure to eliminate all sources of standing water on your property and follow the steps below to reduce the liklihood of mosquito bites. The information below is from the CDC; always a great source for the latest disease information.

Vector Control:

http://www.cdc.gov/chikungunya/resources/vector-control.html  

Types of Transmission

Zika virus is spread to people primarily through the bite of an infected Aedes species mosquito (Ae. aegypti and Ae. albopictus). To date, Zika has not been spread by mosquitoes in the continental United States. However, lab tests have confirmed Zika virus in travelers returning to the United States from areas with Zika. These travelers have gotten the virus from mosquito bites. Zika virus can also be sexually transmitted by a man to his partners. A few non-travelers in the United States have become infected with Zika through sex with a traveler.

With the recent outbreaks in the Americas, the number of Zika cases among travelers visiting or returning to the United States will likely increase. CDC is not able to predict how much Zika virus would spread in the continental United States. Many areas in the United States have the type of mosquitoes that can become infected with and spread Zika virus. However, recent outbreaks in the continental United States of chikungunya and dengue, which are spread by the same type of mosquito, have been relatively small and limited to a small area.

Not having sex is the best way to prevent sexual transmission of Zika. Couples with men who live in or travel to areas with Zika can prevent the spread of Zika by not having sex or using condoms the right way every time they have vaginal, anal, or oral (mouth-to-penis) sex.

Symptoms

The most common symptoms of Zika virus disease are

• Fever

• Rash

• Joint pain

• Conjunctivitis (red eyes)

Most people infected with Zika virus won’t even know they have the disease because they won’t have symptoms. The sickness is usually mild with symptoms lasting for several days to a week. People usually don’t get sick enough to go to the hospital, and they very rarely die of Zika.

Treatment

There is no vaccine to prevent or medicine to treat Zika virus disease.

The following steps can reduce the symptoms of Zika:

• Get plenty of rest.

• Drink fluids to prevent dehydration.

• Take medicine, such as acetaminophen, to reduce fever and pain.

• Do not take aspirin or other non-steroidal anti-inflammatory drugs (NSAIDS) until dengue can be ruled out to reduce the risk of bleeding.

• If you are taking medicine for another medical condition, talk to your healthcare provider before taking additional medication.

To prevent others from getting sick, strictly follow steps to prevent mosquito bites during the first week of illness. See your doctor or healthcare provider if you develop symptoms.

Prevention

The best way to prevent diseases spread by mosquitoes is to protect yourself and your family from mosquito bites.

• Wear long-sleeved shirts and long pants.

• Stay in places with air conditioning and window and door screens to keep mosquitoes outside.

• Treat your clothing and gear with permethrin or buy pre-treated items.

• Use Environmental Protection Agency (EPA)-registered insect repellents. Always follow the product label instructions.

• Sleep under a mosquito bed net if air conditioned or screened rooms are not available or if sleeping outdoors.

To learn more, please visit CDC's Zika virus page.

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