CRA Pandemic Preparedness and Policy Exercises

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PANDEMIC PREPAREDNESS AND POLICY EXERCISES

CRA, Inc. Pandemic Influenza Exercises and Plans image

New Hampshire Prepares for Bird Flu Outbreak

Statewide Exercise Hones the Response

Image: Caduceus

Boston Globe

New Hampshire Bio Response 2005

November 19, 2005

"It was only a drill, but the potential reality was sobering..."

Avian Influenza and Strategic National Stockpile (SNS) Exercises for the State of New Hampshire’s Department of Safety (DOS) and Department of Health and Human Services (DHHS)

CRA conducted a series of exercises designed to evaluate New Hampshire’s State and local preparedness and response capabilities to what New Hampshire's Commissioner of Health and Human Services called the most pressing public health issue in our country" -- the possibility of an avian flu pandemic."

To test their state's ability to organize a mass vaccination quickly, CRA coordinated the exercise with real flu vaccine clinics throughout the state.

The exercise focused on the threat of two pandemics - one, a novel viral influenza strain similar to the H5N1 Virus or Avian Flu to test New Hampshire's Pandemic Influenza Plan, the other, the appearance of the bubonic plague to test operational response to a plague event using their Strategic National Stockpile Plan (SNS).

''The decision-making has to be clear in advance. The response must be swift, and there must be good communication across all levels of state government."

New Hampshire Governor
John Lynch

CRA’s team of public health and exercise design professionals worked in partnership with the New Hampshire DOS and the Department of Health and Human Services (DHHS). The event was HSEEP-compliant and all CRA's team members are HSEEP-trained providing consistent and thorough exercise involvement and efficient After Action Reports (AAR) which help target the areas which need further work in a way consistent with DHS policy.

The first phase of the New Hampshire Bio Response 2005 focused on the request, receipt, and use of SNS assets in the event of a plague outbreak. This series of SNS-focused exercises included:

a senior leaders’ workshop on the procedures and supporting health data and appropriate procedures for requesting SNS support from CDC;
a National Guard workshop on their roles and responsibilities for activating the Receipt, Staging, and Storage (RSS) warehouse;
and an operational exercise of the RSS warehouse utilizing the CDC SNS Training Package, with assistance from the CDC Technical Advisory Response Unit.

Cover from Exercise Document for New Hampshire

The second phase of the New Hampshire Bio Response 2005 focused on the State’s capabilities to detect, respond, and administer medications in the event of a novel influenza virus outbreak. This phase included:

a 2-week build-up phase of emerging health information and documented influenza cases;
a State Emergency Operations Center (EOC) TTX involving all emergency support functions; and
an 8-hour operational exercise (OpEx). The OpEx included activation of the State EOC; the Public Health Division Operations Center; various points of dispensing (PODs), and emergency management functions in three communities.

Dr. Robert M. Gougelet, medical director for emergency response at the Dartmouth-Hitchcock Medical Center and an adviser to state health officials on emergency preparedness, said he was pleased with how things went.

''We found problems with communications and with how we are going to do isolations and quarantines, but I feel very encouraged overall, and I know we're moving in the right direction," he said. ''The local communities really shine in this, and the hospitals as well, which were looking at surge-capacity issues."

All exercises for the New Hampshire Bio Response 2005 project were planned, executed, and evaluated in accordance with HSEEP methodology.

By Lisa Wangsness, Globe Staff | November 20, 2005

CONCORD, N.H. -- Public health officials across New Hampshire mobilized yesterday to confront a devastating scenario: a deadly bird flu racing across the Granite State.

It was only a drill, but the potential reality was sobering: A college student returned from Indonesia infected with the H5N1 virus, transmitting it to others on her bus ride from Montréal to the University of New Hampshire in Durham. There are outbreaks in Portsmouth, Colebrook, and Manchester, and 46 students are quarantined on the UNH campus. A vaccine is available, but orchestrating a mass immunization while treating the sick, testing those with symptoms, and quarantining all exposed presents a daunting public health challenge -- especially in a small, rural state with just 2,500 hospital beds.

The exercise was designed to help New Hampshire prepare for what state Health and Human Services Commissioner John Stephen called ''the most pressing public health issue in our country" -- the possibility of an avian flu pandemic.

''I think the major concern would be the overwhelming nature of how it would occur and how to respond in the event that thousands of people are affected by it," said Governor John Lynch, who participated in the drill.

Though planning for the exercise began last spring, Lynch said Hurricane Katrina highlighted the need for state and local officials to ensure smooth communication and a quick response.

''The decision-making has to be clear in advance," he said. ''The response must be swift, and there must be good communication across all levels of state government."

So far, bird flu has shown no sign of efficient human-to-human transmission, but public health specialists fear the emergence of an easily-communicable strain could kill millions worldwide. There is no vaccine for avian flu, but New Hampshire officials wanted to test their ability to organize a mass vaccination in a short period of time in case the need arises.

So they combined yesterday's exercise with real flu vaccine clinics, setting up facilities in Manchester, Portsmouth, and Colebrook.

"...orchestrating a mass immunization while treating the sick, testing those with symptoms, and quarantining all exposed presents a daunting public health challenge -- especially in a small, rural state with just 2,500 hospital beds."

When the state learned at the last minute that its vaccine shipments would be delayed, state officials had to revise plans and offer them initially only to those most at risk -- the elderly, the sick, and children. About 2,000 people were vaccinated at the three sites yesterday.

In the basement of a government office building in Concord, three large screens showed computer updates of the drill as it unfolded, monitoring the number of vaccine doses on order from the Centers for Disease Control and the number of patients vaccinated at each of the three sites. State officials from every branch of government discussed wrinkles in the drill as they arose.

Emergency medical services officials notified Manchester ambulances that Catholic Medical Center's emergency room was closed because it was overwhelmed, and told them where to take new patients. Public safety officials kept tabs on a report of vaccine theft. The state veterinarian handled calls from poultry farms about animal testing and food safety. On the perimeter of the room, evaluators took notes.

The drill cost between $150,000 and $200,000. It was paid for by the federal government and coordinated by an Alexandria, Va.-based CRA, a homeland security company. It took place over a number of weeks, culminating in yesterday's eight-hour response-and-vaccination exercise.

In October, the New Hampshire National Guard worked with state officials to discuss procedures for receiving and distributing vaccine from the Centers for Disease Control. On Friday, the state public health lab practiced testing 200 samples for avian flu in a single day.

At the vaccination sites yesterday, police were on hand to monitor the crowd; public health workers logged the names of those receiving shots into a database, and nurses from hospitals across the state administered the shots.

Maria Vazquez, 65, went to Parkside Middle School in Manchester for a shot. Vazquez said she was happy to have the extra protection this flu season, but she has been watching the news and worrying about a bird flu pandemic. She said she was glad to see the state testing its preparedness for an outbreak.

''They promise they're going to do things, and then when something happens, they're not ready for it, as you could see in New Orleans," she said. ''I hope they will be. You have to trust somebody."

Evaluators from CRA will provide a formal assessment within a month, and in January, lawmakers will meet to discuss the drill with Stephen.

Of Recent Note

Based on the World Health Organization's Alert Levels, we are at Pandemic Alert Status (Alert Number 3 of Six) which indicates that there is no or very limited human-to-human transmission of the virus. A Pandemic is when there is efficient and sustained human-to-human transmission.

As of August 23, 2006, the World Health Organization identified that there had been 241 cases of Avian Influenza A/(H5N1) worldwide with an overall morbidity rate of approximately 56% since the signal year of 2003. In 2003, there were only two countries - China and Vietnam - with laboratory-identified cases of the Avian Influenza A/(H5N1) with a total of 4 cases having a morbidity rate of 100%. In 2006 there are now 10 countries affected having a total to date of 96 laboratory-identified cases with a morbidity rate of 66%.

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