Pandemic Influenza Planning and Exercising The Miami-Dade County Experience

1. Pandemic InfluenzaPlanning and Exercising The Miami-Dade County Experience Meeting with GAO Representatives July 23, 2007

2. MDCHD Profile • Eighth Largest County in the US • Population - 2.5 million • MDCHD Budget - $63 Million • MDCHD Employees - 900 • Number of Services Provided Annually – estimated 1,928,000 Source: Catch Study 2004/ ESRI Business Information Solutions Source: HCMS 10/1/04 – 9/30/05

3. Pandemic flu Preparedness and ResponseMDCHD* Roles • Coordinate preparedness actions with community partners • Monitor worldwide progress of new influenza strains • Establish a robust surveillance system • Inform and Educate the public • Convene the County pandemic planning workgroup • Draft the Miami-Dade Pandemic Flu Plan * Miami-Dade County Health Department

4. How did we Plan for a Pandemic? • The M-D County Influenza Workgroup drafted our Pandemic Preparedness and Response Plan • The Miami-Dade pandemic flu plan took elements from • Florida Department of Health (DOH) • Centers for Disease Control and Prevention (CDC) • World Health Organization (WHO) • The plan was included in the County Emergency Management Plan (CEMP)

5. What Challenges do we Face? • Not enough funding and resources • Staffing • Logistics • Mechanical Ventilators • PPEs • Hospital beds • Alternate Medical Facilities • Ethical concerns • allocation and prioritization of resources • Public and healthcare providers “burned out”

6. Are There Solutions in Miami-Dade? • Build a Medical Reserve Corps with at least 12,000 members • Deliver systematic messages to keep awareness among local government officials and the public • Identify potential alternate medical facilities • Local governments’ commitment is needed • Identify funding sources to help us purchase PPEs, ventilators, and other tools • Keep working in the development of proper ethical guidance for M-D healthcare providers

7. Pandemic Flu Exercisesin Miami-Dade • Three CRI field exercises conducted between 2005 and 2006 included a simulation of massive vaccination for influenza • A pandemic influenza tabletop exercise was conducted in March 2007 CRI: Citi Readiness Initiative

8. Pandemic Flu Exercisesin Miami-Dade • After-action reports of the pandemic influenza field and tabletop exercises were created • MDCHD Office of Public Health Preparedness implemented the results from the after-action report into its annual CRI update

9. Challenges Faced Regarding Exercising for a Pandemic • Requesting and receiving approval to purchase refreshments for participants • Getting local hospitals to participate on a pandemic exercise • Gathering enough people from the community to deliver a real mass vaccination *Points taken from the pandemic influenza tabletop after-action report.

10. Possible Solutions to These Challenges • Purchase of refreshments by CHDs is regulated by the State’s Comptroller’s Office • Perhaps a line item from the CDC in the federal funds send to the State assigning funds specifically for exercise refreshments • Use the Hospital Preparedness Consortium as a platform to enhance hospitals participation in exercises • Work with members of the MRCs and the community at large to increase community participation in exercises (flu season)

12. How do we Coordinate on Planning and Exercising with other Agencies? • It is accomplished through • the Miami-Dade County Pandemic Influenza Workgroup • Representatives of local, state and federal government agencies, and community partners • Active communication with • the Miami-Dade Public Schools System • the Miami-Dade Office of Emergency Management • Local Law Enforcement agencies • CDC MIA Quarantine Office (CDCQS) and MIA administration • DOH Headquarters and CDC CRI program (See Planning Folder, Annex 1)

13. Coordination with MIA and the CDC Quarantine Station • Multiple meetings with MIA authorities and the CDCQS to coordinate a pandemic response • Exploring options for a location outside of MIA (initial 72 hours of quarantine) • Exercise to test M-D local response to a biological threat at MIA (2003) • MDCHD staff attended a two-day training organized by the CDCQS and FLDOH addressing pandemic flu and other threats (2006) • MOU between these entities is being discussed

14. Local Mechanism that facilitate Preparedness in M-D • Miami-Dade County Pandemic Influenza Preparedness Workgroup • MDCHD Influenza Work Group • Miami-Dade Hospital Preparedness Consortium • Miami-Dade County OEM • CRI implementation

15. MDCHD Influenza Workgroup • Review Florida DOH Pandemic Influenza plan • Daily and Weekly influenza reports • Recruiting for the Influenza Sentinel Provider Surveillance System • Providing influenza education to the community

16. Coordination with Private and Non-Profit Sectors • Coordination done through • the Miami Dade Hospital Preparedness Consortium • the Health Council of South Florida • the Greater Miami Chamber of Commerce • The Dade County Medical Association • The Miami Chapter of Infection Control Practitioners • Others • M-D Pandemic Plan shared an available online

17. MDCHD Responsibilities with the Implementation Plan • Ensuring all reasonable measures are taken to limit the spread of an outbreak • Establishing comprehensive and credible preparedness and response plans • Integrating non-health entities in the planning for a pandemic • Law enforcement, utilities, city services and political leadership • Establishing state and community-based stockpiles and distribution systems • Identifying key spokespersons for the community • Providing public education campaigns

18. Public Health Preparedness Funding, MDCHD 2006-07

19. Summary of Critical Challenges • Not enough funding and resources • Staffing • Logistics • Mechanical Ventilators • PPEs • Hospital beds • Alternate Medical Facilities • Ethical concerns • allocation and prioritization of resources • Purchase of refreshments for exercise participants • Public and healthcare providers “burned out”

20. THANK YOU