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Allocation of Ventilators in an Influenza Pandemic

Allocation of Ventilators in an Influenza Pandemic. Statewide Videoconference March 16, 2007 Pandemic Influenza Preparedness Planning Guthrie Birkhead, MD, MPH New York State Department of Health. Source: MMWR 1999;48:621-29. Influenza Pandemics: 20 th Century.

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Allocation of Ventilators in an Influenza Pandemic

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  1. Allocation of Ventilators in an Influenza Pandemic Statewide Videoconference March 16, 2007 Pandemic Influenza Preparedness Planning Guthrie Birkhead, MD, MPH New York State Department of Health

  2. Source: MMWR 1999;48:621-29

  3. Influenza Pandemics:20th Century Credit: US National Museum of Health and Medicine 1918: “Spanish Flu” 1957: “Asian Flu” 1968: “Hong Kong Flu” A(H2N2) A(H1N1) A(H3N2) 50-100 m deaths675,000 US deaths 1-4 m deaths70,000 US deaths 1-4 m deaths34,000 US deaths

  4. Nations With Confirmed Cases of H5N1 Avian Influenza (March 2007) Source: http://www.pandemicflu.gov/#map

  5. Influenza Pandemic Scenarios • DHHS Plan – Moderate Scenario • 1957/1968 Influenza Outbreak • 35% Attack Rate • DHHS Plan – Severe Scenario • 1918 Influenza Outbreak • 35% Attack Rate

  6. Estimated Impact of Pandemic Influenza (6-Week Period), NYS • *vs. 1400 flu deaths in an average season, vs. 17,500 total deaths in an average 6 week period

  7. Estimated Hospital Impact of Pandemic Influenza, NYS *HERDS Critical Asset Survey = 3,981 staffed ICU beds. **An estimated 85% of the 6,100 vents are routinely in use.

  8. Goal of Pandemic Flu Response

  9. Principles of New York’s Pandemic Influenza Response • Early (prior to transmission in State) • Surveillance for illness in recent travelers • Rapid diagnostic laboratory testing • Isolation of ill persons and contacts • Health system and communities placed on alert • Pandemic declared in State (person-to-person transmission) • Community containment or “social distancing” including school closures, cancel mass gatherings, “work from home” and alternate work schedules • Implement health care system surge capacity plan • Manage health care system assets • Mitigate societal and economic impacts

  10. Pan Flu Planning: AccomplishmentsState Health Department • Helps develop and update the Pandemic Influenza Annex to the State’s “All Hazards” plan. Lead response with SEMO. • http://www.nyhealth.gov/diseases/communicable/influenza/pandemic • Since 2003: 16 statewide, multi agency table tops and 18 full scale preparedness exercises • Conducts human disease surveillance and lab testing. • Coordinates health care system response & EMS services • Maintains statewide electronic systems to issue health alerts (HAN) and track health system resources (HERDS) • Maintains Medical Emergency Response Cache (MERC) • 1 million antiviral treatment courses, 4 million surgical masks, 500,000 N95 masks, 850 ventilators, other medical supplies. • Administers federal public health/hospital preparedness grants; liaison with federal emergency medical stockpile

  11. Pan Flu Planning: AccomplishmentsHealth Care System • Surge plan: stop elective admissions, discharge all stable patients from hospitals and nursing homes, expand number of staffed beds • 8 Regional Resource Centers (RRCs) hospitals funded for regional planning. NYC hospitals funded separately • Regional surge plan (500 beds per 1 million pop) • Develop lists of volunteer physicians and nurses • Alternate site care planning, including home care • Ventilator allocation protocol roll out • Drills & Exercises

  12. Ventilator Requests in a Pandemic Hospital Incident Commander Networks, MOU’s, and vendor sources have been exhausted Hospitals report ventilator data Local EOC (Emergency Manager) HERDS State EOC DOH uses data for resource allocation decision making DOH (Unified Health Command) Ventilator resources: national stockpile, state stockpile, redistribution of assets

  13. Pan Flu Planning: Accomplishments“Live Fire Exercises” – i.e. Seasonal flu • 2004 – managed flu vaccine shortage • Disease surveillance and outbreak control • Lab reporting, HERDS reporting of hospital bed reporting, drug utilization • Supply antivirals from MERC • Vaccination “point of dispensing” (POD) drills • Electronic health alert system utilized (HAN, HPN) • Ambulance diversion • Hospital bed management, cohorting

  14. Pan Flu Planning: Ongoing Challenges • 1918-style pandemic would overwhelm current healthcare planning (500 surge beds per million) • Pharmaceutical interventions: • Vaccine would not be available for 6 months:and then only limited supply (e.g. 100K doses per week) • Antivirals would only be available for treatment, not prophylaxis • Non-pharmaceutical interventions (community containment): • Social distancing/school closures/ban mass gatherings • 35% illness rate and higher rates of absenteeism would strain infrastructure functioning at all levels • High number of deaths would strain mortuary capacity as well as societal resolve.

  15. Pan Flu Planning: Ongoing ChallengesMedical Surge • Locate, equip and staff surge beds • Volunteer/retired health care workers • Provide care in home/community settings • Protocols for ethical rationing of limited resources • Ventilator Triage protocol

  16. Contact Information NYSDOH email for comments: PanFlu@health.state.ny.us Websites for more information: State: www.nyhealth.gov Federal www.pandemicflu.gov

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