March 22, 2007

Local Health Care Providers Preparing for Possibility of Pandemic Influenza Outbreak

Every winter, area health care providers deal with flare ups of the flu and other sicknesses. But these annual battles pale in comparison to the possibility of a pandemic outbreak of influenza.

The possibility of such a disaster has led national and state officials to require the implementation of local plans for dealing with such an outbreak.

Scotland County health officials have taken the first steps in generating such a game plan.

Representatives from a variety of local health care providers met March 14th in Memphis to further address the project.

The meeting began when planner Ron Stewart introduced a Power Point presentation covering the four identified gaps contained within the Pandemic Influenza Plan for Scotland County.

Stewart outlined how critical preparedness for all hazards is an ongoing continuous process and requires the community to stand together to identify the key stakeholders, enable the community and the importance of coordinating local resources.

Stewart also provided an overview of Phase II requirements expected of the Scotland County Health Department and the importance of community support.

A general discussion of Community Critical Infrastructure (with handouts distributed), Non-Pharmacological measures, and Antiviral/Vaccine distribution to those identified community priority groups.

Following Stewarts presentation, a short overview of the Mass Care vision was presented by Gail McCurdy. This vision could vary in most communities but a combination of home care, clinic care, mass sick care, and sheltering was the concept that was most common.

The ensuing presentation detailed the points for potential methods to provide successful mass sick care. These keys included that the community stakeholders holding discussions on where services will be provided and how well in advance of an event the community can be prepared. Other keys were knowledge of the location of resources like manpower and equipment/supplies. The last key for success included the potential trigger mechanism(s) and who should be notified at the time of the trigger.

The discussion, facilitated by McCurdy, included naming possible mass sick care sites in the community. With the limitations and capabilities of each site reviewed, the list included the First Baptist Church, Rec-Plex, hotels and the nursing home. The school was discussed but was ruled out.

Scotland County Memorial Hospital (SCMH) CEO Marcia Dial explained that the hospitals surge capacity plan included movement of non-infectious patients from their care to the attached nursing home that could accommodate up to an additional 30 patients.

Dial approximated that the hospital could handle approximately 40 total patients including four with short-term ventilators at normal levels. The discussion revealed that mass sick care would not be the same level of care as expected or provided in an acute care hospital (the sites would only provide alternate home care).

Jose Padilla, SCMH EMS Supervisor, explained that the plan included sites for mass care for sick and sheltering. He expects to be meeting soon with local stakeholders to review the plan with these persons. Padilla also felt that manpower resources were defined in the plan.

Discussion then turned to persons currently with chronic health care needs that may not have anyone to provide care during such an emergency. A pandemic could divert current health care providers from these patients and might require these providers to stay at community shelter sites.

Margaret Curry, Administrator of Scotland County Health Department, felt that this area could be handled by her agency if necessary. Clients would still be encouraged to remain in their homes as long as they could be supported by the health department, but if it became unmanageable due to the nature of their care, the client would be triaged to a site outside of their home. These sites were not specifically named in this discussion.

Triggers for determining when a site for mass care of the ill should be opened was not discussed as a specific criteria.

Criteria could include:

* Regional and local medical care facilities were all unavailable for accepting sick patients and uncertain when they would become available.

* Escalation and anticipation in the next 12-24 hours of losing the above medical resources.

* Rapid escalation and increase in the volume of sick/medically needy occurs as to overwhelm the transfer/transport capabilities available either temporarily or for an uncertain length of time

Notification of persons for the decision-making and implementation of Mass Sick Care was discussed in general terms but specifics of notification were not elaborated.

Discussion also took place on the prioritization of vaccine and antivirals for the community. The current information from CIDRAP includes that the US Federal Pandemic Flu plan, HHS, hopes to have a large enough stockpile of antivirals to treat approximately 25% of the US population, the numbers for the locals was guided to be in this range. While a prioritization of persons who need to maintain critical infrastructure for health care and business should guide the decision of who those persons should be, it was suggested that the epidemiology of the disease at the time of its presentation should also be a factor. The prioritization table decided at this time will need to be revisited by the local authorities at the time of presentation of disease. Margaret Curry will pursue the prior information locally.

A question and answer period after the meeting allowed additional discussion revealing that concerns related to mass medical care, sheltering and other Gaps still needed clarification and dialogue.

These concerns included the issues of non-pharmacologic containment measures like special needs populations (Mennonites), school closings, child-care, quarantine and the authority for these actions with their impact and timing.

Since the community members felt they needed additional planning and discussion locally, it was decided that the group needed to become more familiar with the information from the hospital plan.

Padilla will facilitate this action to allow the local personnel to define which gaps still needed to be addressed. He suggested meeting with some of the stakeholders before another community meeting was held.

In the meantime, Curry will pursue acquiring information from local personnel the numbers and titles of those who would be prioritized for antivirals and vaccine.

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