Avagene Moore: Welcome to the EIIP Virtual Forum! We are so pleased to see you here today. Please note that Lori Wieber is assisting me today. Avagene Moore: Today's topic is "Pandemic Flu: Historical and Hospital Perspectives." If you have not read the background materials, including our speaker's bio, please do so after today's session. Linda Smith: I'm back! Avagene Moore: For the benefit of any first-timers, we will begin today's session with a formal presentation followed by an opportunity for your questions. Avagene Moore: We will provide further instructions on the protocol for asking questions or commenting just before we begin the Q&A section. However, it is wise to jot down your questions or comments as we go along. Avagene Moore: Please do not send private messages to our speaker or the moderator, as we will be busy with the presentation. If you need assistance, you may send a private message to Lori Wieber. Avagene Moore: The transcript of today's session will be available late this afternoon or early this evening -- just check back on our home page. Avagene Moore: It is my pleasure to introduce our guest today. Dr. Linda Smith is the Medical Director for Alaska's Emergency Preparedness Program where she provides medical oversight to program activities. Avagene Moore: She works closely with Public Health and Emergency Managers to establish response protocols for events such as mass casualty incidents and pandemic flu planning activities as they relate to hospital participation and preparation. Avagene Moore: Please see Dr. Smith's bio for more of her background. She is a very accomplished person in her field. Avagene Moore: On behalf of the EIIP, we welcome you to the Virtual Forum, Linda. Lori will be inputting Linda's formal remarks today - Linda will take over for the Q&A. Lori, I turn the floor to you. Lori Wieber: Thank you very much for attending today's discussion on Pandemic flu. I hope that today's subject matter helps to reveal some of the concerns that the CDC and the health care community has regarding the potential emergence of a pandemic flu. Lori Wieber: As many of you know the CDC and Public Health have recently taken a very proactive position in preparation for a pandemic flu threat that, by all accounts, appears to be well overdue. Lori Wieber: Dr. Julie Gerberding, head of CDC, addressed the American Association for the Advancement of Science on February 21, 2005 in a plenary speech and stated that scientists expect that an avian flu virus that has swept through chickens and other poultry in Asia will genetically change into a flu that can be transmitted from person to person (1). Lori Wieber: The genes of the avian flu change rapidly and experts believe that it is highly likely that the virus will evolve into a pathogen deadly for humans. She made further reference to the pandemic flu of 1918 in her remarks. The flu of 1918 ("Spanish flu") was also felt to be a deadly pandemic flu that mutated from birds and spread to humans and resulted in the deaths of somewhere between 20 and 100 million persons worldwide (2). Lori Wieber: In order to fully understand the implications of the statements made by Dr. Gerberding, it would be useful to review some background information on the pandemic flu of 1918 that was responsible for the loss of so many lives and now serves as the template for preparation for pandemic flu nearly 100 years later. Lori Wieber: In the spring of 1918 flu struck in the town of San Sebastian, Spain striking predominantly healthy young adults. Nearly simultaneously in the United States, a thousand workers at Ford Motor Company in Detroit were sent home with the flu, and some 500 of 1900 prisoners at San Quentin Prison in California were also struck with flu. Lori Wieber: British, American, French and German troops all reported excessive numbers of illnesses during this time frame. Asian populations were also reported to have experienced flu - like illness. Lori Wieber: Very little detailed information on the flu of 1918 is available even today from foreign countries since a news blackout was in effect for all countries involved in the war effort at that time. In fact, it is highly likely that the "Spanish flu" was named as such since Spain was not involved in WWI and did not have a news blackout in effect. As the summer arrived the flu disappeared. Lori Wieber: However, in the fall of 1918 this flu returned almost simultaneously in the three separate locations of Sierra Leone, Freetown British colony of West Africa; Brest, France – the disembarkation sight of American troops; and in Boston, Massachusetts at Camp Devens – the embarkation site of American troops deployed to France to fight in WWI (3). Lori Wieber: By September of 1918 the Hospital at Camp Devens that was built to a capacity of 2000 inpatients was flooded with 8000 critically ill and dying soldiers. Four prominent physicians were dispatched by the U.S. Surgeon General to Camp Devens to evaluate and report on the outbreak of disease. Lori Wieber: A description by one of the Doctors who was the former President of the American Medical Association and had experienced the devastation of typhoid fever and innumerable deaths of soldiers in the Spanish - American war sums up his observations in the quotation that follows (4): Lori Wieber: "...hundreds of stalwart young men in the uniform of their country coming into the wards of the hospital in groups of ten or more. They are placed on the cots until every bed is full yet others crowd in. Their faces soon wear a bluish cast; a distressing cough brings up the blood stained sputum. In the morning the dead bodies are stacked about the morgue like cord wood. This picture was painted on my memory cells at the division hospital, Camp Devens, in the fall of 1918, when the deadly influenza virus demonstrated the inferiority of human inventions in the destruction of human life." Lori Wieber: Cities such as Philadelphia reported as many as 759 deaths on a single day of October 10th and 2600 deaths the week of October 25th, 1918. Cities all across the United States and around the world experienced an illness that took countless lives, orphaned an unknown number of children and nearly brought the war effort to a halt. Lori Wieber: Cities such as Philadelphia reported as many as 759 deaths on a single day of October 10th and 2600 deaths the week of October 25th, 1918. Cities all across the United States and around the world experienced an illness that took countless lives, orphaned an unknown number of children and nearly brought the war effort to a halt. Lori Wieber: An estimated 500,000 U.S. Citizens died in 1918 from a flu that was 25 times more deadly than the 'regular flu.' Such an impact did it have that the average life span in the United States fell by 12 years from 1917 to 1918 (5). If a flu of similar lethality were to strike the United States today, an estimated 1.5 million Americans would lie dead at its conclusion (6). Lori Wieber: Still, you may ask, "How does a flu that stuck 87 years ago pertain to the avian flu of today?" The answer lies in the retrospective review of two other flu outbreaks that occurred in 1957 and 1968. Lori Wieber: By 1957 the World Health Organization (WHO) had a virological monitoring and early warning system in place for the detection of flu outbreak that identified an influenza epidemic in Hong Kong and Singapore (Asian flu 1957). The virus was analyzed and identified as a new virus subtype later genetically identified as a mutation of an avian type of flu (H2N2). Lori Wieber: Samples of the virus were distributed to vaccine manufacturers throughout the world but production was slow and the volume produced was woefully inadequate for population-wide vaccination. Measures to delay the spread such as quarantine and closing of schools and other public events seemed to only delay the inevitable. Adequate medical and hospital services were the greatest challenge. Lori Wieber: This flu strain was considered to be much less virulent than the 1918 strain and resulted in approximately 70,000 deaths in the United States (CDC) and 2 million deaths worldwide. Lori Wieber: The pandemic of 1968 was even milder than that of 1957 and was again identified as a novel subtype (H3N2) of avian origin. The virus was initially identified in the United Kingdom in mid-July but was traced in origin to south-eastern China. The spread of the virus was worldwide and rapid however the lethality or mortality was relatively low resulting in approximately 34,000 deaths in the United States (CDC) and only a million estimated deaths worldwide. Lori Wieber: In summary, the last three pandemics had in common the following features (6): 1. Rapid surge in the number of cases over a very brief period of time 2. A 'sneak-preview' springtime appearance followed by a recurrence with a much more lethal form of the virus with those effected in the spring being spared in the later outbreak (or second wave) 3. Animals, particularly birds, seem to serve as the reservoir for viral replication and mutation for these viruses 4. Milder forms of the virus are characterized by more severe disease and increased numbers of deaths at extreme ends of the age spectrum 5. Lethality in the non-traditional age groups, namely young adults is a major determinant of the overall impact of the virus. 6. Most pandemics appear to originate in Asia in populations who live in close proximity to poultry and pigs. Lori Wieber: So, with this information in hand, let's now look at the present outbreak of the avian influenza. In December of 2003 veterinarians reported a large number of chicken deaths in a commercial poultry farm in Seoul, South Korea. The strain was identified as H5N1. Lori Wieber: This particular strain, an avian flu, was known to infect humans in a previous but much smaller outbreak of the Hong Kong flu in 1997 in which 6 of 18 victims who contracted the disease died. During this outbreak in 1997, 1.5 million chickens were slaughtered and the progression of disease among humans was halted. Lori Wieber: The striking feature of that flu was the presence of a primary "viral pneumonia" which occurred directly as a result of the avian strain. This is in contrast to bacterial pneumonia that is sometimes seen as a secondary complication of usual flu strains. Bacterial pneumonias have a high rate of successful treatment with antibiotics, whereas antibiotics serve little if any use in viral pneumonia. Lori Wieber: During the outbreak of 2003/2004 more than 100 million birds have been sacrificed or died in order to control the outbreak. The disease appeared to be under control until the virus emerged again in June of 2004 and continues to this day despite efforts to curtail its spread. Lori Wieber: The reported death rate from this outbreak is somewhat variable depending upon the location of the disease but statistics reported from the WHO website (7) thus far are as follows: Lori Wieber: Country - Cases - Death - Mortality Cambodia 4 4 100% Thailand 17 12 70.5% Viet Nam 68 36 52.9% Total 89 52 58.4% (Data from WHO: Cumulative number of confirmed Human Cases of Avian Influenza A/(H5N1) since January 2004) Lori Wieber: Efforts to stop the spread of the disease are of global implications. Health care organizations across the world are pooling resources, manpower, and brain power to control the outbreak and monitor the potential for human to human transmission. This is being accomplished by a several pronged approach including intensified surveillance and faster reporting. Lori Wieber: Molecular characterization of the virus is occurring much quicker and development of a pandemic vaccine is underway. Governments have agreed upon the safe slaughter of poultry, limitations of human and occupational exposure to poultry. Infection control in health care settings has been improved and stockpiling of anti-viral drugs has begun. Lori Wieber: Despite these efforts, all of the ingredients for a pandemic flu remain. We have a highly pathogenic virus that is known to infect humans. It originates from poultry in Asia which has been the source of at least two, if not three major pandemics previously. This particular strain of flu is known to mix readily with other types of viruses in order to mutate and enhance its survivability. Lori Wieber: This predisposes the current circulating strain of avian influenza to a significant antigenic shift which has the potential to render the immune system of the human population markedly unprepared to combat the new strain of infection which would result in increased numbers of those infected and potentially increased numbers of those dead and or disabled. Lori Wieber: The world population density coupled with international travel is occurring in unprecedented numbers. In the May 1, 2005 issue of "In Focus" (WHO bulletin), an estimated 2-50 million deaths are estimated to occur if this strain of avian influenza evolves to pandemic proportions under these conditions (8). Lori Wieber: The implications for hospital systems if such an event occurs are staggering. Our current hospital system is already seeing marked increases in Emergency Department visits as a result of significant numbers of hospital closures and decreases in available hospital beds. Reports of "overcrowding" in hospital Emergency Department (at or over capacity) range from 19% in rural hospitals to as much as 48% in urban hospitals (Lewis Group). Lori Wieber: Wait times in an Emergency Department (National Center for Health Statistics) as of 2002 were estimated to be 3.2 hours on average (9). Since then, the numbers of hospital beds has continued to decline and staffing of hospitals by Registered Nurses has fallen by at least 25%. The overall result is fewer beds with fewer staff, and longer wait times for evaluation and or admission. This is the situation without a pandemic flu. Lori Wieber: In short, should a pandemic flu strike, the hospital systems of the United States are not in a position to provide the "expected" standard of care to which the American public has become accustomed. Not only are staffing ratios inadequate to address such a surge of patients, but the closure of hospitals has resulted in inadequate space available to care for such large numbers of ill, critically ill, and dying patients. Lori Wieber: Supplies, including vaccines, anti-viral medications, ventilators, and medicinal items for supportive care would be delayed in manufacturing, and short in supply. For hospitals that are literally fighting on a day to day basis for financial stability, planning for pandemic flu (which may arguably never to come to fruition) seems a daunting and unrealistic task to administrators who face 'real' and current day to day challenges of running a health care facility. Lori Wieber: The bulk of the burden for preparation has therefore landed in the laps of Emergency Planners and Public Health officials who provide invaluable resources for planning for such "surge" events. Recent efforts by Public Health have resulted in improved electronic communications, comprehensive disease analysis and disease surveillance. Lori Wieber: This has dramatically improved our abilities to respond to outbreaks as was evidenced in the recent SARS pandemic. Further efforts by the U.S. governments to improve availability and rapid production of vaccine are also under way and will require collaborative efforts by governments, academia, and industry. Lori Wieber: In summary, all of the ingredients for a pandemic flu exist at this time. Historical perspective indicates that these conditions were also present in prior pandemic outbreaks with similar strains of virus. While much work has been done to prepare for such an outbreak of illness, still more work remains on many fronts to fight what could conceivably be a devastating outbreak of avian influenza. Lori Wieber: In the words of Dr. Lee Jong-wook, Director General of the World Health Organization, "The unpredictable nature of influenza viruses makes it impossible to know whether recent events will turn out to be another close call with a dangerous virus, or the prelude to the first pandemic of the 21st century. Should the latter event occur, the world will find itself warned far in advance, better prepared than at the start of 2004, yet still highly vulnerable."(6) Lori Wieber: Thank you for your attention. I have added the bibliography for you as follows: Lori Wieber: BIBILIOGRAPHY 1. The American Association for the Advancement of Science, plenary speech, Dr. Julie Gerberding, February 21, 2005. 2. (Patterson, K. David, and Pyle, Gerald, F., "The Geography and Mortality of the 1918 Influenza Pandemic," Bulletin of the History of Medicine, vol. 65 (1991), pp 4-21.) 3. Crosby, Alfred W., "America's Forgotten Pandemic: The Influenza of 1918." Cambridge University Press, 2003, pp. 37-41. 4. Kolata, Gina, "Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus That Causes It." Simon & Schuster, 1999, pp.16. (Quotation from Colonel Victor C. Vaughan) 5. World Almanac, U.S. Life Expectancy (statistics for 1917 & 1918) 6. World Health Organization (WHO) "Avian Influenza: assessing the pandemic threat." January, 2005 pp.5-62. 7. WHO, Cumulative Number of Confirmed Human Cases of Avian Influenza A/H5N1 since January, 2004. 8. WHO, In Focus. "Governments in dilemma over bird flu," May 1, 2005. 9. National Center for Health Statistics, 2002. Lori Wieber: I will now do my best to address any questions that you might have. I turn you back to our Moderator. Avagene Moore: Linda is here to answer your questions. I am sure you have several questions for her. ... Avagene Moore: Our protocol for audience questions is to enter a question mark ? to indicate you wish to ask a question or make a comment. ... Avagene Moore: Then go ahead and compose your question or comment to have it ready, but do NOT hit your Enter key or click on the Send button until you are recognized by name. Please WAIT your turn. ... Avagene Moore: But be ready when you are called upon. We want to get to as many questions as we can today. .. Avagene Moore: We will take questions in the order the question marks are sent to the screen. One question at a time please. If you have a follow up question, please get back in line with another ? ... Avagene Moore: We are ready to begin now. Please input a question mark (?) at any time. Avagene Moore: Don't be shy. Input your ? if you have question or comment. Ed PearceCBCP: ? Sunny Ahn: / Avagene Moore: Ed, thank you - please send your question to the screen when you are ready. Ed PearceCBCP: Is Alaska making an effort to include the private sector in pandemic preparedness efforts? Linda Smith: Good question Ed.... Linda Smith: Involving the private sector is proving to be one of the mmore difficult tasks.... Linda Smith: We have developed a "critical infrastructure group"... Linda Smith: It is composed primarily of private sector interest groups... Avagene Moore: ? Linda Smith: groups like oil gas, electric, water, hospitals, transportation Michaela Kekedy: ? Linda Smith: We all have input into decision making Avagene Moore: Linda, are you through with you response? Linda Smith: Does that answer your question? Ed PearceCBCP: ? Linda Smith: Yes. Avagene Moore: Sunny, your turn, please. Ed, we will come back to you. Larry Heidenberg: ? Sunny Ahn: Linda – can you talk more about the devlopments in electronic communication you mentioned earlier – what are the means at which you are getting important messages out? Linda Smith: thanks Sonny Linda Smith: We are working right now with the Health Alert Network through Public Health as our primary info system for notification... Linda Smith: It has some faults though, like lack of a feedback loop to know who has received the notice... Linda Smith: We are also developing a real time talk group.... Linda Smith: which means we are basically encouraging ERs, Public Health, and EMS to work together on special protocols to communicate much more effectively. Avagene Moore: Linda, are all the States taking similar actions (i.e., your response to Ed's question)? Are the States collaborating with each other and how? Linda Smith: Avagene, do you mean State to state communications?... Linda Smith: Or, are we sharing with other states things that are working? Avagene Moore: Yes, state to state. Linda Smith: We are getting better at it.... Linda Smith: for example, we are working on transfer protocols to the lower 48 by identifying those individuals who would take patients and establishing tabletop drills to include them in our planning. Avagene Moore: Michaela, please. Michaela Kekedy: We have plans to put a centralized dispatch center for fire & EMS into a local hospital and are looking at policies and procedures. What signs should we look for in an outbreak as a trigger to move our people from the hospital to another location to continue operations? Sherline Lee: ? Avagene Moore: (If you have a question, please input your ? at any time.) Linda Smith: Good question Michaela... Linda Smith: I'm not sure I completely understand your question though.... Linda Smith: Most dispatch is not directly involved or near patient areas so they should not be vulnerable (per say) to infectious outbreaks. Michaela Kekedy: With the anticipated activity at the hospital and the risk of transmission of the flu from person to person, we would want to minimize the risk to our personnel. Linda Smith: Agreed... Linda Smith: We have selected a separate site on campus as a back up and have trialed it with exercises over the past several months.... Linda Smith: The trigger would be primarily initiated by the staff' comfort level. Avagene Moore: Ed, you have another question? Please go ahead. Michaela Kekedy: Thank you. Ed PearceCBCP: Can I send you an email to obtain contact information for the critical infrastructure group? We have a regional public / private group addressing the issue as well. I'd like to share ideas. Linda Smith: Thanks Ed. Please do. Avagene Moore: Do you mind inputting your email address, Linda? Linda Smith: lapollo15@gci.net Avagene Moore: Thanks. Larry, your question, please.. Isabel McCurdy: ? Larry Heidenberg: Linda, has Alaska begun thinking about altered standards of care for pandemic flu, as discussed in the recent report from the HHS's Agency for Healthcare Research and Quality's recent report and if so, what modifications has Alaska begun to make for preplanning? Linda Smith: We have, yes... Linda Smith: We are establishing offsite treatment centers in conjunction with Red Cross, Public Health... Linda Smith: this group has identified list of common needs, and locations that might serve our needs.... Linda Smith: We are establishing MOA's with the sites.. Linda Smith: And we will try to prioritize needs as the situation arises. It has been a good cooperative effort for all involved thus far. Avagene Moore: Sherline, you are next, please. Avagene Moore: (If you have a question, please input your ? at any time.) Sherline Lee: Is Alaska also addressing the possible scenario that a pandemic strain will not be related to the avian strain currently receiving media attention? (In which case, the availability of the aforementioned vaccine may be delayed further.) In other words, what scenarios are your collaborators considering as part of this preparedness effort for pandemic flu? Linda Smith: Again another good question.... Linda Smith: We are trying to look at lots of different scenarios.... Linda Smith: but I think the basic preparation is similar.... Linda Smith: Long term staffing solutions and space seem to be the major issues for us and for many.... Linda Smith: We have decided not to wait for ESAR-VHP to establish guidelines for medicall assistance but to create our own... Linda Smith: The establishment of offsite treatment locations with other organizations has helped tremendously for space issues.... Linda Smith: the biggest problem, I think, will be the graceful degradations of care. Avagene Moore: Linda, would you please spell out the acronym ESAR-VHP? Don't know that our folks are familiar with that one. Linda Smith: Emergency System for Advance Registration of Volunteer Health Care Personnel Avagene Moore: Thank you! Isabel, you are next. Please. (If you have a question, please input your ? at any time.) Linda Smith: It is a HRSA driven function that I suspect will die a slow and painful death. Isabel McCurdy: Linda- Since Alaskan cruises originate here from Vancouver and given the close proximity of Alaska and British Columbia, are you collaborating with our health officials? Avagene Moore: ? Linda Smith: Great Question... Linda Smith: Yes we are, but not to the degree that I should like.... Linda Smith: The Coast Guard has taken a pro-active role there and is working across borders to establish protocols.... Linda Smith: Cruise lines have established protocols, but I don't know how well they are communicating with the Canadian sector about their plans. Avagene Moore: The tasks and potential for a pandemic flu seem daunting. Is there also a need for preparing the public? Or is the need more pressing for the health professionals to be prepared? Larry Heidenberg: ? Linda Smith: Avagene, you hit on a pet peeve... Linda Smith: I have a strong sense that Public Health should be doing a lot more public education in this arena.... Linda Smith: I believe that the public may be deceived as to how well we are prepared to handle such an outbreak... Lori Wieber: ? Linda Smith: Public education about limitations and potential roles that they as individuals could do for quarantine and isolation should have started a long time ago. Avagene Moore: Larry, please. (We have time for a few more questions. Please input your ? at any time.) Larry Heidenberg: A few questions ago you spoke about your concern about the biggest problem being the "graceful degradations of care". Do you believe this will be at all graceful? We recently participated in the TopOff 3 exercise and we found that many things were expected to be happening "notionally" that none of us suspect will occur in real life. How do we prepare to make things at all graceful, as opposed to the sudden drop off we fear may occur? Linda Smith: Great question... Linda Smith: I believe that the pandemic (if it occurs) will be more gradual than scenarios project... Isabel McCurdy: ? Linda Smith: It will occur over days to weeks and with improved surveillance we should see it coming.... Linda Smith: But, that doesn't mean we will be prepared for its implications... Linda Smith: That is why I think educating the public early about health care limitations and isolation and quarantine are so important. Avagene Moore: Lori, your turn, please. Lori Wieber: Linda, First let me say that I enjoyed your presentation material so much that I couldn't resist giving several portions an immediate encore. Forgive me :-). As someone outside of the health profession I am left wondering what role the general citizenry, as individuals, should or could play in preparedness, prevention, and in subsequent response? Can you give some specifics? Linda Smith: thank you. and yes I'll try.. Linda Smith: A good example is community emergency Response teams.... Linda Smith: There is funding available to start and establish community leaders as volunteers within neighbor hoods to establish roles they would or could play to help one another without depending on outside resources.... Linda Smith: I can get you the info if you would like. Just email me please. Avagene Moore: Isabel, please. Isabel McCurdy: Linda - being a health care professional - I have never heard the term- graceful degradations of care- would you elaborate what it means, please? Linda Smith: Yes. thank you... Linda Smith: It is a new term that is emerging in the face of mass casualty care.... Linda Smith: It refers to the limitations of resources such as nursing, or supplies such as ventilators.... Linda Smith: It assumes that if 25% of the population is ill (flu) or injured (explosives) we will not have enough resources to go around... Linda Smith: In that instance, difficult choices would need to be made as to who gets what... Avagene Moore: ? Linda Smith: Dr John Hicks from Minneapolis speaks to this in his research. Avagene Moore: We have time for a few more questions; please input your ? if you have one or a comment. ... Isabel McCurdy: ? Avagene Moore: Linda, how is the global status of the avian flu being monitored? Linda Smith: Another good question... Linda Smith: WHO has established surveilance sites in several countries overseas... Linda Smith: They are monitoring closely flu reports and tracking them within and between countries and families. Avagene Moore: Thank you. Isabel, please. Isabel McCurdy: Do you have Dr John Hicks contact information- Linda? Linda Smith: Additionally I should say that CDC has many surveillance systems here as well. Debbie Kim: I have a question Avagene Moore: (Other questions for Linda? Please input your ? now.) Linda Smith: Yes. I do but not immediately on hand. I can provide it for you later today though if you send an email. Avagene Moore: Debbie, your question, please. Debbie Kim: Could you expand more on the graceful degradation of care? This is an issue I have wrestled with especially in light of JCAHO Standards of Care Linda Smith: Thanks Debbie... Linda Smith: I guess the question is a bit of ethics really.... Linda Smith: How do prioritize medications, supplies and care when it is in demand for say several thousand an you can supply it for only a few hundred?.... Linda Smith: Who makes the decisions as to who gets vaccine? or who gets a ventilator when you need a hundred and only have 5?.... Linda Smith: there are models out there to try to help us to decide, but it' really like battlefield medicine.... Linda Smith: those that have the most likely chance of survival should be giventhe available assets.... Linda Smith: Are we as an American Public ready or willing to accept that?... Linda Smith: I don't think so. At least not yet. It is a concept hat is very foreign to us and will require a lot of education and difficult decision making. Avagene Moore: Last call for questions, folks. Anyone? Isabel McCurdy: ! Debbie Kim: Most HCP's I think have had little experience with the Military model of triage. Patients and families expect treatment. Avagene Moore: Isabel, comment, please. Linda Smith: I agree. Isabel McCurdy: Linda- didn't that play out given your recent flu vaccine shortage? Linda Smith: Yes.... Linda Smith: Interesting that you should bring that up... Linda Smith: As soon as there was a shortage we had a flood of people who never get vaccine come into the ER demanding that they get it... Linda Smith: Thank heavens Public Health put out clear guidelines and we were able to stick to them, but the numbers were impressive... Larry Heidenberg: ! Linda Smith: Hence my fear that the public will ask the same if the flu has a horrendous pneumonia and ventilators are in short supply or meds or anti-virals can't be found. Avagene Moore: Larry, your comment will be the last we take today. Please go ahead. Larry Heidenberg: Public Health here (county based) saw a major increase in requests for vaccine, we instituted a computer generated lottery based upon applications received. Even with that, people were most upset, trying to trade their vaccine to someone who they felt needed it "more" even though they themselves needed it. Luckily, we were able to meet the demand completely, in the end, but it was NOT a pleasant experience Avagene Moore: Do you wish to comment further, Linda? Linda Smith: Very true. Public education needs to be done on a huge scale... Linda Smith: We need to be honest with them about the limitations that we perceive and enlist their help and support in preparation efforts... Linda Smith: Of all of the preparation work that is being done, this is the one area that is lacking the most, in my opinion... Linda Smith: and the one area in which we could gain so much help and perspective. An educated, insightful community is "enabled" and will be an asset rather than a liability. Avagene Moore: Thank you, Linda. We greatly appreciate your effort and time on our behalf. I am sure our audience will benefit from the information and history you shared with us today. ... Avagene Moore: If you are not currently on our mailing list and would like to get program announcements and notices of transcript availability, please see the Subscribe link on our home page. Avagene Moore: We are proud to announce a new EIIP Partner -- the Disability Preparedness Center http://www.disabilitypreparedness.org . The Point of Contact (POC) is Carl T. Cameron, Ph.D. Welcome! Avagene Moore: If you are interested in becoming an EIIP Partner, please see the "Partnership for You" link on the EIIP Virtual Forum homepage http://www.emforum.org . Avagene Moore: Again, the transcript of today's session will be posted later today (tonight most likely) and you will be able to access it from our home page. An announcement will also be sent to our Mail Lists when the transcript is available. Avagene Moore: Thanks to everyone for participating today. We appreciate you, the audience! Avagene Moore: Before you go, please help me show our appreciation to Dr. Linda Smith for a fine job. The EIIP Virtual Forum is adjourned! Thank you, Linda! Lori Wieber: Linda, do you have time for another question now that we are adjourned? Linda Smith: Yes.. I can stay for a few more minutes. Lori Wieber: I work in EM planning in the critical infrastructure sector. We have kicked ideas around on how we could minimize loss of workforce during a pandemic. It seems to me that business should be very interested in this area. Do you have any thoughts on how this could be accomplished? Linda Smith: A few ideas... Linda Smith: Since we have a statewide exercise coming up in August we are serving as a prototype for critical infrastructure... Linda Smith: I think you will find our efforts published in the next several months. Businesses are interested in keeping workforce active and also in keeping business flowing. So they are very wiling partners at the table here in Alaska. Lori Wieber: Thank you Linda, I will be interested in the outcome of your statewide exercise...where is the best point to retrieve info once things conclude? Linda Smith: I would recommend Googling Alaska Shield Northern Edge exercise. That should bring up most of the information... Linda Smith: Once we have concluded the exercise I would be willing to share whatever part of it are of interest to folks and is not classified. Avagene Moore: Very generous of you, Linda. Thanks.