By: Kory L. Sandoz, EMT, EMD
There is really no question as to if we will have another pandemic. The only question is when it will occur and how severe it will be. What is a pandemic? A pandemic is a disease that occurs over a wide geographic area and affects a high proportion of the population because they have little or no natural immunity. Influenza (the Flu) is a contagious respiratory infection. Even though the Flu is not generally fatal, it is very contagious and can make those infected quite ill with high temperature, aches, and coughing. The Flu generally lasts 4-7 days. Influenza can be serious or even fatal for certain groups. People with Asthma, Diabetes, compromised immune systems, COPD, the very young, and the very old can be especially vulnerable.
History shows that we have had at least 10 Flu pandemics in the last 300 years. The largest outbreak of the Flu was the Spanish Flu pandemic in 1918-1919. An estimated 675,000 people died in the United States. The worldwide death toll is thought to be in the millions. The 1957 Flu pandemic killed approximately 70,000 in the United States. The Hong Kong Flu pandemic in 1968 caused around 30,000 deaths in the United States. So how do these numbers translate to today? In an average year, the seasonal Flu will hospitalize 114,000 people and cause about 36,000 fatalities in the USA.
Here are some figures from state pandemic plans to give you an idea how a pandemic could affect us today: The State of Utah’s Pandemic Plan estimates that approximately one million of their residents would become ill during a pandemic. The State of Minnesota estimates one and a half million would become ill. The State of California estimates that 9.5 million could become ill and 200,000 could die.
The virus that caused a small scale pandemic in 2009 was the Swine Flu or H1N1. It was not so widespread that it caused the operational problems we will be discussing here. H1N1 was thought to make 61 million people ill worldwide, but only 274,000 of those required hospitalization. It is estimated that 18,300 died from H1N1. Keep in mind that the H1N1 virus is still circulating today and can cause serious illness in humans.
Many believe that the next pandemic may be caused by the “Bird Flu.” Bird Flu is actually the Avian Influenza virus H5N1 that originated in birds. This virus has shown the ability to kill humans. There is concern that it could evolve into a strain capable of causing a pandemic.
Importance of Pandemic Planning
Why is pandemic planning important? The large numbers of people that may become ill will create a variety of challenges. Demands for emergency services are likely to increase and your staffing levels will be decreased. Keeping your EMS agency staffed could prove to be difficult.
Once a pandemic Flu strain is identified, it could take four months or more to produce vaccines. Even after vaccines are in production they will initially be in short supply. The best advice I can offer for pandemic planning is planning to do more with less. It is estimated that during a serious pandemic, 30 percent of your staff will be too ill to report for work. At the peak of a pandemic, absenteeism rates could be closer to 40 percent.
Employees who are not ill themselves will be unable to get to work or will need to stay home to care for sick family members. Schools and daycare centers may close or be required to close to help reduce the spread of Influenza. Public transportation may be unavailable or limited. The transit organizations will face the same staffing challenges as everyone else. Even if public transportation is available the safety of using it must be considered. Riding mass transit could expose your staff to any other passengers who may be sick. Emergency personnel often have outside public safety interests. Agencies like volunteer fire departments, rescue squads, other EMS services, police reserve or auxiliary, and the National Guard could all be placing additional demands on your staff’s time.
During Hurricane Katrina we observed that some New Orleans police, firefighters, and EMS staff abandoned their job to flee the city or to assist friends or family. We should expect to see similar abandonment during a serious pandemic.
Possible Staffing Solutions
Here are a few possible staffing solutions that you may want to consider for inclusion in your pandemic plan: Transportation may be an issue for your staff. A family member may need the car to get medical care. Public transportation may not be available. Consider creating solutions like having the outgoing shift pick up the incoming shift with the rig. An unused supervisor vehicle or wheelchair van could be used to pick up staff and get them to work. Keep in mind that any staff in close quarters such as a vehicle should wear a mask and gloves for protection. You could consider using retirees or trusted former employees temporarily for less essential roles.
I know it sounds implausible to run a public safety communications center from a remote location but take a moment to consider it. Your contingency plan for continuity of operations in the event that your dispatch center is inaccessible should include moving dispatch operations to a remote location. Is it that farfetched to think that maybe your dispatch staff could do this from home? Of course, this is not an ideal situation. It probably would not work for a large PSAP but it could work for a smaller dispatch center. Consider if this could work for your organization. Ask your information technology people these sorts of questions before an emergency strikes. A lot can be done today with a cell phone, laptop, and a portable radio.
Dispatch staff often hold medical certifications like EMT. They could be an additional resource in triage and mass care situations.
Who wants to stay at work 24/7? The answer to that question could be very different right now versus during a pandemic. Some people may elect to spend more time at work if it meant less chance of exposure for their families. This idea is known as social distancing. The less that people are out in the world and exposed to others, the lower their risk of infection. Since EMS staff cannot prevent contact with the sick, they can at least limit their exposure to family after work. Maybe under those circumstances working a 24 hour shift might make sense. Longer shifts could allow you to maximize time from staff members who you know are healthy. Consider in advance which of your staff members may elect for this option. Take into account who is young, who is single, who has young children to care for at home, and similar considerations. Consider this example: Your communications center normally has two telecommunicators on duty per shift. Maybe under the contingency 24 hour plan, the two dispatchers will take turns resting while still being available if things get too busy. Maybe you have three dispatchers on duty and rotate one out for a rest period every six or eight hours. Take time in advance to consider what would work for your organization.
Keeping your staff on site 24/7 requires some logistical considerations. Staff will be on site for meals. Food preparation and storage areas need to be available. Food should be stocked in ahead of time so no one needs to go out and risk additional exposure. Sleeping and hygiene facilities will need to be available. Infection control is important. Masks, gloves and disinfecting wipes need to be available to decontaminate portable radios, Toughbooks, desk surfaces, radio microphones, telephones, keyboards, door handles, and any other common surfaces between users.
Entertainment and Exercise
A TV should available for weather and news. A TV with a DVD or Blue Ray player would also provide entertainment during an extended shift. A game system like a Nintendo Wii can provide entertainment as well as exercise.
Hospital based EMS will face the biggest security challenges. Hospitals have long been thought of as a safe haven. When people are sick or injured they are taught to head for a hospital. What happens when the resources of the hospital are exceeded? They will need to start turning people away. The sick will keep coming. Even those turned away may hang around because they don’t know where else to go. People coming to visit those who are hospitalized will add to the confusion. Access to your facility may become very difficult. Your staff may be faced with walking through a crowd of the potentially infected just to get in to work. Consider alternatives like having staff park at a remote location. They can then be shuttled to the facility and taken in through a loading dock or service entrance. Another option could be supplying staff with gloves and masks to use when traveling into or around the facility.
Community based emergency medical bases may have an easier time but they will still face challenges. Just because your facility is not at a hospital does not guarantee that you won’t have the infected show up at your facility. If people see medical symbols on your building or see ambulances coming in and out they still may show up looking for help. If you normally leave entrances unlocked during business hours you may want to consider securing them. Limit access to essential personnel only. If you must admit visitors require them to enter and exit through one entrance. Consider allowing your essential staff to park in a secure area like a garage, loading dock, or ambulance bay. Offer and encourage your staff to use masks and gloves when entering the facility or interacting with others.
These recommendations are good practice day to day but are essential during a pandemic. All staff should be required to have and wear photo ID at all times at your facility. All visitors and contractors should be required to wear a temporary ID and or be escorted by a staff member. Discourage staff members from wearing visible uniforms or ID that may identify them as a first responder when they are outside the facility. This will discourage people from approaching them for assistance they cannot provide. Communications centers should be secure at all times. Only people with dispatch specific business should be allowed access. The need to keep noise interference down and the ongoing presence of sensitive information are just a few reasons to enforce this policy. During a pandemic, this could help prevent your dispatch staff from becoming infected through social distancing.
People in public safety are often trained to give media inquiries a standard “no comment”. A better alternative is that members of the media should be directed to a pre-determined media representative in your organization. With some prior planning, your media representative may be able to use the news media to your advantage. Local media can be essential in helping disseminate vital information to the public during a pandemic or other emergency. This can include things like where to go to get Flu shots, steps to prevent infection, and notification about closed medical facilities.
Pandemic Planning Drills and Exercise
It is important to consider the effects that a pandemic (or any emergency) will have on your organization and the continuity of your operation. This needs to be done in advance of a crisis. This allows you to make arrangements and stockpile needed supplies while they are still readily available. Supplies such as N95 masks will become very difficult to obtain during a pandemic.
One of the easiest ways to start pandemic planning is with a tabletop exercise. Begin by sitting down with a few of your key people. Start with a scenario. One example would be an Avian Flu epidemic in your area. Twenty percent of your staff is out sick with the Flu. What challenges will your organization face? How will you maintain staffing? How quickly will your resources be exhausted? What supplies and equipment will be needed? Do not assume that you will have state or federal resources available. Large scale incidents like 9/11 and Hurricane Katrina have shown us that we need to rely on resources at the local level. Keep in mind that pandemic infections tend to come in waves.
As the pandemic subsides and daily life slowly returns to normal you will be faced with several lingering issues like financial fallout and ongoing staffing issues. It is likely that your organization will incur considerable costs during a pandemic. You will have additional staffing and overtime costs from trying to maintain staffing levels. You may have incurred costs related to food, transportation, and other logistics that were required to maintain staffing levels. You may have costs from offering Flu shots or purchasing personal protective equipment. It is recommended that you look at these financial considerations in advance. Include your financial team in the tabletop exercise. Consider purchasing needed supplies like infection control products ahead of time and in bulk while they are still available.
Ongoing Staffing Issues
You may continue to have staffing issues even after the worst of the crisis has passed. You may have to deal with issues involving staff who died, abandoned their job, or had a family member succumb to the Flu. Employees may need extended time off for bereavement. What do you do with employees who left town or simply failed to show up for work during the crisis? Your first reaction may be to consider them as having voluntarily terminated their employment and hire someone else. The reality may not be that simple. You will need to take into account the cost in time and money to recruit and train a new employee. If you allowed someone who abandoned their job to return after the crisis how would that be viewed by the staff who stuck it out? These issues need to be discussed with your human resources department before a crisis occurs.
Every public safety agency should have some employee assistance plan in place. A 24 hour employee assistance line and access to some kind of peer and professional counseling is important. Your staff may have been touched by the death of patients, friends, and family members during a pandemic crisis.
The best way to keep your staff at work during a crisis is to keep them healthy. Provide Flu vaccinations to your staff. Consider providing Flu shots to employee’s families as well. The cost of a Flu shot is a relatively inexpensive way to insure your staff member will not need to take time off work to care for a sick child.
Infection control is critical. Start with the basics like frequent hand washing and the use of hand sanitizer. Use social distancing. Offer and encourage the use of masks and gloves by your staff. This is especially important when they are out in public during an outbreak. Wipe down all common surfaces with disinfectant wipes. Encourage sick employees to stay home. It may be inconvenient to cover one open shift, but it will be much worse if they get several other employees sick.
Sources and Additional Information
The FEMA Emergency Management Institute has two free independent study courses on the subject of Pandemic Planning that may be useful:
IS –520 Introduction to Continuity of Operations for Pandemic
IS-522 Exercising Continuity Plans for Pandemics