# Presentation: 493775

## VHA National Exercise

- End of Day 5 Summary
- June 27, 2008

**VHA National Exercise**
**Assessing VHA’s Pandemic Influenza Plan**

*This document is confidential and is intended solely for the use and information of the client to whom it is addressed.*

## Table Of Contents

- Introductions
- Current Situation Description
- Results from Pan Flu Advisor and EMCG meetings
- VHA Needs
- Feedback from CRT
- Information Related to this Exercise
- Closing

## Table Of Contents

- Introductions
- Current Situation Description
- Results from Pan Flu Advisor and EMCG meetings
- VHA Needs
- Feedback from CRT
- Information Related to this Exercise
- Closing

## Current Situation Description

- It is now three months after initial influenza cases were reported in the U.S. and 6.5 months after the initial outbreak in Asia.
- Government officials have confirmed recent media reports that a “second wave” of influenza is being reported across the country.  Incoming patient percentages are beginning to rise again, just as they had during the first wave of patients three months earlier.  The influx of patients into hospitals and clinics is reaching an average of 140% of baseline for facilities.
- Census numbers are increasing as well, with hospitals nation-wide reporting an average 150%.

## Current Situation Description

- Community mitigation measures of school closings, social distancing of children, social distancing of adults and workplace social distancing are again in effect in many communities.
- The second wave of the epidemic is affecting medical facility staff resources.
- Media reports indicate that staff absences are once again occurring because of  staff illnesses, caring for family members, voluntary home quarantine and fear of infection. After the experience of the first wave, many more are asking to tele-work. Staff absences have reached 20% for hospitals and clinics.
- After six months of effort by government, academic and private industry resources, a vaccine for the specific influenza virus is now available with efficacy in preventing illness estimated at 75% in healthy adults and children. Vaccinations are proceeding according to the national prioritization plan (_[http://](http://www.pandemicflu.gov/vaccine/prioritization.html)__[www.pandemicflu.gov/vaccine/prioritization.html](http://www.pandemicflu.gov/vaccine/prioritization.html)_).

## Current Situation Description

- In general, some states are deviating from the plan to administer vaccine to personnel in industries critical to their own economies. VA healthcare facilities are serving as vaccination sites for approximately 18,000 Federal workers (distributed across the Nation) in the highest prioritization tiers.
- Though not yet confirmed by health authorities, there have been media reports early in this second wave regarding patients not responding to anti-viral treatment with Tamiflu as well as patients responded during the first wave. This has raised concerns that a new, Tamiflu resistant strain may have emerged.  CDC is investigating these isolated reports.

## Current Situation Description

- VHA facilities report an average patient increase of 40% over baseline.  Increases range from a low of 33% to a high of 60%.
- Inpatient census for VHA facilities shows an average increase of 130% – slightly below the national trend.  Increases range from a low of 100% to a high of 160%.
- Staff absenteeism at VHA facilities has risen to an average of 20%.  Although the reasons for staff absences are the same as for the first wave of the pandemic (e.g., staff illness, caring for sick family members, and fear of infection), the percentage of staff members staying home due to fear of infection is higher (among staff still susceptible to the influenza) than during the first wave.
- An HR survey indicates that this appears to be due to four factors:
- Concern about the severity of the influenza strain
- “Burn-out” from the first wave, and
- Increased ability to work from home based on telework capabilities and procedures put into effect during the first wave
- Reports that a new strain resistant to Tamiflu may exist

## Table Of Contents

- Introductions
- Current Situation Description
- Results from Pan Flu Advisor and EMCG meetings
- VHA Needs
- Feedback from CRT
- Information Related to this Exercise
- Closing

## Results from Pan Flu Advisors/EMCG meetings

**VHA is providing guidance on key issues related to protection of employees, patients and family against the very real potential second wave of flu.**
**Vaccination strategy**
**Prioritization and distribution of anti-virals**
**Personal Protective Equipment**
**VHA discussed the supply chain vulnerabilities for special needs of home based patients.**
**Oxygen**
**Home Dialysis**
**Wound care**
**Postal workers and truck drivers are not among the highest priorities for vaccinations, potentially delaying delivery of mail order prescriptions and medical supplies.**

## Results from Pan Flu Advisors/EMCG meetings

**VHA has been given an ESF 8 mission assignment for supporting non Veterans at VA facilities.  The decision on which facilities can treat non Veterans would have to be delegated to VAMCs as they have a better understanding of their available resources.**
**VHA is developing policy on the strategy for protection against the second wave of flu.  Discussions centered on whether it is spread via droplet or aerosolized.**

## Table Of Contents

- Introductions
- Current Situation Description
- Results from Pan Flu Advisor and EMCG meetings
- VHA Needs
- Questions for CRT
- Closing

## VHA Needs

**VHA requests support from OSP on how the delivery of pharmaceuticals and medical supplies will be prioritized for delivery to home based care patients. **

## Table Of Contents

- Introductions
- Day 1 Situation Description
- Results from Pan Flu Advisor and EMCG meetings
- VHA Needs
- Feedback from CRT
- Closing

## Feedback from CRT 

**Office of General Counsel has determined that family concerns would override CDC’s authority during a medical emergency.**
**Office of Human Resources determined that Director’s have the authority to grant leave as an award for outstanding performance during the pandemic.**
**As an after action item, VA needs to define how hazardous duty pay would apply and what the authorities would be.**

## Table Of Contents

- Introductions
- Current Situation Description
- Results from Pan Flu Advisor and EMCG meetings
- VHA Needs
- Feedback from CRT
- Information Related to this Exercise
- Closing

## EXERCISE MESSAGE to VISN EXERCISE COORDINATORS

**VISN Exercise Coordinators please forward this message to all VAMC Exercise Coordinators.**
**This is a reminder to VISN and VAMC Exercise Coordinators**_** **_**to collect comments from exercise players.  **
**Instructions:**
**VAMC and VISN Exercise Coordinators should distribute the Exercise Feedback Form to all participants at the VAMC and VISN Office levels. **
**VAMC Exercise Coordinators should collect the Exercise Feedback Forms and use   the input to complete the AAR Form for the VAMC play.   VAMC Exercise Coordinators should send the completed AAR Form (not the Feedback Forms) to the VISN Exercise Coordinators by close of business, Thursday, July 3rd. **
**VISN Exercise Coordinators should collect the Exercise Feedback Forms and use the input to complete the AAR Form for the VISN Office play by Thursday, July 3rd. **
**VISN Exercise Coordinators should send the completed VISN Office AAR Form and all of the VAMC AAR Forms to **_**[Janice.Phiffer@va.gov](mailto:Janice.Phiffer@va.gov)**_** by close of business Monday, July 7th. **

## EXERCISE MESSAGE to VISN EXERCISE COORDINATORS

**Forms:**
**Exercise Feedback Form: **_**[http://www1.va.gov/emshg/docs/VHA_National_Exercise_Local_Feedback_Form.doc](https://webmail.bah.com/exchweb/bin/redir.asp?URL=http://www1.va.gov/emshg/docs/VHA_National_Exercise_Local_Feedback_Form.doc)**_
**AAR Form: **_**[http://www1.va.gov/emshg/docs/AAR_Form_6_19_08.xls](https://webmail.bah.com/exchweb/bin/redir.asp?URL=http://www1.va.gov/emshg/docs/AAR_Form_6_19_08.xls)**_
**National AAR Call:**
**VAMC and VISN Exercise Coordinators are invited to attend the National AAR Conference Call on Thursday, July 10th from 11:00am-1:00pm eastern on 1-800-767-1750 access code 77060.  A preliminary AAR Report will be available prior to the call.**
**Questions:**
**Please direct questions on this request to Janice Phiffer at 304-264-4827.**

## Table Of Contents

- Introductions
- Current Situation Description
- Results from Pan Flu Advisor and EMCG meetings
- VHA Needs
- Feedback from CRT
- Information Related to this Exercise
- Closing

## Closing