One lesson H1N1 highlighted is the value of having a continuity of operations plan (COOP) to support business operations and critical functions throughout an extended response period. Many organizations already had or created a COOP to help solve issues like dealing with inventory shortages (especially respirators), personnel shortages and patient surges.
As we personally look back on the 2009 H1N1 event, here are a few of our observations and major lessons we think will help everyone with future continuity of operations planning:
The first wave may surprise you, but the second will have you reeling. As you know, pandemics can have up to three waves of significant illness in a community. The initial wave will have huge media coverage, some illness and many worried people. However, the second wave is what catches many hospitals off guard, facing supply shortages and patient surges. This illustrates the importance of planning ahead even before the first wave occurs.
Dependencies are important. Most hospitals have completed some type of COOP and know what their essential services are. However, problems will arise if those essential services haven’t had their dependency services identified. For example, an Arizona hospital used post-exposure prophylaxis (PEP) with Tamiflu for employees who had come into contact with a patient that had 2009 H1N1, but it forgot to provide PEP to the admitting clerks in the emergency department. Needless to say, there were significant issues.
Pandemics become the operating environment. For years, pandemic planners have known that not every pandemic is the same, but generally the pandemic will last between 12 to 18 months. Some pandemics are severe (e.g., the Spanish flu of 1918) and are worse than other more moderate pandemics of the 20th century (e.g., 1957 and 1968). Most hospitals planned for a severe pandemic, yet those plans lacked the flexibility needed for moderate pandemics. All too often, emergency managers overlook the possibility that the pandemic will become the operating environment, instead of an incident that requires response. As a pandemic wears on, continuity of operations planning becomes more essential, especially if the hospital starts to think about a pandemic as an event that will last between 12 and 18 months. The need to revise the COOP, including how to stagger shifts or access additional human support, becomes quite apparent.
The virus isn’t ever really gone. Viruses are unpredictable by nature. While some attack in waves, leading to upswings, peaks and downswings, H1N1 has not. The 2009 H1N1 virus came into communities and has lingered. Even within a single community, everyone isn’t affected at the same time or to the same extent. A good example of this was seen in school closures; between April and May 2009, when the pandemic began, there were sporadic and isolated school closures. Unfortunately H1N1 doesn’t roll through a community all at once and then leave. Because of this, staffing has become unpredictable and difficult to coordinate at hospitals. Employee absentee rates will ebb and flow during this protracted event.
The unexpected should be expected. It’s easy to be lulled into expecting the H1N1 pandemic to behave like previous outbreaks. The influenza virus is notoriously unpredictable and can do almost anything.
Stockpiling is hard, if often impossible. The N95 respirators quickly fell in short supply, despite best efforts to keep them on hand. Some memorandums of understanding aren’t worth the paper they are written on, especially if your supplier developed a pandemic plan that says it will only provide equipment to its primary customers. Emergency managers would do well to account for this when drafting memorandums of understanding.
Automate when possible. Internal inventory and pharmaceutical management systems should be tracked carefully throughout the pandemic with daily reports provided. This can assist in critical decision-making. Also using an emergency management software tool will help track all decisions, costs, staffing and resources used. Technology can provide an invaluable tool for sharing critical information among other hospitals, the health department and other stakeholders. It’s also a convenient method of organizing everything for after-action report creation, corrective action plans, documentation and possible reimbursement.
About the authors:
Onalee Grady-Erickson is a certified emergency manager and principal at Emergency Response and Global Security Solutions, which provides a wide range of emergency response training programs. Grady-Erickson is an adjunct faculty member with the Center for Domestic Preparedness; formerly the infectious disease outbreak program coordinator for Minnesota’s Department of Public Safety, Division of Homeland Security and Emergency Management; and a national leader in pandemic influenza planning. She may be contacted at 612/360-8163 or ogradyerickson@ergss.com.
Mitch Saruwatari is vice president of Quality and Compliance at LiveProcess, in Verona, N.J. Saruwatari co-chaired the development of the National Incident Management System compliant Hospital Incident Command System. He may be contacted at 973/571-2500 or msaruwatari@liveprocess.com.
[Photo courtesy of Victor Burnside | Dreamstime.com]
