Anita L. Barkin Dr.P.H., M.S.N., C.R.N.P.
November 19, 2014
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Introduce the emergency response planning
concepts related to infectious disease and
pandemic.
List key partners –internal and external- in
the planning and implementation phases of
the infectious disease/pandemic plan.
Review special considerations for smaller
nurse-directed clinics with minimal
resources.
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More effective response to any public
health threat/emergency.
Global travel increases speed and
opportunity for the spread of disease.
There will be little time to act once the
event starts.
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Inclusive, collaborative
Plans must be flexible, adaptable,
resilient
Plans must be tailored to the particular
type of infectious disease
Plans must be tailored to address the
particular needs of institution and
available resources
Plans must be tested and rehearsed
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Isolation of the sick
Quarantine of the exposed
Social Distancing
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Public education
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◦ Actions taken to discourage close social
contact between individuals
◦ Accurate, clear
◦ Consistent with those being given by other
public health authorities
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Support the goals of public health by:
◦ being knowledgeable about infectious disease
planning guidelines and recommendations.
◦ having a plan to isolation the sick/quarantine the
exposed.
◦ developing an health education/communication plan.
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To develop a detailed plan for Student Health
operations.
To be an active participant in the campuswide planning process.
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To identify and establish contacts in the
local health care community including
hospitals, local health departments,
emergency response personnel.
To provide sound medical and public
health information to the incident
commander, key decision makers and the
campus community when an event
occurs.
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Who is responsible for emergency
preparedness on your campus?
Does your school have an emergency
response plan/template?
Can it be adapted for infectious
disease/pandemic planning?
Who do you engage in the conversation on
your campus to get emergency planning
on the table?
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Executive management (President, Provost, Chancellor or designees)
Student Health
Public Safety
Environmental Health & Safety
Public Affairs
Government Relations
Facilities Management
Student Affairs (residence life)
International Student Services
Housing
Dining
Human Resources
Risk Management
Telecommunications
Information Technology
Operations and Finance
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Establish relationships with the local public
health department and hospital emergency
departments.
Create templates for communication.
Develop a protocol for screening travelers.
Develop protocols for managing a case or cases
(will be tweaked according to the infectious disease)
◦ What do you do when a student walks in the door?
◦ When and how does a hand off to a medical treatment
center occur?
◦ What is your role after the patient is in the hands of the
medical treatment center?
◦ What is your role in mitigation strategies?
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Health Service Staff education and
preparation
◦ Engage staff in infectious disease/pandemic
planning and provide exercises and drills to
rehearse plan
◦ Provide regular updates for staff on the latest
developments regarding emerging threats
◦ Vaccinations
◦ Fit testing for N95s
◦ Inservices on PPE
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Supplies/equipment/services
◦ Compile a list
◦ Identify vendors/storage
◦ Cleaning services, waste removal
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Level One – Unit Level Response
◦ Student Health can handle situation solely or with
the assistance of a few other departments.
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Level Two – Small Scale EOC
◦ Case(s) of an infectious disease with high mortality
or morbidity that potentially threatens campus
health & safety.
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Level Three – Full EOC (Pandemic level)
◦ Cases of an infectious disease with high mortality
and morbidity that disrupts the conduct of
university business.
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Can this situation be handled by the Health
Service alone?
◦ What are the ramifications of a case or cases to the
institution?
 Human Impact
 Asset Impact
 Mission Impact
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If not:
◦ What aspects of the response can be managed by
Health Services
◦ Who are your partners? External? Internal?
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Primary duties
◦ Care/referral of the ill
 How does the student access care? Transportation?
◦ Identification of index case and assessment of mitigation
strategies to limit transmission
 Patient education/campus education
 Isolation
 Surveillance partners
◦ Determine the nature/level of communication to
targeted audience(s)
 Crafted appropriate message(s) in advance of the event
 Timing of messages – winter break travel, prior to
commencement
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University Police or other transportation partner
Campus EMS
◦ Coordinate response and provide case reports
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Student Life
◦ Residential support for the ill
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Housing and Dining
◦ Special meal accommodations
◦ Isolation housing (single room)
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Counseling Services
◦ For student/friend/family member
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Facilities Management
◦ Special cleaning requirements
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Local Public Health Department
Local Hospital Emergency Department/Urgent
Care
 What are the suggested protocols?
 Is this a reportable disease?
 If needed, what assistance can they provide to you?
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Case(s) of an infectious disease with high
mortality or morbidity that potentially
threatens campus health & safety
◦ Greater impact to the university
◦ Executive leadership involvement
◦ Requires coordination with multiple key
stakeholders
◦ Communication/media impact outside of campus
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Depends on resources and role of Health
Services on the Emergency Response Team
Very limited role:
◦ Director/Member of the Emergency Response team
in a consulting capacity
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Limited role:
◦ Liaison to local health department and other local
health care partners
◦ Review communication to the community
◦ Health Services provides assessment and referral
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Expanded role
◦ Health Services director is the Incident
Commander
◦ Chief communicator
 Creates the communications to campus in
collaboration with Media Relations
◦ Organizer
 Leads the meetings of the Emergency Response
Team
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Executive Leadership involvement
Internal Communications engaged
Establish and communicate a response
protocol for suspected cases
Assist in planning/execution of a mass
vaccination clinic, if appropriate
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Communicate early and often
Timing of messages
Collaborate with media relations
Tweak the messages that were crafted in
advance
Ensure materials are easy to understand and
culturally appropriate
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Acknowledge responsibility for campus safety.
Reassure that the university is taking the
situation seriously.
Say what you know, don’t know, what you are
doing to prepare for an event.
Include the recommendations/policy on travel
and workplace safety (handwashing, cover your
cough).
Offer resources (CDC website, WHO website, HS
website).
Establish expectations for further communication
updates.
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External
◦ Maintain communications with local public
health authorities, emergency preparedness
groups, hospital systems
 Identify key contacts
 Participate in community planning/drills
◦ Benchmark activities/planning of other like
colleges and universities
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Housing and Dining
◦ Identify additional isolation areas.
◦ Assist in relocation of students if necessary.
◦ Arrange for meal delivery.
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Student Life/Activities
◦ Assist with support for students in isolation
housing.
◦ Act in a surveillance role.
◦ Consider mitigation strategies for student events
(screening participants, hand washing stations).
◦ Consider postponement/cancellation of events.
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Facilities Management
◦ Restrict key access to buildings if needed.
◦ Initiate decontamination protocols and manage
turnover of isolation housing.
◦ Assist with securing/moving additional medical and
cleaning supplies.
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Environmental Health & Safety
◦ Contract with the hazardous material disposal
company for waste disposal and disinfection.
◦ Obtain and distribute PPE
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Telecom
◦ Additional phone support for Health Services.
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Office of International Education
◦ Provide guidance regarding international student
issues.
◦ Assist in communication of travel advice to
students studying abroad.
◦ Identify contacts in host countries regarding access
to health care, travel issues, status of disease in the
region.
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Campus Police
◦ Receive additional PPE training.
◦ Implement a dispatch screening protocol.
◦ Alert Health Services if encountering individuals
with symptoms consistent with illness.
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Human Resources
◦ Prepare Call-off and or telecommuting policy for
staff/faculty who are in isolation.
◦ Communicate protocols or travel restrictions.
◦ Communicate work expectations and leave policies.
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Initiate National Incident Management
Structure (NIMS)
◦ Appoint health of Operations, Liaison, Logistics,
Planning, Safety, Finance and Record Keeper
• May have outside agency involvement – City, State,
Federal
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Limited, likely advisory only.
Determine staffing, scheduling, hours of
operations needed to support remaining
students, if possible. Closure?
May support mass vaccination conducted by
public health agency.
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Evaluate the institutional effects of the
situation.
Notify Deans and Department Heads of
decisions.
Provide oversight for family notifications.
Review business continuity plans.
Review audiences and content for internal
and external communications.
Authorize a temporary suspension of classes,
campus evacuation, closure.
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Telecom
◦ Establishing a phone bank.
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Student Life/Housing/Dining
◦ Support students who cannot go home.
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Counseling and Psychological Services
◦ Providing teletherapy if possible.
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Office of International Education
◦ Providing advice to students who are studying
abroad.
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Human Resources
◦ Identify personnel to staff essential functions.
◦ Identify personnel available for telephone support
work.
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Campus Police
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Enforcing public health orders
Securing the perimeter of isolation areas.
Securing the health care facility.
Maintaining civil order and controlling traffic.
Parking
◦ Opening gates for evacuation
◦ Arranging public transportation options.
20 year old student from China presents to the Health Service
with 3 week history of cough, fever, night sweats. His health
history indicates that he his last PPD was one year ago. He
traveled recently over winter break to see family. He lives in a
residence hall.
His fever is 100.8, he coughs throughout the exam.
Actions:
Instructs the patient to cover his cough and hands him
a mask.
The nurse dons an N95 mask as she is concerned
about the possibility of TB.
Arranges transport to the local emergency room with a
mask on by way of the local ambulance company and
informs them of her concerns.
Calls Environmental Health and Safety to clean the
room.
Operationalize the response plan when you find out
from the local health department that the student is
diagnosed with active TB and in isolation in the hospital.
◦ Communication
 with Health Dept, Student Affairs, Student Life
 assist with contact tracing including any student(s) who were in the
waiting room at the same time as the ill student.
 Targeted communication to the academic dept. or residence hall
◦ Assist with arrangements/provide post-exposure testing
for HS staff and others potentially exposed.
◦ Collaborate with the Health Dept. to ensure proper followup of contacts.
◦ Monitor student’s return to campus – compliance with
treatment protocol.
◦ Advise Dean of Students of the possible impact on
academic progress.
Graduate student arrives from Liberia after
spending winter break with family. She follows
instructions given in a communication from HS sent
to the campus community prior to students
returning to campus for the spring term. She
monitors her health and takes her temperature
twice a day. On the 8th day after her return to the
U.S., she notes the onset of fatigue and nausea.
She has a low grade temp and calls the Health
Service. The student is told to call the local ER to
discuss how to approach for care.
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Health Services
◦ Notify response team of the call and need to meet
 This will hit media – increased institutional impact
◦ Stay in touch with local health care agency for updates
◦ Check on PPE supplies
◦ Post instructions outside waiting room and on website
regarding the procedure for accessing care
◦ Reinforce phone screening with HS staff and Campus
Police dispatch
◦ Assist in preparation of communication to campus
community
◦ Be the voice of science…be the voice of reason…
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ACHA website
◦ www.acha.org/topics/ebola.cfm
◦ www.acha.org/Publications/docs/ACHA_Guidelines_
Emergency_Planning_AllHazards_Approach_Feb201
1.pdf
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CDC
 http://wwwnc.cdc.gov/travel/page/advice-forcolleges-universities-and-students-about-ebola-inwest-africa
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Medscape
◦ EBOLA: CDC Enhanced Guidelines for Wearing PPE
Dr. Margaret Chan
Director-General WHO