A Place at the Table

     From the beginning, the medical and research communities have been divided on whether avian flu would be the next big pandemic. And although it now appears that avian flu cases are occurring less frequently, it is clear that historically and statistically, we are due for such a pandemic in the next 5-10 years. For this reason, planning for a potential pandemic should continue, and it's important that fire and EMS services become active participants in planning for their communities. Your department should have a seat at the table. This article is designed to assist you in preparing your department for this role. It offers talking/discussion points and information for active participation in a successful planning process.

     First, it is important that your department have plans in place to take to the discussion table. There should be a designated member of the department charged with establishing the plan and educational activities to support it. The designated officer for infection control (DOIC) is ideal for this role. The DOIC has been trained in disease-transmission issues and established a working relationship with local medical facilities and the public-health department. The DOIC should also already have in place a working communication system for disease reporting and information sharing. The DOIC has resources for tracking information on disease issues and should have an established network with other DOICs in the area. Using the DOIC as your representative will not require the investment of additional resources and education to bring another person in the department into a similar role.

     Second, ensure that your department has its own plan before taking on discussions and recommendations in a group. The group may ask you for suggestions. The checklist sheets found at www.pandemicflu.gov are useful tools in the planning process. The specific checklist for emergency medical services and transport agencies provides a detailed guide. Download it and establish where your agency is now. The checklists all begin with having one individual designated to run the response program.

     Third, begin an evaluation and education program. You will need to consider the emotional reaction and potential for fear among your fellow providers if and when a pandemic occurs. During the 1918 Spanish flu pandemic, 25% of fire and police employees did not report for duty. One reason was fear of contracting the disease; another was concern for family members. Even the best-looking plan on paper will fail if these issues aren't addressed. Lessons can be learned from the way Hong Kong officials dealt with SARS: It was established that education was critical and had a direct bearing on employees' attitudes toward working. The government set up education and training programs for the employees and kept the population informed as well. Education was, and should be, two-pronged: for staff and for the public. Here is the Hong Kong approach:

Public Education
     The Hong Kong Department of Health prepared ongoing informational booklets for the public. These kept the population up to date on the outbreak and gave them instructions for personal protection. The government set up practice drills for a high-case-rate event in which the public also participated. This is not currently being done in this country, but could be a key component of reducing fear and panic in the public. The U.S. has some areas that have had practice drills, but they've asked for volunteers. That is not the same as using the community at large. A mass panic situation would have disastrous results. Why can't the public know and practice reporting to points of distribution (PODs)? This may be a key point in planning discussions. A CDC survey conducted during smallpox response planning found that 25% of the population surveyed would not report to a POD, but would seek treatment/medication elsewhere. This could have a major impact on control and response.