Resource Availability & Allocation in an Emergency SUNY Pandemic Flu Symposium November 8, 2006 Libby Caruso; Dir. Health & Counseling; SUNY Brockport Heidi Levine; Dir. Health & Counseling; SUNY Geneseo Charles Welge; Senior Public Health Planner; Albany County Dept. of Health Pandemic Resource Assumptions * Insufficient resources for all * <10% will receive effective vaccine * Inadequate supplies of anti-virals * Insufficient number of ventillators * Rationing inevitable * “Who shall live when not all can live?” - John Arras, Hastings Center Fellow Foundations for Decision Making * Personal/emotional * Individualistic vs. pluralistic * Focus on greater societal good * Scientific information * Ethical principles Guiding Principles * Duty to provide care * Medical & mental health care givers * Allocating scarce resource * Expect government to determine & communicate rationale for allocation of resources “Substantive” Values Grounding Ethical Decision Making * Duty to provide care * Reciprocity * Equity * Solidarity * Stewardship University of Toronto Joint Centre for Bioethics; Nov. 21, 2005 Procedural Values Grounding Ethical Decision Making * Reasonable * Open & transparent * Inclusive * Responsive * Accountable University of Toronto Joint Centre for Bioethics; Nov. 21, 2005 State/County: What do Colleges Expect? * Vaccine distribution * Anti-viral stockpiling & distribution * Public health messages * Guidance/guidelines: * Prioritization for vaccine * Quarantine decisions * Possible assistance with contact identification & notification (unlikely!) Flu Pandemics: A Comparison YEAR 1918 2000 World Population 1.8 Billion 5.9 Billion Primary Mode of Troopships, Jet Aircraft, Transportation Railroad automobile Time for Virus to 4 months 4 days Circle the Globe Estimated Dead 20+Million 60 Million? Worldwide If a Pandemic Happens: What to Expect * At the peak of the most dramatic pandemic influenza outbreak scenario (e.g., 35% attack rate, 6-week duration) New York State (excluding New York City) can expect a maximum of: * 14,916 influenza-related hospital admissions per week * 3,728 influenza-related deaths per week * 2,609 deaths in the hospital * Influenza patients will most likely utilize: * 63% of hospital bed capacity * 125% of intensive care capacity * 65% of hospital ventilator capacity Public Health Emergency Preparedness - A Shared Responsibility! * Local – state – federal * Domestic – international * Public – private * Multi-sector * Animal – human * Health protection – homeland security – economic protection Goal of Public Health: Saving Lives * Slow spread, decrease illness and death, buy time * Antiviral treatment and isolation for people with illness * Quality medical care * Quarantine for those exposed (antiviral prophylaxis if available) * Social distancing, travel restrictions * Infection control * Vaccine when available * Maintain essential services * Local decisions * Communication General Infection Control Assumptions in a Pandemic * Core prevention and control measures (e.g., vaccination and antivirals) will not be available or will be limited * We must prepare for that! Role of University/College: What do Local Governments Expect? * To identify and establish contact in local health care community including local health departments, hospitals, emergency response personnel * To provide sound medical and public health information to campus community * Resources – e.g. volunteers, physical assets to support home isolation To Whom do we have Responsibility * Students * Staff/faculty * Community at large * Village * County * State Student Issues * Not all students will be able to evacuate * International students * Students from communities with widespread illness * Extent of travel restrictions * Balancing responsibility to students with responsibility to broader communities Individual College Resources * Based on level of severity of outbreak * In event of college closure, may use campus resources to help meet community needs * Facility: housing, field hospitals, morgue * Food * Health professionals * Plan for altered standards of care & associated impact (need pre-education) Staff * Determination of “essential services” personnel * Health * Counseling * Facilities * University Police * Food services * Medical reserve corps (? students) * Depth of staff (expect alterations) Facilities * Space – may be a scarce resource * Housing * Isolated community members * International students * Others * Maintenance of facilities – who would provide? Supplies * Medical – What is on hand? Who gets it? How to safeguard supply? * Medical supplies: anti-virals, oxygen, vaccine * Face masks * Energy and water * Food * Receiving shipments * Distributing to isolated/quarantined individuals “Suggested list”: part of SUNY plan Resources * University of Toronto Joint Centre for Bioethics – http://www.utoronto.ca/jcb * The Hastings Center – http://thehastingscenter.org * American College Health Association – http://www.acha.org * SUNY Pandemic Influenza Plan * U.S. Department of Health and Human Services – http://www.pandemicflu.gov * New York State Department of Health – http://www.health.state.ny.us/diseases/communicable/influenza/pandemic/docs/pandemic_influenza_plan.pdf