Friday, May 1, 2009

Influenza A (H1N1) response


Last Saturday afternoon I got a call from my boss that he was on the way back from the coast and could I meet him at work to discuss a possible national response to passengers that had returned that day from Mexico.

I got in about 20 mins before him and in that time grabbed the first 'ready box' containing a couple of laptops and a couple of phones out of the National Health Coordination Centre (NHCC) 'armoury' and had them and the Smart board up and running in time for when he got in.

Things started a little slowly but rapidly started to escalate as we made contact with Auckland Regional Public Health Service who were undertaking the contact tracing of passengers off the flight that had arrived from Los Angeles that morning.

After a late finish I mountain biked in the next day for a 0930 start and that was the last I saw of my bike until i stuck it on the back of the car on Friday night. By midday we had another 6 positions established within the Ministry's executive board room giving us a Cooridinated Incident Management System (the NZ equivalent to ICS) with a couple of seperate briefing rooms on the side. This room had been identified previously and we fortunate to have 3 ceiling mounted projectors that we used t display EOC and National Sig Events.

Monday brought a welcome surge of additional staff back to Wellington but the fact that NZ is one of the the first countries in the world to wake up every day meant that we had a very high operational tempo from day one responding to developments in Europe and the US that had occured during the night whilst Australia and Asia would start to contact us for updates just as we were hoping things may be slowing down for the day!

Monday afternoon it was decided to relocate the NHCC to a much larger suite of meeting rooms. We had some great support from Information Directorate who established the new NHCC whilst we continued to work upstairs meaning that the last thing we had to do on Monday night was slide the projectors from their ceiling mounts and relocate them and the laptops we had been using down to the second floor. The room we had been working in then became the media briefing room for a series of press conferences including regular joint video media conferences with the Incident Controller in Auckland - a first for NZ I think.

Since the Tuesday the NHCC has been running at a very high intensity in support of operations across the health sector. This has been the first time the sector has operated in Code Yellow, a preparatory state and we are fortunate in having an internationally regarded NZ Influenza Pandemic Action Plan to guide some of our key decisions as well as having reviewed the generic National Health Emergency Plan in th last few months.

The NHCC, like many of the local District Health Board and Public Health Units across the country has been operational for on average 16 hours a day this week, with most staff covering two shifts from 0700-1900 and a number of us covering the hours outside of this as well.

WebEOC has worked extremely well but of course a number of challenges and issues have been raised and will of course be addressed in due course.

The National Sig Event board and the Incident Details board have proven to be an extremely effective way of rapidly disseminating key information to the sector in a matter of seconds. The Incident Details board has been adapted to reflect the key information around the response that we wanted to capture and now functions as a one-stop shop for information such as the latest case definitions, border status or national stockpile.
ESI have provided details of a WebFusion server that will allow any jurisdiction around the world to share relevant data on Influenza A (H1N1) and I've got a teleconference with their health users and international customers VP on Monday to discuss the range of data they are trying to pull together.
We have also provided read only or limited access to a large number of government department and a few companies that we have been working closely with and have been supported superbly by Jeremy and Ian who have been working non-stop to address minor tweaks and improvements as well as building a number of new boards to record summary details of case management and other areas.

We still need to work on the business process to better intergrate WebEOC with agencies single point of contact emails. One of the attractions of WebEOC was that it gave the Health Sector a resilient seperate system in the event that any agency looses their corporate email however for events like this in the future we need to ensure we can operate WebEOC alongside business as usual emails without double handling information.

I'll be making contact with some of the multi-national WebEOC corporate users through the ESI forums to review how they intergrate the two systems together.
I also think there is an opportunity to better utilise the database elements of WebEOC by developing interfaces with other systems, whether these are mobilising, patient management systems or epidemiological surveillance. The challenge is to keep WebEOC at the appropriate strategic level, rather than micromanaging the response.

It's too early to say what will happen with Non Seasonal Influenza A but I'm hopeful the EMIS reference group meeting and training will still go ahead towards the end of May. This ongoing incident has certainly provided a robust test of the system.

I'd just like to thank everyone I've worked with over the last week, especially the support we've received in our EOC from other agencies and I'll see you again on my next shift. By then the National Coordinator will have probably worked out that I can still work on WebEOC from home and will have got Jeremy to suspend my account.

I'd also like to recognise all of the work out in the sector, especially the emergency management staff who will be working hard to bring together a range of diverse staff groups to manage the incident.
If any WebEOC administrators need any support or assistance in your jurisdictions with managing this feel free to drop me a line. I'm grateful to the support of Eric Epley at South Texas Regional Advisory Centre for trauma and Phil at WA Police, both WebEOC innovators over the last 4 years, whom I was able to bounce some ideas off over the last few days.