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Untitled Document

University at Albany Center for Public Health Preparedness

Pandemic Planning for Academic Institutions

Original Satellite Broadcast: 3/13/2008

Moderator: Good morning and welcome to The University at Albany Center for Public Health Preparedness Grand Round Series. I'm Kris Smith and I'll be your moderator today. Before we start, we would like to ask you to please fill out your evaluations on-line. Your feedback is always helpful for the development of our programs and continuing education credits are available after completing the post-test. We'll be taking your calls later in the hour. The toll-free number is 800-452-0662. You may also send your questions by fax at any time during the program the fax number is 518-426-0696 and you can send your questions by e-mail to the address you see on your screen. Today's program is Pandemic Planning for Academic Institutions. Our speaker is Elizabeth Hosmanek, Program Associate, at the University at Iowa. Elizabeth thank you for joining us.

Elizabeth: Thank you for having me here.

Moderator: We have a very full program, so let's get right to it. Could you go over the learning objectives for us?

Elizabeth: Definitely, our learning objectives are to: Identify a process and organizational structure for pandemic planning in academic institutions. Then we are going to examine strategies to develop an effective evaluation and review plan. Finally, explore new collaborations to strengthen on and off-campus relationships.

Moderator: What specific topics are you going to cover Elizabeth?

Elizabeth: As you said, we are going to go through a lot and we have definitions and backgrounds, academic institutions as communities-why is pandemic planning important for this group; planning assumptions; the pandemic planning process; evaluation and next steps; ASPH/CDC Collaborative Group that we were part of last year; and finally references and resources.

Moderator: Well for those of us outside the field of Public Health, perhaps we should start by defining our terms. What exactly is pandemic influenza, which is often called "pan flu," and how does it differ from the seasonal flu, which we are very much familiar with.

Elizabeth: Well the three big definitions for this speak will be: Pandemic Influenza, Avian Influenza, and Seasonal Influenza. Pandemic Influenza is a global outbreak of a novel influenza strain that spreads rapidly. Avian Influenza is a respiratory illness caused by a virus, usually found only in birds. Season Influenza is what we deal with every year, it is a human respiratory illness caused by a virus, most common during winter months. And it is still very serious, because every year about 36,000 American's die from just regular seasonal influenza.

Moderator: It seems we are hearing about Pandemic Flu a great deal, almost everywhere we turn, why the focus on planning and preparing for pan flu?

Elizabeth: Well, mainly because experts state we are overdue for a severe pandemic, normally three pandemics occur each century, that is historically and the three most recent were in 1918, 1957 and 1968.

Moderator: And what one of those, or were they all considered to be a major pandemic, and what is the outlook for our immediate future?

Elizabeth: No, the last major pandemic that we really had was in 1918 and that was called the "Spanish Flu," even though experts think it may have actually started in the United States. There were 20 to 40 million deaths worldwide and between 500,000 and 675,000 just in the United States.

Moderator: So, I think probably it would be important to stress that even if its pandemic it might not be major, it may not be severe?

Elizabeth: Yeah, there is a whole different scale and the United States government has a new scale there kind of comparing to categories; 1-5 for natural disasters, hurricanes and such. But what we are really planning for is for a more severe, moderate to severe pandemic. We figure that we have enough surge capacity in our daily operations that we could take care of something that would be a few days interruption.

Moderator: Elizabeth when you were talking about the definitions, you mentioned Avian Influenza, which we should probably stress is not the same thing as Pandemic Influenza, although it has the potential to turnout to cause a pandemic. How many deaths has the World Health Organization reported with Avian Influenza, in the United States?

Elizabeth: There are none in the United States. H5N1 is the Avian Influenza that is really making a lot of news lines. It is a strain of bird flu, it is closely being monitored, it is mainly in South East Asia, and it is epidemic to large parts of South East Asia in birds. But there have been human deaths, as a result of, most of them had extensive contact with the diseased poultry and as of the end of last month, the end of February the World Health Organization reported 368 cases and 234 deaths, which is pretty significant because you are looking at about a 63.5% mortality rate.

Moderator: And again as you noted on your slide it may or may not be this strain that cause the next pandemic, but experts are saying something will cause a pandemic sooner rather than later.

Elizabeth: Right, and it may not even be influenza for all we know.

Moderator: We'll we have done a lot of pandemic planning in general, we have been talking about it for a number of years in the public health community. How is pandemic planning at academic institutions different from pandemic planning in the general population?

Elizabeth: We'll academic institutions are really unique because you are dealing with a certain population, generally young people between 18 and say 25 and you have a lot of unique things you need to look at to take care of this population; their housing, food, safety and health care issues. Students generally look to administrators of the school to make sure they remain safe, which will be difficult during a pandemic.

Moderator: What about the fact that on a college campus, particularly a residential school, people are crowded together in dormitories, in cafeterias, in libraries.

Elizabeth: Large lecture halls.

Moderator: Exactly, how does that population density enter into your planning?

Elizabeth: Well that is a concern because during a pandemic or other public health emergency with an infectious disease, you are talking about rapid transmission from person to person. So social density is a big concern in colleges and universities, they are among the most socially dense environments you can have and another thing to think about is sporting events we are a big 10 university our hawk guys love our football and during a pandemic when we first started planning one of the questions was well what will happen to football season, and you probably don't want to put 70,000 people into a large stadium during a public health emergency.

Moderator: Probably a good idea.

Elizabeth: Right, so we probably will have to cancel a few games if it happens during football season.

Moderator: And a lot of other, even more critical considerations as well. Well to put this into context for our viewers can you share a few details about the specific circumstances at the University of Iowa.

Elizabeth: Sure, the University at Iowa community has about 42,000 people. We consider ourselves an urban campus, though we are not urban by New York or Boston standards. There are about 115,000 people in Johnson County and from the 42,000 university community members we have nearly 30,000 students, 11,000 staff and 1,700 faculty. We are looked to for education through classes; we have a large hospital; we have a lot of sports and cultural events; we have our own police force, through the Department of Public Safety and we engage in a lot of commerce with the surrounding community.

Moderator: What do you mean by commerce?
Elizabeth: Well people who are from the University of Iowa; about 5,000 students live in dorms, but the rest live in the community. They are either in apartments or houses that are generally rented. Faculty and staff also own property, or rent. Also, we eat at the local restaurants and we really mingle with the community, to the extent that there is so much co-mingling that it is hard to kind of separate what the town might be like without the University of Iowa

Moderator: So a huge economic impact.

Elizabeth: Huge economic impact.

Moderator: And your school is part of the community. How about international students-what is the percentage of students at the University at Iowa who are International students and is that a particular concern?

Elizabeth: Approximately 7% of the student population are international, they are from 109 different countries and it is a concern because a lot of these students are from regions of the world that are starting see epidemics of Avian Influenza (H5N1). But another concern that is one that is a lot harder to control and follow is what happens with faculty, staff and students who travel to these other parts of the world on business or personal reasons. Because we don't really track movement, so we don't know who is going there and who is coming back, especially if it is done on personal time.

Moderator: Something, you really need to keep in consideration in your planning.

Elizabeth: Right.

Moderator: We are going to take a look at a slide that has a lot of numbers on it, some very significant percentages- it is appearing on your screen right now. What do these percentages mean in terms of shared numbers, using the University of Iowa as an example?

Elizabeth: Well these are our planning assumptions for the University of Iowa and it is based on Federal Projections of a moderate to severe pandemic. So you have 35% of the population ill; 15% required treatment and a 2% mortality rate. For the University of Iowa this would mean 14,700 illnesses, 6,300 individuals who require treatment and 840 people may die-and this is just for the University of Iowa.

Moderator: Those are some very significant numbers. Do they include students and staff and also residents in the surrounding community?

Elizabeth: These numbers include students, faculty and staff, but it does not include the surrounding community. The surrounding community has about 115,000 people total, so you could take the University of Iowa numbers and double them, and then still add a little bit more on top of that to see what you would be expecting to see for a severe or moderately severe pandemic.
Moderator: So a conclusion might be: with things bad all over the University of Iowa is going to have to do a lot for its own community, on its own.

Elizabeth: We will.

Moderator: Absolutely, O.K. Social Distancing, we hear that term when we talk about pandemic influenza planning, take us through that. What does that mean?

Elizabeth: Well, social distancing fits into a group of things we call "non-pharmaceutical interventions." That is essentially; what can you do to help prevent spread, prevent illness and prevent death without relying on drugs-on either vaccines or antivirals. So social distancing is a public health tactic to essentially break up groups, to move-to separate people and make sure that they are not close together. It includes quarantine, which would be removal of people who have been exposed and isolation which is people who are actually ill.

Moderator: And you had mentioned on that slide we saw previously, the possibility of economic disruptions. Does that go back to the effect that your school has on the commerce of the surrounding area?

Elizabeth: It does. Economic disruptions also mean that-it will depend; it will vary based on school. For the University of Iowa about 60% of our consumables, everything we use come from out of state so it is a big deal for us if there is a pandemic, if there is any restriction of movement between states. You know where will we get our supplies, and how will we restock when we run out.

Moderator: So you are just in time.

Elizabeth: Yeah, so we are just in time. We have just in time business practices, as many universities do because it is extremely expensive to store things (more than a few days worth) and so how we addressed that was starting to talk to our suppliers, and say "well what are you doing for a pandemic." And we are pretty surprised to find most of them said "well this isn't our responsibility-you know, this isn't on us"..."a pandemic is not going to happen."

Moderator: We'll we hope not.

Elizabeth: Yeah, those are generally their responses. So some have started planning, but some still really are a cause for concern-and how are we going to get our stuff. We can have the greatest plans but a lot of pandemic planning is just relying on communications and making sure everyone is planning, it is everyone's responsibility.

Moderator: So that sounds like a loop that is yet to be closed. Let's talk about your plan. Your first draft I understand, took less than six months to develop, that seems to be pretty short order. Did you start from scratch or did you work from an existing all-hazards plan?
Elizabeth: Well the task force was initiated in January 2006 under our previous provost. And as you said it was six months, so it was kind of a whirlwind production but it started with a template from the Centers for Disease Control and Prevention. They have a check list for you, and Universities which is literally just a check-list, about a page and a half long. So we started looking at that and trying to fill in the blanks and see what do we need to do. So our first plan was very general, very basic. It was 60 pages long and just said generally what we hope to do during a pandemic.

Moderator: I think we should probably take a look at some of your organizational charts, Elizabeth, and just a little warning to our views, the details may be a bit challenging for you to make out. But Elizabeth you are going to provide us with a verbal overview.

Elizabeth: Well the details were difficult for us to. This was our first organizational chart for fiscal year 2006-2007, which ended the middle of last year. And we have a structure here that didn't really take into account either the national incident command system or the general University at Iowa chart that we work from on a daily basis. So it was confusing but the part that wasn't confusing is on the bottom part we have: Pandemic Influenza Task Force, and that is chaired by my supervisor Christopher Atchison who is director of University Hygienic Lab and an Associate Dean in the College of Public Health. And then below that we have four different sub-committees: we have Public Health Services, Health Care Services, Continuity of Operations and Communications.

Moderator: O.K. and I want to just remind our audience that the slides are with the handouts so that you will be able to take a little bit closer look at those. Now this organizational chart, I believe that you mentioned that you didn't have one when you started, and now it's changed again.

Elizabeth: It has, we have a new one for fiscal year 2008, which is quite a bit cleaner and on that you can see we still have the pandemic influenza task force-its color coded and I will explain the colors later on. But the whole top of the structure is just the University of Iowa Structure from our regular organizational chart of our operations manual. So it is a lot cleaner and easier to understand the initiative of the provost office- that is clear to see from this chart. And we tie in directly to our all-hazards plan, the critical incident management plan.

Moderator: And again, those charts are available with the handouts so if the folks in our audience weren't able to make out every detail, all is not lost, you can still check those out. Obviously, once you plan, that's a great thing, and that's where to start, but then you need to see whether those plans are going to work. So you need to test them. I understand that you at the University of Iowa put together a tabletop exercise in the spring of last year. How did you develop that exercise?

Elizabeth: We had the exercise in April of 2007, and we started because as you said, you have plans, what do you do once you have them, how do you know if they work? Short of an actual emergency, it's hard to tell if your plan will work. And that is where our tabletop exercise came in. We wanted to know where we had the gaps and where we needed improvements. So we called a facilitator, Dr. Paul Biddinger, from Harvard School of Public Health. He is the director of their Center for Public Health Preparedness. We said we want to stimulate a public health emergency on campus will you help us, and he said "sure." So he was our main facilitator and on the day of the exercise we had 65 participants from across campus and they role-played through a fictional scenario.

Moderator: How about students, were they involved in this exercise?

Elizabeth: Students were involved in the exercise. We asked the college of nursing to send out an email, (which they did, we were very appreciative of that) to their nursing students. We had nursing students as recorders, on the day of the event, which was great because here are these individuals who are use to a fast paced environment, and they were able to take wonderful notes for us to get some great feedback.

Moderator: And one of the objectives of an exercise would be to promote something they call "rapid decision making." Can you give us an example of what that is?

Elizabeth: Sure, rapid decision making is pretty much decision making on-the-spot. Throughout the tabletop exercise you're working with an accelerated time frame, so you have about 14 days worth of materials crammed into 1 to 2 hours of actual exercise play. And rapid decision making is when a question is asked, you need to answer it, and this is very difficult for some of our upper level administrators. One example that I can give, is once we knew that there was a public health problem on campus; a couple of people were getting sick, we didn't know what it was quite yet, the question came up- well do we suspend classes-do we tell students you know, to stay home; not to go into the environment where they are possibly exposed to people who have this horrible thing that is going on around campus. We went to the Dean's table; we call it the CAWG, the College Advisory Work Group and we said well are classes suspended? And they said well we don't know. And so we went to our provost who was there, and he said "yes, suspend classes now, because we have this threat on campus and we want to make sure everyone stays safe, and better to be safe than sorry in a situation like this." So, that was an example of rapid decision making.

Moderator: Also, helped you to understand who'd be making that decision.

Elizabeth: Yes.

Moderator: I saw on the slide that you used the principals of the National Incident Management System Incident Command System. Were the participants in the exercise trained in NIMS ICS in advance?

Elizabeth: There was-one of the challenges of running an exercise, especially with multidisciplines is you have varying levels of training and a lot of our participants did not have any former experience with NIMS. The Iowa Department of Homeland Security sends a training officer to our campus each year to give kind of a mini executive level of NIMS, but it is not a full course. So we had some participants who really didn't know what NIMS was and some-our healthcare professionals and our public safety were very well versed. One of the challenges of designing an exercise is to make sure everyone has enough to do, and no one gets bored and at the same time you can't overwhelm. So it was interesting.

Moderator: Because I wouldn't imagine that NIMS ICS is really a part of academic culture.

Elizabeth: It's not at all. Part of academic culture, you know is shared governance and taking your time to make these decisions and National Incident Management System is very much about structure and delineated responsibilities. 

Moderator: Elizabeth, give us a thumbnail sketch of how you organize the tabletop.

Elizabeth: Well, we had our introduction, and our objectives and ground rules was all kind of thrown together at the beginning. We originally thought that would take about 15 minutes, on our original agenda we had 15 minutes written for that. In reality, it actually took well over an hour.

Moderator: Doesn't it always?

Elizabeth: It always does. You know we assumed everyone agreed to all the materials that we sent out week in advance. That just isn't the case. So and then we had our exercise play which was a little bit over an hour-this is when people actually work through the scenario, they are receiving new facts, they are asked to make answers, asked to provide answers and make decisions and then we had short break for lunch. During that time, the facilitators from the table and the evaluators met in a separate room to discuss their first impressions and what was going on at the tables and who was having problems and what went well. And then, after that we had our hot wash. Which was a full hour and this is when everyone gets back together again. This is probably one of the most important parts of the exercise because this is when you receive your first impressions and everyone is talking about you know, what was their experience- what went well, what didn't and what do we need to improve on.

Moderator: Well, share with us; what went well, what didn't- what were your lessons learned?

Elizabeth: Well, first I think I'd like to tell you about the scenario, what we actually did on the day of the exercise.

Moderator: Okay. That would be good.

Elizabeth: We had a pretty-- you know, when you hear this you're going to think we'll that would never happen on college campus. But just, bear with me. So we had two students returning from an alternative spring break overseas. They were on a humanitarian mission and were cleaning poultry farms. So, they returned, one is already ill, and the other one is kind of not feeling well, but she is not sure it might just be a cold. So the ill student-They both go to their classes, their different major, their undergraduates. Student number one than goes to a bar crawl later in the day and she is just feeling awful. By 11 p.m. she decides to go to the emergency room. Student number two, next day she decides she needs health care also so she goes to student health service and takes the CAN Bus which is our public transportation and the scenario balloons. By day 11 our hospitals are full. We still have about 30% of students on campus. We're just really getting stressed out at that point.

Moderator: I can't imagine why.

Elizabeth: No.

Moderator: I would like to say as is often the case in scenario, throw in everything but the kitchen sink and it could never happen, but this sounds like a pretty realistic scenario.

Elizabeth: And we had a lot of things, you know parents were showing up to take their student's home. You know some of them got cranky and unhappy; there were car accidents. We kept public safety busy that way we tried to figure out good things to throw at them to keep them running around. There was a break-in at the local pharmacy and things like that.

Moderator: Trying to get antiviral's. Remind us of the demographics of your college community and their surrounding community. How many hospitals in the surrounding community?

Elizabeth: We have three hospitals. They are Mercy Hospital, which is a private hospital. University of Iowa Hospitals and Clinics, which is our state school's hospital and then the Veteran's Affairs Medical Center, which is a federal hospital.

Moderator: Who developed the evaluation instrument for your tabletop?

Elizabeth: The evaluation was created by our exercise planning team and what they did was they went through and they looked at what happened, they looked at the feedback from the evaluators in order to create the after-action report. They were the ones who did that, I was tasked with writing the draft. We went back to our group a week later, we all met and looked at the draft after-action report. And decided what needed to be changed. About a month and a half after that we had our full after-action report ready to go.

Moderator: Let me ask you about your evaluators. Did you have any neutral observers as evaluators?

Elizabeth: We did. We had a couple of people come from the state. That was one of the reasons we had we had Dr. Bidinger come from Harvard University because we wanted a neutral facilitator to guide the group.

Moderator: I think that's important. So you put together your after-action report and this is the question I probably should have waited to ask you what were the lessons learned; what went well?

Elizabeth: Well, what really went well was we were able to care for students. We had very much success with that which was a big deal, because in our original plan, we only planned to have about 500 students left on campus and during the scenario we had close to 10,000. So we were able to make sure they were all fed, they were all housed. They had their basic needs met. The other thing that went really well was health care services. At the time, we didn't have actual protocol written to get an alternate care facility set up. So that was very important. They were able to just kind of "wing it" and go on.

Moderator: What would you say is a realistic time frame to accomplish the goals that you set out to achieve in a tabletop?

Elizabeth: Well, that will really vary based on what your goal is. For us, one of our goals is to get the alternate care facility set up, and our goal is to get done by the end of this year and health care services group is well on their way to doing that. But at the same time getting that NIM's structure the National Incident Management System, getting our NIM's chart populated and naming two-deeps and three-deeps for alternates. That's more of a long-term process and there are a lot of questions that we need to resolve also at a region's level. So that is probably going to take more like two years, another two years to get everything worked out in there.

Moderator: You said two and three deep, correct? What do you mean by that, redundancy?

Elizabeth: Redundancies. If person number one can't fill the role, whose person number two and if person number two isn't available, who is person number three? And, again if you're dealing with a public health situation where up to 40% could be, you know 35-40% -- of people are absent, whether they're ill themselves or caring for loved ones or other family members or just don't want to show up, you know they say "this isn't worth it, I am staying home." You need to make sure you have person two and three identified.

Moderator: And did you do that in your tabletop? Did you arbitrarily tell some people you're out, you're sick, you can't come to work?

Elizabeth: We didn't do that, but that is a popular tactic that I've heard about. Someone at the hygienic lab, she likes to give out ducks and there are black ducks and there are white ducks. If you receive a black duck, it means you're either sick or dead and you have to leave.

Moderator: Do you get a choice to be sick or dead?

Elizabeth: No, you don't, they com out of a basket and the person handing them out doesn't know when they give them out.

Moderator: Alright. You talked about went well. I probably should ask the follow-up question- what areas needed improvement based on your tabletop?

Elizabeth: Well, our National Incident Management System didn't work so well. We didn't have those people identified. We need job action sheets for them and in addition to job action sheets we also need to tell them in advance that they're going to be in those positions. Because on the day of the exercise we chose the people based on who was coming and we pretty much went through the attendee list and said well this person would be a good fit for here. That worked for the most part but people were confused and frustrated because they said I need to know what I need to be doing during the situation. So we need that and we also need to work on communications, mainly redundancies. On the day of the tabletop we had a large screen set up and people were putting their updates on there. At one point, everyone at the Incident Command System table got very excited and just stood up about 15 minutes into a scenario. So a lot of participants assumed there were no updates happening and they couldn't see the screen and they started making decisions that they probably wouldn't have. One of the ways this has been fixed and is a system that is we now we talk alert on campus which can send out messages by either text-messaging, which is one thing we really determined is necessary for students, everyone text-messages nowadays. And it can also send prerecord messages to your phone, whether its your cell phone, home phone or work phone and it also sends out e-mails and the system can keep bothering you until you respond and say yes, I got the message, I know there is an emergency and I am not going to go to campus. And we tested it this year for both ice storm and a snowstorm and it works.

Moderator: That is such an important point. Because time after time in a real event, a real incident, stimulated incident, tabletops, we find in the after-action reports the biggest three-- three biggest problems was communications, communications, communications. So no matter how great your system is you have to have a backup and a backup for that because something will go wrong. That was just hilarious, not probably at the time, people standing up-.

Elizabeth: Everyone stood up- everyone was standing up all around. It was just 15 minutes and everyone shot up like jack in the boxes and didn't sit down again.

Moderator: Like when you are at a concert, you can't see what is coming on stage because everybody is standing up. So have those redundant capacities. Talk about the next steps that your task force has recommended now that you've done your first table top and gotten some lessons learned.

Elizabeth: Well we want to make sure we complete our fiscal year 2008 goals; we were recharged last year by our interim provost and the Executive Vice President so we want to make sure we get that done. Another big thing we want to do is include students in our pandemic planning. We realized they have really been left out of the process and since it's them we want to protect and them we're most concerned about, we need to start including them more. So we started last fall The U.I. PHESVAR which is Public Health Emergency Student Volunteer Advanced Registration. I know it's a mouthful. But what the concept is based on, on a smaller scale that one or two people can run.

Moderator: So students are involved in the planning.

Elizabeth: Yes.

Moderator: The progress reports that you put together, who did you share them with? Just your own internal leadership or were they shared with a broader community?

Elizabeth: Well, we consider our pandemic plans to be our progress report and we have both of them up on our University of Iowa web site. So we have the old plan and the new plan and the newer plan from last year was 287 pages. So there is a big difference. There was a lot added, a lot of work was done in between the two. We have those available online, for anyone who wants to see them.

Moderator: We had talked earlier about NIMS ICS. Not being exactly intuitive for many members of the academic community. How did you formalize NIMS ICS training on campus?

Elizabeth: Well, that's an issue. We still don't have it completely formalized for everyone. The hospital has regulations that they abide by, federal regulations on who needs training. So they're very well set. But for the rest of the campus, part of being at a university is academic freedom and nobody really likes to be told what to do and what training they have to have. We do not have it formalized right now. We are making recommendations that anyone that is in one of those NIMS section chief or officer positions have at least 100,200,300 and 400 level training through the Federal Emergency Management Agency- FEMA.

Moderator: So you've done a lot of internal planning but you also explained how much the university is integrated into the community. What external partners are you planning with?

Elizabeth: We are planning with the Iowa Department of Public Health, which is our state public health agency. Johnson County Public Health, which is our local agency. The American Red Cross; Mercy Hospital, Iowa City and the other region schools. We have a school for Braille and Sight Saving, Iowa School for the Deaf, Iowa State University and University of Northern Iowa.

Moderator: Did all of these partners participate in your tabletop?

Elizabeth: No. At that time we were not including all of the other region schools. We wanted to go first-run through. I believe we did have a representative from Iowa State University and University of Northern Iowa.

Moderator: So you did this first tabletop planning in I think you said six months. What's one significant improvement you can share that would be helpful for the 2008 exercise coming up?

Elizabeth: Well, our NIMS chart-we are very proud of this, we finally added a couple of names to the chart, so this is not the most updated chart, but if you want the most updated chart you can email me, my contact information is in the materials. But we have our four different Section Chiefs. We have our Public Information Officer, Safety Office and Liaison Officer, and our Incident Commander who we expect will be the president for the University of Iowa. Let me emphasize that this is just for a large scale emergency that we would be using this, that we would be populating it this deep. For something smaller, we probably wouldn't need to activate it fully.

Moderator: So you can make that decision.

Elizabeth: It's very flexible.

Moderator: That's good, because so are emergencies. Is there a particular training tool that other schools can use to plan their own exercises? What could you recommend?

Elizabeth: Well, I really enjoyed the H.C. for Homeland Security exercise and evaluation program. That is by the Department of Homeland Security. It's a national exercise program. It is a two-day training but if you don't have time to go to the training, you can go to their web site, download all their materials are available online. They focus on evaluation and scale. They have a "Building Block Approach" and pretty much it really helps you to identify recommendations, corrective actions, a time line for completion and how to build next exercise to test for improvements and to make sure those issues you identified are resolved.

Moderator: Elizabeth, what have you found to be personally most instructive in the H.C. training course?

Elizabeth: What I really like is how they assist in helping to build objectives. They recommend "smart objectives" which are simple, measurable-- not simple, I'm sorry. Specific, measurable, achievable and realistic and in a time frame.

Moderator: I think we're going to talk about them later as well. Is the "H.C. Building Block Approach" that you talked about, what does that mean?

Elizabeth: It means start small and continue to work up. Don't try to do everything at once. One of the big failures of universities and agencies when they try to do an exercise is they say "well we want to do a full scale, we're just going to do a full scale." That's really not the best way to go about it because if you're dealing with a group who's untrained, who is not use to exercising, you are really just setting yourself up for failure and then you have a hard time recruiting people for the next exercise.

Moderator: So there are options available in terms of planning activities. Are certain activities recommended over others though?

Elizabeth: Well, we have discussion-based exercises which will be your tabletops, your seminars and workshops. Then you also have operations-based activities which are drills, functional and full scale exercises. Again, start small is the key. Tabletops are really good. What we do at the University of Iowa is we actually call our table tops "advanced tabletops" because they have a mix of the two. Your operations would be your full scale. The big difference between operations and discussions, being that during operations-based exercises you are deploying people and things. If you say we're going to set up this alternate care facility, you're actually moving the beds, you're clearing out the facility (whoever's in their before you) and during a tabletop you really just talk about what you're doing and you might make a few phone calls, but you pretty much going to be in the same room for the duration of the exercise.

Moderator: For instance, when you talked about the tabletop that you developed and conducted, you found that health care worked out really well but it was notional, right?

Elizabeth: Yeah, it was notional. So we didn't actually have those students ill and we didn't have actors either. Another big thing during a full scale is you have actual actors, which also changes the atmosphere and environment.

Moderator: What's the most difficult part of planning an exercise?

Elizabeth: Forming objectives, because objectives are incredibly important, they are the cornerstone of design and development. They provide a basis for measurement. When choosing objects, one of the hard things is how many do you want to have? For some reasons when I speak to other people, they say oh ten objectives, for some reason 10 is a good round number. But it's really not; it's too much to try to do, so we say stick to five objectives and avoid arbitrarily choosing weaknesses. Don't just go through your pandemic plan and say well we can test this and we can test this. Make sure you have reasoning for choosing your objectives.

Moderator: So go into choosing weaknesses a little more. I wasn't quite sure- would seem like you should test something that you think would be the most difficult but you say choosing weakness is not necessarily the thing to do?

Elizabeth: Well, there are different levels of weaknesses. It really depends on what you want to test and what's important to the group and you will know where your problems are, especially if the person who's writing the scenario and writing the objectives has been involved in the pandemic planning in the institution. They see what the groups struggle with on a regular basis during meetings, but just to randomly pick things and say we're picking this and that- it's really a collaborative effort and you have to meet with the different groups and say what is important and where do we really need work and your objectives are how you will meet them goes into your after action report and form your improvement plan for the next year.

Moderator: Who is the person who should be writing those objectives? Who chooses the objectives?

Elizabeth: Well, for us, and it's different for everyone-- some people like to have an outside evaluator come and choose the objectives. But what we do is we have an exercise writing team and they go through and they're pretty much made of our basic plan committee, who are the chairs of the different subcommittees. And they go through and they say this is what we had problems with, this is what we think we need to test and then you work through that and build your objectives off of that feedback.

Moderator: Sometimes having that outside evaluator gives you obviously a new set of eyes and you don't really understand- you're so close it to it you can't pick the best objectives so that sometimes is a good thing. Does the H.C. Program provide recommendations to help to ascertain what should be the most effective exercise objectives?

Elizabeth: Yes, it does, and they advocate the SMART approach, which I talked about a little earlier.

Moderator: Do tell us about that.

Elizabeth: That is to make sure your exercise objectives are specific, measurable, achievable, and realistic and filled out within a certain time (completed within time).

Moderator: So time means-

Elizabeth/Moderator: The time frame.

Moderator: But SMART's a great acronym because we can all remember what that is. I assume you learned for your objectives what makes for good and realistic objectives as a result of your experience?

Elizabeth: Well, the best way to illustrate is go through three slides called the good, the bad and the ugly, and you'll see why they're named that. The good exercise is a draft objective we have for this year. Participants will activate and utilize an incident command structure within 24 hours of declared emergency on the University of Iowa campus.

Moderator: Tell me what's good about that?

Elizabeth: It's specific. It says exactly what you're going to do. You are going to activate utilize that I.C.S. System. It's measurable, either it happened or it didn't. You know you fill the people in the blanks or you don't.

Moderator: And you have your time frame.

Elizabeth: Exactly. You have your time frame, 24 hours.

Moderator: Alright, tell us about a bad objective.

Elizabeth: Well, for a bad one I like to go back to one that we used last year and it's a draft- and it started off as something we were going to write for this year. But the exercise will maintain a challenging pace for both advance and beginner participants. This is bad because it's really our job, as the exercise writing team, to make sure we keep people on track and that everyone is interested but not overwhelmed.

Moderator: Challenging is kind of a nebulous term as well.

Elizabeth: Yes. It's not specific. There's really no way to measure it and-- for any exercise, some people will be happy and some people will say it was the worst waste of time of their life.

Moderator: So how do you make that better?

Elizabeth: So what we did was we said participants will identify their roles and responsibilities as outlined in the pandemic plan. So for the goal of this, is to get them to look through the pandemic plan during the exercise rather than just fall back on instinct and oh this is how I should react. No, no, we have this written down. If what we have written down is not good then we need to revise it or change it. And the way to make that even better, would be if I added a time frame like 48 hours.

Moderator: Yes so we probably Dare we go to the ugly? (Laughter)

Elizabeth: If we must.

Moderator: How do we go about improving on your original objectives?

Elizabeth: Well this one, the ugly is just bad. This was from last year and we are not reusing anything remotely close to this for this year. Just look at the length of the slide, you can see it's ugly. Meet basic needs, (including and not limited to safety, healthcare, (that's my lawyer coming out), psychosocial, housing and nutrition) of University of Iowa students who remain on campus during a pandemic. It's not specific at all, you could easily break this up into a half a dozen other objectives.

Moderator: But you can't really test this, that's the problem.

Elizabeth: No

Moderator: It is just too all over the place.

Elizabeth: Exactly, it's all over the place, it doesn't really have a goal it's very unruly.

Moderator: O.K. so rule of thumb: don't put anything in a parenthetical in your objectives.

Elizabeth: Yeah, there should be no parenthesis within your objectives.

Moderator: And don't use "not limited to." That can't be specific, can it?

Elizabeth: Nope

Moderator: Well, I really appreciate you talking about those because it's good and everybody wants to talk about what went right. But I think we learn from what didn't go. And, there were obviously multiple lessons learned. What topped your own list of concerns?

Elizabeth: For us, in 2007 it was continuity of operations, alternate care facilities, and screening and triage. With continuity of operations, the big deal for us is how do we define it? Do we have a broad definition or do we have a narrow definition? Who is essential? And you know, no one really likes the term essential because everyone wants to be essential. If you define it broadly, that would be every activity at the University of Iowa because that's what makes us what we are. So we had decided that we really needed a narrow definition of what needs to continue. So it is defined as only those things necessary to protect health and safety of community members in the University of Iowa community and the greater community to avoid irreparable damaged property or health. So, we want to make sure facilities, management stays open. If it's winter that we have enough heating going through the buildings, the pipes don't burst and damage the building. It includes human resources and a number of other things.

Moderator: Alright, so those are the core functions we are talking about. We need to be able to have filled in that's where you really need to think about going two and three deep, probably three deep, so that when one and two get sick we can still maintain those essential functions.

Elizabeth: Well and also, you don't want the same people showing up on a lot of different parts of the chart, because you know if they are filling in for someone else they can't do ten things at once, especially not during an emergency.

Moderator: Some of what you had alluded to, that's basic you need to feed people. You need to make sure they're housed. But you talked about human resources that is a core function, maybe that doesn't come first to mind.

Elizabeth: Well, in human resources, some of the questions that are being bounced around a lot are, were worried about the worried well. Which is this group of people who will stay home whether or not they're sick and who think they are sick or they don't want to go out and be exposed. So a human resource issue is do you pay these people extra or are there repercussions if they don't come to work and they are essential and what do you do? A lot of discussions have been happening in that area.

Moderator: You have to do that ahead of time. Worried sick people I think they call them now as well, they may be suffering symptoms. Or because of social distancing, you may be asking them to stay home if they are not performing a core function.

Elizabeth: Well, exactly and the issue is well do we continue to pay them? Or do we not? Or what do we do?

Moderator: Another one of the issues that you had placed on your slides was alternate care options. Talk about that.

Elizabeth: Well, students are going to need different levels of care during a pandemic. You will have those who are extremely ill and need to hospitalized, and then you will have this whole other group who has symptoms, who does probably have this pandemic we test for. So what we decide to do is create an alternate care facility to keep these people who are not really sick enough to need the hospital, out of the hospital. There facilities mainly for students who require quarantine or isolation. But realistically, as we go through a pandemic we don't think quarantine will be as viable an option.

Moderator: So you are going to put six students in a particular dormitory. Do the students that are already living in the dormitory know that you're planning to do that?

Elizabeth: Well, we have it in our plan, so it open knowledge but we don't exactly go through the dormitory and knock on doors weekly and say you know, hey this pandemic is not here but we're going to kick you out when it comes though. What were planning to do, it about 48 hours before we need to repurpose the dormitory, is to go through and give students time to pack up. We also expect that during a pandemic, as it approaches, most students will not stay on campus.

Moderator: What about for your special needs students in terms of alternate care facilities are there logistical issues that you really have to think through?

Elizabeth: There are, there are still staffing issues, there is food issues. You know, people who may require special diet and there are there also communications issues for if a student has a hearing impairment or a visual impairment, how can we make sure that these students also receive the services that they need.

Moderator: Keeps coming back to communications, doesn't itthat seems to be key.

Elizabeth: Yes, and one communications for one person doesn't work for another. So we need lots of alternates.

Moderator: Alternate channels, right. You talked about that in your learning function earlier. Remind us again of the demographics of the area, number of residents etc. Do you think they'll try to use the services on campus?

Elizabeth: Definitely. There are a about 115,000 people in Johnson County. Tens of thousands and surrounding counties who we figure might come in. We realized after our first year of planning that for our screening and triage centers we will have community members. There will be students who will bring their family with them or they will just be community members who might only live a block or two from the screening center. And say, well why should I go much further away? So we partnered with the county and with Johnson County Public Health to create our screening triage centers to also be county pod's (points of dispensing). They will be open to all county residents. We're not going to say no to people that come in from out of the county. But we still have logistics' issues with those, and staffing and supplies. If we're having the same screening centers for the three different hospitals, we have three different sets of patient populations showing up, we think that for staffing we might need to have a mix of staffing from the different organizations.

Moderator: So your plans are scalable to meet that potential surge?

Elizabeth: Yes. We plan to have about five right now, screening and triage centers. They will open one at a time, so as needed. Also, building on the lessons learned from 1. As much planning as we're doing now, a lot of it will probably be on the fly. When we figure out, well we planned for this, we wrote this into the plan but it's not working, we need to change it.

Moderator: Tell us about your trihospital collaborative group.

Elizabeth: This is a group that was started by Dr. John Daily who is chair of our Healthcare Services Group and it includes the University of Iowa Hospitals and Clinics, Mercy Hospital and the Veterans' Affairs Medical Center. It also includes our local and state public health. What they do is they meet to discuss these screening and triage issues and how will the county react in a coordinated manner.

Moderator: So, healthcare partners, obviously. What about other partners: E.M.S., fire, police, any of those involved in.

Elizabeth: Not specifically in the trihospital collaborative group. But each of the members of the trihospital has their own planning, occurring at their own institutions. We have the University of Iowa Pandemic Influenza Planning Task Force and they have their equivalents. We do have public safety involved in ours and we do have emergency center doctors and people like that who would be first responders.

Moderator: Elizabeth, based on the work you've done, preparedness planning, leading to the tabletop and leading to evaluation after action, neck steps, what does the task force see as being essential to becoming more prepared?

Elizabeth: Well, we need to complete our goals for this year and we also need to expand that UIPHESVAR and student involvement and make sure that we try to involve students in the next goaround or next phase of planning. Then another thing is just applicability to all hazards. You know, how can you use everything that we did within the pandemic task force to move it to others, to see that they're also benefited from everything we did. The human resources issues and all of those would be the same for any long-term emergency on campus.

Moderator: I want to go back to the students because you said the students did play in your exercise and you want them to become involved as volunteers. What kind of credentials would students have to have to be an effective volunteer, what kind of training would they need?

Elizabeth: Right now we don't have any specific credentials for them. We ask that they all take a basic training for volunteers course which is available on our prepare Iowa Learning Management System. It is a four-part series, each about 15 minutes long, so it is a short course. We want them to take that. When we created this group, we weren't looking to take away the students already in rotations in the hospital or other medical facilities. We wanted students to fill maybe some of the university positions--
They could deliver messages across campus if communications are down or they could deliver food to people who are quarantined or isolated or staff a hotline, things like that.

Moderator: You know I was glad that a couple of minutes ago you referenced the applicability of pandemic planning to all hazards. Because as you say, people say it's not going to be a pandemic, why do I need to do that but you are in Iowa, there is probably going to be a tornado

Elizabeth: Oh, yeah.

Moderator: Maybe a flood, a severe snowstorm or something else that the university has to be prepared for, even disturbingly some of the violence that we've seen on campuses, hope it never happens there but it could.

Elizabeth: Well and it did, in the early '90s we had an active shooter situation on the University of Iowa campus. It's been a while since we've had anything that horrible but Northern Illinois isn't very far from us. That shook us up quite a bit, too. So, yeah, a lot of these situations would be applicable. The human resources issues, the business continuity issues and health care, too. Health care issues if you have-- unfortunately if you need to open an alternate care facility for mass injuries.

Moderator: And you have to identify who needs training and what kind of training that they are going to be provided and how that will be provided. Who decides that?

Elizabeth: Well, again, right now we really don't have a system in place for that. We've been consulting a lot with the Iowa department of homeland security. They've been wonderful. We have a Johnson County Emergency Manager who is very active and who is very happy to answer our questions when we say who needs what training. It really will really just depend on the individual and what they're doing, what their function will be.

Moderator: We've been through so much in the last 50 minutes. Maybe we could just stop for a second and go over some of the real key points that we would like our audience to remember.

Elizabeth: Sure, well, support from central administration is crucial. We've been lucky in that we've had really wonderful administration at the University of Iowa who has been supportive of our activities. Because we are asking for a lot, from people, you know embrace diversity. Naturally, when you think public health emergency planning, you think public health. When you think public health emergency planning you think public health and healthcare services. But again, there are those human resources people. There are people in information technologies and just across campus who also need to be involved. Stay situationally aware. You know, know how far you can push the plan. What the university is ready for, what your school is ready for. Don't try to do too much at once. Because people will need training and they will need to be caught up to speed on a lot of things. And then, objectives drive the exercise. When you do have an exercise, if you don't have good objectives it will be very chaotic, more than it needs to be.

Moderator: I guess be aware of the type of exercise that's for you-should it be a discussion-based? Should it be a fully functional, where for instance you might possibly administer vaccine to someone to test how quickly that could happen? What's right for your circumstances? You need to decide that before you go full speed ahead. What about in terms of making sure that you have down on paper the progress that's been made, is that another important thing to remember?-

Moderator: Oh definitely. You need to document all of your progress. You know what are you doing-To know where you're going, you need to know where you came from. What have you been successful with, what still needs continued work. A lot of writing comes into play and you need people who are willing to do the writing. You need after action reports, improvement plans. People will need to update the plan on a regular basis. You know, just a lot of writing.

Moderator: I like that last bullet. Don't let the perfect be the enemy of the good.

Elizabeth: This is very-yeah this is a popular one and everyone likes this. Everyone wants to have the perfect plan. The plan, you know, the one you just open up and it magically turns to the right page. You know, there you are, it tells you exactly what you need to do, step by step, and that plan doesn't exist. It never has for anyone, and it shouldn't be an impediment to start planning. Because everyone needs - you know your plan only needs to be good.

Moderator: I want to just mention to our viewers that we're ready to take your calls now: The toll free number is 800-452-0662. The fax number, if you would like to fax a quesiton is: 518-426-0696. And of course you may also send your questions by e-mail to the address that you see on your screen. Are there any documents, Elizabeth, currently in review that colleges and universities should be anticipating?

Elizabeth: There is. Last year the Association for Schools of Public Health had a collaborative group with the Centers for Disease Control and Prevention and we created "pandemic influenza preparedness resource kit for academic institutions." That's forthcoming, it's still in the works, it's still in the final levels of review. But it is intended to provide guidance for institutions at all levels of planning.

Moderator: What other resources are available to our audience?

Elizabeth: Well the Centers for Disease Control and Prevention, has a really good Social Distancing Guidance which they produced last year, February 2007. There is a Cough Etiquette training video which is a pretty neat thing, it's very short, it just pretty much instructs people to cough into their sleeve, you know if you cough into a tissue throw it out. Flu Wiki is an interesting site, it's not a federal site or state, it's private, privately run. They have a link that includes planning of specific schools. It has a lot of different school plans right up there, all in one place. There are a few others listed here. Finally Albany has a really neat Public Health Incident Command System document that addresses how public health agencies can work the incident command system into their plans.

Moderator: So you don't have to reinvent the wheel.

Elizabeth: No, you don't. There's a lot already out there.

Moderator: I seem to recall that Pandemicflu.gov has a checklist for colleges and universities.

Elizabeth: Yes, they do.

Moderator: That you can just go down and see how it-probably doesn't apply perfectly to everyone but it's a really good place to start. I also want to remind our audience that Albany Center for Public Health Preparedness online course entitled Preparedness and Community Response to Pandemics now has registered over 6,000 learners and you certainly could be one of them, if you want to get more information about that as well. So while we're waiting for some questions, talk about any other web sites or references that we ought to be looking at.

Elizabeth: Again, the CDC Pandemicflu.gov that you referenced, that has a lot of materials on there and they also have links to a lot of other places which is convenient. Health and Human Services has their "pandemic plan" posted, and they also recently, about a month ago released a new web site called the "great pandemic" which has pictures and informational materials from the 1918 pandemic. Then Department of Homeland Security also has their pandemic plan publicly posted. There's a Hospital Incident Command System web site that really helps for getting that incident command system going in a hospital. And then the World Health Organization, if you want to know what is going on overseas, has a web site for pandemic influenza as well. That's where you'll get the figure and numbers of who is sick and cases, and mortality rate and those kinds of fun things.

Moderator: Yeah we see some color coding on the sides. Does that have a distinction?

Elizabeth: That did, the colors according to our- on our 2008 organizational chart matched up with our N.I.M.S. chart, because when we started planning, we said o.k. here is a great group of individuals from across campus, you know nearly 100 people involved; what role would they play during a pandemic. So the color is to help them when the national incident management structure is activated so the University is to find a place that could serve as a good reference.

Moderator: We had a question faxed in; I am going to paraphrase it. But the person wanted to know how is the best way for an academic institution really to reach out to their community to get them involved. Because as you've explained, you expect the community members will try to take advantage of the resources of the institution and the institution may need to call on the community if your supplies don't come in. What is the best way to make those linkages?

Elizabeth: Well I would say use the phone, it's really effective you know you can just-it depends on who they want to contact within the community. Call your county or local public health and say what are you are doing? Because they'll know the business leaders in the community. They will know what is already going on and, you know, things like that. Just start small and it just balloons. It's just-its like spike's on a wheel, it will go off in all directions. Generate interest like that. And also be willing to speak to the community. We send, when we have requests for people that want to have pandemic preparedness presentations, something short and sweet. We go and we do those things and be ready to do that for free because a lot of these community organizations, they don't have resources and they might be interested in it but they also might be intimidated by the factor of contacting someone in academia.

Moderator: What about the planning outreach toward the parents? I mean what kind of initiatives are being made or should be made to the parents in terms of when students would leave school and go back home; how would they get there?

Elizabeth: Well one of the things we've thought of doing is to draft a letter to go out to parents. This is the idea has been bounced around, and in the end we didn't actually send anything out but probably as we move through the World Health Organization Disease Progression Phases, (right now we're in phase 3), there is no infections from human to human. So once we move up that, we're thinking that when we hit about stage 4 when there starts to be more of a realistic threat, that we would contact parents, send out a letter; send out an e-mail to students saying this is approaching. This is our plan, you know just remind people. Here is our web site. We've been doing-we've been planning for a long time. This is what we'd ask you to do. Another issue in that, in Iowa our state epidemiologists has told us, you know, if it starts in Iowa City, if someone in Iowa City, if the public health emergency starts there, you guys are going to be closed down. I'm going to quarantine you and then parents won't be able to come in. That's a big issue, too.

Moderator: So even if it doesn't start on campus, the plan is to quarantine the students on campus instead of sending them home?

Elizabeth: Only if-- Iowa City is the only place it's occurring in Iowa. We think that beyond that, it's probably not realistic or effective-- it wouldn't be very useful to keep the students there if it's already spreading rapidly across the country.

Moderator: My neighbor is a college student and we talk about pandemic planning and she mentioned that at her school the parents actually have to let the administration know how their students will get home, how their children will get home, whether they plan to ride a bus, or if they have a car, they even go so far as, you know how will you make sure there's fuel for that car to get the student home.

Elizabeth: Wow.

Moderator: So, and it's probably because that's a more rural school and they may well need to do it. I guess again you need to be flexible enough to fit your situation. We do have a fax that came in and Karen who's a Health Care Professional, is asking us to elaborate a bit more. Actually, she's asking you to elaborate a bit more on how the University of Iowa health care students, that is the medical students, nursing students, will be used as volunteers during an influenza pandemic. Have there been any arrangements made to use their skills in a strategic national stock pile point of dispensing, an S.N.S. Pod and if so, what type of roles will they fulfill?

Elizabeth: Well, as I said, our, the pod, the county pods will be part of our screening and triage efforts. So, those people are already speaking. To specifically use just the college of nursing students or just the medical students, we don't have any plan in place right now because we assume a lot of these students will already be in rotations. A lot of these students have families or they already have part time jobs in health care communities and medical facilities and areas. So we really don't know that we will be using-- we don't want to take those students away from where they're needed most. Were thinking that we could provide just-in-time training to teach people to do vaccines. And another issue is that we really don't think we're going have a lot of vaccines and antivirals available. We expect there will be shortages. That's part of our assumptions is that we will probably be on our own, that the national stock pile might not reach Iowa.

Moderator: Elizabeth, especially given that you've gone to law school and you know these things, talk about any legal implications. For instance, in using students as volunteers in a situation in which it could impair their health or any legal implications to having people giving immunizations that perhaps is not necessarily in their usual scope of work?

Elizabeth: Well, I can't really go into that because that's not really my scope of work, but one of the things to consider with volunteers is credentialing and for that we have human resources involved. And that is another reason with our UI PZEPHAR why we don't have students placed in a lot of these medical environments because we don't currently have them credentialed right now, you know, we have on paper what they may or may not have listed as their qualifications. But we figure that during an emergency-we can go through- right now we have unfortunately, only about 120 students in that database and we can kind of hand pick and see who needs to go. We can send their applications to human resources to investigate and make sure that everything checks out with that.

Moderator: I wanted to ask you- you had talked about the just in time supplies and has the University of Iowa stockpiled n-95 masks or surgical masks for use by faculty, staff, students?

Elizabeth: We don't have any large scale stockpiling under way. So we do have a small quantity of stock piling but the amount of items that we have stockpiled right now would not even fill up half of this room.

Moderator: How would you get them then?

Elizabeth: Well, one of the issues is that we hope that as a pandemic threat becomes more realistic and that we move through the disease progression phases that we'll contact suppliers. And then we do have facilities set aside where we can keep things. We have the facilities but at that point we'll start getting things in and rotating them in as we use them, so nothing sits and gets too old

Moderator: You had mentioned that you-- you thought it would be doubtful that you would get material from the strategic national stock pile in any great quantities in the time you need it. Hopefully that wouldn't happen, but if it does happen, does the state of Iowa have its own stock pile that you can call on?

Elizabeth: You know, I'm not sure what they have in there. I'm sure they have something, but we're not sure what's in it. That's one of the issues, too. What we need might not be what they have.

Moderator: I guess that's one of the reasons their in your collaborative so you can flesh out exactly what's available, when, and how much.

Elizabeth: We really-- as we go through our planning, we kind of expect that we're going be on our own for these things. That's how we worked the scenario last year, too. When the students returned from spring break from the fictional scenario, they transferred planes in Los Angeles so they got everyone sick there first, before they came through Chicago and then to Iowa City, so. We had-the pandemic was starting to balloon in other, much larger metropolitan areas.

Moderator: What you just said is exactly what the secretary of Health and Human Services, Mike Levit has said at every one of the state pandemic summits he has gone to-essentially communities will be on their own. You know, the federal government and state government, everybody will do what they can but it's going to be a lot of helping yourself and helping others. We do have a fax question. Can you provide more detail on recruiting faculty and students. What specific measures have you defined for continuity education when many students and faculty may be quarantined or off campus or just plain sick. And a second part of the question-I'll wait till you answer the first.

Elizabeth: Sure, well continuity of education is one of those hot topics on campus. Because when we went through the essential core functions it wasn't on there. Because right now we're considering, we would rather go along with the public health recommendations and send students home. So when we started talking about this, a lot faculty said we'll we will just move our classes online. In which, the I.T. people in the room said you can't do that. You know, it takes months to prepare a course, to make it an online course, we have ICON which is our University of Iowa Online Learning System and you could do that, but if that's something the school is thinking about, and wants to do, I would say start doing it now. Get the courses online now, so that if you do want to continue teaching during a pandemic, during a public health emergency, that it's ready to go because it takes a long time to set up. And then you also have the issue of how many students have internet connections at home, how many faculty do-who is wired in? In Iowa City we have about two internet service providers, two technicians for the whole area. So if those two people are sick, whether we have the courses online or not, if the internet goes down at that point, we won't be able to have those courses anyway.

Moderator: I believe I recently read a federal report that talked about the weaknesses of the internet, getting it from whatever your service provider is to your own computer. Unless those are made more robust, the availability may indeed be in question. I want to ask you something, you had mentioned students probably would be quarantined, meaning they would be asked to stay in their rooms and classes would be suspended, so they are not sitting in the large lecture halls sharing germs, but they have to eat so aren't they going to be in the cafeterias together sharing germs?

Elizabeth: Well no, one of the ways we're trying to plan around that, is to have something similar to the military meals ready to eat M.R.E.S. in which you have a self-contained unit. My husband would love these, he loves military meals ready to eat.

Moderator: I'll have to try them. Haven't so far.

Elizabeth: Well, it's more that you get a little canister and you can heat your meal. You have everything you need in one place. We could place these outside of students' rooms who are quarantined or isolated and you know, just kind of knock and say-and move on and you so you're not exposing the person who is distributing the meals ready to eat, and the student-we would make sure that they still get their meals

Moderator: Are they stockpiled? Do you have the M.R.E.S. stockpiled?
Elizabeth: We have a few. But not-certainly not enough for this level. They're not the most delicious thing to begin with, so I can't imagine what they would be like after a few years more of sitting around.

Moderator: We are talking cafeteria food, so it may be okay. Second part of the person who faxed in, wanted to know; who makes the decision to implement the college pandemic plan? Was it the university president, the board of regents, or the local health department?

Elizabeth: Well the way were looking at it, is there's no clear-cut definition. Another person, another set of- group we need to think about is the board of regents or the governor. Certainly, we think the governor could tell the university to close class, its time to suspend classes, but we assume also the president could do that and certainly public health could do it, local public health could, as could state public health, they could make those decisions for us.

Moderator: We have a question about how do you decide as a university if the illness that you are seeing is within normal parameters or is something novel; unusual; large enough to require this emergency action? Are there percentages that are used, a certain percentage of people reporting for evaluation and that triggers it, what are the triggers?

Elizabeth: Well we're part of a laboratory response network at the hygienic lab. Generally, we test a lot of these samples that come in, so we're able to see what's normal and what's not and I don't have enough expertise to speak directly on that, but there are surveillance networks set up throughout the state different hospitals reporting different illnesses they see. We would definitely see if a trend was beginning. The issue is at the beginning of that too, you know if you just have five extra people sick in one day and I know our student health service is looking into-- making everything computerized and tracking it over time so when a spike does happen, even if it's just a few people, if its outside a certain number of standard deviations that's when to make the calls.

Moderator: And the student health services would report to state health department or other entities?

Elizabeth: No, county, they would report to county public health. County Public Health is our intermediary between the state. We don't really want people calling directly to the state, because we have communication channels that are better followed than not. During our exercise, actually its funny you mention that, because during our exercise last year, that was one of the issues. Our county public health was the last to know when something was going on, on campus. Because people were calling the state and even the C.D.C., (hypothetically, I mean we didn't make the real calls). So county, we actually had a county public health table and they kind of looked up and said, you know why didn't you tell us?

Moderator: Again-

Elizabeth: That's communications

Moderator: And the beauty of the tabletop exercise and fully functional as well because you can make those mistakes when it doesn't really count against you. You want to make mistakes so that you can learn your lessons. You know, we've just gone through a ton of information, Elizabeth and I appreciate all that you shared. But before we conclude our program, what have we missed, what else should we be thinking about? What are some of the last things that-- tame-home messages that we should hear?

Elizabeth: Again, it's, make sure you involve everyone on campus. Don't try to do it in a small contained unit. Public health can't do this alone, they need to reach out, see who is there, you know, a lot of people don't understand the function of public heat and what public health people do. A lot of it is education and training and that is really what it comes down to, education and training and you know, once you have the plan, exercise it, and don't be afraid to find faults with it. If it looks perfect to you, then there are probably some pretty serious faults in there you're just not seeing.

Elizabeth: Look afield from your usual suspects; your nursing school, your medical school, you know, your health folks on campus are great to have involved but you need students involved and you need human resources. You need the diversity.

Moderator: Definitely.

Elizabeth: Probably going to have a little challenge in making them understand the importance, of it especially when you want them to get NIMS and ICS Training.

Elizabeth: Well, and we have a lot of buy-in on campus, this is our third year. We've done three full years of this now. It takes a while. It's not going to happen overnight.

Moderator: Elizabeth, share with us your contact information in case somebody would want to go ahead and contact you.

Elizabeth: Sure. They are welcome to send me an e-mail Elizabeth-hosmanek@uiowa.edu and I'd be happy to share any of the materials I spoke about or there's any specific questions that people didn't have a chance to ask, then I'd be happy to answer them.

Moderator: O.K. because I'm sure that there are questions. And as you said, the University of Iowa circumstances, is certainly not going to fit every university or college setting. But there are lessons learned and lessons that can be shared, we certainly want everyone to do that. So thank you very much for joining us today, we would of course like you to fill out your evaluation online. Your feedback is always helpful to the development of our programs and continuing education credits are available. This program, I want to remind you will be available via web streaming within a week. Please see our web site for more details. We hope you'll join us on April 10th for a program on Alternative Messaging for Vulnerable Populations with Anne Marie Jones of CARD, that's Collaborating Agencies Responding to Disasters. I'm Kris Smith. See you next time on the University at Albany Center for Public Health Preparedness Grand Rounds. (Music)

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