Federal Agencies Address Maintenance of Response Capabilities During Pandemic

Dallas, Texas -- Two million Americans are estimated to have been infected with the H1N1 or "swine flu" virus as of August 28, 2009, but you don't hear a lot about it. In the public's view, "It will become a crisis when the media says it is," noted U.S. Fire Administration advisor Al Conners at Fire-Rescue International.

With the surge expected to return this fall, senior officials from the USFA and the Department of Homeland Security's Office of Health Affairs addressed the topic of maintaining first responder capabilities during a pandemic at their Friday classroom session.

The federal partners are preparing a pandemic guidance document for the public safety community, and used the presentation as an opportunity to exchange ideas with the officials in attendance, as well as to share the latest flu information. A completed guidance document will be made available in the near future on the USFA's website, said Deputy U.S. Fire Administrator Glenn Gaines.

The virus's return this fall has the potential for increased virulence and is expected to take hold before any vaccine programs are in place. "What this thing is going to look like and how virulent it's going to be is difficult to predict," Gaines said.

A flu update was provided by Capt. Scott A. Middlekauff of the DHS. He reported that numbers are up in the southern hemisphere right now, and the age group primarily affected is five to 24. Also, the flu is expected to occur in multiple waves, not a single outbreak, so responders shouldn't let their guard down if they see one wave subside. Perhaps most importantly, the flu strain has remained stable so far.

"We do anticipate this to be around a while," Middlekauff said. "The fear is that it could change -- that's what viruses do."

Conners added that others at particular risk are pregnant women and those with underlying medical conditions. Most people recover in 7-10 days without medical intervention. "That's great news. That's one of the things we have going for us," he said. "One of the other things we have going for us is that much of our workforce is older [than 24]." The military may be harder hit due to its larger proportion of people in their early 20s.

Regarding symptoms, Conners said H1N1 looks like the regular flu, but can impact more than just the upper respiratory tract. "So how do you know which you're seeing? You don't," he said. "Those determinations are not being made." Currently any flu case that has occurred outside of the typical flu season is being treated as H1N1, so we don't have specific data.

Although the virus is generally similar to the regular seasonal flu, it is explosive in the nature of how quickly it spreads, warned Rick Patrick, Director of Medical First Responder Coordination at DHS. "It's not business as usual," he said. For those who do get seriously ill, the H1N1 flu can manifest as a serious disease in as little as 7 days.

Response agencies should prepare for high rates of personnel absenteeism, just as the general public. Many ideas were discussed for maintaining operations during absenteeism, but the federal partners stressed that there is no official advice being released at this time. Some of the concepts discussed were common sense while others were outside the box.

"Pre-decisional" considerations included:

Community mitigation: Asking sick people and possibly their family members to stay home, and keeping kids out of schools and programs, though this has serious social and economic impacts as well.

Responder mitigation: Early vaccination for both H1N1 and seasonal flu; emphasis on standard hygiene and universal precautions; telework; limiting staff gatherings in favor of communication through technology; asking sick employees to stay home for 7 days or until symptom-free for 24 hours; monitoring absenteeism schedules; planning ahead for alternative child care; and stocking up on everything from medical supplies to fuel to food and water.

Some practical considerations might include establishing triage areas and informational phone lines, designating certain transport vehicles as "flu wagons," addressing chain of command and payroll continuity, and establishing a policy regarding payment for those exceeding their sick leave.

In a worst case scenario, agencies might consider limiting types of responses handled, and tapping other groups to fill any support roles for which they might be legally qualified, such as retired personnel, citizen emergency response groups, bus drivers, ski patrols, medical students, etc. Though high numbers of fatalities are not anticipated, agencies might also consider how to handle a high volume of corpses.

The one official piece of advice at this point is to stay up to speed on flu news and developments, which responders can do at www.flu.gov.