Table of Contents
III List of supplies
D. Public Health District Directory
The Emergency Preparedness Coalition for People with Disabilities and Elderly Persons has developed this resource kit to aid organizations that serve people with disabilities and elderly persons in preparing for and responding to seasonal flu and H1N1. As with all emergency planning, it is important for you to get in touch with your local Public Health Department and your local Public Health District for details concerning local planning and response activities.
Influenza is a contagious respiratory illness caused by influenza viruses. It can cause mild to severe illness, and at times can lead to death. Influenza viruses cause disease among people of all ages and also in animals. Children become infected more frequently, but the risks for complications, hospitalizations, and deaths from influenza are normally higher in people age 65 and older, young children, and persons of any age who have medical conditions that weaken their immune system or that put them at high risk for complications from influenza. This “seasonal influenza” comes along every year in the United States and on average causes seasonal influenza in 5% to 20% of the population; causes 200,000 people to be hospitalized with influenza-related complications; and causes about 36,000 influenza-related deaths.
This year there is a new strain of influenza virus. This new strain is called Novel (or “new”) A (H1N1) virus. You may have heard it called “Swine Flu”. This virus is particularly dangerous because it is so new that we have no natural antibodies, nor vaccines to fight against it. It is a combination of bird (Avian), pig (Swine), and human influenza genes that have combined to form this new influenza. This flu has spread world-wide which is the meaning of the term Pandemic. It means that there is a world-wide outbreak of this Novel A H1N1 virus. Vaccine manufacturers have had to produce not only the regular seasonal flu vaccine; but make a vaccine for the novel virus.
This year instead of taking one influenza vaccination; we will need to take two. The vaccine that we receive for “seasonal influenza” will not work on “H1N1 influenza”. Antiviral drugs have also been placed around the state to treat those who are ill with, or hospitalized by influenza, their contacts. (Like people who live in the same house, work closely in the same area, etc.) Due to unexpected delays in the manufacturing process, the H1N1 vaccine has been limited, and slow in coming. This has been a very frustrating process for the general public and healthcare providers alike. We all must keep an eye on our local news sources, check in with our physicians, and monitor the public health and CDC websites if you have access to the internet. Stay informed!
Due to the fact that information regarding H1N1 is constantly changing, the internet provides the most up to date source of guidance. Here are some web sites that you may find useful.
B. Centers for Disease Control and Prevention (CDC): http://www.cdc.gov/h1n1flu/
C. H1N1 Flu (Swine Flu): Information for Specific Groups may be found at http://www.cdc.gov/h1n1flu/groups.htm.
D. H1N1 (Swine Flu): Resources for People who are Deaf and Hard of Hearing may be found at http://www.cdc.gov/h1n1flu/deaf.htm.
E. CDC Guidance for HC Professionals: Interim Guidance for Infection Control for Care of Patients with Confirmed or Suspected Novel Influenza (H1N1) Virus Infection in a Healthcare Setting. http://www.cdc.gov/h1n1flu/guidelines_infection_control.htm
F. For information on H1N1 planning tips for outpatient facilities, see the Department of Health and Human Services’ pandemic flu planning checklist for medical offices and clinics at http://pandemicflu.gov/plan/healthcare/medical.html
G. CDC guidance on planning for outpatient facilities may be found at http://www.cdc.gov/h1n1flu/10steps.htm.
H. Georgia Division of Public Health: http://health.state.ga.us/h1n1flu/
I. Georgia’s Disaster Mental Health web site: www.georgiadisaster.info
Here is a list of basic supplies that you should have on hand for staff, consumers and visitors. We suggest that you reinforce the use of these supplies often.
• Hand sanitizer - kept in a secure location
• Face masks – Keep a supply of these masks at hand and offer them to visitors.
• Soap and water (see the hand washing posters in Section 3 below)
• Disinfectant wipes for high-touch surfaces – Even if you have a cleaning service, it’s good practice to go over high-touch surfaces with disinfectant to make sure they’re clean.
A. Print out and place these posters near the entrance to your facility and in other prominent places:
1. Keep Germs to Yourself http://health.state.ga.us/pdfs/publications/manuals/cough02.pdf
2. Health Alert poster with symptoms, what to do if you think you have the flu and proper respiratory etiquette http://www.cdc.gov/h1n1flu/pdf/airport_poster_for_print.pdf.
3. Keep illness from spreading http://health.state.ga.us/pdfs/publications/manuals/cough01.pdf
B. Print out and place this poster near sinks.
Hand washing posters http://health.state.ga.us/pdfs/epi/handwashing.03.pdf
C. This handout provides good information about hand cleaning.
A. Set up procedures for how your agency will respond when someone is very ill. Exercise those procedures regularly and make adjustments to the plan based on the lessons learned from your exercise.
B. Develop an emergency call down list for you staff. Make sure your list includes leadership staff and appropriate back-up for key positions. Update this list quarterly to ensure all the contact numbers are accurate.
C. Know who to call when an emergency occurs.
D. Frequently check the CDC and GDPH website because information is constantly updated.
F. Make sure you know who to call for after hours emergencies. Frequently check to make sure that contact number has not changed.
F. It is very important that all staff receive a seasonal flu shot. Contact you local Public Health Department or Public Health District for details.
worried. What can I do?
All this information about H1N1 may be stressful to you. You may worry about your own health and the health of those you care about. Worry, fear, anxiety and concerns about the future are common reactions in this kind of situation. When you go through a stressful event, it is common to experience some of the following:
• Change in sleep and appetite
• Less interest in daily activities
• Increased irritability and impatience
Some people may have more severe stress reactions. These reactions can affect your life at home, work, school and in the community. These can include:
• Pounding or racing heart
• Shortness of breath
• Tightness in the chest
• Feeling dizzy or faint
• Chills or hot flushes
• Fear of losing control
• Trembling, shaking, sweating
• Feelings of choking or smothering
• Nausea or stomachache
• Numbness or tingling sensations
• Feeling like things are unreal
Sometimes when people have feelings of stress, they think that they are sick. Feelings such as worry, fear and anxiety are usually not signs of a physical illness. They are usually signs of stress. However, it is always important to check with a medical provider to assess your health status if unusual symptoms occur.
• To reduce stress, try to breathe slowly and deeply.
• If you have severe anxiety and feel breathless, it may help to breathe into a paper bag.
• Try not to think or talk about fears for the future.
• STAY IN THE PRESENT. Notice what is really happening now, rather than what might happen in the future.
• Focus on simple routine tasks.
• Continue routines for yourself and your family, such as regular meals, bedtimes and exercise.
• Keep busy. Find tasks that you and your family can do together. Focus on day-to-day plans.
• Avoid drugs and alcohol. These can make you less alert and can cause serious health problems.
• Stay connected with friends and family. Reach out to people by phone and email.
• Try to avoid upsetting images. Listen to the television or radio for health and safety information. Turn off the TV or radio if they continue to play frightening images or stories.
• If you feel scared or overwhelmed, talk with someone about your feelings. This can reduce your stress and help you feel less lonely.
How will children respond to the stress
associated with H1N1 Flu?
Some children may start acting like they did when they were younger:
• Thumb sucking or bed wetting
• Unusual amount of crying
• Clinging to parents
• Not wanting to go to bed
• Worry about what might happen
• Act without thinking or act aggressively
• Use drugs or alcohol
• Resist parental authority
• Withdraw or become depressed
• Become easily irritated or impatient
How can I help my child to cope?
• Talk about your own feelings clearly and calmly. This shows your child that many different feelings are a common response to stress.
• Provide information that your child can understand.
• Encourage questions. Expect repeat questions.
• Tell your child that you will do everything you can to keep him safe. Repeat this often.
• Help your child to keep in touch with friends by phone and email.
• Encourage children to draw pictures. Art work can help children to express their feelings.
• Hold and hug your child often. This provides extra reassurance, comfort and caring.
• Spend extra time with your child, especially at bedtime.
• Maintain your child’s routine.
• Teach your child things she can do to protect herself (hand washing, coughing into her sleeve).
• Praise good behavior.
• The effects of stress may show up right away or may come months later. For most people, stressful feelings go away soon after the stressful event ends. Sometimes, people still feel stressed long after the emergency is over. These are all common responses to a stressful situation.
• If you have feelings that make it difficult to function in your daily life, consider seeking professional help. Find help through your health care provider or clergy person. Or call the Georgia Crisis and Access Line at 1-800-715-4225.
• Remember that stress reactions are common responses to abnormal events. For most people, THEY WILL GO AWAY in time.
• Talk to someone about your feelings.
• Find fun and relaxing activities for you and your family.
• Get plenty of rest and exercise.
• Find ways to help others.
• Offer support to others.
• Share information about resources.
Get information on how to make an emergency plan for your family at www.ready.georgia.gov.
Adapted by the Georgia Department of Behavioral Health and Developmental Disabilities from the Indiana Division of Mental Health and Addiction and the Massachusetts Department of Public Health
For more information contact:
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You may have the flu if you have some or all of these symptoms:
· fever *
· sore throat
· runny or stuffy nose
· body aches
· sometimes diarrhea and vomiting
*It’s important to note that not everyone with flu will have a fever.
If you get sick with flu-like symptoms this flu season, you should stay home and avoid contact with other people except to get medical care. Most people with 2009 H1N1 have had mild illness and have not needed medical care or antiviral drugs and the same is true of seasonal flu.
However, some people are more likely to get flu complications and they should talk to a health care provider about whether they need to be examined if they get flu symptoms this season. They are:
People at High Risk for Developing Flu-Related Complications
· Children younger than 5, but especially children younger than 2 years old
· Adults 65 years of age and older
· Pregnant women
People who have:
· Neurological and neurodevelopmental conditions [including disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy (seizure disorders), stroke, intellectual disability (mental retardation), moderate to severe developmental delay, muscular dystrophy, or spinal cord injury].
· Chronic lung disease (such as chronic obstructive pulmonary disease [COPD] and cystic fibrosis)
· Heart disease (such as congenital heart disease, congestive heart failure and coronary artery disease)
· Blood disorders (such as sickle cell disease)
· Endocrine disorders (such as diabetes mellitus)
· Kidney disorders
· Liver disorders
· Metabolic disorders (such as inherited metabolic disorders and mitochondrial disorders)
· Weakened immune system due to disease or medication (such as people with HIV or AIDS, or cancer, or those on chronic steroids)
· People younger than 19 years of age who are receiving long-term aspirin therapy
The Advisory Committee on Immunization Practices (ACIP) has issued separate recommendations on Who Should Get Vaccinated Against Seasonal Flu.
Also, it’s possible for healthy people to develop severe illness from the flu so anyone concerned about their illness should consult a health care provider.
There are emergency warning signs. Anyone who has them should get medical care right away.
· Fast breathing or trouble breathing
· Bluish skin color
· Not drinking enough fluids
· Not waking up or not interacting
· Being so irritable that the child does not want to be held
· Flu-like symptoms improve but then return with fever and worse cough
· Fever with a rash
· Difficulty breathing or shortness of breath
· Pain or pressure in the chest or abdomen
· Sudden dizziness
· Severe or persistent vomiting
No. The emergency room should be used for people who are very sick. You should not go to the emergency room if you are only mildly ill. If you have the emergency warning signs of flu sickness, you should go to the emergency room. If you get sick with flu symptoms and are at high risk of flu complications or you are concerned about your illness, call your health care provider for advice. If you go to the emergency room and you are not sick with the flu, you may catch it from people who do have it.
Yes. There are drugs your doctor may prescribe for treating both seasonal and 2009 H1N1 called “antiviral drugs.” These drugs can make you better faster and may also prevent serious complications. This flu season, antiviral drugs are being used mainly to treat people who are very sick, such as people who need to be hospitalized, and to treat sick people who are more likely to get serious flu complications. Your health care provider will decide whether antiviral drugs are needed to treat your illness. Remember, most people with 2009 H1N1 have had mild illness and have not needed medical care or antiviral drugs and the same is true of seasonal flu.
CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other things you have to do and no one else can do for you. (Your fever should be gone without the use of a fever-reducing medicine, such as Tylenol®.) You should stay home from work, school, travel, shopping, social events, and public gatherings.
Stay away from others as much as possible to keep from making them sick. If you must leave home, for example to get medical care, wear a facemask if you have one, or cover coughs and sneezes with a tissue. And wash your hands often to keep from spreading flu to others. CDC has information on “Taking Care of a Sick Person in Your Home” on its website at http://www.cdc.gov/h1n1flu/guidance_homecare.htm
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This document has been updated in accordance with the CDC Recommendations for the Amount of Time Persons with Influenza-Like Illness Should be Away from Others . This document provides interim guidance and will be updated as needed.
2009 H1N1 flu virus infection (formerly known as swine flu) can cause a wide range of symptoms, including fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. Some people may also have vomiting and diarrhea. People may be infected with the flu, including 2009 H1N1, and have respiratory symptoms without a fever. Like seasonal flu, 2009 H1N1 flu in humans can vary in severity from mild to severe. Severe disease with pneumonia, respiratory failure and even death is possible with 2009 H1N1 flu infection. Certain groups might be more likely to develop a severe illness from 2009 H1N1 flu infection, such as pregnant women and persons with chronic medical conditions. Sometimes bacterial infections may occur at the same time as or after infection with influenza viruses and lead to pneumonias, ear infections, or sinus infections.
The following information can help you provide safer care at home for sick persons during a flu outbreak or flu pandemic.
Dr Joe Bresee describes how to keep from getting the flu, and spreading it to others. The main way that influenza viruses are thought to spread is from person to person in respiratory droplets of coughs and sneezes. This can happen when droplets from a cough or sneeze of an infected person are propelled through the air and deposited on the mouth or nose of people nearby. Influenza viruses may also be spread when a person touches respiratory droplets on another person or an object and then touches their own mouth or nose (or someone else’s mouth or nose) before washing their hands.
People with 2009 H1N1 flu who are cared for at home should:
· check with their health care provider about any special care they might need if they are pregnant or have a health condition such as diabetes, heart disease, asthma, or emphysema
· check with their health care provider about whether they should take antiviral medications
· keep away from others as much as possible. This is to keep from making others sick. Do not go to work or school while ill
· stay home for at least 24 hours after fever is gone, except to seek medical care or for other necessities. (Fever should be gone without the use of a fever-reducing medicine.)
· get plenty of rest
· drink clear fluids (such as water, broth, sports drinks, electrolyte beverages for infants) to keep from being dehydrated
· cover coughs and sneezes. Wash hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub.*
· wear a facemask – if available and tolerable – when sharing common spaces with other household members to help prevent spreading the virus to others. This is especially important if other household members are at high risk for complications from influenza. For more information, see the Interim Recommendations for Facemask and Respirator Use
· be watchful for emergency warning signs (see below) that might indicate you need to seek medical attention.
Check with your healthcare provider or pharmacist for correct, safe use of medications
Antiviral medications can sometimes help lessen influenza symptoms, but require a prescription. Most people do not need these antiviral drugs to fully recover from the flu. However, persons at higher risk for severe flu complications, or those with severe flu illness who require hospitalization, might benefit from antiviral medications. Antiviral medications are available for persons 1 year of age and older. Ask your health care provider whether you need antiviral medication.
Influenza infections can lead to or occur with bacterial infections. Therefore, some people will also need to take antibiotics. More severe or prolonged illness or illness that seems to get better, but then gets worse again may be an indication that a person has a bacterial infection. Check with your health care provider if you have concerns.
Warning! Do not give aspirin (acetylsalicylic acid) to children or teenagers who have the flu; this can cause a rare but serious illness called Reye’s syndrome. For more information about Reye’s syndrome, visit the National Institute of Health website.
Check with your health care provider or pharmacist if you are taking other over-the-counter or prescription medications not related to the flu. For more information on products for treating flu symptoms, see the FDA website.
When to Seek Emergency Medical Care
Get medical care right away if the sick person at home:
When providing care to a household member who is sick with influenza, the most important ways to protect yourself and others who are not sick are to:
· keep the sick person away from other people as much as possible (see “placement of the sick person”) especially others who are at high risk for complications from influenza
· remind the sick person to cover their coughs, and clean their hands with soap and water often. If soap and water are not available, they should use an alcohol-based hand rub*, especially after coughing and/or sneezing
· have everyone in the household clean their hands often, using soap and water (or an alcohol-based hand rub*, if soap and water are not available). Children may need reminders or help keeping their hands clean
· ask your health care provider if household contacts of the sick person—particularly those contacts who may be pregnant or have chronic health conditions—should take antiviral medications such as oseltamivir (Tamiflu®) or zanamivir (Relenza®) to prevent the flu
· If you are in a high risk group for complications from influenza, you should attempt to avoid close contact (within 6 feet) with household members who are sick with influenza. If close contact with a sick individual is unavoidable, consider wearing a facemask or respirator, if available and tolerable. Infants should not be cared for by sick family members. For more information, see the Interim Recommendations for Facemask and Respirator Use
Placement of the sick person
· Keep the sick person in a room separate from the common areas of the house. (For example, a spare bedroom with its own bathroom, if that’s possible.) Keep the sickroom door closed.
· Unless necessary for medical care or other necessities, people who are sick with an influenza-like-illness should stay home and keep away from others as much as possible, including avoiding travel, for at least 24 hours after fever is gone except to get medical care or for other necessities. (Fever should be gone without the use of a fever-reducing medicine). This is to keep from making others sick. Children, especially younger children, might potentially be contagious for longer periods.
· If persons with the flu need to leave the home (for example, for medical care), they should wear a facemask, if available and tolerable, and cover their nose and mouth when coughing or sneezing
· Have the sick person wear a facemask – if available and tolerable – if they need to be in a common area of the house near other persons.
· If possible, sick persons should use a separate bathroom. This bathroom should be cleaned daily with household disinfectant (see below).
Protect other persons in the home
· The sick person should not have visitors other than caregivers. A phone call is safer than a visit.
· If possible, have only one adult in the home take care of the sick person. People at increased risk of severe illness from flu should not be the designated caretaker, if possible.
· If you are in a high risk group for complications from influenza, you should attempt to avoid close contact (within 6 feet) with household members who are sick with influenza. If close contact with a sick individual is unavoidable, consider wearing a facemask or respirator, if available and tolerable. For more information, see the Interim Recommendations for Facemask and Respirator Use.
· Avoid having pregnant women care for the sick person. (Pregnant women are at increased risk of influenza-related complications and immunity can be suppressed during pregnancy).
· Avoid having sick family members care for infants and other groups at high risk for complications of influenza.
· All persons in the household should clean their hands with soap and water frequently, including after every contact with the sick person or the person’s room or bathroom.
· Use paper towels for drying hands after hand washing or dedicate cloth towels to each person in the household. For example, have different colored towels for each person.
· If soap and water are not available, persons should use an alcohol-based hand rub.*
· If possible, consideration should be given to maintaining good ventilation in shared household areas (e.g., keeping windows open in restrooms, kitchen, bathroom, etc.).
· Antiviral medications can be used to prevent the flu, so check with your health care provider to see if some persons in the home should use antiviral medications.
If you are the caregiver
· Avoid being face-to-face with the sick person.
· When holding small children who are sick, place their chin on your shoulder so that they will not cough in your face.
· Clean your hands with soap and water after you touch the sick person or handle used tissues, or laundry. If soap and water are not available, use an alcohol-based hand rub*
· Talk to your health care provider about taking antiviral medication to prevent the caregiver from getting the flu.
· If you are at high risk of influenza associated complications, you should not be the designated caretaker, if possible.
· If you are in a high risk group for complications from influenza, you should attempt to avoid close contact (within 6 feet) with household members who are sick with influenza. Designate a person who is not at high risk of flu associated complications as the primary caretaker of household members who are sick with influenza, if at all possible. If close contact with a sick individual is unavoidable, consider wearing a facemask or respirator, if available and tolerable. For more information, see the Interim Recommendations for Facemask and Respirator Use
· Monitor yourself and household members for flu symptoms and contact a telephone hotline or health care provider if symptoms occur.
Using Facemasks or Respirators
· Avoid close contact (less than about 6 feet away) with the sick person as much as possible.
· If you must have close contact with the sick person (for example, hold a sick infant), spend the least amount of time possible in close contact and try to wear a facemask (for example, surgical mask) or N95 disposable respirator.
· An N95 respirator that fits snugly on your face can filter out small particles that can be inhaled around the edges of a facemask, but compared with a facemask it is harder to breathe through an N95 mask for long periods of time. More information on facemasks and respirators can be found at H1N1 Flu (Swine Flu) website.
· Facemasks and respirators may be purchased at a pharmacy, building supply or hardware store.
· Wear an N95 respirator if you help a sick person with respiratory treatments using a nebulizer or inhaler, as directed by their doctor. Respiratory treatments should be performed in a separate room away from common areas of the house when at all possible.
· Used facemasks and N95 respirators should be taken off and placed immediately in the regular trash so they don’t touch anything else.
· Avoid re-using disposable facemasks and N95 respirators, if possible. If a reusable fabric facemask is used, it should be laundered with normal laundry detergent and tumble-dried in a hot dryer.
· After you take off a facemask or N95 respirator, clean your hands with soap and water or an alcohol-based hand sanitizer.
· For more information, see the Interim Recommendations for Facemask and Respirator Use
· Throw away tissues and other disposable items used by the sick person in the trash. Wash your hands after touching used tissues and similar waste.
· Keep surfaces (especially bedside tables, surfaces in the bathroom, and toys for children) clean by wiping them down with a household disinfectant according to directions on the product label.
· Linens, eating utensils, and dishes belonging to those who are sick do not need to be cleaned separately, but importantly these items should not be shared without washing thoroughly first.
· Wash linens (such as bed sheets and towels) by using household laundry soap and tumble dry on a hot setting. Avoid “hugging” laundry prior to washing it to prevent contaminating yourself. Clean your hands with soap and water right after handling dirty laundry. If soap and water are not available, use an alcohol-based hand rub.*
· Eating utensils should be washed either in a dishwasher or by hand with water and soap.
For More Information
The Centers for Disease Control and Prevention (CDC) Hotline (1-800-CDC-INFO) is available in English and Spanish, 24 hours a day, 7 days a week.