Transcript Public Health Emergency - South Carolina Medical Association

What You Can Do
What DHEC Can Do
Roles of Public Health and Health Care Providers
Is this an outbreak?
What is the potential impact?
Epidemiological investigation and on-going
surveillance for cases
Could this be bioterrorism?
Inform, educate & coordinate with healthcare
community, first responders, officials & public
Isolate ill persons
What controls can be
placed to
prevent spread of disease,
reduce injury and
promote restoration of
health?
Quarantine & monitor exposed
Provide preventive treatment
Environmental health monitoring & controls
Assistance with sheltering; mortuary support; mass
care
Healthcare facility monitoring
Coordination of volunteers
Source: MMWR 48(29);621
Projected Number
Of Deaths
Case Fatality
Ratio
>2.0%
1.0 - <2.0%
(Based on U.S. Population, 2006)
Category 5
>1,800,000
Category 4
900,000 - <1,800,000
0.5 - <1.0%
Category 3
450,000 - <900,000
0.1 - <0.5%
Category 2
90,000 - <450,000
<0.1%
Category 1
<90,000
Pandemic Severity Index
Assumes 30% Illness Rate and Unmitigated Pandemic
South Carolina Projections (CDC FluAID Models –
15% - 35% Attack Rate)
• 371,000 - 867,000 outpatient visits
• 8,467 – 19,756 hospitalizations
• Surge capacity needed during peak (week 5 of 8week pandemic wave) to manage additional:
• 486 hospitalization admissions per day
• 688 ICU beds
• 344 patients requiring mechanical ventilation
South Carolina Projections (U.S. Geo Survey & SC
Hazards Vulnerability Lab – 2 PM Event)
• 31,250 outpatient visits
• 9,537 hospitalizations
• 14 of 108 hospitals with moderate damage
• 92,000 households displaced
• 62,500 seeking temporary shelter
• Damage to facilities and utilities
• Disrupted communication channels
• Transportation disrupted
• Quantity of and severity of cases
• Insufficient quantity of resources
• Absenteeism
• Altered standards of care
• Social distancing, isolation, quarantine
• Identify community partners
• Emergency contact information
• Establish communication systems
• Routine coordination and collaboration
• Shared data systems
• Joint planning and exercises
• Decontamination
• Isolation and quarantine
• Surge capacity
• Altered standards of care
• Disease Reporting
• Infection Control Committee
• Hospital Emergency Preparedness
• Community Coalitions
• Communications
• HAN
• Establish communication channels ASAP
• ICS - Liaison Officers
• Establish protocols
• Clinical/Surge
• Reporting and tracking
• PPE
• Consistent communications to the public
• ICS – JIC
• Designated spokespersons
• Message maps and talking points
• Medication Distribution
• Mass Vaccinations
• Community Triage
• Mass Care
• Crisis Counseling
• Medical Reserve Corps
GOVERNOR’S POWERS
• SECTION 1-3-420.
Proclamation of emergency by Governor
• SECTION 1-3-430.
Orders to prevent danger
• SECTION 1-3-440.
Further powers of Governor
• SECTION 1-3-450.
Intervention by Governor in situations of
violence or public disorder
• SECTION 1-3-460.
Governor’s powers under article shall be
supplemental to powers granted by other laws
• SECTION 25-1-440.
Additional powers and duties of Governor
during declared emergency
• SECTION 44-4-100
Emergency Health Powers Act
DHEC: State Public Health Agency
• Duties and powers of Board regarding
communicable or epidemic diseases
• Duties of Department regarding public health, in
general
• Department may promulgate and enforce rules and
regulations for public health
DHEC: Traditional Public Health Powers
• Authority to require reporting cases and deaths from
contagious, infectious diseases, chemical or other terrorism;
• Authority to require reporting of increased prescription rates
of drugs for diseases caused by chemical terrorism or
infectious agents
• Physicians, licensed nurses and public health employees
participating in mass immunization projects exempt from
liability; exceptions
• Authority to request assistance from peace and health
officers and the National Guard to enforce isolation and
quarantine orders
DHEC Powers Expand under
Declaration of Public Health Emergency
• Only in effect after the Governor, with consultation
from the Public Health Emergency Committee if
possible, declares a Public Health Emergency
(PHE).
• (“Emergency Health Powers Act,” SC Code
Sections 44-4-100, et seq)
Public Health Emergency
"Public health emergency" (PHE) means the occurrence or
imminent risk of a qualifying health condition.
• “Qualifying Health Condition” means:
• (1) a natural disaster; or
• (2) an illness or health condition that may be caused by
terrorism, epidemic or pandemic disease, or a novel
infectious agent or biological or chemical agent and that
poses a substantial risk of a significant number of human
fatalities, widespread illness, or serious economic impact
to the agricultural sector, including food supply.
Control of Persons during PHE
• DHEC must use every means to prevent transmission of
infectious disease and ensure all cases are subject to proper
control and treatment.
• DHEC may perform voluntary physical examinations or tests
as necessary for the diagnosis or treatment of individuals.
• DHEC may isolate or quarantine any person who refuses
examination or testing.
• Physical exams or tests may be performed by any qualified
person authorized to do so by DHEC and must not be
reasonably likely to result in serious harm.
Vaccinations and Treatment
•
•
•
•
During a PHE, DHEC may use powers to:
(1) vaccinate persons;
(2) treat persons exposed to or infected with disease; and
(3) to prevent spread of contagious or possibly contagious
disease. DHEC, upon provision of due process outlined in
statute, may isolate or quarantine persons who are unable or
unwilling for any reason (including, but not limited to,
health, religion, or conscience) to undergo vaccination or
treatment pursuant to this section.
Vaccinations and Treatment
• Vaccinations or treatment must be provided only to those
who agree to the vaccinations or treatment.
• Vaccinations or treatment may be administered by any
qualified person authorized by DHEC. DHEC works closely
with LLR on PHE issues.
• To be administered pursuant to this section, a vaccine or
treatment must not be such as is reasonably likely to lead to
serious harm to the affected individual.
Isolation and Quarantine
• DHEC may isolate infected individuals and quarantine
exposed individuals. Includes those who have not been
vaccinated, treated, tested, or examined.
• Must be least restrictive means necessary to prevent the
spread of disease (may include confinement to private and
public premises.)
• Health status of isolated and quarantined individuals must be
monitored regularly.
• Must be immediately released when pose no substantial risk
of transmitting disease.
• Must comply with DHEC's rules and orders. Failure to
comply constitutes a felony.
Isolation and Quarantine
• DHEC may authorize access of physicians, health
care workers, or others to individuals in isolation or
quarantine as necessary to meet needs.
• Law enforcement officers may arrest, isolate, or
quarantine an individual who is acting in violation
of an isolation or quarantine order.
• Jobs of isolated or quarantined individuals
protected.
Emergency Licensing Issues
• DHEC with the Department of Labor, Licensing and
Regulation (LLR), may exercise the following emergency
powers regarding licensing of health personnel:
• (1) to require in-state health care providers to assist in the
performance of vaccination, treatment, examination, or
testing of any individual as a condition of licensure,
authorization, or the ability to continue to function as a
health care provider in this State;
• (2) to accept the volunteer services of in-state and out-ofstate health care providers, to appoint such health care
providers as emergency support function volunteers, and to
prescribe the duties as may be reasonable and necessary for
emergency response; and
Licensing – cont’d
• The appointment of in-state and out-of-state health
care providers must not exceed the termination of
the PHE. DHEC may terminate in-state and out-ofstate appointments at any time or for any reason
provided that termination will not jeopardize health,
safety, and welfare of the people of this State.
• The licensing authority may waive any or all
licensing requirements, permits, or fees required by
law and applicable orders, rules or regulations for
health care providers from other jurisdictions to
practice in this State.
Immunity from Liability
• Any health care provider appointed pursuant to this
section must not be held liable for any civil
damages as a result of medical care or treatment
including, but not limited to, trauma care and triage
assessment, related to the appointment of the health
care provider and the prescribed duties, unless the
damages result from providing, or failing to
provide, medical care or treatment under
circumstances demonstrating a reckless disregard
for the consequences so as to affect the life or health
of the patient.
Immunity from Liability– cont’d
• Applies if health care provider does not receive
payment from the State other than as allowed in
Section 8-25-40 for the services and duties.
• Applies whether health care provider was paid,
should have been paid, or expected to be paid for
the services at the time of rendering the services
from sources including, but not limited to,
Medicaid, Medicare, reimbursement under the
Stafford Act, 42 U.S.C. Section 512, et seq., or
private health insurance.
Crisis Standards of Care
• During a wide-reaching catastrophic public health
emergency or disaster, existing surge capacity plans may not
be sufficient to enable health care providers to continue to
adhere to normal treatment procedures and follow usual
standards of care. This is a particular concern for
emergencies that may severely strain resources across a large
geographic area, such as a pandemic influenza or the
detonation of a nuclear device. Under these circumstances, it
may be impossible to provide care according to the standards
of care used in non-disaster situations, and, under the most
extreme circumstances, it may not even be possible to
provide basic life sustaining interventions to all patients who
need them. Institute of Medicine, “Crisis Standards of
Care,” 2010.
Crisis Standards of Care - SC
During the H1N1 pandemic, the SCHA began a series
of meetings to discuss Crisis Standards of Care in SC.
While this effort did not result in a final
determination of CSCs, the effort was very
educational.
Why is it difficult to pre-determine CSCs?
Purchase and Distribution of Pharmaceuticals
• DHEC may purchase and distribute antitoxins,
serums, vaccines, immunizing agents, antibiotics,
and other pharmaceutical agents or medical supplies
in the interest of preparing for or controlling a
public health emergency, without any additional
legislative authorization.
Cont’d
• If shortage of such a product results, whether or not the
product has been purchased by DHEC, DHEC may control,
restrict, and regulate by rationing and using quotas,
prohibitions on shipments, price fixing, allocation or other
means, the use, sale, dispensing, distribution, or
transportation of the relevant product necessary to protect the
health, safety, and welfare of the people of the State. In
making rationing or other supply and distribution decisions,
DHEC must give preference to health care providers,
disaster response personnel, and mortuary staff.
DHEC may procure products across state
• During PHE, DHEC may procure, store, or
distribute any antitoxins, serums, vaccines,
immunizing agents, antibiotics, and other
pharmaceutical agents or medical supplies located
within the State as may be reasonable and necessary
for emergency response, with the right to take
immediate possession thereof.
Control of Property during PHE
• With other agencies, DHEC handles dangerous
facilities and materials.
• Power to close, direct evacuation of or
decontaminate facility or material.
• Purchase and distribution of pharmaceutical agents
or medical supplies.
• Destruction of property; civil proceedings.
Control of Healthcare Facility
• Use of health care facility or services in response to public
health emergency.
• DHEC may require a health care facility to provide services,
as condition of licensure, authorization, or ability to continue
doing business.
• Facility may be used to isolate or quarantine individuals
during PHE. Management and supervision of the health care
facility must be coordinated with DHEC to ensure protection
of existing patients and compliance with the terms of this
act.
Thank you!
Thank you for all you do for the people of the State
and your interest in Public Health Preparedness.
While no one wants a public health emergency to
occur, being informed about the program structure
and laws is very important for everyone.
Questions?
Lilian Peake, M.D.
Director of Health Services