The Big One?
Every couple of months, I get a copy of the magazine Emergency Management delivered to my inbox at work. Now, I’m not usually one for paper magazines, and I generally find the content of emergency management-type magazines to generally be lots of rah-rah and advertisement (bleh), but Emergency Management isn’t so bad. On top of that, they’ve got a robust website and have delved into social media pretty heavily (posting new stories to Twitter and curating an entire stable of blogs). And it’s free.
In this month’s edition, and online apparently, Valerie Lucus had a pretty interesting article on how H1N1 influenza forced UC Davis to rethink their pandemic plans. She brings up a point I’ve danced around for the last few months, but feel pretty strongly about: our pandemic plans were not very well designed. They were written with H5N1 in mind, and tied almost exclusively to the WHO pandemic levels (some places, I’m sure, added the CDC’s Pandemic Severity Index, but probably not all).
Case in point, and one of Ms. Lucus’ examples; many places had plans to institute drastic social distancing measures when WHO raised the pandemic level to 5, like closing schools and canceling sporting events. The reality is that we hit level 5 with only a handful of cases in this country. I’ve talked about this before, back when we were just trying to figure things out, about the ineffectiveness of the pandemic level system.
This article, though, takes that thinking to the next level. It says that we planned for the worst possible situation, with the intention to “roll back” our response to match the pandemic (which in my mind is totally defensible). And planning for the worst case scenario is the easiest, in my mind. Give it everything, shut everything down, 12-hour shifts, activate volunteers, altered standards of care, the whole nine yards. Alternatively, we already knew the plan for a normal flu season–basically, do nothing.
The real tough decisions, though, were in the middle of those two. What do you do for a flu that’s spreading like wildfire…somewhere else? What do you for a flu that’s about the same as seasonal flu, but carries the weight of the pandemic moniker? If Houston and San Diego were closing schools, should we?
No one had talked about that before. Scratch that, no one I talked to talked about that. We all happily talked about how the government would shut everything down and save the world. Then it happened, and we were forced to make those critical decisions in the heat of the moment–which is EXACTLY what we were supposed to have avoided with all of that pre-planning.
Like I said above, though, everything we did was totally defensible. It was right at the time. The problem is that we’d never had to plan for a pandemic before. Thanks to CRI, we’re ready as all get-out for an anthrax attack (which, if you ask me, is why everyone’s first planning response was to set up PODs–when all you’ve got is a hammer, everything looks very much like a nail), but no one talked about how specifically we could roll back those bludgeoning 1918-like response plans. What were the triggers that should have kicked it into a higher level of response?
When everyone rewrites their pandemic plan this spring, remember these lessons. Planning for the worst case is the easiest; planning for the best case is next easiest; figuring out the middle is the really difficult part. With that in mind, write your plans from the bottom up. What constitutes the best case scenario? What triggers would cause you to respond more aggressively? Even more aggressively? Now, what does the worst case scenario look like? Build plans for each level of the response.
Sure it’s more writing and more exercising. But if we planned from the bottom up, instead of the top down, this spring might have been filled with fewer late night meetings and panicked conference calls.