Pandemic Influenza Table Top Exercise

On Thursday and Friday (I'm only a couple of days behind, go me), I participated in a table top exercise about pandemic influenza preparedness. It had a tendency to drag on and get into the weeds at time, but was overall fairly educational.

One thing I didn't know before going into this is that we have definitions of pandemic severity, based on the case fatality ratio (below). In terms of pandemic influenza, the H1N1 (or swine flu) from 2009 was a category 1 pandemic (I feel like I need to back-up for a second and define 'pandemic'. It doesn't mean 'bad disease'; it means a disease outbreak that is spread around the world. An epidemic, on the other hand, is an outbreak that is in one area or part of the world. So H1N1 is a pandemic, because it's found everywhere, but obesity is an epidemic, because it isn't). Anyway, back to what I was saying: H1N1 is a category 1, because while there were a lot of cases, there weren't a lot of deaths. The 1918 flu, on the other hand, was a category 5 pandemic, and was the only category 5 influenza pandemic in history.

For the table top exercise, we were using a pandemic influenza modeling tool developed by the Innova Group, where you can enter in the severity of the pandemic (from 1-5), duration (typically 6-12 weeks for influenza, depending on the size of the geographic area you're talking about), the population size and age distributions, and expected attack rate by age (for example, children tend to have higher attack rates for influenza than adults). You enter in all that stuff, and then it spits out a bunch of reports about how many healthcare workers you need, how many gloves, the amount of storage space required for everything you're going to need, etc, etc. 

For this exercise, they modeled the Northern Region Medical Command, which is all the Army treatment facilities from the Canadian border through North Carolina, and a category 3 pandemic. The people running the table top were logisticians, not epidemiologists, so they didn't know all the right terminology of influenza surveillance or epidemiology and some of the things just didn't make sense. For example, based on the scenario, we knew there was a pandemic coming before the first cases hit the United States, which isn't the situation. With H1N1, it had been going on in Mexico for a couple of months before anybody typed the virus in San Diego and realized that it was a new influenza. So a little unrealistic, at least at the beginning of the outbreak, but it still generated a lot of good discussion about what we can do to prepare and how individual treatment facilities have to respond.

Overall, I don't know how much it taught me about policy (which is what I'm supposed to be learning on this rotation), but still educational overall.

Periodic Health Assessment

Today was a meeting of the Joint Preventive Medicine Policy Group (another acronym: JPMPG, pronounced jip-em-pig), which is a group of preventive medicine people from all of the services (Army, Navy, Air Force, Coast Guard, sometimes foreign militaries, etc), and the topic of the meeting was the periodic health assessment.

The periodic health assessment is done by each of the services, but each one is different, which in today's fairly integrated military, makes things a bit difficult. There's an online portion that each service member completes on his/her own time, and then there's a face-to-face with a medical provider (doc, PA, NP, etc). The problem comes in for the face-to-face... if a sailor goes to an Army clinic to do the PHA, there's no guarantee that that Army doc knows how to do a Navy PHA (or even knows which computer program to use). For the record, I don't know how to do Navy or Air Force PHAs, nor do I know what programs they use. As you can figure, that creates some problems on joint bases.

So the purpose of the meeting (which extends into tomorrow, but I won't be going to, because I'll be at WRAIR for didactics), is to figure out 1) what the purpose of the PHA is (that's an entirely different conversation, which I won't get into); 2) if the multiple different PHAs can be standardized into one form; and 3) what that might look like.

Easier said than done. There's a lot more to policy than meets the eye.

Proponency Office for Preventive Medicine at the Office of the Surgeon General

That's where I'm rotating now (today was the first day). Or, because the military likes acronyms the way normal people like breathing, POPM/OTSG (which we just call POPM, pronounced pop-'em).

To put it (very) simply, POPM is where medical policy in the Army comes from. Whenever there's a question about the way things are done in the Army medical department (AMEDD, back to the acronym thing), it goes to POPM, they check the research and what the civilian side and other services are doing and get the opinions of subject matter experts, and then make policy. Yes, that was very simplified.

Today I spent the morning doing the standard for a new rotation: in-processing. Fortunately, every Army prev med resident as rotated through POPM since 2008, so they know what they're doing (which is impressive; usually when someone should know better, they act as if it's never been done before and the wheel needs to be reinvented). Then the afternoon was taken by a teleconference about the new regulation for the Army program, which mostly turned into public health nurses bashing just about everyone else (including prev med docs). That took over three hours, and when it was done, they sent me home, because the snow was falling pretty heavily (not sticking, but still falling). Unfortunately, people around here become idiots on the road when there's weather involved (and I mean any weather... snow, rain, sunshine, hurricane, earthquake...). It's a little more than 15 miles from work to home, and it took me almost two and a half hours. I was not happy with that commute.