THE NEWSLETTER OF THE BUREAU OF HEALTH SERVICES • COUNSELING SERVICES UNIT • FDNY SEPTEMBER 2009

H1N1 FLU PANDEMIC PREPAREDNESS FDNY GETS READY

Each fall, BHS gears up for flu season with influenza vaccination for our work force.

As the fall season approaches, the current flu has been labeled a Pandemic. Each year, there is a predominant flu virus strain that causes illness in the population. This year, however, there are significant changes in the influenza pattern. In the spring, a new viral strain, initially labeled swine flu and now correctly called H1N1 FLU, emerged and reached Pandemic levels.

When a new strain of influenza virus emerges in a population, the virus can spread uncontrollably through the whole population because there is no natural immunity. Even though the symptoms are the same as seasonal influenza, the effects of a Pandemic virus are more severe due to the lack of immunity to the virus. Compared to seasonal flu, H1N1 flu illness has shown a different pattern with many young adults (under 30), school age children and pregnant women developing this illness. Some in this group have been very ill and some have died. Children, teenagers and adults under 50 have accounted for about 75% of hospitalizations and 60% of deaths. Many of the very ill have certain risk factors such as chronic lung diseases (especially asthma, COPD, emphysema), pregnancy, severe obesity or immunosuppression (ex. HIV, recent chemotherapy, transplant patients).

Pandemic will last longer than a normal flu outbreak and activity of the virus occurs in "waves" which last 6-8 weeks separated by months. The H1N1 flu virus is expected to be the predominant flu strain in the coming months.

IS THERE TREATMENT FOR THE FLU?

FLU TREATMENT
In most cases, individuals with the flu will get better with rest, fluids and the tried and true chicken soup. But for those with underlying medical problems, their illness may be more severe and early treatment will be needed.

WE MUST PREPARE FOR THE NEXT WAVE EXPECTED THIS FALL

Flu, or influenza, is a virus. Starting an antibiotic will not fight a viral infection. Anti-viral medications like Tamiflu or Relenza do help stop the replication of this virus. The medications are useful if begun within the first 48 hours of symptoms, which is a critical time to fight the infection. The medication can minimize the symptoms and shorten the course of the illness. So far this virus has been responsive to these medications. The medications are of importance when the individual is in a high risk group with underlying medical problems such as pregnancy, lung diseases (especially asthma and COPD), heart disease, immunosuppression (AIDS, recent chemotherapy, organ transplant recipient), neurological diseases or extreme obesity.

NEW FDNY FREE PANDEMIC MEDICATION PROGRAM LAUNCH
In recognition that our FDNY membership may be exposed at home or at work, and to minimize spread to coworkers and family members, a new pharmaceutical program is being launched for the H1N1 virus.

All members of the UFA union will have an expansion of their current Line of Duty ('LODI') Prescription Card coverage for Pandemic Medical Coverage. The UFA LODI card will cover two specific medications - Tamiflu and Relenza. These medications would be prescribed to you in the event of a work-related exposure to the H1N1 flu. They are the only medications covered under this new expanded coverage.

Members of the UFOA, EMT, Paramedic and EMS Officers unions will be sent a "Pandemic Medical Coverage" prescription card in the mail shortly.

These cards, (UFA LODI and UFOA/EMT/Paramedic/EMS Officer Pandemic Medical Coverage) can be presented to the pharmacy with a prescription (FDNY Members only/not Family members) written by either your treating personal physician or by a BHS physician. This new program will ensure that members are protected, can seek attention quickly and be sure that co-workers and family are protected.

Pandemic medical coverage can only be utilized ONE time during the flu season but if medication is needed a second time, then it will be filled again if a BHS physician approves or writes the prescription.

These medications can also be used for prophylaxis to prevent infection but only if a true exposure to H1N1 FLU has occurred, due to failure of PPE and if the individual exposed has underlying medical problems that increase the risk for coming down with life-threatening complications (ex. pneumonia), or is the caretaker for an infant or others with medical risks.

FLU VACCINATION
Vaccines are the best tool we have to prevent infection. Vaccination provides needed immunity to prevent infection. It helps reduce infection in you, the vaccinated person, and reduces the risk that you can give the illness to others.

The traditional seasonal influenza (flu) vaccine protects against three strains of virus. This seasonal influenza vaccine will be offered starting in September of 2009. The seasonal flu vaccine will not protect against the H1N1 FLU but will protect against three other strains of flu. It is recommended for those in a high risk group which includes first responders, health care workers, those with infants and small children, the elderly, or those who care for the elderly. Keep in mind that the seasonal flu vaccine needs to be received each year because the vaccine only protects for one season. Although some may experience a mild fever or pain at the site for the first 24-48 hours after vaccination, this is not a live vaccine and cannot cause influenza illness.

This flu vaccination will be offered starting in September at annuals, at WTC Monitoring and Treatment sites, at Union meetings and at BHS.

H1N1 FLU VACCINATION
This vaccine had been formulated specifically to prevent H1N1 flu. It is completing testing this summer and will be available starting in the Fall. It has done well in testing and is well tolerated. This vaccine will be distributed to FDNY through the NYC Dept of Health and we have been assured that adequate vaccine will be available. The dates of distribution are not yet known. It is expected that this will be a two (2) vaccine immunization schedule with a several week interval between the first and second immunization.

FDNY expects to distribute this vaccine as part of our FDNY BIOPOD exercise. During the FDNY BIO-POD, on duty members are brought to strategically placed sites for distribution of influenza vaccine. The term POD stands for Point of Distribution.

This exercise mobilizes the entire workforce to these sites so that our first responders, FIRE and EMS can be offered needed protection against the flu.

The groups recommended to receive the H1N1 influenza vaccine include:

1. Pregnant women because they are at a higher risk of complications and can potentially provide protection to infants who cannot be vaccinated.
2. Household contacts and caregivers for children younger than 6 months, again because infants are at higher risk of complications and cannot be vaccinated.
3. Healthcare and emergency medical services personnel because infections among healthcare workers have been reported and this can be a potential source of infection for vulnerable patients. Also increased absenteeism in this population could reduce healthcare system capacity.
4. All individuals from 6 months through 24 years of age 5. Individuals aged 25 through 64 years who have health conditions associated with higher risk of medical complications from influenza. The roll out of this vaccination will begin in the fall. FDNY will continue to work with our local partners NYC DOHMH and follow the guidelines of the City, State and Federal experts, including the CDC.

HOW DO WE PROTECT OURSELVES AT WORK
Use your Personal Protective Equipment (PPE) when indicated. For Fire, on every CFR-D run, the Recon team (2 firefighters) should enter the patient environment wearing N95 mask, helmet eye shield in the down position and gloves. They should assess the patient to determine if fever and respiratory symptoms exist. If so, they should tell the rest of the CFR team to don PPE (N95, eye shield down and gloves) before entering the environment.

For EMS, on every call where fever and respiratory symptoms exist, use your PPE (N95, goggles and gloves). If procedures are being done (nebulized medications, suctioning, intubation, etc.) then a gown should also be worn. To further reduce the risk for infection, the patient should be given a mask to wear (surgical or oxygen mask). Updated information will continue to be posted on the ADMINISTRATION PAGE of the FDNY Intranet, giving further advice and modifications of response as needed.

Wash your hands, cover your mouth when you sneeze or cough and if you are sick with a fever and other flu symptoms, STAY HOME until the fever is gone for 24 hours.

HOW DO WE PROTECT OURSELVES AND OUR FAMILY AT HOME
Prevention of any infectious illness starts with common sense advice: wash your hands, cover your mouth when you sneeze or cough, when you have a fever, and stay away from others. When a family member becomes sick, he/she should, if possible, be isolated from others in the family to avoid spreading it to other household contacts. Even young children can be taught to cover their mouth, sneeze into their arm to avoid contaminating their hands and to wash their hands frequently. During the months ahead, when flu activity is expected to rise, avoid crowds and if your child is ill, keep the child home. If you have a fever and other flu symptoms, STAY HOME!

The mission of the FDNY is to save lives. We do this both by providing fire suppression, EMS treatment and transport to those that are ill and by all of us stepping up to provide this city with the finest disaster response available. The Pandemic flu provides a new challenge to the City and to our first responders. BHS will continue to provide guidance and offer protection to prevent and minimize the risk of this illness.

Stay safe and protect yourself on each and every run. Your PPE remains your best defense in preventing illness in your self, your coworkers and your families.

And remember what your mother always said: Wash Your Hands!

Back to Top