PANDEMIC PLANNING AT EPHRATA COMMUNITY HOSPITAL By: Beverly McAllister, MS, MT(ASCP) SC Laboratory Operations Manager

PANDEMIC PLANNING AT PANDEMIC PLANNING AT EPHRATA COMMUNITY EPHRATA COMMUNITY

HOSPITALHOSPITAL

By: Beverly McAllister, MS, By: Beverly McAllister, MS, MT(ASCP) SCMT(ASCP) SC

Laboratory Operations Laboratory Operations ManagerManager

OBJECTIVES: OBJECTIVES:

• Identify the components of a well-Identify the components of a well-defined Pandemic Plandefined Pandemic Plan

• Describe the role your facility plays Describe the role your facility plays in response to a pandemicin response to a pandemic

• Describe your role as a laboratorian Describe your role as a laboratorian in response to a pandemicin response to a pandemic

Components of a well-defined Components of a well-defined Pandemic Pandemic

PlanPlanPandemic Planning Committee focused on Pandemic Planning Committee focused on

defining a process for the following: defining a process for the following: Facility Surveillance for and detection of Facility Surveillance for and detection of

influenzainfluenza Communication processes are adequate and Communication processes are adequate and

availableavailable Supply managementSupply management Surge capacitySurge capacity Maintaining essential servicesMaintaining essential services Security Security Release of information is uniform, coordinated Release of information is uniform, coordinated

and adequateand adequate

Pandemic Plan CommitteePandemic Plan Committee• Direct initiative of Emergency Management CommitteeDirect initiative of Emergency Management Committee• Goal: Develop a Pandemic Influenza PlanGoal: Develop a Pandemic Influenza Plan• Formed in July 2006Formed in July 2006• Meet on a monthly basisMeet on a monthly basis• Consists of the following members: Consists of the following members:

COOCOO VP of Medical AffairsVP of Medical Affairs VP of Physician PracticesVP of Physician Practices Director of Emergency Management ServicesDirector of Emergency Management Services Director of Facilities ManagementDirector of Facilities Management Director of Public RelationsDirector of Public Relations Director of Purchasing ServicesDirector of Purchasing Services Director of Home CareDirector of Home Care Director of PharmacyDirector of Pharmacy Director of Ephrata Medical EquipmentDirector of Ephrata Medical Equipment

Pandemic Plan Committee members cont’dPandemic Plan Committee members cont’d Infection Control CoordinatorInfection Control Coordinator Laboratory Operations ManagerLaboratory Operations Manager Employee Health NurseEmployee Health Nurse Nursing EducationNursing Education ChaplaincyChaplaincy Director of Emergency ServicesDirector of Emergency Services Advanced Life Support Unit ManagerAdvanced Life Support Unit Manager Physician Practice RepresentationPhysician Practice Representation

What resources have we used What resources have we used to develop the Pandemic Plan?to develop the Pandemic Plan?

1. United States Department of Health 1. United States Department of Health and Human Services Pandemic and Human Services Pandemic Influenza Plan was used as a blueprint Influenza Plan was used as a blueprint for pandemic influenza preparation for pandemic influenza preparation and response. and response.

www.hhs.gov.pandemicflu/planwww.hhs.gov.pandemicflu/plan

2. SCTTF planning resources2. SCTTF planning resources

http://www.hhs.gov.pandemicflu/plan

Ephrata Community Hospital Plan as of Ephrata Community Hospital Plan as of 3/10/07 (still in development)3/10/07 (still in development)

I. Inter-pandemic and Pandemic Alert PeriodsI. Inter-pandemic and Pandemic Alert Periods 1. ECH facility responsibilities1. ECH facility responsibilities

a. ECH will respond to alerts and pandemic a. ECH will respond to alerts and pandemic related issues through utilization of the related issues through utilization of the EMC, Pandemic Planning Committee and the EMC, Pandemic Planning Committee and the Hospital Incident Command Structure (HICS)Hospital Incident Command Structure (HICS)

b. Written Plan includes: b. Written Plan includes: a. disease surveillancea. disease surveillance b. facility accessb. facility access c. occupational healthc. occupational health d. use and administration of vaccines and d. use and administration of vaccines and

antiviral drugsantiviral drugs e. surge capacitye. surge capacity f. supply chain and access to critical f. supply chain and access to critical

inventory needsinventory needs g. mortuary issuesg. mortuary issuesc. Participation in pandemic influenza c. Participation in pandemic influenza

response exercisesresponse exercises

Plan cont’d: Inter-pandemic and Pandemic Alert PeriodsPlan cont’d: Inter-pandemic and Pandemic Alert Periods

B. State and local responsibilities: B. State and local responsibilities:

1. ECH works within the framework of the SCTTF and 1. ECH works within the framework of the SCTTF and through the Hospital Medical Sub-Committee a Regional through the Hospital Medical Sub-Committee a Regional Hospital Response Plan has been developed.Hospital Response Plan has been developed.

2. Exercises with local emergency management, local first 2. Exercises with local emergency management, local first responders and receivers, regional assets including responders and receivers, regional assets including hospitals and state agencies. hospitals and state agencies.

3. Open lines of communication through the use of faxes, 3. Open lines of communication through the use of faxes, direct lines, FREDS, HAN, NEDSS and RODS.direct lines, FREDS, HAN, NEDSS and RODS.

4. Human Relations Department and Employee Health have 4. Human Relations Department and Employee Health have

developed guidelines for any legal issues affecting staff and developed guidelines for any legal issues affecting staff and patient care. patient care.

Plan cont’d: Inter-pandemic and Pandemic Alert PeriodsPlan cont’d: Inter-pandemic and Pandemic Alert Periods

C. HHS responsibilitiesC. HHS responsibilities

1. ECH response plan is adopted under the 1. ECH response plan is adopted under the guidelines of the US Department oh Health and guidelines of the US Department oh Health and Human Services and the PA Department of Human Services and the PA Department of Health (DOH) Pandemic Response PlanHealth (DOH) Pandemic Response Plan

2. ECH will utilize the Department of Homeland 2. ECH will utilize the Department of Homeland Security model protocols for early detection and Security model protocols for early detection and treatment of influenza among patients and treatment of influenza among patients and staff; knowing that these protocols can be staff; knowing that these protocols can be practiced during routine influenza seasons. practiced during routine influenza seasons.

II. Pandemic PeriodII. Pandemic Period

A. If an influenza pandemic begins in another A. If an influenza pandemic begins in another country:country:

1. ECH facility responsibilities1. ECH facility responsibilities

a. heighten institutional surveillancea. heighten institutional surveillance

b. communicate with key public health, b. communicate with key public health,

healthcare and community partnershealthcare and community partners

c. Implement a system of early detectionc. Implement a system of early detection

and treatment of healthcare personnel and treatment of healthcare personnel

who might be infectedwho might be infected

d. reinforce infection control proceduresd. reinforce infection control procedures

e. accelerate staff training in accordance with e. accelerate staff training in accordance with the the

pandemic influenza education and trainingpandemic influenza education and training

Plan cont’d: Pandemic Period- begins in another Plan cont’d: Pandemic Period- begins in another countrycountry

2. State and local responsibilities2. State and local responsibilities

a. Working with HHS to provide local a. Working with HHS to provide local

physicians and hospital physicians and hospital administratorsadministrators

with updated information andwith updated information and

guidance as the situation unfolds. guidance as the situation unfolds.

Plan cont’d: Pandemic Period- begins in or enters Plan cont’d: Pandemic Period- begins in or enters the USthe USB. If an influenza epidemic begins in or enters the United B. If an influenza epidemic begins in or enters the United

StatesStates

1. ECH facility responsibilities1. ECH facility responsibilities

a. Activate facility pandemic response plan in a. Activate facility pandemic response plan in

accordance with the “Hospital Pandemic Influenza accordance with the “Hospital Pandemic Influenza

Triggers”Triggers”

b. Implement activities to increase capacity, b. Implement activities to increase capacity,

supplement staff and provide supplies and supplement staff and provide supplies and

equipmentequipment

c. Post respiratory/cough etiquette signsc. Post respiratory/cough etiquette signs

d. Maintain high index of suspicion that patients d. Maintain high index of suspicion that patients

presenting with flu-like symptoms have the presenting with flu-like symptoms have the

pandemic strain pandemic strain

Plan cont’d: Pandemic Period- begins in or enters Plan cont’d: Pandemic Period- begins in or enters the USthe US

e. Implement infection control practicese. Implement infection control practices f. Rapid communication within and between f. Rapid communication within and between healthcare facilities and DOHhealthcare facilities and DOH g. Implement surge-capacity plansg. Implement surge-capacity plans h. If pandemic strain is detected in local or h. If pandemic strain is detected in local or community, transmission can be assumed and community, transmission can be assumed and hospital would move to the next level of responsehospital would move to the next level of response2. State and Local Health Responsibilities2. State and Local Health Responsibilities a. Provide healthcare facilities with information on a. Provide healthcare facilities with information on the global, national and local situationthe global, national and local situation b. Work with HHS to provide guidance on infectionb. Work with HHS to provide guidance on infection control measures for healthcare and non-control measures for healthcare and non- healthcare facilitieshealthcare facilities c. work with healthcare facilities to address surgec. work with healthcare facilities to address surge capacity needscapacity needs

Plan cont’d: Pandemic Period- begins in or enters Plan cont’d: Pandemic Period- begins in or enters the USthe US

3. HHS Responsibilities3. HHS Responsibilities a. Assist state and local healthcare and public a. Assist state and local healthcare and public health health

partners on issues related to hospital infection partners on issues related to hospital infection

control, occupational health, antiviral drug usecontrol, occupational health, antiviral drug use

and clinical management, vaccination and and clinical management, vaccination and medicalmedical

surge capacity. surge capacity.

b. Provide states with materials from the Strategicb. Provide states with materials from the Strategic

National Stockpile for further distribution to National Stockpile for further distribution to

healthcare facilities. healthcare facilities.

III. Pandemic ResponseIII. Pandemic ResponseA. Planning for provision of care in the facilityA. Planning for provision of care in the facility

1. Detecting the introduction of Pandemic 1. Detecting the introduction of Pandemic

InfluenzaInfluenza

2. Preventing the spread of Pandemic 2. Preventing the spread of Pandemic

InfluenzaInfluenza

3. Managing the impact on facility and staff3. Managing the impact on facility and staff

4. Expansion of preparedness and response4. Expansion of preparedness and response

plans for bioterrorism, SARS and otherplans for bioterrorism, SARS and other

infectious diseases to include influenzainfectious diseases to include influenza

Pandemic Response cont’dPandemic Response cont’d

5. Identify criteria and methods for measuring: 5. Identify criteria and methods for measuring: a. Infection control practicesa. Infection control practices b. Case reportingb. Case reporting c. Patient placementc. Patient placement d. Healthcare workers illness surveillanced. Healthcare workers illness surveillance6. Review and update inventories of supplies that6. Review and update inventories of supplies that will be in high demand during the pandemicwill be in high demand during the pandemic7. Review procedures for receipt, storage, and 7. Review procedures for receipt, storage, and distribution of assets received from federaldistribution of assets received from federal stockpilesstockpiles8. Approach to planning will be consistent with an 8. Approach to planning will be consistent with an “ “All-Hazards” responseAll-Hazards” response


B. Planning ProcessB. Planning Process

1. Committee Structure- Define 1. Committee Structure- Define membersmembers

2. Planning Resources2. Planning Resources

a. Pandemic Response Plan DHSa. Pandemic Response Plan DHS

b. SCTTF-Hospital Regional b. SCTTF-Hospital Regional Response Response

PlanPlan

c. Inter-facility multi-disciplines c. Inter-facility multi-disciplines

d. Outside resources as identifiedd. Outside resources as identified


C. Planning ElementsC. Planning Elements 1. Hospital Surveillance1. Hospital Surveillance a. Laboratory testing will be consistenta. Laboratory testing will be consistent and monitored closelyand monitored closely b. Absenteeism rates will monitored weeklyb. Absenteeism rates will monitored weekly c. ED visits will be monitored through RODS c. ED visits will be monitored through RODS and laboratory testing through NEDSSand laboratory testing through NEDSS d. Data to be evaluated includes: d. Data to be evaluated includes: 1. admissions1. admissions 2. discharges/deaths2. discharges/deaths 3. Patient characteristics such as: 3. Patient characteristics such as: age, underlying disease, secondary age, underlying disease, secondary complications, illness in healthcare complications, illness in healthcare

personnel personnel


e. Guidelines for distinguishing betweene. Guidelines for distinguishing between

influenza and other respiratory diseaseinfluenza and other respiratory disease

f. Symptoms of Influenzaf. Symptoms of Influenza

1. fever1. fever

2. headache2. headache

3. myalgia3. myalgia

4. prostration4. prostration

5. coryza5. coryza

6. sore throat 6. sore throat

7. cough7. cough


2. Hospital Communications2. Hospital Communications

a. External communications outside the facilitya. External communications outside the facility

will occur through the following contactwill occur through the following contact

individuals: Infection Control Coordinator, individuals: Infection Control Coordinator,

VP of Medical Affairs, Public RelationsVP of Medical Affairs, Public Relations

b. Internal Communications will occurb. Internal Communications will occur

through Incident Command through Incident Command

3. Education and Training3. Education and Training

a. Hospital Plan and response educationa. Hospital Plan and response education

b. Hospital staff guide to the Pandemicb. Hospital staff guide to the Pandemic

c. Unit specific educationc. Unit specific education

d. Internet Plansd. Internet Plans


D. Triage/Clinical Evaluation/Admission ProcessD. Triage/Clinical Evaluation/Admission Process

1. Identification of patients w/pandemic flu1. Identification of patients w/pandemic flu

2. Separation of pandemic patients2. Separation of pandemic patients

3. Identify type of care needed3. Identify type of care needed

4. Identify “triage coordinator” for patient4. Identify “triage coordinator” for patient

managementmanagement

5. Define ED/OP clinical evaluation disposition5. Define ED/OP clinical evaluation disposition

proceduresprocedures

6. Review/streamline admission process6. Review/streamline admission process

7. Entry “Trigger points” switch from passive 7. Entry “Trigger points” switch from passive

(signs) to active (direct questioning) (signs) to active (direct questioning)


E. Facility AccessE. Facility Access The following criteria and procedures will The following criteria and procedures will be used to limit access if pandemic occurs: be used to limit access if pandemic occurs: 1. Definition of “essential” visitors1. Definition of “essential” visitors 2. Protocols for limiting non-essential visitors2. Protocols for limiting non-essential visitors 3. Criteria or “triggers” for temporary closing3. Criteria or “triggers” for temporary closing hospital to new admissions/transfershospital to new admissions/transfers a. staffing ratios, isolation capacity, risksa. staffing ratios, isolation capacity, risks to non-influenza patientsto non-influenza patients b. who makes decision regarding closing/b. who makes decision regarding closing/ communication of informationcommunication of information c. consult with state and local health c. consult with state and local health

departments ondepartments on their role in determining what assistance they their role in determining what assistance they

offeroffer


F. Occupational HealthF. Occupational Health 1. Managing ill workers1. Managing ill workers a. plan for detecting signs and symptoms a. plan for detecting signs and symptoms of influenza in healthcare personnel of influenza in healthcare personnel before reporting to dutybefore reporting to duty b. policies for managing healthcare b. policies for managing healthcare

workersworkers with respiratory symptoms with respiratory symptoms c. Consider assigning staff recovering fromc. Consider assigning staff recovering from influenza to care for influenza patientsinfluenza to care for influenza patients 2. Time-off Policies2. Time-off Policies 3. Reassignment of High-Risk Personnel 3. Reassignment of High-Risk Personnel


4. Psychosocial health services4. Psychosocial health services5. Influenza vaccination and use of anti-viral drugs5. Influenza vaccination and use of anti-viral drugs a. Employee annual vaccination programa. Employee annual vaccination program b. Increased vaccination coverage during b. Increased vaccination coverage during Inter-pandemic periodInter-pandemic period c. Documentation of vaccination of employeesc. Documentation of vaccination of employees d. Program established for rapidly vaccinatingd. Program established for rapidly vaccinating or providing antiviral prophylaxis or or providing antiviral prophylaxis or treatment to healthcare personnel as treatment to healthcare personnel as recommended by HHS and PADOHrecommended by HHS and PADOH


G. Use and Administration of vaccines and G. Use and Administration of vaccines and antiviral drugsantiviral drugs 1. Pandemic influenza vaccine and 1. Pandemic influenza vaccine and “ “pre-pandemic” influenza vaccinepre-pandemic” influenza vaccine a. Interim recommendationsa. Interim recommendations 1. Monitor updated HHS information and 1. Monitor updated HHS information and recommendations on the development, recommendations on the development, distribution, and use of vaccinedistribution, and use of vaccine 2. Work with local and state health depts. 2. Work with local and state health depts. on vaccine distribution planson vaccine distribution plans 3. Have estimated quantities of vaccine 3. Have estimated quantities of vaccine

neededneeded 4. Develop vaccination prioritization plan4. Develop vaccination prioritization plan 5. Develop Pandemic Influenza Plan 5. Develop Pandemic Influenza Plan


H. Surge CapacityH. Surge Capacity 1. Plans to include addressing emergency staffing 1. Plans to include addressing emergency staffing

needsneeds and increase demand for isolation wards, ICUs, and increase demand for isolation wards, ICUs, assisted ventilation services and consumable and assisted ventilation services and consumable and durable suppliesdurable supplies 2. FluSurge software2. FluSurge software 3. Staffing3. Staffing a. Assign responsibility for assessment and a. Assign responsibility for assessment and coordination of staffing during an emergencycoordination of staffing during an emergency through Hospital Incident Command Systemthrough Hospital Incident Command System b. Estimate minimum number and categories of b. Estimate minimum number and categories of personnel needed to care for a single patient or a personnel needed to care for a single patient or a small group of patients with influenza on a given small group of patients with influenza on a given dayday


c. Determine how the hospital will meet staffing needs c. Determine how the hospital will meet staffing needs asas

number of patients with pandemic influenza number of patients with pandemic influenza increasesincreases

or staff become illor staff become ill 1. consider patient-care responsibilities to clinical1. consider patient-care responsibilities to clinical administratorsadministrators 2. recruiting retired healthcare personnel2. recruiting retired healthcare personnel 3. Using trainees3. Using trainees 4. Using patients’ family members in ancillary 4. Using patients’ family members in ancillary healthcare capacityhealthcare capacity d. Collaborate regionally under the regional hospitald. Collaborate regionally under the regional hospital response planresponse plan


e. Increase cross-training of personnele. Increase cross-training of personnel

f. List essential support staff personnel f. List essential support staff personnel titlestitles

g. PADOH-”emergency staffing crisis” g. PADOH-”emergency staffing crisis”

credentialingcredentialing

h. Identify insurance and liability issues h. Identify insurance and liability issues relatedrelated

to non-facility staff to non-facility staff

i. Use of healthcare providers from other i. Use of healthcare providers from other

systemssystems


4. Bed Capacity4. Bed Capacity

a. Review and revise admission criteria for times when a. Review and revise admission criteria for times when

bed capacity is limitedbed capacity is limited

b. Polices and procedures for expediting discharge of b. Polices and procedures for expediting discharge of

patients who do not require on-going carepatients who do not require on-going care

c. Plan with homecare agencies for follow-up on earlyc. Plan with homecare agencies for follow-up on early

dischargesdischarges

d. “Triggers” for canceling elective surgical proceduresd. “Triggers” for canceling elective surgical procedures

e. Disposition of those patients requiring emergency e. Disposition of those patients requiring emergency

proceduresprocedures

Pandemic Response cont’dPandemic Response cont’d f. Bed tracking through DOH Facility Resourcef. Bed tracking through DOH Facility Resource Emergency Data Systems (FREDS)Emergency Data Systems (FREDS) g. Hospital licensed bed expansion during the g. Hospital licensed bed expansion during the PandemicPandemic h. Discussion regarding “Altered Standards of h. Discussion regarding “Altered Standards of Care in Mass Casualty Events” Care in Mass Casualty Events” i. Polices and Procedures for shifting patientsi. Polices and Procedures for shifting patients between nursing units to free up bed space in between nursing units to free up bed space in critical care areas and cohorting of patientscritical care areas and cohorting of patients j. MOU’s with other healthcare facilitiesj. MOU’s with other healthcare facilities k. Identification of areas to be vacated for k. Identification of areas to be vacated for

cohorting of cohorting of pandemic patientspandemic patients


5. Consumable and durable supplies5. Consumable and durable supplies a. Evaluation of existing system for tracking medical a. Evaluation of existing system for tracking medical supplies to detect rapid consumptionsupplies to detect rapid consumption b. Consider stockpiling enough consumable b. Consider stockpiling enough consumable

resourcesresources such as masks for duration of pandemic eventsuch as masks for duration of pandemic event c. Assess anticipated needs for consumable and c. Assess anticipated needs for consumable and durable resources, and determine trigger point fordurable resources, and determine trigger point for ordering extra suppliesordering extra supplies d. Anticipate need for antibiotics to treat bacterial d. Anticipate need for antibiotics to treat bacterial complications of influenzacomplications of influenza e. Establish contingency plans for situations in which e. Establish contingency plans for situations in which primary sources of medical supplies become primary sources of medical supplies become

limitedlimited


I. SecurityI. Security 1. Healthcare facility plan for additional 1. Healthcare facility plan for additional securitysecurityJ. Mortuary IssuesJ. Mortuary Issues 1. Assess current capacity for refrigeration of 1. Assess current capacity for refrigeration of deceased personsdeceased persons 2. Discuss mass fatality plans with local and2. Discuss mass fatality plans with local and state health officials and medical state health officials and medical

examinersexaminers 3. Identification of temporary morgue sites3. Identification of temporary morgue sites 4. Determine scope and volume of supplies 4. Determine scope and volume of supplies needed to handle the dead. needed to handle the dead.

Planning for provision of care in Planning for provision of care in the non-hospital setting the non-hospital setting

1. Effective Management1. Effective Management a. plan to establish and staff telephonea. plan to establish and staff telephone hotlineshotlines b. develop training modules, protocols, b. develop training modules, protocols, and algorithms for hotline staffand algorithms for hotline staff c. Provide public education materialsc. Provide public education materials d. clinics and offices should have plans that d. clinics and offices should have plans that

include: include: education, staffing, triage, infection control in education, staffing, triage, infection control in waiting rooms, communication with healthcare waiting rooms, communication with healthcare partners and public health authorities partners and public health authorities

Planning for provision of care in the non-Planning for provision of care in the non-hospital setting- cont’dhospital setting- cont’d

e. communication plane. communication plan

f. plan for procuring suppliesf. plan for procuring supplies

g. participation in community plan g. participation in community plan for for

distribution of vaccine and distribution of vaccine and antiviralsantivirals


2. Planning2. Planning a. create planning committeea. create planning committee b. decision making and coordinating b. decision making and coordinating structurestructure c. How to conduct surveillance for c. How to conduct surveillance for pandemic influenza in healthcarepandemic influenza in healthcare personnel and for residential facilitiespersonnel and for residential facilities in population servedin population served d. staff educationd. staff education


3. Alternative care sites3. Alternative care sites

a. bed capacity and spatial separation of a. bed capacity and spatial separation of

patientspatients

b. facilities and supplies for hand hygieneb. facilities and supplies for hand hygiene

c. lavatory and shower capacity for largec. lavatory and shower capacity for large

number of patientsnumber of patients

d. food serviced. food service

e. medical servicee. medical service


f. staffing for patient care and f. staffing for patient care and support support

servicesservices

g. cleaning and disinfection suppliesg. cleaning and disinfection supplies

h. environmental servicesh. environmental services

i. safety and securityi. safety and security

RELEASE OF SUPPLIES FROM STRATEGIC NATIONAL RELEASE OF SUPPLIES FROM STRATEGIC NATIONAL STOCKPILESTOCKPILE

EPHRATA COMMUNITY HOSPITAL (EMERGENCY MANAGEMENT COMMITTEE)

COUNTY (LEMA)

PENNSYLVANIA STATE DEPT. OF HEALTH (PEMA)

Governor informs PEMA to submit requestFederal and State hold conference call and decide to deploy SNS

FEDERAL DEPARTMENT OF HEALTH AND HUMAN SERVICES

(FEMA)

Role of Laboratorian during a Role of Laboratorian during a pandemicpandemic

• Perform necessary tests to determine Perform necessary tests to determine presence or absence of influenza presence or absence of influenza virus in a patientvirus in a patient

• Report positive influenza results to Report positive influenza results to Pennsylvania Department of Health Pennsylvania Department of Health via PA-NEDSS reporting systemvia PA-NEDSS reporting system

• Report information to infection Report information to infection control coordinatorcontrol coordinator

QUESTIONS? QUESTIONS?

Contact Information:Contact Information:

[email protected]@ephratahospital.org

Phone: 717-738-6527Phone: 717-738-6527

mailto:[email protected]

Documents

PANDEMIC PLANNING AT EPHRATA COMMUNITY HOSPITAL By: Beverly McAllister, MS, MT(ASCP) SC Laboratory Operations Manager