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Emergency Preparedness at General Mills

2006 Public Health Preparedness: Cross-Borders Issues Roundtable

Lessons Learned: Models for Planning and Response

Gary Olmstead

Products Today

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General Mills Manufacturing Facilities are Located on Six ContinentsGeneral Mills Manufacturing Facilities are Located on Six Continents

Emergency Action Plan

• Required by OSHA 29 CFR 1910.38• Provides general/specific guidelines

for:– employee/visitor safety– evacuation or relocation– emergency shutdown of equipment

Emergency Incidents Confronting General Mills

• Medical• Fire/explosion• Chemical release• Weather – tornado, hurricane, flood• Bomb threat• Workplace violence

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Emergency Management Definitions

Emergency Management

• Identify potential emergencies• Prevent problems as much as possible• Minimize the consequences by thorough

preparation• Test the plan periodically• Improve continuously

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Incident Reporting System

• Corporate 800-800-5050• Facility Emergency Telephone List

Emergency Communication Alerts

• Variety of audible and visual alarms• Must practice evacuations• Drill on responses

POLICEWORKPLACE VIOLENCE

POLICEBOMB THREAT

CIVIL DEFENSE, POLICEWEATHER

FIRE, AMBULANCE, POLICE, CHEMICAL RESPONSE

CONTRACTORSCHEMICAL RELEASE

FIRE, AMBULANCE, POLICEFIRE/EXPLOSION

AMBULANCE, POLICE, FIREMEDICAL

OUTSIDE RESPONDERSEMERGENCY

COLLABORATIVE PLANNING AND RESPONSE

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Strength/Weaknesses of Internal Resources

No weapons allowedWORKPLACE VIOLENCE

No internal capabilityBOMB THREAT

Can “shelter in place” effectively –need to monitor government broadcasts

WEATHER

Knowledgeable staff, but can’t respond off-siteCHEMICAL RELEASE

Insufficient ability to respond to major fire or explosionFIRE/EXPLOSION

Trained only in CPR / First AidMEDICAL

Advantages/Disadvantages of External Resources in Preparing for and Responding to Emergencies

Expert help but may be delayed respondingWORKPLACE VIOLENCE

Expert help but may be delayed respondingBOMB THREAT

Good advice from weather channels and Civil DefenseWEATHER

Some fire departments are trained, but many will not enter a “release” areaCHEMICAL RELEASE

Expert help – but lack of knowledge on plant layout and operationsFIRE/EXPLOSION

Expert help – but response time may be slowMEDICAL

Emergency Planning

• Internal response• 911 system• Pull alarms• Table top scenarios• On site drills

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National Incident Management System (NIMS)

• First standardized management approach that unifies federal, state, and local lines of government in the U.S. for incident response

• Incident Command System – command, operations, planning, logistics, finance/administration

• Standardized interoperable communications systems for incident and information management

• Preparedness – planning, training, etc.

DHS’s National Response Plan"One team, one goal...a safer, more secure America"

The National Response Plan establishes a comprehensive all-hazards approach to enhance the ability of the United States to manage domestic incidents. The plan incorporates best practices and procedures from incident management disciplines—homeland security, emergency management, law enforcement, firefighting, public works, public health, responder and recovery worker health and safety, emergency medical services, and the private sector—and integrates them into a unified structure. It forms the basis of how the federal government coordinates with state, local, and tribal governments and the private sector during incidents. It establishes protocols to help

– Save lives and protect the health and safety of the public, responders, and recovery workers;

– Ensure security of the homeland; – Prevent an imminent incident, including acts of terrorism, from

occurring; – Protect and restore critical infrastructure and key resources; – Conduct law enforcement investigations to resolve the incident,

apprehend the perpetrators, and collect and preserve evidence for prosecution and/or attribution;

– Protect property and mitigate damages and impacts to individuals, communities, and the environment; and

– Facilitate recovery of individuals, families, businesses, governments, and the environment.

Avian Influenza – A Different Kind of Emergency

• Only people affected - not equipment or buildings

• Potential high number of people getting sick and/or dying

• Exposure may occur off the job and spread through workforce

• No familiarity with this type of problem• Different government agencies taking the lead –

CDC, WHO, Provincial Ministries of Health

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Influenza Preparednessat General Mills

WHO Classification of Pandemic Phases

Increased and sustained transmission in general population6

Larger cluster(s) but human-to-human spread still localized, suggesting that the virus is becoming increasingly better adapted to humans, but may not yet be fully transmissible (substantial pandemic risk).

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Small cluster(s) with limited human-to-human transmission but spread is highly localized, suggesting that the virus is not well adapted to humans

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Human infection(s) with a new subtype, but no human-to-human spread, or at most rare instances of spread to a close contact.

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No new influenza virus subtypes have been detected in humans. However, a circulating animal influenza virus subtype poses a substantial risk of human disease.

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No new influenza virus subtypes have been detected in humans. Aninfluenza virus subtype that has caused human infection may be present in animals. If present in animals, the risk of human infection or disease is considered low.

1DetailPhase

Avian Flu Human Influenza Pandemic

What might happen?In the USA:

20 to 47 million become ill 18 to 42 million outpatient visits, 314,000 - 734,000 hospitalizations90,000 to 200,000 deaths

• Travel will be limited as governments restrict entry.• Businesses and schools will close• Health care systems will be overwhelmed • Essential services may break down as key personnel are

infected and others stay home from work

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H5N1 Influenza Vaccine

• Present H5N1 vaccine may only “prime”immune system, likely little actual protection and inadequate stocks

• Likely would need two doses (novel H type –no immune memory)

• Time lag to produce pandemic vaccine – 6 months +

• Once identified, still unable to manufacture realistic quantities to prevent pandemic

• Manufactured by a few multinationals –national or international pressures may affect distribution

• Federal Government is stockpiling

WHO Situational Assessment as of August 2005

• Risk of human influenza pandemic is great• The risk will persist over next 1-2 years• The evolution of the threat cannot be

predicted• The early warning systems are weak• Preventative intervention is possible, but

untested• Reduction of morbidity and mortality

impeded by inadequate medical supplies• Preparation is the best protection

A Pandemic Preparedness PlanThe Challenge:A pandemic will not be a “bomb” going off, but will: • Evolve over time (days/weeks), and follow WHO

phases• Require thoughtful and timely “triggered” responses

An Influenza Prevention Plan must address:• Leadership, authority and chain of command• “Triggers” that initiate organizational actions• Actions that are proven to reduce transmission and

illness• Communication to all employees• Business continuity

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A Pandemic Preparedness PlanThe Plan needs to encompass:

Vaccination strategyCompany wide flu vaccination (No avian flu vaccine)

Health Alerts (employee education)Get vaccinated/Don’t come to work sick/ Don’t panic.

Travel and work restrictions (HR policy)Restrict travel or business critical only

Respiratory protection practicesHEPA and N95 travel respirators

Medication strategyTamiflu, Relenza, Rimantidine

Treatment and Prevention of Influenza• Treatment: If used within 48 hours of symptoms, reduces

– Length of illness, Complications (24%), – Antibiotic use, no data on changes in contagiousness, (best if =<

6 hours)

• Tamiflu – 75 mg tablet: 1 tablet twice daily for 5 days• Relenza - 2 puffs twice daily for 5 days• Prophylaxis:

– About 80 percent effective – Currently used for close contacts of H5N1 cases and health care

workers.• Tamiflu - 1 tablet daily for 1 to 12 weeks• Rimantidine – 1 tablet (100 mg) twice daily for 14

days or one week after the last reported case• Tamiflu cost - $7/tablet• Rimantidine - $1.10/tablet

Availability of Antivirals?1. Why:

• Before pandemic vaccine available, antiviral drugs likely the only influenza-specific medical intervention available

2. When:• Pre purchase is the only way to ensure sufficient supplies

available • Many governments actively stockpiling

3. How:• Complex process with multiple issues:• Decide amount of medications - treatment vs prophylaxis• Confirm availability of product, expiration date• Determine if local providers able to manage and prescribe

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Evacuation of Expatriates

In high risk locations, evacuation of personnel may be an option which will require answers to the following:• What is the trigger for evacuation?• Elective or mandatory?• How do you communicate this?• Where do they go?• HR issues – housing, compensation,

schooling, etc• How long do they stay?• When can they return?

Emergency Evacuation Issues1. Based on CDC aviation guidelines, SOS may be capable of medical

and mass personnel evacuation, but there may be local and globaltravel restrictions

2. Destination may likely only be the country of nationality3. Need multiple approvals:

• CDC/WHO • Governmental • Release from hospital• Ground transport• Receiving country• Receiving hospital• Over flight clearances• Medical Team & crew

Portable Isolation Unit

FLU Season CommunicationInfluenza is a serious viral disease that can cause fever, cough, sore throat, headache and muscle aches. The “flu”vaccine is highly effective in preventing influenza, however it does not protect everyone against all viruses that can cause a fever and respiratory symptoms.

An influenza epidemic is possible in the United States this year. Please get your vaccine. If you believe you have influenza, seek medical care with your doctor or clinic and follow their instructions regarding treatment.

This cough and cold season, employees who are sick with a fever and cough or sore throat, are encouraged to stay at home until 24 hours after the fever has subsided. For questions about when to return to work, contact Health Services at 763-764-3952 to talk with a nurse, physician’s assistant or doctor.

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The 7 Steps of an Effective Pandemic Plan

• Step 1 – Define your team and Chain of Command• Step 2 – Build a Body of Knowledge to support the

basic operational issues related to a pandemic and educate your team

• Step 3 – Define “Triggers” for when to activate your internal processes, based on WHO pandemic phases

• Step 4 – Evaluate need for Enhanced Resources at high risk and significant business asset locations

• Step 5 – Train personnel – beginning at management and high risk locations

• Step 6 – Practice – set up pandemic scenarios to test processes, then re-evaluate systems

• Step 7 – Surveillance – ensure your team is able to gather and evaluate data, and disseminate a plan in a timely manner

GENERAL MILLS INFLUENZA PREVENTION AND TREATMENT PROTOCOL

INFLUENZA WORKSITE TRAVEL RESPIRATORY MEDICATIONRISK LEVEL PRECAUTIONS RESTRICTIONS PROTECTION STRATEGY

•Probably there will be no medication available by this time

•N-95 Masks provided to employees•Clinic, caregivers wear HEPA respirators

•No business travel•Only essential people at worksite•Work from home strategy

•Risk Level lV

• Full pandemic, high attack rate, high mortality rate (>30%)

•Tamiflu (1 twice daily for 5 days) at onset of symptoms•Relenza, if resistant strains appear•Preventive use for known contacts

• N-95 Masks worn in public places (airports)•HEPA respirators used by clinic, direct contacts, and caregivers

•Only business critical travel to affected areas•Repatriation arrangements through SOS

•Employee education •Supervisors send employee home for respiratory infections

•Risk Level lll

• Avian influenza (H5N1) spreading in humans (higher transmissibility and mortality >10%)

•Tamiflu provided for business travelers going to affected areas. (Use as directed for symptoms)

•Masks to travelers to areas with active H2N2 if requested

•Clinic gives masks to symptomatic patients

•Travel restricted case by case by Health Services to highly affected areas•No travel for unvaccinated employees

•Employee education (vaccination reminders, recognition and prevention of influenza)

•Risk Level ll

•Active (H2N2) human influenza (“regular”flu morbidity & mortality)

•All GMI employees vaccinated (H2N2)•Tamiflu provided for international business travelers (Use as directed)

•Masks to International Travelers if requested•N-95 Masks required for employees visiting Asian poultry farms/markets

•Prohibit travel to bird farms and live birds markets unless business critical

•On site flu immunizations•Employee education (get vaccine, cover your cough, don’t come to work sick)

•Risk Level l

•No active cases of human influenza

Next StepsInfluenza preparedness in an ongoing process• Start your “Get your flu vaccine” campaign when

supply arrives• Review HR policy: Travel restrictions, absentee

policy • Initiate “Don’t come to work sick” campaign at onset

of influenza season • Pre-purchase antiviral medications• Purchase N 95 dust and travel respirators• Train employees on respiratory protection• Designate local clinics and check their protocols• Monitor illnesses• Coordinate the Influenza “Strike Force” Team

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Business Continuity Planning

• Develop plans for operating with a 5%, 25%, and 50% absenteeism rate

• Prioritize food production to meet public needs

• Organize incoming supplies and distribution of finished products

The Response to Avian Flu

• This is a very current example of the need for cross-borders collaboration– Governments– Government agencies– National Business Group on Health– Regional businesses– Trade associations

Questions?