Influenza Pandemic Preparation and Response: A Citizen's Guide

Appendix E

Home-made Oral Rehydration Solution

Allow sick individuals sips of liquids every 5 minutes, day and night, until he or she begins to urinate normally.

A large person needs 3 or more liters a day. A small child usually needs at least 1 liter a day, or 1 glass for each watery stool.

Keep giving fluids often in small sips, even if the person vomits. Do not stop administering fluids until the person has been able to keep down at least a quart of fluids.

This requires caregivers to "push fluids" and be persistent with maintaining adequate hydration.

Stir the following ingredients until the salt and sugar dissolve.

You an also add 1/2 cup orange juice or some mashed banana to improve the taste and provide some potassium.

• one level teaspoon of salt
• eight level teaspoons of sugar
• one liter (just over four cups) of clean drinking or boiled water and then cooled

Hydration Maintenance Guidelines Based on Age

Infants (under 1 year of age)

• Breast milk
• Infant formula
• Store-bought oral rehydration solution (Pedialyte for example)
• Diluted fruit juice (50% water, 50% juice)
• Home-made cereal-based oral rehydration solution (see below for recipe)

Toddlers (1-3 years of age)

• Milk
• Store-bought oral rehydration solution (Pedialyte for example)
• Soup broth
• Jell-O water (1 package per quart of water, or twice as much water as usual)
• Popsicles
• Gatorade
• Kool-Aid
• Juices
• Home-made cereal-based oral rehydration solution

Children over 3, teens, and adults

• Water
• Soup broth
• Jell-O water (1 package per quart of water, or twice as much water as usual)
• Popsicles
• Gatorade
• Kool-Aid
• Juices

Home-made Cereal-based Oral Rehydration Solution Recipe

A homemade cereal-based solution can be prepared by mixing one-half cup of dry, precooked baby rice cereal with two cups of water and one-quarter teaspoon of salt.

This should produce an oral rehydration solution containing about 60 g of rice per L and 50 mEq of sodium per L. The salt must be measured carefully, using a level quarter-teaspoon.

The resulting mixture should be thick, but pourable and drinkable, and it should not taste salty.

Appendix F

Possible Roles for Community Volunteers

Area Leader Duties:

• Maintain communication with local emergency operations center
• Manage neighborhood surveillance and documentation
• Maintain command structure within volunteer group
• Establish new areas that need specific leadership, such as mental health
• Maintain contact with the media

Volunteer Coordinator Duties:

• Recruit volunteers and maintain updated contact list
• Add new volunteers to database
• Work with area leader to determine current needs of the community

Supplies Manager Duties:

• Coordinate supply pick-up in case of donations
• Help obtain food and medical supplies
• Coordinate storage of area refrigerators, generators, propane tanks
• Coordinate usage of essential pandemic supplies: temperature sensors, respirators, etc.

Medical Operations Manager Duties:

• Liaison with hospitals and care centers
• Provide care for the ill
• Set up areas for the sick with guidance from public health authorities: for example, designate and establish a house or building as an infirmary (see stage 5)
• Establish makeshift infirmaries
• Establish nursing roles using survivors and those with existing immunity
• Provide supplies such as food and medicine to those who are ill
• Establish means of transportation for the ill and the deceased

Communications Leader Duties:

• If phone system fails maintain Ham radio (ARES/RACES) www.arrl.org

Coroner Function Duties:

• Coordinate transportation of dead bodies
• Document death information: time of death, surviving family, etc.

(see stage 6)

Public Educators Duties:

• Maintain clear, consistent and up-to-date education directed toward the public
• Organize at-home school activities for area children

Mental Health Monitors Duties:

• Monitor mental health of response workers and community members
• Organize mental health treatment for those in need
• Work with public educators to inform community about maintaining mental health

Special Skills Duties:

• Include community members with skills needed for community maintenance such as mechanics, plumbers, electricians, computer technicians, etc.

• Work with volunteer coordinator and communications leader to assist community as necessary

Trained Alternates: All specified roles, particularly the area leader and volunteer coordinator, should have trained alternates ready to assume responsibilities in the event that the originally designated individual falls ill.

!!! Appendix G14

Example: Home Patient Medical Record

Patient Name: Mary Smith Date of Birth: 3-31-1951 Date symptoms first began: January 15, 2006 1-17-05 3:00 PM Initial Note

Subjective (S)19: Mary became weak and faint today after suffering from muscle aches and pains for the last couple of days.

She has trouble standing up without dizziness. She is nauseated and also complains of headache and sore throat.

She is urinating but not as much as usual. She has been trying to drink more but has been busy taking care of the sick.

She has not been getting much sleep for the last 2 weeks.

Objective (O): Vital Signs: Temp: 102 F, Pulse: 110/min and regular, Resp Rate: 22/min, BP 100/60 The skin is pale and mildly moist.

Mary looks very tired but is awake and alert. Her mouth is moist.

Assessment (A): Flu with mild dehydration and fatigue

Plan (P): Push fluids (ORS), ibuprofen 800 mg every 24 hours as needed for temp > 101 or pain. Bed rest.

Keep track of fluid intake and urine output. Take VS and check hydration, fluid input/output, and 4 times daily.

(Use anti-nausea meds if available). 1-17-05 6:30 PM

(S) Mary's sleeping on and off. She feels less faint but still dizzy.

She is peeing

(O) Temp 100 F, Pulse 90/min, BP 100/60 Fluid In: 1500 ml24 ORS, Urine Out: 250 ml

(A) Flu, improved symptoms, patient still dehydrated but hydration underway

(P) Push more fluids

Appendix H

FACT SHEET

Overview of Influenza Surveillance in the United States

The Influenza Branch at CDC collects and reports information on influenza activity in the United States each week from October through May.