To describe the Emergency Management Plan for H1N1 Major Epidemic Event to reduce the impact of the patients in a general emergency department.

Einstein hospital has a catastrophe management program which is regularly tested for several scenarios: accidents, fire, and biological attack among others. Special concern is given for pandemics since we need to keep employees' fit to keep the hospital running as usual.

On April 24, WHO issued an alert about the rising cases of influenza virus H1N1. Immediately we provided a plan of care for suspected or confirmed cases based on WHO and CDC guidelines. On April 29 increased level of alert to Phase 5 (pandemic imminent). The crisis management group created a multidisciplinary team with actions directed to Einstein's doctors and staff, 6,000 registered professionals, engineering, emergency care, laboratory, occupational medicine, hygiene, waste disposal, among others. Communication was maintained with government to update the official guidelines. Two specific drills were performed to train staff and support teams. Debriefings were made to all participants and lessons learnt were incorporated.

Official figures showed that in São Paulo until August 2 have been reported 6,383 cases, 11.8% (756 cases) of these were reported by HIAE. From 5 May 2009 to 05 December 2009, 1,324 cases were reported. There were only four deaths of patients with influenza A H1N1 and two acquired in hospital and the daily business were not compromised by the epidemic showing the importance of a crises management plan.

The methodology of realistic simulations has showed effectiveness in the planning of how to manage Major Epidemic Events and improvement actions from this exercise has been showing best results for the patient flow and safety whenever this kind of situation happens at Hospital Albert Eisntein.