Federal Guidance To Assist States In Improving State Level ...
FEDERAL GUIDANCE TO ASSIST STATES IN
IMPROVING STATE-LEVEL PANDEMIC
INFLUENZA OPERATING PLANS
Presented to the American States, Territories and District of Columbia
By
U. S. GOVERNMENT, including:
Department of Agriculture
Department of Commerce
Department of Defense
Department of Education
Department of Health and Human Services
Department of Homeland Security
Department of Interior
Department of Justice
Department of Labor
Department of State
Department of Transportation
Department of Treasury
Department of Veterans Affairs
Homeland Security Council
Office of Personnel Management
March 11, 2008
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TABLE OF CONTENTS
I.
Introduction
II.
Background
III.
Strategic Goals and Operating Objectives
IV.
Planning Fundamentals
V.
Instructions for Submitting Planning Information
VI.
Evaluation Process
VII.
Technical Assistance
VIII. Appendices – Detailed Information regarding the Strategic Goals and their associated
Operating Objectives
IX
Annex: Resource Documents
I. INTRODUCTION
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Effective State, local and community functioning during and following an influenza pandemic requires
focused planning and practicing in advance of the pandemic to ensure that States can maintain their
critical functions. The Interim Pre-pandemic Planning Guidance: Community Strategy for Pandemic
Influenza Mitigation in the United States – Early, Targeted, Layered Use of Nonpharmaceutical
Interventions (February 2007) was developed to provide guidance for pandemic planning and
response. For community mitigation strategies to be effective, State governments need to incorporate
them into their operating plans and assist local communities, businesses, non-governmental
organizations, and the public in doing the same. State governments must have robust operating plans
that have been sufficiently tested and improved by staff who understand and perform proficiently their
supporting activities. Community partners must also perform proficiently their roles and
responsibilities and understand accurately what the State government will and won’t do and how it will
communicate with both them and the public.
This document provides a strategic framework to help the 50 States, the District of Columbia (DC),
and the five U.S. Territories improve and maintain their operating plans for responding to and
sustaining functionality during an influenza pandemic. Hereinafter within this document, the terms
“States” and “State-level” refer to all 56 governmental entities.
At the heart of the strategic framework are the supporting activities that State-level operating plans
should address. Representatives of several United States Government (USG) Departments (see
Annex) developed this document with input from State representatives.
II. BACKGROUND
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During the past year, the US Department of Health and Human Services (HHS) – in collaboration with
the US Department of Homeland Security (DHS) and six other USG Cabinet-Level Departments –
assessed States’ pandemic influenza planning. This endeavor was part of the implementation of the
National Strategy for Pandemic Influenza, which the White House Homeland Security Council (HSC)
issued in May 2006 (http://www.whitehouse.gov/homeland/pandemic-influenza-implementation.html).
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This first round of assessments revealed important progress in many areas but also underscored the
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need for better guidance from the USG Departments and increased efforts by State-level agencies to
fill the many remaining gaps in preparedness.
This document provides guidance for States’ submissions of planning information for the second round
of assessments. The guidance builds on the States’ progress made since the first round of assessments
and manifests lessons learned by the USG Departments. The guidance also manifests comments and
recommendations provided by States’ representatives – primarily through their responses to the first
round of assessments or during a series of regional workshops co-hosted by HHS and DHS regional
staff during January 2008.
As did the guidance for the first round of assessments, this revised guidance focuses on operating
plans1 F – that is, plans that manifest a) clear-cut operating objectives, b) definitive implementation
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strategies, c) unequivocal specification as to which organizations or individuals are responsible for
which elements, and d) measurable performance objectives. A defining characteristic of an operating
plan is that, in whole or in part, it readily lends itself to evidence-based evaluation using the results of
discussion-based exercises, operational-based exercises, or performance measurements obtained in the
course of responses to actual incidents.
III. STRATEGIC GOALS AND OPERATING OBJECTIVES THAT MERIT INCLUSION IN
STATE-LEVEL PANDEMIC INFLUENZA OPERATING PLANS
An operating plan for combating pandemic influenza should address at least the three strategic goals
listed below. The goals provide an overarching framework for the various functions of State
government during an influenza pandemic. This framework acknowledges the fact that the State
government is simultaneously striving to continue its basic operations, respond to the influenza
pandemic, and facilitate the maintenance of critical infrastructure.
The Strategic Goals
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Strategic Goal A, “Ensure Continuity of Operations of State Agencies and Continuity of State
Government” focuses on the role of State government in as an employer (i.e., looking inward). State
governments are “large employers” and as such need to consider how they will continue to function
during the pandemic. Continuing critical services and lifelines that many State citizens rely on for
survival (e.g., Medicaid, newborn screening, safe food and unemployment insurance) is paramount. If
State governments fail to prepare themselves by developing, exercising, and improving comprehensive
operating plans, then they will fail in their abilities to meet the other two strategic goals, which focus
on external functions (i.e., responding to the event and helping to maintain critical infrastructure).
Strategic Goal B, “Protect Citizens,” reflects the role of the State government as a responder in to the
influenza pandemic. During a pandemic, the State government is conducting business as usual (and
perhaps with more intensity) with functions such as disease surveillance and is altering the way the
1 Federal Emergency Management Agency (FEMA) defines an emergency operations plan as “a document that: describes
how people and property will be protected in disaster and disaster threat situations; details who is responsible for carrying
out specific actions; identifies the personnel, equipment, facilities, supplies, and other resources available for use in the
disaster; and outlines how all actions will be coordinated. See State and Local Guide (SLG) 101: Guide for All-Hazard
Emergency Operations Planning, page 1-1. http://www.fema.gov/plan/gaheop.shtm
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State conducts its business to delay the introduction, slow the spread, or lessen the severity of
pandemic influenza (e.g., advising that sick people stay home, banning public gatherings, dismissing
students from schools).
Strategic Goal C, "Sustain/Support 17 Critical Infrastructure and Key Resource Sectors" (CIKR),
focuses on the State government's role with respect to sustaining its publicly- and privately-owned
critical infrastructure. Note that infrastructure includes not only physical plants associated with it but
also the processes, systems and information that support it.
States are responsible for developing and implementing Statewide CIKR protection programs that
reflect and align with the full range of homeland security activities presented in the National
Infrastructure Protection Plan (NIPP). The 17 CIKR sectors are: Agriculture and Food; Banking and
Finance; Chemical; Commercial Facilities; Commercial Nuclear Reactors, Materials, and Waste;
Dams; Defense Industrial Base; Drinking Water and Water Treatment; Emergency Services; Energy;
Government Facilities; Information Technology; National Monuments and Icons; Postal and Shipping;
Public Health and Healthcare; Telecommunications; and Transportation Systems.
The Operating Objectives
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Associated with each Strategic Goal are Operating Objectives (Table 1) that merit inclusion in State
pandemic influenza plans. Each operating objective has a corresponding Appendix containing (1)
helpful hints for planning or preparedness activities (which contribute to comprehensive and
exercisable operating plan development); and, (2) associated tables of supporting activities that should
be specified in State operating plans.
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Table 1. Strategic Goals and Operating Objectives
Strategic Goal
Operating Objectives
Appendix
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A. Ensure Continuity of
Sustain Operations of State Agencies & Support and Protect Government Workers A.1
5B
6B
7B
Operations of State
Ensure Public Health COOP During Each Phase of a Pandemic
A.2
Agencies & Continuity of 8B
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State Government
Ensure Continuity of Food Supply System
A.3
10B
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Ensure Ability to Respond to Agricultural Emergencies & Maintain Food Safety A.4
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Net Programs
Ensure Integration of Uniformed Military Services Needs & Assets
A.5
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Sustain Transportation Systems
A.6
15B
16B
B. Protect Citizens
Ensure Surveillance and Laboratory Capability During Each Phase of a Pandemic B.1
17B
18B
19B
Assist with Controls at U.S. Ports of Entry
B.2
20B
21B
Implement Community Mitigation Interventions
B.3
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B
23B
Enhance State Plans to Enable Community Mitigation through Student Dismissal B.4
24B
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and School Closure
Acquire & Distribute Medical Countermeasures
B.5
26B
27B
Ensure Mass Vaccination Capability During Each Phase of a Pandemic
B.6
28B
29B
Provide Healthcare
B.7
30B
31B
Manage Mass Casualties
B.8
32B
33
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Ensure Communication Capability During Each Phase of a Pandemic
B.9
34B
35B
Mitigate the Impact of an Influenza Pandemic on Workers in the State
B.10
36B
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Understand Official Communication Mechanisms for Foreign Missions,
B.11
38B
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International Organizations, and Their Members in the United States
Integrate EMS and 9-1-1 into Pandemic Preparedness
B.12
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Integrate Public Safety Answering Points into Pandemic Preparedness
B.13
42B
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Public Safety and Law Enforcement
B.15
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B
45B
C. Sustain/Support 17
Define CIKR Protection, Planning &Preparedness Roles & Responsibilities
C.1
46B
47B
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Critical Infrastructure
Build Public-Private Partnerships & Support Networks
C.2
Sectors and Key Assets
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Implement the NIPP Risk Management Framework for a Pandemic
C.3
51B
52B
Bolster CIKR Information Sharing & Protection Initiatives
C.4
53B
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Leverage Emergency Preparedness Activities for CIKR Protection, Planning &
C.5
55
B
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Preparedness
Integrate Federal & State CIKR Protection, Planning & Preparedness Activities
C.6
57B
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Allocate Scarce Resources
C.7
59B
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Again, this guidance document aims to assist States in improving their State government operating
plans – necessitating a focus on the supporting activities that should be found in an operating plan. It is
understood that preparedness and planning activities would not be included in an operating plan, and it
is understood that many response activities are not the responsibility of the State government.
However, to ignore the importance of preparedness and planning (e.g., breadth of disciplines that must
be involved, accuracy of planning principles and assumptions) would be shortsighted. Therefore, both
are included in this document.
To avoid confusion, it is important to distinguish between the tasks and capabilities that would be
found in operating plans versus the preparedness and planning advice provided in this document.
Therefore, within each operating objective, the helpful hints, planning guidance, and preparedness
activity considerations are separated from the items that would be found in an operating plan. This
was done using the widely accepted and adopted Federal Emergency Management Agency (FEMA)
framework of “Prepare, Respond, and Recover”.
Per the National Response Framework (January 2008) the following definitions apply:
“Preparedness- Actions that involve a combination of planning, resources, training, exercise
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and organizing to build, sustain, and improve operational capabilities. Preparedness is the process of
identifying the personnel, training, and equipment for delivering capabilities when needed for an
incident.”
“Response - Immediate actions to save lives, protect property and the environment, and meet
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basic human needs. Response also includes the execution of emergency plans and actions to support
short-term recovery.”
”Recovery- The development, coordination and execution of service-and site-restoration plans;
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the reconstitution of government operations and services; individual, private-sector, nongovernmental,
and public-assistance programs to provide housing and to promote restoration; long-term care and
treatment of affected persons; additional measures for social, political, environmental, economic
restoration; evaluation of the incident to identify lessons learned; post incident reporting; and
developmental initiatives to mitigate the effects of future incidents.”
Many supporting activities required to plan for, respond to, and recover from an influenza pandemic
are implemented by organizations (e.g., philanthropic organizations, community- and faith-based
organizations, local health agencies) or individuals independently of the State government. This
document provides some helpful hints and planning advice with respect to facilitating their
preparedness; however, the focus of this document is on the operations of the State government. In
some instances, the role of the State government might be facilitating communication or analyzing data
or promoting consistency in rigor of interventions across communities.
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IV. PLANNING FUNDAMENTALS
While pandemic influenza operating plans vary from other response plans in many ways, there are
many planning fundamentals that apply regardless of threat. They should be integrated into all plans
and operations – including those for an influenza pandemic. Several are described below.
Keys for successful preparation
1. UInvolve State and local Leadership.U At the federal government level, the White House
Homeland Security Council coordinates the work of the Departments, Independent Agencies,
and other White House offices. We urge you to identify a coordinator from the Governor’s
Office to coordinate your State’s integrated planning activities and include coordination with
local government pandemic planning to ensure that all communities in the State will have a
plan. In addition to consistent, strong leadership from the Governor’s Office, there should be a
senior level official designated as the pandemic influenza coordinator for the State.
2. UTreat Pandemic as an All-Sectors (Community-Wide) Issue, not just a Health Issue. The USG
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views the threat of pandemic influenza as not just a health threat but as a threat to all sectors of
our society. The USG has committed to using all instruments of national power against the
threat. We urge you to address the threat of pandemic with all instruments of State power.
This guidance document reinforces this message by identifying State entities that should be
involved in specific areas of planning.
3. Collaborate with neighbor
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ing and distant States. Prom
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ising practices abound. We urge you to
connect with planners in neighboring and distant States to share promising practices and
lessons learned.
4. Collaborate across so
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ciety at the State level.U Local governments, faith- and community-based
organizations, philanthropic organizations, and the business community are critical partners for
State government. We urge you to engage with them early and often as you develop and refine
your plans.
5. Collabora
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te with regional Principal Federal Officials.U To coordinate the USG’s responses to
pandemic influenza, the Department of Homeland Security has divided the nation into 5
regions and designated a Principal Federal Official (PFO) for each region. The Department of
Health and Human Services has enlarged the expertise available to the PFOs by designating 5
corresponding medical professionals, called Senior Federal Officials for Health (SFOs). You
should make contact now and ensure that you understand the channels of communication and
the roles of the federal officials. Please note that these officials are listed in the Annex.
Citizen Preparedness
As individual citizens plan and prepare, it is important to think about the challenges that they might
face, particularly if a pandemic is severe. States can work with local health departments and
emergency services agencies across the State to bolster citizen preparedness and community resiliency.
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Below are a few links to websites that identify some guidance to the challenges that could be caused by
a severe pandemic and possible ways to address them. A checklist and fill-in sheets for family health
information and emergency contact information have been prepared to help guide individuals planning
and preparation. More information might be obtained at
http://www.pandemicflu.gov/plan/individual/index.html, citizencorps.com and www.ready.gov.
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State-to-State Support
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The Emergency Management Assistance Compact (EMAC), established in 1996, has weathered the
storms of repeated testing in real-world emergencies and stands today as the cornerstone of mutual aid.
The EMAC mutual aid agreement and partnership between member States exist because from
hurricanes to earthquakes, from wildfires to toxic waste spills, and from terrorist attacks to biological
and chemical incidents, all States share a common enemy: the threat of disaster. To learn more about
the EMAC see http://www.emacweb.org/.
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National Response Framework (NRF)
The National Response Framework presents the guiding principles that enable all response partners to
prepare for and provide a unified national response to disasters and emergencies – from the smallest
incident to the largest catastrophe. The Framework establishes a comprehensive, national, all-hazards
approach to domestic incident response. More information is available at
http://www.fema.gov/emergency/nrf/.
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National Incident Management System (NIMS)
While most emergency situations are handled locally, when there's a major incident help may be
needed from other jurisdictions, the State and the Federal Governments. NIMS was developed so
responders from myriad jurisdictions and disciplines can work together better to respond to natural
disasters and emergencies, including acts of terrorism. NIMS benefits include a unified approach to
incident management; standard command and management structures; and emphasis on preparedness,
mutual aid and resource management.
State-Local Emergency Management
States need to develop a plan for maintaining essential emergency functions and services during an
influenza pandemic. To do so, State Emergency Management Operations should conduct a
comprehensive assessment of the State’s current capability. The assessment should reflect what the
State will do to protect itself from its unique hazard with the unique resources it has or can obtain
while maintaining essential emergency management functions during an influenza pandemic.
The Emergency Support Functions associated with the National Response Framework provide the
structure for coordinating Federal interagency support for a Federal response to an incident. They are
mechanisms for grouping functions most frequently used to provide Federal support to States and
Federal-to-Federal support, both for declared disasters and emergencies under the Stafford Act and for
non-Stafford Act incidents. http://www.fema.gov/pdf/emergency/nrf/nrf-esf-intro.pdf
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Emergency Support Function (ESF) Annexes
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ESF #1 – Transportation
ESF #2 – Communications
ESF #3 – Public Works and Engineering
ESF #4 – Firefighting
ESF #5 – Emergency Management
ESF #6 – Mass Care, Emergency Assistance, Housing, and Human Services
ESF #7 – Resource Support
ESF #8 – Public Health and Medical Services
ESF #9 – Search and Rescue
ESF #10 – Oil and Hazardous Materials
ESF #11 – Agriculture and Natural Resources
ESF #12 – Energy
ESF #13 – Public Safety and Security
ESF # 14 – Long-Term Community Recovery
ESF # 15 – External Affairs
Other Locally defined ESFs
States must consider the inherent interagency nature of emergency management operations and it’s
reliance on voluntary organizations and how that might be affected by a pandemic. States should also
identify best practices for social distancing, alternative work arrangement and a modified COOP to
ensure essential emergency management capabilities are maintained.
Information or guidance on the Federal Government’s Pandemic Influenza COOP plan can be found at
http://www.fema.gov/government/coop/index.shtm .
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At-Risk Populations2
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Communities are best-positioned to address the special needs of at-risk populations during an influenza
pandemic. For all practical purposes, State agencies will be limited to promoting such community-
level preparedness and facilitating and coordinating as resources allow. This section is included to
help States plan for their largely indirect but nevertheless important role.
At-risk individuals, along with their needs and concerns, must be addressed in all Federal, State,
Tribal, Territorial, and local emergency plans, and thus need to be addressed in State pandemic plans.
HHS has developed a working definition of “at-risk individuals” that is function-based and designed to
be harmonious with the NRF definition of “special needs.” The HHS working definition is:
“Before, during, and after an incident, members of at-risk populations might have additional
needs in one or more of the following functional areas:
• maintaining independence,
• communication,
• transportation,
• supervision, and
• medical care.
2 Sometimes referred to as special needs individuals or vulnerable populations.
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In addition to those individuals specifically recognized as at-risk in the Pandemic and All
Hazards Preparedness Act (i.e., children, senior citizens, and pregnant women), individuals who
might need additional response assistance should include those who have disabilities; live in
institutionalized settings; are from diverse cultures; have limited English proficiency or are non-
English speaking; are transportation disadvantaged; have chronic medical disorders; and have
pharmacological dependency.”
This approach to defining at-risk individuals establishes a flexible framework that addresses a broad
set of common function-based needs irrespective of specific diagnoses, statuses, or labels (e.g.,
children, the elderly, transportation disadvantaged). These functional needs of at-risk individuals are
ones that may exist across segments of the population.
In simple terms, at-risk individuals are those who, in addition to their medical needs, have other needs
that may interfere with their ability to access or receive medical care. Although children, pregnant
women, and the elderly were the populations cited as most vulnerable in the influenza epidemics of the
20th century, many others among those listed above would be adversely affected when another
pandemic occurs – despite modern science and medical capabilities. For example:
An individual with HIV/AIDS who does not speak English and who contracts influenza could
easily find herself in a precarious situation. In addition to treatment for influenza, her
functional needs would be medical care (for the HIV/AIDS) and communication (her lack of
English may keep her from hearing about where and how to access services). Without
addressing those functional needs, she cannot obtain healthcare services.
The health status of an individual receiving home dialysis treatment that relies on a local Para-
transit system to attend medical appointments and food shopping could quickly become critical
if 40% of the drivers are ill and transportation is suspended. In addition to treatment for
influenza, his functional needs would be medical care (for dialysis) and transportation.
Without addressing those functional needs, he cannot obtain healthcare services.
An individual with a progressive chronic illness living alone on a limited income in the
community with the help of a part-time care giver may become fearful and agitated during a
pandemic event and be unable to access additional care. In addition to treatment for influenza,
her functional need would be maintaining independence (to help address the impact of the
condition) and possibly supervision (if she is not able to live alone safely). Without addressing
those functional needs, she cannot obtain healthcare services.
Models currently being used to facilitate planning for at-risk individuals emphasize 1) locating
individuals in the community who may have additional needs such as the home bound, homeless and
disabled 2) establishing good relationships with community service providers and advocates to develop
planning response and recovery actions that are realistic - sometimes through a coalition of providers
and social organizations, and 3) using a trusted source in the community such as a community leader or
organization to ensure that messages about influenza reach at-risk populations. These three elements
account for the critical at-risk planning issues of outreach and communication and the delivery of
public health and medical and human services during a pandemic. Recommended resources and
models are provided in the Annex..
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Legal Authorities
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Legal preparedness is crucially important to successful implementation of States’ operational plans for
responding to, and sustaining functionality during, an influenza pandemic. A definition for public
health legal preparedness is provided here. However, all agencies should review, understand, and
follow or seek changes to existing legal authorities.
Public health legal preparedness is defined as “the attainment by a public health system of specified
legal benchmarks or standards essential to preparedness of the public health system.” Legal
preparedness has four core elements:
• Laws and legal authorities,
• Competency in applying those laws,
• Coordination across jurisdictions and sectors in implementing laws, and
• Information about public health law best practices.
Operational plans should cite the applicable State laws that authorize and regulate components
consistent with protection of civil liberties and other due process requirements of their pandemic plans
such as:
• employee ability to report to work/use of sick leave,
• isolation and quarantine,
• restriction of traveler movement,
• closure of public venues,
• suspension of public gatherings,
• curfews ,
• related social distancing,
• school closing/school dismissal,
• advice to close childcare facilities
• dispensation of antiviral drugs (e.g., laws authorizing State/local health agencies to mass
dispense prescription drugs; laws specifying the professionals that may mass dispense
prescription drugs), and,
• administration of mass vaccination without the completion of standard medical examinations.
For example, as part of the preparedness activities outlined in Appendix B.10 (Mitigate the impact of
an influenza pandemic on workers in the State), States will assess which State benefits and other
assistance programs can help workers during a pandemic and whether new resources, laws or
programs may be needed. In this assessment of State programs or services, particularly the triggers for
eligibility, States will need to consider if legal/statutory flexibilities may be needed because of the
unique circumstances of a pandemic. Examples of such statutes include State workers’ compensation
laws and State family and medical leave laws.
Additionally, as part of an operational plan, the agencies and specific officials authorized to implement
these laws should be included as well as the status of liability protection for participating officials.
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Pandemic Severity Index
The Interim Pre-pandemic Planning Guidance: Community Strategy for Pandemic Influenza
Mitigation in the United States (February 2007) features the Pandemic Severity Index (Figure 1) which
uses case fatality ratios as critical drivers for categorizing the severity of a pandemic. Interventions
will be recommended based on the severity of pandemic, including: isolation and treatment of ill
persons with antiviral drugs; voluntary home quarantine of members of households containing
confirmed or probable cases; dismissal of students from school; closure of childcare facilities, and use
of social distancing measures to reduce contacts between adults in the community and workplace.
State pandemic plans should take into account implementation of these mitigation strategies and their
possible secondary effects.
Figure 1. Pandemic Severity Index
Pandemic Intervals, Triggers and Actions
In November 2005, the President of the United States released the National Strategy for Pandemic
Influenza, followed by the Implementation Plan in May 2006. These documents introduced the
concept of “stages” for Federal Government response3 . The six USG stages have provided greater
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specificity for U.S. preparedness and response efforts than the pandemic phases outlined in the World
Health Organization (WHO) global pandemic plan.4 The stages have facilitated initial planning efforts
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by identifying objectives, actions, policy decisions, and messaging considerations for each stage.
While the stages have provided a high-level overview of the Federal Government approach to a
pandemic response, more detailed planning for Federal, State, and local responses requires a greater
level of specificity than is afforded with the current USG stages.
The Pandemic In
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tervals
The incorporation of known principles regarding epidemic influenza transmission, along with the
adoption of well-defined triggers for action, will enhance the development of more detailed plans and
3 Pandemicflu.gov – Federal Planning & Response Activities. Available at
http://www.pandemicflu.gov/plan/federal/index.html#national.
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4 WHO global influenza preparedness plan: The role of WHO and recommendations for national measures before and
during pandemics. Available at hHUttp://www.who.int/csr/resources/publications/influenza/GIP_2005_5Eweb.pdfU
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guidance. Moreover, these refinements will facilitate better coordinated and timelier containment and
mitigation strategies at all levels, while acknowledging the heterogeneity of conditions affecting
different U.S. communities during the progression of a pandemic.
Typically, epidemic curves are used to monitor an outbreak as it is occurring or to describe the
outbreak retrospectively. While epidemic curves are useful during an outbreak or retrospectively for
noting the possible effects of interventions (graphically showing when they are or were implemented
relative to the rise and fall of the epidemic), model epidemic or pandemic curves can also be used to
describe likely events over time. These hypothetical models may be particularly valuable
prospectively for anticipating conditions and identifying the key actions that could be taken at certain
points in time to alter the epidemic or pandemic curve. Classic epidemic curves have been described
in the literature as having a: growth phase, hyperendemic phase, decline, endemic or equilibrium
phase, and potentially an elimination phase.56
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For the purposes of pandemic preparedness, the Federal Government will use intervals representing the
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sequential units of time that occur along a hypothetical pandemic curve F .. For state planning, using
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the intervals to describe the progression of the pandemic within communities in a state helps to provide
a more granular framework for defining when to respond with various interventions during U.S.
Government stages 4, 5 and 6. (Figure 2) These intervals could happen in any community from the
time sustained and efficient transmission is confirmed.
While it is difficult to forecast the duration of a pandemic, we expect there will be definable periods
between when the pandemic begins, when transmission is established and peaks, when resolution is
achieved, and when subsequent waves begin. While there will be one epidemic curve for the United
States, the larger curve is made up of many smaller curves that occur on a community by community
basis. Therefore, the intervals serve as additional points of reference within the phases and stages to
provide a common orientation and better epidemiologic understanding of what is taking place. State
health authorities may elect to implement interventions asynchronously within their states by focusing
early efforts on communities that are first affected. The intervals thus can assist in identifying when to
intervene in these affected communities. The intervals are also a valuable means for communicating
the status of the pandemic by quantifying different levels of disease, and linking that status with
triggers for interventions.
5 Liang W, Zhu Z, Guo J, et al. Severe acute respiratory syndrome, Beijing, 2003. Emerg Infect Dis (2004); 10(1): 25-31.
http://www.cdc.gov/ncidod/EiD/vol10no1/pdfs/03-0553.pdf
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6 Wasserheit JN, Aral SO. The dynamic typology of sexually transmitted disease epidemics: Implications for prevention
strategies. J Infect Dis (1996); 174 (suppl 2): S201-13.
7 Pandemic curves can be drawn to represent many different outbreaks—an epidemic curve for the world is distributed over
a long period of time and around the globe and might be correlated to the WHO phases. A pandemic curve for the U.S. is
likely shorter and references only the geographic bounds of the United States, and can be correlated with the U.S.
government planning stages. A pandemic curve for a state or community is likely shorter still and references only the
geographic bounds of the state or community. In this document, we apply these intervals to State and community planning
during U.S. government stages 4, 5 and 6. (Of course these intervals have utility for national and international efforts as
well.)
8 Because we recognize that the pandemic may begin, or first be detected, in the United States or elsewhere in North
America, the intervals do not distinguish between the occurrence of pre-pandemic or pandemic cases overseas versus the
occurrence of cases domestically. Therefore, this framework can be applied in community, state, national, or international
settings.
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The intervals are designed to inform and complement the use of the Pandemic Severity Index (PSI) for
choosing appropriate community mitigation strategies.9 F The PSI guides the range of interventions to
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consider and/or implement given the epidemiological characteristics of the pandemic. The intervals
are more closely aligned with triggers to indicate when to act, while the PSI is used to indicate how to
act.
9 CDC. Interim Pre-Pandemic Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United
States – Early, Targeted, Layered Use of Nonpharmaceutical Interventions. February 2007. Available at
http://www.pandemicflu.gov/plan/community/commitigation.html
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Figure 2: Periods, Phases, Stages, and Intervals
Inter
Pandemic Alert Period
Pandemic Period
WHO Phase
1
2
3
4
5
6
New Domestic
Confirmed
First
Suspected
Widespread
Animal
Human
Human
Human Outbreak
Outbreaks
Spread Throughout United States
Recovery
Outbreak in At-
Outbreak
Case in
Overseas
Overseas
Risk Country
Overseas
N.A.
USG Stage
0
1
2
3
4
5
6
For planning, intervals provide additional specificity
for implementing state and community level interventions
during stages 4, 5 and 6.
Investigation
Recognition
Initiation Accel
Peak
Decel
Resolution
CDC Intervals
Pre- Pandemic Intervals
Pandemic Intervals
•
Peak Transmission
•
Investigation
•
Initiation
•
Deceleration
•
Recognition
•
Acceleration
•
Resolution
Definitions of the Different Pandemic Intervals
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For each interval shown in Figure A, a definition of the interval is provided below for communities,
states and for the nation.
For states that are “affected” (i.e., they have met the definition for the interval), selected actions to
initiate during the interval are provided. For states that are “unaffected” (i.e., they have not met the
definition for the interval at a time when other states have met the definition), selected actions and
preparations are provided. Questions regarding the use of these intervals can be obtained at
intervals@cdc.gov
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“Investigation” Interval – Investigation of Novel Influenza Cases: This pre-pandemic interval
represents the time period when sporadic cases of novel influenza may be occurring overseas or within
the United States. During this interval, public health authorities will use routine surveillance and
epidemiologic investigations to identify human cases of novel influenza and assess the potential for the
strain to cause significant disease in humans. Investigations of animal outbreaks also will be
conducted to determine any human health implications. During this interval, pandemic preparedness
efforts should be developed and strengthened. Case-based control measures (i.e., antiviral treatment
and isolation of cases and antiviral prophylaxis of contacts) are the primary public health strategy for
responding to cases of novel influenza infection. The national case definition for novel influenza is
located at http://www.cdc.gov/ncphi/disss/nnd
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Affected State – A state where a sporadic case of novel influenza is detected.
• Voluntarily isolate and treat human cases
• Voluntarily quarantine if human-to-human transmission is suspected, monitor, and provide
chemoprophylaxis to contacts
• Assess case contacts to determine human to human transmission and risk factors for infection
• Share information with animal and human health officials and other stakeholders, including
reporting of cases according to the Nationally Notifiable Diseases Surveillance System and
sharing virus samples
• Disseminate risk communication messages
Unaffected State – A state not currently investigating novel influenza cases.
• Continue to maintain state surveillance
• Continue to build state and local countermeasures stockpile
• Continue to develop and promote community mitigation preparedness activities, including plans
and exercises
• Continue refining and testing healthcare surge plans
“Recognition” Interval – Recognition of Efficient and Sustained Transmission: This interval occurs
when clusters of cases of novel influenza virus in humans are identified and there is confirmation of
sustained and efficient human-to-human transmission indicating that a pandemic strain has emerged
overseas or within the United States. During the recognition interval, public health officials in the
affected country and community will attempt to contain the outbreak and limit the potential for further
spread in the original community. Case-based control measures, including isolation and treatment of
cases and voluntary quarantine of contacts, will be the primary public health strategy to contain the
spread of infection; however, addition of rapid implementation of community-wide antiviral
prophylaxis may be attempted to fully contain an emerging pandemic.
Affected State – A state where human to human transmission of a novel influenza virus infection is
occurring and where the transmission of the virus has an efficiency and sustainability that indicates it
has potential to cause a pandemic. This represents the detection of a potential pandemic in the U.S.
before recognition elsewhere in the world.
• Continue/initiate actions as above (Investigation)
• Implement case-based investigation and containment
• Implement voluntary contact quarantine and chemoprophylaxis
• Confirm all suspect cases at public health laboratory
• Consider rapid containment of emerging pandemic influenza
• Report cases according to Nationally Notifiable Diseases Surveillance System
• Conduct enhanced pandemic surveillance
• Prepare to receive SNS countermeasures
• Disseminate risk communication messages, including when to seek care and how to care for ill
at home
• Implement appropriate screening of travelers and other border health strategies, as directed by
CDC
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Unaffected State – A state not meeting the criteria above. This may represent either that recognition of
a potential pandemic is occurring in another state, or is occurring outside the United States.
• Continue/initiate actions as above (Investigation)
• Prepare for investigation and response
• Conduct enhanced pandemic surveillance
• Prepare to receive SNS countermeasures
• Disseminate risk communication messages
• Implement appropriate screening of travelers and other border health strategies, as directed by
CDC
“Initiation” Interval – Initiation of the Pandemic Wave: This interval begins with the identification
and laboratory-confirmation of the first human case due to pandemic influenza virus in the United
States. If the United States is the first country to recognize the emerging pandemic strain, then the
“Recognition” and “Initiation” intervals are the same for affected states. As this interval progresses,
continued implementation of case-based control measures (i.e., isolation and treatment of cases,
voluntary prophylaxis and quarantine of contacts) will be important, along with enhanced surveillance
for detecting potential pandemic cases to determine when community mitigation interventions will be
implemented.
Affected State – A state with at least one laboratory-confirmed pandemic case.
• Continue/initiate actions as above (Recognition)
• Declare Community Mitigation Standby if PSI Category 1 to 3, declare Alert if PSI Category is
4 or 5
• Continue enhanced state and local surveillance
• Implement (pre-pandemic) vaccination campaigns if (pre-pandemic) vaccine is available
• Offer mental health services to health care workers.
Unaffected States – A state with no laboratory-confirmed pandemic cases.
• Continue/initiate actions as above (Recognition)
• Declare Community Mitigation Standby if PSI Category 4 or 5
• Prepare for investigation and response
• Prepare for healthcare surge
• Review and prepare to deploy mortuary surge plan
• Deploy state/local caches
• Prepare to transition into emergency operations
“Acceleration” Interval – Acceleration of the Pandemic Wave: This interval begins in a State when
public health officials have identified that containment efforts have not succeeded, onward
transmission is occurring, or there are two or more laboratory-confirmed cases in the State that are not
epidemiologically linked to any previous case. It will be important to rapidly initiate community
mitigation activities such as school dismissal and childcare closures, social distancing, and the efficient
management of public health resources.10 F Isolation and treatment of cases along with voluntary
F
10 CDC. Interim Pre-Pandemic Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United
States – Early, Targeted, Layered Use of Nonpharmaceutical Interventions. February 2007. Available at
http://www.pandemicflu.gov/plan/community/commitigation.html
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quarantine of contacts should continue as a key mitigation measure. Historical analyses and
mathematical modeling indicate that early institution of combined, concurrent community mitigation
measures may maximize reduction of disease transmission (and subsequent mortality) in the affected
11 12 13 14
areas.F FF FF FF
Affected State – A state that has two or more laboratory-confirmed pandemic cases in a state that are
not epidemiologically linked to any previous case; or, has increasing numbers of cases that exceed
resources to provide case-based control measures
• Continue/initiate actions as above (Initiation)
• Activate community mitigation interventions for affected communities
• Transition from case-based containment/contact chemoprophylaxis to community interventions
• Transition surveillance from individual case confirmation to mortality and syndromic disease
monitoring
• Begin pre-shift healthcare worker physical and mental health wellness screening
• Implement vaccination campaigns if (pre-pandemic) vaccine is available
• Monitor vaccination coverage levels, antiviral use, and adverse events
• Monitor effectiveness of community mitigation activities
Unaffected State – A state that has not met the criteria above.
• Continue/initiate actions as above (Initiation)
• Prepare for investigation and response
• Prepare for healthcare surge
• Review and prepare to deploy mortuary surge plan
• Deploy state/local caches
• Prepare to transition into emergency operations
• Implement vaccination campaigns if (pre-pandemic) vaccine is available
• Monitor vaccination coverage levels, antiviral use, and adverse events
“Peak/Established Transmission” Interval – Transmission is Established and Peak of the Pandemic
Wave: This interval encompasses the time period when there is extensive transmission in the
community and the state has reached it’s greatest number of newly identified cases. The ability to
provide treatment when the healthcare system is overburdened will be particularly challenging. To
reduce the societal effects of the pandemic, available resources must be optimized to maintain the
critical infrastructure and key resources in the face of widespread disease.
Affected State – A state in which 1) >10% of specimens from patients with influenza-like illness
submitted to the state public health laboratory are positive for the pandemic strain during a seven day
11 Hatchett RJ, Mecher CE, Lipsitch M. Public health interventions and epidemic intensity during the 1918 influenza
pandemic. Proceedings of National Academy of Sciences of USA, (2007); 104 (18): 7583-7587.
12 Markel H, Lipman HB, Navarro JA, et al. Nonpharmaceutical Interventions Implemented by US Cities During the 1918-
1919 Influenza Pandemic. JAMA (2007);298 (6): 644-654.
13 Ferguson NM, Cummings DA, Fraser C, et al. Strategies for mitigating an influenza pandemic Nature (2006); 442:7:
448-452.
14 Bootsma MC, Ferguson NM. The effect of public health measures on the 1918 influenza pandemic in U.S. cities.
Proceedings of National Academy of Sciences of USA, (2007);104 (18): 7588-7593.
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period, or, 2) “regional” pandemic influenza activity is reported by the State Epidemiologist using
CDC-defined criteria, or, 3) the healthcare system surge capacity has been exceeded.
• Continue/initiate actions as above (Acceleration)
• Manage health care surge
• Maintain critical infrastructure and key resources
• Laboratory confirmation of only a sample of cases as required for virologic surveillance
• Implement surveillance primarily for mortality and syndromic disease
Unaffected States – As transmission increases in the U.S., states are likely to be in different intervals.
Thus, states should anticipate the actions needed for subsequent intervals and plan accordingly.
“Deceleration” Interval – Deceleration of the Pandemic Wave: During this interval, it is evident that
the rates of pandemic infection are declining. The decline provides an opportunity to begin planning
for appropriate suspension of community mitigation activities and recovery. State health officials may
choose to rescind community mitigation intervention measures in selected regions within their
jurisdiction, as appropriate; however mathematical models suggest that cessation of community
mitigation measures are most effective when new cases are not occurring or occur very infrequently.15
F
F
[10]
Affected State – A state where <10% of specimens from patients with influenza-like illness submitted
to the state public health laboratory are positive for the pandemic strain for at least two consecutive
weeks, or, the healthcare system capacity is below surge capacity.
• Continue/initiate actions as above (Peak/Established Transmission)
• Assess, plan for, and implement targeted cessation of community mitigation measures if
appropriate
• Transition surveillance from syndromic to case-based monitoring and confirmation
• Initiate targeted cessation of surge capacity strategies
• Maintain aggressive infection control measures in the community
“Resolution” Interval – Resolution of the Pandemic Wave: In this interval, pandemic cases are
occurring only sporadically. The primary actions to be taken during this interval include discontinuing
all community mitigation interventions, facilitating the recovery of the public health and healthcare
infrastructure, resuming enhanced surveillance protocols to detect possible subsequent waves, and
preparing for next waves of infection should they occur.
Affected State – A state where active virologic surveillance detects pandemic cases occurring
sporadically.
• Continue/initiate actions as above (Deceleration)
• Rescind community mitigation interventions
• Continue case confirmation of selected cases to verify resolution of pandemic wave
• Resume enhanced virologic surveillance to detect emergence of increased transmission.
• Prepare for possible second wave
• Continue to promote community mitigation preparedness activities on standby for second wave
• Conduct after-action review for lessons learned
• Replenish stockpiles/caches as able
15 Davey VJ, Glass RJ. Rescinding Community Mitigation Strategies in an Influenza Pandemic. Emerging Infectious
Diseases, (2008);14 (3): 365-372. Available at: http://www.cdc.gov/eid/content/14/3/365.htm?s_cid=eid365_e#cit
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V. INSTRUCTIONS FOR SUBMITING PLANNING INFORMATION
Format
98B
Inform
99
B
ation regarding the State’s / District’s / Territory’s planning for countering pandemic influenza
should be presented in accord with the following 5-part outline:
1. 100BCover Page
2. 0B11Table of Contents
3. 102BContributing Agencies
4. Generic Planning Principles and Assumptions
5. Information Specific to Each Operating Objective
See the Appendices for additional instructions regarding the information requested for each Operating
Objective.
103B
Information to be included under each of the five headings identified in the aforementioned
outline
111
BU
Cover Page
• Name of State / District of Columbia / Territory
• Name and title of the official submitting the report
• Date of submission
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2BU
Table of Contents
• Starting pages of each of the 5 headings and the major sections under headings 3-5,
respectively
• Full title of each plan, if any, that is referenced and included as part of the response to item 5
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3BU
Contributing Agencies
Please provide a table identifying each contributing agency and, for each, the printed name and
signature of the individual responsible for its contribution.
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4BU
Generic Planning Principles and Assumptions
• Please describe briefly the overarching principles and assumptions that guide the State’s /
District’s / Territory’s planning to counter pandemic influenza. Note the adjective “generic”,
and be aware that the Appendices request descriptions of planning principles and assumptions
specific to the Operating Objectives.
• Please describe briefly how pandemic preparedness plans are documented. That is, do they
exist as a freestanding Pandemic Influenza Plan? Or are they included in one or more broader
ranging plans such as an All-Hazards Emergency Response Plan or a Continuity-of-Operations
Plan? List the full title of each State plan, if any, that is referenced and included as part of the
response to item 5.
• With respect to the National Incident Management System, please provide the following
information:
o Name and contact information for lead individual for State.
o Plan for conformance with all NRF/NIMS principles and guidelines; and,
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o Plan for relating to the Joint Field Office Principal Federal Official during a pandemic.
Inform
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5BU
ation Specific to Each Operating Objective
• Note that each Operating Objective listed in Table B has a corresponding Sub-Appendix, which
provides guidance for States’ consideration in planning and lists in tabular form the Supporting
Activities for which planning information is requested. Thus, the USG Departments are
seeking planning and operating information only for the Supporting Activities cited in the
tables. The rest of the material in the Appendices and Sub-Appendices is intended only to
facilitate planning and does not require a response.
• Note also that the tables in the Sub-Appendices correspond to the format of the worksheets that
reviewers will use. The intent is to enable responders to know precisely what is to be
evaluated.
104B
Organization of the information submitted
The submission may take either of two forms:
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6BU
Option 1
• A WORD document that presents the information requested for Items 1-4;
• A set of EXCEL spreadsheets (templates forthcoming) providing citations to a WORD
document that contains all of the information requested for the Operating Objectives; AND
• The WORD document that contains all of the information cited in the EXCEL spreadsheets.
OR
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7BU
Option 2
• A WORD document that presents the information requested for Items 1-4;
• A set of EXCEL spreadsheets (templates forthcoming) providing citations to the documents
that contain the information requested for the Operating Objectives;
• A copy of each freestanding plan that is cited in the spreadsheets – for example, a Pandemic
Influenza Plan, an All-Hazards Emergency Response Plan, or a Continuity of Operations Plan;
AND
• A WORD document that presents any information that is cited in the spreadsheets but not
contained in any freestanding plan such as those mentioned above.
For Option 2, the copy of each freestanding plan cited in the EXCEL spreadsheets should be provided
in PDF format.
For both Options 1 and 2, the several computer-manipulable files (WORD only or WORD plus PDF)
must be submitted on compact disc (CD ROM) because the volume might be too large to be
accommodated by conventional e-mail systems.
NOTE: HHS WILL PROVIDE AN SET OF EXCEL SPREADSHEETS ESPECIALLY
DESIGNED TO FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN
THIS DOCUMENT. These templates will be available soon on HUwww.pandemicflu.gov.
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In the interim, State officials may wish to use the tables included in the Sub-Appendices as worksheets
in preparation for submitting documentation in Excel spreadsheets. The Excel spreadsheets will mimic
the format of the Word tables included herein.
Due date, number of copies and address for submissions
105B
Submissions are due on June 16, 2008.
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Please submit three copies (3) of the CD ROM containing the requested information.
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Please send the material to US Department of Health and Human Services, ATTN: Shelia Jones,
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Hubert H. Humphrey Building, Room 638G, 200 Independence Avenue SW, Washington DC, 20201U
by a private package delivery service (DHL, FEDEX, or UPS).
NOTE: Do not use US Mail. The irradiation applied to US Mail received by the Federal
Government might damage CD ROMs.
VI. EVALUATION PROCESS AND SCORING
62B
Evaluation Process
The participating USG Departments will follow a five-step process as follows:
1. Subject matter experts within the participating USG Departments will review those portions of
the submissions that fall within their respective mission areas.
2. Reviewers will assess the information provided for each Operating Objective in accord with the
scoring schema described below.
3. HHS will compile the preliminary results of the reviews into State-specific reports; provide
them to the States, District, and Territories individually and privately in the form of “Draft
Concluding Assessments”; and solicit comments related to any apparent procedural
irregularities or factual errors. The adjective “concluding” signifies that this is the second
phase of a two-phase assessment process – the first phase having resulted in the “Interim”
Assessments” that the States, District, and Territories received in Fall 2007/Winter 2008.
4. Once in receipt of the States’ / District’s / Territories’ comments, HHS will share them with the
appropriate USG Department(s) for their consideration in concluding their respective reviews.
5. HHS will compile the review results in the form of State-specific “Concluding Assessments”
and share them first with the States individually and then with the Congress and the general
public.
Scoring for Comprehensiveness
The information provided for the Operating Objectives will be rated for comprehensiveness. That is,
reviewers will consider the information submitted for each associated Supporting Activity and assess
the degree to which the response describes a) a definitive implementation strategy and b) unequivocal
specification as to which organizations or individuals are responsible for which elements.
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Before commencing to rate, reviewers may modify the list of Supporting Activities in one or both of
two ways. First, they will not assign a rating to a particular Supporting Activity if the State has
indicated that the item is “not applicable” and offered a convincing justification. Second, they will add
and rate a new Supporting Activity as proposed by the State if they judge the proposed addition to be
relevant to the Operating Objective and of comparable significance to the Supporting Activities
already listed.
The scoring schema to be used for each Operating Objective is as follows. For each supporting
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activity, the review team will award a score of 0, 1, 2, or 3. A percentage for the Operating Objectives
will be calculated by summing the scores of the supporting activities under that Operating Objective
and dividing by the total number possible (number of supporting activities X 3).
Example:
Operating O
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bjective X.1
Supporting activity - 3/3
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Key:
Supporting
activity
-
2/3
≥85% = “No Major Gaps”
Supporting activity - 2/3
69-84% = “A Few Major Gaps”
Supporting activity - 3/3
50-68% = “Many Major Gaps”
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Supporting activity - 2/3
1-49% = “Inadequate Preparedness”
12/15 = 80%
The percentage derived for the Operating Objective will be translated into a standardized verbal
designation in accord with the key shown in the text box. No submission or a non-responsive
submission will be classified as “insufficient information to allow assessment.”
Using the example provided, the Score for Operating Objective X.1 would be “A Few Major Gaps.”
Scoring for Operational Readiness
The USG Departments jointly will assign a single rating for Operational Readiness for the entire State
submission. In particular, based on the information requested in the last sub-Appendix for each of the
3 Strategic Goals, the Departments will determine the number of the Operating Objectives for which
the State submitted evidence that it has tested its response capability in some appropriate way.
This number then will be divided by the total number of Operating Objectives, expressed as a
percentage, and translated into a standardized verbal designation in accord with the key shown in the
text box.
Key
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>
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50% = “Substantial Evidence of Operational Readiness”
25-49% = “Significant Evidence of Operational Readiness”
1-24% = “Little Evidence of Operational Readiness”
No submission or a non-responsive submission will be classified as “insufficient information to enable
assessment.”
______________________________________________________________________________
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VII. TECHNICAL ASSISTANCE
In January 2008, the USG held a series of regional workshops to obtain States’ preferences regarding
technical assistance mechanisms. Preferences ranged from “to pick up the phone and ask a “Fed” a
specific question” to hoping for on-site assistance with drafting operating plans to wanting national
conference calls on complicated aspects of pandemic influenza response that involve State and federal
coordination. In response to States’ requests, the USG is offering a variety of technical assistance
mechanisms. Some are in the form of documents – which are provided in citations or accompany this
document. Others are under development (e.g., webcasts) and should be forthcoming soon. Some
hands-on, individualized technical assistance is also available to State planners, and instructions for
tapping into it are included in this document. Keep in mind that the technical assistance mechanisms
span the spectrum of pandemic influenza related concerns – not only the personal health impact of the
threat. This might include preparing businesses to operate in the face of community mitigation
strategies, maintaining transportation response capabilities during hurricane season, coping with
mental health impact of mass fatalities, or protecting the energy infrastructure.
Operating Plan Assistance
States that do not have staff that are very familiar and are experienced in drafting, testing and
improving plans based on continuous quality improvement mechanisms. But in some jurisdictions
these assets remain marginalized or disconnected from efforts to improve planning and practicing for
an influenza pandemic and other threats. States are strongly urged to utilize existing State and local
resources for assistance. Many State militia and National Guard staff have extensive training and
experience in writing operating plans. Since these individuals are part of the State government
planning community, they will have detailed knowledge of and thorough understanding about the
infrastructure and systems context surrounding the State- and region-specific needs, assets, and gaps.
States might also utilize USG (e.g., DOD, DHS) regional staff for support and guidance. Because of
their distribution across the country, these staff may be better able than their headquarters counterparts
to provide on-site technical assistance or provide region-specific context or advice. Many regional
staff have expertise in writing operating plans and are able to provide: (1) models or templates of
operating plans, and (2) approaches for States to consider for improving their operating plans. Federal
assets available to provide guidance and answer questions regarding State planning issues include the
HHS regional health offices (http://www.hhs.gov/about/regionmap.html), FEMA regional offices
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(http://www.fema.gov/about/regions/index.shtm), and the pre-designated pandemic influenza regional
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Principal Federal Officials.
Another regional asset that can be utilized to assist State and local CI/KR security efforts are the DHS
Protective Security Advisors (PSAs). PSAs are deployed to local communities throughout the United
States to assist with local efforts to protect critical assets, serve as DHS’ on-site critical infrastructure
and vulnerability assessment specialists, and serve as DHS liaisons between Federal agencies, State,
territorial, local, and tribal governments, and the private sector. Additionally, PSAs support the
development of the national risk picture by identifying, assessing, monitoring and minimizing risk to
critical assets, and provide reach-back capabilities to DHS and other Federal resources. PSA contact
information can be obtained, and PSAs may be contacted through the national PSA Duty Desk at
psadutydesk@hq.dhs.gov or by calling 703-235-5724.
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Content Assistance
The Annex contains the names of USG Working Group members that have been involved in
developing this guidance document. State officials are encouraged to contact Working Group
members with questions about the guidance document itself or to obtain referrals to other USG staff.
Resource Document
The Annex also contains a collection of references, resources and citations that might be of assistance
to States while developing their operating plans. One example is the “Return to Work” brochure – a
one-page document ready for distribution and use with individuals who have been diagnosed with
pandemic influenza by a healthcare provider or who believe that they have pandemic influenza base on
symptoms of illness explaining to them when they might return to work or to school. Additionally, the
Existing Resources Document includes excerpts or summaries of other documents that might save
planners time. Reading any excerpt included in this document, of course, is not a substitute for
reading subject-specific recommendations, models or guidelines in full.
Website
Many resources referenced in the Existing Resources Document or the Primer can be found at
http://www.pandemicflu.gov. This website serves as the federal clearinghouse for pandemic influenza
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documents, recommendations, checklists, planning tools, exercises, and as such provides a much more
comprehensive collection of documents which provide in-depth information on general and topic-
specific pandemic influenza operational and preparedness concerns. Materials specific to pandemic
planning can be found at http://www.pandemicflu.gov/plan/index.html
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Webinars
HHS invites State officials to live discussions with USG officials in a series of three web seminars
("webinars") to help State planners in the next round of pandemic influenza planning.
The first webcast will be held on March 13, 2 p.m. – 3 p.m. EDT. It will provide an overview of the
guidance and will provide an opportunity for a live question-and-answer session with representatives
from the U.S. Department of Health and Human Services (including its Centers for Disease Control
and Prevention), the U.S. Department of Homeland Security, and the U.S. Department of Labor.
Participants can access the webcast by going to
http://www.pandemicflu.gov/news/panflu_webinar.html. Questions for the webcast panelists may be
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emailed, during the program, to hhsstudio@hhs.gov. Please include your first name and hometown.
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Future webcasts on the State planning and assessment process will be held on April 2, 2008, and April
30, 2008. Additional details will be available on www.pandemicflu.gov. All of the webcasts will be
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videotaped and archived on www.pandemicflu.gov for future viewing.
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Conference calls
The USG will offer conference calls on various Operating Objectives, depending upon the nature and
extent of States’ continuing queries. Additional information on topics and dates will be posted on
www.pandemicflu.gov and, as they become available, disseminated via the SFOs and PFOs.
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APPENDIX A.0 – GENERIC GUIDANCE FOR ENSURING CONTINUITY OF
OPERATIONS OF STATE AGENCIES & CONTINUITY OF STATE
GOVERNMENT
This section of the Appendix is informational only and is provided as a resource for the State
Workforce Planning process. It does not establish any reporting requirements. See
www.pande
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micflu.gov/plan/States/Statelocalchecklist.html for a com
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plete list of activities that may
be considered as part of pandemic planning by States. States may also find the Federal agency
checklist of value to them. See HUwww.pandemicflu.gov/plan/federal/operationalplans.html. UH
Basic Pandem
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ic Operational Planning for State Agencies:
1) Identify a pandemic coordinator and/or team with defined roles and responsibilities for preparedness
and response planning. The planning process should include input from labor representatives. Ensure
accountability through an independent review of its pandemic influenza plan and preparedness.
2) Identify essential employees and other critical inputs (e.g. suppliers, sub-contractor services/
products, and logistics) required to maintain operations by location and function during a pandemic.
3) Develop and plan for scenarios likely to result in an increase or decrease in demand for State
services during a pandemic (e.g. increased filings of unemployment insurance, increased calls to public
health, effect of restriction on mass gatherings, need for hygiene supplies, distribution of antiviral
drugs).
4) Establish an emergency communications plan and revise periodically. This plan includes
identification of key contacts (with back-ups), chain of communications (including suppliers, key
constituencies and public), and processes for tracking and communicating State operational and
employee status.
5) Implement an exercise/drill to test your pandemic plan, and revise periodically.
6) Set up authorities, triggers, and procedures for activating and terminating your plan, altering
business operations (e.g. temporarily shutting down non-essential operations), implementing selected
HR policies, distributing antiviral drugs, and other preparedness actions.
7) Enhance communications and information technology infrastructures as needed to support employee
telecommuting and remote customer access. Develop platforms (e.g. hotlines, dedicated Web sites) for
communicating pandemic status and actions to employees, vendors, suppliers, and the public in a
consistent and timely way, including redundancies in the emergency contact system.
8) Collaborate with federal and local public officials, particularly health agencies and emergency
responders, as well as neighboring States to participate in their planning processes, share your
pandemic plans, and understand their capabilities and plans.
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APPENDIX A.1
Operating Objective: Sustain Operations of State Agencies and Support and
Protect Government Workers
This Appendix will help States ensure personnel/human resource policies and practices support
continuity of State operations, community mitigation strategies, and State government employees
during a pandemic. The Appendix has two parts:
Part I. Sustain Operations of State
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Agencies
Operating sub-objective A.1.1. Ensure continuity of government in face of significantly
increased absenteeism
Operating sub-objective A.1.2. Assist employees of State agencies unable to work for a
significant time period
Operating sub-objective A.1.3. Communicate with employees of State agencies
Operating sub-objective A.1.4. Consult with bargaining units (if the State has bargaining unit
employees)
Part II. Pro
U
tect the Health and Safety of State Government Workers
Operating sub-objective A.1.5. Make State agency workplaces safe places
Operating sub-objective A.1.6. Revise human resource and other workplace policies affecting
the safety of State government workers
Note: Each Operating sub-objective contains a section preceding its corresponding table to assist the
State in understanding what is required and the reasoning behind the requirements in the “PREPARE”
section of the table. The “RESPOND AND RECOVER” section of the table lists actions to be taken
during or after a pandemic that should be included in the State’s pandemic plan. (Whether some
“RESPOND AND RECOVER” actions will be taken depends on specific conditions, such as the
severity of the influenza pandemic.)
27
Part I. Sustain Operations of State Agencies16
F
F
Intent: To ensure personnel/human resource policies support implementation of the State’s pandemic
plan while promoting community mitigation strategies, such as social distancing and dismissal of
children from schools, and help mitigate the impact of these strategies on State government employees.
Operating sub-objective A.1.1: Ensure continuity of government in face of significantly increased
U
U
absenteeism17
F
a. UAssess potential employee absences during a severe pandem
U
ic due to:
personal illness due to the pandemic influenza;
caring for family members who are ill;
staying home after exposure to pandemic influenza or caring for children dismissed
from school (as per community mitigation strategies); and,
possible reductions in public transportation services.
Based on expected levels of absenteeism, determine the potential impact of a pandemic on the
State agencies’ workforce. (It may help to develop human capital related “what if” scenarios.)
b. Identify “essential” services, functions, and processes
U
that must be m
U
aintained during each
H
Federal Government Response Stage or defined pre-pandem
H
ic and pandemic intervals. Take
into account staffing for programs or functions that are essential during pandemic and will need
a higher level of staffing (e.g., law enforcement or healthcare18 ). Also Udetermine which
F
F
employees have unique credentialsU (e.g., physicians, contract officers, positions which have
licensure requirements).
c. UCross-train to provide 3-deep back-ups for the employees performing essential functions or
who have unique credentialsU. (For essential functions, it is recommended that in order to
sustain continuity of operations, orders of succession go at least three positions deep.)
d. Establish Ustandard operating proceduresU for essential functions.
e. Assess whether some employees can work from home during a pandemic, particularly those
caring for children dismissed from school or unable to get to work. If not already in place,
crea
U
te telework plans to be used during a pandemic and
U
test those plans
U
U
.19 Telework plans
F
F
must take into account whether the stage agencies’ IT infrastructure can support the number of
users in the plan and if sensitive data can be protected.
16 Some actions or activities described below are taken at the State agency level; others at State level. Given the variation
U
U
in how States operate, it is left to the States to determine if actions should be taken by agencies or by the State.
17 The Federal Government recommends that government entities and the private sector plan with the assumption that
during a severe pandemic, up to 40% of their staff may be absent for periods of about 2 weeks at the height of a pandemic
wave with lower levels of staff absent on either side of the peak; for pandemic planning purposes, the need for essential
services and functions may be broader than in the 30-day Continuity of Operations (COOP) plan.
18 Other State programs that should be evaluated include: unemployment insurance; disaster unemployment insurance;
Food Stamps; medical assistance; children, youth and family protective services; juvenile justice; foster care; income
support services; and public food and nutrition services.
19 The USG expects there will be some limitations in Internet accessibility during a pandemic but does expect telework, if
planned properly, to be a realistic option for many employers.
28
f. Assess changes in dem
U
ands on State agencies’ servicesU during a pandemic, particularly for
essential functions.20
F
g. Given telework plans and above assessments of staffing levels and demand for services, if a
State agency expects there may be a shortage of staff needed to maintain essential functions,
identify specific hiring needs
U
U
(e.g., critical positions, geographic locations) and Udetermine
which hiring flexibilitiesU the agency may need. Identify which of these can be implemented
with existing authorities and which need new authorities. For example, will “buyout”
repayment and dual compensation (for returning retired annuitants) waivers be needed?
h. If it is expected staffing levels will not be sufficient, train and/or prepare
U
ancillary workforceU
(e.g. contractors, employees in other job titles/descriptions, retirees) or Ucreate alternative plans
for providing staff.21
U
F
i. UConsult with procurement staff and major contractorsU to discuss the effect of pandemic-related
human capital issues on the Ucontract workforceU and make needed changes to contracts (e.g.,
require contractors to have pandemic plans, telework capabilities, etc.).
j. UReview relationships with suppliers, shippers, and other businesses that support essential
functionsU and, as necessary, implement standing agreements for back-ups.
20 Also note that State revenues tied to general economic activity (such as sales tax) may be lower during a severe
pandemic.
21 Where it is not feasible to train an ancillary workforce or use employees from other State agencies, other alternatives to
staffing essential functions would have to be employed such as temporarily hiring retirees during a pandemic or having
contracts in place that would allow for hiring experts from outside the State workforce.
29
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
DESCRIPTION OF
CITATION TO
IF NOT
SUPPORTING ACTIVITY
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
Sub-objective A.1.1 – Ensure continuity of government in face of significantly increased absenteeism
PREPARE
Assess potential employee absences/ determine potential impact of a
For this activity
pandemic on the agencies’ workforce
and each one
below, please
include
Title
Page(s)
First 5 words of
first sentence
Determine essential functions and which employees have unique credentials
Cross-train to provide 3-deep back-ups for the employees performing
essential functions or who have unique credentials
Establish standard operating procedures for essential functions
Create telework plans
Assess changes in demands on State agencies’ services
Identify specific hiring needs and determine needed hiring flexibilities
If needed, train and/or prepare ancillary workforce or create alternative plans
for staffing of essential functions
Consult with procurement staff and major contractors re HR issues
Review relationships with suppliers/ shippers/other businesses that support
States’ essential functions; as necessary, implement backup plans
Activity Added by State
RESPOND AND RECOVER
Implement telework and other HR flexible work schedules as per plan
Employ pre-identified plans to maintain sufficient staffing (FTE and
contractor) for essential functions and high-demand services
Collect data and report the status of employees for the purpose of monitoring
agency workforce levels and reporting such information to appropriate
agencies (This includes a plan for accountability of personnel and their status
and a plan to monitor who is sick, those that have recovered, those that are
available for re-entry to work)
Use pre-identified hiring/contracting flexibilities to replace employees/
contractors unable to work (or return to work)
Implement previously developed employee-labor relations plan
Refer to Respond and Recover requirement
under Sub-Objective A.1.4. Consult with
bargaining units
Monitor effectiveness and consistency of application of HR flexibilities by
agencies
Activity added by State
30
Operating sub-objective A.1.2: Assist employees of State agencies unable to w
U
ork for a
U
significant time period22
F
Note: To the extent practicable and allowed by law and by function, policies should be consistent
U
across State agencies. Do not assume that only essential or mission critical employees will be working
U
– during a 12-week pandemic wave many employees will need and want to work and States should
strive to maintain as many normal functions as possible. Also note that working at alternative sites
across the State is not a viable option during an influenza pandemic since a pandemic will likely move
quickly across a State.
a. Assess policies and practices that would allow employees to continue to work (a benefit both to
the agency and individual) when they must be absent to care for a child dismissed from school,
are staying home after exposure to pandemic influenza, etc. In addition to providing the
opportunity to Utelework when feasible (see A.1.1.e. above),
U
agencies should review and revise,
as necessary, agency policy and/or guidance on alternative work schedules
U
(flexible and
U
compressed work schedules).
b. For those employees that will not be able to work even with the above workplace flexibilities,
review and revise, as necessary, policies and/or guidance on pay, leave and benefits
U
.
U
Review
the federal Family and Medical Leave Act provisions as well as the State Family and Medical
Leave Act (as applicable). In order to encourage ill employees or those exposed to ill persons
to stay home (as per community mitigation strategies), consider establishing policies for
employee compensation and sick-leave absences specific to a pandemic (e.g., non-punitive,
liberal leave) and guidance on when a previously ill person is no longer infectious and can
return to work. (See Annex for the Return to Work brochure.) Attention should also be paid to
employees’ options for pay and benefits (e.g., health care) when all leave is exhausted.
(Exactly what leave and benefit policies are adopted are up to the State; the required action is to
assess current policies and take appropriate actions given the impact of a pandemic on State
government employees.)
c. Ensure m
U
anagers and supervisors are familiar with various leave options, the procedures and
U
obligations for requesting and approving leave, and the limited circumstances under which an
employee may be directed to take leave.
d. Consult with procurement staff and major contractors to discuss the effect of pandemic-related
human capital issues on the contrac
U
t workforce and the contractors’ pandem
U
ic plans.
22 With a mitigated Category 4 or 5 pandemic, a wave could last up to 12 weeks; absences for parents caring for children
dismissed from school thus could last the full 12 weeks.
31
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
DESCRIPTION OF
CITATION TO
IF NOT
SUPPORTING ACTIVITY
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
Sub-objective A.1.2 - Assist employees of State agencies unable to work for a significant time
period
PREPARE
Assess flexible work schedules (can include cross reference to telework
For this activity
plans from A.1.1.e.) (States should assess current policies and then
and each one
report on decisions)
below, please
include
Title
Page(s)
First 5 words of
first sentence
Review and revise, as necessary, policies and/or guidance on leave and
benefits (States should assess current policies and then report on
decisions)
Ensure managers/supervisors are familiar with various leave options
Consult with procurement staff/major contractors regarding pandemic
plans for the contract workforce
Activity Added by State
RESPOND AND RECOVER
Implement telework and other flexible work schedules as per plan
Refer to the first Respond and Recover
requirement under Sub-Objective A.1.1 -
Ensure continuity of government in face of
significantly increased absenteeism
Implement any special pandemic compensation/ leave/benefit policies
Activity Added by State
Operating sub-objective A.1.3:
U
Communicate with employees of State agencies
U
a. Develop a Ucommunications planU for managers, employees, and contractors that includes, at a
minimum:
An internal Web site23 with pandemic related information;
F
F
Instructions for determining status of agency operations;
Distribution of critical agency information. (An Emergency Notification System is one
mechanism for distributing critical information to employees.)
b. UConvey to all employees the measures the agency/State has taken or has planned to deal with a
pandemicU, including plans for continuity of government; leave plans, alternative work
23 If the Web site is to be used from home, ensure it is accessible to all employees.
32
arrangements and other HR policies; and steps to be taken to prevent or minimize workplace
exposure to contagious disease.
c. UProvide reliable pandemic informationU to employees from community public health, emergency
management, and other sources such as HUwww.pandemicflu.gov. UH Disseminate materials
covering pandemic fundamentals (e.g. signs and symptoms of influenza, modes of
transmission), personal and family protection, and response strategies (e.g., hand hygiene,
coughing/sneezing etiquette, contingency plans). Provide information to assure employees that
their workplace is safe. Also encourage employees to develop a family emergency preparation
plan.
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
DESCRIPTION OF
CITATION TO
IF NOT
SUPPORTING ACTIVITY
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
Sub-objective A.1.3 - Communicate with employees of State agencies
PREPARE
Develop a communications plan
For this activity
and each one
below, please
include
Title
Page(s)
First 5 words of
first sentence
Convey to all employees the State’s pandemic plan
Provide reliable pandemic influenza information to employees
Activity Added by State
RESPOND AND RECOVER
Update information for employees on State’s operating status and latest
pandemic influenza information; continue to advise employees
concerning HR policies, workplace flexibilities, pay and benefits, etc.
Activity Added by State
Operating sub-objective A.1.4: Consult with bargaining units (if the State has bargaining unit
U
U
employees)
a. Consult (and bargain, if appropriate) with exclusive representatives of bargaining unit
employees on human resources issues that may affect employees or collective bargaining
agreements. Such issues may include:
Telework during a pandemic health crisis;
33
Leave benefits available during a pandemic health crisis (including options for pay
when all leave is exhausted).
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
DESCRIPTION OF
CITATION TO
IF NOT
SUPPORTING ACTIVITY
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
Sub-objective A.1.4 - Consult with bargaining units (if the State has bargaining unit employees)
PREPARE
Consult with bargaining units (if the State has bargaining
For this activity
unit employees)
and each one
below, please
include
Title
Page(s)
First 5 words of
first sentence
Activity Added by State
RESPOND AND RECOVER
Implement previously developed employee-labor relations
plan
Activity Added by State
34
Part II. Protect the Health and Safety of State Government Workers
Note: To the extent practicable and allowed by law and by function, policies should be consistent
across State agencies.
Intent: To allow all UState government employeesU who are able to work to do so safely.
U
Operating sub-objective A.1.5U: Make State agency workplaces safe places
a. UEstablish policies and encourage practices that will help prevent influenza spread at the
worksiteU (as part of community mitigation strategies). These policies and practices include:
promoting respiratory hygiene/cough etiquette;
modifying the frequency and type of face-to-face contact (e.g. hand-shaking, seating in
meetings, office layout, shared workstations, telework, alternate work schedules) among
employees and between employees and customers (see CDC recommendations,
HU
Stopping the Spread of Germs at WorkUH (www.cdc.gov/germstopper/work.htm));
providing sufficient and accessible infection control supplies (e.g., hand-hygiene
products, tissues and receptacles for their disposal) in all work locations and public
areas.24
F
b. Complete a Urisk assessment for all jobsU and determine which category of occupational
exposure they fall in (very high or high exposure risk occupations; medium risk occupations; or
lower risk occupations). (The level of risk depends in part on whether or not the job requires
close proximity to people potentially infected with the pandemic influenza virus, or whether the
job requires employees to have either repeated or extended contact with known or suspected
sources of pandemic influenza virus such as coworkers, the general public, outpatients, school
children or other such individuals or groups. See HUGuidance on Preparing Workplaces for an
Influenza PandemicUH (www.osha.gov/Publications/influenza_pandemic.html) for more detailed
information.)
c. UDevelop plans to protect those employees in the very high, high, or medium risk categoriesU.
First determine if risk can be controlled with engineering, administrative and work practice
measures or if personal protective equipment should be provided. For those employees who
need personal protective equipment (PPE), purchase sufficient stockpiles to last through a
pandemic wave (and check shelf life on a regular basis), and train employees in use of PPE. If
providing respirators, establish a respirator program including fit-testing if or as required under
the State occupational safety and health plan. (See Guidance on Preparing Workplaces for an
Influenza Pandemic for more detailed information. Also see
HU
www.osha.gov/dcsp/osp/public_sector.html regarding jurisdiction of Federal OSHA
UH
Regulations.)
24 Providing these supplies now can help workers avoid getting sick and spreading germs and will be essential during a
pandemic to help prevent influenza spread.
35
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
DESCRIPTION OF
CITATION TO
IF NOT
SUPPORTING ACTIVITY
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
Sub-objective A.1.5 - Make State agency workplaces safe places
PREPARE
Establish policies and practices for preventing influenza spread at the
For this activity
worksite; implement those that can be done in advance of a pandemic
and each one
(e.g., providing infection control supplies)
below, please
include
Title
Page(s)
First 5 words of
first sentence
Complete a risk assessment for all jobs (see OSHA guidance at
www.osha.gov/Publications/ influenza_pandemic.html)
HU
UHU
U
Develop plans to protect those employees in the very high, high, or
medium risk categories including stockpiling PPE (if PPE is needed);
provided needed training and if respiratory protection is indicated,
establish a respiratory protection program and fit-test those employees
who will be provided with respirators.
Activity Added by State
RESPOND AND RECOVER
Implement infection control policies and practices (see OSHA guidance
at www.osha.gov/Publications/ influenza_pandemic.html)
HU
UHU
U
Institute protection plans; if in plan, provide PPE to employees in very
high, high, or medium risk categories
If part of pandemic plan, distribute antiviral drugs
Activity Added by State
36
Operating sub-objective A.1.6: Revise human resource and other workplace policies affecting
the safety of State government workers
a. As per assessment done in Part I. Sustaining Operations of State Agencies, Operating sub-
objective A.1.2., “Assist employees of State agencies unable to work for a significant time”,
review and revise, as necessary, policies and
U
/or guidance on leave. U In order to encourage ill
employees or those exposed to ill persons to stay home, consider establishing policies for
U
employee compensation and sick-leave absences unique to a pandemic (e.g. non-punitive,
U
liberal leave). Policies could also include infection control response, screening25 , etc. Please
F
F
see the Workplace FAQs (at www.p
HU
andemicflu.gov/faq/workplace_questions/ ) for inform
UH
ation
on legal issues surrounding screening and to Community Strategy for Pandemic Influenza
HU
Mitigation.
UH
b. Establish guidelines for determining when a previously ill person is no longer infectious and
can re
U
turn to work and who is authorized (e.g., an occupa
U
tional health nurse) to make that
determination. (The CDC will probably provide updated information on the length of time a
person with pandemic influenza is contagious after the pandemic begins.)
c. Consider establishing polic
U
ies for restricting travelU to affected areas overseas and provide
guidance for employees returning from affected areas. These policies could be more stringent
that the recommendations of CDC or the State Department (see CDC travel recommendations
Travelers H
HU
ealth: Avian Influenza A (H5N1) Virus ).
UH
If travel is essential, assess what must be
done to protect workers.
d. Collaborate with insurers, health plans, and local health
U
care facilities to share pandem
U
ic plans,
and understand their capabilities to process claims of State government employees during a
pandemic and how their plans may affect employees. Evaluate governm
U
ent employee access to
and availability of healthcare services during a pandem
U
ic, and consider improving services
and/or putting in place provisions to ensure access to services during a pandemic.
e. Evaluate governm
U
ent employee access to and availability of mental health and social servicesU
during a pandemic, including community and faith-based resources, and improve agency-
provided services as needed. Employee Assistance Program (EAP) should be prepared to offer
psychosocial support services (including educational and training materials) for employees who
participate in or provide support for the response to an influenza pandemic. Develop workforce
resilience programs and ensure readiness to deploy to maximize agency performance and
personal resilience during the emergency.
25 From Community Strategy for Pandemic Influenza Mitigation, p. 24 (emphasis added): “Although the hallmarks of a
HU
UH
pandemic strain will not be known until emergence, patients with influenza may shed virus prior to the onset of clinical
symptoms and may be infectious on the day before illness onset. Most people infected with influenza develop
symptomatic illness (temperature of 100.4° F or greater, plus cough or sore throat), and the amount of virus they shed
correlates with their temperature; however, as many as one-third to one-half of those who are infected may either have very
mild or asymptomatic infection. This possibility is important because even seemingly healthy individuals with influenza
infection as well as those with mild symptoms who are not recognized as having influenza could be infectious to others.”
Also note that one-third to one-half of those who are infected may either have very mild or asymptomatic
infection (see above), so screening for symptoms will not identify all ill persons.
37
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
DESCRIPTION OF
CITATION TO
IF NOT
SUPPORTING ACTIVITY
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
Sub-objective A.1.6 - Revise human resource and other workplace policies affecting the safety of
State government workers
PREPARE
Review and revise policies on leave, as needed; consider new policies
For this activity
for employee compensation and sick-leave absences unique to a
and each one
pandemic to encourage ill employees or those exposed to ill persons to
below, please
stay home (States should assess current policies and then report on
decisions)
include
Title
Page(s)
First 5 words of
first sentence
Establish guidelines on when a previously ill person is no longer
infectious and can return to work
Consider establishing policies for restricting travel (States should assess
current policies and then report on decision)
Collaborate with insurers, health plans, and local healthcare facilities on
pandemic planning; evaluate government employee access to and
availability of healthcare services
Evaluate government employee access to and availability of mental
health and social services; develop workforce resilience programs
Activity Added by State
RESPOND AND RECOVER
Implement policies/guidance developed to assist employees to stay
home when exposed to the influenza or if ill
Implement return to work guidelines
Implement any travel policies; issue instructions for employees in high-
risk situations
Activate programs to address the psychological and social needs of
government employees
Activity Added by State
38
APPENDIX A.2
Operating Objective: Ensure Public Health COOP During Each Phase
of a Pandemic
This appendix provides planners with information that should be included in emergency operations
plans to address surveillance and laboratory issues specific to an influenza pandemic. Please refer to
Appendix A.1 for assistance regarding monitoring sick/well employees.
PREPARE
63B
Capability issues and critical tasks that should be included in the creation of the public health agency’s
COOP can be found in the Centers for Disease Control and Prevention’s Public Health Emergency
Preparedness Cooperative Agreement, FY 07, at (http://www.bt.cdc.gov/planning/coopagreement.
Additional COOP planning resources can be found at
• http://www.fema.gov/pdf/government/coop/influenza_coop_annex.pdf
HU
U
• http://www.umaryland.edu/dhscoop
HU
U
RESPOND AND RECOVER
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
DESCRIPTION OF SUPPORTING ACTIVITY
CITATION TO
IF NOT
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
Sub-objective A.2.1 - Maintain Essential Public Health Functions
Does the plan include definitions and identification of essential
For this activity and
services and functions needed to sustain agency mission and
each one below,
operations
please include
Title
Page(s)
First 5 words of first
sentence
Does the plan include a determination of which, if any, essential
services and functions, or non-essential operating support functions
can be suspended temporarily and for what duration before adversely
impacting the States public health mission
Is there a plan to sustain essential services and functions during a
pandemic influenza outbreak include the following scenarios:
39
o Work force reduction up to 40%
o Limited access to facilities (social distancing,
staffing or security concerns)
o Broad-based implementation of social distancing
policies
Does the plan ensure and consider the following:
o Appropriate level of staffing (to include
contractors) to continue essential functions
o Coordination of planning with contractors,
suppliers, shippers, State agencies and other
businesses that support or are supported by your
essential functions
As appropriate, initiation of pre-solicited, signed and standing
agreements with contractors and other third parties to ensure
fulfillment of mission essential requirements, including contingencies
for backup should primary supplies or contractor be unable to
provide required personnel, services, or supplies
Activity Added by State
Sub-objective A.2.2 - Pre-Identify Personnel, Equipment and Resource to Support Sustained
Response/Survivability and Recovery
Does the plan identify positions, skills and personnel needed to
continue essential services and functions?
Does the plan include a roster of identified personnel and back-up
personnel, by position, needed to continue essential services and
functions?
Does the plan include identification and training of approximately
two to three back-up personnel to continue essential services and
functions?
Does the plan include delegations of authority to take into account
the expected rate of absenteeism?
Does the plan include orders of succession that are at least three deep
per responsibility to take into account the expected rate of
absenteeism?
Does the plan identify adequate alternate worksites (e.g. home or
other adequate alternate worksites that maintain social distancing
measures), as appropriate, to assure capability to maintain essential
services for the duration of a pandemic wave?
Does the plan identify which essential services and functions can be
continued from designated operating facilities or alternative operating
facilities (e.g., home or other adequate alternate worksites) and those
that need to be performed at a designated department or agency
operating facility (A designated operating facility is an existing
agency facility that may remain open during a pandemic with
appropriate social distancing for staff that cannot perform their
functions remotely and are needed to support the continuation of
essential services and functions)?
• Does the plan include a plan for accountability of personnel
and their status?
• Does the plan include a plan to monitor who is sick, those
that have recovered, those that are available for re-entry to
work?
Does the plan include redundant or back-up sources, as appropriate,
for essential resources (such as food, water, fuel, medical facilities,
electrical utilities, information technology support, communications
and municipal services) at designated operating facilities and/or
40
alternative worksites?
Activity Added by State
Sub-objective A.2.3 - Pre-Identify Primary and Secondary Individuals for core functional roles per the
Incident Command System
The plan pre-identifies primary and secondary individuals for the
following core functional areas:
• Assessment of health/medical needs
• Health Surveillance
• Medical Care Personnel
• Health/Medical Equipment and Supplies
• Patient Evacuation
• In-hospital Care
• Food/Drug/Medical Device Safety
• Worker Health / Safety
• Radiological/Chemical/Biological Hazards
• Consultation
• Mental Health Care
• Public Health Information
• Vector Control
• Potable Water/Wastewater and Solid Waste
• Disposal
• Veterinary Services
Activity Added by State
41
APPENDIX A.3
OPERATING OBJECTIVE: Ensure Continuity of the Food Supply
System
“Equal to” means that the following States must establish and enforce inspection program
requirements equal to those of the Federal program: AL, AZ, DE, GA, IL, IN, IA, KS, LA, ME, MN,
MS, MO, MT, NC, ND, OH, OK, SC, SD, TX, UT, VT, VA, WV, WI, AND WY.
PREPARE
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
DESCRIPTION OF SUPPORTING ACTIVITY
CITATION TO
IF NOT
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
State plan designates coordinator for State pandemic preparedness
For this activity and
planning, including contact for food safety, in “Equal to” States.
each one below,
please include
Title
Page(s)
First 5 words of first
sentence
State plan designates food safety program as essential to ensure
continued “at least equal to” compliance with Federal statutes
administered by USDA.
State plan provides for backup personnel being identified for
responsibility in the planning and preparedness of State “Equal to”
food safety programs for a pandemic.
State plan contains procedures for reporting of operating status of
State inspected slaughter/processing establishments, and other food
supply information.
State plan contains communication plan to provide food safety
related information to stakeholders, during a pandemic.
State plan addresses generic operating objectives, under this strategic
goal, for preparing State to carry out food supply system
responsibilities, during a pandemic.
Activity Added by State
42
RESPOND
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
DESCRIPTION OF SUPPORTING ACTIVITY
CITATION TO
IF NOT
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
State plan deploys personnel, assigned to pool of trained backup
For this activity and
program staff, to carry out State “Equal to” food safety program
each one below,
requirements, during the pandemic.
please include
Title
Page(s)
First 5 words of first
sentence
State plan implements procedures for reporting operating status of
State inspected slaughter/processing establishments, and other food
supply information, as required during the pandemic.
State plan implements phased communication plan to provide food
safety related information to stakeholders, during the pandemic.
State plan implements generic operating procedures, under this
strategic goal, in maintaining State food supply system
responsibilities, during the pandemic.
Activity Added by State
43
RECOVER
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
DESCRIPTION OF SUPPORTING ACTIVITY
CITATION TO
IF NOT
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
State plan assigns personnel to assess capability to meet pre-
For this activity and
pandemic State “Equal to” food safety program requirements, in the
each one below,
last stages of the pandemic.
please include
Title
Page(s)
First 5 words of first
sentence
State plan calls for assessing the pre-pandemic level operational
capability of State inspected slaughter/processing establishments, and
other food supply system assets, in the last stages of the pandemic.
State plan provides for reporting on the pre-pandemic level
operational capability of State inspected slaughter/processing
establishments, and other food supply system assets, in the last stages
of the pandemic.
State plan’s phased communication plan provides food safety related
recovery information to stakeholders, in the last stages of the
pandemic.
State plan implements generic operating procedures, under this
strategic goal, in recovering to pre-pandemic State food supply
system responsibilities, in the last stages of the pandemic.
Activity Added by State
44
APPENDIX A.4
106B
Operating Objective: Ensure Ability to Respond to Agricultural
Emergencies and Maintain Food Safety Net Programs
States must ensure continued ability to provide response support to agricultural emergencies –
especially animal and plant disease outbreaks – as well as administration of Federal nutrition assistance
programs to children and needy families, during a pandemic.
PREPARE
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
DESCRIPTION OF
CITATION TO
IF NOT
SUPPORTING ACTIVITY
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
State plan addresses generic operating objectives, under this strategic
For this activity and
goal, for preparing State to carry out critical agriculture programs,
each one below,
during a pandemic—including designation of coordinator for State
please include
pandemic preparedness planning.
Title
Page(s)
First 5 words of
first sentence
State plan designates Federal nutritional assistance programs, and
agriculture emergency response support, as essential to ensure
continued State administration of Federal nutritional assistance and
support to agricultural emergencies.
State plan provides for backup personnel being identified for
responsibility in the planning and preparedness of State-administered
nutritional assistance and agriculture emergency response support
responsibilities.
State plan provides for alternative approaches for carrying out State-
administered nutritional assistance, during a pandemic.
State plan provides for backup personnel being identified for
responsibility in the planning and preparedness of State-administered
nutritional assistance, and animal disease response, in a National
Response Framework (NRF) emergency, (e.g., ESF-11).
State plan contains procedures for reporting of operating status of State
nutritional assistance mechanisms and agriculture emergency response
support.
State plan contains communication plan to provide essential agriculture
and nutrition assistance information to stakeholders, during a pandemic.
Activity Added by State
45
RESPOND
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
DESCRIPTION OF
CITATION TO
IF NOT
SUPPORTING ACTIVITY
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
State plan deploys personnel, assigned to pool of trained backup
For this activity and
program staff, to carry out State-administered nutritional assistance and
each one below,
agriculture emergency response support responsibilities, during the
please include
pandemic.
Title
Page(s)
First 5 words of
first sentence
State plan deploys personnel, assigned to pool of trained backup
program staff, to carry out State-administered nutritional assistance
programs, and animal disease response, in a National Response
Framework (NRF) emergency, (e.g., ESF-11), during the pandemic.
State plan implements procedures to initiate alternative approaches for
carrying out State-administered nutritional assistance, during the
pandemic.
State plan implements procedures for reporting operating status of State
nutritional assistance activities and agriculture emergency response
support, as required during the pandemic.
State plan implements phased communication plan to provide
nutritional assistance program, and agricultural emergency response
support, related information to stakeholders, during the pandemic.
State plan implements generic operating procedures, under this strategic
goal, in maintaining State ability to carry out critical agriculture
programs, during the pandemic.
Activity Added by State
46
RECOVER
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
DESCRIPTION OF
CITATION TO
IF NOT
SUPPORTING ACTIVITY
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
State plan assigns personnel to assess capability to meet pre-pandemic
For this activity and
State nutritional assistance program administration requirements, and
each one below,
meet pre-pandemic agriculture emergency response support
please include
responsibilities, in the last stages of the pandemic.
Title
Page(s)
First 5 words of
first sentence
State plan provides for assessing and reporting on the operational
capability to meet pre-pandemic level of performance for State-
administered nutritional assistance programs, and agriculture emergency
response support responsibilities, in the last stages of the pandemic.
State plan calls for assessing and reporting on the operating status of
State-administered nutritional assistance programs, and animal disease
response, in a National Response Framework (NRF) emergency, (e.g.,
ESF-11), in the last stages of the pandemic.
State plan’s phased communication plan provides nutritional assistance
program, and agricultural emergency response support, related recovery
information to stakeholders, in the last stages of the pandemic.
State plan implements generic operating procedures, under this strategic
goal, in recovering to pre-pandemic State ability to carry out critical
agriculture programs, in the last stages of the pandemic.
Activity Added by State
47
APPENDIX A.5
OPERATING OBJECTIVE: UNIFORMED MILITARY SERVICES
The intent of this guidance is four-fold:
1) to encourage State Emergency Managers and Public Health Officials to develop an understanding
of the National Guard capabilities and how to efficiently utilize them during all phases of
pandemic planning and response;
2) to ensure that the roles and responsibilities of the National Guard are clearly codified in the State
Pandemic response plan;
3) to promote unity of effort among all state agencies in a PI environment; and
4) to ensure that National Guard members and their beneficiaries are considered during all phases of
the PI planning process.
This can be achieved by ensuring that:
1) the full spectrum of the National Guard domestic response capabilities is integrated into all
phases of State Pandemic Influenza planning; and
2) local emergency managers and local health departments coordinate planning with active federal
military installations in their jurisdictions, if present.
The Department of Defense recommends that the State Health Department invite a representative from
the State National Guard to attend all planning meetings associated with emergency planning to
include Pandemic Influenza. Further, the State Health Department should coordinate with the local
health departments to ensure unity of effort and ensure there is an effective communication mechanism
between state health officials, the State National Guard, and DoD installations within the state.
The National Guard has 10 domestic support capabilities that can provide assistance to the State. These
capabilities and their corresponding Emergency Support Functions are given in the table below:
National Guard
NRF Emergency Support Function
26
CapabilityF F
Aviation and Airlift
ESF 1, 4, 9 and 13
Communications ESF
2
Command and Control
ESF 5, 14, and 15
Engineering
ESF 3, 4, and 9
Logistics
ESF 6, 7 ,11 and 12
Medical
ESF 8, and 11
CBRNE Response
ESF10
Maintenance
ESF 6, 7, 8 and 12
Security ESF
13
Transportation ESF
1
Additionally, the National Guard operational planners can provide technical assistance and support in
the development of a multi-agency integrated, actionable State response plans.
26 National Guard Bureau Joint Capabilities Database (JCD)
48
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
PREPARE (Note: These activities are applicable to “respond” and “recover” as well.)
DESCRIPTION OF
CITATION TO
IF NOT
SUPPORTING ACTIVITY
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
Ensure key State Emergency Planners and Public Health Officials have
For this activity and
met with the Adjutant General27 and his/her key leaders to coordinate PI
F
F
each one below,
planning efforts to include identifying critical issues, shortfalls, and
please include
planning gaps during the Prepare Phase of PI planning.
If requested by the Governor, or his designee, the National Guard shall
Title
provide technical assistance to the Lead State Agency in developing and Page(s)
writing an actionable response plan.
First 5 words of
first sentence
Ensure key State Public Health and Emergency planning officials have
been briefed on the full spectrum of State National Guard domestic
support capabilities and have incorporated these capabilities into all
phases of the State response plan.
Ensure State PI planning and Public Health officials have been briefed
on the capabilities of the National Guard of the surrounding states.
Consideration has been given to a regional response plan to share low
density or unusual response assets.
Ensure the State National Guard leadership has been briefed by the
Lead Pandemic Influenza planning agency to facilitate joint
understanding of roles, missions and responsibilities during a pandemic.
Ensure the State Plan recommends continuous and close coordination
between the State National Guard, State Emergency Planners and Public
Health Officials during a PI event.
Ensure the State National Guard has developed and published an
actionable PI plan that been synchronized to, and supports, the
overarching State response plan.
Ensure the essential domestic response capabilities of the State National
Guard have been identified by the Lead State PI Planning Agency.
State planners have cross walked National Guard capabilities to the
appropriate NRF ESF’s. Shortfalls and critical resource gaps have been
identified and specific tasking and requests for support have been issued
to the office of the Adjutant General.
Ensure the National Guard requirements for PPE during a pandemic are
included in the State Plan.
The State is responsible to provide for the antiviral medications and
vaccine requirements of the National Guard, unless Federalized.
Ensure the State PI planners have included the National Guard in State
antiviral and vaccine distribution plan.
Ensure state plans include DoD beneficiaries who receive their medical
care from the civilian sector are accounted for in determining medical
countermeasure requirements, e.g. PPE, anti-viral drugs, and vaccine
(when available).
Ensure plans recommend the State Health Department advise local
27 The Adjutant General is the Commander of the state military forces and the military advisor to the Governor
49
health departments in jurisdictions adjacent to Active Federal Military
Installations to contact and coordinate their activities with the
installation Public Health Emergency Officer (PHEO).
Ensure plans recommend continuous coordination and communication
between State Emergency planners and the PI coordinators assigned to
the five PI Principal Federal Official regions (A thru E) from U.S.
Northern Command (NORTHCOM).
Ensure plans recommend the State Emergency Management Agency
advise local emergency managers in jurisdictions adjacent to Active
Federal military installations to contact and coordinate their activities
with base/post installation managers or the installation commander to
identify areas for mutual support.
Activity Added by State
50
APPENDIX A.6
Operating Objective: Sustain Transportation Systems
The transportation system, vital to every citizen of the U.S., is responsible for delivering billions of
people and trillions of dollars of goods each year28 . Often built around the “just-in-time” delivery of
F
F
goods and services, any disruption to the national transportation system could have repercussions to
the U.S. population regardless of rural or urban settings. Maintaining a healthy and viable
transportation system during pandemic influenza will be highly dependent on the degree of
preparedness, ability to respond, and capability of recovery within each of the major transportation
modes: aviation, rail, highway, maritime, pipeline, and mass transit.
In order to keep the vast and complex transportation systems moving during a severe pandemic, the
preparedness, response, and recovery of each transportation mode within every State and territory
should encompass three principal goals or sub-objectives listed below.
The first goal is to keep goods and people moving. This includes both inter and intraState movement
of goods and people as well as across international borders. Prioritizing essential transportation and
cargo services; minimizing virus spread through alerts, advisories and restrictions; cleaning or
sanitizing cargo and facilities; temporary relief from regulatory requirements without compromising
safety; and other related measures.
The second goal is to protect transportation workers. Plans should consider measures that ensure the
safety of front line workers such as: communication, public and employee education, mitigation
methods, and worker training in order to stop, slow, or limit the spread of a pandemic. While general
information related to protection of State government workers is found in section A.1 (pages 21-33),
transportation-specific protection methods are listed below.
The third goal is to protect the public when using the transportation system. Plans should provide,
through a systematic approach to public awareness and education, guidance to the public on how to
safely utilize the transportation system during a pandemic and how to limit the spread of the virus.
PREPARE
64B
Sub-objective A.6.1 - Keep goods and people moving
• Develop contacts and establish working groups with transportation authorities in neighboring
jurisdictions, key stakeholders, emergency response, law enforcement, Department of Defense
(National Guard), Department of Homeland Security, and any other officials to discuss ways to
mitigate consequences of a worst-case pandemic on transportation systems (including
infrastructure, and movement of essential cargo).
• Identify and prioritize “essential” transportation services, functions, and processes that must be
maintained during each Federal Government Response Stage, Pandemic Severity Index, or
HU
UH
Pandemic Interval (See pages 11-13).
• Ensure continuity of State transportation operations by initiating outreach to the private sector
and discussing its business services and prioritization of transportation services during a
pandemic.
28 National Strategy for Pandemic Influenza: Implementation Plan, Chapter 5 – Transportation and borders
51
• Identify “non-essential” transportation services, functions, and processes that may be
suspended or modified for more essential
U
U
use during each HUFederal Government Response Stage, UH
Pandemic Severity Index, or Pandemic Interval (See pages 11-13).
• Identify and prioritize cargo that could be deemed “essential” and ensure its continuity during a
pandemic. Essential cargo might be: vaccine or other medicine, chlorine for water treatment,
coal for power plants, oil, gas, etc.
• Plan for and develop procedures related to potential surges in different transportation modes
and cargo depending on pandemic severity. For example, one common assumption is that there
will likely be an increased demand for shipping, postal and cargo services (as customers order
products on-line rather than shopping in person) combined with a lowered demand for
passenger travel in public transit and aviation. Therefore, rail, passenger aircraft, or bus
services might be modified to accept more essential cargo transport rather than passengers.
Likewise, cargo normally shipped on passenger airlines may need to be transferred to cargo
aircraft during the most severe pandemic outbreak.
• Become familiar with current research on decontamination or sanitization of transportation
systems and prepare to implement new techniques or methodologies.
(http://wwwn.cdc.gov/travel/conten
HU
tAvianFluAirlinesCleaning.aspx)
UH
• Develop pre-scripted or draft Memoranda of Agreement or Emergency Compacts with
neighboring jurisdictions, key suppliers, temporary help services, privately owned
transportation resources, or similar entities.
• Determine what impacts a severe pandemic would have on the transportation sector and plan to
initiate requests to waive certain regulations as necessary29 . Examples of possible
F
F
transportation waivers, each subject to the applicable specific regulatory requirements, are:
commercial motor vehicle (CMV) requirements concerning safety, hours of service, driver
qualifications, operation and inspections, repair and maintenance, and employee safety and
health standards needed by a carrier or driver to provide direct
U
em
U
ergency assistance; special
permits for transporting hazardous materials; special permits for pipeline safety requirements;
and waivers of railroad safety rules, regulations, and standards.
ub-objective A.6.2 – Protect transportation workers30
S
F
• Prepare a risk assessment for transportation activities in accord with Appendix A.1, Sub-
Objective A.5 and develop plans to protect employees in the very high, high, or medium risk
categories.
• Likewise, ensure a risk assessment is done for on-site contract personnel and plans are in place
to protect its employees in the very high, high, or medium risk categories.
• Develop and distribute employee training for those requiring PPE as appropriate and ensure
that all workers can conduct activities in a reasonable and safe manner.
• Likewise, ensure that similar training for contractors requiring PPE is conducted and that
activities can be conducted in a reasonable and safe manner.
• Ensure that operators of State-owned or contractor-supplied equipment and facilities are ready
to respond to new guidance on cleaning and/or sanitizing requirements or any safety-related
procedures for handling or storing the agents.
29 During an emergency, the U.S. Department of Transportation (DOT) may have the ability to waive certain safety
regulations in accordance with specific statutory and regulatory authority. However, waivers of and exemptions from
existing regulations and requirements are fact-based, and DOT’s ability to waive existing authority will depend heavily on
the facts surrounding the emergency.
30 See section A.1, pages 20-33 for general PPE methods.
52
• Acquire, pre-position and store supplies that will be needed to conduct cleaning/ sanitizing
operations.
• Develop and have ready for distribution instructions for workers on how to handle passengers
who may exhibit pandemic influenza symptoms.
Sub-objective A.6.3 – Protect the public while using transportation systems
• Coordinate public messaging with lead public health or other authority regarding travel
advisories for different modes of transportation. Messaging should indicate level of risk for
travelers when utilizing particular transportation mode.
• Develop additional safety measures to be implemented on public transportation systems based
on the Pandemic Severity Index (Pages 11-13).
• Develop (or obtain from other sources) training material such as posters, videos, brochures and
other pandemic flu countermeasures. This might also include advice reminding the public of its
responsibility to provide its own personal protection (such as the use of facemasks) when going
to unavoidable crowded public areas and when using public transit.
• Develop plans to distribute training material such as brochures to the public when utilizing the
transportation system.
RESPOND
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
DESCRIPTION OF SUPPORTING ACTIVITY
CITATION TO
IF NOT
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
Sub-objective A.6.1 - Keep goods and people moving
Communicate with transportation authorities in neighboring
jurisdictions, key stakeholders, emergency response, law
enforcement, Department of Defense (National Guard), Department
of Homeland Security and any other officials to activate plans or
procedures regarding the transportation modes.
Review “essential” transportation services, functions, and processes
For this activity and
and ensure they continue during a pandemic. Alternative routes may
each one below,
need to be considered for freight transport. Consult the DOT Freight
please include
Analysis Framework to determine alternate transportation routes.
Title
Page(s)
First 5 words of first
sentence
Review and implement procedures to ensure continuity of essential
cargo during a pandemic.
Review and implement procedures related to potential surges or
declines in transportation modes and essential cargo services and
ensure there is no disruption of these services.
Implement additional cleaning/sanitizing methods for transportation
systems and cargo.
Initiate Memoranda of Agreement or Emergency Compacts with
neighboring jurisdictions, key suppliers, temporary help services,
53
privately owned transportation resources, or similar entities.
Submit request for waivers to appropriate authorities if necessary.
Communicate with Federal Operations Centers in accordance with
the National Response Framework and Emergency Support Function
1 to provide transportation–specific information during a pandemic.
Activity Added by State
Sub-objective A.6.2 - Protect transportation workers
Provide special instructions or additional guidance to essential or
unique employees31 who must travel to regions that have experienced
F
F
severe outbreak; focusing on worker safety and what to do. Advice
should also be given to the employee on health monitoring, PPE use,
and training.
Ensure that all transportation workers and operators of State-owned
or contractor-supplied equipment and facilities receive updated
policy, procedures, and supplies necessary for cleaning or sanitizing
transportation systems.
Issue instructions to workers on how to detect sick passengers and
what to do if detected.
Activity Added by State
Sub-objective A.6.3 - Protect the public while using transportation systems.
Issue transportation travel advisories. Some advisories could attempt
to discourage or limit non-essential travel to affected regions during
an outbreak.
Issue advisories to the general public on how to safely ride public
transportation during a pandemic. These advisories could remind the
public of their responsibility to provide their own PPE (such as
facemasks) when utilizing public transportation systems, to
frequently wash their hands, etc.
Issue public service announcements, and initiate public safety
campaigns via posters, brochures, websites, or other media regarding
how to reduce or limit the spread of the virus.
Distribute educational material to passengers on how to avoid
spreading the flu virus when utilizing public transportation.
Keep transportation assets, such as buses, subway cars or trains clean
by implementing more frequent cleaning or sanitization procedures.
Deliver or display pandemic influenza alert levels or situational
reports to the public when using transportation systems.
Activity Added by State
31 Both State government and contract employees
54
RECOV ER
65B
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
DESCRIPTION OF SUPPORTING ACTIVITY
CITATION TO
IF NOT
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
Sub-objective A.6.1 - Keep goods and people moving
ReinState public transportation to normal operating levels and
For this activity and
prepare for another possible pandemic wave.
each one below, please
include
Title
Page(s)
First 5 words of first
sentence
Integrate best practices or lessons learned during the previous
pandemic wave across all transportation modes and issue an after
action report.
Activity Added by State
Sub-objective A.6.2 - Protect transportation workers
Thoroughly disinfect and prepare workplace before resumption of
duties.
Deliver messages to personnel regarding resumption of normal
duties and working hours.
Prepare for another possible pandemic wave by re-stocking
supplies, reviewing and addressing deficiencies noted during first
wave.
Integrate best practices or data points from lessons learned during
the previous pandemic wave across all transportation modes and
issue an after action report.
Activity Added by State
Sub-objective A.6.3 - Protect the public while using transportation systems
Issue Statements and advisories to the general public informing
them that the immediate pandemic threat is over, but to be prepared
for another possible wave.
Thoroughly clean or sanitize public transportation conveyances and
facilities and prepare for public use.
Integrate best practices or data points from lessons learned during
the previous pandemic wave across all transportation modes and
issue an after action report. Prepare for another pandemic wave.
Activity Added by State
55
APPENDIX A.7
66
B
COOP & COG: Operational Readiness (Testing through Exercises and
Real Events)
A defining characteristic of an operating plan is that, in whole or in part, it readily lends itself to
evidence-based evaluation using the results of discussion-based exercises (“table tops”), operational-
based exercises (drills and enacted responses to simulated incidents), or performance measurements
obtained in the course of responses to actual incidents.
The table below describes the type of information that is requested regarding readiness to meet the
Operational Objectives that constitute the Goal “Ensure Continuity of Operations of State Agencies
and Continuity of State Government”. Although an imperfect measure of readiness, this information
tells reviewers that States have practiced and tested their plans – through exercises or responses to real
events – and used the results of such experience to improve their pandemic influenza preparedness.
The USG Departments jointly will assign a single rating for Operational Readiness for the entire State
submission. In particular, based on the information requested at the end of each sub-Appendix, the
Departments will determine the number of the Operating Objectives for which the State submitted
evidence that it has tested its response capability in some appropriate way. This number then will be
divided by the total number of Operating Objectives, expressed as a percentage, and translated into a
standardized verbal designation in accord with the key shown in the text box.
Key:
>
U
U
50% - “Substantial Evidence of Operational Readiness”
25-49% - “Significant Evidence of Operational Readiness”
1-24% - “Little Evidence of Operational Readiness”
No submission or a non-responsive submission will be classified as “insufficient information to enable
assessment”.
In accord with the table below, please indicate, for each Operating Objective, whether or not an aspect
of that objective was tested. If it was tested, what was the measurable objective that was tested (this
would have been your exercise objective or the objective you were trying to achieve during a
response)? Then, please provide one or two sentences about the a change that was made to the State
operating plan as a result of the lessons learned and incorporated into an Improvement Plan and then
acted upon.
56
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
COOP & COG: OPERATING READINESS
Operating Objective
Tested?
What was tested and
How did result improve the
67B
F
32 (Y/N)
why?33
Operating Plan?
F
F
F
Ensuring Continuity of
Operations of State Agencies &
Continuity of State Government
• Telework plans (test for
capability for people,
processes, and
technology; ensure
teleworkers have access
to vital records,
databases and other
files, consistent with
encryption protocols)
• Communications plan
and communications
mechanisms
• Other plans from
Appendix A.1 related to
actions to be taken
during a pandemic
Public Health COOP
68B
Food Supply System
69B
Uniform Military Services
70B
Agriculture
71B
Transportation
72B
32 Examples of events might include: National Governor’s Association regional exercises, Department of Treasury national
finance and banking CIKR exercise, TOPOFF, wildfire response, intraState antiviral drug distribution exercise, Hurricane
Dean response, and use of VTC to conduct regional workshops to inform planning.
33 If an exercise, what was the purpose? If a real-world incident, what was its nature?
57
APPENDIX B.0 – PROTECT CITIZENS
This Appendix, “Protect Citizens,” reflects the role of the State government as a responder in to the
107B
influenza pandemic. During a pandemic, the State government is conducting business as usual (and
perhaps with more intensity) for functions such as disease surveillance and is altering the way it
conducts other functions to delay the introduction, slow the spread, or lessen the severity of pandemic
influenza (e.g., advising that sick people stay home, banning public gatherings, dismissing students
from schools). Should an influenza pandemic reach the United States, our primary focus will be to
safeguard the health of the U.S. population. Our ability to meet this goal will require accomplishment
of a number of critical tasks including: (1) Ensure surveillance and laboratory capability during each
phase of a pandemic, (2) Implement controls at U.S. ports of entry to delay the spread of the disease,
(3) Implement community mitigation interventions at the appropriate time. (4) Enhance State plans to
enable community mitigation through student dismissal and school closure; (5) Acquire and distribute
medical countermeasures during each phase of a pandemic; (6) Ensure mass vaccination capability; (7)
provide health care; (8) Manage mass fatalities; (8) Ensure communication capability during each
phase of a pandemic; (9) Mitigate the impact of an influenza pandemic on workers in the State; (10)
Understand official communication mechanisms for foreign missions, international organizations, and
their members in the United States; (11) Integrate EMS and 9-1-1 into pandemic preparedness; (12)
Integrate public safety answering points into pandemic preparedness; and (13) Protect citizens
operating readiness (testing through exercises and real events).
When carrying out such operating objectives it is important that State officials work with local
jurisdictions to ensure or promote the following with respect to At-Risk populations:
• Engagement with at-risk individuals (or organizations that represent them) – ensuring that
critical planning gaps are identified and filled;
• A mechanism for continuous and close coordination between local officials and organizations
that serve at-risk individuals during the influenza pandemic; and,
• Community organizations have a tested and improved mechanism for educating at-risk
individuals on the highlights of their local response plans.
58
APPENDIX B.1
Operating Objective: Ensure Surveillance and Laboratory Capability
During Each Phase of a Pandemic
This appendix provides planners with information that should be included in emergency operations
plans to address surveillance and laboratory issues specific to an influenza pandemic.
PREPARE
Checklist items for general consideration on this topic can be found at
http://www.pandem
HU
icflu.gov/plan/States/Statelocalchecklist.html#laboratoriesUH.
U
Implementation Steps for Enhanced Human Surveillance
Implementation steps for enhanced human surveillance to rapidly detect initial cases of pandemic
influenza virus in humans early in a pandemic that include the following:
• Conducting year-round surveillance for seasonal influenza (e.g., virologic and outpatient visits)
including electronic reporting
• Methods for notification of healthcare providers of enhanced surveillance testing and reporting
recommendations
• Method for healthcare providers to contact the State health department to report cases that meet
the criteria for pandemic influenza testing and obtain the appropriate testing.
• Identification of influenza surveillance coordinator positions
• A plan for investigation of early cases and clusters of pandemic influenza
• Plan for reporting early novel influenza cases to CDC on a daily basis
U
Monitoring of Influenza-Related Hospitalizations and Deaths throughout the Pandemic
A plan for developing systems or identifying data sources for monitoring severe disease throughout the
pandemic such as:
• Developing and implementing a Statewide electronic death reporting system or accessing
available sources of electronic death data (e.g. vital records data).
• Developing methods for estimating influenza-associated deaths if no electronic data are
available.
• Monitoring the number of pneumonia and influenza hospitalizations using tabulated from
hospitals or available source of electronic data.
• Estimating rates of influenza associated hospitalizations for your jurisdiction.
U
Procedures for Notification and Information Sharing
A process for information sharing between the following:
• Health
Departments
• Hospitals
• Medical
Examiners
• Vital Statistic Offices
• Other stakeholders (e.g. DoD)
• Links animal and human health surveillance systems
• Staff identified with contact information for information sharing between the animal and
human health surveillance systems
59
Operational Steps to Obtain and Track Impact of the Pandemic
U
A plan to obtain, track and report numbers or rates daily to the State department of health and to the
CDC in a timely manner during the early period of pandemic influenza virus introduction and spread
on the following:
• Attack rate in early case and cluster investigations
• Case fatality rate
• The numbers of hospitalized persons with pandemic influenza or rate of pandemic
influenza-associated hospitalization
• The number of pandemic influenza-associated deaths
RESPOND AND RECOVER
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
DESCRIPTION OF SUPPORTING ACTIVITY
CITATION TO
IF NOT
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
Sub-objective B.1.1 - Implementation Steps for Enhanced Human Surveillance
Does the plan include implementation steps for enhanced human
For this activity and
surveillance to rapidly detect initial cases of pandemic influenza virus each one below,
in humans early in a pandemic that include the following:
•
please include
Conducting year-round surveillance for seasonal influenza
(e.g. virologic and outpatient visits) including electronic
reporting
Title
• Methods for notification of healthcare providers of enhanced Page(s)
surveillance testing and reporting recommendations
First 5 words of first
• Method for healthcare providers to contact the State health
sentence
department to report cases that meet the criteria for
pandemic influenza testing and obtain the appropriate
testing
Does the plan include identification of influenza surveillance
coordinator positions?
Does the plan include a plan for investigation of early cases and
clusters of pandemic influenza?
Is there a plan for reporting early novel influenza cases to CDC on a
daily basis?
Activity Added by State
Sub-objective B.1.2 - Monitoring of Influenza-Related Hospitalizations and Deaths throughout the
Pandemic
Does the plan include a plan for developing systems or identifying
data sources for monitoring severe disease throughout the pandemic
such
as:
• Developing and implementing a Statewide electronic death
reporting system or accessing sources of electronic death
data (e.g., vital records data)
• Developing methods for estimating or counting influenza-
associated deaths if no electronic data are available
• Monitoring the number of pneumonia and influenza
60
hospitalizations using tabulated data from hospitals or
available electronic sources
• Estimating rates of influenza associated hospitalization for
your jurisdiction
Sub-objective B.1.3 - Procedures for Notification and Information Sharing
Does the plan include a process for information sharing between the
following:
• Health
Departments
• Hospitals
• Medical
Examiners
• Vital
Statistic
Offices
• Other stakeholders (e.g. DoD)
Does the plan include links between animal and human health
surveillance systems?
Does the plan include staff identified with contact information for
information sharing between the animal and human health
surveillance systems?
Sub-objective B.1.4 -Operating Steps to Obtain and Track Impact of the Pandemic
Does the plan include a plan to obtain, track and report numbers and
rates daily to the State department of health and to the CDC in a
timely manner during the early period of pandemic influenza virus
introduction and spread on the following:
• Attack rate in early case or cluster investigations
• Case fatality rate
• The numbers of hospitalized persons with pandemic
influenza or rate of pandemic influenza-associated
hospitalization
• The numbers of newly isolated and quarantined persons
• The number of pandemic influenza-associated deaths
Sub-objective B.1.5 - Implementation Steps for Augmenting the Capacity of Public Health and Clinical
Laboratories
Is there a plan to augment the capacity of public health and clinical
laboratories to meet the needs of their jurisdiction during an influenza
pandemic? Capacity includes but is not limited to:
• The ability to test for influenza viruses year-round
• Performing PCR or IF Testing for rapid detection and
subtyping of influenza viruses
• Protocols for safe specimen collection and testing
• How and to whom a potential case of novel influenza should
be reported
• Mechanism for submitting specimens to referral laboratories
• Protocols for proper handling and shipment of specimens
• Protocols for notifying and reporting any novel specimen
findings
Sub-objective B.1.6 - Systems and Procedures that will be used to Exchange Specimen-Level Data
Electronically Among Laboratories
Does the plan include systems and procedures that will be used to
exchange specimen-level data electronically among laboratories
within the following:
• Healthcare facilities
• Other clinical laboratories
61
• State public health laboratories
• CDC
Sub-objective B.1.7 - Call-Down Procedures
Does the plan include call-down procedures and laboratory staff
contact information?
Sub-objective B.1.8 - Locations for Additional Laboratory Facilities
Does the plan include locations of and Memoranda of Agreement
with additional laboratory and personnel facilities to enhance current
laboratory capacity for a response of pandemic proportions?
Activity Added by State
62
APPENDIX B.2
108B
Operating Objective: Assist with Controls at U.S. Ports of Entry
The millions of people and goods that daily traverse the globe disperse microbial threats in their wake,
usually without intent to harm. To contain the spread of a contagious illness, public health authorities
rely on many strategies. Two of these strategies are isolation and quarantine. Both are common
practices in public health, and both aim to control exposure to infected or potentially infected persons.
Both may be undertaken voluntarily or compelled by public health authorities. The two strategies
differ in that isolation applies to persons who are known to have an illness, and quarantine applies to
those who have been exposed to an illness but who may or may not become ill.
Growing concern about the threat of an influenza pandemic and other emerging infectious diseases has
prompted HHS to invest in building a Quarantine System that meets the needs of the 21st Century.
This Quarantine System includes an integrated and comprehensive partnership of local, State, national,
and global health authorities to prevent, detect, and contain infectious diseases in countries of origin
and at U.S. ports of entry; and to plan responses to public health threats.
The purpose of this guidance is to provide an outline of essential minimum planning elements for
preparedness in detecting, reporting, investigating and responding to at influenza pandemic at the
Nation’s major airports, and strengthening multi-sector response at US ports of entry.
This appendix applies to States that host a Department of Health and Human Services, CDC
Quarantine Station.
PREPARE
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APPLICABLE,
DOCUMENT
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Sub-objective B.2.1 - Plan strategies for controls at ports of entry
Develop a port of entry (POE) communicable disease response plan For this activity and each
-- for locations with a Quarantine Station --which includes triggers
one below, please include
(that follow CDC guidance) for its implementation.
Title
Page(s)
First 5 words of first
sentence
Ensure the port of entry (POE) communicable disease response plan
includes the incident command and control structure.
Ensure the port of entry (POE) communicable disease response plan
addresses ill passenger assessment and isolation procedures.
Ensure the port of entry (POE) communicable disease response plan
addresses issuance of legal order for detention, isolation,
quarantine, and conditional release of passengers or crew members
at POEs.
Ensure the port of entry (POE) communicable disease response plan
63
addresses arrangements for separate quarantine facilities for
detaining multiple cohorts of potentially exposed passengers, either
on- or off-port or both, including (but not limited to):
a. Evaluation of exposed cases, periodic fever checks,
prophylaxis, therapeutics, and needed laboratory services
b. Passenger transportation and security
c. Passenger processing at quarantine facility
d. Crowd control and law enforcement
e. Situation updates and communication with detained
persons
f. Interpretation
g. Mental health services
h. Food, water, toilet and hand washing facilities, chairs, PA
system, bedding, and other comfort measures
Ensure the port of entry (POE) communicable disease response plan
addresses the plans and procedures for managing the conditional
release of those passengers not deemed as high risk contacts of the
index case(s) (i.e., allowing them to continue their travel plans due
to the decreased risk of in-flight disease transmission). These
procedures include but are not limited to collection of passenger
locator information, distribution of health information,
administration of antiviral drugs or other prophylactic interventions,
and tracking of conditionally released persons.
Ensure the port of entry (POE) communicable disease response plan
addresses public and media communication.
Ensure the port of entry (POE) communicable disease response plan
includes protocols that address conveyance reuse/decontamination
issues.
Ensure the port of entry (POE) communicable disease response plan
includes procedures for POE incident “hand off” from one agency
to another, and triggers for altering or terminating POE controls.
Describe the number of hospitals under a memorandum of
agreement (MOA) with Quarantine Station, and plans for
collaboration with Quarantine Station in obtaining additional MOA
hospitals.
Activity Added by State
64
RESPOND
73B
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
DESCRIPTION OF SUPPORTING ACTIVITY
CITATION TO
IF NOT
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
Sub-objective B.2.2 - Implement strategies for port of entry control of pandemic disease.
Create plans to address surge capacity needs at POEs. Define roles
For this activity and each
and responsibilities for the following functions that must include,
one below, please include
but are not limited to:
• Establishing and staffing passenger public health screening Title
• Distributing health alert notices to passengers and crew
Page(s)
members
First 5 words of first
• Providing laboratory support
sentence
• Following up on suspect and isolated cases
• Responding to the needs of quarantined persons
Activity Added by State
65
APPENDIX B.3
Operating Objective: Implement Community Mitigation Interventions
This appendix provides State planners with recommendations for implementing community mitigation
interventions to help limit the spread of a pandemic, prevent disease and death, lessen the impact on
the economy, and keep society functioning. The spectrum of supporting activities under the FEMA
framework of “Prepare, Respond and Recover” is critical to overall State capability. However, only
those activities under “Respond” and “Recover” will be reviewed, since the focus of this guidance is
on operational activities. States are asked to provide detailed information as to how they plan to
address only those recommendations in the attached table.
The CDC issued The Interim Pre-pandemic Planning Guidance: Community Strategy for Pandemic
Influenza Mitigation in the United States – Early, Targeted, Layered Use of Nonpharmaceutical
Interventions (February 2007) to provide guidance for pandemic planning and response at the onset of
a pandemic. This pandemic mitigation framework is based upon an early, targeted, layered application
of multiple partially effective nonpharmaceutical and pharmaceutical measures. It is recommended that
the measures be initiated early before explosive growth of the epidemic and, in the case of severe
pandemics, that they be maintained consistently during an epidemic wave in a community. All such
community-based strategies should be used in combination with individual infection control measures,
such as hand washing and cough etiquette.
The pandemic mitigation interventions described in this document include:
1. Isolation and treatment (as appropriate) with influenza antiviral medications of all persons with
confirmed or probable pandemic influenza. Isolation may occur in the home or healthcare
setting, depending on the severity of an individual’s illness and/or the current capacity of the
healthcare infrastructure.
2. Voluntary home quarantine of members of households with confirmed or probable influenza
case(s) and consideration of combining this intervention with the prophylactic use of antiviral
medications, providing sufficient quantities of effective medications exist and that a feasible
means of distributing them is in place.
3. Dismissal of students from school (including public and private schools as well as colleges and
universities) and school-based activities and closure of childcare programs, coupled with
protecting children and teenagers through social distancing in the community to achieve
reductions of out-of-school social contacts and community mixing. (See Appendix B-4)
4. Use of social distancing measures to reduce contact between adults in the community and
workplace, including, for example, cancellation of large public gatherings and alteration of
workplace environments and schedules to decrease social density and preserve a healthy
workplace to the greatest extent possible without disrupting essential services. Enable
institution of workplace leave policies that align incentives and facilitate adherence with the
interventions outlined above.
Implementing these interventions in a timely and coordinated fashion will require advance planning.
Communities must be prepared for the cascading second- and third-order consequences of the
interventions. Decisions about what tools should be used during a pandemic should be based on the
observed severity of the event, its impact on specific subpopulations, the expected benefit of the
66
interventions, the feasibility of success in modern society, the direct and indirect costs, and the
consequences on critical infrastructure, healthcare delivery, and society.
The Centers for Disease Control and Prevention has recently developed a document entitled Interim
Guidance for the Use of Intervals, Triggers, and Actions in Pandemic Influenza Planning which
provides a framework and thresholds for implementing the community mitigation interventions.
During the “Acceleration” phase, affected communities are moving from case-based approaches to
control to a broader set of community interventions for control. This interval begins in a jurisdiction
when public health officials have identified sufficient factors to initiate community mitigation
activities. Historical analyses and mathematical modeling indicate that early institution of combined,
concurrent community mitigation measures, including dismissing students and closing childcare
facilities, may maximize reduction of disease transmission (and subsequent mortality) in the affected
areas.
RESPOND
74B
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
DESCRIPTION OF SUPPORTING ACTIVITY
CITATION TO
IF NOT
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
Sub-objective B.3.1 - Implement strategies for isolation and treatment of ill individuals.
The State has identified clear triggers that follow CDC guidance for For this activity and
initiating community mitigation interventions (including detailed
each one below, please
actions to take by pandemic severity) and has distributed these
include
guidelines to all local health departments.
Title
Page(s)
First 5 words of first
sentence
Identify the State spokesperson who will provide messages
to local health departments, the public and the media to
initiate community mitigation interventions as well as the
second person in the line of succession for this function.
The State has collaborated with local health departments to
develop plans for rapid remote identification of possible
cases (e.g., hotlines, influenza triage centers), including
processes to train volunteers/others who will staff the
hotline and/or triage centers.
The State has provided initial guidance to local health
departments to develop communications and education to
the general public as to how to access hotlines, when and
where to seek medical care, how to care for ill persons at
home, how to protect family members if there is a sick
person at home, and when to stay home. Provide examples
of how these educational materials will be distributed to the
public.
The State has provided guidance to local health departments
67
to coordinate their pandemic treatment plans with
community Emergency Medical Services (EMS) and 911
services and develop established protocols and algorithms.
The State has identified case definitions for presumptive/definitive
diagnosis of pandemic influenza and distributed these to local
health departments and hospitals in the State. Provide citation.
The State has developed processes to train and communicate with
private sector and public sector health professionals, during the
early and later stages of a pandemic, on case definitions and
methods for determining influenza diagnosis.
The State has developed strategies for advising hospitals and other
treatment facilities to recommend patients with ILI to remain at
home, with triage protocols to identify critically ill patients
The State has developed specific plans to distribute treatment
medications to ill individuals in isolation. Provide a full description
of how ill individuals will access antiviral medication for treatment.
Activity Added by State
Subobjective B.3.2 - Provide clear policies and procedures for advising voluntary quarantine of
household contacts to a known or suspected case, including processes to monitor households under
quarantine.
The State has initiated plans for communications and education to
the general public regarding recommendations for voluntary
household quarantine for family members if there is a sick person at
home, and how long to stay home. Provide citation that describes
how these educational materials will be distributed to the public.
The State has developed a method to provide information to
households under voluntary quarantine and a method of identifying
those households.
The State has designed an interview form and has distributed it to
local health departments to capture demographic characteristics of
household members (both ill and contacts) and has a developed a
clear plan for how these data will be collected.
The State has worked with local health departments to create plans
for follow-up (monitoring) of known or suspected households under
voluntary quarantine in the community at the State/local level.
The State has provided guidance to local public health departments
for their work with community organizations to distribute
medications, vaccine and other subsistence (e.g. food, water, if
needed) items to households in isolation.
The State has outlined a process to use by local health departments
to identify vulnerable populations and to make plans for support
and outreach to these populations during a pandemic.
The State has advised local health departments to conduct outreach
to community and faith-based organizations to develop plans that
68
will be coordinated with those organizations for meeting the needs
of vulnerable households who may be quarantined during a
pandemic.
The State has developed a plan to monitor the implementation of
and effectiveness of community mitigation interventions.
Activity Added by State
Subobjective B.3.3 - Develop clear policies and procedures for advising social distancing practices in
the community and at the worksite.
The State has developed specific recommendations for community
social distancing. Include the levels of social distancing that will be
recommended based on the Pandemic Severity Index.
The State has recommended to local health departments to conduct
outreach to community partners to promote social distancing
including public transportation, operators of large venues for
sporting events and other activities, businesses, education, faith-
based communities and others that have been identified as playing a
role during a pandemic.
The State has developed processes for distribution on informational
materials to workplaces and the community at large explaining the
rationale and steps to take regarding social distancing.
The State has disseminated guidance to local health departments to
share with community businesses and organizations for canceling
large public gatherings
The State has identified processes to help businesses to encourage
ill employees to stay home and identify ill individuals in the
workplace (including guidance regarding who needs to be sent
home or for treatment and where they should go).
The State has identified processes to help businesses adjust leave
policies to facilitate sick employees to stay home.
The State has an identified process for monitoring the secondary
and tertiary effects of community mitigation interventions and
recommended solutions to prevent excessive community disruption.
Activity Added by State
69
RECOVER
75B
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
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DESCRIPTION OF SUPPORTING ACTIVITY
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IF NOT
SUPPORTING
APPLICABLE,
DOCUMENT
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Sub-objective B.3.4 - Implement steps for cessation of community mitigation interventions
List steps for recommending cessation of community mitigation
For this activity and
activities. Include clear triggers for these recommendations that
each one below, please
follow CDC guidance for cessation of community mitigation
include
interventions.
Title
Page(s)
First 5 words of first
sentence
Identify the State spokesperson who will provide messages to local
health departments, the public and the media to cease community
mitigation interventions during the recovery stage, as well as the
second person in the line of succession for this function.
List steps the State will take to provide recovery/reopening
guidance to businesses, workplaces and large venues for sporting
events and other activities that closed during a pandemic.
List steps the State will take to monitor the effects of the cessation
of community mitigation interventions.
Activity Added by State
70
APPENDIX B.4
Operating Objective: Enhance state plans to enable community
mitigation through student dismissal and school closure
Dismissing students from schools is cited as a critical component of mitigating the consequences of an
influenza pandemic. However, dismissing students from schools is a complex operation, with a range
of considerations not only about the act itself, but also second and third order consequences that may
follow student dismissal.
One looming consideration is the appropriate time that schools should be closed and, consequently,
reopened (In this document, school closure is defined as dismissing students from schools and closing
childcare facilities. “Student dismissal may also be used in this document.”). The HHS/CDC have
recently developed a document entitled Interim Guidance for the Use of Intervals, Triggers, and
Actions in Pandemic Influenza Planning which provides a framework and thresholds for student
dismissal and school closure. During the “Acceleration” Phase, affected communities will no longer
be able to control the spread of the virus between affected individuals and will need to enact a broader
set of community interventions to minimize transmission. This interval begins in a jurisdiction when
public health officials have identified sufficient factors to initiate community mitigation activities such
as school dismissal and childcare closures, social distancing, and the efficient management of public
health resources. Historical analyses and mathematical modeling indicate that early institution of
combined, concurrent community mitigation measures, including dismissing students and closing
childcare facilities, may maximize reduction of disease transmission (and subsequent mortality) in the
affected areas. (*Note: This Interim Guidance document is still under consideration by CDC and
Federal agencies. This Interim Guidance should not be considered final guidance.)
Other questions specifically about education policy are addressed in the Department of Education’s
guidance on preparing for prolonged school closures during a severe pandemic, which can be accessed
at: http://www.ed.gov/admins/lead/safety/emergencyplan/pandemic/guidance/pan-flu-guidance.pdf.
HU
UH
This guidance addresses issues related to No Child Left Behind requirements and how state and local
educational agencies should plan for school closures.
The following delineates basic minimum components for states to consider in planning for a pandemic.
The actions cited in this document are specifically focused on the roles and responsibilities of the state
educational agency. For some items, the state may not have any responsibility and this should be
reflected in the “Not Applicable” column. Because some of the actions or activities may be
coordinated at the local level and not the State level, the State should identify contacts at the local level
to ensure optimal coordination.
Also, some of the information included here may be addressed in other sections of the pandemic plan,
such as information on protecting or paying the workforce or communications. Please reference these
sections; there is no need to re-create other parts of the state’s entry if the education sector’s needs are
addressed elsewhere in the state’s plan.
71
PREPARE
76B
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
DESCRIPTION OF SUPPORTING ACTIVITY
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APPLICABLE,
DOCUMENT
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Sub-objective B.4.1 - Review legal authorities and delegations of authority for closing schools and/or
dismissing students.
Identify the legal authority to close schools during a pandemic prior
For this activity and
to declaration of state of emergency. (For example, does this
each one below,
authority rest with the Governor? State Educational Agency? Local
please include
authorities?). Provide citation.*
Title
Page(s)
First 5 words of first
sentence
Identify the legal authority to close schools during an emergency
(declared state of emergency) (For example, does this authority rest
with the Governor? State Educational Agency? Local authorities?).
Provide citation.
If there are no existing authorities, identify the state’s plans for
establishing this authority.
Identify the state’s legal authority to dismiss students from state-
funded post-secondary schools (PSSs). Provide citation, if available.
If not, describe state’s legal role in and/or obligations to PSSs, if
applicable. (For example, do PSSs function under a Board of
Regents? If so, does this body have legal authority to dismiss
students?)
Identify the state’s legal authority to close day care centers, if
applicable.
Activity Added by State
Sub-objective B.4.2 - Develop and/or enhance planning and coordination efforts for school
closure/student dismissal and reopening.
Delineate process for coordinating the response efforts for the state
educational agency (SEA). Identify the positions designated in lines
of authority. (For example, describe who within the State
Educational Agency (SEA) the Governor would contact if a state of
emergency was declared, as well as who would be designated next if
the person in that position was not available.)
Identify the position within the governing entity for PSSs that serves
on the state-level pandemic planning team.
Designate representative to the state’s Pandemic Flu coordinating
team for state educational agency.
Describe relationships between SEA, public health, and other entities,
72
such as mental health. Describe the other partners involved in
planning the educational response to a pandemic and their specific
roles. (For example, do these entities collaborate on issues related to
pandemic influenza? Are there formal Interagency Agreements or
Memoranda of Understanding?)
Describe if state has disease surveillance system in which schools or
PSSs participate or plans for developing such a system (If
applicable.) (Refer to Appendix B.1 if applicable)
Activity Added by State
Sub-objective B.4.3 - Develop and/or enhance communications planning for school closure/student
dismissal and reopening.
Describe the SEA’s mechanism in place for communicating with
LEAs in the event of an emergency (e.g. reverse 911, email groups,
phone tree, etc) and key audiences for messaging (For example, will
private schools also be included in communications or will this
audience receive messages from LEAs?)
Describe if and how the communications systems are redundant and
if not, plans for ensuring redundancy.
Designate the state-level education spokesperson (spokespeople, if
applicable) for both media relations and communicating with LEAs.
(For example, is this the SEA’s Public Information Officer? Who
will back up this position?)
Identify the position designated to communicate with PSSs.
Identify the position designated to communicate with day care
centers.
Activity Added by State
Sub-objective B.4.4 - Establish expectations and procedures for providing continuity of education for
students.
Describe the SEA’s expectations for continuity of education (for
example, does the state or do communities plan to offer educational
content that allows for students to remain connected to “normalcy”
vs. expectation for advancement).
Identify who will have the primary responsibility for development
and/or delivery of educational content. (For example, is this the SEA
or LEAs?)
Describe the existing technological resources at the state level for
continuing education. (For example, does the SEA have a website,
access to public cable, etc.? Will these resources be available to K-
12 or to PSSs also?)
Describe how the state will address the needs of special education
students or students with special needs, if applicable. (For example,
will the SEA provide technical assistance to districts in assessing
IEPs or developing content for these students to be delivered
remotely?)
Activity Added by State
Sub-objective B.4.5 - Establish policies and procedures for use of school facilities and resources
during a pandemic.
Describe the SEA’s policies or guidance about alternative uses of K-
12 school facilities or resources. (For example, are there assets that
are owned by the SEA or whose contracts are negotiated by the SEA,
such as buses?)
Describe the state’s policies or guidance about the use of state-funded
PSS property or assets. (For example, could the state use PSS’s
73
facilities, such as a stadium as vaccination sites? If so, has the state
developed appropriate Memoranda of Understanding with the
relevant PSS?)
Activity Added by State
Sub-objective B.4.6 - Ensure that Continuity of Operations and Business Continuity Plans include
considerations for pandemic for the state educational agency.
Provide a hyperlink or reference to the Labor section of the pandemic
plan (Appendix A.1), ensuring that the SEA has included
considerations for the implications on staffing levels of a pandemic in
their COOP or BCPs and if SEA staff will be covered in the state’s
overall plan for paying state staff.
Describe the state responsibility, if any, for paying staff/faculty at
state-funded PSSs.
Activity Added by State
RESPOND
77
B
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DESCRIPTION OF SUPPORTING ACTIVITY
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APPLICABLE,
DOCUMENT
PLEASE
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Sub-objective B.4.7 - Implement policies and procedures for closing schools and/or dismissing
students.
List steps for closing schools/dismissing students (if applicable).
For this activity and
each one below, please
include
Title
Page(s)
First 5 words of first
sentence
List process for closing day care centers (if applicable).
List process for closing state PSSs (if applicable).
List steps for working with health officials to assess/coordinate
closures in regions of state that border other states.
Activity Added by State
Sub-objective B.4.8 - Implement policies and procedures for continuing education during prolonged
school closure/student dismissal.
List steps for activating continuity of education plans. (For
example, would these plans only be activated as a result of a formal
declaration of emergency?)
List how the state would assist in delivering educational content to
students across the age spectrum (For example, would educational
content be coordinated for K-12 students? PSS?).
Describe how the state will participate in helping provide nutrition
assistance to children who normally would receive free meals
74
through USDA’s school/child care feeding programs (National
School Lunch Program, School Breakfast Program, Child and Adult
Care Food Program), if applicable..
Activity Added by State
Sub-objective B.4.9 - Clearly communicate policies and procedures about school closures/dismissal of
students and other important information.
List steps that SEA will take to provide ongoing communications
about key health information to specific audiences, including LEAs
and stakeholders. Designate key positions and lines of authority for
receipt of and responsibility for dissemination of health
information.
(For example, if CDC or state health authority provides information
about thresholds for dismissing students, reconvening students, etc.,
who at the SEA will be the recipient of this information and how
will this person disseminate information?)
List process for how the State will provide ongoing communication
about education-related issues (such as declarations of emergency
which would trigger school closures) and whether or not this will be
the same person as above. Designate key positions and lines of
authority for receipt of and responsibility for dissemination of
education information (if different than above).
List steps the education spokesperson will take to coordinate
messages with other state entities. (If appropriate, link to
communications section of pandemic plan.)
If applicable, describe process by which LEAs and/or state PSSs
will report to SEA on closures.
Activity Added by State
Sub-objective B.4.10 - Protect state assets (school facilities and resources) during a pandemic.
List SEA’s steps to protect state-owned assets related to schools or
PSSs (if applicable).
List steps state will undertake if the state will use state-owned
educational facilities for alternate uses (if applicable). Describe the
steps necessary to ensure that sites are prepared to function in
desired capacity (for example, if a university stadium is being used
for a vaccination delivery site, are there sufficient refrigeration units
available and easily accessible? How will these sites be cleaned
and maintained?)
Activity Added by State
75
RECOVER
78B
DESCRIPTION OF SUPPORTING ACTIVITY
CITATION TO
IF NOT
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
Sub-objective B.4.11 - Implement steps to reopen schools/reconvene students.
List SEA’s steps for reopening schools/reconvening students (if this For this activity and
is a state function).
each one below, please
include
Title
Page(s)
First 5 words of first
sentence
List steps the state will take to facilitate reopening/reconvening day
care centers and children.
List steps the state will take to facilitate reopening/reconvening
PSSs and students.
Activity Added by State
Sub-objective B.4.12 - Communicate policies for reopening schools/reconvening students.
Describe the communication plan for reopening
schools/reconvening students (if this is a state function). (For
example, will the state provide messaging for the LEAs to use
uniformly about state policy? Will these messages be delivered in
daily press conferences? Letters to LEA staff? Email?)
Identify the state spokesperson who will provide messages during
the recovery stage, as well as the second person in the line of
succession for this function (if different than during response).
Activity Added by State
Sub-objective B.4.13 - Restore the learning environment.
Describe process State will recommend that LEAs use to assess
student’s levels with respect to state academic standards.
List steps that SEA will take to support LEAs in screening and
referring students for mental health services, if applicable. (For
example, does the state support efforts for linkages between schools
and mental health systems?)
Describe if/how the state will provide additional mental health staff
or funding for services to students and staff.
List steps that the SEA will take to support LEAs in assessing
students with special needs in reviewing, revising, or creating
Individualized Education Plans (IEPs).
If the state used state-owned school facilities for alternate uses,
identify the process and/or funding stream that the state will use to
support any necessary remediation.
Activity Added by State
76
APPENDIX B.5
Operating Objective: Acquire and Distribute Medical
Countermeasures during Each Phase of a Pandemic
This appendix provides planners with information that should be included in emergency operations
plans to support the acquisition and distribution of medical countermeasures during an influenza
pandemic. Background guidance and specific assistance are available from the CDC’s Division of
Strategic National Stockpile. The Division’s “SNS Medical Countermeasure Distribution for
Pandemic Influenza” which includes 1) references to storage requirements, logistics requirements,
model workscope documents, and 2) links to Program Preparedness Branch Program Services
Consultants.
PREPARE
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
DESCRIPTION OF SUPPORTING ACTIVITY
CITATION TO
IF NOT
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
Sub-objective B.5.1 – Receive and store antiviral drugs, personal protective equipment and medical
supplies from SNS
A central warehouse [Receipt/Store/Stage (RSS) facility location has
For this activity and
been selected for the receipt of antiviral drugs, personal protection
each one below,
equipment (N95 masks, etc.) and other ancillary medical supplies from
please include
SNS. (For recommended RSS specifications, please refer to the
Strategic National Stockpile’s State Storage Requirements for
Pandemic Influenza Antiviral Drug Response).
Title
Page(s)
First 5 words of
first sentence
A contract, memorandum of agreement (MOA) or other appropriate
documentation is in place that guarantees the availability of the selected
RSS.
The RSS management team and back-up personnel have been identified
The RSS management team and back-up personnel have job action
sheets for their specific functions
The RSS staff/volunteers and back-up personnel have been identified.
Call down rosters for 24/7 operations for all RSS Managers and
staff/volunteers are documented, reviewed and tested for accuracy
Job action sheets and just-in-time training materials have been
developed for each of the RSS functions
An inventory of material handling equipment that’s available at the RSS
is documented along with a list of materials/supplies that need to be
procured and/or delivered at the time of activation
An inventory of office equipment that’s available at the RSS is
documented along with a list of materials/supplies that need to be
procured and/or delivered at the time of activation
77
Plan for a primary and back-up inventory management system (IMS) is
in place
IMS staff have been identified to perform inventory management
functions
Activity Added by State
RESPOND
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
DESCRIPTION OF SUPPORTING ACTIVITY
CITATION TO
IF NOT
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
Sub-objective B.5.2 – Allocate and distribute drugs within the State
An allocation methodology and plan is in place.
For this activity and
each one below,
please include
Title
Page(s)
First 5 words of first
sentence
Recipient locations have been agreed upon (e.g. hospitals, skilled
nursing facilities, community health centers, and other treatment
facilities) and documented. Documentation includes but is not
limited to:
• Location name, address and telephone #s
• Points of contact and contact information
• Facility off-load location and assessment of the site off-load
capabilities
The plan to train recipient locations on the antiviral drug distribution
activation procedures is in place.
Procedures are documented for recipient locations to request
additional supplies.
A Distribution Manager and back-up(s) have been identified.
Procedures to monitor chain of custody are in place.
A distribution plan is in place that includes:
• Delivery locations and routes
• Load planning
• Communication plan with RSS/drivers/recipient locations
• Delivery schedule/frequency
Primary agency/Organization has been assigned to distribute antiviral
drugs, personal protection equipment (N95 masks, etc.) and other
ancillary medical supplies. A contract, memorandum of agreement
(MOA) or other appropriate documentation is in place that guarantees
the availability of the selected resource.
• Agreement should include but not be limited to
o Activation procedures
o 24/7 availability
78
o Guaranteed number and type of delivery vehicles
o Guaranteed number of drivers
o Available communications equipment
Just in time training materials have been applied to the distribution
functions:
• Chain of custody procedures
• Routing
• Communication procedures
• Security procedures
Activity Added by State
Sub-objective B.5.3 – Ensure a safe and secure environment
State-level Security Coordinator has been identified to coordinate
overall security issues.
State security support agencies have been identified and oriented to
security issues/needs.
Security plans are in place for RSS. The plan should include but not
be limited to:
• Written site security and vulnerability assessment
• Plans for interior and exterior security
• Number of officers and designated posts
• Need for physical barriers, lighting, etc…
• Plans for access control
• Plans for security communications
• Plans for security breaches
Security plans are in place for the escort of the delivery trucks to
recipient locations.
Security plans are in place for the recipient locations.
Staff badging/credentialing system for all response personnel is in
place.
Activity Added by State
Sub-objective B.5.4 – Administer drugs in a legal and ethical manner
Plans are in place to administer antiviral drugs for treatment to
priority groups when treatment of illness is indicated.
Plans and protocols are in place for antiviral drugs that may need to
be administered under Investigational New Drug (IND) or
Emergency Use Authorization. Plans should include procedures for
the receipt on the IND protocol consent forms to be received and
mass copied for distribution.
Activity Added by State
RECOVER
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
DESCRIPTION OF SUPPORTING ACTIVITY
CITATION TO
IF NOT
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
79
Sub-objective B.5.5 – Monitor for adverse reactions to drugs
Steps for utilizing the tracking system to track outcomes and adverse
For this activity and
events following treatment with antiviral drugs is in place.
each one below,
please include
Title
Page(s)
First 5 words of
first sentence
Information systems are available that support monitoring of adverse
reactions that comply with the Public Health Information Network
functional requirements for Countermeasure and Response
Administration.
Activity Added by State
80
APPENDIX B.6
Operating Objective: Ensure Mass Vaccination Capability During
Each Phase of a Pandemic
This appendix provides planners with information that should be included in emergency operations
plans to support the acquisition and distribution of medical countermeasures during an influenza
pandemic. Documents should incorporate references to “Pandemic Influenza Vaccination: A Guide for
State, Local and Territorial and Tribal Planners (December 2006)”, produced by CDC’s
Immunization Service Division, as well as the document “Status of pandemic influenza vaccine
manufacturing capacity, pre-pandemic stockpile, and planning for vaccine distribution” (October
2007).
PREPARE
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
DESCRIPTION OF SUPPORTING ACTIVITY
CITATION TO
IF NOT
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
Does the plan provide guidance for priority groups on whether they will For this activity and
be vaccinated by public health, or by institutions or agencies to whom
each one below,
responsibility has been delegated, or a combination?
please include
Title
Page(s)
First 5 words of
first sentence
Does the plan include developing memoranda of agreements or other
formal agreements with institutions and agencies to whom vaccination
will be delegated, where applicable?
Does the plan develop protocols for verification of priority
group membership?
Sub-objective B.6.1 - Vaccine Monitoring
Does the plan designate a vaccine safety coordinator position?
Is there a plan to ensure timely reporting of adverse events?
Activity Added by State
RESPOND AND RECOVER
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
DESCRIPTION OF SUPPORTING ACTIVITY CITATION
TO IF
NOT
81
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
Is there a plan to estimate the project area’s weekly allocation of
For this activity and
vaccine based on vaccine availability assumptions and project area
each one below,
population size?
please include
Title
Page(s)
First 5 words of
first sentence
Does the plan include designated recipient's ship-to sites for pre-
pandemic and pandemic vaccine?
Is there a plan for the following:
• Personnel and backups identified for receipt of vaccines
• Detailed written Operating Procedures (SOPS) in place
• Temperature Monitoring (audible/manual or both)
management system in place
• Inventory Accountability
Does the plan determine what proportion of vaccine will be
allocated to each ship-to site?
At ship-to sites, is there a process to determine what proportion of pre-
pandemic and pandemic vaccine will be allocated to further points of
distribution, if applicable? Is the Distribution manager identified?
Does the plan ensure the availability of sufficient storage at
all relevant locations to maintain the cold chain?
Does the plan determine how vaccine will be transported to
vaccinating sites?
Does the plan include chain of custody procedures?
Does the plan include a vaccine security plan that includes State-level
Security coordinator identified, State security support agencies
identified, vulnerability assessment, badging/credentialing system in
place?
Does the plan determine number and location of clinics based on
planning assumptions? Does it include:
• MOA’s (or other appropriate documentation)
• Points of contact identified
Does the plan include estimated number of doses to be administered per
shift, based on assumed vaccine availability and relative allocation
within project areas?
Does the plan identify sources of staffing and develop
memoranda of agreement with the following:
• Backups identified
• Job descriptions
Does the plan include an incident response plan for security situations?
Does the plan include instructions about a second dose?
Does the plan include how data will be collected at the
administration sites?
Activity Added by State
82
APPENDIX B.7
Operating Objective: Provide Health Care
This appendix provides State planners with recommendations for developing health care operational
plans to manage an influenza pandemic. These recommendations are not intended to be prescriptive in
nature, but are intended to provide expected outcomes of the planning process. The spectrum of
supporting activities under the FEMA framework of “Prepare, Respond and Recover” is critical to
overall State capability. However, only those activities under “Respond” and “Recover” will be
reviewed, since the focus of this guidance is on operational activities. States are asked to provide
detailed information as to how they plan to address only those recommendations in the attached table.
Much of the information in this guidance is extrapolated from the Department of Health and Human
Services (HHS) Pandemic Influenza Plan Supplement 3 Healthcare Planning. This supplement can be
found at: www.hhs.gov/pandem
HU
icflu/plan/sup3.html#s3-11. Additional planning resources are
UH
available at: www.panflu.gov
HU
,
UH
http://www.ahrq.g
HU
ov/prep/#tools, UH
http://www.cna.org/docu
HU
ments/mscc_aug2004.pdf and
UH
www.us
HU
fa.dhs.gov/downloads/pdf/PI_Best_Practices_Model.pdfUH.
PREPARE
States should plan and develop pandemic influenza plans with local, regional, State, and federal
partners. Planning should include, but is not limited to the following:
• Form community-wide coalitions to include hospitals, urgent care facilities, other ambulatory
care facilities, public health, long term care facilities, nursing homes, home health care
agencies, community health centers, primary care offices, mental health and substance abuse
treatment facilities, EMS, and other first responders to accommodate surge in patients expected
from pandemic influenza.
• Assist healthcare facilities in conducting exercises and drills to test health care response issues
and build partnerships among health care and public health officials, community leaders, and
emergency response workers.
• Address the medical concerns and needs of at-risk individuals and populations,
• Assist non-hospital community-based providers for at-risk individuals (e.g. day psychosocial
treatment centers, advocacy organizations with recreational programs, and facilities managing
congregate living in the local community) in participating in exercises and drills to test at-risk
response issues and build partnerships among providers and public health officials, community
leaders, and emergency response workers.
• Develop an interoperable communications infrastructure to facilitate and ensure the timely
dissemination and transfer of information between health care and other sectors (such as
emergency management, public safety, EMS, service providers for at-risk individuals, etc.).
• Address legal and ethical issues that can affect staffing and patient care (such as credentialing
issues and providing care with scarce medical resources).
• Assist the health care community with planning for provision of care in hospitals to include:
hospital surveillance, education and training, triage, clinical evaluation, admission procedures,
83
facility access, occupational health, use and administration of vaccines and antiviral drugs,
surge capacity, security, and mortuary issues.
• Assist the health care community with planning for provision of care in non-hospital settings to
include non-hospital health care facilities (e.g. long term care facilities, dialysis centers, nursing
homes, mental health and substance abuse treatment facilities, Federally Qualified Health
Centers (FQHCs), etc.), home healthcare networks and/or alternative care sites.
• Anticipate needs for medical supplies and equipment to treat complications of pandemic
influenza and determine how supplies will be maintained.
Additional considerations for the Department of Veterans Affairs (VA) and the Indian Health
Service (IHS)
• Are VA and IHS beneficiaries included in the State numbers for PPE, antiviral drugs, vaccine,
etc.?
• Have States encouraged local planners to establish a communication network with local VA
and IHS facilities?
• Have State planners included State and federal VA partners in their planning process?
• Do State planners understand the VA and IHS roles in the National Response Framework?
• Do State planners understand the process for requesting VA and IHS assistance?
84
RESPOND
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
DESCRIPTION OF SUPPORTING ACTIVITY
CITATION TO
IF NOT
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
Interoperable communications network in place between State, public
For this activity and
health, health care community, and other sectors.
each one below,
please include
Title
Page(s)
First 5 words of
first sentence
Mechanism in place to address the concerns and needs of at-risk
individuals and populations.
Mechanism in place to provide guidance (as needed) on infection
control measures for health care and non-healthcare settings
Procedures for reporting available beds using National Hospital
Available Beds for Emergencies and Disasters (HAvBED) System
definitions
Procedures for deploying and tracking volunteer health care providers
using the State’s Emergency System for Advance Registration of
Volunteer Health Professionals (ESAR-VHP) requirements
Procedures developed and approved by an Ethics Committee for
providing for the ethical distribution of scarce medical resources among
the health care community
Procedures to expand healthcare services into non-hospital/alternate
care sites including identification of locations, scope of care,
procurement of staffing, equipment, supplies and pharmaceuticals
Activity Added by State
85
RECOVER
79B
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
DESCRIPTION OF SUPPORTING ACTIVITY
CITATION TO
IF NOT
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
Recovery mechanism in place to assist the health care
For this activity and each
community in restoring essential staffing, equipment, supplies
one below, please include
and pharmaceuticals
Title
Page(s)
First 5 words of first
sentence
Recovery mechanism in place for assisting with plans for
restoring essential mental health, substance abuse and
congregate living services to pre-pandemic conditions.
Recovery mechanism in place to perform after action reviews
to identify strengths and weaknesses in the execution of the
plan
Activity Added by State
86
APPENDIX B.8
Operating Objective: Manage Mass Fatalities
PREPARE
States should base planning on the estimated number of fatalities expected during an influenza
pandemic. Planning should address the need for expanded refrigerated storage capacity and body bags,
and delineate roles and responsibilities of all agencies involved in mass fatality management.
Challenges
-
Roles of local, State and federal partners
-
Functionality of local coroners
-
Contamination, bodily fluids and other hazards
-
Crime scene considerations and evidence preservation
-
Political pressure to “do something”
-
Contract development and monitoring
-
Data collection and other contract performance issues
Develop a Fatality Management plan
U
• May need a temporary interment site initially
• Must be large enough to accommodate the need
• Consider options other than cold storage units
• Consider public property first – especially if this may be the final resting place
• Consider a permanent memorial in the event of a specific result of natural / terror-related
incident.
• Use local transport to transport remains from home or collection point directly to morgue.
Incorporate security measures at the collection points.
• Work with the Religious Ritual Burial Committees- establish fatality plans that either
utilize their services or can meet their religious traditions to the best of ability considering
the circumstances of the situation.
• Consider implementing a unified fatality management task force structure
• Ensure coordination with local authorities
• Database synchronization and networking are critical components in support of information
management
• Integration between morgue operations and Family Assistance Center (FAC) operations
87
RESPOND AND RECOVER
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
DESCRIPTION OF SUPPORTING ACTIVITY
CITATION TO
IF NOT
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
Arrange for Web-based death certificate processing and secure tracking
For this activity and
to the State Department of Health.
each one below,
please include
Title
Page(s)
First 5 words of
first sentence
Plan for [behavioral health/grief] community education that includes an
expectation of death at home, not in a medical facility.
Plan for [behavioral health/grief] public messages to address
stress management
Activity Added by State
88
APPENDIX B.9
Operating Objective: Ensure Communication Capability During Each
Phase of a Pandemic
This appendix provides planners with information that should be included in emergency operations
plans to support both the tactical equipment/hardware communication capability and the risk
communication capabilities during an influenza pandemic. Additional items for consideration for
planning can be found at
http://www.pandemicflu.gov/plan/States/Statelocalchecklist.html#communications.
HU
UH
PREPARE
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
DESCRIPTION OF SUPPORTING ACTIVITY
CITATION TO
IF NOT
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
Sub-objective B.9.1 - Operating Plans for Two-Way Communications
Does a plan exist for two-way communications through the State
For this activity and
Emergency Operations Center between (1) State partners (e.g.,
each one below,
health, emergency management, education, transportation, economic
please include
development) and (2) regional multi-agency coordination centers
(regional healthcare coalitions, local public health, local emergency
management, EMS, local Citizen Corps, etc.)?
Title
Page(s)
First 5 words of first
sentence
Does the plan ensure a process to ensure redundant communications
systems are in place in the event that primary communications
systems are unavailable?
Does the plan ensure a process to ensure that communication
networks (equipment/hardware) between Command and Control
locations and support agencies will be tested and exercised at least
quarterly?
Does the plan ensure a process for an intraState communication
enhancement network to ensure that public health communicators at
all levels of State and local government are interacting on a regular
basis with uniform communications?
Does the plan ensure access to information systems that have been or
are being evaluated for PHIN* compliance *All States are expected
to have or to be working towards information technology systems
whose implementation meets the PHIN requirements, as per
Pandemic Influenza Guidance Supplement to the 2006 Public Health
Emergency Preparedness Cooperative Agreement Phase II.
Does the plan include a process for communicating preparedness
messages to the public?
89
Does the plan ensure that communication processes (working from
the JIC) will be exercised at least bi-annually?
Activity Added by State
Sub-objective B.9.2 - Culturally-Appropriate and Language Specific Information
Does the plan ensure a process for the development of culturally
appropriate and language-specific essential information in
appropriate media and in advance as part of the preparation for an
influenza pandemic?
• Culturally-appropriate?
• Pictograms?
• Available to special needs populations (such as disability
communities (including those that are hearing or visually
impaired), citizens with low level English comprehension
and individuals with English as a second language?
Identification of trusted leaders, liaisons, or other networks in
communities for effective outreach and information dissemination?
Activity Added by State
RESPOND AND RECOVER
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
DESCRIPTION OF SUPPORTING ACTIVITY
CITATION TO
IF NOT
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
Sub-objective B.9.3 - Development and Dissemination of Essential Information
Does the plan include a crisis communication and emergency risk
For this activity and
plan (for public information and media, partner, and stakeholder
each one below,
relations) that addresses all phases of an influenza pandemic?
please include
Title
Page(s)
First 5 words of first
sentence
Does the plan address how State and local health departments will
work with other response organizations to educate the media, public,
partners and stakeholders, specifically including:
• Designated line and staff responsibilities for the public
information team
• Information verification and clearance/approval procedures
for public information releases
• Regional/stand and/or local media contact list with normal
duty and after-hour contact numbers and addresses
• Contact numbers/addresses for emergency response
information partners (e.g., Governor’s public affairs officers,
local FBI public information agent in charge, American Red
90
Cross and other non-government organizations)
• Procedures to join the Joint Information Center (JIC) of the
State Emergency Operations Center (if activated)including a
call-down list with contact information for primary and
secondary staff members
Does the plan ensure that rapidly-needed public health
recommendations and information can be provided to the public,
partners and stakeholders during a pandemic, specifically including:
• Critical communication links to other intra-dept and inter-
dept response officials
• Identification of vehicles of information dissemination to
public, stakeholders, partners (e.g., e-mail, fax, Health Alert
Network messages, brochures, PSAs, press releases)
• A contact list of additional persons outside the State health
department who can be available as subject matter experts
on pandemic health issues if needed
• Support materials for public health issues that are unique to
an influenza pandemic such as issues of isolation,
quarantine, social distancing, and public health law have
been prepared
• Use of hotlines and other community resources to respond to
local questions from the public and professional groups
Does the plan identify individuals responsible for development and
dissemination of multi-media essential information to the general
public and professional response partners (e.g., regional multi-agency
coordination centers, State emergency managers, State transportation
officials) to enhance their respective preparedness before and during
an influenza pandemic?
Activity Added by State
Sub-objective B.9.4 - Culturally-Appropriate and Language Specific Information
Does the plan ensure a process for the development of culturally
appropriate and language-specific essential information in
appropriate media and in advance as part of the preparation for an
influenza pandemic?
• Culturally-appropriate?
• Pictograms?
• Identification of trusted leaders/liaisons in communities for
information dissemination?
Activity Added by State
Sub-objective B.9.5 - Media Spokesperson
Does the plan include a list of trained spokespersons to work with the
media?
Does the plan include an up-to-date contact list of key stakeholders
and media contacts?
Does the plan include a process for regular briefings and updates with
key stakeholders to develop working relationships in the event of a
pandemic:
• Ethnic/language-specific media
• Main media
• Special needs/at risk populations
Activity Added by State
91
APPENDIX B.10
Operating Objective: Mitigate the impact of an influenza pandemic on
workers in the State
Intent: To ensure workers are supported during and after a pandemic.
Note that States should also help employers and individuals prepare to implement community
mitigation strategies and assist them in understanding the importance of pandemic planning. See
Appendix B.3, Implement Community Mitigation Interventions and the Annex for recommendations
on actions that can be taken to assist employers and individuals.
States should: 1) assess which State benefits and other assistance programs can help workers during a
pandemic and whether new resources, laws or programs may be needed, and 2) provide information to
help workers and their families prepare for a pandemic. Many individuals in the State will be unable
to work due to illness, the need to care for ill family members, the need to stay home temporarily when
exposed to an ill person, or the need to care for a child dismissed from school. Some workers will lose
their jobs because of the pandemic; others may be on unpaid leave (after exhausting their paid leave or
because they do not have paid leave). States need to assess the benefits and services available to
workers during a pandemic in order to assist them.
a. UReview State and federal benefit programsU that may assist workers, particularly unemployed
workers. Programs of particular importance during or after a pandemic may include: children,
youth and family protective services; juvenile justice; foster care; income support services; and
public-supported food and nutrition services.
For workers who become unemployed and are looking for work, the relevant State or
federal programs may include: unemployment insurance (UI) (and perhaps Disaster
Unemployment Assistance (DUA)), Food Stamps, medical assistance, and cash assistance.
Some States may also have Dislocated Worker Rapid Response Units.
For workers who become unemployed and are unable to work during a pandemic,
assistance may include Food Stamps, medical assistance, and cash assistance programs.
(Note that workers are generally not eligible for UI/DUA if they are not available for work.
This may occur more frequently than usual during a pandemic because of the need to care
for children dismissed from school.)
b. Assess triggers for these program
U
s to determ
U
ine if the unique circumstances of a pandemic
affect workers’ eligibility for these programs. For State-provided programs or services,
determine if additional legal/statutory and other flexibilities may be needed.
If there is a State family and medical leave law, assess whether the State law will be
applicable for workers who need to take time off from work during a pandemic, i.e.,
whether eligibility requirements would be met for those with a job but unable to work due
to care of sick family members, care for children dismissed from school, or because they
themselves are ill.
For workers who become ill with pandemic influenza at work, assess whether workers’
compensation benefits plans would generally apply and thus could provide temporary
income support.
Assess whether there are State-supported, local, or non-profit mental health and substance
abuse services that may be able to provide psychological and social support to workers and
92
their families during and after a pandemic. Include these services in State pandemic
planning resource lists.
c. Assess whether these State services or benefits can be provided during a pandem
U
ic withU Usocial
distancing practices in place and with a reduced State workforceU. Review agency plans to
handle a potential increase in filing of claims or requests for service. (See Appendix A.1, Part
I.)
d. Discuss pandemic plans and coordinate with current workforce partners in order to Umatch
unemployed workers with employersU who may have additional labor force needs during a
pandemic. Assess whether these Uemployment servicesU can be provided with social distancing
practices in place and with a reduced State workforce. (See Appendix A.1)
e. UAssess what post-pandemic services or benefitsU may be needed for workers, particularly those
that are unemployed; include the need for psychological and social support. (Psychological and
social support services may be available from community or other non-profit sources if they are
not available from the State.)
Note: The text above is provided to assist the State in understanding what is required and the reasoning
behind the requirements in the “PREPARE” section of the table. The “RESPOND AND RECOVER”
section of the table lists actions to be taken during or after a pandemic that should be included in the
State’s pandemic plan. (Whether some “RESPOND AND RECOVER” actions will be taken depends
on specific conditions, such as the severity of the influenza pandemic.)
PREPARE
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
DESCRIPTION OF SUPPORTING ACTIVITY
CITATION TO
IF NOT
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
Review State and federal benefit programs and services that may assist
For this activity and
workers, particularly unemployed workers; assess triggers for these
each one below,
programs and services; implement any needed changes
please include
Title
Page(s)
First 5 words of
first sentence
Assess whether services or benefits can be provided with social
distancing practices in place and with a reduced State workforce; review
agency plans to handle a potential increase in filing of claims or
requests for service
Discuss pandemic plans and coordinate with current workforce partners
Assess what post-pandemic services or benefits may be needed for
workers, particularly those that are unemployed (include psychological
and social support)
Activity Added by State
93
RESPOND AND RECOVER
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
DESCRIPTION OF SUPPORTING ACTIVITY
CITATION TO
IF NOT
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
Communicate to State workers the availability of any new
For this activity and
programs or services (See Appendix B.9)
each one below,
please include
Title
Page(s)
First 5 words of
first sentence
Implement any special programs/ triggers/statutes for
assisting workers during a pandemic
Implement any special programs/ services for assisting
workers after a pandemic (include psychological and social
support)
Activity Added by State
94
APPENDIX B.11
Operating Objective: Understand Official Communication Mechanisms
For Foreign Missions, International Organizations, and Their Members
in the United States
While States do not have any official role to play in communicating with foreign missions,
international organizations and their members, it is important for them to understand that the US
Department of State (DOS) will communicate with these entities. The DOS message will be one of
expectation that employees of diplomatic missions follow the instructions of the State and local
officials – just like the U.S. citizen population.
PREPARE
Regarding international coordination, DOS will take the lead, with input from HHS and other relevant
agencies, on communications with foreign governments, foreign missions in the United States34 F and U.
F
S. citizens abroad. DOS will also serve as the USG’s interagency coordinator for general international
communications; it will review the domestic pandemic communications of other USG agencies for
possible international ramifications.
Employees of diplomatic missions are expected to cooperate (just like everyone else) with the State
and local officials as they carry out their duties in the event of a pandemic situation. DOS will ensure
that all foreign missions are reminded of that, in the event of an actual pandemic. In the event that
problems or questions that arise when local officials are carrying out their duties, and dealing with
foreign missions, the DOS has provided, in the Annex, how a State should obtain assistance from
DOS.
Upon WHO Designation of Phase 4: Upon the Director General of the World Health Organization
announcement that there is evidence of significant human to human transmission such that the world
has entered “Phase 4” of the global influenza preparedness plan, DOS and HHS will implement the
following plan:
Formal Communication of Phase 4 to th
U
e Foreign Government Mission Community:
DOS will issue a Circular Diplomatic Note to the Chiefs of all Foreign Missions and International
Organizations informing them of the measures that the United States is taking to address the pandemic,
the legal and practical concerns of that community, and provide information on how to transmit
questions or concerns to the DOS pertaining to the Pandemic Influenza. The Circular Diplomatic Note
will also set forth the expectations of foreign mission personnel. For example, if, as part of a targeted
layered containment the public is requested to stay at home, not attend schools, minimize shopping and
other social interaction, the same request is likely to be made of the foreign mission community.
The Circular Diplomatic Note will be posted on the Pandemic Influenza section of the DOS Office of
Foreign Mission’s (OFM) website HUwww.State.gov/ofmUH; it will also be disseminated to foreign missions
and international organizations via electronic mail, US mail and facsimile. OFM’s six regional offices
34 National Strategy for Pandemic Influenza: Implementation Plan (May 2006), Action #4.1.4.3.
95
(Chicago, Houston, Los Angeles, Miami, New York and San Francisco) will ensure that the note is
distributed to the consulates located in their respective regions.
HHS will use its existing networks with State, local and tribal leaders to convey any guidance prepared
by the Department of State. The HHS Office of Intergovernmental Affairs will send such guidance to
governors’ health policy advisors and other key State, local and tribal officials, as well as national
organizations representing governors, State legislators and State and local health officials, and tribal
leaders. These organizations include the National Governors Association, Association of State and
Territorial health officials, National Association of Counties, National Association of County and City
Health Officials, U.S. Conference of Mayors, National Congress of American Indians, and National
Indian health Board. In addition, the HHS Regional Directors will conduct outreach to appropriate
State, local and tribal officials, as needed.
DOS guidance that HHS will share with such authorities might well include a copy of the Circular
Note, as well as any relevant considerations in the context of implementing measures that address the
pandemic that would arise in the context of the privileges and immunities enjoyed by some members
of that community. For example, if relevant, DOS may want to remind such authorities that while
certain foreign mission personnel have personal inviolability and cannot be arrested or detained, they
do have a duty to “respect” local law. In addition, it may be relevant, for example, that diplomatic
mission premises cannot be entered without the consent of the chief of mission.
Reference: http://www.State.gov/ofm/c19455.htm
HU
U
RESPOND AND RECOVER
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
DESCRIPTION OF SUPPORTING ACTIVITY
CITATION TO
IF NOT
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
The State ensures that localities include foreign missions in For this activity and
the distribution lists of public messages regarding pandemic each one below,
influenza and precautions needed to be taken by
please include
individuals.
Title
Page(s)
First 5 words of
first sentence
Activity Added by State
96
APPENDIX B.12
Operating Objective: Assure the Emergency Medical Services System
(EMS) and the 9-1-1 System are Integral Component of a State’s
Pandemic Influenza Planning and Response.
An influenza pandemic could seriously impact the Nation – its health care delivery system, its
transportation system, its economy and its social structure. As the nation’s health care “safety net,”
Emergency Medical Services will be faced with higher demands for services while experiencing
problems similar to the rest of the Nation – increased employee absenteeism, disruption of supply
chains and increased rates of illness and death. Ensuring EMS is well-integrated into the Nation’s
pandemic influenza planning and response is essential to the Nation’s health and safety in the event of
a pandemic.
This operating objective and sub-objectives are adopted from the U.S. Department of Transportation’s
EMS Pandem
U
ic Influenza Guidelines for Statewide Adoption dUeveloped in response to Task 6.1.13.6
of the National Strategy for Pande
U
mic Influenza: Implementation Plan.U The document is available
online at www.e
HU
ms.govUH States and local EMS agencies are encouraged to review these documents for
additional information on EMS and 9-1-1 Influenza Pandemic planning and response. The sub-
objectives are as follows:
Sub-objective 1. EMS planning
Sub-objective 2. EMS as a component of influenza surveillance & mitigation
Sub-objective 3. Maintaining continuity of EMS operations
Sub-objective 4. Legal authority for EMS operations during pandemic influenza
Sub-objective 5. Clinical standards and treatment protocols
Sub-objective 6. EMS Workforce protection
Sub-objective 1: EMS Planning
PREPARE
EMS must be “at the table” to provide leadership during planning of State and community pandemic
influenza surveillance, mitigation and response. EMS must be a part of community-wide planning and
exercise. EMS pandemic influenza plans should address all patient population including children, the
elderly, and those with special needs.
• State, local, tribal, and territorial EMS agencies should adopt EMS pandemic influenza plans
and operational procedures that define the role of EMS in preparing for, mitigating and
responding to pandemic influenza.
• State, local, tribal, and territorial pandemic influenza plans and operational procedures should
identify leadership and authority that are consistent with the National Response Framework and
the National Incident Management System, including the Incident Command System, and be
carefully coordinated with local emergency management plans.
97
• EMS pandemic influenza plans should establish a program of pre-pandemic training and
exercising to prepare EMS personnel for their role in the local pandemic influenza plan.
• State, local, tribal and territorial EMS agencies, in coordination with Federal, State and local
public health, 9-1-1, emergency management and health care officials should ensure that EMS
pandemic influenza plan define a process for gathering and developing updated pandemic
influenza information, including clinical standards, treatment protocols and just-in-time
training and disseminate it to local EMS medical directors and EMS agencies.
• State, local, tribal, and territorial EMS and 9-1-1 agencies should define a public and media
communications plan that is coordinated with the Incident Command System and public health
officials to assure consistent education and instructions to the public.
RESPOND
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
DESCRIPTION OF
CITATION TO
IF NOT
SUPPORTING ACTIVITY
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
Has the State adopted EMS pandemic influenza plans and operational
For this activity
procedures that define the role of EMS in preparing for, mitigating and
and each one
responding to pandemic influenza?
below, please
include
Title
Page(s)
First 5 words of
first sentence
Has the State established a Statewide program of pre-pandemic training and
exercising to prepare EMS personnel for their role in preparing for,
mitigating and responding to pandemic influenza?
Has the State established a method for developing and distributing pandemic
influenza information, including clinical standards, treatment protocols and
just-in-time training to local EMS medical directors and EMS agencies?
Activity Added by State
98
RECOVER
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
DESCRIPTION OF
CITATION TO
IF NOT
SUPPORTING ACTIVITY
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
Has the State established methods to integrate best practices or lessons
For this activity
learned during the previous pandemic wave into EMS system operations and and each one
to issue an after action report?
below, please
include
Title
Page(s)
First 5 words of
first sentence
Activity Added by State
Sub-objective 2: The Role of EMS in Influenza Surveillance and Mitigation
PREPARE
State, local, tribal, and territorial EMS agencies should integrate pandemic influenza surveillance,
mitigation and response in their EMS system. An EMS system’s response to pandemic influenza
should be flexible, scaleable, dynamic and timely with the ability to change rapidly based on new
information about the virus and other public health emergencies. Standards, protocols and other
guidelines will be modified based on the specific threat to the public’s health.
EMS providers can play a role in pandemic influenza mitigation due to their capability to rapidly
respond, assess, treat and report patients with signs and symptoms of pandemic influenza. Their early
involvement in community mitigation strategies such as Targeted Layered Containment may help to
control the spread of the virus and reduce the subsequent use of health care resources.
• State, local, tribal, and territorial EMS pandemic influenza plans should identify the role that
EMS agencies should play in ongoing disease surveillance.
• State EMS pandemic influenza plans should establish or identify a Statewide system that
tracks: a) patient location, b) healthcare facility availability, and c) patient disposition to allow
public health and epidemiologic analysis.
• State, local, tribal, and territorial EMS agencies, in coordination with public health
authorities and consistent with resources, legal authority and education, should define
procedures for involving EMS providers in pandemic influenza community mitigation
strategies, including Targeted Layered Containment.
99
RESPOND AND RECOVER
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
DESCRIPTION OF
CITATION TO
IF NOT
SUPPORTING ACTIVITY
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
Has the State established procedures for involving EMS agencies in ongoing
For this activity
disease surveillance?
and each one
below, please
include
Title
Page(s)
First 5 words of
first sentence
Has the State identified procedures for involving EMS providers in
pandemic influenza community mitigation strategies, including Targeted
Layered Containment?
Activity Added by State
Sub-Objective 3: Maintaining Continuity of EMS Operations During an Influenza Pandemic
PREPARE
Continuity of operations planning for EMS should address maintaining the day-to-day EMS response
during a pandemic; workforce augmentation; disruption of equipment, supplies and services;
interoperable communications; and compatible communications equipment and communications
frequencies.
• As part of a systematic all-hazards approach to EMS pandemic influenza planning, State,
local, tribal, and territorial EMS agencies should have plans in place that allow EMS to
maintain its response to day-to-day emergencies while addressing the demands of pandemic
influenza mitigation.
• State, local, tribal, and territorial EMS pandemic influenza plans should include a continuity
of operations (COOP) plan that ensures essential functions and vital services can be
performed during an influenza pandemic or other major public health emergency.
• State, local, tribal, and territorial EMS agencies should have backup plans to augment the
EMS workforce.
• EMS agencies should plan for disruptions in the availability of equipment, supplies and
services.
100
• State, local, tribal, and territorial EMS pandemic influenza plans should include effective,
reliable interoperable communications systems among EMS, 9-1-1, emergency management,
public safety, public health and health care agencies.
• EMS pandemic influenza plans should include compatible communications equipment and
communications radio frequency plans for common hospital diversion and bed capacity
situational awareness at the local, State and regional level.
RESPOND AND RECOVER
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
DESCRIPTION OF
CITATION TO
IF NOT
SUPPORTING ACTIVITY
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
Does the State have backup plans to augment the local EMS workforce if
For this activity
needed?
and each one
below, please
include
Title
Page(s)
First 5 words of
first sentence
Does the State have backup plans to address disruptions in the availability of
EMS equipment, supplies and services throughout the State?
Does the State have an effective, reliable interoperable communications
system among EMS, 9-1-1, emergency management, public safety, public
health and health care agencies?
Is there a Statewide communications plan, including communications
equipment and radio frequency plan to support common hospital diversion
and bed capacity situational awareness at the local, State and regional level?
Activity Added by State
Sub-Objective 4: Legal Authority
PREPARE
Planning for EMS operations during an influenza pandemic should address issues of legal authority
such as deviation from established procedures and EMS freedom of movement.
• State EMS pandemic influenza plans should establish procedures for EMS providers to
deviate legally from their established treatment procedures to support mitigation of and
response to pandemic influenza and other public health emergencies while still assuring
appropriate education, medical oversight and quality assurance.
101
• State EMS pandemic influenza plans should, in coordination with public health, emergency
management, and law enforcement agencies, identify mechanisms to ensure freedom of
movement of EMS assets (vehicles, personnel, etc.).
RESPOND AND RECOVER
DESCRIPTION OF
CITATION TO
IF NOT
SUPPORTING ACTIVITY
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
Has the state established procedures for EMS providers to deviate legally
For this activity
from their established treatment procedures to support mitigation of and
and each one
response to pandemic influenza and other public health emergencies while below, please
still assuring appropriate education, medical oversight and quality
assurance?
include
Title
Page(s)
First 5 words of
first sentence
Has the state identified mechanisms to ensure freedom of movement of
EMS assets (vehicles, personnel, etc.)?
Activity Added by State
Sub-objective 5: Clinical Standards and Treatment Protocols
PREPARE
Planning for EMS pandemic influenza clinical standards and treatment protocols should address EMS
medical direction; modification of treatment and triage protocols; rapid distribution of new protocols;
just-in-time training; fatality management; and EMS treat and release.
One solution or protocol may not be applicable for all EMS systems at a State or a local level. It is
impossible to establish one set of protocols/procedures that works for every single jurisdiction.
Optimal patient outcomes will depend on an EMS system’s pre-planned ability to quickly integrate
emerging medical research/information. The effectiveness of patient care will require responsive
medical direction, training and coordinated system oversight.
EMS and 9-1-1 stakeholders must be integrated into the Incident Command System and be fully
engaged as collaborative partners in the response to pandemic influenza. Pandemic influenza
mitigation and response may require the integration of disciplines not traditionally involved in incident
mitigation and response, such as medical direction, EMS education, disease surveillance and 9-1-1.
• Each State, local, tribal, and territorial EMS system should have an EMS medical director to
provide medical oversight of EMS pandemic influenza planning, mitigation and response.
• State, local, tribal and territorial EMS pandemic influenza plans should define mechanisms for
rapid development, adoption or modification of prehospital clinical standards and triage and
102
treatment protocols before or during an influenza pandemic that are based upon the most recent
scientific information.
• State, local, tribal, and territorial EMS pandemic influenza plans should define consistent,
system-wide procedures for the rapid distribution of new or modified prehospital EMS
treatment and triage protocols before or during an influenza pandemic.
• State, local, tribal, and territorial EMS pandemic influenza plans should define a process for
providing just-in-time training for EMS agencies, EMS providers, EMS medical directors
and PSAPs.
• State, local, tribal, and territorial EMS pandemic influenza plans should coordinate with public
health and 9-1-1 officials and the local medical examiner/coroner to define protocols and
processes for fatality management during pandemic influenza.
• EMS pandemic influenza plans should consider the role EMS providers could serve in
“treating and releasing” patients without transporting them to a healthcare facility.
RESPOND AND RECOVER
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
DESCRIPTION OF
CITATION TO
IF NOT
SUPPORTING ACTIVITY
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
Is there coordinated Statewide medical oversight of EMS pandemic
For this activity
influenza planning, mitigation and response?
and each one
below, please
include
Title
Page(s)
First 5 words of
first sentence
Has the State developed mechanisms for rapid development, adoption or
modification of prehospital clinical standards and triage/ treatment protocols
before or during an influenza pandemic that are based upon the most recent
scientific information?
Has the State defined consistent, system-wide procedures for the rapid
distribution of new or modified prehospital EMS treatment and triage
protocols before or during an influenza pandemic?
Has the State defined a process for providing just-in-time training for EMS
agencies, EMS providers, EMS medical directors and PSAPs?
Has the State defined the role of EMS providers in “treating and releasing”
patients without transporting them to a healthcare facility?
Activity Added by State
103
Sub-objective 6: EMS Workforce Protection
PREPARE
Planning for EMS workforce protection during a pandemic should address protection of the EMS and
9-1-1 workforce and their families; infection control and decontamination; vaccines and anti-virals for
EMS personnel; isolation and quarantine considerations; and support for EMS personnel and their
families.
• State, local, tribal, and territorial EMS pandemic influenza plans should identify strategies to
protect the EMS and 9-1-1 workforce and their families during an influenza pandemic.
• EMS agencies should consistently practice basic infection control procedures including
vehicle/equipment decontamination, hand hygiene, cough and respiratory hygiene, and proper
use of FDA cleared or authorized medical personal protective equipment (PPE) regardless of
the likelihood of an influenza pandemic.
• State, local, tribal, and territorial EMS pandemic influenza plans should define system-
wide processes for providing vaccines and anti-viral medication to EMS personnel.
• State, local, tribal, and territorial EMS agencies, in coordination with public health
authorities, should identify a mechanism to address issues associated with isolation and
quarantine of EMS personnel.
• State, local, tribal, and territorial EMS pandemic influenza plans should define a process for
offering support services, including mental health services, to EMS personnel and their
families during an influenza pandemic.
104
RESPOND AND RECOVER
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
DESCRIPTION OF
CITATION TO
IF NOT
SUPPORTING ACTIVITY
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
Has the State identified strategies to assist local EMS agencies with the
For this activity
protection of the EMS and 9-1-1 workforce and their families during an
and each one
influenza pandemic?
below, please
include
Title
Page(s)
First 5 words of
first sentence
Does the State have requirements or recommendations for EMS agencies for
basic infection control procedures?
Does the State have system-wide processes for providing vaccines and anti-
viral medication to EMS personnel?
Have State EMS agencies and public health agencies identified mechanisms
to address issues associated with isolation and quarantine of EMS personnel?
Has the State defined processes to supplement local EMS agencies in
offering support services, including mental health services, to EMS
personnel and their families during an influenza pandemic?
Activity Added by State
105
APPENDIX B.13
Operating Objective: Assure the Local, Regional and State Public
Safety Answering Points are an Integral Component of a State’s
Pandemic Influenza Planning and Response
9-1-1 Public Safety Answering Points (PSAPs) serve as the public’s single point of access to EMS, law
enforcement and fire services – as well as an avenue for requesting many other services. Ensuring 9-1-
1 is well-integrated into the Nation’s pandemic influenza planning and response is essential to the
Nation’s health and safety in the event of a pandemic.
This operating objective and sub-objectives are adopted from the U.S. Department of Transportation’s
Pandemic Influenza: Recommendations for Protocol Development for 9-1-1 Personnel and Public
Safety Answering Points (PSAPs), developed in response to Task 6.1.4.2 of the National Strategy for
Pandemic Influenza: Implementation Plan and available online at www.ems.gov. The sub-objectives
H
H
are as follows:
Sub-objective 1. Guiding Principles for Public Safety Answering Points
Sub-objective 2. Provision of information to the public
Sub-objective 3. Facilitation of call screening
Sub-objective 4. Assistance with priority dispatch of limited EMS resources
Sub-objective 5. Education and training of PSAP personnel
Sub-objective 6. Continuity of Operations
Recognizing there is variable State oversight of 9-1-1 services, much of the PREPARE guidance is
oriented toward the PSAP, rather than the State, level. To the extent there is State-level coordination
of 9-1-1, this preparatory information may be useful. The Respond and Recovery chart contains those
activities in which, as a minimum, there should be State-level involvement.
Sub-objective 1: Guiding Principles for Public Safety Answering Points (PSAPs)
PREPARE
There are basic preparation tenets for creating plans and protocols that involve Primary
and Secondary Public Safety Answering Points (PSAPs):
• Overall planning for pandemic influenza must be coordinated with 9-1-1
• “Just-in-Time” training and education must be provided to call-takers and other PSAP
personnel.
• PSAPs should use standardized 9-1-1 protocols that capture symptoms specific to the pandemic
along with other possible indicators
• 9-1-1 personnel should be trained in incident command per the requirements of NIMS.
• PSAPs should have Continuity of Operations Plans in place
• Infection control procedures must implemented in PSAPs.
• PSAPs should be included in community-wide pandemic influenza drills and exercises.
• Effective use of limited PSAP resources should be coordinated with EMS
• PSAP plans should take into account specific accommodations and considerations for special
needs communities.
106
RESPOND
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
DESCRIPTION OF
CITATION TO
IF NOT
SUPPORTING ACTIVITY
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
Does the Statewide pandemic influenza plan delineate the role of PSAPs?
Are PSAPs involved in Statewide pandemic influenza planning
Does the Statewide pandemic flu plan establish mechanisms for “Just-in-
Time” training and education to call-takers and other PSAP personnel?
Is there a consistent Statewide mechanism for communications of pandemic
flu updates to PSAPs?
Does the State pandemic influenza plan establish standardized 9-1-1
protocols that capture symptoms specific to the pandemic?
Activity Added by State
RECOVER
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
DESCRIPTION OF
CITATION TO
IF NOT
SUPPORTING ACTIVITY
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
Does the State have established processes for the integration of best practices
For this activity
or lessons learned during the previous pandemic wave across the 9-1-1
and each one
system and issue an after action report?
below, please
include
Title
Page(s)
First 5 words of
first sentence
Activity Added by State
Sub-objective 2: Provision of Information to the Public
PREPARE
The public has been trained to call 9-1-1 when help is needed, whether the problem is small or large,
urgent or not. The PSAP is a trusted source of information for the public and will be inundated with
calls for help during a pandemic. Plans need to ensure that PSAPs have current, factual information
107
regarding the events affecting their communities, that they have resources to update that information as
changes arise, and that they can effectively communicate that information to the public.
• Plans need to ensure that PSAPs have current, factual information regarding the events
affecting their communities, that they have resources to update that information as changes
arise, and that they can effectively communicate that information to the public.
RESPOND AND RECOVER
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
DESCRIPTION OF
CITATION TO
IF NOT
SUPPORTING ACTIVITY
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
Does the State have a mechanism and protocols in place to coordinate
For this activity
quickly the latest public health and other information and messages with
and each one
PSAPs to assure a coordinated system-wide message?
below, please
include
Title
Page(s)
First 5 words of
first sentence
Activity Added by State
Sub-objective 3: Facilitation of Call Screening
PREPARE
For purposes of monitoring, surveillance, treatment and the potential of contamination and quarantine,
during the influenza pandemic period it will be important for the PSAP to be able to identify callers
who are likely afflicted by the pandemic influenza virus and to assign the appropriate resource to help
them. This resource may not be a responding EMS unit, but an alternative source of care, such as a
nurse assist line or other health care call line.
• PSAP protocols should allow for automated data gathering and data packaging of specific
symptoms for purposes of real-time analysis to identify geographic and temporal clusters of
symptoms and patients.
• PSAPs should establish and maintain policies and procedures for sharing data with State and
local public health authorities.
• PSAPSs should be prepared to query callers with a pandemic influenza symptom set consistent
with recommendations by the local public health office and based on criteria established by the
CDC.
• State and local EMS authorities should be prepared to provide rapid updates to the PSAP
pandemic influenza symptom set.
108
• PSAPs should follow protocols to conduct triage and patient classification during an influenza
pandemic.
RESPOND AND RECOVER
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
DESCRIPTION OF
CITATION TO
IF NOT
SUPPORTING ACTIVITY
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
Does the State pandemic influenza surveillance system incorporate the role
For this activity
of the PSAPs in implementing automated data gathering and data packaging
and each one
of specific symptoms for purposes of real-time analysis to identify
below, please
geographic and temporal clusters of symptoms and patients?
include
Title
Page(s)
First 5 words of
first sentence
Does the State have a mechanism established to disseminate rapid updates to
pandemic influenza symptom set to PSAPs for caller screening and for data
collection/analysis?
Are there Statewide policies and procedures and legal protections for
sharing pertinent data with State and local public health authorities?
Are there Statewide protocols and procedures in place to guide PSAP triage
and patient classification during an influenza pandemic?
Activity Added by State
Sub-objective 4: Assistance with Priority Dispatch of Limited EMS
PREPARE
During an influenza pandemic, EMS and public health resources will likely be limited and normal
services curtailed. In addition to identifying and assisting likely pandemic flu patients, PSAPs will
need to safely triage other non-influenza related requests for help, appropriately matching need to
resource, including alternative treatments, such as nurse assist lines. Telecommunicators need to know
what to tell callers if no response is available or will be delayed. This should be part of the pre-
pandemic planning effort. PSAPs need to have pre-established links with other types of call centers
(such as 2-1-1 or nurse assist lines) or alternate care centers to ensure these resources can effectively be
utilized in transferring or referring callers. PSAPs should ensure that any such plans are in concert with
the appropriate medical and legal authority.
• PSAP protocols should provide for tiered response of different EMS unit types based on input
of local EMS authorities.
• PSAP planning should address the need for dispatch protocols with their EMS medical director
when limited response, severely restricted response or no response occurs.
109
• PSAP protocols should identify those 9-1-1 callers or patients appropriate for transfer to a
secondary triage specialist or alternate call center.
• PSAP planning should include coordination of efforts with alternate call centers and other
resources to handle inquiries regarding death and general information.
• PSAPs should develop mitigation strategies for 9-1-1 call overcapacity.
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
DESCRIPTION OF
CITATION TO
IF NOT
SUPPORTING ACTIVITY
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
Is there Statewide legal authority and protocols to allow tiered response of
For this activity
different EMS unit during a pandemic influenza?
and each one
below, please
include
Title
Page(s)
First 5 words of
first sentence
Does the State pandemic influenza plan establish mechanisms to identify
those 9-1-1 callers or patients appropriate for transfer to a secondary triage
specialist or alternate call center? Is there coordination between public
health, EMS and PSAPs to coordinate this transfer?
Activity Added by State
Sub-objective 5: Education and Training of PSAPs
PREPARE
Establish a training program that will prepare the PSAP for their role during an influenza pandemic.
• Assess the PSAP’s needs for education and training. Determine what responsibilities can be
handled by non-PSAP staff.
• Identify processes and curriculum for regular continuing education and training as well as “just
in time” training to address the specifics of the pandemic.
• Identify existing tools and resources to support the PSAP during a pandemic
• Ensure 9-1-1 personnel are aware of the overall emergency action plan
• Address infection control training for 9-1-1 personnel
• In the planning process, PSAPs need to address how they will staff different positions based on
the skill levels needed. More routine tasks within the PSAP may be handled with alternative
staffing, with the goal to have trained public safety telecommunicators available to interface
with the public for the most critical 9-1-1 calls.
110
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
DESCRIPTION OF
CITATION TO
IF NOT
SUPPORTING ACTIVITY
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
Does the State identify PSAP pandemic influenza continuing education and
For this activity
training?
and each one
below, please
include
Title
Page(s)
First 5 words of
first sentence
Does the State identify methods for pandemic influenza “just in time”
training for PSAP personnel and their medical directors that is coordinated
with EMS, public safety and public health?
Activity Added by State
Sub-objective 6: Continuity of Operations
PREPARE
Consider the needs of the PSAPS beyond the normal planning that exists in the Continuity of
Operations Plan.
• Identify staffing alternatives (retirees, former employees, staff from other departments to free
up trained staff and supervisors to answer critical 9-1-1 calls).
• Identify infection control procedures specifically for the pandemic influenza virus.
• Identify isolation and quarantine policies and procedures.
• To limit the exposure of 9-1-1 staff, identify isolation and lock-down procedures. Identify on-
site treatment areas for those who have become infected.
• Identify policies related to paid and unpaid leave and care of the families of PSAP staff.
• State and local 9-1-1 pandemic influenza plans should define system-wide processes for
vaccinating 9-1-1 personnel, as an element of the critical infrastructure.
• State 9-1-1 pandemic influenza plans should, in coordination with public health, law
enforcement and emergency management agencies, identify mechanisms for freedom of
movement of PSAP personnel.
111
RESPOND AND RECOVER
DESCRIPTION OF
CITATION TO
IF NOT
SUPPORTING ACTIVITY
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
Does the state define isolation and quarantine policies and procedures for
For this activity
PSAPs?
and each one
below, please
include
Title
Page(s)
First 5 words of
first sentence
Does the state define system-wide processes for vaccinating 9-1-1 personnel,
as an element of the critical infrastructure.
Does the state identify mechanisms for freedom of movement of PSAP
personnel?
Activity Added by State
112
APPENDIX B.14
Protect Citizens: Operational Readiness (Testing through Exercises and
Real Events)
A defining characteristic of an operating plan is that, in whole or in part, it readily lends itself to
evidence-based evaluation using the results of discussion-based exercises (“table tops”), operational-
based exercises (drills and enacted responses to simulated incidents), or performance measurements
obtained in the course of responses to actual incidents.
The table below describes the type of information that is requested regarding readiness to meet the
Operational Objectives that constitute the Goal “Protect Citizens”. Although an imperfect measure of
readiness, this information tells reviewers that States have practiced and tested their plans – through
exercises or responses to real events – and used the results of such experience to improve their
pandemic influenza preparedness.
The USG Departments jointly will assign a single rating for Operational Readiness for the entire State
submission. In particular, based on the information requested at the end of each sub-Appendix, the
Departments will determine the number of the Operating Objectives for which the State submitted
evidence that it has tested its response capability in some appropriate way. This number then will be
divided by the total number of Operating Objectives, expressed as a percentage, and translated into a
standardized verbal designation in accord with the key shown in the text box.
Key:
>
U
U
50% - “Substantial Evidence of Operational Readiness”
25-49% - “Significant Evidence of Operational Readiness”
1-24% - “Little Evidence of Operational Readiness”
No submission or a non-responsive submission will be classified as “insufficient information to enable
assessment.”
In accord with the table below, please indicate, for each Operating Objective, whether or not an aspect
of that objective was tested. If it was tested, what was the measurable objective that was tested (this
would have been your exercise objective or the objective you were trying to achieve during a
response)? Then, please provide one or two sentences about the a change that was made to the State
operating plan as a result of the lessons learned and incorporated into an Improvement Plan and then
acted upon.
113
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
PROTECT CITIZENS: OPERATING READINESS
Operating Objective
Tested?
What was tested and
How did result improve the
80B
F
35 (Y/N)
why?36
Operating Plan?
F
F
F
Ensure Surveillance and
Laboratory Capability During
Each phase of a Pandemic
Assist with Controls at U.S.
Ports of Entry
Implement community
Mitigation Interventions
Enhance Sate Plans to Enable
Community Mitigation Through
Student Dismissal and School
Closure
Acquire and Distribute Medical
Countermeasures
Ensure Mass Vaccination
81B
Capability During Each Phase
of a Pandemic
Provide Healthcare
82B
Manage Mass Casualties
83B
Ensure Communication
84B
Capability During Each Phase
of a Pandemic
Mitigate the Impact of an
85B
Influenza Pandemic on Workers
in the State
Understand Official
86B
Communication Mechanisms
For Foreign Missions,
International Organizations, and
Their Members in the United
States
Integrate EMS and 9-1-1 into
87B
Pandemic Preparedness
Integrate Public Safety
88
B
Answering Points into
Pandemic Preparedness
Public Safety and Law
89B
Enforcement
35 Examples of events might include: National Governor’s Association regional exercises, Department of Treasury national
finance and banking CIKR exercise, TOPOFF, wildfire response, intraState antiviral drug distribution exercise, Hurricane
Dean response, and use of VTC to conduct regional workshops to inform planning.
36 If an exercise, what was the purpose? If a real-world incident, what was its nature?
114
APPENDIX B.15
Operating Objective: Public Safety and Law Enforcement
It is likely that, as health and mortality issues increase during a pandemic, the responsibility of the
justice system will rapidly expand-greater calls for service, added security responsibilities for health
care and related facilities, enforcement of court-imposed restrictions, public education, control of panic
and fear and associated behaviors, and ensuring that the public health crisis is not used as an
opportunity for individual or organizational (criminal) gains. It is critical that all components of public
safety, public and private, be concerned with preserving the rule of law in our communities, whether
they be civil and criminal courts at the state, county or municipal level, law enforcement and private
security agencies, and institutional and community corrections agencies. That can be best achieved
through coordinated planning in advance of a pandemic.
The following guidance from the National Strategy for Pandemic Influenza Implementation Plan37 F is
F
relevant to planning by State law enforcement officials:
8.1.1.1. States should ensure that pandemic response plans adequately address law enforcement
and public safety preparedness across the range of response actions that may be implemented,
and that these plans are integrated with authorities that may be exercised by Federal agencies
and other State, local, and tribal governments.
8.1.1.3. State, local, and tribal governments should review their legal authorities that may be
needed to respond to an influenza pandemic, identify needed changes in the law, and pursue
legislative action as appropriate.
8.1.1.5. States should ensure pandemic response plans address EMS, fire, public works,
emergency management, and other emergency response and public safety preparedness.
8.1.4.1. State, local, and tribal law enforcement agencies should coordinate with appropriate
medical facilities and countermeasure distribution centers in their jurisdictions (as recognized
in Chapter 6, security at these facilities will be critical in the event of an outbreak) to coordinate
security matters.
While it is recognized that the primary State level law enforcement agency does not exercise
operational control over county sheriffs and local law enforcement departments, it is essential that an
appropriate State level agency or committee provide guidance and assistance to local law enforcement
officials to help ensure they have up to date information for protecting their employees and continuing
to provide essential services when facing the challenges created by a pandemic. In addition to
operational considerations, these efforts and procedures could include the development of training
materials and guidance on protective measures for workforce sustainability, as well as meeting the
needs of families.
Coordinated planning with Public Health and Emergency Management officials at the State, county
and local level is also essential to enable a proper response in a public health emergency such as a
pandemic. Similarly, law enforcement officials should ensure there is coordinated planning and
37 A copy of Chapter 8 - Law Enforcement, Public Safety and Security can be found at www.pandemicflu.gov.
115
coordination between all interdependent components of the criminal justice system (courts,
corrections, law enforcement, prosecutors and probation/parole), to ensure uninterrupted essential
services and ability to perform essential functions. Resources to assist states in their planning have
been collected at: http://www.ojp.usdoj.gov/BJA/pandemic/resources.html .
H
H
CDC/HHS has released planning checklists for corrections and law enforcement. These can be found
at http:// www.pandemicflu.gov/workplaceplanning/correctionchecklist.html .
H
H
Coordination at the State level with National Guard officials would also be useful in the event these
guard forces were needed to supplement law enforcement. States should consider making reference to
these resources in their plans and consider the circumstances or “triggers” under which such assistance
would be requested. A memorandum from the National Guard Bureau outlines the procedure for
obtaining support38 .
F
F
In the event State law enforcement and national guard personnel need further augmentation to enforce
order or perform other law enforcement functions, federal law enforcement assistance can be
requested. As a last resort, federal military personnel can also be requested. A letter, which was sent
to each Governor last year, outlines the procedures and requirements for obtaining such assistance39 .
F
F
38 State National Guard law Enforcement Training Requirements are available at ww
HU
w.pandemicflu.gov. UH
39 Requests for Assistance from Federal Military Forces are available at HUwww.pandemicflu.gov. UH
116
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
PREPARE
DESCRIPTION OF
CITATION TO
IF NOT
SUPPORTING ACTIVITY
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
Has the State, in collaboration with local and tribal governments,
For this activity and
reviewed their respective legal authorities relative to what may be
each one below,
needed during an influenza pandemic, assessed whether changes are
please include
needed in laws or regulations, and, if so, pursued legislative remedies?
Title
Page(s)
First 5 words of
first sentence
Has the State provided guidance for local and tribal law enforcement
agencies regarding how to meet the potential security needs of medical
facilities and countermeasure distribution centers during an influenza
pandemic?
Has the State provided local and tribal law enforcement agencies with
training materials and guidance on protective measures for workforce
sustainability as well as the meeting the needs of officers’ household
members?
Activity Added by State
117
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
RESPOND AND RECOVER
DESCRIPTION OF
CITATION TO
IF NOT
SUPPORTING ACTIVITY
SUPPORTING
APPLICABLE,
DOCUMENT
PLEASE
EXPLAIN
How will State officials coordinate the actions of the interdependent
For this activity and
components of the criminal justice system (to include courts,
each one below,
corrections, law enforcement agencies, prosecutors, and
please include
probation/parole officials) to avoid or limit interruption of essential
services and functions during an influenza pandemic?
Title
Page(s)
First 5 words of
first sentence
Are triggers and procedures in place use the National Guard to
supplement State, local, or tribal law enforcement agencies?
Are appropriate State officials aware of the procedures to request
emergency federal law enforcement assistance?
For jurisdictions which have international ports, airports or borders, has
coordination been made with appropriate federal officials in the event
security must be provided for facilities where individuals may be
temporarily quarantined?
Are appropriate State officials aware of the procedures to request
federal military assistance to provide law enforcement functions, or
military equipment and facilities, training, and maintenance support?
Activity Added by State
118
APPENDIX C.0 – GENERIC GUIDANCE FOR SUPPORTING/SUSTAINING
THE
17 CRITICAL INFRASTRUCTURE AND KEY RESOURCE (CIKR) SECTORS
States are responsible for developing and implementing Statewide CIKR protection programs that
reflect and align with the full range of homeland security activities presented in the National
Infrastructure Protection Plan (NIPP). For influenza pandemic specifically, the Department of
Homeland Security (DHS) Pandemic Influenza Preparedness, Response, and Recovery Guide for
Critical Infrastructure and Key Resources (CIKR Pandemic Guide) and Sector-specific Pandemic
Influenza Planning Guidelines (still in development) identify planning and preparedness actions that
entities within each CIKR sector should consider in advance of a pandemic influenza outbreak.
Furthermore, for State CIKR pandemic influenza planning to be comprehensive and successful, State
CIKR plans should accomplish the following:
• address all relevant aspects of CIKR protection, planning, and preparedness;
• leverage support from homeland security assistance programs that apply across the homeland
security mission area;
• emphasize communications and collaboration between government and CIKR public- and
private-sector businesses;
• integrate government and CIKR planning and preparedness actions including training and
exercises; and
• reflect priority activities in their strategies to ensure CIKR businesses have adequate and
appropriate support, resources are allocated effectively, and essential goods and services
remain available during a pandemic event.
State pandemic plans should support public- and private-sector CIKR businesses to ensure continuity
of operations for essential services. For the social and economic well-being of all Americans, these
plans should ensure that critical infrastructure operate as "near normal" as possible. To this end, State
plans should explicitly address seven broad categories regarding their CIKR protection, planning and
preparedness approach:
1. Define CIKR protection, planning and preparedness roles and responsibilities;
2. Build public-private partnerships and support networks;
3. Implement NIPP risk management framework for a pandemic;
4. Bolster CIKR information sharing and protection initiatives;
5. Leverage emergency preparedness activities for CIKR protection, planning and
preparedness;
6. Integrate Federal CIKR protection, planning and preparedness activities.
7. Allocate scarce resources
119
APPENDIX C.1
Operating Objective: Define CIKR Protection, Planning, Preparedness,
Response, and Recovery Roles and Responsibilities
Rationale: The numerous critical roles and responsibilities specific to effectively supporting CIKR sector
essential protection, planning and preparedness activities involves diverse government
departments/agencies at all levels from Federal to local. Ensuring all these government groups are aware of
their roles and synchronized in their efforts will greatly increase the opportunity for success.
PREPARE
These preparedness considerations and activities serve as a reference States can use to augment and
tailor their existing emergency response plans given the unique challenges a pandemic influenza
presents our nation’s CIKR. These potential activities will likely not be found in a State’s operational
plan and therefore will not be graded. While not necessarily applicable to all States, these
considerations represent a starting point for States to stimulate thinking about further actions and
options.
• Identify the gaps, which exist between the State’s current approach with those roles and
responsibilities outlined in the NIPP, SSP, and in CIKR Pandemic Guide.
• Develop a mechanism to identify any government roles and responsibilities that should be
revised, modified, or consolidated to accommodate the unique impacts and environment of a
pandemic influenza outbreak and the operating attributes of the State.
RESPOND AND RECOVER
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
IF NOT
CITATION TO
DESCRIPTION OF
APPLICABLE,
SUPPORTING
SUPPORTING ACTIVITY
PLEASE
DOCUMENT
EXPLAIN
Are the State, local, tribal, and territorial government
For this activity and
surveillance, detection and protection actions described in the
each one below,
Implementation Plan for the National Strategy for Pandemic
please include
Influenza and the HHS Pandemic Influenza Implementation Plan
being effectively implemented to help protect CIKR businesses?
Title
Page(s)
First 5 words of first
sentence
Does the State have a dedicated Pandemic Influenza
Implementation Plan, and does this Plan clearly define the
assigned roles and responsibilities of all State, local, tribal, and
territorial government entities in supporting and sustaining CIKR
essential businesses?
120
Is the State addressing potential gaps in the Plan between the
State’s current assignment and those roles and responsibilities
outlined in the NIPP, SSP, and in CIKR Pandemic Guide?
Has the State identified the authorities and measures necessary
for implementation of these temporary regulatory
adjustments/waivers for CIKR?
Has the State identified and assessed the relevant Federal, State,
local, tribal, and territorial government regulations and oversight
requirements affecting public- and private-sector CIKR business
continuity operations during a pandemic?
Has the State identified temporary adjustments/waivers to
mitigate any negative impacts of these regulations and
requirements on CIKR continuity of operations during a
pandemic that the State and/or other authorized government
regulators may consider using?
Has the State assessed the State’s and/or other authorized
Federal, tribal, territorial or local government regulators’
authorities and other measures necessary for implementation of
any temporary regulatory adjustments/waivers to support and
sustain CIKR?
Has the State communicated and fully coordinated these
potential temporary regulatory adjustments/waivers with all
appropriate CIKR stakeholders?
Activity Added by State
121
APPENDIX C.2
Operating Objective: Build Public-Private Partnerships and Support
Networks
Rationale: Although each government and CIKR entity must strive to become as resilient as practical to
sustain their own operations, the additional strengths derived from effective public-private partnerships and
support networks may prove the difference in whether individual businesses and critical supply chains can
successfully sustain their essential operations over an extended duration during a severe influenza
pandemic
PREPARE
These preparedness considerations and activities serve as a reference States can use to augment and
tailor their existing emergency response plans given the unique challenges a pandemic influenza
presents our nation’s CIKR. These potential activities will likely not be found in a State’s operational
plan and therefore will not be graded. While not necessarily applicable to all States, these
considerations represent a starting point for States to stimulate thinking about further actions and
options.
• Build effective protection, planning and preparedness support networks with and for CIKR.
Determine if these actions include all appropriate representatives from the relevant CIKR
sectors.
• Identify unique geographical issues, including trans-border concerns, as well as critical
interdependencies within and across sectors and jurisdictions within those geographical
boundaries. Share these issues with all appropriate CIKR.
122
RESPOND AND RECOVER
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
IF NOT
CITATION TO
DESCRIPTION OF
APPLICABLE,
SUPPORTING
SUPPORTING ACTIVITY
PLEASE
DOCUMENT
EXPLAIN
For this activity and
each one below,
please include
What mechanism does the State plan to use to coordinate CIKR
pandemic influenza response and recovery efforts?
Title
Page(s)
First 5 words of first
sentence
Has the State identified unique geographical issues, including
trans-border concerns, as well as critical interdependencies
within and across sectors and jurisdictions within those
geographical boundaries affecting CIKR?
Has the State shared these issues with all appropriate public-
and private-sector CIKR partners and support networks?
What specific actions has the State taken to develop and
implement systems to communicate and collaborate with all
appropriate CIKR to build public-private partnerships at the
State, regional and local levels during and after a pandemic
influenza outbreak?
Activity Added by State
123
APPENDIX C.3
Operating Objective: Implement NIPP Risk Management Framework
for a Pandemic
Rationale: The NIPP risk assessment calculus emphasizes identifying and specifically addressing the key
variables of threat, vulnerability and consequence in order to affect potential risk. Given the likely limited
medical and non-medical support resources, exploiting this risk model to better organize and focus
government and CIKR pandemic influenza preparedness actions on the highest priority options for
protecting against the threat, and reducing vulnerabilities and consequences will significantly improve
chances for success.
PREPARE
These preparedness considerations and activities serve as a reference States can use to augment and
tailor their existing emergency response plans given the unique challenges a pandemic influenza
presents our nation’s CIKR. These potential activities will likely not be found in a State’s
operational plan and therefore will not be graded. While not necessarily applicable to all States,
these considerations represent a starting point for States to stimulate thinking about further actions
and options.
• Develop a method to determine risk to prioritized essential resources and services by
combining potential direct and indirect consequences of an influenza pandemic (including
seasonal changes in consequences, and dependencies and interdependencies associated with
each identified asset, system, or network) with known vulnerabilities.
• Aggregate and analyze risk assessment results to develop a comprehensive picture of asset,
system, and network risk to the delivery of prioritized essential resources and services;
establish mitigation priorities based on risk; and determine protection and business continuity
planning and preparedness initiatives that provide the greatest mitigation of risk.
RESPOND AND RECOVER
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
CITATION TO
IF NOT APPLICABLE,
DESCRIPTION OF SUPPORTING ACTIVITY
SUPPORTING
PLEASE EXPLAIN
DOCUMENT
For this activity and
Does the State’s Pandemic Plan include a method to
each one below,
determine risk to prioritized essential CIKR resources and
please include
services by combining potential direct and indirect
consequences of an influenza pandemic (including seasonal
changes in consequences, and dependencies and
Title
interdependencies associated with each identified asset,
Page(s)
system, or network) with known vulnerabilities?
First 5 words of first
sentence
124
In collaboration with appropriate public- and private-sector
partners; has the State identified all the CIKR delivered
“essential” resources and services necessary to sustain the
nation’s social and economic well-being?
Has the State identified, all CIKR delivered “essential”
resources and services to ensure appropriate and timely
allocation of limited government and private sector support
in order to mitigate vulnerabilities and consequences?
Has the State assessed all CIKR delivered “essential”
resources and services to ensure appropriate and timely
allocation of limited government and private sector support
in order to mitigate vulnerabilities and consequences?
Has the State prioritized all CIKR delivered “essential”
resources and services to ensure appropriate and timely
allocation of limited government and private sector support
in order to mitigate vulnerabilities and consequences?
Is there a mechanism in place to identify those individual
or networks of public- and private-sector CIKR assets in a
State that are most likely to be affected and most
vulnerable during a pandemic, and thus may require special
attention and support?
Is there a mechanism that designates the State and private
sector response and recovery roles and responsibilities
necessary to maintain the delivery of essential resources
and services during and after a pandemic influenza
outbreak?
Has the State identified mission critical personnel
(specifically, personnel that work with CIKR or high
consequence systems) to participate in government- or
private-sponsored CIKR response and recovery programs
(i.e., credentialing programs)?
Activity Added by State
125
APPENDIX C.4
Operating Objective: Bolster CIKR Information Sharing and
Protection Initiatives
Rationale: The timely availability of appropriate and valid information to the right decision makers
concerning CIKR sustainment operations and possible/actual status changes will prove critical to
effectively supporting those sustainment needs in times of crisis.
PREPARE
These preparedness considerations and activities serve as a reference States can use to augment and
tailor their existing emergency response plans given the unique challenges a pandemic influenza
presents our nation’s CIKR. These potential activities will likely not be found in a State’s operational
plan and therefore will not be graded. While not necessarily applicable to all States, these
considerations represent a starting point for States to stimulate thinking about further actions and
options.
• Assess whether public and private sector CIKR businesses in your State share information with
government on their current and projected State of protection, planning, and preparedness for a
pandemic flu. Determine the percentage of CIKR entities in your State that are sharing
protection actions and pandemic-specific continuity plans.
• Collect other critical information/data on essential CIKR assets and systems that address cross-
sector dependencies, cascading effects, and interdependencies that affect CIKR functionality,
performance and recovery.
126
RESPOND AND RECOVER
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
CITATION TO
DESCRIPTION OF
IF NOT APPLICABLE,
SUPPORTING
SUPPORTING ACTIVITY
PLEASE EXPLAIN
DOCUMENT
For this activity and
each one below,
Does the State have a public-private sector system in please include
place to share information on CIKR preparedness,
response and recovery actions during a pandemic
Title
influenza outbreak?
Page(s)
First 5 words of first
sentence
Does the State have a public-private sector system in
place to share information on CIKR preparedness,
response, recovery and preparedness for next wave
actions during and after a pandemic influenza
outbreak?
Does the State have a reliable and effective
information management and protection system in
place to satisfy privacy and security concerns of
CIKR owners and operators who are willing to share
information during a pandemic?
Has the State collected and appropriately shared
other critical information/data on CIKR assets and
systems that address cross-sector dependencies and
interdependencies that affect CIKR functionality,
performance and recovery?
Has the State implemented a mechanism to update
and report as necessary the changes in status of all
CIKR and especially high-risk and high-
consequence CIKR assets and interdependent cross-
sector networks to all appropriate government and
public- and private-sector CIKR partners and
stakeholders?
Activity Added by State
127
APPENDIX C.5
Operating Objective: Leverage Emergency Preparedness Activities for
CIKR Protection, Planning, Preparedness, Response, and Recovery
Rationale: Obviously government and CIKR businesses and organizations have already made significant
protection, planning and preparedness investments for various type disasters. Adapting and exploiting these
significant investments to serve for a pandemic influenza disaster makes good sense.
PREPARE
These preparedness considerations and activities serve as a reference States can use to augment and
tailor their existing emergency response plans given the unique challenges a pandemic influenza
presents our nation’s CIKR. These potential activities will likely not be found in a State’s operational
plan and therefore will not be graded. While not necessarily applicable to all States, these
considerations represent a starting point for States to stimulate thinking about further actions and
options.
• Determine the existing State, local, and/or tribal government and private sector emergency
preparedness activities in place for other disasters, such as hurricanes and earthquakes, which
may be adapted for pandemic influenza protection, planning and preparedness. Assess whether
or not your State identified, assessed, and incorporated them.
• Formalize the distribution process for determining which mission critical CIKR personnel will
be prioritized highest for stockpiled medical and non-medial countermeasures.
• Assess your State stockpiles to ensure they have adequate types/quantities of appropriate
medical and non-medical countermeasures. Take the necessary measures to procure additional
material, if appropriate.
128
RESPOND AND RECOVER
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
CITATION TO
DESCRIPTION OF
IF NOT APPLICABLE,
SUPPORTING
SUPPORTING ACTIVITY
PLEASE EXPLAIN
DOCUMENT
For this activity and
each one below,
Has the State identified existing State, local, and/or
please include
tribal government and private sector emergency
resources stockpiled for other disasters that may be
useful for pandemic influenza response and recovery Title
and incorporated them into their State Plan?
Page(s)
First 5 words of first
sentence
Have existing Federal, State, local, territorial and/or
tribal government and private sector formal and
informal emergency response and recovery support
networks for other type disasters been identified,
enlisted and enhanced for pandemic influenza
response?
Activity Added by State
129
APPENDIX C.6
Operating Objective: Integrate Federal, State, Local, Tribal, and
Territorial Government with Public- and Private-Sector CIKR
Protection, Planning, Preparedness, Response, and Recovery Activities
Rationale: Taking the actions described in Appendix C1 to the next level, not only must all appropriate
government and CIKR groups be aware and synchronized in their roles and responsibilities, they must also
efficiently integrate where practical their planning and preparedness actions to optimize validity,
acceptance, transparency, expertise and responsiveness and thereby enhance individual and overall
resilience.
PREPARE
These preparedness considerations and activities serve as a reference States can use to augment and
tailor their existing emergency response plans given the unique challenges a pandemic influenza
presents our nation’s CIKR. These potential activities will likely not be found in a State’s operational
plan and therefore will not be graded. While not necessarily applicable to all States, these
considerations represent a starting point for States to stimulate thinking about further actions and
options.
• Develop, establish, and implement a mechanism to coordinate pandemic influenza protection,
planning and preparedness efforts among Federal and State authorities.
• Determine if appropriate Federal and State representatives have participated in reciprocal
protection, planning and preparedness activities (e.g., training and exercises).
• Assess whether all Federal and State pandemic plans been coordinated to ensure these plans are
mutually supportive and executable.
130
RESPOND AND RECOVER
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
CITATION TO
DESCRIPTION OF SUPPORTING
IF NOT APPLICABLE,
SUPPORTING
ACTIVITY
PLEASE EXPLAIN
DOCUMENT
For this activity and
each one below,
please include
Has the State employed a mechanism to report an
accurate assessment of the status of CIKR with its
Federal partners during and after a pandemic event?
Title
Page(s)
First 5 words of first
sentence
Has the State employed a mechanism to report an
accurate assessment of the status of CIKR with its
local and regional partners during and after a
pandemic event?
Has the State employed a mechanism to coordinate
direct and indirect government and community
support and relief?
Activity Added by State
131
APPENDIX C.7
Operating Objective: Prioritize and Allocate Scarce Resources
Rationale: Having the right information at the right time to the right decision makers about the right
priorities for actions will greatly improve system responsiveness and support for CIKR sustainment.
However, even with the best decisions there still must be something practical that can be affected from the
decisions to ensure essential sustainment. Government as well as public- and private-sector CIKR must
have efficient delivery systems and the necessary tools, materials, people and supplies in reserve before the
pandemic influenza outbreak to be successful at supporting sustainment efforts during the outbreak.
PREPARE
These preparedness considerations and activities serve as a reference States can use to augment and
tailor their existing emergency response plans given the unique challenges a pandemic influenza
presents our nation’s CIKR. These potential activities will likely not be found in a State’s operational
plan and therefore will not be graded. While not necessarily applicable to all States, these
considerations represent a starting point for States to stimulate thinking about further actions and
options.
• Assess the extent to which CIKR owners and operators in the State have pre-negotiated,
established, and maintained contracts with vendors who supply critical resources and essential
services for all essential CIKR within the State.
RESPOND AND RECOVER
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
CITATION TO
IF NOT
DESCRIPTION OF
SUPPORTING
APPLICABLE,
SUPPORTING ACTIVITY
DOCUMENT
PLEASE EXPLAIN
Has the State prioritized the mission critical personnel and
essential public- and private-sector CIKR organizations and
businesses in the State for resource stockpile support that are vital
to sustaining CIKR operations and the nation’s social and
economic well-being?
Has the State assessed its disaster response stockpiles to ensure it
has adequate types/quantities of appropriate medical and non-
medical countermeasures and other pandemic-specific supplies
and materials to support essential CIKR organizations and
businesses and their mission critical personnel during possibly
multiple response and recovery waves?
Has the State taken measures to procure and stockpile additional
medical and non-medical supplies and material as required?
132
Has the State pre-negotiated, established, and maintained key
contracts with vendors who supply critical resources and essential
services for the State, and supporting similar arrangements for
tribal, territorial and local government entities?
Has the State supported CIKR businesses and organizations
within the State to pre-negotiate, establish, and maintain key
contracts with vendors who supply their critical resources and
essential services?
Are all State plans, procedures, and systems functional and pre-
positioned to distribute all other direct and indirect government
and community support and relief for CIKR securely and rapidly?
Do plans specify the State statutory and/executive order
authorities for, officials responsible for, and process to be used, to
allocate/ration scarce essential resources?
Have officials identified public- and private-sector
organizations/businesses in their State that play central roles in
essential CIKR sectors?
Has the State identified and prioritized measures that will be
required to speed economic and community recovery within the
State and/or region?
Activity Added by State
133
APPENDIX C.8
90B
CI/KR: Operational Readiness (Testing through Exercises and Real
Events)
A defining characteristic of an operating plan is that, in whole or in part, it readily lends itself to
evidence-based evaluation using the results of discussion-based exercises (“table tops”), operational-
based exercises (drills and enacted responses to simulated incidents), or performance measurements
obtained in the course of responses to actual incidents.
The table below describes the type of information that is requested regarding readiness to meet the
Operational Objectives that constitute the Goal "Sustain/Support 17 Critical Infrastructure and Key
Resource Sectors". Although an imperfect measure of readiness, this information tells reviewers that
States have practiced and tested their plans – through exercises or responses to real events – and used
the results of such experience to improve their pandemic influenza preparedness.
The USG Departments jointly will assign a single rating for Operational Readiness for the entire State
submission. In particular, based on the information requested at the end of each sub-Appendix, the
Departments will determine the number of the Operating Objectives for which the State submitted
evidence that it has tested its response capability in some appropriate way. This number then will be
divided by the total number of Operating Objectives, expressed as a percentage, and translated into a
standardized verbal designation in accord with the key shown in the text box.
Key:
>
U
U
50% - “Substantial Evidence of Operational Readiness”
25-49% - “Significant Evidence of Operational Readiness”
1-24% - “Little Evidence of Operational Readiness”
No submission or a non-responsive submission will be classified as “insufficient information to enable
assessment.”
In accord with the table below, please indicate, for each Operating Objective, whether or not an aspect
of that objective was tested. If it was tested, what was the measurable objective that was tested (this
would have been your exercise objective or the objective you were trying to achieve during a
response)? Then, please provide one or two sentences about the a change that was made to the State
operating plan as a result of the lessons learned and incorporated into an Improvement Plan and then
acted upon.
134
NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
CI/KR: OPERATING READINESS
Operating Objective
Tested?
What was tested and
How did result improve the
91B
F
40 (Y/N)
why?41
Operating Plan?
F
F
F
Define CIKR Protection,
Planning and Preparedness
Roles and Responsibilities
Build Public-Private
92B
Partnerships and Support
Networks
Implement the NIPP Risk
93B
Management Framework for a
Pandemic
Bolster CIKR Information
94B
Sharing and Protection
Initiatives
Leverage Emergency
95B
Preparedness Activities for
CIKR Protection, Planning and
Preparedness
Integrate Federal and State
96B
CIKR Protection, Planning and
Preparedness Activities
Allocate Scarce Resources
97B
40 Examples of events might include: National Governor’s Association regional exercises, Department of Treasury national
finance and banking CIKR exercise, TOPOFF, wildfire response, intraState antiviral drug distribution exercise, Hurricane
Dean response, and use of VTC to conduct regional workshops to inform planning.
41 If an exercise, what was the purpose? If a real-world incident, what was its nature?
135
