Download Section 1 RISK COMMUNICATION

CHAMPAIGN-URBANA PUBLIC
HEALTH DISTRICT (CUPHD)
Communications, Triage and Information Technology
Considerations during a Pandemic Influenza Event
Prepared by:
CONFIDENTIAL
FOR INTERNAL DISTRIBUTION ONLY
February 2010
Communication, Triage and IT Considerations during a Pandemic Influenza Event /February 2010
i
COMMUNICATIONS,TRIAGE AND INFORMATION
TECHNOLOGY CONSIDERATIONS DURING A
PANDEMIC INFLUENZA EVENT
Table of Contents
Table of Contents
List of Tables
List of Figures
Section 1 RISK COMMUNICATION
1.1 Risk Communication Overview ............................................................... 1-1
1.1.1 Coordination ................................................................................ 1-1
1.1.2 Risk Communication Principles .................................................. 1-1
1.1.3 Risk Communication Planning Assumptions and
Considerations.............................................................................. 1-2
1.1.4 Vulnerable Population Considerations ........................................ 1-3
1.1.5 Desired Outcomes ........................................................................ 1-3
1.2 Communications Infrastructure ............................................................... 1-3
1.2.1 Interpandemic/Pandemic Alert Period ......................................... 1-3
1.2.2 Pandemic Response Period .......................................................... 1-4
1.2.3 Post-Pandemic (Recovery) Period ............................................... 1-4
1.3 Communicating with the General Public ................................................. 1-4
1.3.1 Message Development ................................................................. 1-4
1.3.2 Public Education and Awareness Campaign ............................... 1-5
1.3.3 Message Dissemination ............................................................... 1-6
1.4 Working with the Media .......................................................................... 1-7
1.4.1 Communicating with the Media................................................... 1-7
1.4.2 Spokesperson Training................................................................. 1-7
1.5 Coordinating with Healthcare Public Information Officers..................... 1-8
1.6 Communicating with Key Partners .......................................................... 1-8
1.7 Risk Communication/Public Education Strategies and Key
Messages ................................................................................................ 1-10
1.7.1 Interpandemic/Pandemic Alert Period ....................................... 1-10
1.7.2 Pandemic Response Period ........................................................ 1-11
1.7.3 Post-Pandemic (Recovery) Period ............................................. 1-13
1.8 Risk Communication Guidance for Hospitals ....................................... 1-13
1.8.1 Risk Communication Strategies ................................................. 1-13
1.8.2 Education and Training .............................................................. 1-15
Section 2 TRIAGE
2.1 Triage Overview ...................................................................................... 2-1
2.2 Introduction .............................................................................................. 2-1
Communication, Triage and IT Considerations during a Pandemic Influenza Event /February 2010
i
Table of Contents
2.3
2.4
ii
Overview.................................................................................................. 2-1
2.3.1 Step 1 – Identify and Meet with Key Partners ............................. 2-2
2.3.2 Step 2 – Discuss Objective .......................................................... 2-3
2.3.3 Step 3 – Identify Concept of Operations ..................................... 2-3
2.3.4 Step 4 – Determine How to Accomplish the Objective ............... 2-4
2.3.4.1 Single Entry Point ......................................................... 2-4
2.3.4.2 Routing Calls Manually ................................................ 2-5
2.3.4.3 Routing Calls Technologically ...................................... 2-6
2.3.4.4 Disseminating Information ............................................ 2-7
2.3.5 Step 5 – Prepare for the Next Wave ............................................ 2-7
CDC Interim Guidance For 9-1-1 Public Safety Answering
Points, The Ems System And Medical First Responders ........................ 2-8
2.4.1 Background .................................................................................. 2-8
2.4.2 Interim Recommendations ........................................................... 2-8
2.4.3 Infectious Period .......................................................................... 2-9
2.4.4 Recommendations for 9-1-1 Public Safety Answering
Points ........................................................................................... 2-9
2.4.5 Recommendations for EMS and Medical First Responder
Personnel Including Firefighter and Law Enforcement
First Responders ........................................................................ 2-10
2.4.5.1 Patient assessment ....................................................... 2-10
2.4.5.2 Personal Protective Equipment ................................... 2-11
2.4.5.3 Infection Control ......................................................... 2-11
2.4.6 Interfacility Transport ................................................................ 2-12
2.4.7 Interim Guidance for Cleaning EMS Transport Vehicles
After Transporting a Suspected or Confirmed SwineOrigin Influenza A (H1N1) Patient ........................................... 2-12
2.4.8 EMS Transfer of Patient Care to a Healthcare Facility ............. 2-13
2.2.1 Coordination .............................................................................. 2-15
2.2.2 Triage Principles ........................................................................ 2-15
2.2.3 Triage Planning Assumptions and Considerations .................... 2-16
Communication, Triage and IT Considerations during a Pandemic Influenza Event /February 2010
Table of Contents
List of Tables
Table 2-1 Key Partners................................................................................................ 2-2
Table 2-2 Types of Call Centers ................................................................................. 2-6
List of Figures
Figure 2-1 Sample Pandemic Influenza EMS Dispatch Protocol ............................. 2-13
Figure 2-2 U.S. Department of Transportation. “EMS Pandemic Influenza
Guidelines for Statewide Adoption.” May 2007 .......................................... 2-14
Figure 2-3 All volunteer staff must identify themselves as volunteers when
taking a call and must respond using predetermined scripts to advise
and direct callers on a course of action ......................................................... 2-16
Communication, Triage and IT Considerations during a Pandemic Influenza Event /February 2010
iii
Section 1
RISK COMMUNICATION
1.1 Risk Communication Overview
Risk communication and public education play a vital role in pandemic influenza
preparedness and response. Strong risk communication and public outreach activities
help build trust, confidence, and cooperation, and support effective preparedness and
response efforts.
Dissemination and sharing of timely and accurate information will be one of the most
important facets of the pandemic response. Instructing the public and partners in
actions to take to minimize risk of exposure or actions to take if they have been
exposed will reduce the spread of the pandemic and may also reduce anxiety and
unnecessary demands on vital services.
This section will help guide and prepare the Champaign-Urbana Public Health District
(CUPHD) in communicating key messages to the general public, news media,
healthcare providers, and other partners and stakeholders (for example, first
responders, law enforcement, local government, schools, and businesses) before,
during, and after a pandemic influenza.
1.1.1 Coordination
The CUPHD public information officer (PIO) will (1) identify public health issues and
concerns that need to be addressed through public information messages regarding
pandemic influenza, and (2) identify affected target audiences for messages. The PIO
will consult the following, as appropriate:

CUPHD public health administrator

Infectious Disease and Management Division

Illinois Department of Public Health (IDPH)

Centers for Disease Control and Prevention (CDC)
CUPHD will also coordinate dissemination of information with the Champaign
County PIO and the Champaign County Emergency Management Agency as
appropriate (see the Champaign County Emergency Operations Plan for more
information).
1.1.2 Risk Communication Principles
In all emergency communication efforts, CUPHD will make every effort to adhere to
risk communication and ethics principles:
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Section 1

Be first, be right, and be credible. Balance the public’s need to know in a timely
manner with the need to ensure that information is accurate.

Engage the public in a manner that allows non-expert citizens to combine
technical facts with their values.

Provide enough information to create transparency so that the public understands
how decisions are made, who is making the decisions, and where the resources
are going.
1.1.3 Risk Communication Planning Assumptions and
Considerations

An influenza pandemic will generate intense and sustained demand for
information from the public, healthcare providers, policy makers, and the news
media.

Informing healthcare providers and the public about influenza and the course of
the pandemic, the ability to treat mild illness at home, and the availability of
antiviral medications and vaccines will be important to ensure appropriate use of
medical resources. It will also help to avoid possible panic or overwhelming of
vaccine delivery sites.

Effective communication with community leaders and the media is important to
maintain public awareness, avoid social disruption, and provide information on
evolving pandemic response activities. Spokespersons need to acknowledge the
anxiety, distress, and grief people will experience during a major public health
crisis such as a pandemic.

Communication efforts will be directed to rapid sharing of appropriate, up-to-date
information on the progression of the outbreak, the possible disruptions to
routines and events, and contingency measures.

The public must be provided as much information as possible to help them
understand that uncertainty is part of the process and that answers may change as
new information and science becomes available.

Emergency communication is approved by the CUPHD public health
administrator or the administrator’s designee.

All government and non-government resources will use a single source of
information on Champaign County’s position regarding the emergency.

Federal partners at the CDC and U.S. Department of Health and Human Services
(HHS) will provide regular updates regarding the pandemic.

Local information will be provided to IDPH through existing reporting systems
from local sources, such as local health departments, hospitals, physician’s
offices, and schools.
1-2
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RISK COMMUNICATION

Coordination of release of information among federal, state, and local health
officials is critical to avoid confusion that can undermine public trust, raise fear
and anxiety, and impede response measures.
1.1.4 Vulnerable Population Considerations
CUPHD is committed to providing healthcare services to those in need and most
vulnerable. Including vulnerable populations and the organizations that serve them in
pandemic influenza risk communication planning is consistent with CUPHD’s mission
to improve the health, safety, and well-being of the community through prevention,
education, collaboration, and regulation.
The following issues will be taken into consideration as preparedness and response
actions are implemented:

Key messages delivered in multiple languages (English and Spanish, and others as
resources allow)

Key messages delivered using multiple communication modes

Key messages delivered through grassroots mechanisms (community-based and
faith-based) to people who are homeless, geographically isolated, or culturally
isolated

Key messages delivered to people who are homebound, including those with
services (for example, Senior Transportation or First Call for Help) and without
services
1.1.5 Desired Outcomes
CUPHD will provide timely and accurate pre-event information to the public about
pandemic influenza, pandemic influenza preparedness and actions, and CUPHD plans.
During a pandemic event, CUPHD will provide the most current and accurate
information, including what is happening, what is being done, and what people can do
to protect themselves.
1.2 Communications Infrastructure
CUPHD will use a range of communication methods, as appropriate, to notify
CUPHD staff, health providers, first responders, partners, stakeholders, the public, and
the media of changes in pandemic influenza stages and recommend actions (such as
the use of personal protective equipment (PPE) and social distancing).
1.2.1 Interpandemic/Pandemic Alert Period
During this period, CUPHD will:

Test local communication systems through training, drills, and exercises to ensure
that local and statewide communications are functional
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Section 1

Establish and maintain health provider contact information

Maintain fax and e-mail contact list for media

Maintain fax and e-mail contact list for community-based organizations

Maintain contact list for business and industry partners, schools and colleges, day
care providers, organizations that serve vulnerable populations, etc.
1.2.2 Pandemic Response Period
During a pandemic, CUPHD will follow World Health Organization (WHO), HHS,
CDC, and IDPH guidance to issue recommendations locally, and will:

Use CUPHD communication methods to notify hospitals, public and private
healthcare providers, first responders, other appropriate PIOs, and other public
and private sector partners and stakeholders of the change in pandemic stage

Implement contingency plans, if any, for obtaining critical hardware, software, or
personnel to expand communication systems if needed for a pandemic

Maintain ongoing communication with healthcare providers, first responders, and
all partners and stakeholders, including posting information on the CUPHD Web
site
1.2.3 Post-Pandemic (Recovery) Period
During this period, CUPHD will:

Take appropriate corrective action steps identified in after action reports (AARs)

Return to interpandemic/pandemic alert period activities
1.3 Communicating with the General Public
1.3.1 Message Development
Messages are developed with key CUPHD staff and are approved by the CUPHD
public health administrator or the administrator’s designee, and, as appropriate, with
the IDPH. CUPHD also will coordinate, as appropriate, with the Champaign County
Emergency Management Agency.
During the course of pre-event activities and especially during a pandemic influenza
event, messages and other information will be updated and customized.
Interpandemic/Pandemic Alert Period
During this period, CUPHD will:

Develop key messages for printed materials, public presentations, and the media

Provide a solid foundation of information upon which future actions can be based
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RISK COMMUNICATION

Develop key messages to address CUPHD activities, including planning efforts,
avian (H5N1) or swine-origin influenza A (H1N1) education, pandemic influenza,
and general preparations
Pandemic Response Period
During this period, CUPHD will:

Update and further develop key messages as the situation warrants

Develop messages to be used primarily for communicating key actions to the
general public through the media

Post materials to the CUPHD Web site as they are developed
Post-Pandemic (Recovery) Period
During this period, CUPHD will:

Take appropriate corrective action steps identified in AARs

Return to interpandemic/pandemic alert period activities
1.3.2 Public Education and Awareness Campaign
The public is more likely to respond and cooperate if they:

Are involved in the discussions and planning for pandemic influenza

Have general knowledge of the situation

Are aware of the issues and concerns that are to be addressed

Understand their individual roles and responsibilities
Planning checklists for individuals and families, workplaces, schools, healthcare
providers, and community and faith-based organizations have been created and are
posted
on
the
CDC
pandemic
influenza
Web
site:
http://www.pandemicflu.gov/plan/checklists.html
Interpandemic/Pandemic Alert Period
During this period, CUPHD will conduct a public education and awareness campaign
as resources allow. Key messages are used in the various components of the
campaign, which is directed at the general public and conducted in both English and
Spanish.
Pandemic Response Period
During this period, CUPHD will:

Continue and increase public education and awareness campaign as resources
allow; key messages are used in the various components of the campaign, which
is directed at the general public and conducted in both English and Spanish
Communication, Triage and IT Considerations during a Pandemic Influenza Event /February 2010
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Section 1

Use pandemic influenza information materials available in Amharic, Arabic,
Chinese, Farsi, Russian, and Vietnamese on the CDC’s pandemic influenza Web
site: www.pandemicflu.gov

Update current materials and develop new materials as the situation warrants;
updated materials will be posted as they are developed to the CUPHD Web site,
the Health Emergency Information Line (HEIL), etc.
Post-Pandemic (Recovery) Period
During this period, CUPHD will:

Take appropriate corrective action steps identified in AARs

Return to interpandemic/pandemic alert period activities
1.3.3 Message Dissemination
Depending on resources, the following tools may be used to disseminate the message:

Educational materials on pandemic influenza

Media campaigns

Bill inserts

Web postings

Phone scripts

Radio ads and public service announcements (PSAs)

Print ads

Theater and mall signs

Bus shelters, bus interior signs, and bus boards

Billboards

Television ads

Emergency alerts (such as ChampCoPrepares.com)

Speakers bureau

Collateral materials/handouts

Special events and venues (such as health fairs, public meetings, etc.)

Direct mail

HEIL, if created
1-6
Communication, Triage and IT Considerations during a Pandemic Influenza Event /February 2010
RISK COMMUNICATION
1.4 Working with the Media
1.4.1 Communicating with the Media
Interpandemic/Pandemic Alert Period
During this period, CUPHD will:

Develop a packet of materials for the media, including CUPHD materials and
approved outside materials. These materials include samples of public education
materials as well as guidelines for planning and personal protection.

Hold informational meetings with the media to educate them on Champaign
County preparedness activities, pandemic influenza, and their role in helping
CUPHD educate the public on the pandemic threat.
Pandemic Response Period
During this period, CUPHD will communicate regularly with the media to disseminate
updated public information and risk communication materials about pandemic
influenza as part of ongoing media outreach through press releases, Web postings,
media interviews, and press conferences.
Post-Pandemic (Recovery) Period
During this period, CUPHD will:

Take appropriate corrective action steps identified in AARs

Update materials as needed

Return to interpandemic/pandemic alert period activities
1.4.2 Spokesperson Training
Interpandemic/Pandemic Alert Period
During this period, CUPHD will:

Identify, train, and drill CUPHD and other county spokespersons on specific
pandemic influenza risk communications

Conduct an informational training with healthcare provider PIOs and appropriate
members of the county’s PIOs
Pandemic Response Period
During this period, CUPHD will distribute updated public information and risk
communication materials about pandemic influenza to spokespersons as part of
ongoing public outreach.
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Section 1
Post-Pandemic (Recovery) Period
During this period, CUPHD will:

Take appropriate corrective steps identified in AARs

Update training and materials as needed

Return to interpandemic/pandemic alert period activities as appropriate
1.5 Coordinating with Healthcare Public Information
Officers
Interpandemic/Pandemic Alert Period
During this period, CUPHD will:

Maintain a hospital PIO contact list

Provide the hospital PIOs with pandemic influenza materials and updates
Pandemic Response Period
During this period, CUPHD will:

Communicate regularly with hospital PIOs about CUPHD activities as well as any
new developments regarding avian influenza (H5N1), swine-origin influenza A
(H1N1), and/or pandemic influenza; healthcare PIO information will be
communicated primarily through e-mail and fax, as appropriate

Provide updated public information and risk communication materials about
pandemic influenza regularly as part of ongoing public outreach
Post-Pandemic (Recovery) Period
During this period, CUPHD will:

Take appropriate corrective steps identified in AARs

Update training and materials as needed

Return to interpandemic/pandemic alert period activities as appropriate
1.6 Communicating with Key Partners
The CUPHD PIO provides support to CUPHD staff and programs that are primarily
responsible for outreach, coordination, and content development with key partners and
stakeholders. Key partners include:

Champaign County Board

Local businesses

Local governments
1-8
Communication, Triage and IT Considerations during a Pandemic Influenza Event /February 2010
RISK COMMUNICATION

Parkland College

University of Illinois at Urbana-Champaign

Community-based and faith-based organizations

Champaign County Coroner

County government

Emergency medical services and pre-hospital responders

Fire services

Champaign County legal/court system

Law enforcement agencies

Local healthcare system

Mental health facilities

News media

University of Illinois-Willard Airport

Local transit

Area schools
Interpandemic/Pandemic Alert Period
During this period, CUPHD will:

Maintain contact lists for business and industry partners, schools and colleges,
day care centers, organizations that serve vulnerable populations, etc.

Make existing materials available for distribution. Key partners may use these
materials for distribution to employees, customers, clients, vendors, students, etc.
Post all information to the CUPHD Web site.
Pandemic Response Period
During this period, CUPHD will regularly distribute updated information and risk
communication materials about pandemic influenza as part of ongoing public
outreach.
Post-Pandemic (Recovery) Period
During this period, CUPHD will:

Take appropriate corrective steps identified in AARs

Update training and materials as needed

Return to interpandemic/pandemic alert period activities as appropriate
Communication, Triage and IT Considerations during a Pandemic Influenza Event /February 2010
1-9
Section 1
1.7 Risk Communication/Public Education Strategies
and Key Messages
CUPHD will use the following communication strategies as appropriate to notify
providers, first responders, partners, stakeholders, the public, and the media of
changes in pandemic influenza stages and inform them of recommended actions to
prepare for, prevent, respond to, and recover from pandemic influenza. Based on
federal and state guidance, and in consultation with the CUPHD public administrator
and CUPHD Infectious Disease Division, the CUPHD PIO will perform public
education activities and disseminate information on recommended actions to the
public (such as the use of PPE, school dismissal or closures, and other risk reduction
measures).
1.7.1 Interpandemic/Pandemic Alert Period
Strategy
The CUPHD PIO and staff will prepare to respond to a pandemic through the
following activities and strategies:

Conduct community education and media campaigns on pandemic influenza,
disease prevention, and CUPHD preparedness activities

Work with schools, child care providers, law enforcement, and volunteer
organizations (for example, American Red Cross) to coordinate pandemic
influenza preparedness and response plans

Maintain and update the pandemic influenza plan components as needed,
including fact sheets, media contact lists, and Web site

Create and maintain a pandemic preparedness page on the CUPHD Web site

Create and update pandemic influenza messages to be activated when needed on
the HEIL

Designate and train appropriate pandemic spokespersons

Develop pandemic influenza materials to advise nurses and staff if a health
emergency call center is created

Educate CUPHD staff about pandemic influenza planning, preparedness, and
response
Key Messages

General public education about pandemic influenza

What to consider when preparing for a pandemic (home, business, etc.)

Champaign County and CUPHD is planning for the event of pandemic influenza
1-10
Communication, Triage and IT Considerations during a Pandemic Influenza Event /February 2010
RISK COMMUNICATION

Planning is not just a government issue; every resident and business must take
responsibility to prepare themselves, their families, and their business for
pandemic influenza

Practice good hygiene habits such as hand washing and covering coughs and
sneezes with a tissue or sleeve to prevent the spread of germs

Promote seasonal influenza and pneumonia vaccination

Encourage residents to
ChampCoPrepares.com
sign
up
for
local
emergency
alerts
on
1.7.2 Pandemic Response Period
Strategy
During this period, communicating information to the public in a timely and accurate
manner will be essential to ensure compliance with health directives. CUPHD will
use a variety of strategies to communicate with partners and the public to provide
appropriate messages. To get information out quickly, CUPHD will use a number of
redundant communications methods, including the following:

If created, update the HEIL on a regular basis

Activate health emergency call center as needed

Modify and update written materials (fact sheets, materials for schools, etc.) as
needed

Post documents intended for electronic distribution on CUPHD Web site

Provide press releases, Web postings, media interviews, and press conferences for
media on a timely basis

Implement public information campaigns by creating PSAs to air on local cable
and satellite television as well as broadcast media

Provide advice nurses, call center staff, and any phone representatives with the
latest information on pandemic influenza prevention, treatment, etc.

Alert schools, child care providers, law enforcement, and other local public and
private agencies of the need to activate their own pandemic influenza response
plans

Provide risk communication guidance to hospitals in Champaign County

Disseminate guidelines on influenza precautions for workplaces, healthcare
facilities, schools, jails and prisons, public safety agencies, and individuals

Provide internal information to employees through the intranet, all-staff e-mail
messages, the media, and other mechanisms

Communicate with partners and stakeholders (including the Champaign County
Board) and keep them updated, including if and when school and child care
closures or dismissals are needed
Communication, Triage and IT Considerations during a Pandemic Influenza Event /February 2010
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Section 1

Coordinate messages with appropriate agencies, such as the Champaign County
EMA, IDPH, CDC, and law enforcement agencies

Identify contact person (and backup person) for communication with IDPH
communication staff

Use PIO mutual aid as necessary; however, be aware that in a pandemic every
county across the United States will be hit at approximately the same time.
Relying on mutual aid will likely be a risky strategy

Staff the PIO position at the Champaign County EOC and/or Joint Information
Center (JIC) as needed
Key Messages

Projected severity of the novel virus

Current surveillance information

Travel alert information received from the state or CDC

Provide updates about Champaign County, Illinois State, and federal response
activities

Announce the availability of a telephone hotline and Web site updates

Update the public about critical services that are still available

Disseminate information about how to stop the spread of the disease. These
should be risk reduction tips and other instructions to the general public,
healthcare providers, first responders, partners, and stakeholders, and should
include the importance of hand washing, social distancing, and other nonpharmaceutical interventions, as appropriate.

Offer suggestions about how to care for sick family members

Provide information about isolation and quarantine

Declare school and business closures as necessary

Provide updates on the availability/status of antiviral medications and vaccines

Provide information on how and where to get antiviral medications and vaccines,
if available

Communicate with and update healthcare providers on:

Pandemic influenza status

Screening

Infection control

Reporting

Treatment

Lab protocols
1-12
Communication, Triage and IT Considerations during a Pandemic Influenza Event /February 2010
RISK COMMUNICATION


Vaccine/antiviral status and priority groups
Provide updated guidance on infection control, health monitoring, and precautions
to businesses, schools, and the general public
1.7.3 Post-Pandemic (Recovery) Period
Strategy
A pandemic influenza is predicted to come in waves; the recovery period may be
delayed by several waves. CUPHD’s goal is to return CUPHD services to normal as
quickly as possible. Recovery period activities will include:

Return Web site to normal function

Deactivate communication tools specifically activated for the pandemic, including
HEIL and the health emergency call center

Have the public, media, and key partners prepare AARs on how well CUPHD
performed during the pandemic event; correct deficiencies identified in the AARs

Update fact sheets and appropriate materials

Evaluate media coverage

Return to interpandemic/pandemic alert period activities
Key Messages

Officially declare the pandemic over and summarize the impact on the county and
the county’s preparedness and response efforts

Announce the deactivation of any communication tools specifically activated for
the pandemic

Continue messages on the importance of hygiene to prevent influenza and other
illnesses

Continue messages to promote seasonal influenza and pneumonia vaccinations

Provide information regarding community resources and strategies for
psychosocial effects
1.8 Risk Communication Guidance for Hospitals
1.8.1 Risk Communication Strategies
Pandemic influenza risk communication strategies are a critical and necessary
component of pandemic influenza preparedness and response. Hospitals will play an
important role in providing vital information to the public, healthcare providers, and
hospital staff before, during, and after a pandemic to help ensure people respond
appropriately to outbreak situations and follow public health measures. To ensure that
Communication, Triage and IT Considerations during a Pandemic Influenza Event /February 2010
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Section 1
this information is consistent, accurate, and timely, it is critical that hospitals
coordinate pandemic influenza messages with CUPHD.
The CUPHD PIO will collaborate with Champaign County’s PIO, taking the lead in
development of public health and medical risk communication materials for release to
the public, business community, schools, and critical infrastructure, including
healthcare facilities. Hospital PIOs should initiate and maintain a close working
relationship with the CUPHD PIO, if they have not already done so.
Information regarding a pandemic and pandemic planning comes from a variety of
sources. The federal government provides background information and frequent
updates for healthcare professionals through the CDC’s Web site at
www.pandemicflu.gov/. Additionally, the CDC provides information through its
Emergency Communication System. The IDPH is tasked by the governor with
coordinating public health, medical emergency, and risk communication messages for
the state. In that role, IDPH will provide background information and frequent
updates for healthcare professionals. To reduce the likelihood of conflicting or
confusing messages across the healthcare system, every effort should be made to
coordinate media content between CUPHD and hospitals. This is true during both the
interpandemic/pandemic alert period and the pandemic response period.
Interpandemic/Pandemic Alert Period
During the interpandemic/pandemic alert period, it is important for hospitals to
establish methods to ensure that the most current information is being received from
and provided to the CUPHD PIO.
Information received should be shared with appropriate individuals within the
organization, such as healthcare providers, other staff, patients, and partners.
Hospitals are encouraged to include risk communication strategies in their hospital
pandemic plan.
Preparations for implementing the following strategies are
recommended.
External Communication

The CUPHD PIO will maintain a single source of contact with each hospital.
Current contact information should be provided by each hospital, and a plan
should be developed to ensure the information is updated as needed.

Hospital PIOs should consider participating in a PIO network.

Hospitals should prepare or use messages provided by the CUPHD PIO for use in
call centers, Web sites, hotlines, recorded messages, etc. These messages should
be differentiated for patients, community, and employees.

Hospitals should identify and train individuals who may be expected to support
the hospital PIO or serve as the hospital spokesperson during periods where there
is increased communication flow related to pandemic influenza.
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RISK COMMUNICATION
Internal Communication

Hospitals will develop mechanisms for sharing pandemic influenza planning with
employees.

Hospitals will develop frequently asked questions or use those provided by
CUPHD that are focused on answering questions specifically from hospital
personnel.
Pandemic Response Period
During the pandemic response period, hospital PIOs are encouraged to:

Maintain a single source of contact with the CUPHD PIO and ensure this
information is updated as needed

Use established mechanisms for external communication with the media and a
PIO network

Determine how to keep administrators, personnel, patients, and visitors informed
of the ongoing impact of pandemic influenza on the facility and the community

Ensure capacity for increases in communication flow related to the pandemic
influenza

Establish communication with any area JIC if activated; the Champaign County
EOC may open a JIC
1.8.2 Education and Training
Each hospital is encouraged to develop an education and training plan that addresses
the needs of staff, patients, family members, and visitors. Hospitals will need to
assign responsibility for coordination of the pandemic influenza education and training
program and identify training materials (in different languages and at different reading
levels as needed) from HHS agencies, IDPH, CUPHD, and professional associations.
The following guidelines, taken from the HHS Pandemic Influenza Plan, provide a
basis for inclusion of education and training in the hospital’s pandemic influenza plan.
CUPHD and/or IDPH will provide current information that should be used in
developing education and training content.
Interpandemic/Pandemic Alert Period
Each hospital is encouraged to develop a plan to provide staff education. Staff
education should include infection control strategies for influenza, including
respiratory hygiene/cough etiquette, hand hygiene, standard precautions, droplet
precautions, and airborne precautions (see the section on Infection Control and
Prevention Guidelines for Healthcare Settings in the Champaign County Pandemic
Influenza Plan).
Hospital-specific topics for staff education should include:
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Section 1

Policies and procedures for the care of pandemic influenza patients, including
how and where pandemic influenza patients will be located

Pandemic staffing contingency plans, including how the facility will deal with
illness in personnel

Policies for visitation

System for reporting suspected cases of infection caused by novel influenza
strains during the interpandemic/pandemic alert period to CUPHD

Measures to protect family and other close contacts from secondary occupational
exposure
Hospitals should also:

Establish a schedule for training/education of clinical staff and a mechanism for
documenting participation; use annual infection control updates/meetings,
Medical Grand Rounds, and other educational venues as opportunities for training
on pandemic influenza

Cross-train clinical personnel (including outpatient healthcare providers) who can
provide support for essential patient care areas (for example, emergency
department, ICU, medical units)

Train intake and triage staff to detect patients with influenza symptoms and to
implement immediate containment measures to prevent transmission

Create a mechanism for supplying social workers, psychologists, psychiatrists,
and nurses with guidance for providing psychological support to patients and
hospital personnel during an influenza pandemic. Hospitals should also provide
psychological support training to appropriate individuals who are not mental
health professionals (primary-care clinicians, leaders of community and faithbased organizations, etc.)

Develop a strategy for just-in-time training of non-clinical staff who might be
asked to assist clinical personnel (for example, help with triage, distribute food
trays, transport patients), students, retired health professionals, and volunteers
who might be asked to provide basic care (for example, bathing, monitoring of
vital signs) and other potential in-hospital caregivers (for example, family
members of patients)
Education of patients, family members, and visitors should:

Ensure that patients and others know what they can do to prevent disease
transmission in the hospital as well as at home and in community settings

Identify and use language-specific and reading-level appropriate materials,
provided by CUPHD, IDPH, and CDC for educating patients, family members,
and hospital visitors during an influenza pandemic

Develop a plan for distributing information to all persons who enter the hospital

Identify staff to answer questions about procedures for preventing influenza
transmission
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RISK COMMUNICATION
Pandemic Response Period
Hospitals will implement the mechanisms created to distribute updated informational
and educational materials to hospital visitors and the patient community on an ongoing
basis. It will be essential that the hospital PIO maintain regular contact with the
CUPHD PIO to ensure that the hospital receives the most updated pandemic influenza
guidance and that the assigned education and training staff receive the most current
information to use in their training.
Training and education should be ongoing and incorporate information on the
following:

Disease prevention precautions

Home self-care information

The need to either postpone non-critical appointments or procedures or provide
alternative ways for patients to be seen for non-urgent needs

The need to advise the public to use only the emergency department for true
medical emergencies
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2.1 Triage Overview
Patient care begins when a person seeks medical care through any one of a number of
direct or indirect contact methods.
Direct patient contact methods include visits to a primary care physician, urgent care
clinic, hospital emergency center, an alternate care site that has been set up to handle
hospital overflow for non-influenza illness, or an acute influenza center established in
response to the pandemic event.
Indirect patient contact methods include calls made to 9-1-1 (the METCAD public
safety communications center) or calls made directly to the community health hotline
and call center.
Champaign County should consider implementing or expanding any telephone triage
capability they may have to reduce the number of patients reporting to their service
sites unnecessarily and thus reduce the potential for transmission of active H1N1
infection. To the extent possible, Champaign County may want to use telephone
triage capability to follow up with patients with whom they only had telephone contact
in order to inquire about signs of worsening that may require in-person evaluation.
Ongoing experience has demonstrated that there are observed benefits to early
recognition and treatment of patients and that a follow-up regime can help identify
patients whose condition may be rapidly deteriorating.
2.2 Introduction
During a response to a large-scale influenza outbreak such as the 2009-2010 H1N1
outbreak, METCAD and healthcare systems may experience a surge in calls or walkin visits for care, advice, and information. In fact, call volumes or walk-in visits could
reach the point of overwhelming METCAD and healthcare systems, rendering them
unable to respond to other emergencies in an efficient and effective manner. In those
instances, community planners should take steps to divert unnecessary calls away
from the METCAD system and non-critically ill patients away from the healthcare
system to reserve both for actual emergency situations. This implementation tool
provides a step-by-step approach to achieving this objective by focusing on alternative
call center resources.
2.3 Overview
The process for managing calls and call centers is not an exact science. It is not a onesize-fits-all process. Each community varies in size, capacities, and capabilities.
Some communities have a wealth of resources at their disposal; others do not. This
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tool is provided under the premise that each community will work with the resources
and tools currently available. It is not the intent of this tool to dictate that a
community develops a new and perhaps costly process or system. Instead, this tool is
intended to encourage a community to examine existing resources that might not have
otherwise been considered. However, those communities with very limited resources
may need to contact their state agencies (for example, public health and emergency
management) for assistance.
2.3.1 Step 1 – Identify and Meet with Key Partners
The first step to managing calls and call centers is to bring together a team of key
partners to help work through this step-by-step process. Key partners will be subject
matter experts. Subject matter experts should be able to guide the organization on the
logistical, operational, technological, and legal aspects of managing calls and call
centers. Other key partners will be representatives from the local public health
department, emergency management agency, METCAD authority, METCAD call
center, emergency medical services (EMS), N-1-1 call centers (such as 2-1-1 or 3-11), healthcare agencies, and pertinent government officials. The desired representation
from these agencies is shown in Table 2-1. (For those communities with limited
resources, equivalent representation from state agencies may be needed.)
Note: This list is not all-inclusive. As objectives and tasks are discussed with key
partners, the need to bring in other partners may be identified.
Table 2-1
Key Partners
Partner
Representative
Public Health



Public health manager/director
Pandemic influenza planner/coordinator
Health information line manager
Emergency Management (EM)

EM manager/director











9-1-1 authority
9-1-1 call center
9-1-1 medical director
EMS dispatch manager
EMS medical director
N-1-1 operations manager
Pandemic influenza planner/coordinator
Nurse advice line coordinator
Infection control manager
Triage nurse
Disaster/emergency preparedness
coordinator
Public information officers (PIOs) from public
health, EM, and healthcare
City/county public affairs officials
9-1-1/EMS/N-1-1
Healthcare

Communications

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Partner
Local Government/Utilities
Representative



Information technology (IT) representative
Phone service provider representatives
City/county attorney
2.3.2 Step 2 – Discuss Objective
Once the organization has assembled key partners, it will need to discuss diverting
unnecessary calls away from the METCAD system and non-critically ill patients away
from the healthcare system to reserve both for actual emergency situations. The
discussion will focus on four probable courses of action to achieve this objective:

Route non-emergency calls to call centers that are adequately staffed and
equipped to manage them

Accurately triage people with medical needs to direct them to the healthcare
setting that is best equipped to care for them, thus reducing surge within the
healthcare system

Disseminate information to the public to direct them not to call 9-1-1 unless it is
an emergency and to direct them on other actions to take or not to take (for
example, not going to the hospital until they have called a medical
advice/treatment line)

Provide the public with information in advance so that they will not need to call to
ask for it
Key partners will be able to provide suggestions and input on how this objective can
be accomplished from both an operational and technological perspective. They also
may be aware of similar undertakings by others that can be adapted for use in the
community.
2.3.3 Step 3 – Identify Concept of Operations
The community’s response to a large-scale influenza outbreak (or other public health
emergency) will operate under the framework of its Incident Command System (ICS).
As such, management of calls and call centers (call center system) also will operate
within this framework. With the assistance of key partners, the four key points that
will determine the concept of operations should be identified:
1.
Trigger(s) – What set of circumstances causes ICS to be activated during a largescale public health emergency? What set of circumstances causes the call center
system to be activated?
2.
Chain of Command – Who activates the community’s ICS? Who is the incident
commander? Who activates the call center system? Who is the call center
commander?
3.
Operations – How does the call center system get activated (in other words, how
do its parts get set into motion)? How does it get scaled down as the public health
threat subsides?
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4.
Liaison(s) – Who will represent the call center system in the Joint Information
Center (JIC)?
2.3.4 Step 4 – Determine How to Accomplish the Objective
2.3.4.1 Single Entry Point
The most effective approach to directing non-emergency calls to other call centers is
to use a single entry point approach. Using this approach, a single dial-in number to a
system can route the call to the appropriate call center. People are very familiar with
the single phone number 9-1-1; they also can be familiarized with a second number.
Additionally, using an existing call center as a single entry point is desirable because
setting up a dedicated line or new call center takes time and costs money.
There is a possible drawback to using a single-entry-point approach. For those
communities with certain technological configurations in the call center system, a
transferred call ties up a phone channel until the call is completed, reducing overall
call capacity of the system. IT representatives will be able to determine whether the
call centers will experience this issue.
Most community’s have access to one or two N-1-1 call centers that may be adapted to
serve as a single point of entry. These N-1-1 call centers are:

2-1-1: This is a health and human services information and referral line operated
by United Way and Alliance of Information and Referral System’s members. 21-1 services maintain a comprehensive database of local, regional, and national
community resources, and are already managing many of the types of calls that
would be received in a pandemic. They have partnerships with local and state
agencies and can direct calls to them. They also have the ability to manage nonEnglish speaking callers and can be accessed 24 hours per day/7 days per
week/365 days per year.

3-1-1: This is a municipal services and information line. In some areas of the
country, 3-1-1 is a partner of 2-1-1.
Other call center options within the community are telephone triage lines, nurse advice
lines, health information lines, hotlines/crisis centers, utility outage reporting centers,
television/radio telethon centers, or commercial answering services. Key partners will
be able to help identify these types of call centers operating in the community and
determine the feasibility of using them as a single entry point.
If no local call centers are available to assist, this task will need to be approached at
the state, regional, or national level. Two call centers that may be of use are:

5-1-1: This is a transit and traffic information line operated by state Departments
of Transportation.

Poison Control Centers: This line offers medical information, advice, and
assistance as it relates to poisonous or hazardous substances. It can be contacted
via a nationwide, toll-free telephone number: 1-800-222-1222.
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If no call centers are available locally, statewide, or regionally, then there are three
other options:
1.
Use 9-1-1 call centers as a single entry point. However, this course of action may
require expanding the call centers logistically, technologically, and human
resource wise. METCAD and EMS partners will be able to discuss the feasibility
of this approach.
2.
Set up a dedicated call line and work with service providers to design it to route
calls. Toll-free (for example, 800) numbers can be established ahead of time and
activated in minutes. They can be pointed toward existing phone numbers, but
the monetary charge is per call when they are used. A similar capability may
exist for 10-digit phone numbers serviced on telephone service provider
equipment. An IT partner or telecommunications service provider representative
will be able to discuss options, costs, and timelines.
3.
Assign the community’s existing call centers roles (for example, information
dissemination or medical advice) and use an automated answering system or
published materials to direct the public to call these call centers for the
information or advice. The drawback with this approach is that it requires either
an automated system or multiple entry points (phone numbers) which may require
a large public education campaign. It also relies on the public to adhere to
directives to call these call centers. Some of the public likely will not follow
through as directed and will call the number they are most familiar with, which
probably will be 9-1-1.
2.3.4.2 Routing Calls Manually
The calls coming into the single entry point will be from people seeking medical
advice/treatment or general information. A simple set of questions (such as, "Do you
need medical treatment?") can help the call screener route the call to the appropriate
call center. Therefore, the call screener should be provided with questions to ask to
assist in determining where to direct the call. Key partners can help in the
development of these questions. Additionally, the involvement of an EMS medical
director and 9-1-1 medical director can help ensure appropriate medical oversight.
The Interim Guidance for Emergency Medical Services (EMS) Systems and 9-1-1
Public Safety Answering Points (PSAPs) for Management of Patients with Confirmed
or Suspected Swine-Origin Influenza A (H1N1) Infection provides an example of
routing emergency calls for medical assistance. These documents can be found on the
CDC Web site at http://www.cdc.gov/h1n1flu/guidance/.
Calls seeking medical advice or treatment usually must be routed to certified or
licensed medical personnel whereas general information calls do not require certified
or licensed medical personnel to answer questions. These two types of call centers
and examples of each are listed in Table 2-2. METCAD would follow this table to
reroute calls to the appropriate center to handle a caller’s questions. However, the
community can employ a public education campaign to educate the public on what
number to call to get specific questions answered, instead of dialing 9-1-1 for
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Section 2
everything. This will reduce call volume to METCAD and the delays caused by the
rerouting of calls to the appropriate call center.
Table 2-2
Types of Call Centers
Medical Advice/Treatment
General Information
Nurse advice lines
Answering services
Telephone triage lines
Non-profit organizations
Health information lines
Customer service lines
Poison centers
Governmental call centers
Medical hotlines
Communication centers
Medical insurance referral lines
Product/service ordering centers
In anticipation of large call volumes, these call centers may use volunteer call
screeners. These volunteer personnel (as well as regular employees) need to be
trained on how to manage a call and on what information to provide to the caller.
Non-trained volunteers can quickly be trained to manage informational calls using predeveloped scripts coordinated through the community’s JIC. For medical calls, some
communities have used volunteers from local Medical Reserve Corps. Key partners
will be able to help determine who needs to be trained and the scope of the training.
2.3.4.3 Routing Calls Technologically
Using a single-entry-point approach, calls can be routed technologically through:

Interactive Voice Response (IVR) – This is an automated phone system that
allows a caller to make a selection from a voice menu using the telephone’s
keypad or a voice response. The system plays voice prompts that lead the caller
through a series of menu options (for example, “Press or say 1 for customer
service”) to direct the call to the appropriate endpoint. IVR also allows the caller
to listen to prerecorded messages that provide information and updates on
outbreak status, thus lessening the need for the caller to talk to a person.

Automatic Call Distribution (ACD) – As the name implies, this system
automatically distributes calls based on parameters set up by the host of the
system. An example of the use of an ACD is phone banks set up for a fundraising
activity. Calls into the system are automatically routed to the first available call
taker. ACDs usually incorporate IVR technology (for example, “Press 1 for
Medical, press 2 for information…”).
Some of the community’s call centers already use these technologies. Key partners
will be able to identify those that do use them. If one of these call centers is staffed
and equipped to manage high call volumes, it may be possible to use it as the single
entry point.
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2.3.4.4 Disseminating Information
There are two objectives for disseminating information to the general public:
1.
Direct them on what actions to take or not to take (such as, “Do not call 9-1-1
unless it is a true emergency. Instead, call _____.” or “Please call a medical
advice line before going to a hospital.”).
2.
Provide them with the information they may be seeking from 9-1-1 or other call
centers.
The first objective can be accomplished quickly through a news media campaign. The
second objective also can be accomplished through a news media campaign, but can
also be accomplished through other means, such as Web sites, handouts, and mailings.
PIOs will be able to direct and manage these tasks.
When using IVR, it would be beneficial to front load important information for the
caller (such as, “Due to the current emergency, you may experience extended call wait
times. You can find the most current information at CDC.gov.”) To encourage the
caller to seek information from other reliable sources and thus reduce calls into the
system.
Important Note about Information Dissemination
Successful public information campaigns rely on disseminating information that is
delivered on time and is up-to-date, consistent, and accessible by all members of the
community. Having all components of the call center system aligned is essential to
help the public make informed decisions about appropriate actions to take. It also
shows the public that the organization is a reliable source of information and is in
control of the situation.
In emergency situations, information dissemination is a component of the
community’s ICS and would be managed by a JIC. It is imperative that key partners
operate within the community’s ICS and JIC frameworks and that a representative of
the call center system is in the JIC. Additionally, information dissemination should
include information on the closure and recovery after the incident to successfully
return the community to its normal state.
2.3.5 Step 5 – Prepare for the Next Wave
The first wave of H1N1 is not as severe as previously expected or anticipated in prior
community public health planning. However, future waves of the virus or new viruses
may be more severe than what is being seen today, which will result in even higher
call volumes to the METCAD system. In addition, many calls requiring medical
triage or clinical guidance (as opposed to general information) can be expected. As a
result, to prepare for the next wave, communities should continue looking at ways to
manage calls and call centers, with an eventual goal being to develop a coordinated
call center system. In the interim, it would be helpful to look at what other
communities have done to coordinate call centers to find out how they accomplished
the task and what lessons they learned from it. It also would be helpful to bring in
more key partners to discuss call center capacities, capabilities, and technologies to
Communication, Triage and IT Considerations during a Pandemic Influenza Event /February 2010
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Section 2
gauge what truly is available within the community and to look at ways they may be
linked to each other.
2.4 CDC Interim Guidance For 9-1-1 Public Safety
Answering Points, The Ems System And Medical
First Responders
This section provides interim guidance for 9-1-1 public safety answering points
(PSAPs), the EMS system, and medical first responders. Updates will be posted as
needed on the CDC H1N1 Influenza guidance Web page (CDC.gov). The information
contained in this document is intended to complement existing guidance for healthcare
personnel, “Interim Guidance for Infection Control for Care of Patients with
Confirmed or Suspected Swine Influenza A (H1N1) Virus Infection in a Healthcare
Setting,” which can be found at http://www.cdc.gov/h1n1flu/guidance/.
2.4.1 Background
As a component of the nation’s critical infrastructure, EMS (along with other
emergency services) play a vital role in responding to requests for assistance, triaging
patients, and providing emergency treatment to influenza patients. However, unlike
patient care in the controlled environment of a fixed medical facility, pre-hospital
EMS patient care is provided in an uncontrolled environment, often confined to a very
small space, and frequently requires rapid medical decision-making and interventions
with limited information. EMS personnel are frequently unable to determine the
patient history before having to administer emergency care.
2.4.2 Interim Recommendations
Coordination among PSAPs, the EMS system, healthcare facilities (for example
emergency departments), and the public health system is important for a coordinated
response to swine-origin influenza A (H1N1). Each 9-1-1 and EMS system should
seek the involvement of an EMS medical director to provide appropriate medical
oversight. Given the uncertainty of the disease, its treatment, and its progression, the
ongoing role of EMS medical directors is critically important. The guidance provided
in this document is based on current knowledge of swine-origin influenza A (H1N1).
The U.S. Department of Transportation's EMS Pandemic Influenza Guidelines for
Statewide Adoption and Preparing for Pandemic Influenza: Recommendations for
Protocol Development and 9-1-1 Personnel and Public Safety Answering Points
(PSAPs) are available online at www.ems.gov (click on Pandemic News). State and
local EMS agencies should review these documents for additional information. For
instance, Guideline 6.1 addresses protection of the EMS and 9-1-1 workers and their
families and Guideline 6.2 addresses vaccines and antiviral medications for EMS
personnel. In addition, EMS agencies should work with their occupational health
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programs and local public health/public safety agencies to make sure that long-term
personal protective equipment (PPE) needs and antiviral medication needs are
addressed.
2.4.3 Infectious Period
Persons with swine-origin influenza A (H1N1) virus infection should be considered
potentially infectious from one day before to seven days following onset of illness.
Persons who continue to be ill longer than seven days following onset of illness should
be considered potentially contagious until symptoms have resolved. Children,
especially younger children, might be contagious for longer periods.
Non-hospitalized ill persons who have a confirmed or suspected case of swine-origin
influenza A (H1N1) virus infection are recommended to check with their healthcare
provider about any special care they might need if they are pregnant or have a health
condition such as diabetes, heart disease, asthma, or emphysema, and then stay at
home (voluntary isolation) and away from others as much as possible for at least 24
hours after fever is gone (except to get medical care or other necessities) to keep from
making others sick. Fever should be gone without having taken a fever-reducing
medicine. Learn more about how to take care of someone who is ill in “Taking Care
of a Sick Person in your Home” located at http://www.cdc.gov/h1n1flu/guidance/.
2.4.4 Recommendations for 9-1-1 Public Safety Answering
Points
It is important for PSAPs to question callers to ascertain whether there is anyone at the
incident location who is possibly afflicted by the swine-origin influenza A (H1N1)
virus, to communicate the possible risk to EMS personnel prior to arrival, and to
assign the appropriate EMS resources. PSAPs should review existing medical
dispatch procedures and coordinate any modifications with their EMS medical director
and in coordination with their local department of public health.
Interim recommendations:

PSAP call takers should screen all callers for any symptoms of acute febrile
respiratory illness. Callers should be asked if they, or someone at the incident
location, has had nasal congestion, cough, fever, or other influenza-like
symptoms.

If the PSAP call taker suspects a caller is noting symptoms of acute febrile
respiratory illness, they should make sure any first responders and EMS
personnel are aware of the potential for acute febrile respiratory illness before
the responders arrive on scene.
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2.4.5 Recommendations for EMS and Medical First Responder
Personnel Including Firefighter and Law Enforcement
First Responders
For purposes of this section, “EMS providers” means pre-hospital EMS, law
enforcement and fire service first responders. EMS providers' practice should be
based on the most up-to-date swine-origin influenza A (H1N1) clinical
recommendations and information from appropriate public health authorities and EMS
medical direction.
2.4.5.1 Patient assessment
Interim recommendations:
If there HAS NOT been swine-origin influenza A (H1N1) reported in the geographic
area, EMS providers should assess all patients as follows:
1.
EMS personnel should stay more than 6 feet away from patients and bystanders
with symptoms and exercise appropriate routine respiratory droplet precautions
while assessing all patients for suspected cases of swine-origin influenza A
(H1N1).
2.
Assess all patients for symptoms of acute febrile respiratory illness (fever plus
one or more of the following: nasal congestion/rhinorrhea, sore throat, or cough).

If no acute febrile respiratory illness, proceed with normal EMS care.

If symptoms of acute febrile respiratory illness, then assess all patients for
travel to a geographic area with confirmed cases of swine-origin influenza A
(H1N1) within the last 7 days or close contact with someone with travel to
these areas.


If travel exposure, don appropriate PPE for suspected case of swineorigin influenza A (H1N1).
If no travel exposure, place a standard surgical mask on the patient (if
tolerated) and use appropriate PPE for cases of acute febrile respiratory
illness without suspicion of swine-origin influenza A (H1N1) (as
described in PPE section).
If the CDC confirmed swine-origin influenza A (H1N1) in the geographic area, EMS
providers should assess patients as follows:
1.
Address scene safety:

If PSAP advises potential for acute febrile respiratory illness symptoms on
scene, EMS personnel should don PPE for suspected cases of swine-origin
influenza A (H1N1) prior to entering scene.

If PSAP has not identified individuals with symptoms of acute febrile
respiratory illness on scene, EMS personnel should stay more than 6 feet
away from patient and bystanders with symptoms and exercise appropriate
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routine respiratory droplet precautions while assessing all patients for
suspected cases of swine-origin influenza A (H1N1).
2.
Assess all patients for symptoms of acute febrile respiratory illness (fever plus
one or more of the following: nasal congestion/rhinorrhea, sore throat, or cough).

If no symptoms of acute febrile respiratory illness, provide routine EMS care.

If symptoms of acute febrile respiratory illness, don appropriate PPE for
suspected case of swine-origin influenza A (H1N1) if not already on.
2.4.5.2 Personal Protective Equipment
Interim recommendations:

When treating a patient with a suspected case of swine-origin influenza A (H1N1)
as defined above, the following PPE should be worn:



Fit-tested disposable N95 respirator and eye protection (for example, goggles
or eye shield), disposable non-sterile gloves, and gown when coming into
close contact with the patient.
When treating a patient who is not a suspected case of swine-origin influenza A
(H1N1) but who has symptoms of acute febrile respiratory illness, the following
precautions should be taken:

Place a standard surgical mask on the patient if tolerated. If not tolerated,
EMS personnel may wear a standard surgical mask.

Use good respiratory hygiene. Use non-sterile gloves for contact with
patient, patient secretions, or surfaces that may have been contaminated.
Follow hand hygiene, including hand washing or cleansing with alcoholbased hand disinfectant after contact.
Encourage good patient compartment vehicle airflow/ventilation to reduce the
concentration of aerosol accumulation when possible.
2.4.5.3 Infection Control
EMS agencies should always practice basic infection control procedures, including
vehicle/equipment decontamination, hand hygiene, cough and respiratory hygiene, and
proper use of U.S. Food and Drug Administration cleared or authorized medical PPE.
Interim recommendations:

Pending clarification of transmission patterns for this virus, EMS personnel who
are in close contact with patients with suspected or confirmed cases of swineorigin influenza A (H1N1) should wear a fit-tested disposable N95 respirator,
disposable non-sterile gloves, eye protection (for example, goggles or eye shield),
and gown when coming into close contact with the patient.

All EMS personnel engaged in aerosol-generating activities (for example
endotracheal intubation, nebulizer treatment, and resuscitation involving
emergency intubation or cardiac pulmonary resuscitation) should wear a fit-tested
Communication, Triage and IT Considerations during a Pandemic Influenza Event /February 2010
2-11
Section 2
disposable N95 respirator, disposable non-sterile gloves, eye protection (for
example, goggles or eye shield), and gown unless EMS personnel are able to rule
out acute febrile respiratory illness or travel to an affected area in the patient
being treated.

All patients with acute febrile respiratory illness should wear a surgical mask if
tolerated by the patient.
2.4.6 Interfacility Transport
EMS personnel involved in the interfacility transfer of patients with suspected or
confirmed swine-origin influenza A (H1N1) should use standard, droplet, and contact
precautions for all patient care activities. This should include wearing a fit-tested
disposable N95 respirator, wearing disposable non-sterile gloves, eye protection (for
example, goggles or eye shield), and gown, to prevent conjunctival exposure. If the
transported patient can tolerate a facemask (for example, a surgical mask), its use can
help to minimize the spread of infectious droplets in the patient care compartment.
Encourage good patient compartment vehicle airflow/ventilation to reduce the
concentration of aerosol accumulation when possible.
2.4.7 Interim Guidance for Cleaning EMS Transport Vehicles
After Transporting a Suspected or Confirmed SwineOrigin Influenza A (H1N1) Patient
The following are general guidelines for cleaning or maintaining EMS transport
vehicles and equipment after transporting a suspected or confirmed swine-origin
influenza A (H1N1) patient. This guidance may be modified or additional procedures
may be recommended by the Centers for Disease Control and Prevention (CDC) as
new information becomes available.
Routine cleaning with soap or detergent and water to remove soil and organic matter
followed by the proper use of disinfectants is the basic component of effective
environmental management of influenza. Reducing the number of influenza virus
particles on a surface through these steps can reduce the chances of hand transfer of
virus. Influenza viruses are susceptible to inactivation by a number of chemical
disinfectants readily available from consumer and commercial sources.
After the patient has been removed and prior to cleaning, the air within the vehicle
may be exhausted by opening the doors and windows of the vehicle while the
ventilation system is running. This should be done outdoors and away from pedestrian
traffic. Routine cleaning methods should be employed throughout the vehicle and on
non-disposable equipment.
For additional detailed guidance on ambulance decontamination EMS personnel may
refer to "Interim Guidance for Cleaning Emergency Medical Service Transport
Vehicles during an Influenza Pandemic" at http://www.cdc.gov/h1n1flu/guidance/.
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2.4.8 EMS Transfer of Patient Care to a Healthcare Facility
When transporting a patient with symptoms of acute febrile respiratory illness, EMS
personnel should notify the receiving healthcare facility so that appropriate infection
control precautions can be taken prior to patient arrival. Patients with acute febrile
respiratory illness should wear a surgical mask if tolerated. Small facemasks that can
be worn by children are available, but it may be problematic for children to wear them
correctly and consistently. No facemasks (or respirators) have been cleared by the
U.S. Food and Drug Administration specifically for use by children.
Figure 2-1
Sample Pandemic Influenza EMS Dispatch Protocol
The Sample Pandemic Influenza EMS Dispatch Protocol is for illustrative purposes only. It is one example of how
resources may be reallocated within the system during an influenza pandemic utilizing the Pandemic Severity
Index. EMS planners should consider other factors, including community mitigation strategies, that will impact how
resources will be used. These factors may include:
1. Increased demand for services
2. Reduction of EMS/dispatch workforce
3. Healthcare facility bed availability
Dispatch Priority
Level
(should match vendor or
call center based dispatch
protocol/tiered algorithm)
Response
(Standard
Operating Mode)
Pandemic
Severity Index
Category 1
Pandemic
Severity Index
Category 2-3
Pandemic
Severity Index
Category 3-4
Classification 1
Confirmed/suspected
cardiac arrest (not
breathing, unresponsive
per 911 call)
Closest AED unit;
closest first
responder;
closest ALS
ambulance (HOT)
Closest AED Unit; closest
first responder; closest BLS
ambulance if available
(HOT)
Closest AED unit (HOT);
closest first responder if
available (HOT)
Closest AED unit if
available (HOT)
Classification 2
Life threatening
emergency/potentially life
threatening/confirmed
unstable Patients(s)
Closest first
responder;
closest ALS
ambulance (HOT)
Closest first responder;
closest ALS ambulance if
available; BLS ambulance if
ALS unit not available
(HOT)
Closest first responder;
closest ambulance
available (ALS or BLS)
(HOT)
Closest first responder;
closest ambulance
available (ALS or BLS)
(HOT)
Classification 3
Non-critical/currently
stable patient(s) requiring
ALS assessment
Closest ALS
ambulance
(COLD)
Closest ambulance
available (ALS or BLS)
(COLD)
Closest ambulance
available (ALS or BLS)
(COLD)
Referral to alternate call
center; or advise selftransport to alternate
treatment site
Classification 4
BLS assessment for
unknown/possibly
dangerous scenes
Closest first
responder (HOT);
closest BLS
ambulance
(COLD)
Closest first responder
(HOT); Closest BLS
ambulance if available
Closest first responder
(HOT)
Closest first responder if
available; or closest
stand-in responder unit
Classification 5
BLS treatment
BLS ambulance
(COLD)
BLS ambulance (COLD)
Alternate call center (such
as Poison Control Center,
nurse advice line, health
care center, etc.)
Alternate call center
(such as Poison Control
Center, nurse advice
line, health care center,
etc.)
Classification 6
Non-ambulance care
Alternate call
center (such as
Poison Control
Center, nurse
advice line,
health care
center, etc.)
Alternate call center (such
as Poison Control Center,
Nurse advice line, health
care center, etc.)
Alternate call center (such
as Poison Control Center,
nurse advice line, health
care center, etc.)
Alternate call center
(such as Poison Control
Center, nurse advice
line, health care center,
etc.)
Communication, Triage and IT Considerations during a Pandemic Influenza Event /February 2010
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Section 2
HOT = An EMS vehicle involved in an emergency response or transport while using appropriate
audible and visual emergency signaling equipment (lights and siren) in accordance with statutes.
COLD = An EMS vehicle involved in a non-emergency response or transport while not using
emergency signaling equipment (no lights and siren)
ALS = Advanced Life Support
BLS = Basic Life Support
AED = Automatic External Defibrillator
Figure 2-2
U.S. Department of Transportation. “EMS Pandemic Influenza Guidelines for Statewide
Adoption.” May 2007
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2.2.1
Coordination
The call center will be under the control of the CUPHD public health administrator or
designated appointee and shall be staffed by as many medical professionals trained in
phone triage methods as possible. Auxiliary staffing should be provided through
partnership with an organization such as the Medical Reserve Corps that can provide
medical professionals trained in phone triage methods.
When untrained volunteers must be used, the PIO or public health administrator will
provide scripted responses and triage procedures that must be read exactly as given.
Any deviation from a script requires intervention and approval of a trained medical
professional.
A call center will be established to provide staffing to respond to calls and inquiries
made directly to the community health hotline or as redirected by the public safety
communications center. The call center must be large enough to accommodate the
professional staff and trained volunteers necessary to respond at the peak of a
pandemic event.
CUPHD will provide the following for the establishment of a call center:
1.
Adequate utility service (for example, power; water service; heating, ventilation
and air conditioning; telecommunications)
2.
Restroom facilities
3.
Parking
4.
Telephone lines for voice and Internet use
5.
Office space for the preparation of updated messages, scripts, and other PIO
activities
6.
Office equipment (for example, copiers, faxes, computers, desks, and chairs)
7.
Support personnel (for example, computer technicians, custodial personnel, and
security personnel)
8.
Identification badge machine for producing ID badges for staff
2.2.2
Triage Principles
The call center staff will receive calls transferred from the METCAD public safety
communications center or direct calls to the community health hotline and will process
the callers to determine if emergency medical services, information services, or home
healthcare advice is required.
When it is determined that emergency medical service is required, the caller will be
referred to the appropriate emergency care center. If transportation is required,
METCAD will be requested to dispatch EMS.
When it is determined that pandemic information is required, the caller will be
provided general information about the pandemic influenza using pre-scripted
responses to answer the caller’s questions. The caller may also be directed to other
Communication, Triage and IT Considerations during a Pandemic Influenza Event /February 2010
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Section 2
information services, such as the Web sites for IDPH, HHS, or CDC. If it is
determined that home healthcare advice is required, the caller will be provided
guidance using pre-scripted pandemic influenza home medical care instructions and
guidelines for seeking emergency care if the caller experiences worsening symptoms,
such as respiratory difficulty.
Figure 2-3
All volunteer staff must identify themselves as volunteers when taking a call and must
respond using predetermined scripts to advise and direct callers on a course of action
U.S. Department of Health and Human Services. “Adapting Community Call Centers for
Crisis Support: A Model for Home-Based Care and Monitoring.” Agency for Healthcare
Research and Quality, AHRQ Publication No. 07-0048. September 2007.
2.2.3 Triage Planning Assumptions and Considerations
1.
The METCAD public safety communications center answers emergency 9-1-1
calls and provides dispatch services for all of Champaign County, with the
exception of the Village of Rantoul. METCAD will likely see a significant
increase in non-emergency calls as a result of a pandemic event, which could
overwhelm their capacity to receive and dispatch calls.
2.
A community health hotline and call center will be activated at the onset of a
declared emergency that requires activation of the Champaign County Pandemic
Influenza Plan.
3.
Radio and television stations provide emergency and public service information
as a condition of their licensing. These two mediums may be used to inform the
public of preparedness for and recovery from an emergency.
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A. Assumptions
1.
During a pandemic emergency, the public and the media need and will seek out
information about the emergency as well as instructions on proper protective
actions.
2.
Timely and accurate information can save lives, protect property, and reduce
panic and confusion.
3.
An incident can or has occurred, raising the need to communicate accurate and
timely information to the public regarding its safety, evacuation, sheltering, or
other emergency concerns.
4.
METCAD has a continuity of operations plan in place to address a shortage of
trained emergency medical dispatch personnel due to pandemic influenza.
5.
The community health hotline and call center will have sufficient professional
staff and trained volunteers from organizations such as the Medical Reserve
Corps to meet the projected call volume.
6.
The METCAD public safety communications center will have the capability to
transfer calls directly to the community health hotline and call center or will direct
non-emergency callers to contact the hotline directly.
7.
Sufficient telephone equipment, telephone lines, switchgear, and call center
workstations are pre-positioned at an existing call center site to meet the expected
surge in call volume at the time of a pandemic event.
Communication, Triage and IT Considerations during a Pandemic Influenza Event /February 2010
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