# Presentation: 496665

## Pandemic Intervals, Triggers, and Actions

- Approaches to Planning and Response

## Pandemic Severity Index

- Determined using:
- Case-Fatality Ratio
- Excess Mortality
- PSI characterized as categories
- For instance, for categories 4 and 5 (CFRs 1-2% and ≥ 2%) all community measures are recommended
- Complete information available at Pandemicflu.gov, “*Community Strategy for Pandemic Influenza Mitigation in the US*”

## Community Mitigation Interventions

- Home: Cases and Contacts
- Voluntary Isolation of Cases
- Voluntary Quarantine of household members in homes with ill persons, use antivirals if feasible
- School: Child Social Distancing
- Dismissal of students, closure of child care programs
- Reduce out-of-school contacts & community mixing
- Workplace / Community: Adult Social Distancing
- Decrease number of social contacts
- Increase distance between persons
- Minimize public gatherings
- Modify workplace schedules

## When to Initiate Actions?

- WHO Phases identify global progression of pandemic
- US Government Stages provide more framework for national actions
- Pandemic Intervals
- New approach to planning to account for:
- Asynchrony of pandemic transmission
- Need for different responses to occur in different places based on local transmission of influenza
- Identified time intervals that follow an idealized pandemic curve

## Intervals, Triggers, Actions

- Pandemic Intervals
- Initiation
- Acceleration
- Peak Transmission
- Deceleration
- Resolution
- Definitions and triggers for actions such as implementing CMI are provided

## Questions

- _[intervals@cdc.gov](mailto:intervals@cdc.gov)_
- For questions regarding Intervals, Triggers, and Actions approach
- Pandemicflu.gov
- Community Mitigation Guidance

## Uniformed Military Services 

**Daniel Bochicchio, MD**
**Colonel, Medical Corps, USA**

## The National Guard

- The National Guard is the organized militia reserved to the states by the Constitution of the United States* .
- It is a Constitutionally unique “dual hatted” organization
- Since 1636, the Guard has served America as both a wartime force and the first military responders in times of domestic crisis.
- Under Command of the Governor thru The Adjutant General
- May be Federalized by the President to fight wars or quell insurrections
- Currently there are over 450,000 National Guardsmen
- Can provide essential domestic support services to the States during disasters
- Today there over 7000 guardsmen nationwide providing disaster relief support to the States
- The National Guard “Essential 10”:
- Aviation and Airlift, Communications, Command and Control, Engineering, Logistics, Medical, CBRNE Response, Maintenance, Security,  Transportation

- *Article 1, Section 8

## Uniformed Military Services: Specific Considerations during a Pandemic

- Encourage State Emergency Managers and Public Health Officials to:
- Understand how to efficiently utilize the National Guard (NG) capabilities during all phases of PI planning and response
- Clearly codify the responsibilities of the NG in the State plan
- Establish solid lines of communications in a pre-event environment
- Cross walk the “NG Essential 10” to the NRF ESF’s
- Identify critical shortfalls and develop solutions
- Understand constraints and limitations of the NG response
- Ensure that All DoD (Active Duty and Reserve), NG members and their beneficiaries, living in the state are accounted for in all phases of planning for:
- Antiviral medications, PPE, Healthcare, Social Services, etc.
- Encourage local public health officials to establish contact with adjacent Federal military base/post Public Health Emergency Officer
- Coordinate with the Federal Regional PI Planning Office

## National Guard Domestic Support to State: “The Essential 10” 

| National Guard Capability | Emergency Support Function |
| --- | --- |
| 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 |
| CBRNE Response | ESF 10 |
| Maintenance | ESF 6, 7, 8 and 12 |
| Security  | ESF 13 |
| Transportation  | ESF 1 |

## Operating Objective A.6Sustain Transportation SystemsJoan HarrisU.S. DOTjoan.harris@dot.gov

## Sustain Transportation Systems

- _3 Goals_
- Keep Goods and People Moving
- Protect Transportation Workers
- Protect the Public while using Transportation Systems

**Notes:**
The “prepare” items for all three sub-objectives are listed first on pages 51-52. The items that will be evaluated are in the tables. These are the “Respond” and “Recover” items.

## Sustain Transportation Systems (cont)

-  Goal 1. _Keep Goods and People Moving_
- Keep state transportation systems moving
- Keep goods and cargo moving within states and from state to state
- Identify and prioritize essential transportation systems and cargo

**Notes:**
Do not shut down transportation systems, do not close state or international borders, determine which transportation systems and cargo will be critical during a pandemic. Plan for surges or declines in transportation modes.

## Sustain Transportation Systems (cont)

- Goal 2.  _Protect Transportation Workers_
- Measures to ensure the safety of transportation workers
- Training and instruction on personal protective equipment, cleaning/sanitizing operations and protocol for potentially sick passengers

**Notes:**
 General information pertaining to worker safety, located in  Appendix A.0 – A.1 should be followed. This section lists measures specific to transportation workers.
Risk assessment should focus on those “essential” and “unique” workers who are Medium to High risk.

## Sustain Transportation Systems (cont)

- Goal 3.  _Protect the Public while using Transportation Systems_
- Public awareness and education
- Travel advisories
- Public Safety Campaigns

**Notes:**
Coordinate public messaging with lead public health authorities, messaging should indicate level of risk for travelers. Posters, videos, flyers, and other information on pandemic flu should be posted at bus stops, metro & railstations, etc. Advice to the public on how to safely utilize the transportation systems such as wearing masks, etc.

## Additional Reference Material

- Transportation Sub-Sector annexes from “Pandemic Influenza Preparedness, Response, and Recovery”
- Aviation
- Highway and Motor Carrier
- Maritime
- Mass Transit
- Railroad
- Now available in final draft:
- 	_http://www.dot.gov/pandemicflu/_

## Provide HealthcareandManage Mass Fatalities

## At-Risk Populations

- Definition- Functional Needs
- Planning
- Locating populations in the community
- Relationships with advocates
- Messages from trusted sources

## Bed Surge Capacity

- Hospital Available Beds for Emergencies and Disasters (HAvBED)
- Standard Definitions; Seven types
- Available in 24 hours; Available in 72 hours
- ED Status: Open / Closed / NA
- Available ventilators
- http://www.ahrq.gov/prep/havbed/havbed2.htm

## Alternate Care Sites

- Expand into Non-Hospital Settings
- Identify locations
- Scope of care
- Staffing
- Equipment, Supplies, Pharmaceuticals

## Personnel Surge Capacity

- Volunteer Registry (ESAR-VHP)
- Procedures for deploying and tracking
- Databases with credentialed personnel
- Mission definition - Resource types
- Notification & Fitness for duty
- Human resources; Legal protections
- Logistics support
- Reporting procedures

## Scarce Resources

- Ethical Distribution
- Spectrum of adaptations
- Administrative / Clinical changes
- Maximize resources
- Clinical care committee
- Ethical principles and Community norms
- Transparent decision making
- http://www.ahrq.gov/research/mce

## Fatality Management

- Web-based death certificates
- Procedures for deaths at home
- Public messages for stress management

## Healthcare Recovery

- Mechanisms to restore
- Staffing, equipment, supplies, pharmaceuticals
- Mental health, substance abuse and other services
- After action reviews and corrective action plans

## Department of Veterans Affairs

- Primary function is to provide services to eligible veterans
- Serves as a back up for the Department of Defense
- Has expanded responsibilities under the National Response Framework
- States/territories should include their local VA facilities in the PI planning process

**Notes:**
Include local VA facilities in planning process whether those are Federal or state facilities.
National Association of State Directors of Veteran’s Affairs = directors report to governor  
Might not be able to make an agreement, doesn’t mean that they couldn’t share resources in an event.  
Goal learn about the resources that might be able to be shared.  
Know how to contact VA and request resources.  
VA liaison in the SOC would contact VA coordination center.