EMERGENCY MEDICAL SERVICE AND NON-EMERGENT (MEDICAL) 

TRANSPORT ORGANIZATIONS PANDEMIC INFLUENZA PLANNING CHECKLIST 

Planning for pandemic influenza is critical for ensuring a sustainable health care response. The Department of Health and 

Human Services (HHS) and the Centers for Disease Control and Prevention (CDC) have developed the following checklist 

to help emergency medical services (EMS) and non-emergent (medical) transport organizations assess and improve their preparedness 

for responding to pandemic influenza. EMS organizations will be involved in the transport of acutely ill patients with known or suspected 

pandemic influenza to emergency departments; some of these patients might require mechanical ventilation for life support and/or other 

lifesaving interventions. Non-emergent (medical) transport organizations will be called upon to transport recovering pandemic influenza 

patients to their home, residential care facility, or possibly to alternate care sites set up by state or local health departments. This checklist 

is modeled after one included in the HHS Pandemic Influenza Plan (www.hhs.gov/pandemicflu/plan/sup3.html#app2). The list is 

comprehensive but not complete; each organization will have unique and unanticipated concerns that also will need to be addressed as part of 

a pandemic planning exercise. Also, some items on the checklist might not be applicable to all organizations. Collaborations among hospital, 

public health and public safety personnel are encouraged for the overall safety and care of the public. Further information can be found at 

www.pandemicflu.gov. 

This checklist identifies key areas for pandemic influenza planning. EMS and non-emergent (medical) transport organizations can use this 

tool to self-assess and identify the strengths and weakness of current planning. Links to websites with information are provided throughout 

the document. However, actively seeking information that is available locally or at the state level will be necessary to complete the 

development of the plan. Also, for some elements of the plan (e.g., education and training programs), information may not be immediately 

available and monitoring of selected websites for new and updated information will be necessary

1. Structure for planning and decision making. 

Pandemic influenza has been incorporated into emergency management planning and exercises for 

the organization.

A planning committee1 has been created to specifically address pandemic influenza preparedness. 

A person has been assigned responsibility for coordinating pandemic influenza preparedness 

planning (hereafter referred to as the pandemic response coordinator) for the organization.

(Insert name, title, and contact information.)

Members of the planning committee include the following: (Insert below or attach a list with name 

title and contact information for each.)

 Administration: 

 Medical staff: 

 EMS providers: 

 Phone triage personnel/dispatch center: 

 Emergency management officer: 

 State/local health official: 

 Law enforcement official (for quarantine/security): 

 Other member2: 

A point of contact (e.g., internal staff member assigned infection control responsibility for the 

organization or an outside consultant) for questions/consultation on infection control has been 

identified. (Insert name, title, and contact information.)

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March 1, 2006 Version 2.1

1. Size of committee can vary, depending on the size and needs of the organization. 

2. Some organizations may need or want to include a school official or volunteer coordinator for local civic and preparedness groups 

(e.g., Medical Reserve Corps, Citizen Corps, Community Emergency Response Teams, Rotary Club, Lions, Red Cross).
A plan is in place for surveillance and detection of pandemic influenza in the population served and 

the appropriate organizational response. 

 Responsibility has been assigned for monitoring national and state public health advisories (e.g., 

www.cdc.gov/flu/weekly/fluactivity.htm) and informing the pandemic response coordinator and 

members of the pandemic influenza planning committee when cases of pandemic influenza have 

been reported in the United States and when they are nearing the geographic area (e.g., state or city). 

(Insert name, title, and contact information of person responsible.) 

 A system has been created to track influenza-like illness in patients transported to hospitals and 

among EMS staff and to report this information to the pandemic response coordinator (i.e., weekly 

or daily number of patients with influenza-like illness). For more information see www.cdc.gov/flu/

professionals/diagnosis/. (Having a system for tracking illness trends in patients and staff during 

seasonal influenza will ensure that organizations can detect stressors that may affect operating 

capacity, such as staffing and supply needs, and hospital and emergency department capacity during 

a pandemic.)

A communication plan has been developed.

 Key public health points of contact for pandemic influenza have been identified. (Insert below or 

attach a list with the name, title, and contact information for each.)

 Local health department contact: 

 State health department contact: 

 Local emergency management contact: 

 State emergency management contact: 

 Federal health emergency contact(s): 

 The organization’s point person for external communication has been assigned. 

(Insert name, title, and contact information.) 

 

 (Having one person who speaks with the health department, and if necessary, media, local 

politicians, etc., will help ensure consistent communication is provided by the organization.)

 A list of healthcare entities and their points of contact (e.g., other local EMS and non-emergent 

[medical] transport organizations, local hospitals and their emergency departments, community 

health centers, residential care facilities has been created. (Insert location of or attach copy of contact 

list.) 

 

 The pandemic response coordinator has contacted local or regional pandemic influenza planning 

groups to obtain information on communication and coordination plans, including how EMS will be 

represented in the planning process. (For more information on state and local planning, 

see www.hhs.gov/pandemicflu/plan/part2.html#overview.)

 The pandemic response coordinator has contacted other EMS and non-emergent (medical) transport 

organizations regarding pandemic influenza planning and coordination of services.

2. Development of a written pandemic influenza plan. 

Copies of relevant sections of the Department of Health and Human Services Pandemic Influenza 

Plan have been obtained. www.hhs.gov/pandemicflu/plan.

Copies of available community and state pandemic plans have been obtained.

A written plan has been completed or is in progress that includes the elements listed in #3 below.

The plan describes the organizational structure (i.e., lines of authority) that will be used to 

operationalize the plan.

The plan complements or is part of the community response plan.

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3. Elements of an influenza pandemic plan.

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A plan is in place to ensure that education and training on pandemic influenza is provided to ensure 

that all personnel understand the implications of, and control measures for, pandemic influenza and the 

current organization and community response plans.

 A person has been designated to coordinate education and training (e.g., identify and facilitate access 

to education and training programs, ensure that staff attend, and maintain a record of attendance at 

education and training programs). (Insert name, title, and contact information.)

 Current and potential opportunities for long-distance (e.g., web-based) and local (e.g., health department 

or hospital sponsored programs, programs offered by professional organizations or federal agencies) 

education of EMS and medical transport personnel have been identified. (For more information see 

www.cdc.gov/flu/professionals/training/.)

 Language and reading-level-appropriate materials for professional and non-professional personnel on 

pandemic influenza (e.g., available through state and federal public health agencies and professional 

organizations) have been identified and a plan is in place for obtaining these materials.

 Education and training include information on infection control measures to prevent the spread of 

pandemic influenza.

 Differences between responding to pandemic influenza and a mass casualty event have been incorporated 

into education and training programs.

A plan has been developed for triage and management of patients during a pandemic that includes the 

following: 

 A system for phone triage of patients calling 911 or other emergency numbers that might be used 

(provide/post list of appropriate numbers) that includes pre-established criteria and coordination 

protocols to determine who needs emergency transport. The system includes points of referral for 

patients who do not need emergency transport.

 A plan for coordination with receiving facilities (e.g., hospital emergency departments), other EMS and 

non-emergent (medical) transport organizations, and local planning groups to manage the transportation 

of large numbers of patients at the height of the pandemic. 

 A policy and procedure for transporting multiple patients with pandemic influenza during a single 

ambulance run.

 The plan considers the possible necessity of sharing transportation resources or using vehicles other than 

those designed for emergency or medical transport (e.g., buses).

An infection control plan is in place and includes the following: (For information on infection control 

recommendations for pandemic influenza, see www.hhs.gov/pandemicflu/plan/sup4.html).

 A plan for implementing Respiratory Hygiene/Cough Etiquette for patients with a possible respiratory 

illness.

 The plan includes distributing masks3

 to symptomatic patients who are able to wear them (adult and 

pediatric sizes should be available), providing facial tissues and receptacles for their disposal, and hand 

hygiene materials in EMS and medical transport vehicles.

 Implementation of Respiratory Hygiene/Cough Etiquette has been exercised during seasons when 

seasonal influenza and other respiratory viruses (e.g., respiratory syncytial virus, parainfluenza virus) are 

circulating in communities. 

 A policy that requires healthcare personnel to use Standard Precautions (www.cdc.gov/ncidod/dhqp/gl_

isolation_standard.html) and Droplet Precautions (i.e., mask for close contact) (www.cdc.gov/ncidod/

dhqp/gl_isolation_droplet.html) with symptomatic patients. 

3. Elements of an influenza pandemic plan. (continued)

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3. Masks include both surgical and procedure types. Procedure masks that are affixed to the head with ear loops might be used more easily by patients and are available in 

pediatric and adult sizes. Either surgical or procedure masks may be used as a barrier to prevent contact with respiratory droplets.
3. Elements of an influenza pandemic plan. (continued)

An occupational health plan has been developed that includes the following:

 A liberal/non-punitive sick leave policy for managing EMS and non-emergent (medical) transport 

personnel who have symptoms of, or documented illness with, pandemic influenza.

 The policy considers the following:

 • Handling of staff who become ill at work.

 • When personnel may return to work after recovering from pandemic influenza.

 • When personnel who are symptomatic but well enough to work will be permitted to continue 

working.

 • Personnel who need to care for their ill family members.

 A system for evaluating symptomatic personnel before they report for duty that has been tested 

during a non-pandemic influenza period. 

 A list of mental health and faith-based resources available to provide counseling to personnel during 

a pandemic. 

 Management of personnel who are at increased risk for influenza complications (e.g., pregnant 

women, immunocompromised healthcare workers) by placing them on administrative leave or 

altering their work locations.

 The ability to monitor seasonal influenza vaccination of personnel.

 Offering annual influenza vaccine to personnel. 

A vaccine and antiviral use plan has been developed.

 Websites containing current CDC and state health department recommendations for the use and 

availability of vaccines and antiviral medications have been identified. (For more information, see 

www.hhs.gov/pandemicflu/plan/sup6.html and www.hhs.gov/pandemicflu/plan/sup7.html.) 

 An estimate has been made of the number of personnel who will be targeted as first and second 

priority for receipt of pandemic influenza vaccine and antiviral prophylaxis, based on HHS guidance 

for use. (For more information, see www.hhs.gov/pandemicflu/plan/appendixd.html.)

 Discussions have been held with the local and/or state health department regarding the role of the 

organization in a large-scale program to distribute vaccine and antivirals to the general population. 

Concerns related to surge capacity during a pandemic have been addressed. 

 A plan is in place for managing a staffing shortage within the organization because of illness in 

personnel or their family members. 

 The minimum number and categories of personnel necessary to sustain EMS and non-emergent 

(medical) transport services on a day-to-day basis have been determined.

 Contingency staffing plans have been developed in collaboration with other local EMS and nonemergent (medical) transport providers.

 Hospitals and regional planning groups have been consulted regarding contingency staffing 

resources.

 Anticipated consumable resource needs (e.g., masks, gloves, hand hygiene products) have been 

estimated.

 A primary plan and contingency plan to address supply shortages have been developed. These 

include detailed procedures for the acquisition of supplies through normal channels and requesting 

resources for replenishing supplies when normal channels have been exhausted. 

 Plans include stockpiling at least a week’s supply of resources when evidence exists that pandemic 

influenza has reached the United States. 

 An understanding of the process exists for requesting and obtaining assets for the organization made 

available through the community response plan. 

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