COORDINATING PEDIATRIC MEDICAL CARE DURING 

AN INFLUENZA PANDEMIC

HOSPITAL WORKBOOK
The Oak Ridge Institute for Science and Education (ORISE) is a U.S. Department of Energy (DOE) 

institute focusing on scientific initiatives to research health risks from occupational hazards, assess 

environmental cleanup, respond to radiation medical emergencies, support national security and 

emergency preparedness, and educate the next generation of scientists. 

This report was prepared for the Centers for Disease Control and Prevention (CDC) by ORISE through an 

interagency agreement with DOE. ORISE is managed by Oak Ridge Associated Universities (ORAU) under DOE

contract number DE-AC05-06OR23100. 

The findings and conclusions in this report are those of the authors and do not necessarily represent the 

official position of the Centers for Disease Control and Prevention. 
COORDINATING PEDIATRIC MEDICAL CARE 

DURING AN INFLUENZA PANDEMIC

HOSPITAL WORKBOOK

Prepared for: 

Centers for Disease Control and Prevention > Division of Healthcare Quality Promotion > Healthcare 

Preparedness Activity 

Prepared by: 

Oak Ridge Institute for Science and Education 

Version 1, January 2010 
This Page Intentionally Blank
i 

TABLE OF CONTENTS

Background ......................................................................................................................................... 1

Purpose ............................................................................................................................................ 1

How to Use this Workbook ............................................................................................................. 1

Disclaimer ........................................................................................................................................ 2

Children's Hospital Focus ..................................................................................................................... 3

Target Audience............................................................................................................................... 3

Overview ........................................................................................................................................... 3

Area 1 – Pediatric Medical Liaisons Between Children’s Hospitals and General Hospitals .. 4

Area 2 – Internal Surge Capacity Assessment ......................................................................... 10

Area 3 – Pandemic Influenza Alternate Staffing Model ........................................................... 18

Area 4 – Coordination with the Community Pandemic Influenza Response......................... 24

Area 5 – Patient- and Family-Centered Care (PFCC) During a Pandemic Influenza Surge .. 30

Area 6 – Pandemic Influenza Pediatric Triage ......................................................................... 34

General Hospital Focus ...................................................................................................................... 37

Target Audience............................................................................................................................. 37

Overview ......................................................................................................................................... 37

Area 1 – Pediatric Medical Liaisons and Other Key Contacts ................................................ 38

Area 2 – Internal Pediatric Care Capabilities Assessment ..................................................... 44

Area 3 – Coordination with the Community Pandemic Influenza Response......................... 56

Area 4 – Patient- and Family-Centered Care (PFCC) During a Pandemic Influenza Surge .. 62

Area 5 – Pandemic Influenza Pediatric Triage ......................................................................... 66

Appendix A: Acronyms .......................................................................................................................... 1

Appendix B: Acknowledgments ............................................................................................................. 1

Appendix C: References ....................................................................................................................... 1
ii 

This Page Intentionally Blank
1 

BACKGROUND

In September, 2009, the Centers for Disease Control and Prevention's (CDC's) Division of Healthcare 

Quality Promotion (DHQP) convened a Pediatric Healthcare Response to Pandemic H1N1 Influenza 

Stakeholder Meeting in Atlanta, Georgia. Participants in the meeting divided into working groups to 

address pediatric related topics and issues. One group was tasked with identifying and prioritizing 

hospital issues related to pediatric care during the 2009 H1N1 influenza pandemic. The efforts of this

group serve as the basis for this document. 

This workbook is intended to assist hospitals with coordinating medical care for pediatric influenzalike illness (ILI) across their community. Although many of the suggestions were based on 

experiences with the 2009 H1N1 pandemic, this tool can be adapted for use during pandemic spread 

of a novel influenza virus. This tool is presented in two sections, identified by type of hospital focus: 

Children's Hospital Focus and General Hospital Focus. 

Users of the workbook may find it helpful if their community hospitals are able to access accurate and

real-time data on the number of pandemic influenza cases in its community and the severity of illness 

in these cases. Prior to using this workbook, it would be beneficial for the users—hospital and 

community planners—to determine the best way to collect and disseminate these data. 

PURPOSE

The purpose of this workbook is to assist hospitals in the process of coordinating pediatric influenzalike illness (ILI) medical care across a community during an influenza pandemic. 

HOW TO USE THIS WORKBOOK

Throughout this workbook, you will be asked to identify and input information regarding your hospital's 

internal capacity to respond to a pediatric patient surge during an influenza pandemic. You also will 

be asked to integrate your hospital's influenza pandemic response into the external planning efforts of 

your community if this has not been done already. 

This workbook is not intended to replace your hospital's previous planning efforts. Instead, it builds on 

those efforts. The utility of this workbook comes from using existing information to assist in 

coordinating pediatric ILI medical care across a community. 

There are two parts to this workbook: Part A – Children's Hospitals and Part B – General Hospitals. 

To get started, select the appropriate part for your facility and gather your hospital's pandemic 

influenza and/or disaster response plans. 

Both Parts A and B are broken down into focus areas. Part A – Children's Hospitals has six focus 

areas and Part B – General Hospitals has five focus areas. Each focus area provides action steps for 

you to take as well as tips from subject matter experts (SMEs) for addressing the action. 
2 

Each focus area also provides colored side bars that contain supplemental information, such as SME 

suggested resources, to assist you. The following diagram illustrates the layout of the workbook 

pages. 

DISCLAIMER

This workbook is a compilation of suggestions and planning steps discussed by subject matter 

experts at the Pediatric Healthcare Response to Pandemic H1N1 Influenza Stakeholder Meeting. The 

resources cited in the workbook have been used by the SMEs in their own disaster planning 

processes prior to the meeting and therefore, are included as examples or suggestions for other 

hospitals. The inclusion of resources in this workbook does not imply that they have been endorsed 

by CDC, the SMEs, or their organizations. This workbook is also not intended to serve as a 

comprehensive listing of all available disaster planning resources. There may be other helpful 

documents available from many organizations and agencies. 
3 

CHILDREN'S HOSPITAL FOCUS

TARGET AUDIENCE

Children's Hospitals 

OVERVIEW

Subject matter experts (SMEs) identified six areas that 

should be addressed by children's hospitals when 

coordinating medical care for pediatric influenza-like illness 

(ILI) across a community. 

Area 1 Pediatric Medical Liaisons Between 

Children’s Hospitals and General Hospitals 

Area 2 Internal Surge Capacity Assessment 

Area 3 Pandemic influenza alternate staffing model 

Area 4 Coordination with the Community Pandemic 

Influenza Response 

Area 5 Patient- and Family-Centered Care During a 

Pandemic Influenza Surge 

Area 6 Pandemic Influenza Pediatric Triage 

Part A

CHILDREN'S HOSPITAL WORKBOOK
4 

AREA 1 – PEDIATRIC MEDICAL LIAISONS BETWEEN 

CHILDREN’S HOSPITALS AND GENERAL HOSPITALS 

Improving communication between hospitals in a community will 

improve the coordination of pediatric ILI medical care. If 

relationships with other hospitals outside of typical jurisdictions 

and referral patterns have not been established, developing these 

relationships should be a priority. You can achieve this by defining 

the role of a pediatric medical liaison for your hospital and 

selecting the appropriate person to fill this role. The primary role of 

the pediatric medical liaison is to develop relationships with other 

hospitals. Other roles and responsibilities of the pediatric medical 

liaison are to: 

• Develop new relationships with other hospitals 

• Maintain existing relationships with other hospitals 

• Communicate with internal hospital staff to facilitate 

 continuity of care for pediatric patients with ILI

• Provide clinical expertise in pediatric care to non-routine 

 pediatric providers, if possible. If not, develop a relationship 

 with a physician who can provide pediatric expertise 

• Assist in completing the identified areas in this workbook 

• Review this workbook with hospital administrators and 

 other key hospital decision-makers 

Pediatric medical liaison 

A person selected to represent a 

specific hospital when coordinating 

pediatric ILI medical care with other 

hospitals in the community 

Non-routine pediatric 

provider

A provider who does not regularly 

see children (e.g., an internist) 

SME TIP

It is recommended that a 

pediatric medical liaison for 

children’s hospitals be a 

pediatrician, preferably with 

a background in pediatric 

emergency medicine. 
5 

ACTION

► Identify an appropriate pediatric medical liaison for your 

hospital and record their information below. 

ACTION

► Identify pediatric medical liaisons for each hospital in your 

community and record their information in the space provided. 

Hospital Name: 

Liaison Name: 

Title: 

Address: 

Phone: 

Fax: 

E-mail: 

Hospital Name: 

Liaison Name: 

Title: 

Address: 

Phone: 

Fax: 

E-mail: 

Name: 

Title: 

Phone: 

Fax: 

E-mail: 
6 

Hospital Name: 

Liaison Name: 

Title: 

Address: 

Phone: 

Fax: 

E-mail: 

Hospital Name: 

Liaison Name: 

Title: 

Address: 

Phone: 

Fax: 

E-mail: 

In addition to communicating with other hospitals, it is important 

for the pediatric medical liaison to establish relationships with 

other healthcare and supporting sectors that participate in the 

community-wide influenza pandemic response. 

Action 

► Identify primary points of contact for community agencies in 

other healthcare delivery and pandemic response sectors, 

including public health departments, emergency management 

agencies, and specialized pediatric medical care providers. 

Sector: Public Health Department 

Agency: 

Name: 

Title: 

Address: 

Phone: 

Fax: 

E-mail: 
7 

Sector: Public Health Department 

Agency: 

Name: 

Title: 

Address: 

Phone: 

Fax: 

E-mail: 

Sector: Emergency Management Agency 

Agency: 

Name: 

Title: 

Address: 

Phone: 

Fax: 

E-mail: 

Sector: Emergency Management Agency 

Agency: 

Name: 

Title: 

Address: 

Phone: 

Fax: 

E-mail: 
8 

Sector: 

Agency: 

Name: 

Title: 

Address: 

Phone: 

Fax: 

E-mail: 

Sector: 

Agency: 

Name: 

Title: 

Address: 

Phone: 

Fax: 

E-mail: 

Sector: 

Agency: 

Name: 

Title: 

Address: 

Phone: 

Fax: 

E-mail: 
9 

ACTIONS

► Identify and record gaps in your hospital's current planning 

efforts related to Area 1 – Pediatric Medical Liaisons and Other 

Key Contacts. 

► Describe any additional duties of the pediatric medical liaison 

that are specific to your facility. 
10 

AREA 2 – INTERNAL SURGE CAPACITY ASSESSMENT

The ability of a hospital to provide care during an influenza 

pandemic is not focused only on bed availability but also on 

acquiring adequate medical staff, treatment spaces, medical 

equipment, and the supplies that are needed for patient care. 

Address surge capacity by assessing the following resources for 

your hospital: 

• Staffing (see Area 3 – Coaching and Staffing Models) 

• Physical space 

• Equipment, supplies, and medications 

• Pediatric transport capability 

The most effective way to complete this assessment is to refer to 

your existing pandemic influenza and/or disaster response plan. It 

also will be beneficial to utilize any previous pandemic surge 

modeling that you have completed using software such as 

FluSurge 2.0 (see sidebar) to determine your hospital's ability to 

respond to a pediatric ILI patient surge. 

STAFFING

See Area 3 – Coaching and Staffing Models for more detail and 

information about just-in-time (JIT) training for staff. 

PHYSICAL SPACE

A plan to maximize available space for treatment areas will assist 

in expanding your surge capacity. 

ACTIONS

► Identify how various hospital units can be organized, 

reorganized, or combined to allow for increased patient capacity. 

► Determine which units can be closed (e.g., surgical or 

diagnostic suites) and reopened as other types of units to 

increase your hospital's capability to address patient surge. 

An example of an incremental bed space expansion plan is shown 

on the next page. Consider how your facility may be able to 

expand its bed capacity during a surge scenario. Enter that 

information in the space provided. 

Surge Capacity 

A healthcare system’s ability to 

manage a sudden or rapidly 

progressive influx of patients within 

the currently available resources at a 

given point in time 

Capabilities and Services 

Inventory 

If you are unsure of the surge 

capacity of your community's 

healthcare system, consider working 

with your local hospital association 

to conduct a capabilities and 

services inventory with other 

hospitals. 

Possible Inventory Data 

Categories 

• Ancillary services 

• Beds by type (typical and surge 

capacity) 

• Morgue capacity 

• Negative pressure rooms 

• Pediatric ventilators and adult 

ventilators with a converter 

• Personal protective equipment 

• Space and beds used in elective 

procedures that can be 

converted 

• Transport capacity 

Tools 

FluSurge 2.0 

A spreadsheet-based model that 

provides hospital administrators and 

public health officials with estimates 

of the surge in demand for hospitalbased services during the next 

influenza pandemic 

Centers for Disease Control and 

Prevention (CDC) 

http://www.cdc.gov/flu/tools/flusurge/ 
11 

Using the sample above, describe your facility’s steps for surge 

capacity expansion. 

Priority Bed Location Examples/Comments 

1 Unoccupied, staffed 

beds 

Wards, ED 

2 Set-up, unstaffed beds Closed wards 

3 Early transfer and 

discharge of patients 

Medical safety permitting, possible 

transfer to an alternate 

observation facility if opened 

4 Conversion of private 

rooms to semi-private, 

use of alternate locations 

with access to oxygen 

and suction 

Recovery room/PACU, cardiac 

catheterization lab, endoscopy 

suites, ultrasound rooms 

Cohort infected patients 

5 Other spaces without 

oxygen and suction

Rehabilitation gyms, cafeteria, 

physical therapy units, etc., as 

practical 

Priority Bed Location Examples/Comments 

1 

2 

3 

4 

5 

Resources 

Children in Disasters: Hospital 

Guidelines for Pediatric 

Preparedness

Centers for Bioterrorism 

Preparedness Program Pediatric 

Task Force 

http://www.nyc.gov/html/doh/downloads/pdf/b

hpp/hepp-peds-childrenindisasters010709.pdf

Surge Capacity Expansion Tool 

Recommendations for Increasing 

NYC Pediatric Critical Care Surge 

Capacity* 

NYC Pediatric Disaster Coalition and 

New York City Department of Health 

and Mental Hygiene

http://www.nyc.gov/html/doh/downloads/pdf/b

hpp/hepp-pedsconf02-rec-for-incr-picusurge.pdf

*

This document has appendices that 

can be used during your capabilities 

assessment.
12 

ACTION

► With your community partners, discuss creating flexible 

influenza pandemic plans. 

For example, consider how plans may need to change based on 

the ages of persons most impacted by illness during a pandemic. 

Additionally, consider adjustments needed if the ages of impacted 

persons change over time. 

During the 2009 H1N1 influenza pandemic, the highest attack 

rates were observed among the 0-4 and 5-24 years old age 

groups. If community pediatric hospitals became overburdened, 

general hospitals could consider providing care to older 

adolescents and/or young adults in order to preserve pediatric 

hospital capacity for younger children. However, the age group 

that general hospitals might need to care for could continue to 

decrease if the number of young patients continued to surge at 

pediatric hospitals. 

Graph A: Novel H1N1 Confirmed and Probable Case Rate in the United States, By Age Group 

Available at: http://www.cdc.gov/H1N1FLU/surveillanceqa.htm 

Community planners and pediatric medical liaisons should also 

consider discussing 

• Who would be responsible for making decisions on where 

care should be delivered 

• What resources are required to support such a decision, 

• What factors would “trigger” the decision. 

Record information gained from these discussions in the following 

section. 
13 

Other strategies could include: 

Describe the next steps your facility needs to take to improve its 

ability to expand surge capacity. 
14 

EQUIPMENT, SUPPLIES, AND MEDICATIONS

Using data from the modeling exercises mentioned at the 

beginning of this area, identify the discrepancies between your 

facility’s inventory and what might be needed for pediatric patients 

during an influenza pandemic surge scenario. 

ACTION

► Identify additional pediatric medical equipment that is available 

to your hospital to provide pediatric care to a larger than normal 

patient population. Be sure to consider medications, supplies, and 

instruments and equipment. 

When identifying surge capacity, remember to consider 

• Unoccupied beds 

• Gurneys and stretchers 

• Licensed beds 

• Open spaces adequate for care and for which staffing and 

equipment could be arranged 

If you are able to acquire adult beds to augment your inpatient 

capacity, these beds should have side rails, be set at the lowest 

possible height, and be unplugged so the buttons to adjust the 

beds do not work. 

ACTION

► Contact supply vendors to determine reliability of continued 

supply deliveries. 

PEDIATRIC TRANSPORT CAPABILITY

Interfacility transport of children is a critical component of a 

successful coordinated community response to an influenza 

pandemic. Your community must determine the parameters that 

will guide pediatric transport. 

ACTION

► Coordinate with all entities that could provide pediatric patient 

transport both to the hospital (in routine and emergency cases) 

and from the hospital upon transfer or discharge to expedite bed 

availability for other pediatric cases. 

Definitions 

Resources 

Tools 

Resources 

American Academy of Pediatrics 

Section on Transport Medicine. 

Air and Ground Transport of 

Neonatal and Pediatric Patients, 3rd

Edition. 

https://www.nfaap.org/netFORUM/eweb/Dyna

micPage.aspx?webcode=aapbks_productdeta

il&key=fa657e6e-d1ad-4c6b-aecabfb35b421baa 

Resource 

Recommendations for Use of 

Antiviral Medications for the 

Management of Influenza in Children 

and Adolescent for the 2009–2010 

Season―Pediatric Supplement for 

Healthcare Providers 

Centers for Disease Control and 

Prevention (CDC) 

http://www.cdc.gov/h1n1flu/recommendations

_pediatric_supplement.htm
15 

SME TIP

During your planning, use 

the American Academy of 

Pediatric’s revised and 

expanded edition of the Air 

and Ground Transport of 

Neonatal and Pediatric 

Patients which is listed in 

the sidebar. 

Meet with other pediatric medical liaisons and community 

influenza pandemic planning committees to decide which facilities 

in your community will care for the sickest children. It will be 

important to include Emergency Medical Services representatives 

and others from the transportation sector in these discussions and 

planning efforts. Record that information here. 

What are the criteria agreed upon by your community to transport 

pediatric cases to this facility? 

What resources are available to your hospital to aid in this 

transport? 

Resource 

Air and Ground Transport of 

Neonatal and Pediatric Patients, 3rd

Edition 

American Academy of Pediatrics 

(AAP) 

https://www.nfaap.org/netFORUM/eweb/Dyna

micPage.aspx?webcode=aapbks_productdeta

il&key=fa657e6e-d1ad-4c6b-aecabfb35b421baa
16 

ACTIONS

► Identify and record gaps in your hospital's current planning 

efforts related to Area 2 – Assess for Internal Surge Capacity. 

► Describe the next steps your facility needs to take to improve 

its internal capabilities to care for pediatric patients during an 

influenza pandemic surge. 

► Describe the long-term steps your facility needs to take to 

improve internal surge capacity. 
17 

ACTIONS

► Describe potential issues related to maximizing physical space 

that you encountered during planning. 

► Describe potential issues related to equipment, supplies or 

medication that you encountered during planning. 

► Describe potential issues related to pediatric transport that you 

encountered during planning. 
18 

AREA 3 – PANDEMIC INFLUENZA ALTERNATE 

STAFFING MODEL

Coaching and staffing models should address the identification of 

lead staff members and just-in-time (JIT) training for other staff. 

ACTION

► Estimate the minimum number and categories of personnel 

needed to care for pediatric patients presenting with influenza 

complications on a given day. 

The American College of Chest Physicians' Task Force for Mass 

Critical Care made recommendations for staff augmentation in its 

document entitled Definitive Care for the Critically Ill During a 

Disaster: Medical Resources for Surge Capacity. While these 

recommendations are intended for adult critical care, some of the 

position-specific recommendations may be applicable to pediatric 

hospitals, including those for physicians, nurses, respiratory 

therapists, and pharmacists. If it is not already described in your 

facility’s pandemic influenza plan, use the next page of this 

workbook to identify the appropriate alternate staffing models for 

your hospital.

Caring for Pediatric Patients with Influenza Complications 

Staff Position Number Needed 

Resource 

Definitive Care for the Critically Ill 

During a Disaster: Medical 

Resources for Surge Capacity

American College of Chest 

Physicians, Task Force for Mass 

Critical Care 

http://chestjournal.chestpubs.org/content/133/

5_suppl/32S.full.pdf

Principles for Staffing 

Models 

1. Patient care assignments for 

caregivers should be managed 

by the most experienced 

clinician available. 

2. Assignments should be based 

on staff abilities and experience. 

3. Delegation of duties that usually 

lie outside the scope of workers’ 

normal duties may be necessary 

and appropriate under surge 

conditions. 

4. Systematic efforts to reduce 

care variability, procedure 

complications, and errors of 

omission must be used when 

possible. 
19 

ACTION

► Determine the appropriate alternate staffing model for 

physicians in your facility during a sustained influenza pandemic. 

► Determine the appropriate alternate staffing model for nurses in 

your facility during a sustained influenza pandemic. 

► Determine the appropriate alternate staffing model for 

respiratory therapists in your facility during a sustained influenza 

pandemic. 

► Determine the appropriate alternate staffing model for 

pharmacists in your facility during a sustained influenza pandemic. 

► Determine the most effective strategy to educate staff on the 

selected alternate staffing models. 
20 

A well trained staff is an integral component to successfully 

increasing your hospital's surge capacity. Sometimes, however, 

staff have to be trained quickly or "just in time" to perform their 

duties. For 2009 H1N1 influenza training needs, the SMEs who 

provided input for this workbook suggest that the topics outlined 

below be covered in just-in-time (JIT) training for your staff. These 

topics are being included in online training modules that are being 

developed, along with this workbook, as tools resulting from the 

CDC DHQP Pediatric Healthcare Response to Pandemic H1N1 

Influenza Stakeholder Meeting, which was held in September 

2009. 

Suggested JIT Training Topics for pandemic Influenza 

Module 1: Overview

• Define high-risk population 

• Overview of 2009 H1N1 influenza in pediatric patients 

• Personal Protective Equipment (PPE) and isolation 

• CDC antiviral and vaccine recommendations 

Module 2: Mild Patient

• Overview 

• Signs and symptoms 

• Differential diagnosis 

• Assessment 

• Management 

Module 3: Moderate Patient

• Overview 

• Signs and symptoms 

• Differential diagnosis 

• Assessment 

• Management 

Just-in-Time (JIT) Training

It is not practical for clinicians to be 

expected to know everything about 

every possible pandemic that could 

occur. Thus, JIT training delivers up 

to date information, often with the 

help of media and technology, to a 

staff person when it is needed to 

update their knowledge base or 

clinical skills in a specific situation. 

Tool 

Education and Cross Training of 

Healthcare Workers. An interactive, 

Web-based training 

(In development) 

Disaster Training 

Medical Emergency 

Preparedness―Pediatrics (MEP-P) 

Just-in-Time Training Manual

All Alaska Pediatric Partnership 

(AAPP) 

http://www.hss.state.ak.us/prepared/assets/co

nference/MEPP-Manual.pdf

Modules 

1. Pediatric Assessment for 

Occasional Peds Providers 

2. Children in Crisis: Basics of 

Disaster Behavioral Health 

3. S.T.A.R.T. and JumpSTART 

Triage: The Basics 

4. Newport HT50 Ventilator 

Orientation and Training 

Pediatric Disaster Planning and 

Preparedness Web-based Training 

Program 

Children's National Medical Center 

http://uat.dcchildrens.com/chexwizar

ding/pediatricdisasterwbtprogram_b/i

ndex.html

Modules 

1. Why Disaster Planning for 

Children Is Needed 

2. Accessing Community Risk for 

Disasters Involving Children 

3. Preparing the Community for 

Disasters Involving Children 

4. Responding to Disasters 

Involving Children 

(Assessment/Triage) 

5. Responding to Disasters 

Involving Children
21 

Module 4: Severe Patient

• Overview 

• Signs and Symptoms 

• Differential Diagnosis 

• Assessment 

• Management 

Module 5: Advanced Management of the Moderate to Severely Ill 

Patient

• Shock 

• Basic mechanical ventilation 

Module 6: Nursing

• Overview 

Module 7: Respiratory Therapy

• Overview 

Module 8: Office Emergency Preparedness

Module 9: Toolbox

• Patient Care Guidelines 

• Resources 

• Simulations/Drills 
22 

ACTIONS

► Identify and record gaps in your hospital's current planning 

efforts related to Area 3 – Coaching and Staffing Models. 

► Define the next steps your facility needs to take to define its 

coaching and staffing models for a pandemic influenza surge 

scenario. 

► Describe the long-term steps your facility needs to take to 

better prepare staff and staffing models for an influenza pandemic 

surge scenario. 
23 

► Define any facility-specific areas for JIT training for your staff. 

► Identify additional JIT training resources that may be beneficial 

for your facility. 
24 

AREA 4 – COORDINATION WITH THE COMMUNITY 

PANDEMIC INFLUENZA RESPONSE 

Topics in this area include: 

• Reviewing the Hospital Incident Command System (HICS) 

• Engaging in community planning efforts 

• Working with community partners to identify data needs 

• Leveraging community resources 

Improving coordination of your community's overall influenza 

pandemic response can benefit your hospital by: 

• Improving communication between your organization, 

 emergency management agencies, and public health 

 departments 

• Establishing common community emergency response 

 nomenclature and command structures 

• Defining protocols for consistent community messaging 

 and treatment 

• Increasing access to situational awareness regarding 

additional staff, equipment, transportation, and other scarce 

resources 

• Avoiding duplication of planning efforts 

Hospital Incident Command System (HICS) 

Because hospitals routinely face increased or extraordinary 

demands during disaster situations, it is critical that they be 

fully integrated into emergency management planning

efforts at federal, state, and local levels. Successful 

collaboration depends on coordinated pre-event planning 

and a well coordinated Incident Command System (ICS). 

By bringing emergency management agencies, public 

health departments, and healthcare systems together and 

having all entities using a common command system and 

nomenclature, communities can improve the quality of 

coordination that these entities will be able to achieve 

during public health emergencies. 
25 

 Many hospitals are familiar with HICS, which can be a good tool 

for helping healthcare organizations with their internal all-hazard 

planning process. An added benefit of using HICS is that the 

structure, roles, reporting channels, and terms used in HICS are 

standardized with ICS, which is commonly used by local and state 

emergency management agencies. An overview of the HICS 

Training Modules is provided below. These modules can be 

accessed at the FEMA Independent Study Program website 

(http://training.fema.gov/IS/). 

HICS Training Modules 

Module 1 IS-100.HC – Introduction to the Incident 

Command System for Healthcare/Hospitals 

Module 2 ICS-200 – Applying ICS to Healthcare 

Organizations 

Module 3 IS-700.a – National Incident Management 

System (NIMS), An Introduction 

Module 4 IS 800.b – National Response Framework, 

An Introduction 

My hospital currently utilizes the HICS emergency management 

system. 

 Yes 

 No 

Hospital Incident Command 

System (HICS) 

An emergency management system 

that employs a logical, unified 

management/command structure, 

defined responsibilities, clear 

reporting channels, and a common 

nomenclature to help unify hospitals 

with other emergency responders. 

Incident Command System 

(ICS) 

A standardized on-scene incident 

management concept designed 

specifically to allow responders to 

adopt an integrated organizational 

structure equal to the complexity and 

demands of any single incident or 

multiple incidents without being 

hindered by jurisdictional 

boundaries. 

Resources 

Center for HICS Education and 

Training.

http://www.hicscenter.org/

Medical Surge Capacity and 

Capability: A Management System 

for Integrating Medical and Health 

Resources During Large-Scale 

Emergencies. 

http://www.hhs.gov/disasters/discussion/plann

ers/mscc/mscc080626.pdf

Hospital Incident Command 

System (HICS) 

An emergency management system 

that employs a logical, unified 

management/command structure, 

defined responsibilities, clear 

reporting channels, and a common 

nomenclature to help unify hospitals 

with other emergency responders. 

Incident Command System 

(ICS) 

A standardized on-scene incident 

management concept designed 

specifically to allow responders to 

adopt an integrated organizational 

structure equal to the complexity and 

demands of any single incident or 

multiple incidents without being 

hindered by jurisdictional 

boundaries. 

Resources 

FEMA Independent Study Program 

http://training.fema.gov/IS/

Center for HICS Education and 

Training.

http://www.hicscenter.org/

Medical Surge Capacity and 

Capability: A Management System 

for Integrating Medical and Health 

Resources During Large-Scale 

Emergencies. 

http://www.hhs.gov/disasters/discussion/plann

ers/mscc/mscc080626.pdf
26 

SME TIP

Planning by individual 

facilities is necessary 

but not sufficient for 

robust community 

emergency response. 

ENGAGE IN COMMUNITY PLANNING EFFORTS

It is important to establish on-going 

partnerships with your local 

emergency management 

agencies and public health 

departments prior to a public 

health emergency. It is not 

enough to have simply 

identified a contact person. 

ACTION

► Develop partnerships with local emergency management 

agencies and public health departments by participating in a 

community-wide emergency preparedness coalition. 

The U.S. Department of Health and Human Services' (HHS') 

document entitled Medical Surge Capacity and Capability: A 

Management System for Integrating Medical and Health 

Resources During Large-Scale Emergencies states, "A 

healthcare coalition organizes individual healthcare assets into a 

single functional unit. Its goal is to maximize medical surge 

capacity and capability across the coalition through cooperative 

planning, information sharing, and management coordination . . . 

[A healthcare coalition creates] the ability to move medical 

resources to sites of greatest need." 

WORKING WITH COMMUNITY PARTNERS TO COLLECT 

NEEDED DATA 

SMEs that provided input for this workbook determined two 

epidemiological data points needed by hospitals to more 

effectively care for patients during an influenza pandemic surge. 

These data points are (1) the age distribution of pediatric patients 

and (2) the site of care where the patients present for evaluation 

and treatment. Collecting these data will require coordination with 

other healthcare entities and public health partners. Planners 

should consider working with these partners to determine what 

avenues exist for collecting and distributing these data

A review of local healthcare 

emergency preparedness coalitions’ 

objective statements reveal that 

communities use their coalitions for 

a variety of purposes, including: 

• Creating a communication forum 

to enhance regional emergency 

planning 

• Strengthening all-hazards 

emergency preparedness and 

response by the healthcare 

system 

• Developing all-hazard 

preparedness plans with 

emergency management and 

public health officials 

• Creating a policy advisory board 

to review plans and resource 

sharing agreements 

• Implementing an emergency 

communication and coordination 

system for healthcare 

organizations 

• Coordinating training and 

planning support between 

community entities 

• Implementing standardized 

practices between response 

partners 

• Coordinating region wide 

exercises and trainings 

Planning Reminder 

In Area 1 – Pediatric Medical 

Liaisons and Other Key Contacts, 

you identified contact persons at 

your local emergency management 

agency and public health 

department. 
27 

A breakdown of the needed epidemiological data is shown below. 

Age Distribution of Data Collected

0 – 2 years 

2 – 12 years 

12 – 18 years 

> 18 with special healthcare needs 

Sites of Care Where Pediatric Patients Present

Hospitals 

Primary care providers 

Federally Qualified Health Centers 

Urgent care centers 

Schools and school-based health centers 

LEVERAGING COMMUNITY RESOURCES

It is important to know if your local Medical Reserve Corp (MRC) 

and Emergency System for Advance Registration of Volunteer 

Health Professionals (ESAR-VHP) are currently incorporated into 

your state and local response plans. It is very likely that they are 

already engaged by both public health departments and 

emergency management agencies. 

In order for these groups to provide the most benefit to your 

hospital, you need to understand their roles and how they work 

collaboratively before, during, and after the response to a public 

health emergency. 

Medical Reserve Corps 

(MRC) 

A group comprised of organized 

medical and public health 

professionals who serve as 

volunteers to respond to natural 

disasters and emergencies. Assists 

communities nationwide during 

emergencies and for ongoing efforts 

in public health 

Emergency System for 

Advance Registration of 

Volunteer Health 

Professionals (ESAR-VHP) 

A program that provides guidance 

and assistance for the development 

of standardized state-based 

programs for registering and 

verifying the credentials of volunteer 

health professionals in advance of 

an emergency or disaster 
28 

ACTION

► Review the resources in the sidebar to understand better some 

of the resource capabilities in your community, including MRC and 

ESAR-VHP. 

MRC 

Determine if your local MRC is adequately prepared for an 

influenza pandemic in accordance with the laws, plans, and 

procedures of your local jurisdiction and state. 

Expect and allow for absences or unavailability of MRC volunteers 

during an influenza pandemic due to varying factors, such as 

personal or family member illness, community containment 

measures, and school, business, or public transportation closures. 

ESAR-VHP 

Each state ESAR-VHP program collects and verifies information 

on the identity, licensure status, privileges, and credentials of 

volunteers. As part of their responsibilities, each state ESAR-VHP 

program should track, train, and prepare volunteer health 

professionals who are not affiliated with a local MRC unit or 

another local/state response. 

ACTION

► Identify and record gaps in your hospital's current planning 

efforts related to Area 4 – Coordination with External Community 

Response. 

Medical Reserve Corps 

(MRC) 

is comprised of organized medical 

and public health professionals who 

serve as volunteers to respond to 

natural disasters and emergencies. 

These volunteers assist 

communities nationwide during 

emergencies and for ongoing efforts 

in public health. 

Emergency System for 

Advance Registration of 

Volunteer Health 

Professionals (ESAR-VHP) 

a program provides guidance and 

assistance for the development of 

standardized State-based programs 

for registering and verifying the 

credentials of volunteer health 

professionals in advance of an 

emergency or disaster. 

Resources

Pandemic Influenza Planning 

Guidance for Medical Reserve 

Corps Units. 

http://www.medicalreservecorps.gov/File/MR

C_Pandemic_Influenza_Planning_Guidance.p

df

Integration of the MRC and ESARVHP 

http://www.medicalreservecorps.gov/File/ESA

R_VHP/ESARVHPMRCIntegrationFactSheet.pdf

Resources

Pandemic Influenza Planning 

Guidance for Medical Reserve 

Corps Units

Office of the Civilian Volunteer 

Medical Reserve Corps 

http://www.medicalreservecorps.gov/File/MRC

_Pandemic_Influenza_Planning_Guidance.pdf

Integration of the MRC and ESARVHP Medical Reserve Corps Units

Office of the Civilian Volunteer 

Medical Reserve Corps

http://www.medicalreservecorps.gov/File/ESA

R_VHP/ESARVHPMRCIntegrationFactSheet.pdf
29 

ACTIONS

► Define the next steps your facility needs to take to improve 

external coordination with your community’s influenza pandemic 

response planning efforts. 

► Describe the long-term changes your facility could make to 

better integrate into your community’s future pandemic response 

planning efforts. 
30 

AREA 5 – PATIENT- AND FAMILY-CENTERED CARE 

(PFCC) DURING A PANDEMIC INFLUENZA SURGE

In Emergency Care for Children: 

Growing Pains, the Institute of 

Medicine (IOM) concluded that 

failure to implement PFCC into 

emergency care can result in many 

adverse outcomes, such as 

miscommunication, difficulty 

obtaining informed consent, 

inadequate understanding of diagnosis 

and treatment by families, clinical bias, 

ethnic disparities, lower quality of care, and dissatisfaction with 

care. 

ACTION

► Identify ways that your hospital can plan to reasonably provide 

PFCC in the following areas presented in the American Academy 

of Pediatrics (AAP) Technical Report entitled Patient- and FamilyCentered Care of Children in the Emergency Department. 

Patient Flow: Develop a patient flow protocol that limits the 

amount of time a child is separated from family members. 

Security and Identification: Ensure family members are clearly 

identified. 

SME TIP

Your facility should 

determine minimum 

standards of PFCC that 

must be provided 

during times of patient 

surge. 

Family-Centered Care 

An innovative approach to the 

planning, delivery, and evaluation of 

healthcare that is grounded in a 

mutually beneficial partnership 

among patients, families and health 

care professionals 

PFCC embraces these concepts:

1. We are providing care for a 

person, not a condition. 

2. The patient is best understood in 

the context of his or her family, 

culture, values, and goals. 

3. Honoring this context will result 

in better healthcare, safety, and 

patient satisfaction. 

AAP Examples of PFCC 

Patient Flow 

Operations that require a parent to 

leave a child for registration while 

the child is receiving care can be 

made more family centered by 

implementing bedside registration 

that allows the parent to stay with 

the child. 

Security and Identification 

Many emergency departments (EDs) 

require visitor badges. Change the 

labels to read "family" to reinforce 

that family members are valued. 
31 

Family Presence: Describe difficult-to-watch procedures in a 

clear and unbiased manner to parents, and allow them to choose 

if they want to be present during the procedure. 

Interpretation Services: Ensure timely access to professional 

interpreters rather than relying on accompanying friends and 

family members. 

Comfort Care: Plan for routine measurement of patient pain, 

anxiety, and comfort throughout the patient's time in the hospital. 

This may involve pharmacologic or non-pharmacologic

interventions, child-life services, and psychosocial or spiritual 

support. 

Coordination with the Medical Home: As much as possible, try 

to coordinate with a patient's usual healthcare provider for 

valuable insight during initial evaluation and throughout treatment. 

Resources 

Patient- and Family-Centered Care 

of Children in the Emergency 

Department

American Academy of Pediatrics 

(AAP) 

http://aappolicy.aappublications.org/cgi/reprint

/pediatrics;122/2/e511.pdf

Patient- and Family-Centered Care 

and the Role of the Emergency 

Physician Providing Care to a Child 

in the Emergency Department

American College of Emergency 

Physicians (ACEP) 

http://www.acep.org/practres.aspx?id=29598

The Institute for Family-Centered 

Care 

http://www.familycenteredcare.org/index.html

AAP Example of PFCC 

Coordination with the Medical 

Home 

Communication with the medical 

home can be supported through 

teleconferences, electronic health 

records, and automated healthinformation exchange. 

SME TIP

Consider planning 

with psychologists, 

social workers, and 

faith-based leaders to 

assist with providing 

PFCC. 
32 

Discharge Planning: Customize discharge instructions to reflect 

family preferences and to provide instructions for continuing care 

at home and following up with the patient's medical home. 

The Physical Plant: Look at your hospital's physical facility and 

identify areas that could be redesigned to better accommodate 

families, including well siblings. 

Resources

Resources for Parents and Child 

Caregivers 

Centers for Disease Control and 

Prevention (CDC) 

http://www.cdc.gov/h1n1flu/parents/ 

Caring for Someone Sick at Home

Centers for Disease Control and 

Prevention (CDC) 

http://www.cdc.gov/h1n1flu/homecare/

AAP Example of PFCC 

The Physical Plant 

Provide restrooms, diaper changing 

space, dedicated and safe waiting 

areas, and refreshments. 

SME TIP

Provide developmentally 

appropriate videos in 

waiting rooms; these can 

be either for 

entertainment or 

educational purposes. 
33 

ACTIONS

► Identify and record gaps in your hospital's current planning 

efforts related to Area 5 – Pandemic Influenza Pediatric Triage. 

► Describe the immediate next steps your facility needs to take to 

improve pediatric triage. 

► Describe the long-term steps your facility needs to take to 

improve pediatric triage. 
34 

AREA 6 – PANDEMIC INFLUENZA PEDIATRIC 

TRIAGE

Many agencies and SME groups have developed sample 

algorithms to assist with pediatric patient triage during the 2009 

H1N1 influenza pandemic using the data categories included in 

this area of the workbook. Two sample algorithms are provided on 

pages 68 and 69 of this workbook. The algorithm published on 

page 68 was published by CDC and AAP on the CDC H1N1 site 

(and is duplicated here). The algorithm on page 69 was 

developed by the SMEs at the Stakeholder meeting. These may 

be adapted for use in your hospital. 

For non-routine pediatric providers, a more detailed algorithm may 

make the patient assessment process easier, and more 

experienced pediatric providers may prefer a simplified version. 

ACTION

► Determine level of acuity and hospital capacity in order to 

identify which patients to admit, transfer, or discharge to home 

care with consideration to the following criteria: age, underlying 

conditions, illness severity, and community acuity.

Age 

Consider ages for higher risk of complications or vulnerability. 

Underlying conditions 

Consider co-morbidities, such as diabetes, asthma, human 

immunodeficiency virus (HIV), suppressed immune system, and 

heart conditions. 

Illness severity 

Determine the severity of the patient's condition, including the 

number of days since onset of illness. Compare the patient's 

present condition to the average case condition that would 

typically be expected at this current day of illness. 

Community Acuity 

Maintain situational awareness of influenza illness in the 

community. Consider community prevalence, family exposure, 

and school or daycare exposure. 

Triage Algorithms 

Refer to the algorithms on 

pages 52 to 54 for application of 

data categories. 

Page 52

2009-2010 Influenza Season Triage 

Algorithm for Children (≤18 years) 

With Influenza-Like Illness. 

http://www.cdc.gov/h1n1flu/clinicians/pdf/child

algorithm.pdf

Page 53

Outpatient evaluation of the Patient 

with ILI (Pediatric). Developed at the 

Pediatric Healthcare Response to 

Pandemic H1N1 Influenza 

Stakeholder Meeting (September 

2009) to help address the need for 

sample H1N1 influenza triage 

protocols in the pediatric community. 

Page 54

Decision Making Tool for Referral of 

Pediatric Patients with Influenza-like 

Illness 

http://www.health.gov.on.ca/english/providers/

program/emu/pan_flu/ohpip2/ch_18a.pdf

Tool 

Telephone Triage of Patients with 

Influenza. American Academy of 

Family Physicians (AAFP). 

http://www.aafp.org/online/en/home/publicatio

ns/journals/afp/preprint/influenza-telephonetriage.html

Triage Algorithms 

Refer to the algorithms on pages 68 

and 69 for application of data 

categories. 

Page 68 

2009–2010 Influenza Season Triage 

Algorithm for Children (≤18 years) 

With Influenza-Like Illness 

Centers for Disease Control and 

Prevention (CDC) 

http://www.cdc.gov/h1n1flu/clinicians/pdf/child

algorithm.pdf

Page 69 

Outpatient evaluation of the Patient 

with ILI (Pediatric)

Developed at the Pediatric 

Healthcare Response to Pandemic 

H1N1 Influenza Stakeholder Meeting 

(September 2009) to help address 

the need for sample H1N1 influenza 

triage protocols in the pediatric 

community 

Tool 

Telephone Triage of Patients with 

Influenza 

American Academy of Family 

Physicians (AAFP) 

http://www.aafp.org/online/en/home/publicatio

ns/journals/afp/preprint/influenza-telephonetriage.html
35 

ACTIONS

► Identify and record gaps in your hospital's current planning 

efforts related to Area 6 – Pandemic Influenza Pediatric Triage. 

► Describe the immediate next steps your facility needs to take to 

improve pediatric triage. 

► Describe the long-term steps your facility needs to take to 

improve pediatric triage. 
36 

This Page Intentionally Blank
37 

GENERAL HOSPITAL FOCUS

TARGET AUDIENCE

General hospitals that have pediatric units or the capability 

to convert existing hospital units into pediatric units 

OVERVIEW

Subject matter experts (SMEs) identified five areas that 

should be addressed by general hospitals when coordinating 

medical care for pediatric influenza-like illness (ILI) across a 

community. 

Area 1 Pediatric Medical Liaisons and Other Key 

Contacts 

Area 2 Internal Pediatric Care Capabilities 

Assessment 

Area 3 Coordination with the Community Pandemic 

Influenza Response 

Area 4 Patient- and Family-Centered Care During a 

Pandemic Influenza Surge 

Area 5 Pandemic Influenza Pediatric Triage 

Part B 

GENERAL HOSPITAL WORKBOOK
38 

AREA 1 – PEDIATRIC MEDICAL LIAISONS AND 

OTHER KEY CONTACTS

Improving communication between hospitals in a community will 

improve the coordination of pediatric ILI medical care. If 

relationships with other hospitals outside of typical jurisdictions 

and referral patterns have not been established, developing these 

relationships should be a priority. You can achieve this by defining 

the role of a pediatric medical liaison for your hospital and 

selecting the appropriate person to fill this role. The primary role of 

the pediatric medical liaison is to develop relationships with other 

hospitals, including pediatric hospitals. Other roles and 

responsibilities of the pediatric medical liaison are to: 

• Develop new relationships with other hospitals 

• Maintain existing relationships with other hospitals 

• Communicate with internal hospital staff to facilitate 

 continuity of care for pediatric patients with ILI

• Provide clinical expertise in pediatric care to non-routine 

 pediatric providers, if possible. If not, develop a relationship 

 with a physician who can provide pediatric expertise 

• Assist in completing the identified areas in this workbook 

• Review this workbook with hospital administrators and 

 other key hospital decision-makers 

Pediatric Medical Liaison 

A person selected to represent a 

specific hospital when coordinating 

pediatric ILI medical care with other 

hospitals in the community 

Non-routine Pediatric 

Provider

A provider who does not regularly 

see children (e.g., an internist) 

SME TIP

It is recommended that 

pediatric medical liaisons 

for general hospitals be 

pediatric physicians or 

physicians with additional 

training in pediatrics. 
39 

ACTION

► Identify an appropriate pediatric medical liaison for your hospital 

and record their information below. 

ACTION

► Identify pediatric medical liaisons for each hospital in your 

community and record their information in the space provided.

Hospital Name: 

Liaison Name: 

Title: 

Address: 

Phone: 

Fax: 

E-mail: 

Hospital Name: 

Liaison Name: 

Title: 

Address: 

Phone: 

Fax: 

E-mail: 

Name: 

Title: 

Phone: 

Fax: 

E-mail: 
40 

Hospital Name: 

Liaison Name: 

Title: 

Address: 

Phone: 

Fax: 

E-mail: 

Hospital Name: 

Liaison Name: 

Title: 

Address: 

Phone: 

Fax: 

E-mail: 

In addition to communicating with other hospitals, it is important 

for the pediatric medical liaison to establish relationships with 

other healthcare and supporting sectors that participate in the 

community-wide influenza pandemic response. 

ACTION

► Identify primary points of contact for community agencies in 

other healthcare delivery and pandemic response sectors, 

including public health departments, emergency management 

agencies, and specialized pediatric medical care providers. 

Sector: Public Health Department 

Agency: 

Name: 

Title: 

Address: 

Phone: 

Fax: 

E-mail: 
41 

Sector: Public Health Department 

Agency: 

Name: 

Title: 

Address: 

Phone: 

Fax: 

E-mail: 

Sector: Emergency Management Agency 

Agency: 

Name: 

Title: 

Address: 

Phone: 

Fax: 

E-mail: 

Sector: Emergency Management Agency 

Agency: 

Name: 

Title: 

Address: 

Phone: 

Fax: 

E-mail: 
42 

Sector: 

Agency: 

Name: 

Title: 

Address: 

Phone: 

Fax: 

E-mail: 

Sector: 

Agency: 

Name: 

Title: 

Address: 

Phone: 

Fax: 

E-mail: 

Sector: 

Agency: 

Name: 

Title: 

Address: 

Phone: 

Fax: 

E-mail: 
43 

ACTIONS

► Identify and record gaps in your hospital's current planning 

efforts related to Area 1 – Pediatric Medical Liaisons and Other 

Key Contacts. 

► Describe any additional duties of the pediatric medical liaison 

that are specific to your facility. 
44 

AREA 2 – INTERNAL PEDIATRIC CARE 

CAPABILITIES ASSESSMENT

The ability of a hospital to provide care during an influenza 

pandemic is not focused only on bed availability but also on 

acquiring adequate medical staff, treatment spaces, medical 

equipment, and the supplies that are needed for patient care. 

To assess the pediatric care capabilities of your hospital, focus on 

the following four areas: 

• Inpatient capacity 

• Pediatric equipment and supplies 

• Personnel 

• Pediatric transport capability 

The most effective way to complete this assessment is to refer to 

your existing pandemic influenza and/or disaster response plan. It 

also will be beneficial to utilize any previous pandemic surge 

modeling you have completed using software such as FluSurge 

2.0 (see sidebar) to determine your hospital's ability to respond to 

a pediatric ILI patient surge. 

INPATIENT CAPACITY

ACTION

► Identify the capacity of your inpatient hospital units that will be 

able to receive pediatric patients. 

When identifying surge capacity, remember to consider: 

• Unoccupied beds 

• Gurneys and stretchers 

• Licensed beds 

• Open spaces adequate for care for which staffing and 

 equipment could be arranged 

Surge Capacity 

A healthcare system’s ability to 

manage a sudden or rapidly 

progressive influx of patients within 

the currently available resources at a 

given point in time 

Capabilities and Services 

Inventory 

If you are unsure of the surge 

capacity of your community's 

healthcare system, consider working 

with your local hospital association 

to conduct a capabilities and 

services inventory with other 

hospitals. 

Possible Inventory Data 

Categories 

• Ancillary services 

• Beds by type (typical and surge 

capacity) 

• Morgue capacity 

• Negative pressure rooms 

• Pediatric ventilators and adult 

ventilators with a converter 

• Personal protective equipment 

• Space and beds used in elective 

procedures that can be 

converted 

• Transport capacity 

Tools 

FluSurge 2.0 

A spreadsheet-based model that 

provides hospital administrators and 

public health officials with estimates 

of the surge in demand for hospitalbased services during an influenza 

pandemic 

Centers for Disease Control and 

Prevention (CDC) 

http://www.cdc.gov/flu/tools/flusurge/ 
45 

The hospital units for pediatric care of ILI patients at my facility 

are: (Check the appropriate box and then complete the 

corresponding chart below) 

 Units of the hospital that already receive pediatric patients 

Bed Category 

Typical 

Available & 

Staffed Beds 

Surge 

Capacity 

Pediatric Critical Care 

Pediatric Medical/Surgical 

Totals 

 Adult or other hospital units that can be converted to 

provide appropriate care 

If your facility currently does not treat pediatric patients, 

adult beds may be used if the beds have side rails, are set 

at the lowest possible height, and are unplugged so the 

buttons to adjust the beds do not work. 

If acceptable beds can be located at your facility, complete 

the following chart. 

Bed Category (converted) Surge Capacity 

Pediatric Critical Care 

Pediatric Medical/Surgical 

Totals 

Resources 

Children in Disasters: Hospital 

Guidelines for Pediatric 

Preparedness

Centers for Bioterrorism 

Preparedness Program Pediatric 

Task Force 

http://www.nyc.gov/html/doh/downloads/pdf/b

hpp/hepp-peds-childrenindisasters010709.pdf

Surge Capacity Expansion Tool 

Recommendations for Increasing 

NYC Pediatric Critical Care Surge 

Capacity* 

NYC Pediatric Disaster Coalition and 

New York City Department of Health 

and Mental Hygiene

http://www.nyc.gov/html/doh/downloads/pdf/b

hpp/hepp-pedsconf02-rec-for-incr-picusurge.pdf

*

This document has appendices that 

can be used during your capabilities 

assessment. 

 
46 

PEDIATRIC EQUIPMENT AND SUPPLIES

ACTIONS

► Determine the current inventory of pediatric equipment and 

supplies at your facility. 

► Using the resources listed in the sidebar, identify pediatric 

equipment and supplies that every hospital should have available 

in order to provide care for pediatric patients. (Create an inventory 

sheet similar to the one shown on the next page.) 

Be sure to consider the following types of items, especially if 

caring for children in a primarily adult unit or hospital: 

• BroselowTM Pediatric Emergency Tape 

• Medications, including pediatric drug-dosing guidelines 

• Oxygen administration equipment (e.g., masks and nasal 

cannulas) 

• IV administration and initiation equipment (e.g., angio 

catheters and intraosseous drills) 

• Supplies, including a "pediatric crash cart" and 

 appropriately sized: 

o Airway and respiratory supplies 

o Restraints and orthopedic supplies 

o Chest tubes 

o Dressings 

o Linens 

o Personal care supplies, including diapers 

• Instruments and equipment, including disposable blood 

pressure cuffs 

SME TIP

Consider meeting with other 

Pediatric Medical Liaisons 

within your community to 

share information and 

concerns regarding each 

liaison's hospital's 

capabilities assessments. 
47 

What actions do you need to take to address pediatric supply 

needs? 

PERSONNEL

A personnel assessment should address: 

• Identification of lead staff members 

• Alternate staffing models 

• Just-in-time (JIT) training needs 

Non-routine pediatric providers at your facility who will be asked to 

provide medical care to pediatric ILI patients during a surge scenario 

may need to consult with a physician having pediatric expertise. 

During each hospital shift, at least one onsite pediatric physician 

should be available and clearly identified in case of an emergency 

situation. 

These physicians also can be integrated into coaching or alternate 

staffing models to augment existing capacity or to assist with the JIT 

training of other staff.

Sample Inventory Sheet 

Type: Number: 

Type: Number: 

Type: Number: 

Type: Number: 

Type: Number: 

Type: Number: 

Type: Number: 

Type: Number: 

Type: Number: 

Type: Number: 

Type: Number: 

Just-in-Time (JIT) Training 

Training the learner receives "just in 

time" when it is needed for a 

particular purpose. Typically 

includes demonstrations on 

application of the material in several 

patient care scenarios 

Alternate Solution 

If in-house support for pediatric 

expertise is not available, the 

pediatric medical liaison should 

establish a relationship with an 

offsite pediatric physician that can 

provide needed support. This could 

be a pediatric medical liaison from a 

local pediatric hospital. This person 

should be available by phone at all 

times in case of an emergency 

situation. 
48 

ACTION

► For each shift (e.g., day, night, or weekends), identify lead staff 

members who have pediatric experience or pediatric training. 

Name: 

Department: 

Job Title: 

Shift: 

Phone: 

E-mail: 

Name: 

Department: 

Job Title: 

Shift: 

Phone: 

E-mail: 

Name: 

Department: 

Job Title: 

Shift: 

Phone: 

E-mail: 

Name: 

Department: 

Job Title: 

Shift: 

Phone: 

E-mail: 
49 

ACTION

► Estimate the minimum number and categories of personnel 

needed to care for pediatric patients presenting with influenza 

complications on any given day. 

The American College of Chest Physicians' Task Force for Mass 

Critical Care made recommendations for staff augmentation in its 

document entitled Definitive Care for the Critically Ill During a 

Disaster: Medical Resources for Surge Capacity. While these 

recommendations are intended for adult critical care, some of the 

position-specific recommendations may be applicable to pediatric 

hospitals, including those for physicians, nurses, respiratory 

therapists, and pharmacists. If it is not already described in your 

facility’s pandemic influenza plan, use the next page of this 

workbook to identify the appropriate alternate staffing models for 

your hospital. 

Caring for Pediatric Patients with Influenza Complications 

Staff Position Number Needed 

 

Resource 

Definitive Care for the Critically Ill 

During a Disaster: Medical 

Resources for Surge Capacity

American College of Chest 

Physicians, Task Force for Mass 

Critical Care 

http://chestjournal.chestpubs.org/content/133/

5_suppl/32S.full.pdf

Principles for Staffing 

Models 

1. Patient care assignments for 

caregivers should be managed 

by the most experienced 

clinician available. 

2. Assignments should be based 

on staff abilities and experience. 

3. Delegation of duties that usually 

lie outside the scope of workers’ 

normal duties may be necessary 

and appropriate under surge 

conditions. 

4. Systematic efforts to reduce 

care variability, procedure 

complications, and errors of 

omission must be used when 

possible. 
50 

ACTIONS

► Determine the appropriate alternate staffing model for 

physicians in your facility during a sustained influenza pandemic. 

► Determine the appropriate alternate staffing model for nurses in 

your facility during a sustained influenza pandemic. 

► Determine the appropriate alternate staffing model for 

respiratory therapists in your facility during a sustained influenza 

pandemic. 

► Determine the appropriate alternate staffing model for 

pharmacists in your facility during a sustained influenza pandemic. 

► Determine the most effective strategy to educate staff on the 

selected alternate staffing models. 
51 

A well-trained staff is an integral component to successfully 

increasing your hospital's surge capacity. Sometimes however, 

staff have to be trained quickly or "just in time" to perform their 

duties. For 2009 H1N1 influenza training needs, the SMEs who 

provided input for this workbook suggest that the topics outlined 

below be covered in just-in-time (JIT) training for your staff. These 

topics are being included in online training modules that are being 

developed, along with this workbook, as tools resulting from the 

CDC DHQP Pediatric Healthcare Response to Pandemic H1N1 

Influenza Stakeholder Meeting, which was held in September 

2009. 

ACTION

► Provide and record JIT training for non-routine pediatric 

providers. 

Suggested JIT Training Modules for Pandemic Influenza

Module 1: Overview

• Define high-risk population 

• Overview of 2009 H1N1 influenza in pediatric patients 

• Personal Protective Equipment (PPE) and isolation 

• CDC antiviral and vaccine recommendations 

Module 2: Mild Patient

• Overview 

• Signs and symptoms 

• Differential diagnosis 

• Assessment 

• Management 

Module 3: Moderate Patient

• Overview 

• Signs and symptoms 

• Differential diagnosis 

• Assessment 

• Management 

Just-in-Time (JIT) Training

It is not practical for clinicians to be 

expected to know everything about 

every possible pandemic that could 

occur. Thus, JIT training delivers up 

to date information, often with the 

help of media and technology, to a 

staff person when it is needed to 

update their knowledge base or 

clinical skills in a specific situation.

Tool 

Education and Cross Training of 

Healthcare Workers. An interactive, 

Web-based Training 

(In development) 

Disaster Training 

Medical Emergency 

Preparedness―Pediatrics (MEP-P) 

Just-in-Time Training Manual

All Alaska Pediatric Partnership 

(AAPP) 

http://www.hss.state.ak.us/prepared/assets/co

nference/MEPP-Manual.pdf

Modules 

1. Pediatric Assessment for 

Occasional Peds Providers 

2. Children in Crisis: Basics of 

Disaster Behavioral Health 

3. S.T.A.R.T. and JumpSTART 

Triage: The Basics 

4. Newport HT50 Ventilator 

Orientation and Training 

Pediatric Disaster Planning and 

Preparedness Web-based Training 

Program 

Children's National Medical Center 

http://uat.dcchildrens.com/chexwizar

ding/pediatricdisasterwbtprogram_b/i

ndex.html

Modules 

1. Why Disaster Planning for 

Children Is Needed 

2. Accessing Community Risk for 

Disasters Involving Children 

3. Preparing the Community for 

Disasters Involving Children 

4. Responding to Disasters 

Involving Children 

(Assessment/Triage) 

5. Responding to Disasters 

Involving Children 
52 

Module 4: Severe Patient

• Overview 

• Signs and Symptoms 

• Differential Diagnosis 

• Assessment 

• Management 

Module 5: Advanced Management of the Moderate to Severely Ill 

Patient

• Shock 

• Basic mechanical ventilation 

Module 6: Nursing

• Overview 

Module 7: Respiratory Therapy

• Overview 

Module 8: Office Emergency Preparedness

Module 9: Toolbox

• Patient Care Guidelines 

• Resources 

• Simulations/Drills 

Just-in-Time (JIT) Training

Training the learner receives just in 

time when it is needed for a 

particular purpose. JIT Training 

typically includes demonstrations on 

application of the material in several 

patient care scenarios. 

Tools 

Education and Cross Training of 

Healthcare Workers. An interactive, 

Web-based training. 

In Development.

Disaster Training 

Medical Emergency 

Preparedness―Pediatrics (MEP-P) 

Just-in-Time Training Manual. Four 

one-hour, self-study modules. 

http://www.hss.state.ak.us/prepared/assets/co

nference/MEPP-Manual.pdf

Modules 

5. Pediatric Assessment for 

Occasional Peds Providers 

6. Children in Crisis: Basics of 

Disaster Behavioral Health 

7. S.T.A.R.T. and JumpSTART 

Triage: The Basics 

8. Newport HT50 Ventilator 

Orientation and Training 

Emergency Medical Services for 

Children National Resource Center. 

The Pediatric Disaster Planning and 

Preparedness. 

http://uat.dcchildrens.com/chexwizar

ding/pediatricdisasterwbtprogram_b/i

ndex.html

Modules 

6. Why Disaster Planning for 

Children Is Needed 

7. Accessing Community Risk for 

Disasters Involving Children 

8. Preparing the Community for 

Disasters Involving Children 

9. Responding to Disasters 

Involving Children 

(Assessment/Triage) 

10. Responding to Disasters 

Involving Children 
53 

ACTIONS

► Identify and record gaps in your hospital's current planning 

efforts related to Area 3 – Coaching and Staffing Models. 

► Define the immediate next steps your facility needs to take to 

define its coaching and staffing models for a pandemic influenza 

surge scenario. 

► Describe the long-term steps your facility needs to take to 

better prepare staff and staffing models for an influenza pandemic 

surge scenario. 
54 

SME TIP

During your planning, 

use the AAP’s revised 

and expanded edition of 

the Air and Ground 

Transport of Neonatal 

and Pediatric Patients

tool listed in the sidebar.

PEDIATRIC TRANSPORT CAPABILITY

Interfacility transport of children is a critical component of a 

successfully coordinated community response to an influenza 

pandemic. Your community must determine the parameters that 

will guide transport. 

ACTION

► Coordinate with all entities that could provide pediatric patient 

transport both to the hospital (in routine and emergency cases) 

and from the hospital upon transfer or discharge to expedite bed 

availability for other pediatric cases. 

Meet with other pediatric medical liaisons and community 

influenza pandemic committees to decide which facilities in your 

community will care for the sickest children. Record that 

information here. 

What are the criteria agreed upon by your community to transport 

pediatric cases to this facility? 

What resources are available to your hospital to aid in this 

transport? 

Resource 

Air and Ground Transport of 

Neonatal and Pediatric Patients, 3rd

Edition 

American Academy of Pediatrics 

(AAP) 

https://www.nfaap.org/netFORUM/eweb/Dyna

micPage.aspx?webcode=aapbks_productdeta

il&key=fa657e6e-d1ad-4c6b-aecabfb35b421baa
55 

ACTIONS

► Identify and record gaps in your hospital's current planning 

efforts related to Area 2 – Assess for Internal Pediatric Care 

Capabilities. 

► Describe the next steps your facility needs to take to improve 

its internal capabilities to care for pediatric patients during an 

influenza pandemic surge. 

► Describe the long-term steps your facility needs to take to 

integrate pediatric care capabilities into its future influenza 

pandemic preparedness efforts. 
56 

AREA 3 – COORDINATION WITH THE COMMUNITY 

PANDEMIC INFLUENZA RESPONSE

Topics in this area include: 

• Reviewing the Hospital Incident Command System (HICS) 

• Engaging in community planning efforts 

• Working with community partners to identify data needs 

• Leveraging community resources 

Improving coordination of your community's overall influenza 

pandemic response can benefit your hospital by: 

• Improving communication between your organization, 

 emergency management agencies, and public health 

 departments 

• Establishing common community emergency response 

 nomenclature and command structures 

• Defining protocols for consistent community messaging 

 and treatment 

• Increasing access to situational awareness regarding 

 additional staff, equipment, transportation, and other 

 scarce resources 

• Avoiding duplication of planning efforts 

Hospital Incident Command System (HICS) 

Because hospitals routinely face increased or extraordinary 

demands during disaster situations, it is critical that they be 

fully integrated into emergency management planning

efforts at federal, state, and local levels. Successful 

collaboration depends on coordinated pre-event planning 

and a well coordinated Incident Command System (ICS). 

By bringing emergency management agencies, public 

health departments, and healthcare systems together and 

having all entities using a common command system and 

nomenclature, communities can improve the quality of 

coordination that these entities will be able to achieve 

during public health emergencies. 
57 

Many hospitals are familiar with HICS, which can be a good tool 

for helping healthcare organizations with their internal all-hazard 

planning process. An added benefit of using HICS is that the 

structure, roles, reporting channels, and terms used in HICS are 

standardized with ICS, which is commonly used by local and state 

emergency management agencies. An overview of the HICS 

Training Modules is provided below. These modules can be 

accessed at the FEMA Independent Study Program website 

(http://training.fema.gov/IS/). 

HICS Training Modules

Module 1 IS-100.HC – Introduction to the Incident 

Command System for Healthcare/Hospitals 

Module 2 ICS-200 – Applying ICS to Healthcare 

Organizations 

Module 3 IS-700.a – National Incident Management 

System (NIMS), An Introduction 

Module 4 IS 800.b – National Response Framework, 

An Introduction 

My hospital currently utilizes the HICS emergency management 

system. 

 Yes 

 No 

Hospital Incident Command 

System (HICS) 

An emergency management system 

that employs a logical, unified 

management/command structure, 

defined responsibilities, clear 

reporting channels, and a common 

nomenclature to help unify hospitals 

with other emergency responders 

Incident Command System 

(ICS) 

A standardized on-scene incident 

management concept designed 

specifically to allow responders to 

adopt an integrated organizational 

structure equal to the complexity and 

demands of any single incident or 

multiple incidents without being 

hindered by jurisdictional boundaries 

Resources 

FEMA Independent Study Program 

http://training.fema.gov/IS/

Center for HICS Education and 

Training

Washington Hospital Center and 

Kaiser Permanente

http://www.hicscenter.org/

Medical Surge Capacity and 

Capability: A Management System 

for Integrating Medical and Health 

Resources During Large-Scale 

Emergencies

U.S. Department of Health and 

Human Services (HHS) 

http://www.hhs.gov/disasters/discussion/plann

ers/mscc/mscc080626.pdf
58 

SME TIP

Individual facility 

planning is necessary 

but not sufficient for a 

robust community 

emergency response. 

ENGAGE IN COMMUNITY PLANNING EFFORTS

It is important to establish on-going 

partnerships with your local 

emergency management 

agencies and public health 

departments prior to a public 

health emergency. It is not 

enough to have simply 

identified a contact person. 

ACTION

► Develop partnerships with local emergency management 

agencies and public health departments by participating in a 

community-wide emergency preparedness coalition. 

The U.S. Department of Health and Human Services' (HHS') 

document entitled Medical Surge Capacity and Capability: A 

Management System for Integrating Medical and Health 

Resources During Large-Scale Emergencies states, "A healthcare 

coalition organizes individual healthcare assets into a single 

functional unit. Its goal is to maximize medical surge capacity and 

capability across the coalition through cooperative planning, 

information sharing, and management coordination . . . [A 

healthcare coalition creates] the ability to move medical resources 

to sites of greatest need." 

WORKING WITH COMMUNITY PARTNERS TO COLLECT 

NEEDED DATA 

SMEs that provided input for this workbook determined two 

epidemiological data points needed by hospitals to more 

effectively care for patients during a pandemic influenza surge. 

These data points are (1) the age distribution of pediatric patients 

and (2) the site of care where the patients present for evaluation 

and treatment. Collecting these data will require coordination with 

other healthcare entities and public health partners. Planners 

should consider working with these partners to determine what 

avenues exist for collecting and distributing these data. 

A review of local healthcare 

emergency preparedness coalitions’ 

objective statements reveal that 

communities use their coalitions for 

a variety of purposes, including: 

• Creating a communication forum 

to enhance regional emergency 

planning 

• Strengthening all-hazards 

emergency preparedness and 

response by the healthcare 

system 

• Developing all-hazard 

preparedness plans with 

emergency management and 

public health officials 

• Creating a policy advisory board 

to review plans and resource 

sharing agreements 

• Implementing an emergency 

communication and coordination 

system for healthcare 

organizations 

• Coordinating training and 

planning support between 

community entities 

• Implementing standardized 

practices between response 

partners 

• Coordinating region wide 

exercises and trainings 

Planning Reminder 

In Area 1 – Pediatric Medical 

Liaisons and Other Key Contacts, 

you identified contact persons at 

your local emergency management 

agency and public health 

department. 
59 

A breakdown of the needed epidemiological data is shown below. 

Age Distribution of Data Collected 

0 – 2 years 

2 – 12 years 

12 – 18 years 

> 18 with special healthcare needs

Sites of Care Where Pediatric Patients Present 

Hospitals

Primary care providers

Federally Qualified Health Centers

Urgent care centers

Schools and school-based health centers

LEVERAGING COMMUNITY RESOURCES

It is important to know if your local Medical Reserve Corp (MRC) 

and Emergency System for Advance Registration of Volunteer 

Health Professionals (ESAR-VHP) are currently incorporated into 

your state and local response plans. It is very likely that they are 

already engaged by both public health departments and 

emergency management agencies. 

In order for these groups to provide the most benefit to your 

hospital, you need to understand their roles and how they work 

collaboratively before, during, and after the response to a public 

health emergency. 

Medical Reserve Corps 

(MRC) 

A group comprised of organized 

medical and public health 

professionals who serve as 

volunteers to respond to natural 

disasters and emergencies. Assists 

communities nationwide during 

emergencies and for ongoing efforts 

in public health 

Emergency System for 

Advance Registration of 

Volunteer Health 

Professionals (ESAR-VHP) 

A program that provides guidance 

and assistance for the development 

of standardized state-based 

programs for registering and 

verifying the credentials of volunteer 

health professionals in advance of 

an emergency or disaster 
60 

ACTION

► Review the resources in the sidebar regarding some of the 

resource capabilities in your community, including MRC and 

ESAR-VHP. 

MRC 

Determine if your local MRC is adequately prepared for an 

influenza pandemic in accordance with the laws, plans, and 

procedures of your local jurisdiction and state. 

Expect and allow for absences or unavailability of MRC volunteers 

during an influenza pandemic due to varying factors, such as 

personal or family member illness, community containment 

measures, and school, business, or public transportation closures. 

ESAR-VHP 

Each state ESAR-VHP program collects and verifies information 

on the identity, licensure status, privileges, and credentials of 

volunteers. As part of their responsibilities, each state ESAR-VHP 

program should track, train, and prepare volunteer health 

professionals who are not affiliated with a local MRC unit or 

another local/state response. 

ACTION

► Identify and record gaps in your hospital's current planning 

efforts related to Area 3 – Coordination with External Community 

Response. 

Resources

Pandemic Influenza Planning 

Guidance for Medical Reserve Corps 

Units

Office of the Civilian Volunteer 

Medical Reserve Corps 

http://www.medicalreservecorps.gov/File/MRC

_Pandemic_Influenza_Planning_Guidance.pdf

Integration of the MRC and ESARVHP Medical Reserve Corps Units

Office of the Civilian Volunteer 

Medical Reserve Corps

http://www.medicalreservecorps.gov/File/ESA

R_VHP/ESARVHPMRCIntegrationFactSheet.pdf
61 

ACTIONS

► Describe the next steps your facility needs to take to improve 

external coordination with your community’s influenza pandemic 

response planning efforts. 

► Describe the long-term changes your facility could make to 

better integrate into your community’s future influenza pandemic 

response planning efforts. 
62 

AREA 4 – PATIENT- AND FAMILY-CENTERED CARE 

(PFCC) DURING A PANDEMIC INFLUENZA SURGE

In Emergency Care for Children: Growing Pains, the Institute of 

Medicine (IOM) concluded that failure to implement PFCC into 

emergency care can result in many adverse outcomes, including 

miscommunication, difficulty obtaining informed consent, 

inadequate understanding of diagnosis and 

treatment by families, clinical bias, ethnic 

disparities, lower quality of care, and 

dissatisfaction with care. 

All hospitals need to prepare to 

provide some level of PFCC during 

an influenza pandemic. This 

preparation should include a plan to 

track pediatric patients and reunify 

families that may be separated. 

ACTION

► Identify ways that your hospital can plan to reasonably provide 

PFCC in the following areas presented in the American Academy 

of Pediatrics (AAP) Technical Report entitled Patient- and FamilyCentered Care of Children in the Emergency Department.

Patient Flow: Develop a patient flow protocol that limits the 

amount of time a child is separated from family members. 

Security and Identification: Ensure family members are clearly 

identified. 

Family-Centered Care 

An innovative approach to the 

planning, delivery, and evaluation of 

healthcare that is grounded in a 

mutually beneficial partnership 

among patients, families and health 

care professionals 

PFCC embraces these concepts:

1. We are providing care for a 

person, not a condition. 

2. The patient is best understood in 

the context of his or her family, 

culture, values, and goals. 

3. Honoring this context will result 

in better healthcare, safety, and 

patient satisfaction. 

American Academy of 

Pediatrics Examples of 

PFCC 

Patient Flow 

Operations that require a parent to 

leave a child for registration while 

the child is receiving care can be 

made more family centered by 

implementing bedside registration 

that allows the parent to stay with 

the child. 

Security and Identification 

Many emergency departments (EDs) 

require visitor badges. Change the 

labels to read "family" to reinforce 

that family members are valued. 

SME TIP

Consider planning with 

psychologists, social 

workers, and faithbased leaders to assist 

with providing PFCC. 
63 

Family Presence: Describe difficult-to-watch procedures in a 

clear and unbiased manner to parents, and allow them to choose 

if they want to be present during the procedure. 

Interpretation Services: Ensure timely access to professional 

interpreters rather than relying on accompanying friends and 

family members. 

Comfort Care: Plan for routine measurement of patient pain, 

anxiety, and comfort throughout the patient's time in the hospital. 

This may involve pharmacologic or non-pharmacologic

interventions, child-life services, and psychosocial or spiritual 

support. 

Coordination with the Medical Home: As much as possible, try 

to coordinate with a patient's usual healthcare provider for 

valuable insight during initial evaluation and throughout treatment. 

Resources 

Patient- and Family-Centered Care 

of Children in the Emergency 

Department

American Academy of Pediatrics 

(AAP) 

http://aappolicy.aappublications.org/cgi/reprint

/pediatrics;122/2/e511.pdf

Patient- and Family-Centered Care 

and the Role of the Emergency 

Physician Providing Care to a Child 

in the Emergency Department

American College of Emergency 

Physicians (ACEP) 

http://www.acep.org/practres.aspx?id=29598

The Institute for Family-Centered 

Care 

http://www.familycenteredcare.org/index.html

AAP Example of PFCC 

Coordination with the Medical 

Home 

Communication with the medical 

home can be supported through 

teleconferences, electronic health 

records, and automated healthinformation exchange. 
64 

Discharge Planning: Customize discharge instructions to reflect 

family preferences and to provide instructions for continuing care 

at home and following up with the patient's medical home. 

The Physical Plant: Look at your hospital's physical facility and 

identify areas that could be redesigned to better accommodate 

families, including well siblings. 

Resources 

Resources for Parents and Child 

Caregivers 

Centers for Disease Control and 

Prevention (CDC) 

http://www.cdc.gov/h1n1flu/parents/ 

Caring for Someone Sick at Home

Centers for Disease Control and 

Prevention (CDC) 

http://www.cdc.gov/h1n1flu/homecare/

AAP Example of PFCC 

The Physical Plant 

Provide restrooms, diaper changing 

space, dedicated and safe waiting 

areas, and refreshments. 

SME TIP

Provide developmentally 

appropriate videos in 

waiting rooms; these can 

be either for 

entertainment or 

educational purposes. 
65 

ACTIONS

► Identify and record gaps in your hospital's current planning 

efforts related to Area 4 – Patient- and Family Centered Care 

During a Pandemic Influenza Surge 

► Describe the immediate next steps your facility needs to take to 

improve PFCC. 

► Describe the long-term steps your facility needs to take to 

improve PFCC. 
66 

AREA 5 – PANDEMIC INFLUENZA PEDIATRIC 

TRIAGE

Many agencies and SME groups have developed sample 

algorithms to assist with pediatric patient triage during the 2009 

H1N1 influenza pandemic using the data categories included in 

this area of the workbook. Two sample algorithms are provided on 

pages 68 and 69 of this workbook. The algorithm published on 

page 68 was published by CDC and AAP on the CDC H1N1 site 

(and is duplicated here). The algorithm on page 69 was 

developed by the SMEs at the Stakeholder meeting. These may 

be adapted for use in your hospital. 

For non-routine pediatric providers, a more detailed algorithm may 

make the patient assessment process easier, and more 

experienced pediatric providers may prefer a simplified version. 

ACTION

►Determine level of acuity and hospital capacity in order to 

identify which patients to admit, transfer, or discharge to home 

care with consideration to the following criteria: age, underlying 

conditions, illness severity, and community acuity.

Age 

Consider ages for higher risk of complications or vulnerability. 

Underlying conditions 

Consider co-morbidities, such as diabetes, asthma, human 

immunodeficiency virus (HIV), suppressed immune system, and 

heart conditions. 

Illness severity

Determine the severity of the patient's condition, including the 

number of days since onset of illness. Compare the patient's 

present condition to the average case condition that would 

typically be expected at this current day of illness. 

Community Acuity 

Maintain situational awareness of influenza illness in the 

community. Consider community prevalence, family exposure, 

and school or daycare exposure. 

Triage Algorithms

Refer to the algorithms on pages 68 

and 69 for application of data 

categories. 

Page 68 

2009–2010 Influenza Season Triage 

Algorithm for Children (≤18 years) 

With Influenza-Like Illness 

Centers for Disease Control and 

Prevention (CDC) 

http://www.cdc.gov/h1n1flu/clinicians/pdf/child

algorithm.pdf

Page 69 

Outpatient evaluation of the Patient 

with ILI (Pediatric)

Developed at the Pediatric 

Healthcare Response to Pandemic 

H1N1 Influenza Stakeholder Meeting 

(September 2009) to help address 

the need for sample H1N1 influenza 

triage protocols in the pediatric 

community 

Tool 

Telephone Triage of Patients with 

Influenza 

American Academy of Family 

Physicians (AAFP) 

http://www.aafp.org/online/en/home/publicatio

ns/journals/afp/preprint/influenza-telephonetriage.html

Resources 

Resources for Parents and Child 

Caregivers 

Centers for Disease Control and 

Prevention (CDC) 

http://www.cdc.gov/h1n1flu/parents/ 

Caring for Someone Sick at Home

Centers for Disease Control and 

Prevention (CDC) 

http://www.cdc.gov/h1n1flu/homecare/
67 

ACTIONS

► Identify and record gaps in your hospital's current planning 

efforts related to Area 5 – Pandemic Influenza Pediatric Triage. 

► Describe the immediate next steps your facility needs to take to 

improve pediatric triage. 

► Describe the long-term steps your facility needs to take to 

improve pediatric triage. 
68 
69 
A-1 

APPENDIX A: ACRONYMS

AAP ................................................................................. American Academy of Pediatrics 

AAFP ............................................................... American Academy of Family Practitioners 

ACEP ............................................................. American College of Emergency Physicians 

ED .................................................................................................Emergency Department 

ESAR-VHP .................................................. Emergency System for Advance Registration 

of Volunteer Health Professionals 

HHS ................................................................ Department of Health and Human Services 

ILI ....................................................................................................... Influenza-like Illness 

IOM ..................................................................................................... Institute of Medicine 

JIT .................................................................................................. Just-in-Time (Training) 

MRC .............................................................................................. Medical Reserve Corps 

PFCC ........................................................................... Patient- and Family-Centered Care 

SME .................................................................................................. Subject Matter Expert 
B-1 

APPENDIX B: ACKNOWLEDGMENTS 

This workbook could not have been produced without valuable input from the following stakeholders 

and subject matter experts: 

Michael Anderson, MD 

Rainbow Babies & Children’s Hospitals 

Wanda Barfield, MD, MPH 

CDC, Maternal Child Health Epidemiology Program 

Drue Barrett, PhD 

CDC, Office of the Chief Science Officer 

Sarita Chung, MD 

Children’s Hospital Boston 

Edward Conway, Jr., MD 

Continuum Health Partners 

Daniel Dodgen, PhD 

HHS, Assistant Secretary for Preparedness and Response 

Sue Dull, RN, MSN, MBA 

National Association of Children’s Hospitals and Related Institutions 

Caroline Hall, MD 

University of Rochester Schools of Medicine and Dentistry 

Tom Hansen, MD 

Seattle Children’s Hospital 

Ramon Johnson, MD 

American College of Emergency Physicians 

Steven Krug, MD 

Children’s Memorial Hospital 

George Lister, MD 

University of Texas Southwestern Medical Center 

Georgina Peacock, MD 

CDC, Influenza Coordinating Unit 

Sally Phillips, RN, PhD 

HHS, Assistant Secretary for Preparedness and Response 

Irwin Redlener, MD 

The Children’s Health Fund 
B-2 

David Siegel, MD 

HHS, National Institute of Child Health and Human Development 

Christa Singleton, MD, MPH 

CDC, Division of State and Local Readiness 

Beth Stevenson 

CDC, Coordinating Center for Infectious Disease 

Ken Tegtmeyer, MD 

Cincinnati Children’s Hospital Medical Center 

Edwin Trevathan, MD, MPH 

CDC, National Center on Birth Defects and Developmental Disabilities 

Jeff Upperman, MD 

Children’s Hospital Los Angeles 

The findings and conclusions in this document do not necessarily represent the official position of CDC or 

of the contributors to this workbook. This workbook is a compilation of suggestions and planning steps

discussed by subject matter experts at the Pediatric Healthcare Response to Pandemic H1N1 Influenza 

Stakeholder Meeting. The resources cited in this workbook have been used by some of the SMEs in their 

own disaster planning processes prior to the meeting, and therefore are included as examples or 

suggestions for other hospitals. The inclusion of resources in this workbook does not imply CDC 

endorsement, nor does this workbook intend to be a comprehensive listing of all available disaster 

planning resources. The intention of this document is to aid hospitals in part of their influenza pandemic 

planning processes, which should include comprehensive research into available resources
C-1 

APPENDIX C: REFERENCES

General Hospital Focus

Area 2 – Assess Internal Pediatric Care Capabilities

American Academy of Pediatrics Committee on Pediatric Emergency Medicine, American College of Emergency 

Physicians Pediatric Committee, Emergency Nurses Association Pediatric Committee. Joint Policy Statement – 

Guidelines for Care of Children in the Emergency Department [online]. 2009. [cited 2009 Oct 25]. Available from 

URL: http://www.annemergmed.com/article/S0196-0644(09)01435-8/fulltext. 

American College of Emergency Physicians. Health Care System Surge Capacity Recognition, Preparedness,

and Response Policy Statement [online]. 2004. [cited 2009 Oct 22]. Available from URL: 

http://www.acep.org/practres.aspx?id=29506. 

Centers for Bioterrorism Preparedness Program Pediatric Task Force and the New York City Department of

Health and Mental Hygiene. Children in Disasters: Hospital Guidelines for Pediatric Preparedness [online]. 2008. 

[cited 2009 Oct 25]. Available from URL: http://www.nyc.gov/html/doh/downloads/pdf/bhpp/hepp-pedschildrenindisasters-010709.pdf. 

Florida Hospital Association. Hospital Disaster Response Plan [online]. (n.d.). [cited 2009 Oct 24] Available from 

URL: www.fha.org.

Task Force for Mass Critical Care. Definitive Care for the Critically Ill During a Disaster: Medical Resources for 

Surge Capacity [online]. 2007. [cited 2009 Oct 15]. Available from URL: 

http://chestjournal.chestpubs.org/content/133/5_suppl/32S.full.pdf.

Area 3 – Coordination with the Overall Community Pandemic Response

Medical Reserve Corps Program. Pandemic Influenza Planning Guidance for Medical Reserve Corps Units 

[online]. 2006. [cited 2009 Oct 25]. Available from URL: 

http://www.medicalreservecorps.gov/File/MRC_Pandemic_Influenza_Planning_Guidance.pdf.

Medical Reserve Corps Program. Integration of the Medical Reserve Corps and the Emergency System for 

Advance Registration of Volunteer Health Professionals [online]. 2008. [cited 2009 Nov 1]. Available from URL: 

http://www.medicalreservecorps.gov/File/ESAR_VHP/ESAR-VHPMRCIntegrationFactSheet.pdf.

U.S. Department of Health and Human Services. Medical Surge Capacity and Capability: A Management System 

for Integrating Medical and Health Resources During Large-Scale Emergencies [online]. 2004. [cited 2009 Oct 2]. 

Available from URL: http://www.hhs.gov/disasters/discussion/planners/mscc/mscc080626.pdf

Teeter, D. Forming An Emergency Healthcare Coalition [PowerPoint Slides]. 2005. [cited 2009 Oct 2]. Available 

from URL: http://www.kingcounty.gov/healthservices/health/preparedness/hccoalition/~/media/health/publichealth.

Area 4 – Plan for Patient- and Family-Centered Care

American Academy of Pediatrics, Committee on Pediatric Emergency Medicine; American College of Emergency 

Physicians, Pediatric Emergency Medicine Committee. Patient- and Family-Centered Care and the Role of the 

Emergency Physician Providing Care to a Child in the Emergency Department. Pediatrics [serial online]. 2006 

Nov [cited 2009 Oct 12]; 118(5):2242–2244. Available from URL: http://www.acep.org/practres.aspx?id=29598.
C-2 

Committee on the Future of Emergency Care in the United States Health System, Board on Health Care Services, 

Institute of Medicine of the National Academies. Emergency Care for Children Growing Pains. The National 

Academies Press, Washington D.C. 2007. 

Malley, P.O., K. Brown, S. Krug, and the American Academy of Pediatrics Committee on Pediatric Emergency 

Medicine.. Patient- and Family Centered Care of Children in the Emergency Department [online]. 2008. [cited 

2009 Oct 14]. Available from URL: http://aappolicy.aappublications.org/cgi/reprint/pediatrics;122/2/e511.pdf.

Children's Hospital Focus 

Area 2 – Identify Internal Surge Capacity

American College of Emergency Physicians. Health Care System Surge Capacity Recognition, Preparedness,

and Response Policy Statement [online]. 2004. [cited 2009 Oct 22]. Available from URL: 

http://www.acep.org/practres.aspx?id=29506. 

Centers for Bioterrorism Preparedness Program Pediatric Task Force and the New York City Department of

Health and Mental Hygiene. Children in Disasters: Hospital Guidelines for Pediatric Preparedness [online]. 2008. 

[cited 2009 Oct 25]. Available from URL: http://www.nyc.gov/html/doh/downloads/pdf/bhpp/hepp-pedschildrenindisasters-010709.pdf. 

Florida Hospital Association. Hospital Disaster Response Plan [online]. (n.d.). [cited 2009 Oct 24] Available from 

URL: www.fha.org.

Area 3 – Develop an Alternate Staffing Model

Task Force for Mass Critical Care. Definitive Care for the Critically Ill During a Disaster: Medical Resources for 

Surge Capacity [online]. 2007. [cited 2009 Oct 15]. Available from URL: 

http://chestjournal.chestpubs.org/content/133/5_suppl/32S.full.pdf.

Area 4 – Coordinate with the Overall Community Response

U.S. Department of Health and Human Services. Medical Surge Capacity and Capability: A Management System 

for Integrating Medical and Health Resources During Large-Scale Emergencies [online]. 2004. [cited 2009 Oct 2]. 

Available from URL: http://www.hhs.gov/disasters/discussion/planners/mscc/mscc080626.pdf

Medical Reserve Corps Program. Pandemic Influenza Planning Guidance for Medical Reserve Corps Units 

[online]. 2006. [cited 2009 Oct 25]. Available from URL: 

http://www.medicalreservecorps.gov/File/MRC_Pandemic_Influenza_Planning_Guidance.pdf.

Medical Reserve Corps Program. Integration of the Medical Reserve Corps and the Emergency System for 

Advance Registration of Volunteer Health Professionals [online]. 2008. [cited 2009 Nov 1]. Available from URL: 

http://www.medicalreservecorps.gov/File/ESAR_VHP/ESAR-VHPMRCIntegrationFactSheet.pdf.

Teeter, D. Forming An Emergency Healthcare Coalition [PowerPoint Slides]. 2005. [cited 2009 Oct 2]. Available 

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