FEDERAL GUIDANCE TO ASSIST STATES IN 

IMPROVING STATE-LEVEL PANDEMIC 

INFLUENZA OPERATING PLANS 

Presented to the American States, Territories and District of Columbia 

By 

U. S. GOVERNMENT, including: 

Department of Agriculture 

Department of Commerce 

Department of Defense 

Department of Education 

Department of Health and Human Services 

Department of Homeland Security 

Department of Interior 

Department of Justice 

Department of Labor 

Department of State 

Department of Transportation 

Department of Treasury 

Department of Veterans Affairs 

Homeland Security Council 

Office of Personnel Management 

March 11, 2008 

1 
TABLE OF CONTENTS 

I. Introduction 

II. Background 

III. Strategic Goals and Operating Objectives 

IV. Planning Fundamentals 

V. Instructions for Submitting Planning Information 

VI. Evaluation Process 

VII. Technical Assistance 

VIII. Appendices – Detailed Information regarding the Strategic Goals and their associated 

Operating Objectives 

IX Annex: Resource Documents 

0BI. INTRODUCTION 

Effective State, local and community functioning during and following an influenza pandemic requires 

focused planning and practicing in advance of the pandemic to ensure that States can maintain their 

critical functions. The Interim Pre-pandemic Planning Guidance: Community Strategy for Pandemic 

Influenza Mitigation in the United States – Early, Targeted, Layered Use of Nonpharmaceutical 

Interventions (February 2007) was developed to provide guidance for pandemic planning and 

response. For community mitigation strategies to be effective, State governments need to incorporate 

them into their operating plans and assist local communities, businesses, non-governmental 

organizations, and the public in doing the same. State governments must have robust operating plans 

that have been sufficiently tested and improved by staff who understand and perform proficiently their 

supporting activities. Community partners must also perform proficiently their roles and 

responsibilities and understand accurately what the State government will and won’t do and how it will 

communicate with both them and the public. 

This document provides a strategic framework to help the 50 States, the District of Columbia (DC), 

and the five U.S. Territories improve and maintain their operating plans for responding to and 

sustaining functionality during an influenza pandemic. Hereinafter within this document, the terms 

“States” and “State-level” refer to all 56 governmental entities. 

At the heart of the strategic framework are the supporting activities that State-level operating plans 

should address. Representatives of several United States Government (USG) Departments (see 

Annex) developed this document with input from State representatives. 

1BII. BACKGROUND 

During the past year, the US Department of Health and Human Services (HHS) – in collaboration with 

the US Department of Homeland Security (DHS) and six other USG Cabinet-Level Departments – 

assessed States’ pandemic influenza planning. This endeavor was part of the implementation of the 

National Strategy for Pandemic Influenza, which the White House Homeland Security Council (HSC) 

issued in May 2006 (HUhttp://www.whitehouse.gov/homeland/pandemic-influenza-implementation.htmlUH). 

This first round of assessments revealed important progress in many areas but also underscored the 

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need for better guidance from the USG Departments and increased efforts by State-level agencies to 

fill the many remaining gaps in preparedness. 

This document provides guidance for States’ submissions of planning information for the second round 

of assessments. The guidance builds on the States’ progress made since the first round of assessments 

and manifests lessons learned by the USG Departments. The guidance also manifests comments and 

recommendations provided by States’ representatives – primarily through their responses to the first 

round of assessments or during a series of regional workshops co-hosted by HHS and DHS regional 

staff during January 2008. 

As did the guidance for the first round of assessments, this revised guidance focuses on operating 

plansF 

1 

F – that is, plans that manifest a) clear-cut operating objectives, b) definitive implementation

strategies, c) unequivocal specification as to which organizations or individuals are responsible for 

which elements, and d) measurable performance objectives. A defining characteristic of an operating 

plan is that, in whole or in part, it readily lends itself to evidence-based evaluation using the results of 

discussion-based exercises, operational-based exercises, or performance measurements obtained in the 

course of responses to actual incidents. 

III. STRATEGIC GOALS AND OPERATING OBJECTIVES THAT MERIT INCLUSION IN 

STATE-LEVEL PANDEMIC INFLUENZA OPERATING PLANS 

An operating plan for combating pandemic influenza should address at least the three strategic goals 

listed below. The goals provide an overarching framework for the various functions of State 

government during an influenza pandemic. This framework acknowledges the fact that the State 

government is simultaneously striving to continue its basic operations, respond to the influenza 

pandemic, and facilitate the maintenance of critical infrastructure. 

109BUThe Strategic Goals 

Strategic Goal A, “Ensure Continuity of Operations of State Agencies and Continuity of State 

Government” focuses on the role of State government in as an employer (i.e., looking inward). State 

governments are “large employers” and as such need to consider how they will continue to function 

during the pandemic. Continuing critical services and lifelines that many State citizens rely on for 

survival (e.g., Medicaid, newborn screening, safe food and unemployment insurance) is paramount. If 

State governments fail to prepare themselves by developing, exercising, and improving comprehensive 

operating plans, then they will fail in their abilities to meet the other two strategic goals, which focus 

on external functions (i.e., responding to the event and helping to maintain critical infrastructure). 

Strategic Goal B, “Protect Citizens,” reflects the role of the State government as a responder in to the 

influenza pandemic. During a pandemic, the State government is conducting business as usual (and 

perhaps with more intensity) with functions such as disease surveillance and is altering the way the 

1

 Federal Emergency Management Agency (FEMA) defines an emergency operations plan as “a document that: describes 

how people and property will be protected in disaster and disaster threat situations; details who is responsible for carrying 

out specific actions; identifies the personnel, equipment, facilities, supplies, and other resources available for use in the 

disaster; and outlines how all actions will be coordinated. See State and Local Guide (SLG) 101: Guide for All-Hazard 

Emergency Operations Planning, page 1-1. HUhttp://www.fema.gov/plan/gaheop.shtmU 

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State conducts its business to delay the introduction, slow the spread, or lessen the severity of 

pandemic influenza (e.g., advising that sick people stay home, banning public gatherings, dismissing 

students from schools). 

Strategic Goal C, "Sustain/Support 17 Critical Infrastructure and Key Resource Sectors" (CIKR), 

focuses on the State government's role with respect to sustaining its publicly- and privately-owned 

critical infrastructure. Note that infrastructure includes not only physical plants associated with it but 

also the processes, systems and information that support it. 

States are responsible for developing and implementing Statewide CIKR protection programs that 

reflect and align with the full range of homeland security activities presented in the National 

Infrastructure Protection Plan (NIPP). The 17 CIKR sectors are: Agriculture and Food; Banking and 

Finance; Chemical; Commercial Facilities; Commercial Nuclear Reactors, Materials, and Waste; 

Dams; Defense Industrial Base; Drinking Water and Water Treatment; Emergency Services; Energy; 

Government Facilities; Information Technology; National Monuments and Icons; Postal and Shipping; 

Public Health and Healthcare; Telecommunications; and Transportation Systems. 

10BUThe Operating Objectives 

Associated with each Strategic Goal are Operating Objectives (Table 1) that merit inclusion in State 

pandemic influenza plans. Each operating objective has a corresponding Appendix containing (1) 

helpful hints for planning or preparedness activities (which contribute to comprehensive and 

exercisable operating plan development); and, (2) associated tables of supporting activities that should 

be specified in State operating plans. 

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Table 1. Strategic Goals and Operating Objectives 

2BStrategic Goal 3BOperating Objectives 4BAppendix 

5BA. Ensure Continuity of 

Operations of State 

Agencies & Continuity of 

State Government 

6BSustain Operations of State Agencies & Support and Protect Government Workers 7BA.1 

8BEnsure Public Health COOP During Each Phase of a Pandemic 9BA.2 

10BEnsure Continuity of Food Supply System 1BA.3 

12BEnsure Ability to Respond to Agricultural Emergencies & Maintain Food Safety 

Net Programs 

13BA.4 

Ensure Integration of Uniformed Military Services Needs & Assets 14BA.5 

15BSustain Transportation Systems 16BA.6 

17BB. Protect Citizens 18BEnsure Surveillance and Laboratory Capability During Each Phase of a Pandemic 19BB.1 

20BAssist with Controls at U.S. Ports of Entry 21BB.2 

2BImplement Community Mitigation Interventions 23BB.3 

24BEnhance State Plans to Enable Community Mitigation through Student Dismissal 

and School Closure 

25BB.4 

26BAcquire & Distribute Medical Countermeasures 27BB.5 

28BEnsure Mass Vaccination Capability During Each Phase of a Pandemic 29BB.6 

30BProvide Healthcare 31BB.7 

32BManage Mass Casualties 3BB.8 

34BEnsure Communication Capability During Each Phase of a Pandemic 35BB.9 

36BMitigate the Impact of an Influenza Pandemic on Workers in the State 37BB.10 

38BUnderstand Official Communication Mechanisms for Foreign Missions, 

International Organizations, and Their Members in the United States 

39BB.11 

40BIntegrate EMS and 9-1-1 into Pandemic Preparedness 41BB.12 

42BIntegrate Public Safety Answering Points into Pandemic Preparedness 43BB.13 

4BPublic Safety and Law Enforcement 45BB.15 

46BC. Sustain/Support 17 

Critical Infrastructure 

Sectors and Key Assets 

47BDefine CIKR Protection, Planning &Preparedness Roles & Responsibilities 48BC.1 

49BBuild Public-Private Partnerships & Support Networks 50BC.2 

51BImplement the NIPP Risk Management Framework for a Pandemic 52BC.3 

53BBolster CIKR Information Sharing & Protection Initiatives 54BC.4 

5BLeverage Emergency Preparedness Activities for CIKR Protection, Planning & 

Preparedness 

56BC.5 

57BIntegrate Federal & State CIKR Protection, Planning & Preparedness Activities 58BC.6 

59BAllocate Scarce Resources 60BC.7 

5 
Again, this guidance document aims to assist States in improving their State government operating 

plans – necessitating a focus on the supporting activities that should be found in an operating plan. It is 

understood that preparedness and planning activities would not be included in an operating plan, and it 

is understood that many response activities are not the responsibility of the State government. 

However, to ignore the importance of preparedness and planning (e.g., breadth of disciplines that must 

be involved, accuracy of planning principles and assumptions) would be shortsighted. Therefore, both 

are included in this document. 

To avoid confusion, it is important to distinguish between the tasks and capabilities that would be 

found in operating plans versus the preparedness and planning advice provided in this document. 

Therefore, within each operating objective, the helpful hints, planning guidance, and preparedness 

activity considerations are separated from the items that would be found in an operating plan. This 

was done using the widely accepted and adopted Federal Emergency Management Agency (FEMA) 

framework of “Prepare, Respond, and Recover”. 

Per the National Response Framework (January 2008) the following definitions apply: 

“UPreparednessU- Actions that involve a combination of planning, resources, training, exercise 

and organizing to build, sustain, and improve operational capabilities. Preparedness is the process of 

identifying the personnel, training, and equipment for delivering capabilities when needed for an 

incident.” 

“UResponseU - Immediate actions to save lives, protect property and the environment, and meet 

basic human needs. Response also includes the execution of emergency plans and actions to support 

short-term recovery.” 

”URecoveryU- The development, coordination and execution of service-and site-restoration plans; 

the reconstitution of government operations and services; individual, private-sector, nongovernmental, 

and public-assistance programs to provide housing and to promote restoration; long-term care and 

treatment of affected persons; additional measures for social, political, environmental, economic 

restoration; evaluation of the incident to identify lessons learned; post incident reporting; and 

developmental initiatives to mitigate the effects of future incidents.” 

Many supporting activities required to plan for, respond to, and recover from an influenza pandemic 

are implemented by organizations (e.g., philanthropic organizations, community- and faith-based 

organizations, local health agencies) or individuals independently of the State government. This 

document provides some helpful hints and planning advice with respect to facilitating their 

preparedness; however, the focus of this document is on the operations of the State government. In 

some instances, the role of the State government might be facilitating communication or analyzing data 

or promoting consistency in rigor of interventions across communities. 

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IV. PLANNING FUNDAMENTALS 

While pandemic influenza operating plans vary from other response plans in many ways, there are 

many planning fundamentals that apply regardless of threat. They should be integrated into all plans 

and operations – including those for an influenza pandemic. Several are described below. 

Keys for successful preparation 

1.	 Involve State and local Leadership. At the federal government level, the White House 

Homeland Security Council coordinates the work of the Departments, Independent Agencies, 

and other White House offices. We urge you to identify a coordinator from the Governor’s 

Office to coordinate your State’s integrated planning activities and include coordination with 

local government pandemic planning to ensure that all communities in the State will have a 

plan. In addition to consistent, strong leadership from the Governor’s Office, there should be a 

senior level official designated as the pandemic influenza coordinator for the State. 

2.	 Treat Pandemic as an All-Sectors (Community-Wide) Issue, not just a Health Issue.U The USG 

views the threat of pandemic influenza as not just a health threat but as a threat to all sectors of 

our society. The USG has committed to using all instruments of national power against the 

threat. We urge you to address the threat of pandemic with all instruments of State power. 

This guidance document reinforces this message by identifying State entities that should be 

involved in specific areas of planning. 

3.	 Collaborate with neighboring and distant States. Promising practices abound. We urge you to 

connect with planners in neighboring and distant States to share promising practices and 

lessons learned. 

4.	 Collaborate across society at the State level. Local governments, faith- and community-based 

organizations, philanthropic organizations, and the business community are critical partners for 

State government. We urge you to engage with them early and often as you develop and refine 

your plans. 

5.	 Collaborate with regional Principal Federal Officials. To coordinate the USG’s responses to 

pandemic influenza, the Department of Homeland Security has divided the nation into 5 

regions and designated a Principal Federal Official (PFO) for each region. The Department of 

Health and Human Services has enlarged the expertise available to the PFOs by designating 5 

corresponding medical professionals, called Senior Federal Officials for Health (SFOs). You 

should make contact now and ensure that you understand the channels of communication and 

the roles of the federal officials. Please note that these officials are listed in the Annex. 

Citizen Preparedness 

As individual citizens plan and prepare, it is important to think about the challenges that they might 

face, particularly if a pandemic is severe. States can work with local health departments and 

emergency services agencies across the State to bolster citizen preparedness and community resiliency. 

U U

U

U U

U U

U U

7 
Below are a few links to websites that identify some guidance to the challenges that could be caused by 

a severe pandemic and possible ways to address them. A checklist and fill-in sheets for family health 

information and emergency contact information have been prepared to help guide individuals planning 

and preparation. More information might be obtained at 

http://HUwww.pandemicflu.gov/plan/individual/index.htmlUH, HUcitizencorps.comUH and HUwww.ready.govUH. 

61BState-to-State Support 

The Emergency Management Assistance Compact (EMAC), established in 1996, has weathered the 

storms of repeated testing in real-world emergencies and stands today as the cornerstone of mutual aid. 

The EMAC mutual aid agreement and partnership between member States exist because from 

hurricanes to earthquakes, from wildfires to toxic waste spills, and from terrorist attacks to biological 

and chemical incidents, all States share a common enemy: the threat of disaster. To learn more about 

the EMAC see HUhttp://www.emacweb.org/UH. 

National Response Framework (NRF) 

The National Response Framework presents the guiding principles that enable all response partners to 

prepare for and provide a unified national response to disasters and emergencies – from the smallest 

incident to the largest catastrophe. The Framework establishes a comprehensive, national, all-hazards 

approach to domestic incident response. More information is available at 

HUhttp://www.fema.gov/emergency/nrf/UH. 

National Incident Management System (NIMS) 

While most emergency situations are handled locally, when there's a major incident help may be 

needed from other jurisdictions, the State and the Federal Governments. NIMS was developed so 

responders from myriad jurisdictions and disciplines can work together better to respond to natural 

disasters and emergencies, including acts of terrorism. NIMS benefits include a unified approach to 

incident management; standard command and management structures; and emphasis on preparedness, 

mutual aid and resource management. 

State-Local Emergency Management 

States need to develop a plan for maintaining essential emergency functions and services during an 

influenza pandemic. To do so, State Emergency Management Operations should conduct a 

comprehensive assessment of the State’s current capability. The assessment should reflect what the 

State will do to protect itself from its unique hazard with the unique resources it has or can obtain 

while maintaining essential emergency management functions during an influenza pandemic. 

The Emergency Support Functions associated with the National Response Framework provide the 

structure for coordinating Federal interagency support for a Federal response to an incident. They are 

mechanisms for grouping functions most frequently used to provide Federal support to States and 

Federal-to-Federal support, both for declared disasters and emergencies under the Stafford Act and for 

non-Stafford Act incidents. HUhttp://www.fema.gov/pdf/emergency/nrf/nrf-esf-intro.pdfU 

8 
 

 

UEmergency Support Function (ESF) Annexes 

ESF #1 – Transportation 

ESF #2 – Communications 

ESF #3 – Public Works and Engineering 

ESF #4 – Firefighting 

ESF #5 – Emergency Management 

ESF #6 – Mass Care, Emergency Assistance, Housing, and Human Services 

ESF #7 – Resource Support 

ESF #8 – Public Health and Medical Services 

ESF #9 – Search and Rescue 

ESF #10 – Oil and Hazardous Materials 

ESF #11 – Agriculture and Natural Resources 

ESF #12 – Energy 

ESF #13 – Public Safety and Security 

ESF # 14 – Long-Term Community Recovery 

ESF # 15 – External Affairs 

Other Locally defined ESFs 

States must consider the inherent interagency nature of emergency management operations and it’s 

reliance on voluntary organizations and how that might be affected by a pandemic. States should also 

identify best practices for social distancing, alternative work arrangement and a modified COOP to 

ensure essential emergency management capabilities are maintained. 

Information or guidance on the Federal Government’s Pandemic Influenza COOP plan can be found at 

HUhttp://www.fema.gov/government/coop/index.shtmUH . 

18BAt-Risk PopulationsF 

2 

F 

Communities are best-positioned to address the special needs of at-risk populations during an influenza 

pandemic. For all practical purposes, State agencies will be limited to promoting such communitylevel preparedness and facilitating and coordinating as resources allow. This section is included to 

help States plan for their largely indirect but nevertheless important role. 

At-risk individuals, along with their needs and concerns, must be addressed in all Federal, State, 

Tribal, Territorial, and local emergency plans, and thus need to be addressed in State pandemic plans. 

HHS has developed a working definition of “at-risk individuals” that is function-based and designed to 

be harmonious with the NRF definition of “special needs.” The HHS working definition is: 

“Before, during, and after an incident, members of at-risk populations might have additional 

needs in one or more of the following functional areas: 

• maintaining independence, 

• communication, 

• transportation, 

• supervision, and 

• medical care. 

2

 Sometimes referred to as special needs individuals or vulnerable populations. 

9 
 In addition to those individuals specifically recognized as at-risk in the Pandemic and All 

Hazards Preparedness Act (i.e., children, senior citizens, and pregnant women), individuals who 

might need additional response assistance should include those who have disabilities; live in 

institutionalized settings; are from diverse cultures; have limited English proficiency or are nonEnglish speaking; are transportation disadvantaged; have chronic medical disorders; and have 

pharmacological dependency.” 

This approach to defining at-risk individuals establishes a flexible framework that addresses a broad 

set of common function-based needs irrespective of specific diagnoses, statuses, or labels (e.g., 

children, the elderly, transportation disadvantaged). These functional needs of at-risk individuals are 

ones that may exist across segments of the population. 

In simple terms, at-risk individuals are those who, in addition to their medical needs, have other needs 

that may interfere with their ability to access or receive medical care. Although children, pregnant 

women, and the elderly were the populations cited as most vulnerable in the influenza epidemics of the 

20th century, many others among those listed above would be adversely affected when another 

pandemic occurs – despite modern science and medical capabilities. For example: 

An individual with HIV/AIDS who does not speak English and who contracts influenza could 

easily find herself in a precarious situation. In addition to treatment for influenza, her 

functional needs would be medical care (for the HIV/AIDS) and communication (her lack of 

English may keep her from hearing about where and how to access services). Without 

addressing those functional needs, she cannot obtain healthcare services. 

The health status of an individual receiving home dialysis treatment that relies on a local Paratransit system to attend medical appointments and food shopping could quickly become critical 

if 40% of the drivers are ill and transportation is suspended. In addition to treatment for 

influenza, his functional needs would be medical care (for dialysis) and transportation. 

Without addressing those functional needs, he cannot obtain healthcare services. 

An individual with a progressive chronic illness living alone on a limited income in the 

community with the help of a part-time care giver may become fearful and agitated during a 

pandemic event and be unable to access additional care. In addition to treatment for influenza, 

her functional need would be maintaining independence (to help address the impact of the 

condition) and possibly supervision (if she is not able to live alone safely). Without addressing 

those functional needs, she cannot obtain healthcare services. 

Models currently being used to facilitate planning for at-risk individuals emphasize 1) locating 

individuals in the community who may have additional needs such as the home bound, homeless and 

disabled 2) establishing good relationships with community service providers and advocates to develop 

planning response and recovery actions that are realistic - sometimes through a coalition of providers 

and social organizations, and 3) using a trusted source in the community such as a community leader or 

organization to ensure that messages about influenza reach at-risk populations. These three elements 

account for the critical at-risk planning issues of outreach and communication and the delivery of 

public health and medical and human services during a pandemic. Recommended resources and 

models are provided in the Annex.. 

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19BLegal Authorities 

Legal preparedness is crucially important to successful implementation of States’ operational plans for 

responding to, and sustaining functionality during, an influenza pandemic. A definition for public 

health legal preparedness is provided here. However, all agencies should review, understand, and 

follow or seek changes to existing legal authorities. 

Public health legal preparedness is defined as “the attainment by a public health system of specified 

legal benchmarks or standards essential to preparedness of the public health system.” Legal 

preparedness has four core elements: 

•	 Laws and legal authorities, 

•	 Competency in applying those laws, 

•	 Coordination across jurisdictions and sectors in implementing laws, and 

•	 Information about public health law best practices. 

Operational plans should cite the applicable State laws that authorize and regulate components 

consistent with protection of civil liberties and other due process requirements of their pandemic plans 

such as: 

•	 employee ability to report to work/use of sick leave, 

•	 isolation and quarantine, 

•	 restriction of traveler movement, 

•	 closure of public venues, 

•	 suspension of public gatherings, 

•	 curfews , 

•	 related social distancing, 

•	 school closing/school dismissal, 

•	 advice to close childcare facilities 

•	 dispensation of antiviral drugs (e.g., laws authorizing State/local health agencies to mass 

dispense prescription drugs; laws specifying the professionals that may mass dispense 

prescription drugs), and, 

•	 administration of mass vaccination without the completion of standard medical examinations. 

For example, as part of the preparedness activities outlined in Appendix B.10 (Mitigate the impact of 

an influenza pandemic on workers in the State), States will assess which State benefits and other 

assistance programs can help workers during a pandemic and whether new resources, laws or 

programs may be needed. In this assessment of State programs or services, particularly the triggers for 

eligibility, States will need to consider if legal/statutory flexibilities may be needed because of the 

unique circumstances of a pandemic. Examples of such statutes include State workers’ compensation 

laws and State family and medical leave laws. 

Additionally, as part of an operational plan, the agencies and specific officials authorized to implement 

these laws should be included as well as the status of liability protection for participating officials. 

11 
 

Pandemic Severity Index 

The Interim Pre-pandemic Planning Guidance: Community Strategy for Pandemic Influenza 

Mitigation in the United States (February 2007) features the Pandemic Severity Index (Figure 1) which 

uses case fatality ratios as critical drivers for categorizing the severity of a pandemic. Interventions 

will be recommended based on the severity of pandemic, including: isolation and treatment of ill 

persons with antiviral drugs; voluntary home quarantine of members of households containing 

confirmed or probable cases; dismissal of students from school; closure of childcare facilities, and use 

of social distancing measures to reduce contacts between adults in the community and workplace. 

State pandemic plans should take into account implementation of these mitigation strategies and their 

possible secondary effects. 

Figure 1. Pandemic Severity Index 

Pandemic Intervals, Triggers and Actions 

In November 2005, the President of the United States released the National Strategy for Pandemic 

Influenza, followed by the Implementation Plan in May 2006. These documents introduced the 

concept of “stages” for Federal Government response3 

F F. The six USG stages have provided greater 

specificity for U.S. preparedness and response efforts than the pandemic phases outlined in the World 

Health Organization (WHO) global pandemic plan.4 F F The stages have facilitated initial planning efforts

by identifying objectives, actions, policy decisions, and messaging considerations for each stage. 

While the stages have provided a high-level overview of the Federal Government approach to a 

pandemic response, more detailed planning for Federal, State, and local responses requires a greater 

level of specificity than is afforded with the current USG stages. 

The Pandemic Intervals 

The incorporation of known principles regarding epidemic influenza transmission, along with the 

adoption of well-defined triggers for action, will enhance the development of more detailed plans and 

U

3

 Pandemicflu.gov – Federal Planning & Response Activities. Available at 

HUhttp://www.pandemicflu.gov/plan/federal/index.html#national. 4 WHO global influenza preparedness plan: The role of WHO and recommendations for national measures before and 

during pandemics. Available at http://www.who.int/csr/resources/publications/influenza/GIP_2005_5Eweb.pdfU UH HU

12 
 

 

 

 

 

 

guidance. Moreover, these refinements will facilitate better coordinated and timelier containment and 

mitigation strategies at all levels, while acknowledging the heterogeneity of conditions affecting 

different U.S. communities during the progression of a pandemic. 

Typically, epidemic curves are used to monitor an outbreak as it is occurring or to describe the 

outbreak retrospectively. While epidemic curves are useful during an outbreak or retrospectively for 

noting the possible effects of interventions (graphically showing when they are or were implemented 

relative to the rise and fall of the epidemic), model epidemic or pandemic curves can also be used to 

describe likely events over time. These hypothetical models may be particularly valuable 

prospectively for anticipating conditions and identifying the key actions that could be taken at certain 

points in time to alter the epidemic or pandemic curve. Classic epidemic curves have been described 

in the literature as having a: growth phase, hyperendemic phase, decline, endemic or equilibrium 

phase, and potentially an elimination phase.F 

5 6 

FF F 

For the purposes of pandemic preparedness, the Federal Government will use intervals representing the

7,8 sequential units of time that occur along a hypothetical pandemic curve F F F F .. For state planning, using

the intervals to describe the progression of the pandemic within communities in a state helps to provide 

a more granular framework for defining when to respond with various interventions during U.S. 

Government stages 4, 5 and 6. (Figure 2) These intervals could happen in any community from the 

time sustained and efficient transmission is confirmed. 

While it is difficult to forecast the duration of a pandemic, we expect there will be definable periods 

between when the pandemic begins, when transmission is established and peaks, when resolution is 

achieved, and when subsequent waves begin. While there will be one epidemic curve for the United 

States, the larger curve is made up of many smaller curves that occur on a community by community 

basis. Therefore, the intervals serve as additional points of reference within the phases and stages to 

provide a common orientation and better epidemiologic understanding of what is taking place. State 

health authorities may elect to implement interventions asynchronously within their states by focusing 

early efforts on communities that are first affected. The intervals thus can assist in identifying when to 

intervene in these affected communities. The intervals are also a valuable means for communicating 

the status of the pandemic by quantifying different levels of disease, and linking that status with 

triggers for interventions. 

5

 Liang W, Zhu Z, Guo J, et al. Severe acute respiratory syndrome, Beijing, 2003. Emerg Infect Dis (2004); 10(1): 25-31. 

HUhttp://www.cdc.gov/ncidod/EiD/vol10no1/pdfs/03-0553.pdfU 

6 Wasserheit JN, Aral SO. The dynamic typology of sexually transmitted disease epidemics: Implications for prevention 

strategies. J Infect Dis (1996); 174 (suppl 2): S201-13. 7

 Pandemic curves can be drawn to represent many different outbreaks—an epidemic curve for the world is distributed over 

a long period of time and around the globe and might be correlated to the WHO phases. A pandemic curve for the U.S. is 

likely shorter and references only the geographic bounds of the United States, and can be correlated with the U.S. 

government planning stages. A pandemic curve for a state or community is likely shorter still and references only the 

geographic bounds of the state or community. In this document, we apply these intervals to State and community planning 

during U.S. government stages 4, 5 and 6. (Of course these intervals have utility for national and international efforts as 

well.)

8

 Because we recognize that the pandemic may begin, or first be detected, in the United States or elsewhere in North 

America, the intervals do not distinguish between the occurrence of pre-pandemic or pandemic cases overseas versus the 

occurrence of cases domestically. Therefore, this framework can be applied in community, state, national, or international 

settings. 

13 
 

The intervals are designed to inform and complement the use of the Pandemic Severity Index (PSI) for 

choosing appropriate community mitigation strategies.F 

9 

F The PSI guides the range of interventions to

consider and/or implement given the epidemiological characteristics of the pandemic. The intervals 

are more closely aligned with triggers to indicate when to act, while the PSI is used to indicate how to 

act. 

9

 CDC. Interim Pre-Pandemic Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United 

States – Early, Targeted, Layered Use of Nonpharmaceutical Interventions. February 2007. Available at 

HUhttp://www.pandemicflu.gov/plan/community/commitigation.htmlU 

14 
Figure 2: Periods, Phases, Stages, and Intervals 

 

 

WHO Phase 

0 1 2 3 4 5 6

Spread Throughout United States Recovery

First 

Human 

Case in 

N.A. 

Widespread 

Outbreaks 

Overseas 

Confirmed 

Human 

Outbreak 

Overseas 

Suspected 

Human Outbreak 

Overseas 

New Domestic 

Animal 

Outbreak in AtRisk Country 

1 2 3 4 5 6

Inter Pandemic Alert Period Pandemic Period

USG Stage 

For planning, intervals provide additional specificity for implementing state and community level interventions during stages 4, 5 and 6.
 

Investigation Recognition Initiation Accel Peak Decel Resolution 

CDC Intervals 

Pre- Pandemic Intervals Pandemic Intervals • Peak Transmission 

• Investigation • Initiation • Deceleration 

• Recognition • Acceleration • Resolution 

UDefinitions of the Different Pandemic Intervals
 

For each interval shown in Figure A, a definition of the interval is provided below for communities, 

states and for the nation. 

For states that are “affected” (i.e., they have met the definition for the interval), selected actions to 

initiate during the interval are provided. For states that are “unaffected” (i.e., they have not met the 

definition for the interval at a time when other states have met the definition), selected actions and 

preparations are provided. Questions regarding the use of these intervals can be obtained at 

intervals@cdc.gov. 

“Investigation” Interval – Investigation of Novel Influenza Cases: This pre-pandemic interval 

represents the time period when sporadic cases of novel influenza may be occurring overseas or within 

the United States. During this interval, public health authorities will use routine surveillance and 

epidemiologic investigations to identify human cases of novel influenza and assess the potential for the 

strain to cause significant disease in humans. Investigations of animal outbreaks also will be 

conducted to determine any human health implications. During this interval, pandemic preparedness 

efforts should be developed and strengthened. Case-based control measures (i.e., antiviral treatment 

and isolation of cases and antiviral prophylaxis of contacts) are the primary public health strategy for 

responding to cases of novel influenza infection. The national case definition for novel influenza is 

located at http://www.cdc.gov/ncphi/disss/nndss/casedef/novel_influenzaA.htm. 

U U

HU UH

15 
Affected State – A state where a sporadic case of novel influenza is detected. 

•	 Voluntarily isolate and treat human cases 

•	 Voluntarily quarantine if human-to-human transmission is suspected, monitor, and provide 

chemoprophylaxis to contacts 

•	 Assess case contacts to determine human to human transmission and risk factors for infection 

•	 Share information with animal and human health officials and other stakeholders, including 

reporting of cases according to the Nationally Notifiable Diseases Surveillance System and 

sharing virus samples 

•	 Disseminate risk communication messages 

Unaffected State – A state not currently investigating novel influenza cases. 

•	 Continue to maintain state surveillance 

•	 Continue to build state and local countermeasures stockpile 

•	 Continue to develop and promote community mitigation preparedness activities, including plans 

and exercises 

•	 Continue refining and testing healthcare surge plans 

“Recognition” Interval – Recognition of Efficient and Sustained Transmission: This interval occurs 

when clusters of cases of novel influenza virus in humans are identified and there is confirmation of 

sustained and efficient human-to-human transmission indicating that a pandemic strain has emerged 

overseas or within the United States. During the recognition interval, public health officials in the 

affected country and community will attempt to contain the outbreak and limit the potential for further 

spread in the original community. Case-based control measures, including isolation and treatment of 

cases and voluntary quarantine of contacts, will be the primary public health strategy to contain the 

spread of infection; however, addition of rapid implementation of community-wide antiviral 

prophylaxis may be attempted to fully contain an emerging pandemic. 

Affected State – A state where human to human transmission of a novel influenza virus infection is 

occurring and where the transmission of the virus has an efficiency and sustainability that indicates it 

has potential to cause a pandemic. This represents the detection of a potential pandemic in the U.S. 

before recognition elsewhere in the world. 

•	 Continue/initiate actions as above (Investigation) 

•	 Implement case-based investigation and containment 

•	 Implement voluntary contact quarantine and chemoprophylaxis 

•	 Confirm all suspect cases at public health laboratory 

•	 Consider rapid containment of emerging pandemic influenza 

•	 Report cases according to Nationally Notifiable Diseases Surveillance System 

•	 Conduct enhanced pandemic surveillance 

•	 Prepare to receive SNS countermeasures 

•	 Disseminate risk communication messages, including when to seek care and how to care for ill 

at home 

•	 Implement appropriate screening of travelers and other border health strategies, as directed by 

CDC 

16 
 

Unaffected State – A state not meeting the criteria above. This may represent either that recognition of 

a potential pandemic is occurring in another state, or is occurring outside the United States. 

•	 Continue/initiate actions as above (Investigation) 

•	 Prepare for investigation and response 

•	 Conduct enhanced pandemic surveillance 

•	 Prepare to receive SNS countermeasures 

•	 Disseminate risk communication messages 

•	 Implement appropriate screening of travelers and other border health strategies, as directed by 

CDC 

“Initiation” Interval – Initiation of the Pandemic Wave: This interval begins with the identification 

and laboratory-confirmation of the first human case due to pandemic influenza virus in the United 

States. If the United States is the first country to recognize the emerging pandemic strain, then the 

“Recognition” and “Initiation” intervals are the same for affected states. As this interval progresses, 

continued implementation of case-based control measures (i.e., isolation and treatment of cases, 

voluntary prophylaxis and quarantine of contacts) will be important, along with enhanced surveillance 

for detecting potential pandemic cases to determine when community mitigation interventions will be 

implemented. 

Affected State – A state with at least one laboratory-confirmed pandemic case. 

•	 Continue/initiate actions as above (Recognition) 

•	 Declare Community Mitigation Standby if PSI Category 1 to 3, declare Alert if PSI Category is 

4 or 5 

•	 Continue enhanced state and local surveillance 

•	 Implement (pre-pandemic) vaccination campaigns if (pre-pandemic) vaccine is available 

•	 Offer mental health services to health care workers. 

Unaffected States – A state with no laboratory-confirmed pandemic cases. 

•	 Continue/initiate actions as above (Recognition) 

•	 Declare Community Mitigation Standby if PSI Category 4 or 5 

•	 Prepare for investigation and response 

•	 Prepare for healthcare surge 

•	 Review and prepare to deploy mortuary surge plan 

•	 Deploy state/local caches 

•	 Prepare to transition into emergency operations 

“Acceleration” Interval – Acceleration of the Pandemic Wave: This interval begins in a State when 

public health officials have identified that containment efforts have not succeeded, onward 

transmission is occurring, or there are two or more laboratory-confirmed cases in the State that are not 

epidemiologically linked to any previous case. It will be important to rapidly initiate community 

mitigation activities such as school dismissal and childcare closures, social distancing, and the efficient 

management of public health resources.F 

10 F Isolation and treatment of cases along with voluntary

10 CDC. Interim Pre-Pandemic Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United 

States – Early, Targeted, Layered Use of Nonpharmaceutical Interventions. February 2007. Available at 

HUhttp://www.pandemicflu.gov/plan/community/commitigation.htmlU 

17 
 

 

 

quarantine of contacts should continue as a key mitigation measure. Historical analyses and 

mathematical modeling indicate that early institution of combined, concurrent community mitigation 

measures may maximize reduction of disease transmission (and subsequent mortality) in the affected 

11 12 13 14 areas.F FF FF FF 

Affected State – A state that has two or more laboratory-confirmed pandemic cases in a state that are 

not epidemiologically linked to any previous case; or, has increasing numbers of cases that exceed 

resources to provide case-based control measures 

•	 Continue/initiate actions as above (Initiation) 

•	 Activate community mitigation interventions for affected communities 

•	 Transition from case-based containment/contact chemoprophylaxis to community interventions 

•	 Transition surveillance from individual case confirmation to mortality and syndromic disease 

monitoring 

•	 Begin pre-shift healthcare worker physical and mental health wellness screening 

•	 Implement vaccination campaigns if (pre-pandemic) vaccine is available 

•	 Monitor vaccination coverage levels, antiviral use, and adverse events 

•	 Monitor effectiveness of community mitigation activities 

Unaffected State – A state that has not met the criteria above. 

•	 Continue/initiate actions as above (Initiation) 

•	 Prepare for investigation and response 

•	 Prepare for healthcare surge 

•	 Review and prepare to deploy mortuary surge plan 

•	 Deploy state/local caches 

•	 Prepare to transition into emergency operations 

•	 Implement vaccination campaigns if (pre-pandemic) vaccine is available 

•	 Monitor vaccination coverage levels, antiviral use, and adverse events 

“Peak/Established Transmission” Interval – Transmission is Established and Peak of the Pandemic 

Wave: This interval encompasses the time period when there is extensive transmission in the 

community and the state has reached it’s greatest number of newly identified cases. The ability to 

provide treatment when the healthcare system is overburdened will be particularly challenging. To 

reduce the societal effects of the pandemic, available resources must be optimized to maintain the 

critical infrastructure and key resources in the face of widespread disease. 

Affected State – A state in which 1) >10% of specimens from patients with influenza-like illness 

submitted to the state public health laboratory are positive for the pandemic strain during a seven day 

11 Hatchett RJ, Mecher CE, Lipsitch M. Public health interventions and epidemic intensity during the 1918 influenza 

pandemic. Proceedings of National Academy of Sciences of USA, (2007); 104 (18): 7583-7587. 12 Markel H, Lipman HB, Navarro JA, et al. Nonpharmaceutical Interventions Implemented by US Cities During the 1918-

1919 Influenza Pandemic. JAMA (2007);298 (6): 644-654. 13 Ferguson NM, Cummings DA, Fraser C, et al. Strategies for mitigating an influenza pandemic Nature (2006); 442:7:
 

448-452. 

14 Bootsma MC, Ferguson NM. The effect of public health measures on the 1918 influenza pandemic in U.S. cities. 

Proceedings of National Academy of Sciences of USA, (2007);104 (18): 7588-7593. 

18 
 

period, or, 2) “regional” pandemic influenza activity is reported by the State Epidemiologist using 

CDC-defined criteria, or, 3) the healthcare system surge capacity has been exceeded. 

•	 Continue/initiate actions as above (Acceleration) 

•	 Manage health care surge 

•	 Maintain critical infrastructure and key resources 

•	 Laboratory confirmation of only a sample of cases as required for virologic surveillance 

•	 Implement surveillance primarily for mortality and syndromic disease 

Unaffected States – As transmission increases in the U.S., states are likely to be in different intervals. 

Thus, states should anticipate the actions needed for subsequent intervals and plan accordingly. 

“Deceleration” Interval – Deceleration of the Pandemic Wave: During this interval, it is evident that 

the rates of pandemic infection are declining. The decline provides an opportunity to begin planning 

for appropriate suspension of community mitigation activities and recovery. State health officials may 

choose to rescind community mitigation intervention measures in selected regions within their 

jurisdiction, as appropriate; however mathematical models suggest that cessation of community 

mitigation measures are most effective when new cases are not occurring or occur very infrequently.15 F F 

[10] 

Affected State – A state where <10% of specimens from patients with influenza-like illness submitted 

to the state public health laboratory are positive for the pandemic strain for at least two consecutive 

weeks, or, the healthcare system capacity is below surge capacity. 

•	 Continue/initiate actions as above (Peak/Established Transmission) 

•	 Assess, plan for, and implement targeted cessation of community mitigation measures if 

appropriate 

•	 Transition surveillance from syndromic to case-based monitoring and confirmation 

•	 Initiate targeted cessation of surge capacity strategies 

•	 Maintain aggressive infection control measures in the community 

“Resolution” Interval – Resolution of the Pandemic Wave: In this interval, pandemic cases are 

occurring only sporadically. The primary actions to be taken during this interval include discontinuing 

all community mitigation interventions, facilitating the recovery of the public health and healthcare 

infrastructure, resuming enhanced surveillance protocols to detect possible subsequent waves, and 

preparing for next waves of infection should they occur. 

Affected State – A state where active virologic surveillance detects pandemic cases occurring 

sporadically. 

•	 Continue/initiate actions as above (Deceleration) 

•	 Rescind community mitigation interventions 

•	 Continue case confirmation of selected cases to verify resolution of pandemic wave 

•	 Resume enhanced virologic surveillance to detect emergence of increased transmission. 

•	 Prepare for possible second wave 

•	 Continue to promote community mitigation preparedness activities on standby for second wave 

•	 Conduct after-action review for lessons learned 

•	 Replenish stockpiles/caches as able 

15 Davey VJ, Glass RJ. Rescinding Community Mitigation Strategies in an Influenza Pandemic. Emerging Infectious 

Diseases, (2008);14 (3): 365-372. Available at: HUhttp://www.cdc.gov/eid/content/14/3/365.htm?s_cid=eid365_e#citU 

19 
V. INSTRUCTIONS FOR SUBMITING PLANNING INFORMATION 

Format 

Information regarding the State’s / District’s / Territory’s planning for countering pandemic influenza 

should be presented in accord with the following 5-part outline: 

1.	 Cover Page 

2.	 Table of Contents 

3.	 Contributing Agencies 

4.	 Generic Planning Principles and Assumptions 

5.	 Information Specific to Each Operating Objective 

See the Appendices for additional instructions regarding the information requested for each Operating 

Objective. 

Information to be included under each of the five headings identified in the aforementioned 

outline 

Cover Page 

•	 Name of State / District of Columbia / Territory 

•	 Name and title of the official submitting the report 

•	 Date of submission 

Table of Contents 

•	 Starting pages of each of the 5 headings and the major sections under headings 3-5, 

respectively
 

•	 Full title of each plan, if any, that is referenced and included as part of the response to item 5 

Contributing Agencies 

Please provide a table identifying each contributing agency and, for each, the printed name and 

signature of the individual responsible for its contribution. 

Generic Planning Principles and Assumptions 

•	 Please describe briefly the overarching principles and assumptions that guide the State’s / 

District’s / Territory’s planning to counter pandemic influenza. Note the adjective “generic”, 

and be aware that the Appendices request descriptions of planning principles and assumptions 

specific to the Operating Objectives. 

•	 Please describe briefly how pandemic preparedness plans are documented. That is, do they 

exist as a freestanding Pandemic Influenza Plan? Or are they included in one or more broader 

ranging plans such as an All-Hazards Emergency Response Plan or a Continuity-of-Operations 

Plan? List the full title of each State plan, if any, that is referenced and included as part of the 

response to item 5. 

•	 With respect to the National Incident Management System, please provide the following 

information: 

o	 Name and contact information for lead individual for State. 

o	 Plan for conformance with all NRF/NIMS principles and guidelines; and, 

98B9B

10B

0B

102B1 103B1BU12BU13BU14BU

20 
o	 Plan for relating to the Joint Field Office Principal Federal Official during a pandemic. 

Information Specific to Each Operating Objective 

•	 Note that each Operating Objective listed in Table B has a corresponding Sub-Appendix, which 

provides guidance for States’ consideration in planning and lists in tabular form the Supporting 

Activities for which planning information is requested. Thus, the USG Departments are 

seeking planning and operating information only for the Supporting Activities cited in the 

tables. The rest of the material in the Appendices and Sub-Appendices is intended only to 

facilitate planning and does not require a response. 

•	 Note also that the tables in the Sub-Appendices correspond to the format of the worksheets that 

reviewers will use. The intent is to enable responders to know precisely what is to be 

evaluated. 

Organization of the information submitted 

The submission may take either of two forms: 

Option 1 

•	 A WORD document that presents the information requested for Items 1-4; 

•	 A set of EXCEL spreadsheets (templates forthcoming) providing citations to a WORD 

document that contains all of the information requested for the Operating Objectives; AND 

•	 The WORD document that contains all of the information cited in the EXCEL spreadsheets. 

OR 

Option 2 

•	 A WORD document that presents the information requested for Items 1-4; 

•	 A set of EXCEL spreadsheets (templates forthcoming) providing citations to the documents 

that contain the information requested for the Operating Objectives; 

•	 A copy of each freestanding plan that is cited in the spreadsheets – for example, a Pandemic 

Influenza Plan, an All-Hazards Emergency Response Plan, or a Continuity of Operations Plan; 

AND 

•	 A WORD document that presents any information that is cited in the spreadsheets but not 

contained in any freestanding plan such as those mentioned above. 

For Option 2, the copy of each freestanding plan cited in the EXCEL spreadsheets should be provided 

in PDF format. 

For both Options 1 and 2, the several computer-manipulable files (WORD only or WORD plus PDF) 

must be submitted on compact disc (CD ROM) because the volume might be too large to be 

accommodated by conventional e-mail systems. 

NOTE: HHS WILL PROVIDE AN SET OF EXCEL SPREADSHEETS ESPECIALLY 

DESIGNED TO FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN 

THIS DOCUMENT. These templates will be available soon on www.pandemicflu.gov. 

15BU104B16BU17BU HU UH

21 
 

 

In the interim, State officials may wish to use the tables included in the Sub-Appendices as worksheets 

in preparation for submitting documentation in Excel spreadsheets. The Excel spreadsheets will mimic 

the format of the Word tables included herein. 

105BDue date, number of copies and address for submissions 

Submissions are due on UJune 16, 2008U. 

Please submit Uthree copies (3)U of the CD ROM containing the requested information. 

Please send the material to UUS Department of Health and Human Services, ATTN: Shelia Jones, 

Hubert H. Humphrey Building, Room 638G, 200 Independence Avenue SW, Washington DC, 20201U 

by a private package delivery service (DHL, FEDEX, or UPS). 

NOTE: Do not use US Mail. The irradiation applied to US Mail received by the Federal 

Government might damage CD ROMs. 

62BVI. EVALUATION PROCESS AND SCORING 

Evaluation Process 

The participating USG Departments will follow a five-step process as follows: 

1.	 Subject matter experts within the participating USG Departments will review those portions of 

the submissions that fall within their respective mission areas. 

2.	 Reviewers will assess the information provided for each Operating Objective in accord with the 

scoring schema described below. 

3.	 HHS will compile the preliminary results of the reviews into State-specific reports; provide 

them to the States, District, and Territories individually and privately in the form of “Draft 

Concluding Assessments”; and solicit comments related to any apparent procedural 

irregularities or factual errors. The adjective “concluding” signifies that this is the second 

phase of a two-phase assessment process – the first phase having resulted in the “Interim” 

Assessments” that the States, District, and Territories received in Fall 2007/Winter 2008. 

4.	 Once in receipt of the States’ / District’s / Territories’ comments, HHS will share them with the 

appropriate USG Department(s) for their consideration in concluding their respective reviews. 

5.	 HHS will compile the review results in the form of State-specific “Concluding Assessments” 

and share them first with the States individually and then with the Congress and the general 

public. 

Scoring for Comprehensiveness 

The information provided for the Operating Objectives will be rated for comprehensiveness. That is, 

reviewers will consider the information submitted for each associated Supporting Activity and assess 

the degree to which the response describes a) a definitive implementation strategy and b) unequivocal 

specification as to which organizations or individuals are responsible for which elements. 

22 
Before commencing to rate, reviewers may modify the list of Supporting Activities in one or both of 

two ways. First, they will not assign a rating to a particular Supporting Activity if the State has 

indicated that the item is “not applicable” and offered a convincing justification. Second, they will add 

and rate a new Supporting Activity as proposed by the State if they judge the proposed addition to be 

relevant to the Operating Objective and of comparable significance to the Supporting Activities 

already listed. 

The scoring schema to be used for Ueach UOperating Objective is as follows. For each supporting 

activity, the review team will award a score of 0, 1, 2, or 3. A percentage for the Operating Objectives 

will be calculated by summing the scores of the supporting activities under that Operating Objective 

and dividing by the total number possible (number of supporting activities X 3). 

Example: 

Operating Objective X.1
 

Supporting activity - 3/3 

Supporting activity - 2/3 

Supporting activity - 2/3 

Supporting activity - 3/3 

Supporting activity - 2/3

 12/15 = 80% 

Key: 

 ≥85% = “No Major Gaps” 

69-84% = “A Few Major Gaps” 

50-68% = “Many Major Gaps” 

1-49% = “Inadequate Preparedness” 

The percentage derived for the Operating Objective will be translated into a standardized verbal 

designation in accord with the key shown in the text box. No submission or a non-responsive 

submission will be classified as “insufficient information to allow assessment.” 

Using the example provided, the Score for Operating Objective X.1 would be “A Few Major Gaps.” 

Scoring for Operational Readiness 

The USG Departments jointly will assign a single rating for Operational Readiness for the entire State 

submission. In particular, based on the information requested in the last sub-Appendix for each of the 

3 Strategic Goals, the Departments will determine the number of the Operating Objectives for which 

the State submitted evidence that it has tested its response capability in some appropriate way. 

This number then will be divided by the total number of Operating Objectives, expressed as a 

percentage, and translated into a standardized verbal designation in accord with the key shown in the 

text box. 

Key: 

>50% = “Substantial Evidence of Operational Readiness” 

25-49% = “Significant Evidence of Operational Readiness” 

1-24% = “Little Evidence of Operational Readiness” 

 

 

______________________________________________________________________________ 

No submission or a non-responsive submission will be classified as “insufficient information to enable 

assessment.” 

U

U

U

U U

U U

23 
VII. TECHNICAL ASSISTANCE 

In January 2008, the USG held a series of regional workshops to obtain States’ preferences regarding 

technical assistance mechanisms. Preferences ranged from “to pick up the phone and ask a “Fed” a 

specific question” to hoping for on-site assistance with drafting operating plans to wanting national 

conference calls on complicated aspects of pandemic influenza response that involve State and federal 

coordination. In response to States’ requests, the USG is offering a variety of technical assistance 

mechanisms. Some are in the form of documents – which are provided in citations or accompany this 

document. Others are under development (e.g., webcasts) and should be forthcoming soon. Some 

hands-on, individualized technical assistance is also available to State planners, and instructions for 

tapping into it are included in this document. Keep in mind that the technical assistance mechanisms 

span the spectrum of pandemic influenza related concerns – not only the personal health impact of the 

threat. This might include preparing businesses to operate in the face of community mitigation 

strategies, maintaining transportation response capabilities during hurricane season, coping with 

mental health impact of mass fatalities, or protecting the energy infrastructure. 

Operating Plan Assistance 

States that do not have staff that are very familiar and are experienced in drafting, testing and 

improving plans based on continuous quality improvement mechanisms. But in some jurisdictions 

these assets remain marginalized or disconnected from efforts to improve planning and practicing for 

an influenza pandemic and other threats. States are strongly urged to utilize existing State and local 

resources for assistance. Many State militia and National Guard staff have extensive training and 

experience in writing operating plans. Since these individuals are part of the State government 

planning community, they will have detailed knowledge of and thorough understanding about the 

infrastructure and systems context surrounding the State- and region-specific needs, assets, and gaps. 

States might also utilize USG (e.g., DOD, DHS) regional staff for support and guidance. Because of 

their distribution across the country, these staff may be better able than their headquarters counterparts 

to provide on-site technical assistance or provide region-specific context or advice. Many regional 

staff have expertise in writing operating plans and are able to provide: (1) models or templates of 

operating plans, and (2) approaches for States to consider for improving their operating plans. Federal 

assets available to provide guidance and answer questions regarding State planning issues include the 

HHS regional health offices (HUhttp://www.hhs.gov/about/regionmap.htmlUH), FEMA regional offices 

(HUhttp://www.fema.gov/about/regions/index.shtmUH), and the pre-designated pandemic influenza regional 

Principal Federal Officials. 

Another regional asset that can be utilized to assist State and local CI/KR security efforts are the DHS 

Protective Security Advisors (PSAs). PSAs are deployed to local communities throughout the United 

States to assist with local efforts to protect critical assets, serve as DHS’ on-site critical infrastructure 

and vulnerability assessment specialists, and serve as DHS liaisons between Federal agencies, State, 

territorial, local, and tribal governments, and the private sector. Additionally, PSAs support the 

development of the national risk picture by identifying, assessing, monitoring and minimizing risk to 

critical assets, and provide reach-back capabilities to DHS and other Federal resources. PSA contact 

information can be obtained, and PSAs may be contacted through the national PSA Duty Desk at 

HUpsadutydesk@hq.dhs.govUH or by calling 703-235-5724. 

24 
 

 

Content Assistance 

The Annex contains the names of USG Working Group members that have been involved in 

developing this guidance document. State officials are encouraged to contact Working Group 

members with questions about the guidance document itself or to obtain referrals to other USG staff. 

Resource Document 

The Annex also contains a collection of references, resources and citations that might be of assistance 

to States while developing their operating plans. One example is the “Return to Work” brochure – a 

one-page document ready for distribution and use with individuals who have been diagnosed with 

pandemic influenza by a healthcare provider or who believe that they have pandemic influenza base on 

symptoms of illness explaining to them when they might return to work or to school. Additionally, the 

Existing Resources Document includes excerpts or summaries of other documents that might save 

planners time. Reading any excerpt included in this document, of course, is not a substitute for 

reading subject-specific recommendations, models or guidelines in full. 

Website 

Many resources referenced in the Existing Resources Document or the Primer can be found at 

HUhttp://www.pandemicflu.govUH. This website serves as the federal clearinghouse for pandemic influenza 

documents, recommendations, checklists, planning tools, exercises, and as such provides a much more 

comprehensive collection of documents which provide in-depth information on general and topicspecific pandemic influenza operational and preparedness concerns. Materials specific to pandemic 

planning can be found at HUhttp://www.pandemicflu.gov/plan/index.htmlUH 

Webinars 

HHS invites State officials to live discussions with USG officials in a series of three web seminars 

("webinars") to help State planners in the next round of pandemic influenza planning. 

The first webcast will be held on March 13, 2 p.m. – 3 p.m. EDT. It will provide an overview of the 

guidance and will provide an opportunity for a live question-and-answer session with representatives 

from the U.S. Department of Health and Human Services (including its Centers for Disease Control 

and Prevention), the U.S. Department of Homeland Security, and the U.S. Department of Labor. 

Participants can access the webcast by going to 

HUhttp://www.pandemicflu.gov/news/panflu_webinar.htmlUH. Questions for the webcast panelists may be 

emailed, during the program, to HUhhsstudio@hhs.govUH. Please include your first name and hometown. 

Future webcasts on the State planning and assessment process will be held on April 2, 2008, and April 

30, 2008. Additional details will be available on HUwww.pandemicflu.govUH. All of the webcasts will be 

videotaped and archived on HUwww.pandemicflu.govUH for future viewing. 

Conference calls 

The USG will offer conference calls on various Operating Objectives, depending upon the nature and 

extent of States’ continuing queries. Additional information on topics and dates will be posted on 

HUwww.pandemicflu.govUH and, as they become available, disseminated via the SFOs and PFOs. 

25 
APPENDIX A.0 – GENERIC GUIDANCE FOR ENSURING CONTINUITY OF 

OPERATIONS OF STATE AGENCIES & CONTINUITY OF STATE 

GOVERNMENT 

This section of the Appendix is informational only and is provided as a resource for the State 

Workforce Planning process. It does not establish any reporting requirements. See 

www.pandemicflu.gov/plan/States/Statelocalchecklist.html for a complete list of activities that may 

be considered as part of pandemic planning by States. States may also find the Federal agency 

checklist of value to them. See www.pandemicflu.gov/plan/federal/operationalplans.html. 

Basic Pandemic Operational Planning for State Agencies: 

1) Identify a pandemic coordinator and/or team with defined roles and responsibilities for preparedness 

and response planning. The planning process should include input from labor representatives. Ensure 

accountability through an independent review of its pandemic influenza plan and preparedness. 

2) Identify essential employees and other critical inputs (e.g. suppliers, sub-contractor services/ 

products, and logistics) required to maintain operations by location and function during a pandemic. 

3) Develop and plan for scenarios likely to result in an increase or decrease in demand for State 

services during a pandemic (e.g. increased filings of unemployment insurance, increased calls to public 

health, effect of restriction on mass gatherings, need for hygiene supplies, distribution of antiviral 

drugs). 

4) Establish an emergency communications plan and revise periodically. This plan includes 

identification of key contacts (with back-ups), chain of communications (including suppliers, key 

constituencies and public), and processes for tracking and communicating State operational and 

employee status. 

5) Implement an exercise/drill to test your pandemic plan, and revise periodically. 

6) Set up authorities, triggers, and procedures for activating and terminating your plan, altering 

business operations (e.g. temporarily shutting down non-essential operations), implementing selected 

HR policies, distributing antiviral drugs, and other preparedness actions. 

7) Enhance communications and information technology infrastructures as needed to support employee 

telecommuting and remote customer access. Develop platforms (e.g. hotlines, dedicated Web sites) for 

communicating pandemic status and actions to employees, vendors, suppliers, and the public in a 

consistent and timely way, including redundancies in the emergency contact system. 

8) Collaborate with federal and local public officials, particularly health agencies and emergency 

responders, as well as neighboring States to participate in their planning processes, share your 

pandemic plans, and understand their capabilities and plans. 

HU UH HU UH

U

26 
APPENDIX A.1 

Operating Objective: Sustain Operations of State Agencies and Support and 

Protect Government Workers 

This Appendix will help States ensure personnel/human resource policies and practices support 

continuity of State operations, community mitigation strategies, and State government employees 

during a pandemic. The Appendix has two parts: 

Part I. Sustain Operations of State Agencies 

Operating sub-objective A.1.1. Ensure continuity of government in face of significantly 

increased absenteeism 

Operating sub-objective A.1.2. Assist employees of State agencies unable to work for a 

significant time period 

Operating sub-objective A.1.3. Communicate with employees of State agencies 

Operating sub-objective A.1.4. Consult with bargaining units (if the State has bargaining unit 

employees) 

Part II. Protect the Health and Safety of State Government Workers 

Operating sub-objective A.1.5. Make State agency workplaces safe places 

Operating sub-objective A.1.6. Revise human resource and other workplace policies affecting 

the safety of State government workers 

Note: Each Operating sub-objective contains a section preceding its corresponding table to assist the 

State in understanding what is required and the reasoning behind the requirements in the “PREPARE” 

section of the table. The “RESPOND AND RECOVER” section of the table lists actions to be taken 

during or after a pandemic that should be included in the State’s pandemic plan. (Whether some 

“RESPOND AND RECOVER” actions will be taken depends on specific conditions, such as the 

severity of the influenza pandemic.) 

U

U

27 
 

 

 

 

Part I. Sustain Operations of State Agencies F 

16 F 

Intent: To ensure personnel/human resource policies support implementation of the State’s pandemic 

plan while promoting community mitigation strategies, such as social distancing and dismissal of 

children from schools, and help mitigate the impact of these strategies on State government employees. 

UOperating sub-objective A.1.1U: Ensure continuity of government in face of significantly increased 

absenteeismF 

17 

a. Assess potential employee absences during a severe pandemic due to: 

 personal illness due to the pandemic influenza; 

 caring for family members who are ill; 

 staying home after exposure to pandemic influenza or caring for children dismissed 

from school (as per community mitigation strategies); and, 

 possible reductions in public transportation services. 

Based on expected levels of absenteeism, determine the potential impact of a pandemic on the 

State agencies’ workforce. (It may help to develop human capital related “what if” scenarios.) 

b. Identify “essential” services, functions, and processes that must be maintained during each 

Federal Government Response Stage or defined pre-pandemic and pandemic intervals. Take 

into account staffing for programs or functions that are essential during pandemic and will need 

a higher level of staffing (e.g., law enforcement or healthcare18 

F F). Also determine which 

employees have unique credentials (e.g., physicians, contract officers, positions which have 

licensure requirements). 

c. Cross-train to provide 3-deep back-ups for the employees performing essential functions or 

who have unique credentials. (For essential functions, it is recommended that in order to 

sustain continuity of operations, orders of succession go at least three positions deep.) 

d. Establish standard operating procedures for essential functions. 

e. Assess whether some employees can work from home during a pandemic, particularly those 

caring for children dismissed from school or unable to get to work. If not already in place, 

create telework plans to be used during a pandemic and test those plans.

19 

F F Telework plans

must take into account whether the stage agencies’ IT infrastructure can support the number of 

users in the plan and if sensitive data can be protected. 

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16 Some actions or activities described below are taken at the State UagencyU level; others at State level. Given the variation 

in how States operate, it is left to the States to determine if actions should be taken by agencies or by the State. 17 The Federal Government recommends that government entities and the private sector plan with the assumption that 

during a severe pandemic, up to 40% of their staff may be absent for periods of about 2 weeks at the height of a pandemic 

wave with lower levels of staff absent on either side of the peak; for pandemic planning purposes, the need for essential 

services and functions may be broader than in the 30-day Continuity of Operations (COOP) plan.

18 Other State programs that should be evaluated include: unemployment insurance; disaster unemployment insurance; 

Food Stamps; medical assistance; children, youth and family protective services; juvenile justice; foster care; income 

support services; and public food and nutrition services.

19 The USG expects there will be some limitations in Internet accessibility during a pandemic but does expect telework, if 

planned properly, to be a realistic option for many employers. 

28 
 

f. Assess changes in demands on State agencies’ services during a pandemic, particularly for 

essential functions.20 F 

g. Given telework plans and above assessments of staffing levels and demand for services, if a 

State agency expects there may be a shortage of staff needed to maintain essential functions, 

identify specific hiring needs (e.g., critical positions, geographic locations) and determine 

which hiring flexibilities the agency may need. Identify which of these can be implemented 

with existing authorities and which need new authorities. For example, will “buyout” 

repayment and dual compensation (for returning retired annuitants) waivers be needed? 

h. If it is expected staffing levels will not be sufficient, train and/or prepare ancillary workforceU 

(e.g. contractors, employees in other job titles/descriptions, retirees) or create alternative plans 

for providing staff.21 F 

i. Consult with procurement staff and major contractors to discuss the effect of pandemic-related 

human capital issues on the contract workforce and make needed changes to contracts (e.g., 

require contractors to have pandemic plans, telework capabilities, etc.). 

j. Review relationships with suppliers, shippers, and other businesses that support essential 

functions and, as necessary, implement standing agreements for back-ups. 

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20 Also note that State revenues tied to general economic activity (such as sales tax) may be lower during a severe 

pandemic. 

21 Where it is not feasible to train an ancillary workforce or use employees from other State agencies, other alternatives to 

staffing essential functions would have to be employed such as temporarily hiring retirees during a pandemic or having 

contracts in place that would allow for hiring experts from outside the State workforce. 

29 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF 

SUPPORTING ACTIVITY 

CITATION TO 

SUPPORTING 

DOCUMENT 

IF NOT 

APPLICABLE, 

PLEASE 

EXPLAIN 

Sub-objective A.1.1 – Ensure continuity of government in face of significantly increased absenteeism 

PREPARE 

Assess potential employee absences/ determine potential impact of a 

pandemic on the agencies’ workforce 

For this activity 

and each one 

below, please 

include 

Title 

Page(s) 

First 5 words of 

first sentence 

Determine essential functions and which employees have unique credentials 

Cross-train to provide 3-deep back-ups for the employees performing 

essential functions or who have unique credentials 

Establish standard operating procedures for essential functions 

Create telework plans 

Assess changes in demands on State agencies’ services 

Identify specific hiring needs and determine needed hiring flexibilities 

If needed, train and/or prepare ancillary workforce or create alternative plans 

for staffing of essential functions 

Consult with procurement staff and major contractors re HR issues 

Review relationships with suppliers/ shippers/other businesses that support 

States’ essential functions; as necessary, implement backup plans 

Activity Added by State 

RESPOND AND RECOVER 

Implement telework and other HR flexible work schedules as per plan 

Employ pre-identified plans to maintain sufficient staffing (FTE and 

contractor) for essential functions and high-demand services 

Collect data and report the status of employees for the purpose of monitoring 

agency workforce levels and reporting such information to appropriate 

agencies (This includes a plan for accountability of personnel and their status 

and a plan to monitor who is sick, those that have recovered, those that are 

available for re-entry to work) 

Use pre-identified hiring/contracting flexibilities to replace employees/ 

contractors unable to work (or return to work) 

Implement previously developed employee-labor relations plan Refer to Respond and Recover requirement 

under Sub-Objective A.1.4. Consult with 

bargaining units 

Monitor effectiveness and consistency of application of HR flexibilities by 

agencies 

Activity added by State 

30 
 

UOperating sub-objective A.1.2: Assist employees of State agencies unable to work for a 

significant time period22 F 

Note: To the extent practicable and allowed by law and by function, policies should be consistent 

across State agencies. U Do not assume that only essential or mission critical employees will be working 

– during a 12-week pandemic wave many employees will need and want to work and States should 

strive to maintain as many normal functions as possible. Also note that working at alternative sites 

across the State is not a viable option during an influenza pandemic since a pandemic will likely move 

quickly across a State. 

a.	 Assess policies and practices that would allow employees to continue to work (a benefit both to 

the agency and individual) when they must be absent to care for a child dismissed from school, 

are staying home after exposure to pandemic influenza, etc. In addition to providing the 

opportunity to telework when feasible (see A.1.1.e. above), agencies should review and revise, 

as necessary, agency policy and/or guidance on alternative work schedules (flexible and 

compressed work schedules). 

b.	 For those employees that will not be able to work even with the above workplace flexibilities, 

review and revise, as necessary, policies and/or guidance on pay, leave and benefits. Review 

the federal Family and Medical Leave Act provisions as well as the State Family and Medical 

Leave Act (as applicable). In order to encourage ill employees or those exposed to ill persons 

to stay home (as per community mitigation strategies), consider establishing policies for 

employee compensation and sick-leave absences specific to a pandemic (e.g., non-punitive, 

liberal leave) and guidance on when a previously ill person is no longer infectious and can 

return to work. (See Annex for the Return to Work brochure.) Attention should also be paid to 

employees’ options for pay and benefits (e.g., health care) when all leave is exhausted. 

(Exactly what leave and benefit policies are adopted are up to the State; the required action is to 

assess current policies and take appropriate actions given the impact of a pandemic on State 

government employees.) 

c.	 Ensure managers and supervisors are familiar with various leave options, the procedures and 

obligations for requesting and approving leave, and the limited circumstances under which an 

employee may be directed to take leave. 

d.	 Consult with procurement staff and major contractors to discuss the effect of pandemic-related 

human capital issues on the contract workforce and the contractors’ pandemic plans. 

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22 With a mitigated Category 4 or 5 pandemic, a wave could last up to 12 weeks; absences for parents caring for children 

dismissed from school thus could last the full 12 weeks. 

31 
 

 

 

 

 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF 

SUPPORTING ACTIVITY 

CITATION TO 

SUPPORTING 

DOCUMENT 

IF NOT 

APPLICABLE, 

PLEASE 

EXPLAIN 

Sub-objective A.1.2 - Assist employees of State agencies unable to work for a significant time 

period 

PREPARE 

Assess flexible work schedules (can include cross reference to telework 

plans from A.1.1.e.) (States should assess current policies and then 

report on decisions) 

For this activity 

and each one 

below, please 

include 

Title 

Page(s) 

First 5 words of 

first sentence 

Review and revise, as necessary, policies and/or guidance on leave and 

benefits (States should assess current policies and then report on 

decisions) 

Ensure managers/supervisors are familiar with various leave options 

Consult with procurement staff/major contractors regarding pandemic 

plans for the contract workforce 

Activity Added by State 

RESPOND AND RECOVER 

Implement telework and other flexible work schedules as per plan Refer to the first Respond and Recover 

requirement under Sub-Objective A.1.1 - 

Ensure continuity of government in face of 

significantly increased absenteeism 

Implement any special pandemic compensation/ leave/benefit policies 

Activity Added by State 

UOperating sub-objective A.1.3: Communicate with employees of State agencies 

a.	 Develop a communications plan for managers, employees, and contractors that includes, at a 

minimum: 

 An internal Web site23 

F F with pandemic related information; 

 Instructions for determining status of agency operations; 

 Distribution of critical agency information. (An Emergency Notification System is one 

mechanism for distributing critical information to employees.) 

b.	 Convey to all employees the measures the agency/State has taken or has planned to deal with a 

pandemic, including plans for continuity of government; leave plans, alternative work 

 

23 If the Web site is to be used from home, ensure it is accessible to all employees. 

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arrangements and other HR policies; and steps to be taken to prevent or minimize workplace 

exposure to contagious disease. 

c.	 Provide reliable pandemic information to employees from community public health, emergency 

management, and other sources such as www.pandemicflu.gov. Disseminate materials 

covering pandemic fundamentals (e.g. signs and symptoms of influenza, modes of 

transmission), personal and family protection, and response strategies (e.g., hand hygiene, 

coughing/sneezing etiquette, contingency plans). Provide information to assure employees that 

their workplace is safe. Also encourage employees to develop a family emergency preparation 

plan. 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

U U

HU UH

DESCRIPTION OF 

SUPPORTING ACTIVITY 

CITATION TO 

SUPPORTING 

DOCUMENT 

IF NOT 

APPLICABLE, 

PLEASE 

EXPLAIN 

Sub-objective A.1.3 - Communicate with employees of State agencies 

PREPARE 

Develop a communications plan For this activity 

and each one 

below, please 

include 

Title 

Page(s) 

First 5 words of 

first sentence 

Convey to all employees the State’s pandemic plan 

Provide reliable pandemic influenza information to employees 

Activity Added by State 

RESPOND AND RECOVER 

Update information for employees on State’s operating status and latest 

pandemic influenza information; continue to advise employees 

concerning HR policies, workplace flexibilities, pay and benefits, etc. 

Activity Added by State 

UOperating sub-objective A.1.4U: Consult with bargaining units (if the State has bargaining unit 

employees) 

a.	 Consult (and bargain, if appropriate) with exclusive representatives of bargaining unit 

employees on human resources issues that may affect employees or collective bargaining 

agreements. Such issues may include: 

	 Telework during a pandemic health crisis; 

33 
 

	 Leave benefits available during a pandemic health crisis (including options for pay 

when all leave is exhausted). 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF 

SUPPORTING ACTIVITY 

CITATION TO 

SUPPORTING 

DOCUMENT 

IF NOT 

APPLICABLE, 

PLEASE 

EXPLAIN 

Sub-objective A.1.4 - Consult with bargaining units (if the State has bargaining unit employees) 

PREPARE 

Consult with bargaining units (if the State has bargaining 

unit employees) 

For this activity 

and each one 

below, please 

include 

Title 

Page(s) 

First 5 words of 

first sentence 

Activity Added by State 

RESPOND AND RECOVER 

Implement previously developed employee-labor relations 

plan 

Activity Added by State 

34 
 

Part II. Protect the Health and Safety of State Government Workers 

Note: To the extent practicable and allowed by law and by function, policies should be consistent 

across State agencies. 

Intent: To allow all State government employees who are able to work to do so safely. 

Operating sub-objective A.1.5: Make State agency workplaces safe places 

a.	 Establish policies and encourage practices that will help prevent influenza spread at the 

worksite (as part of community mitigation strategies). These policies and practices include: 

 promoting respiratory hygiene/cough etiquette; 

 modifying the frequency and type of face-to-face contact (e.g. hand-shaking, seating in 

meetings, office layout, shared workstations, telework, alternate work schedules) among 

employees and between employees and customers (see CDC recommendations, 

Stopping the Spread of Germs at Work (www.cdc.gov/germstopper/work.htm)); 

	 providing sufficient and accessible infection control supplies (e.g., hand-hygiene 

products, tissues and receptacles for their disposal) in all work locations and public

areas.24

F 

b.	 Complete a risk assessment for all jobs and determine which category of occupational 

exposure they fall in (very high or high exposure risk occupations; medium risk occupations; or 

lower risk occupations). (The level of risk depends in part on whether or not the job requires 

close proximity to people potentially infected with the pandemic influenza virus, or whether the 

job requires employees to have either repeated or extended contact with known or suspected 

sources of pandemic influenza virus such as coworkers, the general public, outpatients, school 

children or other such individuals or groups. See Guidance on Preparing Workplaces for an 

Influenza Pandemic (www.osha.gov/Publications/influenza_pandemic.html) for more detailed 

information.) 

c.	 Develop plans to protect those employees in the very high, high, or medium risk categories. 

First determine if risk can be controlled with engineering, administrative and work practice 

measures or if personal protective equipment should be provided. For those employees who 

need personal protective equipment (PPE), purchase sufficient stockpiles to last through a 

pandemic wave (and check shelf life on a regular basis), and train employees in use of PPE. If 

providing respirators, establish a respirator program including fit-testing if or as required under 

the State occupational safety and health plan. (See Guidance on Preparing Workplaces for an 

Influenza Pandemic for more detailed information. Also see 

www.osha.gov/dcsp/osp/public_sector.htmlUH regarding jurisdiction of Federal OSHA 

Regulations.) 

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24 Providing these supplies now can help workers avoid getting sick and spreading germs and will be essential during a 

pandemic to help prevent influenza spread. 

35 
 

 

 

 

 

 

 

 

 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF 

SUPPORTING ACTIVITY 

CITATION TO 

SUPPORTING 

DOCUMENT 

IF NOT 

APPLICABLE, 

PLEASE 

EXPLAIN 

Sub-objective A.1.5 - Make State agency workplaces safe places 

PREPARE 

Establish policies and practices for preventing influenza spread at the 

worksite; implement those that can be done in advance of a pandemic 

(e.g., providing infection control supplies) 

For this activity 

and each one 

below, please 

include 

Title 

Page(s) 

First 5 words of 

first sentence 

Complete a risk assessment for all jobs (see OSHA guidance at 

HUwww.osha.gov/UHPublications/ influenza_pandemic.htmlU) 

Develop plans to protect those employees in the very high, high, or 

medium risk categories including stockpiling PPE (if PPE is needed); 

provided needed training and if respiratory protection is indicated, 

establish a respiratory protection program and fit-test those employees 

who will be provided with respirators. 

Activity Added by State 

RESPOND AND RECOVER 

Implement infection control policies and practices (see OSHA guidance 

at HUwww.osha.gov/UHPublications/ influenza_pandemic.htmlU) 

Institute protection plans; if in plan, provide PPE to employees in very 

high, high, or medium risk categories 

If part of pandemic plan, distribute antiviral drugs 

Activity Added by State 

36 
 

 

 

 

 

 

Operating sub-objective A.1.6: Revise human resource and other workplace policies affecting 

the safety of State government workers 

a.	 As per assessment done in Part I. Sustaining Operations of State Agencies, Operating subobjective A.1.2., “Assist employees of State agencies unable to work for a significant time”, 

review and revise, as necessary, policies and/or guidance on leave. In order to encourage ill 

employees or those exposed to ill persons to stay home, consider establishing policies for 

employee compensation and sick-leave absences unique to a pandemic (e.g. non-punitive, 

liberal leave). Policies could also include infection control response, screening25 

F F, etc. Please 

see the Workplace FAQs (at www.pandemicflu.gov/faq/workplace_questions/ ) for information 

on legal issues surrounding screening and to Community Strategy for Pandemic Influenza 

Mitigation. 

b.	 Establish guidelines for determining when a previously ill person is no longer infectious and 

can return to work and who is authorized (e.g., an occupational health nurse) to make that 

determination. (The CDC will probably provide updated information on the length of time a 

person with pandemic influenza is contagious after the pandemic begins.) 

c.	 Consider establishing policies for restricting travel to affected areas overseas and provide 

guidance for employees returning from affected areas. These policies could be more stringent 

that the recommendations of CDC or the State Department (see CDC travel recommendations 

Travelers Health: Avian Influenza A (H5N1) Virus ). If travel is essential, assess what must be 

done to protect workers. 

d.	 Collaborate with insurers, health plans, and local healthcare facilities to share pandemic plans, 

and understand their capabilities to process claims of State government employees during a 

pandemic and how their plans may affect employees. Evaluate government employee access to 

and availability of healthcare services during a pandemic, and consider improving services 

and/or putting in place provisions to ensure access to services during a pandemic. 

e.	 Evaluate government employee access to and availability of mental health and social servicesU 

during a pandemic, including community and faith-based resources, and improve agencyprovided services as needed. Employee Assistance Program (EAP) should be prepared to offer 

psychosocial support services (including educational and training materials) for employees who 

participate in or provide support for the response to an influenza pandemic. Develop workforce 

resilience programs and ensure readiness to deploy to maximize agency performance and 

personal resilience during the emergency. 

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25 From HUCommunity Strategy for Pandemic Influenza MitigationUH, p. 24 (emphasis added): “Although the hallmarks of a 

pandemic strain will not be known until emergence, patients with influenza may shed virus prior to the onset of clinical 

symptoms and may be infectious on the day before illness onset. Most people infected with influenza develop 

symptomatic illness (temperature of 100.4° F or greater, plus cough or sore throat), and the amount of virus they shed 

correlates with their temperature; however, as many as one-third to one-half of those who are infected may either have very 

mild or asymptomatic infection. This possibility is important because even seemingly healthy individuals with influenza 

infection as well as those with mild symptoms who are not recognized as having influenza could be infectious to others.” 

Also note that one-third to one-half of those who are infected may either have very mild or asymptomatic 

infection (see above), so screening for symptoms will not identify all ill persons. 

37 
 

 

 

 

 

 

 

 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
 

DESCRIPTION OF 

SUPPORTING ACTIVITY 

CITATION TO 

SUPPORTING 

DOCUMENT 

IF NOT 

APPLICABLE, 

PLEASE 

EXPLAIN 

Sub-objective A.1.6 - Revise human resource and other workplace policies affecting the safety of 

State government workers 

PREPARE 

Review and revise policies on leave, as needed; consider new policies 

for employee compensation and sick-leave absences unique to a 

pandemic to encourage ill employees or those exposed to ill persons to 

stay home (States should assess current policies and then report on 

decisions) 

For this activity 

and each one 

below, please 

include 

Title 

Page(s) 

First 5 words of 

first sentence 

Establish guidelines on when a previously ill person is no longer 

infectious and can return to work 

Consider establishing policies for restricting travel (States should assess 

current policies and then report on decision) 

Collaborate with insurers, health plans, and local healthcare facilities on 

pandemic planning; evaluate government employee access to and 

availability of healthcare services 

Evaluate government employee access to and availability of mental 

health and social services; develop workforce resilience programs 

Activity Added by State 

RESPOND AND RECOVER 

Implement policies/guidance developed to assist employees to stay 

home when exposed to the influenza or if ill 

Implement return to work guidelines 

Implement any travel policies; issue instructions for employees in highrisk situations 

Activate programs to address the psychological and social needs of 

government employees 

Activity Added by State 

38 
 

 

 

 APPENDIX A.2 

Operating Objective: Ensure Public Health COOP During Each Phase 

of a Pandemic 

This appendix provides planners with information that should be included in emergency operations 

plans to address surveillance and laboratory issues specific to an influenza pandemic. Please refer to 

Appendix A.1 for assistance regarding monitoring sick/well employees. 

63BPREPARE 

Capability issues and critical tasks that should be included in the creation of the public health agency’s 

COOP can be found in the Centers for Disease Control and Prevention’s Public Health Emergency 

Preparedness Cooperative Agreement, FY 07, at (http://www.bt.cdc.gov/planning/coopagreement. 

Additional COOP planning resources can be found at 

• HUhttp://www.fema.gov/pdf/government/coop/influenza_coop_annex.pdfU 

• HUhttp://www.umaryland.edu/dhscoopU 

RESPOND AND RECOVER 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF SUPPORTING ACTIVITY CITATION TO 

SUPPORTING 

DOCUMENT 

IF NOT 

APPLICABLE, 

PLEASE 

EXPLAIN 

Sub-objective A.2.1 - Maintain Essential Public Health Functions 

Does the plan include definitions and identification of essential 

services and functions needed to sustain agency mission and 

operations 

For this activity and 

each one below, 

please include 

Title 

Page(s) 

First 5 words of first 

sentence 

Does the plan include a determination of which, if any, essential 

services and functions, or non-essential operating support functions 

can be suspended temporarily and for what duration before adversely 

impacting the States public health mission 

Is there a plan to sustain essential services and functions during a 

pandemic influenza outbreak include the following scenarios: 

39
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

o Work force reduction up to 40% 

o Limited access to facilities (social distancing, 

staffing or security concerns) 

o Broad-based implementation of social distancing 

policies 

Does the plan ensure and consider the following: 

o Appropriate level of staffing (to include 

contractors) to continue essential functions 

o Coordination of planning with contractors, 

suppliers, shippers, State agencies and other 

businesses that support or are supported by your 

essential functions 

As appropriate, initiation of pre-solicited, signed and standing 

agreements with contractors and other third parties to ensure 

fulfillment of mission essential requirements, including contingencies 

for backup should primary supplies or contractor be unable to 

provide required personnel, services, or supplies 

Activity Added by State 

Sub-objective A.2.2 - Pre-Identify Personnel, Equipment and Resource to Support Sustained 

Response/Survivability and Recovery 

Does the plan identify positions, skills and personnel needed to 

continue essential services and functions? 

Does the plan include a roster of identified personnel and back-up 

personnel, by position, needed to continue essential services and 

functions? 

Does the plan include identification and training of approximately 

two to three back-up personnel to continue essential services and 

functions? 

Does the plan include delegations of authority to take into account 

the expected rate of absenteeism? 

Does the plan include orders of succession that are at least three deep 

per responsibility to take into account the expected rate of 

absenteeism? 

Does the plan identify adequate alternate worksites (e.g. home or 

other adequate alternate worksites that maintain social distancing 

measures), as appropriate, to assure capability to maintain essential 

services for the duration of a pandemic wave? 

Does the plan identify which essential services and functions can be 

continued from designated operating facilities or alternative operating 

facilities (e.g., home or other adequate alternate worksites) and those 

that need to be performed at a designated department or agency 

operating facility (A designated operating facility is an existing 

agency facility that may remain open during a pandemic with 

appropriate social distancing for staff that cannot perform their 

functions remotely and are needed to support the continuation of 

essential services and functions)? 

• Does the plan include a plan for accountability of personnel 

and their status? 

• Does the plan include a plan to monitor who is sick, those 

that have recovered, those that are available for re-entry to 

work? 

Does the plan include redundant or back-up sources, as appropriate, 

for essential resources (such as food, water, fuel, medical facilities, 

electrical utilities, information technology support, communications 

and municipal services) at designated operating facilities and/or 

40 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

alternative worksites? 

Activity Added by State 

Sub-objective A.2.3 - Pre-Identify Primary and Secondary Individuals for core functional roles per the 

Incident Command System 

The plan pre-identifies primary and secondary individuals for the 

following core functional areas: 

• Assessment of health/medical needs 

• Health Surveillance 

• Medical Care Personnel 

• Health/Medical Equipment and Supplies 

• Patient Evacuation 

• In-hospital Care 

• Food/Drug/Medical Device Safety 

• Worker Health / Safety 

• Radiological/Chemical/Biological Hazards 

• Consultation 

• Mental Health Care 

• Public Health Information 

• Vector Control 

• Potable Water/Wastewater and Solid Waste 

• Disposal 

• Veterinary Services 

Activity Added by State 

41 
 

 

 

 

 

 

 

APPENDIX A.3 

OPERATING OBJECTIVE: Ensure Continuity of the Food Supply 

System 

 “Equal to” means that the following States must establish and enforce inspection program 

requirements equal to those of the Federal program: AL, AZ, DE, GA, IL, IN, IA, KS, LA, ME, MN, 

MS, MO, MT, NC, ND, OH, OK, SC, SD, TX, UT, VT, VA, WV, WI, AND WY. 

PREPARE 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF SUPPORTING ACTIVITY CITATION TO 

SUPPORTING 

DOCUMENT 

IF NOT 

APPLICABLE, 

PLEASE 

EXPLAIN 

State plan designates coordinator for State pandemic preparedness 

planning, including contact for food safety, in “Equal to” States. 

For this activity and 

each one below, 

please include 

Title 

Page(s) 

First 5 words of first 

sentence 

State plan designates food safety program as essential to ensure 

continued “at least equal to” compliance with Federal statutes 

administered by USDA. 

State plan provides for backup personnel being identified for 

responsibility in the planning and preparedness of State “Equal to” 

food safety programs for a pandemic. 

State plan contains procedures for reporting of operating status of 

State inspected slaughter/processing establishments, and other food 

supply information. 

State plan contains communication plan to provide food safety 

related information to stakeholders, during a pandemic. 

State plan addresses generic operating objectives, under this strategic 

goal, for preparing State to carry out food supply system 

responsibilities, during a pandemic. 

Activity Added by State 

42 
 

 

 

 

 

RESPOND 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF SUPPORTING ACTIVITY CITATION TO 

SUPPORTING 

DOCUMENT 

IF NOT 

APPLICABLE, 

PLEASE 

EXPLAIN 

State plan deploys personnel, assigned to pool of trained backup For this activity and 

program staff, to carry out State “Equal to” food safety program 

requirements, during the pandemic. each one below, 

please include 

Title 

Page(s) 

First 5 words of first 

sentence 

State plan implements procedures for reporting operating status of 

State inspected slaughter/processing establishments, and other food 

supply information, as required during the pandemic. 

State plan implements phased communication plan to provide food 

safety related information to stakeholders, during the pandemic. 

State plan implements generic operating procedures, under this 

strategic goal, in maintaining State food supply system 

responsibilities, during the pandemic. 

Activity Added by State 

43 
 

 

 

 

 

RECOVER 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF SUPPORTING ACTIVITY CITATION TO 

SUPPORTING 

DOCUMENT 

IF NOT 

APPLICABLE, 

PLEASE 

EXPLAIN 

State plan assigns personnel to assess capability to meet prepandemic State “Equal to” food safety program requirements, in the 

last stages of the pandemic. 

For this activity and 

each one below, 

please include 

Title 

Page(s) 

First 5 words of first 

sentence 

State plan calls for assessing the pre-pandemic level operational 

capability of State inspected slaughter/processing establishments, and 

other food supply system assets, in the last stages of the pandemic. 

State plan provides for reporting on the pre-pandemic level 

operational capability of State inspected slaughter/processing 

establishments, and other food supply system assets, in the last stages 

of the pandemic. 

State plan’s phased communication plan provides food safety related 

recovery information to stakeholders, in the last stages of the 

pandemic. 

State plan implements generic operating procedures, under this 

strategic goal, in recovering to pre-pandemic State food supply 

system responsibilities, in the last stages of the pandemic. 

Activity Added by State 

44 
 

 

 

 

 

 

106BAPPENDIX A.4 

Operating Objective: Ensure Ability to Respond to Agricultural 

Emergencies and Maintain Food Safety Net Programs 

States must ensure continued ability to provide response support to agricultural emergencies – 

especially animal and plant disease outbreaks – as well as administration of Federal nutrition assistance 

programs to children and needy families, during a pandemic. 

PREPARE 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF CITATION TO IF NOT 

SUPPORTING ACTIVITY SUPPORTING 

DOCUMENT 

APPLICABLE, 

PLEASE 

EXPLAIN 

State plan addresses generic operating objectives, under this strategic For this activity and 

goal, for preparing State to carry out critical agriculture programs, 

during a pandemic—including designation of coordinator for State 

pandemic preparedness planning. 

each one below, 

please include 

Title 

Page(s) 

First 5 words of 

first sentence 

State plan designates Federal nutritional assistance programs, and 

agriculture emergency response support, as essential to ensure 

continued State administration of Federal nutritional assistance and 

support to agricultural emergencies. 

State plan provides for backup personnel being identified for 

responsibility in the planning and preparedness of State-administered 

nutritional assistance and agriculture emergency response support 

responsibilities. 

State plan provides for alternative approaches for carrying out Stateadministered nutritional assistance, during a pandemic. 

State plan provides for backup personnel being identified for 

responsibility in the planning and preparedness of State-administered 

nutritional assistance, and animal disease response, in a National 

Response Framework (NRF) emergency, (e.g., ESF-11). 

State plan contains procedures for reporting of operating status of State 

nutritional assistance mechanisms and agriculture emergency response 

support. 

State plan contains communication plan to provide essential agriculture 

and nutrition assistance information to stakeholders, during a pandemic. 

Activity Added by State 

45 
 

 

 

 

 

 

RESPOND 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF CITATION TO IF NOT 

SUPPORTING ACTIVITY SUPPORTING 

DOCUMENT 

APPLICABLE, 

PLEASE 

EXPLAIN 

State plan deploys personnel, assigned to pool of trained backup 

program staff, to carry out State-administered nutritional assistance and 

agriculture emergency response support responsibilities, during the 

pandemic. 

For this activity and 

each one below, 

please include 

Title 

Page(s) 

First 5 words of 

first sentence 

State plan deploys personnel, assigned to pool of trained backup 

program staff, to carry out State-administered nutritional assistance 

programs, and animal disease response, in a National Response 

Framework (NRF) emergency, (e.g., ESF-11), during the pandemic. 

State plan implements procedures to initiate alternative approaches for 

carrying out State-administered nutritional assistance, during the 

pandemic. 

State plan implements procedures for reporting operating status of State 

nutritional assistance activities and agriculture emergency response 

support, as required during the pandemic. 

State plan implements phased communication plan to provide 

nutritional assistance program, and agricultural emergency response 

support, related information to stakeholders, during the pandemic. 

State plan implements generic operating procedures, under this strategic 

goal, in maintaining State ability to carry out critical agriculture 

programs, during the pandemic. 

Activity Added by State 

46 
 

 

 

 

RECOVER 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF CITATION TO IF NOT 

SUPPORTING ACTIVITY SUPPORTING 

DOCUMENT 

APPLICABLE, 

PLEASE 

EXPLAIN 

State plan assigns personnel to assess capability to meet pre-pandemic For this activity and 

State nutritional assistance program administration requirements, and 

meet pre-pandemic agriculture emergency response support 

responsibilities, in the last stages of the pandemic. 

each one below, 

please include 

Title 

Page(s) 

First 5 words of 

first sentence 

State plan provides for assessing and reporting on the operational 

capability to meet pre-pandemic level of performance for Stateadministered nutritional assistance programs, and agriculture emergency 

response support responsibilities, in the last stages of the pandemic. 

State plan calls for assessing and reporting on the operating status of 

State-administered nutritional assistance programs, and animal disease 

response, in a National Response Framework (NRF) emergency, (e.g., 

ESF-11), in the last stages of the pandemic. 

State plan’s phased communication plan provides nutritional assistance 

program, and agricultural emergency response support, related recovery 

information to stakeholders, in the last stages of the pandemic. 

State plan implements generic operating procedures, under this strategic 

goal, in recovering to pre-pandemic State ability to carry out critical 

agriculture programs, in the last stages of the pandemic. 

Activity Added by State 

47 
OPERATING OBJECTIVE: UNIFORMED MILITARY SERVICES 

The intent of this guidance is four-fold: 

1) to encourage State Emergency Managers and Public Health Officials to develop an understanding 

of the National Guard capabilities and how to efficiently utilize them during all phases of 

pandemic planning and response; 

2) to ensure that the roles and responsibilities of the National Guard are clearly codified in the State 

Pandemic response plan; 

3) to promote unity of effort among all state agencies in a PI environment; and 

4) to ensure that National Guard members and their beneficiaries are considered during all phases of 

the PI planning process. 

This can be achieved by ensuring that: 

1) the full spectrum of the National Guard domestic response capabilities is integrated into all 

phases of State Pandemic Influenza planning; and 

2) local emergency managers and local health departments coordinate planning with active federal 

military installations in their jurisdictions, if present. 

The Department of Defense recommends that the State Health Department invite a representative from 

the State National Guard to attend all planning meetings associated with emergency planning to 

include Pandemic Influenza. Further, the State Health Department should coordinate with the local 

health departments to ensure unity of effort and ensure there is an effective communication mechanism 

between state health officials, the State National Guard, and DoD installations within the state. 

The National Guard has 10 domestic support capabilities that can provide assistance to the State. These 

capabilities and their corresponding Emergency Support Functions are given in the table below: 

National Guard 

26 CapabilityF F 

Aviation and Airlift 

NRF Emergency Support Function 

ESF 1, 4, 9 and 13 

Communications ESF 2 

Command and Control ESF 5, 14, and 15 

Engineering 

Logistics 

Medical 

ESF 3, 4, and 9 

ESF 6, 7 ,11 and 12 

ESF 8, and 11 

CBRNE Response 

Maintenance 

ESF10 

ESF 6, 7, 8 and 12 

Security 

Transportation 

ESF 13 

ESF 1 

 

APPENDIX A.5 

 Additionally, the National Guard operational planners can provide technical assistance and support in 

the development of a multi-agency integrated, actionable State response plans. 

26 National Guard Bureau Joint Capabilities Database (JCD) 

48 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

PREPARE (Note: These activities are applicable to “respond” and “recover” as well.) 

DESCRIPTION OF CITATION TO IF NOT 

SUPPORTING ACTIVITY SUPPORTING 

DOCUMENT 

APPLICABLE, 

PLEASE 

EXPLAIN 

Ensure key State Emergency Planners and Public Health Officials have For this activity and 

met with the Adjutant GeneralF 

27 F and his/her key leaders to coordinate PI 

planning efforts to include identifying critical issues, shortfalls, and 

planning gaps during the Prepare Phase of PI planning. 

each one below, 

please include 

If requested by the Governor, or his designee, the National Guard shall Title 

provide technical assistance to the Lead State Agency in developing and Page(s)

writing an actionable response plan. First 5 words of 

first sentence 

Ensure key State Public Health and Emergency planning officials have 

been briefed on the full spectrum of State National Guard domestic 

support capabilities and have incorporated these capabilities into all 

phases of the State response plan. 

Ensure State PI planning and Public Health officials have been briefed 

on the capabilities of the National Guard of the surrounding states. 

Consideration has been given to a regional response plan to share low 

density or unusual response assets. 

Ensure the State National Guard leadership has been briefed by the 

Lead Pandemic Influenza planning agency to facilitate joint 

understanding of roles, missions and responsibilities during a pandemic. 

Ensure the State Plan recommends continuous and close coordination 

between the State National Guard, State Emergency Planners and Public 

Health Officials during a PI event. 

Ensure the State National Guard has developed and published an 

actionable PI plan that been synchronized to, and supports, the 

overarching State response plan. 

Ensure the essential domestic response capabilities of the State National 

Guard have been identified by the Lead State PI Planning Agency. 

State planners have cross walked National Guard capabilities to the 

appropriate NRF ESF’s. Shortfalls and critical resource gaps have been 

identified and specific tasking and requests for support have been issued 

to the office of the Adjutant General. 

Ensure the National Guard requirements for PPE during a pandemic are 

included in the State Plan. 

The State is responsible to provide for the antiviral medications and 

vaccine requirements of the National Guard, unless Federalized. 

Ensure the State PI planners have included the National Guard in State 

antiviral and vaccine distribution plan. 

Ensure state plans include DoD beneficiaries who receive their medical 

care from the civilian sector are accounted for in determining medical 

countermeasure requirements, e.g. PPE, anti-viral drugs, and vaccine 

(when available). 

Ensure plans recommend the State Health Department advise local 

27 The Adjutant General is the Commander of the state military forces and the military advisor to the Governor 

49 
 

 

 

 

health departments in jurisdictions adjacent to Active Federal Military 

Installations to contact and coordinate their activities with the 

installation Public Health Emergency Officer (PHEO). 

Ensure plans recommend continuous coordination and communication 

between State Emergency planners and the PI coordinators assigned to 

the five PI Principal Federal Official regions (A thru E) from U.S. 

Northern Command (NORTHCOM). 

Ensure plans recommend the State Emergency Management Agency 

advise local emergency managers in jurisdictions adjacent to Active 

Federal military installations to contact and coordinate their activities 

with base/post installation managers or the installation commander to 

identify areas for mutual support. 

Activity Added by State 

50 
 

APPENDIX A.6 

Operating Objective: Sustain Transportation Systems 

The transportation system, vital to every citizen of the U.S., is responsible for delivering billions of 

people and trillions of dollars of goods each yearF 

28 F. Often built around the “just-in-time” delivery of 

goods and services, any disruption to the national transportation system could have repercussions to 

the U.S. population regardless of rural or urban settings. Maintaining a healthy and viable 

transportation system during pandemic influenza will be highly dependent on the degree of 

preparedness, ability to respond, and capability of recovery within each of the major transportation 

modes: aviation, rail, highway, maritime, pipeline, and mass transit. 

In order to keep the vast and complex transportation systems moving during a severe pandemic, the 

preparedness, response, and recovery of each transportation mode within every State and territory 

should encompass three principal goals or sub-objectives listed below. 

The first goal is to keep goods and people moving. This includes both inter and intraState movement 

of goods and people as well as across international borders. Prioritizing essential transportation and 

cargo services; minimizing virus spread through alerts, advisories and restrictions; cleaning or 

sanitizing cargo and facilities; temporary relief from regulatory requirements without compromising 

safety; and other related measures. 

The second goal is to protect transportation workers. Plans should consider measures that ensure the 

safety of front line workers such as: communication, public and employee education, mitigation 

methods, and worker training in order to stop, slow, or limit the spread of a pandemic. While general 

information related to protection of State government workers is found in section A.1 (pages 21-33), 

transportation-specific protection methods are listed below. 

The third goal is to protect the public when using the transportation system. Plans should provide, 

through a systematic approach to public awareness and education, guidance to the public on how to 

safely utilize the transportation system during a pandemic and how to limit the spread of the virus. 

64BPREPARE 

Sub-objective A.6.1 - Keep goods and people moving 

•	 Develop contacts and establish working groups with transportation authorities in neighboring 

jurisdictions, key stakeholders, emergency response, law enforcement, Department of Defense 

(National Guard), Department of Homeland Security, and any other officials to discuss ways to 

mitigate consequences of a worst-case pandemic on transportation systems (including 

infrastructure, and movement of essential cargo). 

•	 Identify and prioritize “essential” transportation services, functions, and processes that must be 

maintained during each HUFederal Government Response StageUH, Pandemic Severity Index, or 

Pandemic Interval (See pages 11-13). 

•	 Ensure continuity of State transportation operations by initiating outreach to the private sector 

and discussing its business services and prioritization of transportation services during a 

pandemic. 

28 National Strategy for Pandemic Influenza: Implementation Plan, Chapter 5 – Transportation and borders 

51 
 

 

 

 

• Identify “non-essential” transportation services, functions, and processes that may be 

suspended or modified for more essential use during each Federal Government Response Stage, 

Pandemic Severity Index, or Pandemic Interval (See pages 11-13). 

•	 Identify and prioritize cargo that could be deemed “essential” and ensure its continuity during a 

pandemic. Essential cargo might be: vaccine or other medicine, chlorine for water treatment, 

coal for power plants, oil, gas, etc. 

•	 Plan for and develop procedures related to potential surges in different transportation modes 

and cargo depending on pandemic severity. For example, one common assumption is that there 

will likely be an increased demand for shipping, postal and cargo services (as customers order 

products on-line rather than shopping in person) combined with a lowered demand for 

passenger travel in public transit and aviation. Therefore, rail, passenger aircraft, or bus 

services might be modified to accept more essential cargo transport rather than passengers. 

Likewise, cargo normally shipped on passenger airlines may need to be transferred to cargo 

aircraft during the most severe pandemic outbreak. 

•	 Become familiar with current research on decontamination or sanitization of transportation 

systems and prepare to implement new techniques or methodologies. 

(http://wwwn.cdc.gov/travel/contentAvianFluAirlinesCleaning.aspx) 

•	 Develop pre-scripted or draft Memoranda of Agreement or Emergency Compacts with 

neighboring jurisdictions, key suppliers, temporary help services, privately owned 

transportation resources, or similar entities. 

•	 Determine what impacts a severe pandemic would have on the transportation sector and plan to 

initiate requests to waive certain regulations as necessary29 

F F. Examples of possible 

transportation waivers, each subject to the applicable specific regulatory requirements, are: 

commercial motor vehicle (CMV) requirements concerning safety, hours of service, driver 

qualifications, operation and inspections, repair and maintenance, and employee safety and 

health standards needed by a carrier or driver to provide direct emergency assistance; special 

permits for transporting hazardous materials; special permits for pipeline safety requirements; 

and waivers of railroad safety rules, regulations, and standards. 

ub-objective A.6.2 – Protect transportation workers30 F 

•	 Prepare a risk assessment for transportation activities in accord with Appendix A.1, SubObjective A.5 and develop plans to protect employees in the very high, high, or medium risk 

categories. 

•	 Likewise, ensure a risk assessment is done for on-site contract personnel and plans are in place 

to protect its employees in the very high, high, or medium risk categories. 

•	 Develop and distribute employee training for those requiring PPE as appropriate and ensure 

that all workers can conduct activities in a reasonable and safe manner. 

•	 Likewise, ensure that similar training for contractors requiring PPE is conducted and that 

activities can be conducted in a reasonable and safe manner. 

•	 Ensure that operators of State-owned or contractor-supplied equipment and facilities are ready 

to respond to new guidance on cleaning and/or sanitizing requirements or any safety-related 

procedures for handling or storing the agents. 

U U HU UH HU UH

U U

S

29 During an emergency, the U.S. Department of Transportation (DOT) may have the ability to waive certain safety 

regulations in accordance with specific statutory and regulatory authority. However, waivers of and exemptions from 

existing regulations and requirements are fact-based, and DOT’s ability to waive existing authority will depend heavily on 

the facts surrounding the emergency.

30 See section A.1, pages 20-33 for general PPE methods. 

52 
 

 

 

 

 

•	 Acquire, pre-position and store supplies that will be needed to conduct cleaning/ sanitizing 

operations. 

•	 Develop and have ready for distribution instructions for workers on how to handle passengers 

who may exhibit pandemic influenza symptoms. 

Sub-objective A.6.3 – Protect the public while using transportation systems 

•	 Coordinate public messaging with lead public health or other authority regarding travel 

advisories for different modes of transportation. Messaging should indicate level of risk for 

travelers when utilizing particular transportation mode. 

•	 Develop additional safety measures to be implemented on public transportation systems based 

on the Pandemic Severity Index (Pages 11-13). 

•	 Develop (or obtain from other sources) training material such as posters, videos, brochures and 

other pandemic flu countermeasures. This might also include advice reminding the public of its 

responsibility to provide its own personal protection (such as the use of facemasks) when going 

to unavoidable crowded public areas and when using public transit. 

•	 Develop plans to distribute training material such as brochures to the public when utilizing the 

transportation system. 

RESPOND 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF SUPPORTING ACTIVITY CITATION TO 

SUPPORTING 

DOCUMENT 

IF NOT 

APPLICABLE, 

PLEASE 

EXPLAIN 

Sub-objective A.6.1 - Keep goods and people moving 

Communicate with transportation authorities in neighboring 

jurisdictions, key stakeholders, emergency response, law 

enforcement, Department of Defense (National Guard), Department 

of Homeland Security and any other officials to activate plans or 

procedures regarding the transportation modes. 

Review “essential” transportation services, functions, and processes For this activity and 

and ensure they continue during a pandemic. Alternative routes may 

need to be considered for freight transport. Consult the DOT Freight 

Analysis Framework to determine alternate transportation routes. 

each one below, 

please include 

Title 

Page(s) 

First 5 words of first 

sentence 

Review and implement procedures to ensure continuity of essential 

cargo during a pandemic. 

Review and implement procedures related to potential surges or 

declines in transportation modes and essential cargo services and 

ensure there is no disruption of these services. 

Implement additional cleaning/sanitizing methods for transportation 

systems and cargo. 

Initiate Memoranda of Agreement or Emergency Compacts with 

neighboring jurisdictions, key suppliers, temporary help services, 

53 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

privately owned transportation resources, or similar entities. 

Submit request for waivers to appropriate authorities if necessary. 

Communicate with Federal Operations Centers in accordance with 

the National Response Framework and Emergency Support Function 

1 to provide transportation–specific information during a pandemic. 

Activity Added by State 

Sub-objective A.6.2 - Protect transportation workers 

Provide special instructions or additional guidance to essential or 

unique employeesF 

31 F who must travel to regions that have experienced 

severe outbreak; focusing on worker safety and what to do. Advice 

should also be given to the employee on health monitoring, PPE use, 

and training. 

Ensure that all transportation workers and operators of State-owned 

or contractor-supplied equipment and facilities receive updated 

policy, procedures, and supplies necessary for cleaning or sanitizing 

transportation systems. 

Issue instructions to workers on how to detect sick passengers and 

what to do if detected. 

Activity Added by State 

Sub-objective A.6.3 - Protect the public while using transportation systems. 

Issue transportation travel advisories. Some advisories could attempt 

to discourage or limit non-essential travel to affected regions during 

an outbreak. 

Issue advisories to the general public on how to safely ride public 

transportation during a pandemic. These advisories could remind the 

public of their responsibility to provide their own PPE (such as 

facemasks) when utilizing public transportation systems, to 

frequently wash their hands, etc. 

Issue public service announcements, and initiate public safety 

campaigns via posters, brochures, websites, or other media regarding 

how to reduce or limit the spread of the virus. 

Distribute educational material to passengers on how to avoid 

spreading the flu virus when utilizing public transportation. 

Keep transportation assets, such as buses, subway cars or trains clean 

by implementing more frequent cleaning or sanitization procedures. 

Deliver or display pandemic influenza alert levels or situational 

reports to the public when using transportation systems. 

Activity Added by State 

31 Both State government and contract employees 

54 
 

 

 

 

 

 

 

 

65BRECOV ER 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF SUPPORTING ACTIVITY CITATION TO 

SUPPORTING 

DOCUMENT 

IF NOT 

APPLICABLE, 

PLEASE 

EXPLAIN 

Sub-objective A.6.1 - Keep goods and people moving 

ReinState public transportation to normal operating levels and 

prepare for another possible pandemic wave. 

For this activity and 

each one below, please 

include 

Title 

Page(s) 

First 5 words of first 

sentence 

Integrate best practices or lessons learned during the previous 

pandemic wave across all transportation modes and issue an after 

action report. 

Activity Added by State 

Sub-objective A.6.2 - Protect transportation workers 

Thoroughly disinfect and prepare workplace before resumption of 

duties. 

Deliver messages to personnel regarding resumption of normal 

duties and working hours. 

Prepare for another possible pandemic wave by re-stocking 

supplies, reviewing and addressing deficiencies noted during first 

wave. 

Integrate best practices or data points from lessons learned during 

the previous pandemic wave across all transportation modes and 

issue an after action report. 

Activity Added by State 

Sub-objective A.6.3 - Protect the public while using transportation systems 

Issue Statements and advisories to the general public informing 

them that the immediate pandemic threat is over, but to be prepared 

for another possible wave. 

Thoroughly clean or sanitize public transportation conveyances and 

facilities and prepare for public use. 

Integrate best practices or data points from lessons learned during 

the previous pandemic wave across all transportation modes and 

issue an after action report. Prepare for another pandemic wave. 

Activity Added by State 

55 
Key: 

>50% - “Substantial Evidence of Operational Readiness” 

25-49% - “Significant Evidence of Operational Readiness” 

1-24% - “Little Evidence of Operational Readiness” 

6BAPPENDIX A.7 

COOP & COG: Operational Readiness (Testing through Exercises and 

Real Events) 

A defining characteristic of an operating plan is that, in whole or in part, it readily lends itself to 

evidence-based evaluation using the results of discussion-based exercises (“table tops”), operationalbased exercises (drills and enacted responses to simulated incidents), or performance measurements 

obtained in the course of responses to actual incidents. 

The table below describes the type of information that is requested regarding readiness to meet the 

Operational Objectives that constitute the Goal “Ensure Continuity of Operations of State Agencies 

and Continuity of State Government”. Although an imperfect measure of readiness, this information 

tells reviewers that States have practiced and tested their plans – through exercises or responses to real 

events – and used the results of such experience to improve their pandemic influenza preparedness. 

The USG Departments jointly will assign a single rating for Operational Readiness for the entire State 

submission. In particular, based on the information requested at the end of each sub-Appendix, the 

Departments will determine the number of the Operating Objectives for which the State submitted 

evidence that it has tested its response capability in some appropriate way. This number then will be 

divided by the total number of Operating Objectives, expressed as a percentage, and translated into a 

standardized verbal designation in accord with the key shown in the text box. 

U U

No submission or a non-responsive submission will be classified as “insufficient information to enable 

assessment”. 

In accord with the table below, please indicate, for each Operating Objective, whether or not an aspect 

of that objective was tested. If it was tested, what was the measurable objective that was tested (this 

would have been your exercise objective or the objective you were trying to achieve during a 

response)? Then, please provide one or two sentences about the a change that was made to the State 

operating plan as a result of the lessons learned and incorporated into an Improvement Plan and then 

acted upon. 

56 
 

 

 

 

 

 

 

 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

COOP & COG: OPERATING READINESS 

67BOperating Objective Tested?F 

32 F (Y/N) 

What was tested and 

why?F 

33 F 

How did result improve the 

Operating Plan? 

Ensuring Continuity of 

Operations of State Agencies & 

Continuity of State Government 

• Telework plans (test for 

capability for people, 

processes, and 

technology; ensure 

teleworkers have access 

to vital records, 

databases and other 

files, consistent with 

encryption protocols) 

• Communications plan 

and communications 

mechanisms 

• Other plans from 

Appendix A.1 related to 

actions to be taken 

during a pandemic 

68BPublic Health COOP 

69BFood Supply System 

70BUniform Military Services 

71BAgriculture 

72BTransportation 

32 Examples of events might include: National Governor’s Association regional exercises, Department of Treasury national
 

finance and banking CIKR exercise, TOPOFF, wildfire response, intraState antiviral drug distribution exercise, Hurricane
 

Dean response, and use of VTC to conduct regional workshops to inform planning. 

33 If an exercise, what was the purpose? If a real-world incident, what was its nature?
 

57 
APPENDIX B.0 – PROTECT CITIZENS 

107BThis Appendix, “Protect Citizens,” reflects the role of the State government as a responder in to the 

influenza pandemic. During a pandemic, the State government is conducting business as usual (and 

perhaps with more intensity) for functions such as disease surveillance and is altering the way it 

conducts other functions to delay the introduction, slow the spread, or lessen the severity of pandemic 

influenza (e.g., advising that sick people stay home, banning public gatherings, dismissing students 

from schools). Should an influenza pandemic reach the United States, our primary focus will be to 

safeguard the health of the U.S. population. Our ability to meet this goal will require accomplishment 

of a number of critical tasks including: (1) Ensure surveillance and laboratory capability during each 

phase of a pandemic, (2) Implement controls at U.S. ports of entry to delay the spread of the disease, 

(3) Implement community mitigation interventions at the appropriate time. (4) Enhance State plans to 

enable community mitigation through student dismissal and school closure; (5) Acquire and distribute 

medical countermeasures during each phase of a pandemic; (6) Ensure mass vaccination capability; (7) 

provide health care; (8) Manage mass fatalities; (8) Ensure communication capability during each 

phase of a pandemic; (9) Mitigate the impact of an influenza pandemic on workers in the State; (10) 

Understand official communication mechanisms for foreign missions, international organizations, and 

their members in the United States; (11) Integrate EMS and 9-1-1 into pandemic preparedness; (12) 

Integrate public safety answering points into pandemic preparedness; and (13) Protect citizens 

operating readiness (testing through exercises and real events). 

When carrying out such operating objectives it is important that State officials work with local 

jurisdictions to ensure or promote the following with respect to At-Risk populations: 

•	 Engagement with at-risk individuals (or organizations that represent them) – ensuring that 

critical planning gaps are identified and filled; 

•	 A mechanism for continuous and close coordination between local officials and organizations 

that serve at-risk individuals during the influenza pandemic; and, 

•	 Community organizations have a tested and improved mechanism for educating at-risk 

individuals on the highlights of their local response plans. 

58 
APPENDIX B.1 

Operating Objective: Ensure Surveillance and Laboratory Capability 

During Each Phase of a Pandemic 

This appendix provides planners with information that should be included in emergency operations 

plans to address surveillance and laboratory issues specific to an influenza pandemic. 

PREPARE 

Checklist items for general consideration on this topic can be found at 

http://www.pandemicflu.gov/plan/States/Statelocalchecklist.html#laboratories. 

Implementation Steps for Enhanced Human Surveillance 

Implementation steps for enhanced human surveillance to rapidly detect initial cases of pandemic 

influenza virus in humans early in a pandemic that include the following: 

•	 Conducting year-round surveillance for seasonal influenza (e.g., virologic and outpatient visits) 

including electronic reporting 

•	 Methods for notification of healthcare providers of enhanced surveillance testing and reporting 

recommendations 

•	 Method for healthcare providers to contact the State health department to report cases that meet 

the criteria for pandemic influenza testing and obtain the appropriate testing. 

•	 Identification of influenza surveillance coordinator positions 

•	 A plan for investigation of early cases and clusters of pandemic influenza 

•	 Plan for reporting early novel influenza cases to CDC on a daily basis 

 

Monitoring of Influenza-Related Hospitalizations and Deaths throughout the Pandemic 

A plan for developing systems or identifying data sources for monitoring severe disease throughout the 

pandemic such as: 

•	 Developing and implementing a Statewide electronic death reporting system or accessing 

available sources of electronic death data (e.g. vital records data). 

•	 Developing methods for estimating influenza-associated deaths if no electronic data are 

available. 

•	 Monitoring the number of pneumonia and influenza hospitalizations using tabulated from 

hospitals or available source of electronic data. 

•	 Estimating rates of influenza associated hospitalizations for your jurisdiction. 

Procedures for Notification and Information Sharing 

A process for information sharing between the following: 

•	 Health Departments 

•	 Hospitals 

•	 Medical Examiners 

•	 Vital Statistic Offices 

•	 Other stakeholders (e.g. DoD) 

•	 Links animal and human health surveillance systems 

•	 Staff identified with contact information for information sharing between the animal and 

human health surveillance systems 

HU UH

U

U

U

59 
 

 

 

 

 

 

 

 

 

UOperational Steps to Obtain and Track Impact of the Pandemic 

A plan to obtain, track and report numbers or rates daily to the State department of health and to the 

CDC in a timely manner during the early period of pandemic influenza virus introduction and spread 

on the following: 

•	 Attack rate in early case and cluster investigations 

•	 Case fatality rate 

•	 The numbers of hospitalized persons with pandemic influenza or rate of pandemic 

influenza-associated hospitalization 

•	 The number of pandemic influenza-associated deaths 

RESPOND AND RECOVER 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF SUPPORTING ACTIVITY CITATION TO 

SUPPORTING 

DOCUMENT 

IF NOT 

APPLICABLE, 

PLEASE 

EXPLAIN 

Sub-objective B.1.1 - Implementation Steps for Enhanced Human Surveillance 

Does the plan include implementation steps for enhanced human For this activity and 

surveillance to rapidly detect initial cases of pandemic influenza virus 

in humans early in a pandemic that include the following: 

• Conducting year-round surveillance for seasonal influenza 

each one below, 

please include 

(e.g. virologic and outpatient visits) including electronic 

reporting 

• Methods for notification of healthcare providers of enhanced 

surveillance testing and reporting recommendations 

• Method for healthcare providers to contact the State health 

department to report cases that meet the criteria for 

pandemic influenza testing and obtain the appropriate 

testing 

Title 

Page(s) 

First 5 words of first 

sentence 

Does the plan include identification of influenza surveillance 

coordinator positions? 

Does the plan include a plan for investigation of early cases and 

clusters of pandemic influenza? 

Is there a plan for reporting early novel influenza cases to CDC on a 

daily basis? 

Activity Added by State 

Sub-objective B.1.2 - Monitoring of Influenza-Related Hospitalizations and Deaths throughout the 

Pandemic 

Does the plan include a plan for developing systems or identifying 

data sources for monitoring severe disease throughout the pandemic 

such as: 

• Developing and implementing a Statewide electronic death 

reporting system or accessing sources of electronic death 

data (e.g., vital records data) 

• Developing methods for estimating or counting influenzaassociated deaths if no electronic data are available 

• Monitoring the number of pneumonia and influenza 

60 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

hospitalizations using tabulated data from hospitals or 

available electronic sources 

• Estimating rates of influenza associated hospitalization for 

your jurisdiction 

Sub-objective B.1.3 - Procedures for Notification and Information Sharing 

Does the plan include a process for information sharing between the 

following: 

• Health Departments 

• Hospitals 

• Medical Examiners 

• Vital Statistic Offices 

• Other stakeholders (e.g. DoD) 

Does the plan include links between animal and human health 

surveillance systems? 

Does the plan include staff identified with contact information for 

information sharing between the animal and human health 

surveillance systems? 

Sub-objective B.1.4 -Operating Steps to Obtain and Track Impact of the Pandemic 

Does the plan include a plan to obtain, track and report numbers and 

rates daily to the State department of health and to the CDC in a 

timely manner during the early period of pandemic influenza virus 

introduction and spread on the following: 

• Attack rate in early case or cluster investigations 

• Case fatality rate 

• The numbers of hospitalized persons with pandemic 

influenza or rate of pandemic influenza-associated 

hospitalization 

• The numbers of newly isolated and quarantined persons 

• The number of pandemic influenza-associated deaths 

Sub-objective B.1.5 - Implementation Steps for Augmenting the Capacity of Public Health and Clinical 

Laboratories 

Is there a plan to augment the capacity of public health and clinical 

laboratories to meet the needs of their jurisdiction during an influenza 

pandemic? Capacity includes but is not limited to: 

• The ability to test for influenza viruses year-round 

• Performing PCR or IF Testing for rapid detection and 

subtyping of influenza viruses 

• Protocols for safe specimen collection and testing 

• How and to whom a potential case of novel influenza should 

be reported 

• Mechanism for submitting specimens to referral laboratories 

• Protocols for proper handling and shipment of specimens 

• Protocols for notifying and reporting any novel specimen 

findings 

Sub-objective B.1.6 - Systems and Procedures that will be used to Exchange Specimen-Level Data 

Electronically Among Laboratories 

Does the plan include systems and procedures that will be used to 

exchange specimen-level data electronically among laboratories 

within the following: 

• Healthcare facilities 

• Other clinical laboratories 

61 
 

 

 

 

• State public health laboratories 

• CDC 

Sub-objective B.1.7 - Call-Down Procedures 

Does the plan include call-down procedures and laboratory staff 

contact information? 

Sub-objective B.1.8 - Locations for Additional Laboratory Facilities 

Does the plan include locations of and Memoranda of Agreement 

with additional laboratory and personnel facilities to enhance current 

laboratory capacity for a response of pandemic proportions? 

Activity Added by State 

62 
 

 

 

 

108BAPPENDIX B.2 

Operating Objective: Assist with Controls at U.S. Ports of Entry 

The millions of people and goods that daily traverse the globe disperse microbial threats in their wake, 

usually without intent to harm. To contain the spread of a contagious illness, public health authorities 

rely on many strategies. Two of these strategies are isolation and quarantine. Both are common 

practices in public health, and both aim to control exposure to infected or potentially infected persons. 

Both may be undertaken voluntarily or compelled by public health authorities. The two strategies 

differ in that isolation applies to persons who are known to have an illness, and quarantine applies to 

those who have been exposed to an illness but who may or may not become ill. 

Growing concern about the threat of an influenza pandemic and other emerging infectious diseases has 

prompted HHS to invest in building a Quarantine System that meets the needs of the 21st Century. 

This Quarantine System includes an integrated and comprehensive partnership of local, State, national, 

and global health authorities to prevent, detect, and contain infectious diseases in countries of origin 

and at U.S. ports of entry; and to plan responses to public health threats. 

The purpose of this guidance is to provide an outline of essential minimum planning elements for 

preparedness in detecting, reporting, investigating and responding to at influenza pandemic at the 

Nation’s major airports, and strengthening multi-sector response at US ports of entry.

 This appendix applies to States that host a Department of Health and Human Services, CDC 

Quarantine Station. 

PREPARE 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF SUPPORTING ACTIVITY CITATION TO 

SUPPORTING 

DOCUMENT 

IF NOT 

APPLICABLE, 

PLEASE 

EXPLAIN 

Sub-objective B.2.1 - Plan strategies for controls at ports of entry 

Develop a port of entry (POE) communicable disease response plan 

-- for locations with a Quarantine Station --which includes triggers 

(that follow CDC guidance) for its implementation. 

For this activity and each 

one below, please include 

Title 

Page(s) 

First 5 words of first 

sentence 

Ensure the port of entry (POE) communicable disease response plan 

includes the incident command and control structure. 

Ensure the port of entry (POE) communicable disease response plan 

addresses ill passenger assessment and isolation procedures. 

Ensure the port of entry (POE) communicable disease response plan 

addresses issuance of legal order for detention, isolation, 

quarantine, and conditional release of passengers or crew members 

at POEs. 

Ensure the port of entry (POE) communicable disease response plan 

63 
 

 

 

 

 

 

 

 

 

 

 

addresses arrangements for separate quarantine facilities for 

detaining multiple cohorts of potentially exposed passengers, either 

on- or off-port or both, including (but not limited to): 

a. Evaluation of exposed cases, periodic fever checks, 

prophylaxis, therapeutics, and needed laboratory services 

b. Passenger transportation and security 

c. Passenger processing at quarantine facility 

d. Crowd control and law enforcement 

e. Situation updates and communication with detained 

persons 

f. Interpretation 

g. Mental health services 

h. Food, water, toilet and hand washing facilities, chairs, PA 

system, bedding, and other comfort measures 

Ensure the port of entry (POE) communicable disease response plan 

addresses the plans and procedures for managing the conditional 

release of those passengers not deemed as high risk contacts of the 

index case(s) (i.e., allowing them to continue their travel plans due 

to the decreased risk of in-flight disease transmission). These 

procedures include but are not limited to collection of passenger 

locator information, distribution of health information, 

administration of antiviral drugs or other prophylactic interventions, 

and tracking of conditionally released persons. 

Ensure the port of entry (POE) communicable disease response plan 

addresses public and media communication. 

Ensure the port of entry (POE) communicable disease response plan 

includes protocols that address conveyance reuse/decontamination 

issues. 

Ensure the port of entry (POE) communicable disease response plan 

includes procedures for POE incident “hand off” from one agency 

to another, and triggers for altering or terminating POE controls. 

Describe the number of hospitals under a memorandum of 

agreement (MOA) with Quarantine Station, and plans for 

collaboration with Quarantine Station in obtaining additional MOA 

hospitals. 

Activity Added by State 

64 
 

 

 

73BRESPOND 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF SUPPORTING ACTIVITY CITATION TO 

SUPPORTING 

DOCUMENT 

IF NOT 

APPLICABLE, 

PLEASE 

EXPLAIN 

Sub-objective B.2.2 - Implement strategies for port of entry control of pandemic disease. 

Create plans to address surge capacity needs at POEs. Define roles 

and responsibilities for the following functions that must include, 

but are not limited to: 

• Establishing and staffing passenger public health screening 

• Distributing health alert notices to passengers and crew 

members 

• Providing laboratory support 

• Following up on suspect and isolated cases 

• Responding to the needs of quarantined persons 

For this activity and each 

one below, please include 

Title 

Page(s) 

First 5 words of first 

sentence 

Activity Added by State 

65 
APPENDIX B.3 

Operating Objective: Implement Community Mitigation Interventions 

This appendix provides State planners with recommendations for implementing community mitigation 

interventions to help limit the spread of a pandemic, prevent disease and death, lessen the impact on 

the economy, and keep society functioning. The spectrum of supporting activities under the FEMA 

framework of “Prepare, Respond and Recover” is critical to overall State capability. However, only 

those activities under “Respond” and “Recover” will be reviewed, since the focus of this guidance is 

on operational activities. States are asked to provide detailed information as to how they plan to 

address only those recommendations in the attached table. 

The CDC issued The Interim Pre-pandemic Planning Guidance: Community Strategy for Pandemic 

Influenza Mitigation in the United States – Early, Targeted, Layered Use of Nonpharmaceutical 

Interventions (February 2007) to provide guidance for pandemic planning and response at the onset of 

a pandemic. This pandemic mitigation framework is based upon an early, targeted, layered application 

of multiple partially effective nonpharmaceutical and pharmaceutical measures. It is recommended that 

the measures be initiated early before explosive growth of the epidemic and, in the case of severe 

pandemics, that they be maintained consistently during an epidemic wave in a community. All such 

community-based strategies should be used in combination with individual infection control measures, 

such as hand washing and cough etiquette. 

The pandemic mitigation interventions described in this document include: 

1.	 Isolation and treatment (as appropriate) with influenza antiviral medications of all persons with 

confirmed or probable pandemic influenza. Isolation may occur in the home or healthcare 

setting, depending on the severity of an individual’s illness and/or the current capacity of the 

healthcare infrastructure. 

2.	 Voluntary home quarantine of members of households with confirmed or probable influenza 

case(s) and consideration of combining this intervention with the prophylactic use of antiviral 

medications, providing sufficient quantities of effective medications exist and that a feasible 

means of distributing them is in place. 

3.	 Dismissal of students from school (including public and private schools as well as colleges and 

universities) and school-based activities and closure of childcare programs, coupled with 

protecting children and teenagers through social distancing in the community to achieve 

reductions of out-of-school social contacts and community mixing. (See Appendix B-4) 

4.	 Use of social distancing measures to reduce contact between adults in the community and 

workplace, including, for example, cancellation of large public gatherings and alteration of 

workplace environments and schedules to decrease social density and preserve a healthy 

workplace to the greatest extent possible without disrupting essential services. Enable 

institution of workplace leave policies that align incentives and facilitate adherence with the 

interventions outlined above. 

Implementing these interventions in a timely and coordinated fashion will require advance planning. 

Communities must be prepared for the cascading second- and third-order consequences of the 

interventions. Decisions about what tools should be used during a pandemic should be based on the 

observed severity of the event, its impact on specific subpopulations, the expected benefit of the 

66 
 

 

 

 

 

 

 

interventions, the feasibility of success in modern society, the direct and indirect costs, and the 

consequences on critical infrastructure, healthcare delivery, and society. 

The Centers for Disease Control and Prevention has recently developed a document entitled Interim 

Guidance for the Use of Intervals, Triggers, and Actions in Pandemic Influenza Planning which 

provides a framework and thresholds for implementing the community mitigation interventions. 

During the “Acceleration” phase, affected communities are moving from case-based approaches to 

control to a broader set of community interventions for control. This interval begins in a jurisdiction 

when public health officials have identified sufficient factors to initiate community mitigation 

activities. Historical analyses and mathematical modeling indicate that early institution of combined, 

concurrent community mitigation measures, including dismissing students and closing childcare 

facilities, may maximize reduction of disease transmission (and subsequent mortality) in the affected 

areas. 

74BRESPOND 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF SUPPORTING ACTIVITY CITATION TO 

SUPPORTING 

DOCUMENT 

IF NOT 

APPLICABLE, 

PLEASE 

EXPLAIN 

Sub-objective B.3.1 - Implement strategies for isolation and treatment of ill individuals. 

The State has identified clear triggers that follow CDC guidance for For this activity and 

initiating community mitigation interventions (including detailed 

actions to take by pandemic severity) and has distributed these 

guidelines to all local health departments. 

each one below, please 

include 

Title 

Page(s) 

First 5 words of first 

sentence 

Identify the State spokesperson who will provide messages 

to local health departments, the public and the media to 

initiate community mitigation interventions as well as the 

second person in the line of succession for this function. 

The State has collaborated with local health departments to 

develop plans for rapid remote identification of possible 

cases (e.g., hotlines, influenza triage centers), including 

processes to train volunteers/others who will staff the 

hotline and/or triage centers. 

The State has provided initial guidance to local health 

departments to develop communications and education to 

the general public as to how to access hotlines, when and 

where to seek medical care, how to care for ill persons at 

home, how to protect family members if there is a sick 

person at home, and when to stay home. Provide examples 

of how these educational materials will be distributed to the 

public. 

The State has provided guidance to local health departments 

67 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

to coordinate their pandemic treatment plans with 

community Emergency Medical Services (EMS) and 911 

services and develop established protocols and algorithms. 

The State has identified case definitions for presumptive/definitive 

diagnosis of pandemic influenza and distributed these to local 

health departments and hospitals in the State. Provide citation. 

The State has developed processes to train and communicate with 

private sector and public sector health professionals, during the 

early and later stages of a pandemic, on case definitions and 

methods for determining influenza diagnosis. 

The State has developed strategies for advising hospitals and other 

treatment facilities to recommend patients with ILI to remain at 

home, with triage protocols to identify critically ill patients 

The State has developed specific plans to distribute treatment 

medications to ill individuals in isolation. Provide a full description 

of how ill individuals will access antiviral medication for treatment. 

Activity Added by State 

Subobjective B.3.2 - Provide clear policies and procedures for advising voluntary quarantine of 

household contacts to a known or suspected case, including processes to monitor households under 

quarantine. 

The State has initiated plans for communications and education to 

the general public regarding recommendations for voluntary 

household quarantine for family members if there is a sick person at 

home, and how long to stay home. Provide citation that describes 

how these educational materials will be distributed to the public. 

The State has developed a method to provide information to 

households under voluntary quarantine and a method of identifying 

those households. 

The State has designed an interview form and has distributed it to 

local health departments to capture demographic characteristics of 

household members (both ill and contacts) and has a developed a 

clear plan for how these data will be collected. 

The State has worked with local health departments to create plans 

for follow-up (monitoring) of known or suspected households under 

voluntary quarantine in the community at the State/local level. 

The State has provided guidance to local public health departments 

for their work with community organizations to distribute 

medications, vaccine and other subsistence (e.g. food, water, if 

needed) items to households in isolation. 

The State has outlined a process to use by local health departments 

to identify vulnerable populations and to make plans for support 

and outreach to these populations during a pandemic. 

The State has advised local health departments to conduct outreach 

to community and faith-based organizations to develop plans that 

68 
 

 

 

 

 

 

 

 

 

 

will be coordinated with those organizations for meeting the needs 

of vulnerable households who may be quarantined during a 

pandemic. 

The State has developed a plan to monitor the implementation of 

and effectiveness of community mitigation interventions. 

Activity Added by State 

Subobjective B.3.3 - Develop clear policies and procedures for advising social distancing practices in 

the community and at the worksite. 

The State has developed specific recommendations for community 

social distancing. Include the levels of social distancing that will be 

recommended based on the Pandemic Severity Index. 

The State has recommended to local health departments to conduct 

outreach to community partners to promote social distancing 

including public transportation, operators of large venues for 

sporting events and other activities, businesses, education, faithbased communities and others that have been identified as playing a 

role during a pandemic. 

The State has developed processes for distribution on informational 

materials to workplaces and the community at large explaining the 

rationale and steps to take regarding social distancing. 

The State has disseminated guidance to local health departments to 

share with community businesses and organizations for canceling 

large public gatherings 

The State has identified processes to help businesses to encourage 

ill employees to stay home and identify ill individuals in the 

workplace (including guidance regarding who needs to be sent 

home or for treatment and where they should go). 

The State has identified processes to help businesses adjust leave 

policies to facilitate sick employees to stay home. 

The State has an identified process for monitoring the secondary 

and tertiary effects of community mitigation interventions and 

recommended solutions to prevent excessive community disruption. 

Activity Added by State 

69 
 

 

 

 

 

75BRECOVER 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF SUPPORTING ACTIVITY CITATION TO 

SUPPORTING 

DOCUMENT 

IF NOT 

APPLICABLE, 

PLEASE 

EXPLAIN 

Sub-objective B.3.4 - Implement steps for cessation of community mitigation interventions 

List steps for recommending cessation of community mitigation 

activities. Include clear triggers for these recommendations that 

follow CDC guidance for cessation of community mitigation 

interventions. 

For this activity and 

each one below, please 

include 

Title 

Page(s) 

First 5 words of first 

sentence 

Identify the State spokesperson who will provide messages to local 

health departments, the public and the media to cease community 

mitigation interventions during the recovery stage, as well as the 

second person in the line of succession for this function. 

List steps the State will take to provide recovery/reopening 

guidance to businesses, workplaces and large venues for sporting 

events and other activities that closed during a pandemic. 

List steps the State will take to monitor the effects of the cessation 

of community mitigation interventions. 

Activity Added by State 

70 
APPENDIX B.4 

Operating Objective: Enhance state plans to enable community 

mitigation through student dismissal and school closure 

Dismissing students from schools is cited as a critical component of mitigating the consequences of an 

influenza pandemic. However, dismissing students from schools is a complex operation, with a range 

of considerations not only about the act itself, but also second and third order consequences that may 

follow student dismissal. 

One looming consideration is the appropriate time that schools should be closed and, consequently, 

reopened (In this document, school closure is defined as dismissing students from schools and closing 

childcare facilities. “Student dismissal may also be used in this document.”). The HHS/CDC have 

recently developed a document entitled Interim Guidance for the Use of Intervals, Triggers, and 

Actions in Pandemic Influenza Planning which provides a framework and thresholds for student 

dismissal and school closure. During the “Acceleration” Phase, affected communities will no longer 

be able to control the spread of the virus between affected individuals and will need to enact a broader 

set of community interventions to minimize transmission. This interval begins in a jurisdiction when 

public health officials have identified sufficient factors to initiate community mitigation activities such 

as school dismissal and childcare closures, social distancing, and the efficient management of public 

health resources. Historical analyses and mathematical modeling indicate that early institution of 

combined, concurrent community mitigation measures, including dismissing students and closing 

childcare facilities, may maximize reduction of disease transmission (and subsequent mortality) in the 

affected areas. (*Note: This Interim Guidance document is still under consideration by CDC and 

Federal agencies. This Interim Guidance should not be considered final guidance.) 

Other questions specifically about education policy are addressed in the Department of Education’s 

guidance on preparing for prolonged school closures during a severe pandemic, which can be accessed 

at: HUhttp://www.ed.gov/admins/lead/safety/emergencyplan/pandemic/guidance/pan-flu-guidance.pdfUH. 

This guidance addresses issues related to No Child Left Behind requirements and how state and local 

educational agencies should plan for school closures. 

The following delineates basic minimum components for states to consider in planning for a pandemic. 

The actions cited in this document are specifically focused on the roles and responsibilities of the state 

educational agency. For some items, the state may not have any responsibility and this should be 

reflected in the “Not Applicable” column. Because some of the actions or activities may be 

coordinated at the local level and not the State level, the State should identify contacts at the local level 

to ensure optimal coordination. 

Also, some of the information included here may be addressed in other sections of the pandemic plan, 

such as information on protecting or paying the workforce or communications. Please reference these 

sections; there is no need to re-create other parts of the state’s entry if the education sector’s needs are 

addressed elsewhere in the state’s plan. 

71 
 

 

 

 

 

 

 

 

 

 

 

 

76BPREPARE 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF SUPPORTING ACTIVITY CITATION TO 

SUPPORTING 

DOCUMENT 

IF NOT 

APPLICABLE, 

PLEASE 

EXPLAIN 

Sub-objective B.4.1 - Review legal authorities and delegations of authority for closing schools and/or 

dismissing students. 

Identify the legal authority to close schools during a pandemic prior For this activity and 

to declaration of state of emergency. (For example, does this 

authority rest with the Governor? State Educational Agency? Local 

authorities?). Provide citation.* 

each one below, 

please include 

Title 

Page(s) 

First 5 words of first 

sentence 

Identify the legal authority to close schools during an emergency 

(declared state of emergency) (For example, does this authority rest 

with the Governor? State Educational Agency? Local authorities?). 

Provide citation. 

If there are no existing authorities, identify the state’s plans for 

establishing this authority. 

Identify the state’s legal authority to dismiss students from statefunded post-secondary schools (PSSs). Provide citation, if available. 

If not, describe state’s legal role in and/or obligations to PSSs, if 

applicable. (For example, do PSSs function under a Board of 

Regents? If so, does this body have legal authority to dismiss 

students?) 

Identify the state’s legal authority to close day care centers, if 

applicable. 

Activity Added by State 

Sub-objective B.4.2 - Develop and/or enhance planning and coordination efforts for school 

closure/student dismissal and reopening. 

Delineate process for coordinating the response efforts for the state 

educational agency (SEA). Identify the positions designated in lines 

of authority. (For example, describe who within the State 

Educational Agency (SEA) the Governor would contact if a state of 

emergency was declared, as well as who would be designated next if 

the person in that position was not available.) 

Identify the position within the governing entity for PSSs that serves 

on the state-level pandemic planning team. 

Designate representative to the state’s Pandemic Flu coordinating 

team for state educational agency. 

Describe relationships between SEA, public health, and other entities, 

72 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

such as mental health. Describe the other partners involved in 

planning the educational response to a pandemic and their specific 

roles. (For example, do these entities collaborate on issues related to 

pandemic influenza? Are there formal Interagency Agreements or 

Memoranda of Understanding?) 

Describe if state has disease surveillance system in which schools or 

PSSs participate or plans for developing such a system (If 

applicable.) (Refer to Appendix B.1 if applicable) 

Activity Added by State 

Sub-objective B.4.3 - Develop and/or enhance communications planning for school closure/student 

dismissal and reopening. 

Describe the SEA’s mechanism in place for communicating with 

LEAs in the event of an emergency (e.g. reverse 911, email groups, 

phone tree, etc) and key audiences for messaging (For example, will 

private schools also be included in communications or will this 

audience receive messages from LEAs?) 

Describe if and how the communications systems are redundant and 

if not, plans for ensuring redundancy. 

Designate the state-level education spokesperson (spokespeople, if 

applicable) for both media relations and communicating with LEAs. 

(For example, is this the SEA’s Public Information Officer? Who 

will back up this position?) 

Identify the position designated to communicate with PSSs. 

Identify the position designated to communicate with day care 

centers. 

Activity Added by State 

Sub-objective B.4.4 - Establish expectations and procedures for providing continuity of education for 

students. 

Describe the SEA’s expectations for continuity of education (for 

example, does the state or do communities plan to offer educational 

content that allows for students to remain connected to “normalcy” 

vs. expectation for advancement). 

Identify who will have the primary responsibility for development 

and/or delivery of educational content. (For example, is this the SEA 

or LEAs?) 

Describe the existing technological resources at the state level for 

continuing education. (For example, does the SEA have a website, 

access to public cable, etc.? Will these resources be available to K12 or to PSSs also?) 

Describe how the state will address the needs of special education 

students or students with special needs, if applicable. (For example, 

will the SEA provide technical assistance to districts in assessing 

IEPs or developing content for these students to be delivered 

remotely?) 

Activity Added by State 

Sub-objective B.4.5 - Establish policies and procedures for use of school facilities and resources 

during a pandemic. 

Describe the SEA’s policies or guidance about alternative uses of K12 school facilities or resources. (For example, are there assets that 

are owned by the SEA or whose contracts are negotiated by the SEA, 

such as buses?) 

Describe the state’s policies or guidance about the use of state-funded 

PSS property or assets. (For example, could the state use PSS’s 

73 
 

 

 

 

 

 

 

 

 

 

 

 

 

facilities, such as a stadium as vaccination sites? If so, has the state 

developed appropriate Memoranda of Understanding with the 

relevant PSS?) 

Activity Added by State 

Sub-objective B.4.6 - Ensure that Continuity of Operations and Business Continuity Plans include 

considerations for pandemic for the state educational agency. 

Provide a hyperlink or reference to the Labor section of the pandemic 

plan (Appendix A.1), ensuring that the SEA has included 

considerations for the implications on staffing levels of a pandemic in 

their COOP or BCPs and if SEA staff will be covered in the state’s 

overall plan for paying state staff. 

Describe the state responsibility, if any, for paying staff/faculty at 

state-funded PSSs. 

Activity Added by State 

7BRESPOND 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF SUPPORTING ACTIVITY CITATION TO 

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DOCUMENT 

IF NOT 

APPLICABLE, 

PLEASE 

EXPLAIN 

Sub-objective B.4.7 - Implement policies and procedures for closing schools and/or dismissing 

students. 

List steps for closing schools/dismissing students (if applicable). For this activity and 

each one below, please 

include 

Title 

Page(s) 

First 5 words of first 

sentence 

List process for closing day care centers (if applicable). 

List process for closing state PSSs (if applicable). 

List steps for working with health officials to assess/coordinate 

closures in regions of state that border other states. 

Activity Added by State 

Sub-objective B.4.8 - Implement policies and procedures for continuing education during prolonged 

school closure/student dismissal. 

List steps for activating continuity of education plans. (For 

example, would these plans only be activated as a result of a formal 

declaration of emergency?) 

List how the state would assist in delivering educational content to 

students across the age spectrum (For example, would educational 

content be coordinated for K-12 students? PSS?). 

Describe how the state will participate in helping provide nutrition 

assistance to children who normally would receive free meals 

74 
 

 

 

 

 

 

 

 

 

 

 

 

through USDA’s school/child care feeding programs (National 

School Lunch Program, School Breakfast Program, Child and Adult 

Care Food Program), if applicable.. 

Activity Added by State 

Sub-objective B.4.9 - Clearly communicate policies and procedures about school closures/dismissal of 

students and other important information. 

List steps that SEA will take to provide ongoing communications 

about key health information to specific audiences, including LEAs 

and stakeholders. Designate key positions and lines of authority for 

receipt of and responsibility for dissemination of health 

information. 

(For example, if CDC or state health authority provides information 

about thresholds for dismissing students, reconvening students, etc., 

who at the SEA will be the recipient of this information and how 

will this person disseminate information?) 

List process for how the State will provide ongoing communication 

about education-related issues (such as declarations of emergency 

which would trigger school closures) and whether or not this will be 

the same person as above. Designate key positions and lines of 

authority for receipt of and responsibility for dissemination of 

education information (if different than above). 

List steps the education spokesperson will take to coordinate 

messages with other state entities. (If appropriate, link to 

communications section of pandemic plan.) 

If applicable, describe process by which LEAs and/or state PSSs 

will report to SEA on closures. 

Activity Added by State 

Sub-objective B.4.10 - Protect state assets (school facilities and resources) during a pandemic. 

List SEA’s steps to protect state-owned assets related to schools or 

PSSs (if applicable). 

List steps state will undertake if the state will use state-owned 

educational facilities for alternate uses (if applicable). Describe the 

steps necessary to ensure that sites are prepared to function in 

desired capacity (for example, if a university stadium is being used 

for a vaccination delivery site, are there sufficient refrigeration units 

available and easily accessible? How will these sites be cleaned 

and maintained?) 

Activity Added by State 

75 
 

 

 

 

 

 

 

 

 

 

 

78BRECOVER 

DESCRIPTION OF SUPPORTING ACTIVITY CITATION TO 

SUPPORTING 

DOCUMENT 

IF NOT 

APPLICABLE, 

PLEASE 

EXPLAIN 

Sub-objective B.4.11 - Implement steps to reopen schools/reconvene students. 

List SEA’s steps for reopening schools/reconvening students (if this 

is a state function). 

For this activity and 

each one below, please 

include 

Title 

Page(s) 

First 5 words of first 

sentence 

List steps the state will take to facilitate reopening/reconvening day 

care centers and children. 

List steps the state will take to facilitate reopening/reconvening 

PSSs and students. 

Activity Added by State 

Sub-objective B.4.12 - Communicate policies for reopening schools/reconvening students. 

Describe the communication plan for reopening 

schools/reconvening students (if this is a state function). (For 

example, will the state provide messaging for the LEAs to use 

uniformly about state policy? Will these messages be delivered in 

daily press conferences? Letters to LEA staff? Email?) 

Identify the state spokesperson who will provide messages during 

the recovery stage, as well as the second person in the line of 

succession for this function (if different than during response). 

Activity Added by State 

Sub-objective B.4.13 - Restore the learning environment. 

Describe process State will recommend that LEAs use to assess 

student’s levels with respect to state academic standards. 

List steps that SEA will take to support LEAs in screening and 

referring students for mental health services, if applicable. (For 

example, does the state support efforts for linkages between schools 

and mental health systems?) 

Describe if/how the state will provide additional mental health staff 

or funding for services to students and staff. 

List steps that the SEA will take to support LEAs in assessing 

students with special needs in reviewing, revising, or creating 

Individualized Education Plans (IEPs). 

If the state used state-owned school facilities for alternate uses, 

identify the process and/or funding stream that the state will use to 

support any necessary remediation. 

Activity Added by State 

76 
 

 

 

 

 

 

 

 

 

 

APPENDIX B.5 

Operating Objective: Acquire and Distribute Medical 

Countermeasures during Each Phase of a Pandemic 

This appendix provides planners with information that should be included in emergency operations 

plans to support the acquisition and distribution of medical countermeasures during an influenza 

pandemic. Background guidance and specific assistance are available from the CDC’s Division of 

Strategic National Stockpile. The Division’s “SNS Medical Countermeasure Distribution for 

Pandemic Influenza” which includes 1) references to storage requirements, logistics requirements, 

model workscope documents, and 2) links to Program Preparedness Branch Program Services 

Consultants. 

PREPARE 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF SUPPORTING ACTIVITY CITATION TO 

SUPPORTING 

DOCUMENT 

IF NOT 

APPLICABLE, 

PLEASE 

EXPLAIN 

Sub-objective B.5.1 – Receive and store antiviral drugs, personal protective equipment and medical 

supplies from SNS 

A central warehouse [Receipt/Store/Stage (RSS) facility location has 

been selected for the receipt of antiviral drugs, personal protection 

equipment (N95 masks, etc.) and other ancillary medical supplies from 

SNS. (For recommended RSS specifications, please refer to the 

Strategic National Stockpile’s State Storage Requirements for 

Pandemic Influenza Antiviral Drug Response). 

For this activity and 

each one below, 

please include 

Title 

Page(s) 

First 5 words of 

first sentence 

A contract, memorandum of agreement (MOA) or other appropriate 

documentation is in place that guarantees the availability of the selected 

RSS. 

The RSS management team and back-up personnel have been identified 

The RSS management team and back-up personnel have job action 

sheets for their specific functions 

The RSS staff/volunteers and back-up personnel have been identified. 

Call down rosters for 24/7 operations for all RSS Managers and 

staff/volunteers are documented, reviewed and tested for accuracy 

Job action sheets and just-in-time training materials have been 

developed for each of the RSS functions 

An inventory of material handling equipment that’s available at the RSS 

is documented along with a list of materials/supplies that need to be 

procured and/or delivered at the time of activation 

An inventory of office equipment that’s available at the RSS is 

documented along with a list of materials/supplies that need to be 

procured and/or delivered at the time of activation 

77 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Plan for a primary and back-up inventory management system (IMS) is 

in place 

IMS staff have been identified to perform inventory management 

functions 

Activity Added by State 

RESPOND 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF SUPPORTING ACTIVITY CITATION TO 

SUPPORTING 

DOCUMENT 

IF NOT 

APPLICABLE, 

PLEASE 

EXPLAIN 

Sub-objective B.5.2 – Allocate and distribute drugs within the State 

An allocation methodology and plan is in place. For this activity and 

each one below, 

please include 

Title 

Page(s) 

First 5 words of first 

sentence 

Recipient locations have been agreed upon (e.g. hospitals, skilled 

nursing facilities, community health centers, and other treatment 

facilities) and documented. Documentation includes but is not 

limited to: 

• Location name, address and telephone #s 

• Points of contact and contact information 

• Facility off-load location and assessment of the site off-load 

capabilities 

The plan to train recipient locations on the antiviral drug distribution 

activation procedures is in place. 

Procedures are documented for recipient locations to request 

additional supplies. 

A Distribution Manager and back-up(s) have been identified. 

Procedures to monitor chain of custody are in place. 

A distribution plan is in place that includes: 

• Delivery locations and routes 

• Load planning 

• Communication plan with RSS/drivers/recipient locations 

• Delivery schedule/frequency 

Primary agency/Organization has been assigned to distribute antiviral 

drugs, personal protection equipment (N95 masks, etc.) and other 

ancillary medical supplies. A contract, memorandum of agreement 

(MOA) or other appropriate documentation is in place that guarantees 

the availability of the selected resource. 

• Agreement should include but not be limited to 

o Activation procedures 

o 24/7 availability 

78 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

o Guaranteed number and type of delivery vehicles 

o Guaranteed number of drivers 

o Available communications equipment 

Just in time training materials have been applied to the distribution 

functions: 

• Chain of custody procedures 

• Routing 

• Communication procedures 

• Security procedures 

Activity Added by State 

Sub-objective B.5.3 – Ensure a safe and secure environment 

State-level Security Coordinator has been identified to coordinate 

overall security issues. 

State security support agencies have been identified and oriented to 

security issues/needs. 

Security plans are in place for RSS. The plan should include but not 

be limited to: 

• Written site security and vulnerability assessment 

• Plans for interior and exterior security 

• Number of officers and designated posts 

• Need for physical barriers, lighting, etc... 

• Plans for access control 

• Plans for security communications 

• Plans for security breaches 

Security plans are in place for the escort of the delivery trucks to 

recipient locations. 

Security plans are in place for the recipient locations. 

Staff badging/credentialing system for all response personnel is in 

place. 

Activity Added by State 

Sub-objective B.5.4 – Administer drugs in a legal and ethical manner 

Plans are in place to administer antiviral drugs for treatment to 

priority groups when treatment of illness is indicated. 

Plans and protocols are in place for antiviral drugs that may need to 

be administered under Investigational New Drug (IND) or 

Emergency Use Authorization. Plans should include procedures for 

the receipt on the IND protocol consent forms to be received and 

mass copied for distribution. 

Activity Added by State 

RECOVER 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF SUPPORTING ACTIVITY CITATION TO IF NOT 

SUPPORTING 

DOCUMENT 

APPLICABLE, 

PLEASE 

EXPLAIN 

79 
 

 

Sub-objective B.5.5 – Monitor for adverse reactions to drugs 

Steps for utilizing the tracking system to track outcomes and adverse 

events following treatment with antiviral drugs is in place. 

For this activity and 

each one below, 

please include 

Title 

Page(s) 

First 5 words of 

first sentence 

Information systems are available that support monitoring of adverse 

reactions that comply with the Public Health Information Network 

functional requirements for Countermeasure and Response 

Administration. 

Activity Added by State 

80 
 

 

 

 

APPENDIX B.6 

Operating Objective: Ensure Mass Vaccination Capability During 

Each Phase of a Pandemic 

This appendix provides planners with information that should be included in emergency operations 

plans to support the acquisition and distribution of medical countermeasures during an influenza 

pandemic. Documents should incorporate references to “Pandemic Influenza Vaccination: A Guide for 

State, Local and Territorial and Tribal Planners (December 2006)”, produced by CDC’s 

Immunization Service Division, as well as the document “Status of pandemic influenza vaccine 

manufacturing capacity, pre-pandemic stockpile, and planning for vaccine distribution” (October 

2007). 

PREPARE 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF SUPPORTING ACTIVITY CITATION TO 

SUPPORTING 

DOCUMENT 

IF NOT 

APPLICABLE, 

PLEASE 

EXPLAIN 

Does the plan provide guidance for priority groups on whether they will 

be vaccinated by public health, or by institutions or agencies to whom 

responsibility has been delegated, or a combination? 

For this activity and 

each one below, 

please include 

Title 

Page(s) 

First 5 words of 

first sentence 

Does the plan include developing memoranda of agreements or other 

formal agreements with institutions and agencies to whom vaccination 

will be delegated, where applicable? 

Does the plan develop protocols for verification of priority 

group membership? 

Sub-objective B.6.1 - Vaccine Monitoring 

Does the plan designate a vaccine safety coordinator position? 

Is there a plan to ensure timely reporting of adverse events? 

Activity Added by State 

RESPOND AND RECOVER 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF SUPPORTING ACTIVITY CITATION TO IF NOT 

81 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SUPPORTING 

DOCUMENT 

APPLICABLE, 

PLEASE 

EXPLAIN 

Is there a plan to estimate the project area’s weekly allocation of 

vaccine based on vaccine availability assumptions and project area 

population size? 

For this activity and 

each one below, 

please include 

Title 

Page(s) 

First 5 words of 

first sentence 

Does the plan include designated recipient's ship-to sites for prepandemic and pandemic vaccine? 

Is there a plan for the following: 

• Personnel and backups identified for receipt of vaccines 

• Detailed written Operating Procedures (SOPS) in place 

• Temperature Monitoring (audible/manual or both) 

management system in place 

• Inventory Accountability 

Does the plan determine what proportion of vaccine will be 

allocated to each ship-to site? 

At ship-to sites, is there a process to determine what proportion of prepandemic and pandemic vaccine will be allocated to further points of 

distribution, if applicable? Is the Distribution manager identified? 

Does the plan ensure the availability of sufficient storage at 

all relevant locations to maintain the cold chain? 

Does the plan determine how vaccine will be transported to 

vaccinating sites? 

Does the plan include chain of custody procedures? 

Does the plan include a vaccine security plan that includes State-level 

Security coordinator identified, State security support agencies 

identified, vulnerability assessment, badging/credentialing system in 

place? 

Does the plan determine number and location of clinics based on 

planning assumptions? Does it include: 

• MOA’s (or other appropriate documentation) 

• Points of contact identified 

Does the plan include estimated number of doses to be administered per 

shift, based on assumed vaccine availability and relative allocation 

within project areas? 

Does the plan identify sources of staffing and develop 

memoranda of agreement with the following: 

• Backups identified 

• Job descriptions 

Does the plan include an incident response plan for security situations? 

Does the plan include instructions about a second dose? 

Does the plan include how data will be collected at the 

administration sites? 

Activity Added by State 

82 
APPENDIX B.7
 

Operating Objective: Provide Health Care 

This appendix provides State planners with recommendations for developing health care operational 

plans to manage an influenza pandemic. These recommendations are not intended to be prescriptive in 

nature, but are intended to provide expected outcomes of the planning process. The spectrum of 

supporting activities under the FEMA framework of “Prepare, Respond and Recover” is critical to 

overall State capability. However, only those activities under “Respond” and “Recover” will be 

reviewed, since the focus of this guidance is on operational activities. States are asked to provide 

detailed information as to how they plan to address only those recommendations in the attached table. 

Much of the information in this guidance is extrapolated from the Department of Health and Human 

Services (HHS) Pandemic Influenza Plan Supplement 3 Healthcare Planning. This supplement can be 

found at: www.hhs.gov/pandemicflu/plan/sup3.html#s3-11. Additional planning resources are 

available at: www.panflu.gov, http://www.ahrq.gov/prep/#tools, 

http://www.cna.org/documents/mscc_aug2004.pdfUH and 

www.usfa.dhs.gov/downloads/pdf/PI_Best_Practices_Model.pdf. 

PREPARE 

States should plan and develop pandemic influenza plans with local, regional, State, and federal 

partners. Planning should include, but is not limited to the following: 

•	 Form community-wide coalitions to include hospitals, urgent care facilities, other ambulatory 

care facilities, public health, long term care facilities, nursing homes, home health care 

agencies, community health centers, primary care offices, mental health and substance abuse 

treatment facilities, EMS, and other first responders to accommodate surge in patients expected 

from pandemic influenza. 

•	 Assist healthcare facilities in conducting exercises and drills to test health care response issues 

and build partnerships among health care and public health officials, community leaders, and 

emergency response workers. 

•	 Address the medical concerns and needs of at-risk individuals and populations, 

•	 Assist non-hospital community-based providers for at-risk individuals (e.g. day psychosocial 

treatment centers, advocacy organizations with recreational programs, and facilities managing 

congregate living in the local community) in participating in exercises and drills to test at-risk 

response issues and build partnerships among providers and public health officials, community 

leaders, and emergency response workers. 

•	 Develop an interoperable communications infrastructure to facilitate and ensure the timely 

dissemination and transfer of information between health care and other sectors (such as 

emergency management, public safety, EMS, service providers for at-risk individuals, etc.). 

•	 Address legal and ethical issues that can affect staffing and patient care (such as credentialing 

issues and providing care with scarce medical resources). 

•	 Assist the health care community with planning for provision of care in hospitals to include: 

hospital surveillance, education and training, triage, clinical evaluation, admission procedures, 

HU UH HU UH HU UH HUHU UH

83 
facility access, occupational health, use and administration of vaccines and antiviral drugs, 

surge capacity, security, and mortuary issues. 

•	 Assist the health care community with planning for provision of care in non-hospital settings to 

include non-hospital health care facilities (e.g. long term care facilities, dialysis centers, nursing 

homes, mental health and substance abuse treatment facilities, Federally Qualified Health 

Centers (FQHCs), etc.), home healthcare networks and/or alternative care sites. 

•	 Anticipate needs for medical supplies and equipment to treat complications of pandemic 

influenza and determine how supplies will be maintained. 

Additional considerations for the Department of Veterans Affairs (VA) and the Indian Health 

Service (IHS) 

•	 Are VA and IHS beneficiaries included in the State numbers for PPE, antiviral drugs, vaccine, 

etc.? 

•	 Have States encouraged local planners to establish a communication network with local VA 

and IHS facilities? 

•	 Have State planners included State and federal VA partners in their planning process? 

•	 Do State planners understand the VA and IHS roles in the National Response Framework? 

•	 Do State planners understand the process for requesting VA and IHS assistance? 

84 
 

 

 

 

 

 

 

RESPOND 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF SUPPORTING ACTIVITY CITATION TO 

SUPPORTING 

DOCUMENT 

IF NOT 

APPLICABLE, 

PLEASE 

EXPLAIN 

Interoperable communications network in place between State, public 

health, health care community, and other sectors. 

For this activity and 

each one below, 

please include 

Title 

Page(s) 

First 5 words of 

first sentence 

Mechanism in place to address the concerns and needs of at-risk 

individuals and populations. 

Mechanism in place to provide guidance (as needed) on infection 

control measures for health care and non-healthcare settings 

Procedures for reporting available beds using National Hospital 

Available Beds for Emergencies and Disasters (HAvBED) System 

definitions 

Procedures for deploying and tracking volunteer health care providers 

using the State’s Emergency System for Advance Registration of 

Volunteer Health Professionals (ESAR-VHP) requirements 

Procedures developed and approved by an Ethics Committee for 

providing for the ethical distribution of scarce medical resources among 

the health care community 

Procedures to expand healthcare services into non-hospital/alternate 

care sites including identification of locations, scope of care, 

procurement of staffing, equipment, supplies and pharmaceuticals 

Activity Added by State 

85 
 

 

79BRECOVER 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF SUPPORTING ACTIVITY CITATION TO 

SUPPORTING 

DOCUMENT 

IF NOT 

APPLICABLE, 

PLEASE 

EXPLAIN 

Recovery mechanism in place to assist the health care 

community in restoring essential staffing, equipment, supplies 

and pharmaceuticals 

For this activity and each 

one below, please include 

Title 

Page(s) 

First 5 words of first 

sentence 

Recovery mechanism in place for assisting with plans for 

restoring essential mental health, substance abuse and 

congregate living services to pre-pandemic conditions. 

Recovery mechanism in place to perform after action reviews 

to identify strengths and weaknesses in the execution of the 

plan 

Activity Added by State 

86 
 

APPENDIX B.8 

Operating Objective: Manage Mass Fatalities 

PREPARE 

States should base planning on the estimated number of fatalities expected during an influenza 

pandemic. Planning should address the need for expanded refrigerated storage capacity and body bags, 

and delineate roles and responsibilities of all agencies involved in mass fatality management. 

Challenges 

- Roles of local, State and federal partners 

- Functionality of local coroners 

- Contamination, bodily fluids and other hazards 

- Crime scene considerations and evidence preservation 

- Political pressure to “do something” 

- Contract development and monitoring 

- Data collection and other contract performance issues 

UDevelop a Fatality Management plan 

•	 May need a temporary interment site initially 

•	 Must be large enough to accommodate the need 

•	 Consider options other than cold storage units 

•	 Consider public property first – especially if this may be the final resting place 

•	 Consider a permanent memorial in the event of a specific result of natural / terror-related 

incident. 

•	 Use local transport to transport remains from home or collection point directly to morgue. 

Incorporate security measures at the collection points. 

•	 Work with the Religious Ritual Burial Committees- establish fatality plans that either 

utilize their services or can meet their religious traditions to the best of ability considering 

the circumstances of the situation. 

•	 Consider implementing a unified fatality management task force structure 

•	 Ensure coordination with local authorities 

•	 Database synchronization and networking are critical components in support of information 

management 

•	 Integration between morgue operations and Family Assistance Center (FAC) operations 

87 
 

 

RESPOND AND RECOVER 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF SUPPORTING ACTIVITY CITATION TO 

SUPPORTING 

DOCUMENT 

IF NOT 

APPLICABLE, 

PLEASE 

EXPLAIN 

Arrange for Web-based death certificate processing and secure tracking 

to the State Department of Health. 

For this activity and 

each one below, 

please include 

Title 

Page(s) 

First 5 words of 

first sentence 

Plan for [behavioral health/grief] community education that includes an 

expectation of death at home, not in a medical facility. 

Plan for [behavioral health/grief] public messages to address 

stress management 

Activity Added by State 

88 
 

 

 

 

 

 

 

APPENDIX B.9 

Operating Objective: Ensure Communication Capability During Each 

Phase of a Pandemic 

This appendix provides planners with information that should be included in emergency operations 

plans to support both the tactical equipment/hardware communication capability and the risk 

communication capabilities during an influenza pandemic. Additional items for consideration for 

planning can be found at 

HUhttp://www.pandemicflu.gov/plan/States/Statelocalchecklist.html#communicationsUH. 

PREPARE 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF SUPPORTING ACTIVITY CITATION TO 

SUPPORTING 

DOCUMENT 

IF NOT 

APPLICABLE, 

PLEASE 

EXPLAIN 

Sub-objective B.9.1 - Operating Plans for Two-Way Communications 

Does a plan exist for two-way communications through the State For this activity and

Emergency Operations Center between (1) State partners (e.g., 

health, emergency management, education, transportation, economic 

development) and (2) regional multi-agency coordination centers 

each one below, 

please include 

(regional healthcare coalitions, local public health, local emergency 

management, EMS, local Citizen Corps, etc.)? Title 

Page(s) 

First 5 words of first 

sentence 

Does the plan ensure a process to ensure redundant communications 

systems are in place in the event that primary communications 

systems are unavailable? 

Does the plan ensure a process to ensure that communication 

networks (equipment/hardware) between Command and Control 

locations and support agencies will be tested and exercised at least 

quarterly? 

Does the plan ensure a process for an intraState communication 

enhancement network to ensure that public health communicators at 

all levels of State and local government are interacting on a regular 

basis with uniform communications? 

Does the plan ensure access to information systems that have been or 

are being evaluated for PHIN* compliance *All States are expected 

to have or to be working towards information technology systems 

whose implementation meets the PHIN requirements, as per 

Pandemic Influenza Guidance Supplement to the 2006 Public Health 

Emergency Preparedness Cooperative Agreement Phase II. 

Does the plan include a process for communicating preparedness 

messages to the public? 

89 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

Does the plan ensure that communication processes (working from 

the JIC) will be exercised at least bi-annually? 

Activity Added by State 

Sub-objective B.9.2 - Culturally-Appropriate and Language Specific Information 

Does the plan ensure a process for the development of culturally 

appropriate and language-specific essential information in 

appropriate media and in advance as part of the preparation for an 

influenza pandemic? 

• Culturally-appropriate? 

• Pictograms? 

• Available to special needs populations (such as disability 

communities (including those that are hearing or visually 

impaired), citizens with low level English comprehension 

and individuals with English as a second language? 

Identification of trusted leaders, liaisons, or other networks in 

communities for effective outreach and information dissemination? 

Activity Added by State 

RESPOND AND RECOVER 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF SUPPORTING ACTIVITY CITATION TO 

SUPPORTING 

DOCUMENT 

IF NOT 

APPLICABLE, 

PLEASE 

EXPLAIN 

Sub-objective B.9.3 - Development and Dissemination of Essential Information 

Does the plan include a crisis communication and emergency risk For this activity and 

plan (for public information and media, partner, and stakeholder 

relations) that addresses all phases of an influenza pandemic? each one below, 

please include 

Title 

Page(s) 

First 5 words of first 

sentence 

Does the plan address how State and local health departments will 

work with other response organizations to educate the media, public, 

partners and stakeholders, specifically including: 

• Designated line and staff responsibilities for the public 

information team 

• Information verification and clearance/approval procedures 

for public information releases 

• Regional/stand and/or local media contact list with normal 

duty and after-hour contact numbers and addresses 

• Contact numbers/addresses for emergency response 

information partners (e.g., Governor’s public affairs officers, 

local FBI public information agent in charge, American Red 

90 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Cross and other non-government organizations) 

• Procedures to join the Joint Information Center (JIC) of the 

State Emergency Operations Center (if activated)including a 

call-down list with contact information for primary and 

secondary staff members 

Does the plan ensure that rapidly-needed public health 

recommendations and information can be provided to the public, 

partners and stakeholders during a pandemic, specifically including: 

• Critical communication links to other intra-dept and interdept response officials 

• Identification of vehicles of information dissemination to 

public, stakeholders, partners (e.g., e-mail, fax, Health Alert 

Network messages, brochures, PSAs, press releases) 

• A contact list of additional persons outside the State health 

department who can be available as subject matter experts 

on pandemic health issues if needed 

• Support materials for public health issues that are unique to 

an influenza pandemic such as issues of isolation, 

quarantine, social distancing, and public health law have 

been prepared 

• Use of hotlines and other community resources to respond to 

local questions from the public and professional groups 

Does the plan identify individuals responsible for development and 

dissemination of multi-media essential information to the general 

public and professional response partners (e.g., regional multi-agency 

coordination centers, State emergency managers, State transportation 

officials) to enhance their respective preparedness before and during 

an influenza pandemic? 

Activity Added by State 

Sub-objective B.9.4 - Culturally-Appropriate and Language Specific Information 

Does the plan ensure a process for the development of culturally 

appropriate and language-specific essential information in 

appropriate media and in advance as part of the preparation for an 

influenza pandemic? 

• Culturally-appropriate? 

• Pictograms? 

• Identification of trusted leaders/liaisons in communities for 

information dissemination? 

Activity Added by State 

Sub-objective B.9.5 - Media Spokesperson 

Does the plan include a list of trained spokespersons to work with the 

media? 

Does the plan include an up-to-date contact list of key stakeholders 

and media contacts? 

Does the plan include a process for regular briefings and updates with 

key stakeholders to develop working relationships in the event of a 

pandemic: 

• Ethnic/language-specific media 

• Main media 

• Special needs/at risk populations 

Activity Added by State 

91 
APPENDIX B.10 

Operating Objective: Mitigate the impact of an influenza pandemic on 

workers in the State 

Intent: To ensure workers are supported during and after a pandemic. 

Note that States should also help employers and individuals prepare to implement community 

mitigation strategies and assist them in understanding the importance of pandemic planning. See 

Appendix B.3, Implement Community Mitigation Interventions and the Annex for recommendations 

on actions that can be taken to assist employers and individuals. 

States should: 1) assess which State benefits and other assistance programs can help workers during a 

pandemic and whether new resources, laws or programs may be needed, and 2) provide information to 

help workers and their families prepare for a pandemic. Many individuals in the State will be unable 

to work due to illness, the need to care for ill family members, the need to stay home temporarily when 

exposed to an ill person, or the need to care for a child dismissed from school. Some workers will lose 

their jobs because of the pandemic; others may be on unpaid leave (after exhausting their paid leave or 

because they do not have paid leave). States need to assess the benefits and services available to 

workers during a pandemic in order to assist them. 

a.	 Review State and federal benefit programs that may assist workers, particularly unemployed 

workers. Programs of particular importance during or after a pandemic may include: children, 

youth and family protective services; juvenile justice; foster care; income support services; and 

public-supported food and nutrition services. 

 For workers who become unemployed and are looking for work, the relevant State or 

federal programs may include: unemployment insurance (UI) (and perhaps Disaster 

Unemployment Assistance (DUA)), Food Stamps, medical assistance, and cash assistance. 

Some States may also have Dislocated Worker Rapid Response Units. 

	 For workers who become unemployed and are unable to work during a pandemic, 

assistance may include Food Stamps, medical assistance, and cash assistance programs. 

(Note that workers are generally not eligible for UI/DUA if they are not available for work. 

This may occur more frequently than usual during a pandemic because of the need to care 

for children dismissed from school.) 

b.	 Assess triggers for these programs to determine if the unique circumstances of a pandemic 

affect workers’ eligibility for these programs. For State-provided programs or services, 

determine if additional legal/statutory and other flexibilities may be needed. 

 If there is a State family and medical leave law, assess whether the State law will be 

applicable for workers who need to take time off from work during a pandemic, i.e., 

whether eligibility requirements would be met for those with a job but unable to work due 

to care of sick family members, care for children dismissed from school, or because they 

themselves are ill. 

	 For workers who become ill with pandemic influenza at work, assess whether workers’ 

compensation benefits plans would generally apply and thus could provide temporary 

income support. 

	 Assess whether there are State-supported, local, or non-profit mental health and substance 

abuse services that may be able to provide psychological and social support to workers and 

U U

U U

92 
 

 

 

 

their families during and after a pandemic. Include these services in State pandemic 

planning resource lists. 

c. Assess whether these State services or benefits can be provided during a pandemic with social 

distancing practices in place and with a reduced State workforce. Review agency plans to 

handle a potential increase in filing of claims or requests for service. (See Appendix A.1, Part 

I.) 

d. Discuss pandemic plans and coordinate with current workforce partners in order to match 

unemployed workers with employers who may have additional labor force needs during a 

pandemic. Assess whether these employment services can be provided with social distancing 

practices in place and with a reduced State workforce. (See Appendix A.1) 

e. Assess what post-pandemic services or benefits may be needed for workers, particularly those 

that are unemployed; include the need for psychological and social support. (Psychological and 

social support services may be available from community or other non-profit sources if they are 

not available from the State.) 

Note: The text above is provided to assist the State in understanding what is required and the reasoning 

behind the requirements in the “PREPARE” section of the table. The “RESPOND AND RECOVER” 

section of the table lists actions to be taken during or after a pandemic that should be included in the 

U U U

U

U

U

U U

U U

State’s pandemic plan. (Whether some “RESPOND AND RECOVER” actions will be taken depends 

on specific conditions, such as the severity of the influenza pandemic.) 

PREPARE 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF SUPPORTING ACTIVITY CITATION TO 

SUPPORTING 

DOCUMENT 

IF NOT 

APPLICABLE, 

PLEASE 

EXPLAIN 

Review State and federal benefit programs and services that may assist For this activity and 

workers, particularly unemployed workers; assess triggers for these 

programs and services; implement any needed changes each one below, 

please include 

Title 

Page(s) 

First 5 words of 

first sentence 

Assess whether services or benefits can be provided with social 

distancing practices in place and with a reduced State workforce; review 

agency plans to handle a potential increase in filing of claims or 

requests for service 

Discuss pandemic plans and coordinate with current workforce partners 

Assess what post-pandemic services or benefits may be needed for 

workers, particularly those that are unemployed (include psychological 

and social support) 

Activity Added by State 

93 
 

 

RESPOND AND RECOVER 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF SUPPORTING ACTIVITY CITATION TO 

SUPPORTING 

DOCUMENT 

IF NOT 

APPLICABLE, 

PLEASE 

EXPLAIN 

Communicate to State workers the availability of any new 

programs or services (See Appendix B.9) 

For this activity and 

each one below, 

please include 

Title 

Page(s) 

First 5 words of 

first sentence 

Implement any special programs/ triggers/statutes for 

assisting workers during a pandemic 

Implement any special programs/ services for assisting 

workers after a pandemic (include psychological and social 

support) 

Activity Added by State 

94 
Operating Objective: Understand Official Communication Mechanism

For Foreign Missions, International Organizations, and Their Member

in the United States 

s 

s 

 

 

APPENDIX B.11 

While States do not have any official role to play in communicating with foreign missions, 

international organizations and their members, it is important for them to understand that the US 

Department of State (DOS) will communicate with these entities. The DOS message will be one of 

expectation that employees of diplomatic missions follow the instructions of the State and local 

officials – just like the U.S. citizen population. 

PREPARE 

Regarding international coordination, DOS will take the lead, with input from HHS and other relevant 

agencies, on communications with foreign governments, foreign missions in the United StatesF 

34 F and U.

S. citizens abroad. DOS will also serve as the USG’s interagency coordinator for general international 

communications; it will review the domestic pandemic communications of other USG agencies for 

possible international ramifications. 

Employees of diplomatic missions are expected to cooperate (just like everyone else) with the State 

and local officials as they carry out their duties in the event of a pandemic situation. DOS will ensure 

that all foreign missions are reminded of that, in the event of an actual pandemic. In the event that 

problems or questions that arise when local officials are carrying out their duties, and dealing with 

foreign missions, the DOS has provided, in the Annex, how a State should obtain assistance from 

DOS. 

Upon WHO Designation of Phase 4: Upon the Director General of the World Health Organization 

announcement that there is evidence of significant human to human transmission such that the world 

has entered “Phase 4” of the global influenza preparedness plan, DOS and HHS will implement the 

following plan: 

Formal Communication of Phase 4 to the Foreign Government Mission Community: 

DOS will issue a Circular Diplomatic Note to the Chiefs of all Foreign Missions and International 

Organizations informing them of the measures that the United States is taking to address the pandemic, 

the legal and practical concerns of that community, and provide information on how to transmit 

questions or concerns to the DOS pertaining to the Pandemic Influenza. The Circular Diplomatic Note 

will also set forth the expectations of foreign mission personnel. For example, if, as part of a targeted 

layered containment the public is requested to stay at home, not attend schools, minimize shopping and 

other social interaction, the same request is likely to be made of the foreign mission community. 

The Circular Diplomatic Note will be posted on the Pandemic Influenza section of the DOS Office of 

Foreign Mission’s (OFM) website www.State.gov/ofm; it will also be disseminated to foreign missions 

and international organizations via electronic mail, US mail and facsimile. OFM’s six regional offices 

U

HU UH

34 National Strategy for Pandemic Influenza: Implementation Plan (May 2006), Action #4.1.4.3. 

95 
(Chicago, Houston, Los Angeles, Miami, New York and San Francisco) will ensure that the note is 

distributed to the consulates located in their respective regions. 

HHS will use its existing networks with State, local and tribal leaders to convey any guidance prepared 

by the Department of State. The HHS Office of Intergovernmental Affairs will send such guidance to 

governors’ health policy advisors and other key State, local and tribal officials, as well as national 

organizations representing governors, State legislators and State and local health officials, and tribal 

leaders. These organizations include the National Governors Association, Association of State and 

Territorial health officials, National Association of Counties, National Association of County and City 

Health Officials, U.S. Conference of Mayors, National Congress of American Indians, and National 

Indian health Board. In addition, the HHS Regional Directors will conduct outreach to appropriate 

State, local and tribal officials, as needed. 

DOS guidance that HHS will share with such authorities might well include a copy of the Circular 

Note, as well as any relevant considerations in the context of implementing measures that address the 

pandemic that would arise in the context of the privileges and immunities enjoyed by some members 

of that community. For example, if relevant, DOS may want to remind such authorities that while 

certain foreign mission personnel have personal inviolability and cannot be arrested or detained, they 

do have a duty to “respect” local law. In addition, it may be relevant, for example, that diplomatic 

mission premises cannot be entered without the consent of the chief of mission. 

Reference: HUhttp://www.State.gov/ofm/c19455.htmU 

RESPOND AND RECOVER 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF SUPPORTING ACTIVITY CITATION TO 

SUPPORTING 

DOCUMENT 

IF NOT 

APPLICABLE, 

PLEASE 

EXPLAIN 

The State ensures that localities include foreign missions in 

the distribution lists of public messages regarding pandemic 

influenza and precautions needed to be taken by 

individuals. 

For this activity and 

each one below, 

please include 

Title 

Page(s) 

First 5 words of 

first sentence 

Activity Added by State 

96 
 

 

APPENDIX B.12 

Operating Objective: Assure the Emergency Medical Services System 

(EMS) and the 9-1-1 System are Integral Component of a State’s 

Pandemic Influenza Planning and Response. 

An influenza pandemic could seriously impact the Nation – its health care delivery system, its 

transportation system, its economy and its social structure. As the nation’s health care “safety net,” 

Emergency Medical Services will be faced with higher demands for services while experiencing 

problems similar to the rest of the Nation – increased employee absenteeism, disruption of supply 

chains and increased rates of illness and death. Ensuring EMS is well-integrated into the Nation’s 

pandemic influenza planning and response is essential to the Nation’s health and safety in the event of 

a pandemic. 

This operating objective and sub-objectives are adopted from the U.S. Department of Transportation’s 

EMS Pandemic Influenza Guidelines for Statewide Adoption developed in response to Task 6.1.13.6 

of the National Strategy for Pandemic Influenza: Implementation Plan. The document is available 

online at www.ems.gov States and local EMS agencies are encouraged to review these documents for 

additional information on EMS and 9-1-1 Influenza Pandemic planning and response. The subobjectives are as follows: 

Sub-objective 1. EMS planning 

Sub-objective 2. EMS as a component of influenza surveillance & mitigation 

Sub-objective 3. Maintaining continuity of EMS operations 

Sub-objective 4. Legal authority for EMS operations during pandemic influenza 

Sub-objective 5. Clinical standards and treatment protocols 

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HU UH

Sub-objective 6. EMS Workforce protection 

Sub-objective 1: EMS Planning 

PREPARE 

EMS must be “at the table” to provide leadership during planning of State and community pandemic 

influenza surveillance, mitigation and response. EMS must be a part of community-wide planning and 

exercise. EMS pandemic influenza plans should address all patient population including children, the 

elderly, and those with special needs. 

•	 State, local, tribal, and territorial EMS agencies should adopt EMS pandemic influenza plans 

and operational procedures that define the role of EMS in preparing for, mitigating and 

responding to pandemic influenza. 

•	 State, local, tribal, and territorial pandemic influenza plans and operational procedures should 

identify leadership and authority that are consistent with the National Response Framework and 

the National Incident Management System, including the Incident Command System, and be 

carefully coordinated with local emergency management plans. 

97 
 

 

 

 

 

•	 EMS pandemic influenza plans should establish a program of pre-pandemic training and 

exercising to prepare EMS personnel for their role in the local pandemic influenza plan. 

•	 State, local, tribal and territorial EMS agencies, in coordination with Federal, State and local 

public health, 9-1-1, emergency management and health care officials should ensure that EMS 

pandemic influenza plan define a process for gathering and developing updated pandemic 

influenza information, including clinical standards, treatment protocols and just-in-time 

training and disseminate it to local EMS medical directors and EMS agencies. 

•	 State, local, tribal, and territorial EMS and 9-1-1 agencies should define a public and media 

communications plan that is coordinated with the Incident Command System and public health 

officials to assure consistent education and instructions to the public. 

RESPOND 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF CITATION TO IF NOT 

SUPPORTING ACTIVITY SUPPORTING 

DOCUMENT 

APPLICABLE, 

PLEASE 

EXPLAIN 

Has the State adopted EMS pandemic influenza plans and operational 

procedures that define the role of EMS in preparing for, mitigating and 

responding to pandemic influenza? 

For this activity 

and each one 

below, please 

include 

Title 

Page(s) 

First 5 words of 

first sentence 

Has the State established a Statewide program of pre-pandemic training and 

exercising to prepare EMS personnel for their role in preparing for, 

mitigating and responding to pandemic influenza? 

Has the State established a method for developing and distributing pandemic 

influenza information, including clinical standards, treatment protocols and 

just-in-time training to local EMS medical directors and EMS agencies? 

Activity Added by State 

98 
 

RECOVER 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF 

SUPPORTING ACTIVITY 

CITATION TO 

SUPPORTING 

DOCUMENT 

IF NOT 

APPLICABLE, 

PLEASE 

EXPLAIN 

Has the State established methods to integrate best practices or lessons 

learned during the previous pandemic wave into EMS system operations and 

to issue an after action report? 

For this activity 

and each one 

below, please 

include 

Title 

Page(s) 

First 5 words of 

first sentence 

Activity Added by State 

Sub-objective 2: The Role of EMS in Influenza Surveillance and Mitigation 

PREPARE 

State, local, tribal, and territorial EMS agencies should integrate pandemic influenza surveillance, 

mitigation and response in their EMS system. An EMS system’s response to pandemic influenza 

should be flexible, scaleable, dynamic and timely with the ability to change rapidly based on new 

information about the virus and other public health emergencies. Standards, protocols and other 

guidelines will be modified based on the specific threat to the public’s health. 

EMS providers can play a role in pandemic influenza mitigation due to their capability to rapidly 

respond, assess, treat and report patients with signs and symptoms of pandemic influenza. Their early 

involvement in community mitigation strategies such as Targeted Layered Containment may help to 

control the spread of the virus and reduce the subsequent use of health care resources. 

•	 State, local, tribal, and territorial EMS pandemic influenza plans should identify the role that 

EMS agencies should play in ongoing disease surveillance. 

•	 State EMS pandemic influenza plans should establish or identify a Statewide system that 

tracks: a) patient location, b) healthcare facility availability, and c) patient disposition to allow 

public health and epidemiologic analysis. 

•	 State, local, tribal, and territorial EMS agencies, in coordination with public health 

authorities and consistent with resources, legal authority and education, should define 

procedures for involving EMS providers in pandemic influenza community mitigation 

strategies, including Targeted Layered Containment. 

99 
 

 

 

RESPOND AND RECOVER 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF CITATION TO IF NOT 

SUPPORTING ACTIVITY SUPPORTING 

DOCUMENT 

APPLICABLE, 

PLEASE 

EXPLAIN 

Has the State established procedures for involving EMS agencies in ongoing 

disease surveillance? 

For this activity 

and each one 

below, please 

include 

Title 

Page(s) 

First 5 words of 

first sentence 

Has the State identified procedures for involving EMS providers in 

pandemic influenza community mitigation strategies, including Targeted 

Layered Containment? 

Activity Added by State 

Sub-Objective 3: Maintaining Continuity of EMS Operations During an Influenza Pandemic 

PREPARE 

Continuity of operations planning for EMS should address maintaining the day-to-day EMS response 

during a pandemic; workforce augmentation; disruption of equipment, supplies and services; 

interoperable communications; and compatible communications equipment and communications 

frequencies. 

•	 As part of a systematic all-hazards approach to EMS pandemic influenza planning, State, 

local, tribal, and territorial EMS agencies should have plans in place that allow EMS to 

maintain its response to day-to-day emergencies while addressing the demands of pandemic 

influenza mitigation. 

•	 State, local, tribal, and territorial EMS pandemic influenza plans should include a continuity 

of operations (COOP) plan that ensures essential functions and vital services can be 

performed during an influenza pandemic or other major public health emergency. 

•	 State, local, tribal, and territorial EMS agencies should have backup plans to augment the 

EMS workforce. 

•	 EMS agencies should plan for disruptions in the availability of equipment, supplies and 

services. 

100 
 

 

 

 

 

 

•	 State, local, tribal, and territorial EMS pandemic influenza plans should include effective, 

reliable interoperable communications systems among EMS, 9-1-1, emergency management, 

public safety, public health and health care agencies. 

•	 EMS pandemic influenza plans should include compatible communications equipment and 

communications radio frequency plans for common hospital diversion and bed capacity 

situational awareness at the local, State and regional level. 

RESPOND AND RECOVER 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF CITATION TO IF NOT 

SUPPORTING ACTIVITY SUPPORTING 

DOCUMENT 

APPLICABLE, 

PLEASE 

EXPLAIN 

Does the State have backup plans to augment the local EMS workforce if 

needed? 

For this activity 

and each one 

below, please 

include 

Title 

Page(s) 

First 5 words of 

first sentence 

Does the State have backup plans to address disruptions in the availability of 

EMS equipment, supplies and services throughout the State? 

Does the State have an effective, reliable interoperable communications 

system among EMS, 9-1-1, emergency management, public safety, public 

health and health care agencies? 

Is there a Statewide communications plan, including communications 

equipment and radio frequency plan to support common hospital diversion 

and bed capacity situational awareness at the local, State and regional level? 

Activity Added by State 

Sub-Objective 4: Legal Authority 

PREPARE 

Planning for EMS operations during an influenza pandemic should address issues of legal authority 

such as deviation from established procedures and EMS freedom of movement. 

•	 State EMS pandemic influenza plans should establish procedures for EMS providers to 

deviate legally from their established treatment procedures to support mitigation of and 

response to pandemic influenza and other public health emergencies while still assuring 

appropriate education, medical oversight and quality assurance. 

101 
 

 

 

 

•	 State EMS pandemic influenza plans should, in coordination with public health, emergency 

management, and law enforcement agencies, identify mechanisms to ensure freedom of 

movement of EMS assets (vehicles, personnel, etc.). 

RESPOND AND RECOVER 

DESCRIPTION OF 

SUPPORTING ACTIVITY 

CITATION TO 

SUPPORTING 

DOCUMENT 

IF NOT 

APPLICABLE, 

PLEASE 

EXPLAIN 

Has the state established procedures for EMS providers to deviate legally 

from their established treatment procedures to support mitigation of and 

response to pandemic influenza and other public health emergencies while 

still assuring appropriate education, medical oversight and quality 

assurance? 

For this activity 

and each one 

below, please 

include 

Title 

Page(s) 

First 5 words of 

first sentence 

Has the state identified mechanisms to ensure freedom of movement of 

EMS assets (vehicles, personnel, etc.)? 

Activity Added by State 

Sub-objective 5: Clinical Standards and Treatment Protocols 

PREPARE 

Planning for EMS pandemic influenza clinical standards and treatment protocols should address EMS 

medical direction; modification of treatment and triage protocols; rapid distribution of new protocols; 

just-in-time training; fatality management; and EMS treat and release. 

One solution or protocol may not be applicable for all EMS systems at a State or a local level. It is 

impossible to establish one set of protocols/procedures that works for every single jurisdiction. 

Optimal patient outcomes will depend on an EMS system’s pre-planned ability to quickly integrate 

emerging medical research/information. The effectiveness of patient care will require responsive 

medical direction, training and coordinated system oversight. 

EMS and 9-1-1 stakeholders must be integrated into the Incident Command System and be fully 

engaged as collaborative partners in the response to pandemic influenza. Pandemic influenza 

mitigation and response may require the integration of disciplines not traditionally involved in incident 

mitigation and response, such as medical direction, EMS education, disease surveillance and 9-1-1. 

• Each State, local, tribal, and territorial EMS system should have an EMS medical director to 

provide medical oversight of EMS pandemic influenza planning, mitigation and response. 

•	 State, local, tribal and territorial EMS pandemic influenza plans should define mechanisms for 

rapid development, adoption or modification of prehospital clinical standards and triage and 

102 
 

 

 

 

 

 

 

treatment protocols before or during an influenza pandemic that are based upon the most recent 

scientific information. 

•	 State, local, tribal, and territorial EMS pandemic influenza plans should define consistent, 

system-wide procedures for the rapid distribution of new or modified prehospital EMS 

treatment and triage protocols before or during an influenza pandemic. 

•	 State, local, tribal, and territorial EMS pandemic influenza plans should define a process for 

providing just-in-time training for EMS agencies, EMS providers, EMS medical directors 

and PSAPs. 

•	 State, local, tribal, and territorial EMS pandemic influenza plans should coordinate with public 

health and 9-1-1 officials and the local medical examiner/coroner to define protocols and 

processes for fatality management during pandemic influenza. 

•	 EMS pandemic influenza plans should consider the role EMS providers could serve in 

“treating and releasing” patients without transporting them to a healthcare facility. 

RESPOND AND RECOVER 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF CITATION TO IF NOT 

SUPPORTING ACTIVITY SUPPORTING 

DOCUMENT 

APPLICABLE, 

PLEASE 

EXPLAIN 

Is there coordinated Statewide medical oversight of EMS pandemic 

influenza planning, mitigation and response? 

For this activity 

and each one 

below, please 

include 

Title 

Page(s) 

First 5 words of 

first sentence 

Has the State developed mechanisms for rapid development, adoption or 

modification of prehospital clinical standards and triage/ treatment protocols 

before or during an influenza pandemic that are based upon the most recent 

scientific information? 

Has the State defined consistent, system-wide procedures for the rapid 

distribution of new or modified prehospital EMS treatment and triage 

protocols before or during an influenza pandemic? 

Has the State defined a process for providing just-in-time training for EMS 

agencies, EMS providers, EMS medical directors and PSAPs? 

Has the State defined the role of EMS providers in “treating and releasing” 

patients without transporting them to a healthcare facility? 

Activity Added by State 

103 
Sub-objective 6: EMS Workforce Protection 

PREPARE 

Planning for EMS workforce protection during a pandemic should address protection of the EMS and 

9-1-1 workforce and their families; infection control and decontamination; vaccines and anti-virals for 

EMS personnel; isolation and quarantine considerations; and support for EMS personnel and their 

families. 

•	 State, local, tribal, and territorial EMS pandemic influenza plans should identify strategies to 

protect the EMS and 9-1-1 workforce and their families during an influenza pandemic. 

•	 EMS agencies should consistently practice basic infection control procedures including 

vehicle/equipment decontamination, hand hygiene, cough and respiratory hygiene, and proper 

use of FDA cleared or authorized medical personal protective equipment (PPE) regardless of 

the likelihood of an influenza pandemic. 

•	 State, local, tribal, and territorial EMS pandemic influenza plans should define systemwide processes for providing vaccines and anti-viral medication to EMS personnel. 

•	 State, local, tribal, and territorial EMS agencies, in coordination with public health 

authorities, should identify a mechanism to address issues associated with isolation and 

quarantine of EMS personnel. 

•	 State, local, tribal, and territorial EMS pandemic influenza plans should define a process for 

offering support services, including mental health services, to EMS personnel and their 

families during an influenza pandemic. 

104 
 

 

 

 

 

 

RESPOND AND RECOVER 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF CITATION TO IF NOT 

SUPPORTING ACTIVITY SUPPORTING 

DOCUMENT 

APPLICABLE, 

PLEASE 

EXPLAIN 

Has the State identified strategies to assist local EMS agencies with the 

protection of the EMS and 9-1-1 workforce and their families during an 

influenza pandemic? 

For this activity 

and each one 

below, please 

include 

Title 

Page(s) 

First 5 words of 

first sentence 

Does the State have requirements or recommendations for EMS agencies for 

basic infection control procedures? 

Does the State have system-wide processes for providing vaccines and antiviral medication to EMS personnel? 

Have State EMS agencies and public health agencies identified mechanisms 

to address issues associated with isolation and quarantine of EMS personnel? 

Has the State defined processes to supplement local EMS agencies in 

offering support services, including mental health services, to EMS 

personnel and their families during an influenza pandemic? 

Activity Added by State 

105 
APPENDIX B.13 

Operating Objective: Assure the Local, Regional and State Public 

Safety Answering Points are an Integral Component of a State’s 

Pandemic Influenza Planning and Response 

9-1-1 Public Safety Answering Points (PSAPs) serve as the public’s single point of access to EMS, law 

enforcement and fire services – as well as an avenue for requesting many other services. Ensuring 9-1-

1 is well-integrated into the Nation’s pandemic influenza planning and response is essential to the 

Nation’s health and safety in the event of a pandemic. 

This operating objective and sub-objectives are adopted from the U.S. Department of Transportation’s 

Pandemic Influenza: Recommendations for Protocol Development for 9-1-1 Personnel and Public 

Safety Answering Points (PSAPs), developed in response to Task 6.1.4.2 of the National Strategy for 

Pandemic Influenza: Implementation Plan and available online at Hwww.ems.govH. The sub-objectives 

are as follows: 

Sub-objective 1. Guiding Principles for Public Safety Answering Points 

Sub-objective 2. Provision of information to the public 

Sub-objective 3. Facilitation of call screening 

Sub-objective 4. Assistance with priority dispatch of limited EMS resources 

Sub-objective 5. Education and training of PSAP personnel 

Sub-objective 6. Continuity of Operations 

Recognizing there is variable State oversight of 9-1-1 services, much of the PREPARE guidance is 

oriented toward the PSAP, rather than the State, level. To the extent there is State-level coordination 

of 9-1-1, this preparatory information may be useful. The Respond and Recovery chart contains those 

activities in which, as a minimum, there should be State-level involvement. 

Sub-objective 1: Guiding Principles for Public Safety Answering Points (PSAPs) 

PREPARE 

There are basic preparation tenets for creating plans and protocols that involve Primary 

and Secondary Public Safety Answering Points (PSAPs): 

•	 Overall planning for pandemic influenza must be coordinated with 9-1-1 

•	 “Just-in-Time” training and education must be provided to call-takers and other PSAP 

personnel. 

•	 PSAPs should use standardized 9-1-1 protocols that capture symptoms specific to the pandemic 

along with other possible indicators 

•	 9-1-1 personnel should be trained in incident command per the requirements of NIMS. 

•	 PSAPs should have Continuity of Operations Plans in place 

•	 Infection control procedures must implemented in PSAPs. 

•	 PSAPs should be included in community-wide pandemic influenza drills and exercises. 

•	 Effective use of limited PSAP resources should be coordinated with EMS 

•	 PSAP plans should take into account specific accommodations and considerations for special 

needs communities. 

106 
 

 

 

 

 

 

 

 

RESPOND 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF 

SUPPORTING ACTIVITY 

CITATION TO 

SUPPORTING 

DOCUMENT 

IF NOT 

APPLICABLE, 

PLEASE 

EXPLAIN 

Does the Statewide pandemic influenza plan delineate the role of PSAPs? 

Are PSAPs involved in Statewide pandemic influenza planning 

Does the Statewide pandemic flu plan establish mechanisms for “Just-inTime” training and education to call-takers and other PSAP personnel? 

Is there a consistent Statewide mechanism for communications of pandemic 

flu updates to PSAPs? 

Does the State pandemic influenza plan establish standardized 9-1-1 

protocols that capture symptoms specific to the pandemic? 

Activity Added by State 

RECOVER 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF 

SUPPORTING ACTIVITY 

CITATION TO 

SUPPORTING 

DOCUMENT 

IF NOT 

APPLICABLE, 

PLEASE 

EXPLAIN 

Does the State have established processes for the integration of best practices 

or lessons learned during the previous pandemic wave across the 9-1-1 

system and issue an after action report? 

For this activity 

and each one 

below, please 

include 

Title 

Page(s) 

First 5 words of 

first sentence 

Activity Added by State 

Sub-objective 2: Provision of Information to the Public 

PREPARE 

The public has been trained to call 9-1-1 when help is needed, whether the problem is small or large, 

urgent or not. The PSAP is a trusted source of information for the public and will be inundated with 

calls for help during a pandemic. Plans need to ensure that PSAPs have current, factual information 

107 
 

regarding the events affecting their communities, that they have resources to update that information as 

changes arise, and that they can effectively communicate that information to the public. 

•	 Plans need to ensure that PSAPs have current, factual information regarding the events 

affecting their communities, that they have resources to update that information as changes 

arise, and that they can effectively communicate that information to the public. 

RESPOND AND RECOVER 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF 

SUPPORTING ACTIVITY 

CITATION TO 

SUPPORTING 

DOCUMENT 

IF NOT 

APPLICABLE, 

PLEASE 

EXPLAIN 

Does the State have a mechanism and protocols in place to coordinate 

quickly the latest public health and other information and messages with 

PSAPs to assure a coordinated system-wide message? 

For this activity 

and each one 

below, please 

include 

Title 

Page(s) 

First 5 words of 

first sentence 

Activity Added by State 

Sub-objective 3: Facilitation of Call Screening 

PREPARE 

For purposes of monitoring, surveillance, treatment and the potential of contamination and quarantine, 

during the influenza pandemic period it will be important for the PSAP to be able to identify callers 

who are likely afflicted by the pandemic influenza virus and to assign the appropriate resource to help 

them. This resource may not be a responding EMS unit, but an alternative source of care, such as a 

nurse assist line or other health care call line. 

•	 PSAP protocols should allow for automated data gathering and data packaging of specific 

symptoms for purposes of real-time analysis to identify geographic and temporal clusters of 

symptoms and patients. 

•	 PSAPs should establish and maintain policies and procedures for sharing data with State and 

local public health authorities. 

•	 PSAPSs should be prepared to query callers with a pandemic influenza symptom set consistent 

with recommendations by the local public health office and based on criteria established by the 

CDC. 

•	 State and local EMS authorities should be prepared to provide rapid updates to the PSAP 

pandemic influenza symptom set. 

108 
 

 

 

 

 

 

•	 PSAPs should follow protocols to conduct triage and patient classification during an influenza 

pandemic. 

RESPOND AND RECOVER 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF CITATION TO IF NOT 

SUPPORTING ACTIVITY SUPPORTING 

DOCUMENT 

APPLICABLE, 

PLEASE 

EXPLAIN 

Does the State pandemic influenza surveillance system incorporate the role For this activity

of the PSAPs in implementing automated data gathering and data packaging 

of specific symptoms for purposes of real-time analysis to identify 

geographic and temporal clusters of symptoms and patients? 

and each one 

below, please 

include 

Title 

Page(s) 

First 5 words of 

first sentence 

Does the State have a mechanism established to disseminate rapid updates to 

pandemic influenza symptom set to PSAPs for caller screening and for data 

collection/analysis? 

Are there Statewide policies and procedures and legal protections for 

sharing pertinent data with State and local public health authorities? 

Are there Statewide protocols and procedures in place to guide PSAP triage 

and patient classification during an influenza pandemic? 

Activity Added by State 

Sub-objective 4: Assistance with Priority Dispatch of Limited EMS 

PREPARE 

During an influenza pandemic, EMS and public health resources will likely be limited and normal 

services curtailed. In addition to identifying and assisting likely pandemic flu patients, PSAPs will 

need to safely triage other non-influenza related requests for help, appropriately matching need to 

resource, including alternative treatments, such as nurse assist lines. Telecommunicators need to know 

what to tell callers if no response is available or will be delayed. This should be part of the prepandemic planning effort. PSAPs need to have pre-established links with other types of call centers 

(such as 2-1-1 or nurse assist lines) or alternate care centers to ensure these resources can effectively be 

utilized in transferring or referring callers. PSAPs should ensure that any such plans are in concert with 

the appropriate medical and legal authority. 

•	 PSAP protocols should provide for tiered response of different EMS unit types based on input 

of local EMS authorities. 

•	 PSAP planning should address the need for dispatch protocols with their EMS medical director 

when limited response, severely restricted response or no response occurs. 

109 
 

 

 

 

•	 PSAP protocols should identify those 9-1-1 callers or patients appropriate for transfer to a 

secondary triage specialist or alternate call center. 

•	 PSAP planning should include coordination of efforts with alternate call centers and other 

resources to handle inquiries regarding death and general information. 

•	 PSAPs should develop mitigation strategies for 9-1-1 call overcapacity. 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF CITATION TO IF NOT 

SUPPORTING ACTIVITY SUPPORTING 

DOCUMENT 

APPLICABLE, 

PLEASE 

EXPLAIN 

Is there Statewide legal authority and protocols to allow tiered response of 

different EMS unit during a pandemic influenza? 

For this activity 

and each one 

below, please 

include 

Title 

Page(s) 

First 5 words of 

first sentence 

Does the State pandemic influenza plan establish mechanisms to identify 

those 9-1-1 callers or patients appropriate for transfer to a secondary triage 

specialist or alternate call center? Is there coordination between public 

health, EMS and PSAPs to coordinate this transfer? 

Activity Added by State 

Sub-objective 5: Education and Training of PSAPs 

PREPARE 

Establish a training program that will prepare the PSAP for their role during an influenza pandemic. 

•	 Assess the PSAP’s needs for education and training. Determine what responsibilities can be 

handled by non-PSAP staff. 

•	 Identify processes and curriculum for regular continuing education and training as well as “just 

in time” training to address the specifics of the pandemic. 

•	 Identify existing tools and resources to support the PSAP during a pandemic 

•	 Ensure 9-1-1 personnel are aware of the overall emergency action plan 

•	 Address infection control training for 9-1-1 personnel 

•	 In the planning process, PSAPs need to address how they will staff different positions based on 

the skill levels needed. More routine tasks within the PSAP may be handled with alternative 

staffing, with the goal to have trained public safety telecommunicators available to interface 

with the public for the most critical 9-1-1 calls. 

110 
 

 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
 

DESCRIPTION OF CITATION TO IF NOT 

SUPPORTING ACTIVITY SUPPORTING 

DOCUMENT 

APPLICABLE, 

PLEASE 

EXPLAIN 

Does the State identify PSAP pandemic influenza continuing education and 

training? 

For this activity 

and each one 

below, please 

include 

Title 

Page(s) 

First 5 words of 

first sentence 

Does the State identify methods for pandemic influenza “just in time” 

training for PSAP personnel and their medical directors that is coordinated 

with EMS, public safety and public health? 

Activity Added by State 

Sub-objective 6: Continuity of Operations 

PREPARE 

Consider the needs of the PSAPS beyond the normal planning that exists in the Continuity of 

Operations Plan. 

•	 Identify staffing alternatives (retirees, former employees, staff from other departments to free 

up trained staff and supervisors to answer critical 9-1-1 calls). 

•	 Identify infection control procedures specifically for the pandemic influenza virus. 

•	 Identify isolation and quarantine policies and procedures. 

•	 To limit the exposure of 9-1-1 staff, identify isolation and lock-down procedures. Identify onsite treatment areas for those who have become infected. 

•	 Identify policies related to paid and unpaid leave and care of the families of PSAP staff. 

•	 State and local 9-1-1 pandemic influenza plans should define system-wide processes for 

vaccinating 9-1-1 personnel, as an element of the critical infrastructure. 

•	 State 9-1-1 pandemic influenza plans should, in coordination with public health, law 

enforcement and emergency management agencies, identify mechanisms for freedom of 

movement of PSAP personnel. 

111 
 

 

 

 

RESPOND AND RECOVER 

DESCRIPTION OF CITATION TO IF NOT 

SUPPORTING ACTIVITY SUPPORTING 

DOCUMENT 

APPLICABLE, 

PLEASE 

EXPLAIN 

Does the state define isolation and quarantine policies and procedures for 

PSAPs? 

For this activity 

and each one 

below, please 

include 

Title 

Page(s) 

First 5 words of 

first sentence 

Does the state define system-wide processes for vaccinating 9-1-1 personnel, 

as an element of the critical infrastructure. 

Does the state identify mechanisms for freedom of movement of PSAP 

personnel? 

Activity Added by State 

112 
Key: 

>50% - “Substantial Evidence of Operational Readiness” 

25-49% - “Significant Evidence of Operational Readiness” 

1-24% - “Little Evidence of Operational Readiness” 

APPENDIX B.14 

Protect Citizens: Operational Readiness (Testing through Exercises and 

Real Events) 

A defining characteristic of an operating plan is that, in whole or in part, it readily lends itself to 

evidence-based evaluation using the results of discussion-based exercises (“table tops”), operationalbased exercises (drills and enacted responses to simulated incidents), or performance measurements 

obtained in the course of responses to actual incidents. 

The table below describes the type of information that is requested regarding readiness to meet the 

Operational Objectives that constitute the Goal “Protect Citizens”. Although an imperfect measure of 

readiness, this information tells reviewers that States have practiced and tested their plans – through 

exercises or responses to real events – and used the results of such experience to improve their 

pandemic influenza preparedness. 

The USG Departments jointly will assign a single rating for Operational Readiness for the entire State 

submission. In particular, based on the information requested at the end of each sub-Appendix, the 

Departments will determine the number of the Operating Objectives for which the State submitted 

evidence that it has tested its response capability in some appropriate way. This number then will be 

divided by the total number of Operating Objectives, expressed as a percentage, and translated into a 

standardized verbal designation in accord with the key shown in the text box. 

U U

No submission or a non-responsive submission will be classified as “insufficient information to enable 

assessment.” 

In accord with the table below, please indicate, for each Operating Objective, whether or not an aspect 

of that objective was tested. If it was tested, what was the measurable objective that was tested (this 

would have been your exercise objective or the objective you were trying to achieve during a 

response)? Then, please provide one or two sentences about the a change that was made to the State 

operating plan as a result of the lessons learned and incorporated into an Improvement Plan and then 

acted upon. 

113 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

PROTECT CITIZENS: OPERATING READINESS 

80BOperating Objective Tested?F 

35 F (Y/N) 

What was tested and 

why?F 

36 F 

How did result improve the 

Operating Plan? 

Ensure Surveillance and 

Laboratory Capability During 

Each phase of a Pandemic 

Assist with Controls at U.S. 

Ports of Entry 

Implement community 

Mitigation Interventions 

Enhance Sate Plans to Enable 

Community Mitigation Through 

Student Dismissal and School 

Closure 

Acquire and Distribute Medical 

Countermeasures 

81BEnsure Mass Vaccination 

Capability During Each Phase 

of a Pandemic 

82BProvide Healthcare 

83BManage Mass Casualties 

84BEnsure Communication 

Capability During Each Phase 

of a Pandemic 

85BMitigate the Impact of an 

Influenza Pandemic on Workers 

in the State 

86BUnderstand Official 

Communication Mechanisms 

For Foreign Missions, 

International Organizations, and 

Their Members in the United 

States 

87BIntegrate EMS and 9-1-1 into 

Pandemic Preparedness 

8BIntegrate Public Safety 

Answering Points into 

Pandemic Preparedness 

89BPublic Safety and Law 

Enforcement 

35 Examples of events might include: National Governor’s Association regional exercises, Department of Treasury national
 

finance and banking CIKR exercise, TOPOFF, wildfire response, intraState antiviral drug distribution exercise, Hurricane
 

Dean response, and use of VTC to conduct regional workshops to inform planning. 

36 If an exercise, what was the purpose? If a real-world incident, what was its nature?
 

114 
Operating Objective: Public Safety and Law Enforcement 

 

APPENDIX B.15 

It is likely that, as health and mortality issues increase during a pandemic, the responsibility of the 

justice system will rapidly expand-greater calls for service, added security responsibilities for health 

care and related facilities, enforcement of court-imposed restrictions, public education, control of panic 

and fear and associated behaviors, and ensuring that the public health crisis is not used as an 

opportunity for individual or organizational (criminal) gains. It is critical that all components of public 

safety, public and private, be concerned with preserving the rule of law in our communities, whether 

they be civil and criminal courts at the state, county or municipal level, law enforcement and private 

security agencies, and institutional and community corrections agencies. That can be best achieved 

through coordinated planning in advance of a pandemic. 

The following guidance from the National Strategy for Pandemic Influenza Implementation PlanF 

37 F is

relevant to planning by State law enforcement officials: 

8.1.1.1. States should ensure that pandemic response plans adequately address law enforcement 

and public safety preparedness across the range of response actions that may be implemented, 

and that these plans are integrated with authorities that may be exercised by Federal agencies 

and other State, local, and tribal governments. 

8.1.1.3. State, local, and tribal governments should review their legal authorities that may be 

needed to respond to an influenza pandemic, identify needed changes in the law, and pursue 

legislative action as appropriate. 

8.1.1.5. States should ensure pandemic response plans address EMS, fire, public works, 

emergency management, and other emergency response and public safety preparedness. 

8.1.4.1. State, local, and tribal law enforcement agencies should coordinate with appropriate 

medical facilities and countermeasure distribution centers in their jurisdictions (as recognized 

in Chapter 6, security at these facilities will be critical in the event of an outbreak) to coordinate 

security matters. 

While it is recognized that the primary State level law enforcement agency does not exercise 

operational control over county sheriffs and local law enforcement departments, it is essential that an 

appropriate State level agency or committee provide guidance and assistance to local law enforcement 

officials to help ensure they have up to date information for protecting their employees and continuing 

to provide essential services when facing the challenges created by a pandemic. In addition to 

operational considerations, these efforts and procedures could include the development of training 

materials and guidance on protective measures for workforce sustainability, as well as meeting the 

needs of families. 

Coordinated planning with Public Health and Emergency Management officials at the State, county 

and local level is also essential to enable a proper response in a public health emergency such as a 

pandemic. Similarly, law enforcement officials should ensure there is coordinated planning and 

37 A copy of Chapter 8 - Law Enforcement, Public Safety and Security can be found at www.pandemicflu.gov. 

115 
 

coordination between all interdependent components of the criminal justice system (courts, 

corrections, law enforcement, prosecutors and probation/parole), to ensure uninterrupted essential 

services and ability to perform essential functions. Resources to assist states in their planning have 

been collected at: Hhttp://www.ojp.usdoj.gov/BJA/pandemic/resources.htmlH . 

CDC/HHS has released planning checklists for corrections and law enforcement. These can be found 

at http:// Hwww.pandemicflu.gov/workplaceplanning/correctionchecklist.htmlH . 

Coordination at the State level with National Guard officials would also be useful in the event these 

guard forces were needed to supplement law enforcement. States should consider making reference to 

these resources in their plans and consider the circumstances or “triggers” under which such assistance 

would be requested. A memorandum from the National Guard Bureau outlines the procedure for 

obtaining supportF 

38 F. 

In the event State law enforcement and national guard personnel need further augmentation to enforce 

order or perform other law enforcement functions, federal law enforcement assistance can be 

requested. As a last resort, federal military personnel can also be requested. A letter, which was sent 

to each Governor last year, outlines the procedures and requirements for obtaining such assistanceF 

39 F. 

38 State National Guard law Enforcement Training Requirements are available at www.pandemicflu.gov. 39 Requests for Assistance from Federal Military Forces are available at www.pandemicflu.gov. 

HU UH HU UH

116 
 

 

 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

PREPARE 

DESCRIPTION OF CITATION TO IF NOT 

SUPPORTING ACTIVITY SUPPORTING 

DOCUMENT 

APPLICABLE, 

PLEASE 

EXPLAIN 

Has the State, in collaboration with local and tribal governments, For this activity and 

reviewed their respective legal authorities relative to what may be 

needed during an influenza pandemic, assessed whether changes are 

needed in laws or regulations, and, if so, pursued legislative remedies? 

each one below, 

please include 

Title 

Page(s) 

First 5 words of 

first sentence 

Has the State provided guidance for local and tribal law enforcement 

agencies regarding how to meet the potential security needs of medical 

facilities and countermeasure distribution centers during an influenza 

pandemic? 

Has the State provided local and tribal law enforcement agencies with 

training materials and guidance on protective measures for workforce 

sustainability as well as the meeting the needs of officers’ household 

members? 

Activity Added by State 

117 
 

 

 

 

 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX.
 

RESPOND AND RECOVER 

DESCRIPTION OF CITATION TO IF NOT 

SUPPORTING ACTIVITY SUPPORTING 

DOCUMENT 

APPLICABLE, 

PLEASE 

EXPLAIN 

How will State officials coordinate the actions of the interdependent For this activity and 

components of the criminal justice system (to include courts, 

corrections, law enforcement agencies, prosecutors, and 

probation/parole officials) to avoid or limit interruption of essential 

each one below, 

please include 

services and functions during an influenza pandemic? 

Title 

Page(s) 

First 5 words of 

first sentence 

Are triggers and procedures in place use the National Guard to 

supplement State, local, or tribal law enforcement agencies? 

Are appropriate State officials aware of the procedures to request 

emergency federal law enforcement assistance? 

For jurisdictions which have international ports, airports or borders, has 

coordination been made with appropriate federal officials in the event 

security must be provided for facilities where individuals may be 

temporarily quarantined? 

Are appropriate State officials aware of the procedures to request 

federal military assistance to provide law enforcement functions, or 

military equipment and facilities, training, and maintenance support? 

Activity Added by State 

118 
APPENDIX C.0 – GENERIC GUIDANCE FOR SUPPORTING/SUSTAINING 

THE 

17 CRITICAL INFRASTRUCTURE AND KEY RESOURCE (CIKR) SECTORS 

States are responsible for developing and implementing Statewide CIKR protection programs that 

reflect and align with the full range of homeland security activities presented in the National 

Infrastructure Protection Plan (NIPP). For influenza pandemic specifically, the Department of 

Homeland Security (DHS) Pandemic Influenza Preparedness, Response, and Recovery Guide for 

Critical Infrastructure and Key Resources (CIKR Pandemic Guide) and Sector-specific Pandemic 

Influenza Planning Guidelines (still in development) identify planning and preparedness actions that 

entities within each CIKR sector should consider in advance of a pandemic influenza outbreak. 

Furthermore, for State CIKR pandemic influenza planning to be comprehensive and successful, State 

CIKR plans should accomplish the following: 

•	 address all relevant aspects of CIKR protection, planning, and preparedness; 

•	 leverage support from homeland security assistance programs that apply across the homeland 

security mission area; 

•	 emphasize communications and collaboration between government and CIKR public- and 

private-sector businesses; 

•	 integrate government and CIKR planning and preparedness actions including training and 

exercises; and 

•	 reflect priority activities in their strategies to ensure CIKR businesses have adequate and 

appropriate support, resources are allocated effectively, and essential goods and services 

remain available during a pandemic event. 

State pandemic plans should support public- and private-sector CIKR businesses to ensure continuity 

of operations for essential services. For the social and economic well-being of all Americans, these 

plans should ensure that critical infrastructure operate as "near normal" as possible. To this end, State 

plans should explicitly address seven broad categories regarding their CIKR protection, planning and 

preparedness approach: 

1.	 Define CIKR protection, planning and preparedness roles and responsibilities; 

2.	 Build public-private partnerships and support networks; 

3.	 Implement NIPP risk management framework for a pandemic; 

4.	 Bolster CIKR information sharing and protection initiatives; 

5.	 Leverage emergency preparedness activities for CIKR protection, planning and 

preparedness; 

6.	 Integrate Federal CIKR protection, planning and preparedness activities. 

7.	 Allocate scarce resources 

119 
 

 

 

 

 

APPENDIX C.1 

Operating Objective: Define CIKR Protection, Planning, Preparedness, 

Response, and Recovery Roles and Responsibilities 

Rationale: The numerous critical roles and responsibilities specific to effectively supporting CIKR sector 

essential protection, planning and preparedness activities involves diverse government 

departments/agencies at all levels from Federal to local. Ensuring all these government groups are aware of 

their roles and synchronized in their efforts will greatly increase the opportunity for success. 

PREPARE 

These preparedness considerations and activities serve as a reference States can use to augment and 

tailor their existing emergency response plans given the unique challenges a pandemic influenza 

presents our nation’s CIKR. These potential activities will likely not be found in a State’s operational 

plan and therefore will not be graded. While not necessarily applicable to all States, these 

considerations represent a starting point for States to stimulate thinking about further actions and 

options. 

•	 Identify the gaps, which exist between the State’s current approach with those roles and 

responsibilities outlined in the NIPP, SSP, and in CIKR Pandemic Guide. 

•	 Develop a mechanism to identify any government roles and responsibilities that should be 

revised, modified, or consolidated to accommodate the unique impacts and environment of a 

pandemic influenza outbreak and the operating attributes of the State. 

RESPOND AND RECOVER 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF 

SUPPORTING ACTIVITY 

CITATION TO 

SUPPORTING 

DOCUMENT 

IF NOT 

APPLICABLE, 

PLEASE 

EXPLAIN 

Are the State, local, tribal, and territorial government 

surveillance, detection and protection actions described in the 

Implementation Plan for the National Strategy for Pandemic 

Influenza and the HHS Pandemic Influenza Implementation Plan 

being effectively implemented to help protect CIKR businesses? 

For this activity and 

each one below, 

please include 

Title 

Page(s) 

First 5 words of first 

sentence 

Does the State have a dedicated Pandemic Influenza 

Implementation Plan, and does this Plan clearly define the 

assigned roles and responsibilities of all State, local, tribal, and 

territorial government entities in supporting and sustaining CIKR 

essential businesses? 

120 
 

 

 

 

 

 

 

 

 

Is the State addressing potential gaps in the Plan between the 

State’s current assignment and those roles and responsibilities 

outlined in the NIPP, SSP, and in CIKR Pandemic Guide? 

Has the State identified the authorities and measures necessary 

for implementation of these temporary regulatory 

adjustments/waivers for CIKR? 

Has the State identified and assessed the relevant Federal, State, 

local, tribal, and territorial government regulations and oversight 

requirements affecting public- and private-sector CIKR business 

continuity operations during a pandemic? 

Has the State identified temporary adjustments/waivers to 

mitigate any negative impacts of these regulations and 

requirements on CIKR continuity of operations during a 

pandemic that the State and/or other authorized government 

regulators may consider using? 

Has the State assessed the State’s and/or other authorized 

Federal, tribal, territorial or local government regulators’ 

authorities and other measures necessary for implementation of 

any temporary regulatory adjustments/waivers to support and 

sustain CIKR? 

Has the State communicated and fully coordinated these 

potential temporary regulatory adjustments/waivers with all 

appropriate CIKR stakeholders? 

Activity Added by State 

121 
APPENDIX C.2 

Operating Objective: Build Public-Private Partnerships and Support 

Networks 

Rationale: Although each government and CIKR entity must strive to become as resilient as practical to 

sustain their own operations, the additional strengths derived from effective public-private partnerships and 

support networks may prove the difference in whether individual businesses and critical supply chains can 

successfully sustain their essential operations over an extended duration during a severe influenza 

pandemic 

PREPARE 

These preparedness considerations and activities serve as a reference States can use to augment and 

tailor their existing emergency response plans given the unique challenges a pandemic influenza 

presents our nation’s CIKR. These potential activities will likely not be found in a State’s operational 

plan and therefore will not be graded. While not necessarily applicable to all States, these 

considerations represent a starting point for States to stimulate thinking about further actions and 

options. 

•	 Build effective protection, planning and preparedness support networks with and for CIKR. 

Determine if these actions include all appropriate representatives from the relevant CIKR 

sectors. 

•	 Identify unique geographical issues, including trans-border concerns, as well as critical 

interdependencies within and across sectors and jurisdictions within those geographical 

boundaries. Share these issues with all appropriate CIKR. 

122 
 

 

 

 

 

 

RESPOND AND RECOVER 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF 

SUPPORTING ACTIVITY 

CITATION TO 

SUPPORTING 

DOCUMENT 

IF NOT 

APPLICABLE, 

PLEASE 

EXPLAIN 

What mechanism does the State plan to use to coordinate CIKR 

pandemic influenza response and recovery efforts? 

For this activity and 

each one below, 

please include 

Title 

Page(s) 

First 5 words of first 

sentence 

Has the State identified unique geographical issues, including 

trans-border concerns, as well as critical interdependencies 

within and across sectors and jurisdictions within those 

geographical boundaries affecting CIKR? 

Has the State shared these issues with all appropriate publicand private-sector CIKR partners and support networks? 

What specific actions has the State taken to develop and 

implement systems to communicate and collaborate with all 

appropriate CIKR to build public-private partnerships at the 

State, regional and local levels during and after a pandemic 

influenza outbreak? 

Activity Added by State 

123 
 

 

APPENDIX C.3 

Operating Objective: Implement NIPP Risk Management Framework 

for a Pandemic 

Rationale: The NIPP risk assessment calculus emphasizes identifying and specifically addressing the key 

variables of threat, vulnerability and consequence in order to affect potential risk. Given the likely limited 

medical and non-medical support resources, exploiting this risk model to better organize and focus 

government and CIKR pandemic influenza preparedness actions on the highest priority options for 

protecting against the threat, and reducing vulnerabilities and consequences will significantly improve 

chances for success. 

PREPARE 

These preparedness considerations and activities serve as a reference States can use to augment and 

tailor their existing emergency response plans given the unique challenges a pandemic influenza 

presents our nation’s CIKR. These potential activities will likely not be found in a State’s 

operational plan and therefore will not be graded. While not necessarily applicable to all States, 

these considerations represent a starting point for States to stimulate thinking about further actions 

and options. 

•	 Develop a method to determine risk to prioritized essential resources and services by 

combining potential direct and indirect consequences of an influenza pandemic (including 

seasonal changes in consequences, and dependencies and interdependencies associated with 

each identified asset, system, or network) with known vulnerabilities. 

•	 Aggregate and analyze risk assessment results to develop a comprehensive picture of asset, 

system, and network risk to the delivery of prioritized essential resources and services; 

establish mitigation priorities based on risk; and determine protection and business continuity 

planning and preparedness initiatives that provide the greatest mitigation of risk. 

RESPOND AND RECOVER 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF SUPPORTING ACTIVITY 

CITATION TO 

SUPPORTING 

DOCUMENT 

IF NOT APPLICABLE, 

PLEASE EXPLAIN 

Does the State’s Pandemic Plan include a method to 

determine risk to prioritized essential CIKR resources and 

services by combining potential direct and indirect 

consequences of an influenza pandemic (including seasonal 

changes in consequences, and dependencies and 

interdependencies associated with each identified asset, 

system, or network) with known vulnerabilities? 

For this activity and 

each one below, 

please include 

Title 

Page(s) 

First 5 words of first 

sentence 

124 
 

 

 

 

 

 

 

 

 

 

In collaboration with appropriate public- and private-sector 

partners; has the State identified all the CIKR delivered 

“essential” resources and services necessary to sustain the 

nation’s social and economic well-being? 

Has the State identified, all CIKR delivered “essential” 

resources and services to ensure appropriate and timely 

allocation of limited government and private sector support 

in order to mitigate vulnerabilities and consequences? 

Has the State assessed all CIKR delivered “essential” 

resources and services to ensure appropriate and timely 

allocation of limited government and private sector support 

in order to mitigate vulnerabilities and consequences? 

Has the State prioritized all CIKR delivered “essential” 

resources and services to ensure appropriate and timely 

allocation of limited government and private sector support 

in order to mitigate vulnerabilities and consequences? 

Is there a mechanism in place to identify those individual 

or networks of public- and private-sector CIKR assets in a 

State that are most likely to be affected and most 

vulnerable during a pandemic, and thus may require special 

attention and support? 

Is there a mechanism that designates the State and private 

sector response and recovery roles and responsibilities 

necessary to maintain the delivery of essential resources 

and services during and after a pandemic influenza 

outbreak? 

Has the State identified mission critical personnel 

(specifically, personnel that work with CIKR or high 

consequence systems) to participate in government- or 

private-sponsored CIKR response and recovery programs 

(i.e., credentialing programs)? 

Activity Added by State 

125 
 

APPENDIX C.4 

Operating Objective: Bolster CIKR Information Sharing and 

Protection Initiatives 

Rationale: The timely availability of appropriate and valid information to the right decision makers 

concerning CIKR sustainment operations and possible/actual status changes will prove critical to 

effectively supporting those sustainment needs in times of crisis. 

PREPARE 

These preparedness considerations and activities serve as a reference States can use to augment and 

tailor their existing emergency response plans given the unique challenges a pandemic influenza 

presents our nation’s CIKR. These potential activities will likely not be found in a State’s operational 

plan and therefore will not be graded. While not necessarily applicable to all States, these 

considerations represent a starting point for States to stimulate thinking about further actions and 

options. 

•	 Assess whether public and private sector CIKR businesses in your State share information with 

government on their current and projected State of protection, planning, and preparedness for a 

pandemic flu. Determine the percentage of CIKR entities in your State that are sharing 

protection actions and pandemic-specific continuity plans. 

•	 Collect other critical information/data on essential CIKR assets and systems that address crosssector dependencies, cascading effects, and interdependencies that affect CIKR functionality, 

performance and recovery. 

126 
 

 

 

 

 

 

 

RESPOND AND RECOVER 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF 

SUPPORTING ACTIVITY 

CITATION TO 

SUPPORTING 

DOCUMENT 

IF NOT APPLICABLE, 

PLEASE EXPLAIN 

Does the State have a public-private sector system in 

place to share information on CIKR preparedness, 

response and recovery actions during a pandemic 

influenza outbreak? 

For this activity and 

each one below, 

please include 

Title 

Page(s) 

First 5 words of first 

sentence 

Does the State have a public-private sector system in 

place to share information on CIKR preparedness, 

response, recovery and preparedness for next wave 

actions during and after a pandemic influenza 

outbreak? 

Does the State have a reliable and effective 

information management and protection system in 

place to satisfy privacy and security concerns of 

CIKR owners and operators who are willing to share 

information during a pandemic? 

Has the State collected and appropriately shared 

other critical information/data on CIKR assets and 

systems that address cross-sector dependencies and 

interdependencies that affect CIKR functionality, 

performance and recovery? 

Has the State implemented a mechanism to update 

and report as necessary the changes in status of all 

CIKR and especially high-risk and highconsequence CIKR assets and interdependent crosssector networks to all appropriate government and 

public- and private-sector CIKR partners and 

stakeholders? 

Activity Added by State 

127 
 

APPENDIX C.5 

Operating Objective: Leverage Emergency Preparedness Activities for 

CIKR Protection, Planning, Preparedness, Response, and Recovery 

Rationale: Obviously government and CIKR businesses and organizations have already made significant 

protection, planning and preparedness investments for various type disasters. Adapting and exploiting these 

significant investments to serve for a pandemic influenza disaster makes good sense. 

PREPARE 

These preparedness considerations and activities serve as a reference States can use to augment and 

tailor their existing emergency response plans given the unique challenges a pandemic influenza 

presents our nation’s CIKR. These potential activities will likely not be found in a State’s operational 

plan and therefore will not be graded. While not necessarily applicable to all States, these 

considerations represent a starting point for States to stimulate thinking about further actions and 

options. 

•	 Determine the existing State, local, and/or tribal government and private sector emergency 

preparedness activities in place for other disasters, such as hurricanes and earthquakes, which 

may be adapted for pandemic influenza protection, planning and preparedness. Assess whether 

or not your State identified, assessed, and incorporated them. 

•	 Formalize the distribution process for determining which mission critical CIKR personnel will 

be prioritized highest for stockpiled medical and non-medial countermeasures. 

•	 Assess your State stockpiles to ensure they have adequate types/quantities of appropriate 

medical and non-medical countermeasures. Take the necessary measures to procure additional 

material, if appropriate. 

128 
 

 

 

 

RESPOND AND RECOVER 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF 

SUPPORTING ACTIVITY 

CITATION TO 

SUPPORTING 

DOCUMENT 

IF NOT APPLICABLE, 

PLEASE EXPLAIN 

Has the State identified existing State, local, and/or 

tribal government and private sector emergency 

resources stockpiled for other disasters that may be 

useful for pandemic influenza response and recovery 

and incorporated them into their State Plan? 

For this activity and 

each one below, 

please include 

Title 

Page(s) 

First 5 words of first 

sentence 

Have existing Federal, State, local, territorial and/or 

tribal government and private sector formal and 

informal emergency response and recovery support 

networks for other type disasters been identified, 

enlisted and enhanced for pandemic influenza 

response? 

Activity Added by State 

129 
 

APPENDIX C.6 

Operating Objective: Integrate Federal, State, Local, Tribal, and 

Territorial Government with Public- and Private-Sector CIKR 

Protection, Planning, Preparedness, Response, and Recovery Activities 

Rationale: Taking the actions described in Appendix C1 to the next level, not only must all appropriate 

government and CIKR groups be aware and synchronized in their roles and responsibilities, they must also 

efficiently integrate where practical their planning and preparedness actions to optimize validity, 

acceptance, transparency, expertise and responsiveness and thereby enhance individual and overall 

resilience. 

PREPARE 

These preparedness considerations and activities serve as a reference States can use to augment and 

tailor their existing emergency response plans given the unique challenges a pandemic influenza 

presents our nation’s CIKR. These potential activities will likely not be found in a State’s operational 

plan and therefore will not be graded. While not necessarily applicable to all States, these 

considerations represent a starting point for States to stimulate thinking about further actions and 

options. 

•	 Develop, establish, and implement a mechanism to coordinate pandemic influenza protection, 

planning and preparedness efforts among Federal and State authorities. 

•	 Determine if appropriate Federal and State representatives have participated in reciprocal 

protection, planning and preparedness activities (e.g., training and exercises). 

•	 Assess whether all Federal and State pandemic plans been coordinated to ensure these plans are 

mutually supportive and executable. 

130 
 

 

 

 

RESPOND AND RECOVER 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF SUPPORTING 

ACTIVITY 

CITATION TO 

SUPPORTING 

DOCUMENT 

IF NOT APPLICABLE, 

PLEASE EXPLAIN 

Has the State employed a mechanism to report an 

accurate assessment of the status of CIKR with its 

Federal partners during and after a pandemic event? 

For this activity and 

each one below, 

please include 

Title 

Page(s) 

First 5 words of first 

sentence 

Has the State employed a mechanism to report an 

accurate assessment of the status of CIKR with its 

local and regional partners during and after a 

pandemic event? 

Has the State employed a mechanism to coordinate 

direct and indirect government and community 

support and relief? 

Activity Added by State 

131 
 

 

 

 

 

 

 

 

APPENDIX C.7
 

Operating Objective: Prioritize and Allocate Scarce Resources 

Rationale: Having the right information at the right time to the right decision makers about the right 

priorities for actions will greatly improve system responsiveness and support for CIKR sustainment. 

However, even with the best decisions there still must be something practical that can be affected from the 

decisions to ensure essential sustainment. Government as well as public- and private-sector CIKR must 

have efficient delivery systems and the necessary tools, materials, people and supplies in reserve before the 

pandemic influenza outbreak to be successful at supporting sustainment efforts during the outbreak. 

PREPARE 

These preparedness considerations and activities serve as a reference States can use to augment and 

tailor their existing emergency response plans given the unique challenges a pandemic influenza 

presents our nation’s CIKR. These potential activities will likely not be found in a State’s operational 

plan and therefore will not be graded. While not necessarily applicable to all States, these 

considerations represent a starting point for States to stimulate thinking about further actions and 

options. 

•	 Assess the extent to which CIKR owners and operators in the State have pre-negotiated, 

established, and maintained contracts with vendors who supply critical resources and essential 

services for all essential CIKR within the State. 

RESPOND AND RECOVER 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

DESCRIPTION OF 

SUPPORTING ACTIVITY 

CITATION TO 

SUPPORTING 

DOCUMENT 

IF NOT 

APPLICABLE, 

PLEASE EXPLAIN 

Has the State prioritized the mission critical personnel and 

essential public- and private-sector CIKR organizations and 

businesses in the State for resource stockpile support that are vital 

to sustaining CIKR operations and the nation’s social and 

economic well-being? 

Has the State assessed its disaster response stockpiles to ensure it 

has adequate types/quantities of appropriate medical and nonmedical countermeasures and other pandemic-specific supplies 

and materials to support essential CIKR organizations and 

businesses and their mission critical personnel during possibly 

multiple response and recovery waves? 

Has the State taken measures to procure and stockpile additional 

medical and non-medical supplies and material as required? 

132 
 

 

 

 

 

 

 

 

Has the State pre-negotiated, established, and maintained key 

contracts with vendors who supply critical resources and essential 

services for the State, and supporting similar arrangements for 

tribal, territorial and local government entities? 

Has the State supported CIKR businesses and organizations 

within the State to pre-negotiate, establish, and maintain key 

contracts with vendors who supply their critical resources and 

essential services? 

Are all State plans, procedures, and systems functional and prepositioned to distribute all other direct and indirect government 

and community support and relief for CIKR securely and rapidly? 

Do plans specify the State statutory and/executive order 

authorities for, officials responsible for, and process to be used, to 

allocate/ration scarce essential resources? 

Have officials identified public- and private-sector 

organizations/businesses in their State that play central roles in 

essential CIKR sectors? 

Has the State identified and prioritized measures that will be 

required to speed economic and community recovery within the 

State and/or region? 

Activity Added by State 

133 
Key: 

>50% - “Substantial Evidence of Operational Readiness” 

25-49% - “Significant Evidence of Operational Readiness” 

1-24% - “Little Evidence of Operational Readiness” 

90BAPPENDIX C.8 

CI/KR: Operational Readiness (Testing through Exercises and Real 

Events) 

A defining characteristic of an operating plan is that, in whole or in part, it readily lends itself to 

evidence-based evaluation using the results of discussion-based exercises (“table tops”), operationalbased exercises (drills and enacted responses to simulated incidents), or performance measurements 

obtained in the course of responses to actual incidents. 

The table below describes the type of information that is requested regarding readiness to meet the 

Operational Objectives that constitute the Goal "Sustain/Support 17 Critical Infrastructure and Key 

Resource Sectors". Although an imperfect measure of readiness, this information tells reviewers that 

States have practiced and tested their plans – through exercises or responses to real events – and used 

the results of such experience to improve their pandemic influenza preparedness. 

The USG Departments jointly will assign a single rating for Operational Readiness for the entire State 

submission. In particular, based on the information requested at the end of each sub-Appendix, the 

Departments will determine the number of the Operating Objectives for which the State submitted 

evidence that it has tested its response capability in some appropriate way. This number then will be 

divided by the total number of Operating Objectives, expressed as a percentage, and translated into a 

standardized verbal designation in accord with the key shown in the text box. 

U U

No submission or a non-responsive submission will be classified as “insufficient information to enable 

assessment.” 

In accord with the table below, please indicate, for each Operating Objective, whether or not an aspect 

of that objective was tested. If it was tested, what was the measurable objective that was tested (this 

would have been your exercise objective or the objective you were trying to achieve during a 

response)? Then, please provide one or two sentences about the a change that was made to the State 

operating plan as a result of the lessons learned and incorporated into an Improvement Plan and then 

acted upon. 

134 
 

 

 

 

 

 

 

 

 

NOTE: HHS WILL PROVIDE AN EXCEL SPREADSHEET ESPECIALLY DESIGNED TO
 

FACILITATE SUBMISSION OF THE INFORMATION REQUESTED IN THIS APPENDIX. 

CI/KR: OPERATING READINESS 

91BOperating Objective Tested?F 

40 F (Y/N) 

What was tested and 

why?F 

41 F 

How did result improve the 

Operating Plan? 

Define CIKR Protection, 

Planning and Preparedness 

Roles and Responsibilities 

92BBuild Public-Private 

Partnerships and Support 

Networks 

93BImplement the NIPP Risk 

Management Framework for a 

Pandemic 

94BBolster CIKR Information 

Sharing and Protection 

Initiatives 

95BLeverage Emergency 

Preparedness Activities for 

CIKR Protection, Planning and 

Preparedness 

96BIntegrate Federal and State 

CIKR Protection, Planning and 

Preparedness Activities 

97BAllocate Scarce Resources 

40 Examples of events might include: National Governor’s Association regional exercises, Department of Treasury national
 

finance and banking CIKR exercise, TOPOFF, wildfire response, intraState antiviral drug distribution exercise, Hurricane
 

Dean response, and use of VTC to conduct regional workshops to inform planning. 

41 If an exercise, what was the purpose? If a real-world incident, what was its nature?
 

135