Public Health Practices

Health department preparedness for chemical emergencies often requires the involvement of multiple state agencies to assure that all aspects of environmental and human health are addressed in response. Given the scientific complexity of responding to a chemical emergency, effective risk communication to responders and to the public is a growing area of concern.

Conducting mass H1N1 vaccination at Michigan State University (MSU)-one of the Big 10 universities-required thoughtful planning. A population of approximately 47,000 students, an unpredictable supply of vaccine, and national guidelines that changed frequently all contributed to a complex vaccine distribution strategy.

During the 2009 H1N1 outbreak, ill students living in on-campus housing posed a special concern for the University of Iowa (UI). The Office of Residence Life focused many of their efforts on training Resident Assistants (RAs) to respond appropriately to ill students living in their halls.

Caring for sick Pennsylvania State University (PSU) students in a pandemic meant tracking their illnesses daily by phone or through secure electronic messages. PSU students identified as having influenza-like illness (ILI) were encouraged to go home.

Philadelphia's Pandemic Influenza Planning Guidance for Healthcare Institutions addresses the needs and situations that may be experienced by hospitals during a pandemic.

The Santa Clara Clinical Triage Guidelines include a protocol and a flow chart that use a modified pneumonia severity index to triage influenza patients. Patients are stratified by objective criteria (e.g., blood pressure, oximetry, age) to hospital admission, Influenza Care Center admission, palliative home care, or recovery at home.

This document presents the concept of Community Care Stations (CCS). These facilities are designed to provide initial assessment triage and would be opened when the hospital system begins to become overwhelmed. The document describes triage criteria, lists required supplies, and presents a staffing plan for the CCS. It also describes criteria for opening and supplying Alternate Care Facilities (ACF) in the area.

A collaborative, evidence-based triage protocol was designed for use as a decision-making tool when a critical care system becomes overwhelmed. The system of triage is applicable to patients with and without pandemic influenza, since all patients would share the same scarce resources.

Fraser Health's toolkit outlines key parameters for establishing alternate triage and care centers by providing guidance for selecting a site, organizing personnel, conducting triage and process flow, and discharging patients. The materials are still in draft form, and any triage or care site would need to modify the materials to fit its individual needs.