PROMISING PRACTICES FOR PANDEMIC PLANNING Collaborations ensure local needs met in city's pandemic planning process

Natalie C. Vestin

Editor's Note: This article is one of an occasional series exploring the development of public health practices included in the CIDRAP Promising Practices: Pandemic Influenza Preparedness Tools online database. We hope that describing the process and context that drove development of these practices serves as a valuable tool for pandemic planning.

Nov 19, 2007 (CIDRAP News) Two strategiescommunicating effectively with the living and managing the bodies of the deademerged as focal points as Alexandria, Va., developed its highly collaborative pandemic plan.

Like many cities, Alexandria incorporated federal, state, and county structures into its pandemic plan. Innovative use of community resources and partnerships ensured that the top-down process still incorporated local needs and assets.

In 2005, Mayor William D. Euille called together more than 60 people representing the health department, city officials, the city's sole hospital, and community organizations. These groups formed pandemic planning subcommittees to address specific challenges facing the city, said John Clizbe, PhD. Clizbe is the emergency planner for the Alexandria Health Department, and he helped identify communications and fatality management as particular challenges facing the city.

"They were the most complex, and the issues about which we knew the least," Clizbe said. To complete its plans, Alexandria embarked on an intense collaboration with local agencies and got a little help from Canada along the way.

Communicating with the public
Alexandria's communications plan is an attempt both to maximize staffing and provide tailored outreach to at-risk populations.

Planners opted to incorporate communications strategies from Toronto, Ontario, rather than create a plan from scratch. Alexandria lacks a Public Information Officer (PIO) to communicate pandemic risk, quell rumors, and provide up-to-date information to the general public. The Toronto plan allowed the city room to assign these communications tasks based on employees' skills, Clizbe said. Employees with public speaking skills, a marketing background, or multicultural knowledge will be enlisted to educate the public or create materials.

The Alexandria Health Department is making the job easier for its ad hoc communicators. Part of the communications planning process involves defining roles for city agencies. Alexandria's base population of 135,000 expands daily to include a large number of tourists and commuters to nearby Washington, D.C. Communicators can craft a unified message to their highly mobile audience if they are aware of agency locations, services, and times of operation before an emergency. For instance, the health department can relay messages about opening mass dispensing sites for medication if sites throughout the city provide the same services at the same times.

Planners also asked city schools to play a significant part in pandemic communications. Pandemic planning "wasn't on the schools' radar" before 2005, said Robin Wallin, nurse coordinator for Alexandria City Public Schools. The community-wide planning set in motion by the city led to grassroots ties between the health department and schools, she added. Her participation on the mayor's working group led to close working relationships between epidemiologists and public schools. These relationships may have tremendous benefit for effective influenza surveillance in schools, she said.

Overcoming confusion about fatality management
Community-wide relationships were not restricted to communications planning. City planners recalled the confusion about identifying jurisdiction and responsibilities during Alexandria's response to the Pentagon attack in 2001, Clizbe said. The city's mass fatalities plan had to resolve the problems encountered on Sep 11. It also had to consider that deaths due to pandemic influenza would require a vastly different jurisdictional response, Clizbe added.

During an influenza pandemic, the medical examiners would determine cause of death only for the first influenza-related cases, Clizbe said. Planners needed to reach out to city groups to define the emergency roles and responsibilities normally filled by the medical examiners. The health department's outreach led to broad collaborations among mortuary providers, cemeteries, public works officials, professional communicators, law enforcement personnel, multicultural organizations, and senior citizens groups, Clizbe said.

Lori Hardin, statewide emergency planner for the Virginia Office of the Chief Medical Examiner, lauded the groups for tackling the tough issue of fatalities. "It's wonderful that Alexandria is talking about it and acknowledging that it's going to be a problem."

Continuing outreach
Alexandria's pandemic plan is still a work in progress. Collaboration between its health department and city organizations has made the ongoing planning process an "all-engaging quality effort," Clizbe said. Further implementation of the plan will involve outreach to community organizations and nonprofits, especially those serving vulnerable populations.

Alexandria recognized that pandemic preparedness requires the involvement of many different agencies. In the city's case, "public health was not doing it all by themselves," Clizbe said. This recognition has been instrumental in building relationships that may benefit the public's health before, during, and after an emergency.