Planning for the Inevitable: Preparing for Epidemic/Pandemic Respiratory Illness in the Shadow of H1N1

Background: Since September 11, 2001 and the SARS outbreak of 2003, the healthcare and public policy communities have extensively discussed the importance of disaster planning. The recent novel H1N1 outbreak demonstrated the importance of hospital preparedness and highlighted critical planning issues that previously were inadequately addressed.

Objective: To provide an approach to hospital epidemic/pandemic respiratory illness (EPRI) planning that incorporates lessons learned in the initial response to 2009 H1N1 influenza.

Methods: Often, EPRI response planning is built on an all-hazards incident command system framework.  However, effective response to outbreaks of respiratory pathogens necessitates addressing certain unique issues, including screening and surveillance algorithms, control of hospital access, and infection control and prevention strategies.   A staged, scalable model allows for a flexible response.  The addition of a Medical Control Chief and Situational Assessment Chief (SAC) to the incident command structure provides the essential clinical and epidemiologic expertise.  Strategies for communication and tools for implementation should be clearly outlined. The planning process must involve key stakeholders to promote broad engagement and support for alterations in hospital operations during a pandemic.  Our response plan, built on this model, was implemented with the emergence of pandemic H1N1 influenza.  After the first wave of cases, the response was reviewed to determine the need for further refinement of this model.

Results: Our experiences with pandemic H1N1 demonstrated the necessity of additional modifications to the EPRI response plan.  Our initial 6-stage plan was refined to 10 stages to integrate severity of illness.  Stages were defined by type of transmission, geographic location of cases, and disease severity as determined by the SAC.  Clinical Case Evaluation Lead and Document Coordinator roles were added to the plan to provide a physician contact for providers and to ensure consistency and accuracy in infection control guidance documents, respectively.  Effective infection control within the hospital required the collection and compilation of key data regarding employees that could be rapidly accessed by the appropriate occupational health and infection control personnel.  Thus development and refinement of a secure, interactive electronic database is a key priority.

Conclusions: Pandemic H1N1 provided a unique opportunity to evaluate and refine hospital EPRI planning and demonstrated the need for revisions to the EPRI planning model.  Priority areas for future development include educational planning, EPRI response drills and integration of planning within health systems, regions, and states.