Pandemic Influenza Tabletop Exercise

June 13, 2006

Albany, New York

Home Care Association of New YorkState

University at Albany

School of Public Health

Center for Public Health Preparedness

Reference Material

Additional Resources......

Glossaries......

Exercise Conduct Terminology......

Emergency Response Terminology......

Preparedness & Community Response to Pandemics – Glossary......

Additional Resources

New York State Department of Health

Influenza Pandemic

Avian Influenza (Bird Flu)

New York State Department of Agriculture & Markets

Avian Influenza

New York State Department of Environmental Conservation

Frequently Asked Questions About Bird Flu

/ ONLINE SELF-PACED COURSE:
“Preparedness & Community Response to Pandemics” helps you:

Describe the historical context of influenza.
Describe what a pandemic is and how they occur (antigenic shift and drift).
Outline the epidemiology of influenza.
Explain surveillance activities related to influenza.
Recognize the clinical features of influenza.
Identify control measures to be taken prior/during a pandemic of influenza.
Identify response efforts and partners to a pandemic (both locally and globally).
Describe the unique characteristics of a virus.
Explain how a pandemic unfolds (pandemic phases and periods).

/ VIDEO PROGRAMS:
“Avian Influenza: State, National and Worldwide Response”
with Barbara Wallace, MD, Director of the NYS DOH Bureau of Communicable Disease Control and Perry Smith, MD, Director of NYS DOH Division of Epidemiology

/ “Isolation and Quarantine: Practice & Law” originally aired November 10, 2005 with Frederic E. Shaw, MD, JD, CDC Public Health Law Program

Glossaries

You talk funny!

Yes, we do.

People who do a lot of emergency planning and emergency exercises use some terms that you might not be familiar with. They are a regular part of the language of other emergency response agencies, like fire and law enforcement, and are becoming more common in public health. Here are some key terms that you may hear today.

Exercise Conduct Terminology

You talk funny! Exercise and Emergency Response Terminology

University at AlbanyCenter for Public Health Preparedness

Players – are the local public health agency personnel who perform their everyday duties during the exercise under an ICS/NIMS model

Controllers – are participants in the exercise who plan and manage the exercise; many may be the members of the Exercise Planning Team as above. There may be specialized briefings for this group’ see below

Evaluators – these may or may not be from within the local public health agency, depending on the size and scale of the exercise. They usually evaluate an area consistent with their expertise and will record and note the actions of the players. There may be specialized briefings for this group

Actors – these may be volunteers or other members of the LPHA who act as patients or victims. There may be specialized briefings for this group

Observers – these serve to observe the overall activities for general process of the exercise itself, and of overall performance by the agency

Briefings – meetings held before the exercise to inform all participants about their roles and responsibilities

Player HotWash – This will take place immediately after the exercise. Evaluators and Controllers can clarify the information about the events of the exercise with everyone involved while it is still fresh in their memories. It also provides a forum for all those involved to air concerns and identify issues for consideration in the Improvement Plan

Debriefings – may be conducted with some or all participants within a short time after the event, to provide additional observations once the exercise is completed

After Action Report – compiled information with multiple inputs in order to decrease the reliance on any single observer/evaluator

Source: ColumbiaUniversitySchool of NursingCenter for Health Policy. Planning, Designing, Conducting and Evaluating Local Public Health Emergency Exercises. 2005. Accessed at

You talk funny! Exercise and Emergency Response Terminology

University at AlbanyCenter for Public Health Preparedness

Emergency Response Terminology

You talk funny! Exercise and Emergency Response Terminology

University at AlbanyCenter for Public Health Preparedness

Chain of Command. A series of command, control, executive, or management positions in hierarchical order of authority.

Command Staff. In an incident management organization, the Command Staff consists of the Incident Command and the special staff positions of Public Information Officer, Safety Officer, Liaison Officer, and other positions as required, who report directly to the Incident Commander. They may have an assistant or assistants, as needed.

EmergencyOperationsCenter (EOC). The physical location at which the coordination of information and resources to support domestic incident management activities normally takes place. An EOC may be a temporary facility or may be located in a more central or permanently established facility, perhaps at a higher level of organization within a jurisdiction. EOCs may

be organized by major functional disciplines (e.g., fire, law enforcement, and medical services), by jurisdiction (e.g., Federal, State, regional, county, city, tribal), or by some combination thereof.

Emergency Operations Plan (EOP). The “steady-state” plan maintained by various jurisdictional levels for managing a wide variety of potential hazards.

Emergency Public Information. Information that is disseminated primarily in anticipation of an emergency or during an emergency. In addition to providing situational information to the public, it also frequently provides directive actions required to be taken by the general public.

First Responder. Local and nongovernmental police, fire, and emergency personnel who in the early stages of an incident are responsible for the protection and preservation of life, property, evidence, and the environment, including emergency response providers as defined in section 2 of the Homeland Security Act of 2002 (6 U.S.C. 101), as well as emergency management, public health, clinical care, public works, and other skilled support personnel (such as equipment operators) who provide immediate support services during prevention, response, and recovery

operations. First responders may include personnel from Federal, State, local, tribal, or nongovernmental organizations.

Incident. An occurrence or event, natural or human-caused, that requires an emergency response to protect life or property. Incidents can, for example, include major disasters, emergencies, terrorist attacks, terrorist threats, wildland and urban fires, floods, hazardous materials spills, nuclear accidents, aircraft accidents, earthquakes, hurricanes, tornadoes, tropical storms, war-related disasters, public health and medical emergencies, and other occurrences requiring an emergency response.

Incident Action Plan (IAP). An oral or written plan containing general objectives reflecting the overall strategy for managing an incident. It may include the identification of operational resources and assignments. It may also include attachments that provide direction and important information for management of the incident during one or more operational periods.

Incident Command System (ICS). A standardized on-scene emergency management construct specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries. ICS is the combination of facilities, equipment, personnel, procedures, and communications operating with a common organizational structure, designed to aid in the management of resources during incidents. ICS is used for all kinds of emergencies and is applicable to small as well as large and complex incidents. ICS is used by various jurisdictions and functional agencies, both public and private, or organized field-level incident management operations.

Incident Commander (IC). The individual responsible for all incident activities, including the development of strategies and tactics and the ordering and release of resources. The IC has overall authority and responsibility for conducting incident operations and is responsible for the management of all incident operations at the incident site. (See page 10 for discussion on DOD forces.)

JointInformationCenter (JIC). A facility established to coordinate all incident-related public information activities. It is the central point of contact for all news media at the scene of the incident. Public information officials from all participating agencies should collocate at the JIC.

Liaison Officer. A member of the Command Staff responsible for coordinating with representatives from cooperating and assisting agencies.

Mobilization. The process and procedures used by all organizations—Federal, State, local, and tribal—for activating, assembling, and transporting all resources that have been requested to respond to or support an incident.

National Incident Management System (NIMS). A system mandated by HSPD-5 that provides a consistent, nationwide approach for Federal, State, local, and tribal governments; the private sector; and NGOs to work effectively and efficiently together to prepare for,

respond to, and recover from domestic incidents, regardless of cause, size, or complexity. To provide for interoperability and compatibility among Federal, State, local, and tribal capabilities, the NIMS includes a core set of concepts, principles, and terminology. HSPD-5 identifies these as the ICS; multiagency coordination systems; training; identification and management of resources (including systems for classifying types of resources); qualification and certification; and the collection, tracking, and reporting of incident information and incident resources.

Preparedness. The range of deliberate, critical tasks and activities necessary to build, sustain, and improve the operational capability to prevent, protect against, respond to, and recover from domestic incidents. Preparedness is a continuous process involving efforts at all levels of government and between government and private-sector and nongovernmental organizations to identify threats, determine vulnerabilities, and identify required resources.

Public Information Officer (PIO). A member of the Command Staff responsible for interfacing with the public and media or with other agencies with incident-related information requirements.

Recovery. The development, coordination, and execution of service- and site-restoration plans for impacted communities and the reconstitution of government operations and services through individual, private-sector, nongovernmental, and public assistance programs that: identify needs and define resources; provide housing and promote restoration; address long-term care and treatment of affected persons; implement additional measures for community restoration; incorporate mitigation measures and techniques, as feasible; evaluate the incident to identify lessons learned; and develop initiatives to mitigate the effects of future incidents.

Resources. Personnel and major items of equipment, supplies, and facilities available or potentially available for assignment to incident operations and for which status is maintained. Resources are described by kind and type and may be used in operational support or supervisory capacities at an incident or at an EOC.

Response. Activities that address the short-term, direct effects of an incident. Response includes immediate actions to save lives, protect property, and meet basic human needs. Response also includes the execution of emergency operations plans and of incident mitigation activities designed to limit the loss of life, personal injury, property damage, and other unfavorable outcomes. As indicated by the situation, response activities include: applying intelligence and other information to lessen the effects or consequences of an incident; increased security operations; continuing investigations into the nature and source of the threat; ongoing public health and agricultural surveillance and testing processes; immunizations, isolation, or quarantine; and specific law enforcement operations aimed at preempting, interdicting, or disrupting illegal activity, and apprehending actual perpetrators and bringing them to justice.

Source: National Response Plan of December 2004, available at

You talk funny! Exercise and Emergency Response Terminology

University at AlbanyCenter for Public Health Preparedness

Preparedness & Community Response to Pandemics – Glossary

A

adjuvant

A substance (e.g., aluminum salt) that is added during vaccine production to increase the body's immune response to a vaccine.1 A substance that is used in a vaccine to improve the immune response so that less vaccine is needed to produce a non-specific stimulator of the immune response.4

AFIP

Armed Forces Institute of Pathology (AFIP) is an agency of the Department of Defense specializing in pathology consultation, education, and research. AFIP maintains 22 subspecialty departments with a combined workforce of over 820 personnel, including over 120 pathologists and other scientists. Its website is

agent

A factor, such as a microorganism, chemical substance, or form of radiation, whose presence, excessive presence, or (in deficiency diseases) relative absence is essential for the occurrence of a disease.5

airborne transmission

In this type of transmission, infective agents are spread as aerosols, and usually enter a person through the respiratory tract. Aerosols are tiny particles, consisting in part or completely of the infectious agent itself, which become suspended in the air. These particles may remain suspended in the air for long periods of time, and some retain their ability to cause disease, while others degenerate due to the effects of sunlight, dryness or other conditions. When a person breathes in these particles, they become infected with the agent—especially in the alveoli of the lungs.7

antibiotic

A substance that fights bacteria.1

antibodies

Molecules (also called immunoglobulins) produced by a B cell in response to an antigen. When an antibody attaches to an antigen, it destroys the antigen. B cells are small white blood cells crucial to the immune defenses. Also known as B lymphocytes, they come from bone marrow and develop into blood cells called plasma cells, which are the source of antibodies.2

antigenic drift

Small changes in the influenza virus that happen continually over time. Antigenic drift produces new virus strains that may not be recognized by the body's immune system. This is one of the main reasons why people can get the flu more than one time and why flu vaccines change every year.6

antigenic shift

An abrupt, major change in the influenza A viruses, resulting in new hemagglutinin and/or new hemagglutinin and neuraminidase proteins. Shift results in a new influenza A subtype. When shift happens, most people have little or no protection against the new virus. While influenza viruses are changing by antigenic drift all the time, antigenic shift happens only occasionally. Type A viruses undergo both kinds of changes; influenza type B viruses change only by the more gradual process of antigenic drift.6

antigenic variation

Changes in the viral surface proteins (e.g., antigenic shift and drift).

antigens

A substance or molecule that is recognized by the immune system. The molecule can be from a foreign material such as bacteria or viruses.2

antitoxin

Antibodies capable of destroying microorganisms including viruses and bacteria.1

antiviral

Literally "against-virus," any medicine capable of destroying or weakening a virus.1

asymptomatic infection

The presence of an infection without symptoms. Also known as inapparent or subclinical infection.1

attack rate

A variant of an incident rate, applied to a narrowly defined population observed for a limited period of time, such as during an epidemic.5

attenuated

To be weakened. An attenuated vaccine is one that has been weakened by chemicals, or other processes so that it will produce an adequate immune response without causing the serious effects of an infection.4

B

biotechnology

A set of biological techniques developed through basic research and now applied to research and product development. In particular, biotechnology refers to the use by industry of recombinant DNA, cell fusion, and new bioprocessing techniques.3

Bioterrorism (BT) is the intentional or threatened use of living organisms or toxins to kill or sicken people, animals, or plants. Intentional or deliberate epidemics may be called BT events.

C

capsid protein

A protein coat that protects and surrounds the genetic material of a virus.

case definition

A set of standard criteria for deciding whether a person has a particular disease or health-related condition, by specifying clinical criteria and limitations on time, place, and person.5

CDC

The Centers for Disease Control and Prevention (CDC) is the lead federal agency for protecting the health and safety of people at home and abroad, providing credible information to enhance health decisions, and promoting health through strong partnerships. CDC, located in Atlanta, Georgia, is an agency of the Department of Health and Human Services. Dr. Julie L. Gerberding is the Director.

cell

The basic unit of any living organism that carries on the biochemical processes of life.3

chromosome

The self-replicating genetic structure of cells containing the cellular DNA that bears in its nucleotide sequence the linear array of genes. In prokaryotes, chromosomal DNA is circular, and the entire genome is carried on one chromosome. Eukaryotic genomes consist of a number of chromosomes whose DNA is associated with different kinds of proteins.3

cluster

An aggregation of cases of a disease or other health-related condition, which are closely grouped in time and place. The number of cases may or may not exceed the expected number; frequently the expected number is not known.5 Three or more cases of acute febrile respiratory illness (AFRI) occurring within 48 to 72 hours, in residents who are in close proximity to each other. An outbreak is a sudden increase of AFRI cases over the normal background rate or when any resident tests positive for influenza. One case of confirmed influenza by any testing method in a long-term care facility resident is an outbreak.9

common source outbreak

An outbreak that results from a group of persons being exposed to a common noxious influence, such as an infectious agent or toxin. If the group is exposed over a relatively brief period of time, so that all cases occur within one incubation period, then the common source outbreak is further classified as a point source outbreak. In some common source outbreaks, persons may be exposed over a period of days, weeks, or longer, with the exposure being either intermittent or continuous.5

Pandemic Influenza Tabletop Exercise