Pre-Event Planning

Coordinating Resouces

When planning for any public health emergency, public health planners need to consider several factors: (Knowing these details will affect the strategy you plan for.)

  1. What personnel and skills are available at the local and national level to assist in the outbreak?
  2. What kind of communications exist to work with these people?
  3. What kinds of medicines, vaccines, and supplies are available?
  4. How will all these resources be transported?

Identify Staff

When identifying staff, the person designated to manage this activity should consider the population size and language(s) of their given area and estimate the number of teams that could respond to a case. They should also consider the number of supervisors and support staff they will need to support these teams. This would include case interviewers. Estimates should take into account whether or not there will be enough contact tracing teams to conduct face-to-face interviews, which will take longer, or work via telephone. Support staff, secretaries, telephonists, data entry, contact team supervisors all need to be identified.

Train Staff

After the teams have been identified, they should be trained in smallpox diagnosis so that they can evaluate contacts for suspect cases of smallpox. They should also receive training in contact interviewing methods, skills, and how to evaluate those contacts for level of risk. They should also have a thorough understanding of the vaccination arrangements to be used, how to screen for contraindications to the vaccine, how to monitor for severe adverse events, and how to evalucate a patient for a vaccination “take.” An essential to good epidemiology, they should understand all forms and databases that will be used.

Materials

Public health authorities should also develop forms before an event occurs. Forms should be developed that will track case information and contact information. And to further assist the case managers, educational materials will need to be developed that help in the description of the disease, as well as various vaccination issues. Some important forms in pre-event planning are Case forms, Contact forms and VAERS forms. Educational materials required for pre-event planning are:

  1. Smallpox recognition card.
  2. Vaccination Status recognition card.
  3. Vaccine contraindication sheet.
  4. Vaccine Information Statement (VIS).
  5. Vaccination ‘ticket’.

Emergency Operations Center

A central entity that can help to coordinate the response and review how things are going will be essential. Response teams in the field will need to confer on issues of all aspects of the investigation, including surveillance, laboratory issues, and vaccine safety. A central location will also need to be identified to monitor the availability of resources and get them out to those in need. And other members will be necessary to provide basic support to those in the field. A National headquarters with specialists for supporting field teams would include:

  1. Operations coordinator and operations staff
  2. Specialists in smallpox investigations, surveillance, lab, vaccine safety.
  3. Specialists in contact tracing, vaccine supply, policy and procedures.
  4. Communications, training, and hot line advisors.
  5. IT and computer support.

Creation Smallpox Response Teams

In order to quickly contain a smallpox outbreak, you will need teams that are already trained in smallpox disease and how to control it. Local resources could become quickly overwhelmed, not to mention concerned about the safety of their own families. With national-level response teams available, they could go in to assist when necessary.

A central leader should be identified to coordinate contact tracing activities. This person will be key if the outbreak should get so large that contact tracing will need to be prioritized. This person should also be responsible for identifying the number of teams that would be needed to do appropriate contact tracing, given the geography and population of the area, as well as getting those teams prepared to respond.

Additional considerations will be what other staff can be quickly mobilized from other parts of public health or the medical community to help in outbreak control and how the health and safety of the team members will be assured. Well functioning teams would have:

  1. Spirit of team work and sharing of information.
  2. “Get the job done” mentality.
  3. Recognize and utilize local experts.
  4. Share credit broadly, particularly with local counterparts. Make others look good.
  5. Use brief, succinct, and positive communications.
  6. Keep messages consistent among all team members.
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