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INFLUENZA PANDEMIC

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					PANDEMIC RESPONSE PLAN

FOR SCHOOLS, COLLEGES AND UNITS

 UNIVERSITY OF HAWAII AT MANOA


        AUGUST 20, 2009




                   Prepared by:
       Dr. K. Qureshi, UHM, Dept. of Nursing
    J. Lagunero, UHM Emergency Management
PAGE INTENTIONALLY LEFT BLANK
                                  Table of Contents

I. Introduction ..………………………………………………………………………………………………. 6

      1. Assumptions ……....……………………………………………………………………………. 7

      2. Objectives ……....………………………………………………………………………………. 9

      3. Pandemic Continuity of Operation Planning ……....………………………………………... 9

      4. Relationship to Current Plans ……....……………………………………………………..…. 9

      5. Testing and Revision ……....……………………………………………………..…………… 9

II. Governance, command and control ……....……………………………………………………..……. 10

      1. Authority ……....……………………………………………………..………………………….. 10

      2. Declaration of Emergency ……....……………………………………………………..……… 10

      3. Delegation of Authority …....……………………………………………………..……………. 11

      4. Activation …………………………....……………………………………………………..…… 11

            a. Notification to the Campus ..……………………………………………………..….. 11

            b. Notification within the Campus …………………………………………………..….. 11

      5. Coordination ……....……………………………………………………..……………..……… 11

      6. Operational Roles and Responsibilities ……....……………………………………………... 11

            a. Emergency Operations Center …....…………………………………………….….. 11

            b. Office of the Chancellor/ and Vice Chancellors ………………………………..….. 12

            c. Deans and Vice Chancellor ……....…………………………………………………. 12

            d. Emergency Responders ……....…………………………………………………….. 12

            e. Staff and Faculty ……....……………………………………………………..………. 12

            f. Students ……....……………………………………………………..………………… 12

III. Risk Assessment ……....……………………………………………………..………………………… 13

      1. Planning Assumptions ……....……………………………………………………..……….…. 13

      2. Campus Planning Process ……....……………………………………………………..…….. 13

      3. Critical and Essential Functions ……....…………………………………………………….. 13

IV. Special Considerations – Campus Wide Issues ……....……………………………………………. 15

      1. Academic instruction ……….……....……………………………………………………..…… 15


                                          2
      2. Critical Research …………………....……………………………………………………..….. 15

      3. Animal Care ……....……………………………………………………..……………………… 15

      4. Human Resource Issues……....……………………………………………………..……….. 15

      5. Information Technology Infrastructure .…………………………………………………..….. 16

      6. Travel ……....……………………………………………………..…………………………….. 17

      7. Public health / Hygiene Etiquette .....……………………………………………………..….. 17

      8. Personal protective Equipment (PPE) ……………………………………………………….. 18

      9. Frequently Asked Questions (FAQ‟s) ……....……………………………………………….. 18

V. Communication ……....……………………………………………………..…………………………… 18

VI. Response ……....……………………………………………………..………………………………… 19

      1. Activation of Emergency Operations Plan ………………………………………………….. 19

      2. Personnel Assignment/Reassignment ……....………………………………………………. 19

      3. UHM Phases-Action Table ……....……………………………………………………..…….. 20

VII. Recovery ……....……………………………………………………..………………………………… 22

      1. Business Resumption ……....……………………………………………………..………….. 22

      2. Support for Staff, Faculty, Students ……....…………………………………………………. 22

      3. Analysis and After Action Reports ……....…………………………………………………… 22

VIII. Summary of PRP Actions for Key Individual Units at UHM ………………………………………. 23

      1. Chancellor‟s Office ……....……………………………………………………..……………… 23

      2. Vice Chancellors, Deans, and Department Chairs ……....……………………………..….. 23

      3. UHM Pandemic Response Working Group ……....…………………………………………. 24

      4. Communications ……....……………………………………………………..………………… 24

      5. Student Health Services ……....……………………………………………………..……….. 25

      6. Environmental, Health and Safety Office (EHSO) ……....…………………………………. 26

      7. Information Technology Services ……....……………………………………………………. 26

      8. Campus Security ……....……………………………………………………..……………….. 27

      9. Transportation ……....……………………………………………………..…………………… 27

      10. University Student Housing and Dining ……....……………………………………………. 27


                                         3
       11. Human Resources ……....……………………………………………………..…………….. 28

       12. Finance …………....……………………………………………………..……………………. 28

       13. Facilities .……....……………………………………………………..……………………….. 29

       14. Animal Care .……....……………………………………………………..…………………… 29

       15. Students / Faculty / Staff ……....……………………………………………………..……… 30

Appendices:

Appendix A-1
Pandemic Continuity of Operations Plan (P-COOP) ……....…………………………………………… A-1

       Appendix A-2
       Individual Emergency Contact Sheet ...…………………………………………………….…… A-8

       Appendix A-3
       Department Group Call down sheet …………………………………………………………….. A-10

Appendix B
Hawai‘i Department of Health Pandemic Influenza Preparedness & Response Plan ………………. B

Appendix C
University of Hawaii System Emergency Operations Plan .………………………………………..…... C

Appendix D
University of Hawai‘i Mānoa Emergency Response Plan ……....…………………………………….. D


Appendix E
Hawai‘i Disaster Response Manual for Managers
(Dept. of Human Resources Development - April 2004) ……………………………………………….. E

Appendix F
Family Personal Plan ………………………………………………………………………………………. F

Appendix G
Supplemental References ………………………………………………………………………………… G

Tabs
UH Mānoa Pandemic Response Plans by individual units, schools, and colleges




                                                 4
Key acronyms used in this document:

       Avian Influenza (AI)
       Centers for Disease Control (CDC)
       College of Tropical Agriculture and Human Resources (CTAHR)
       Command Centers (CC)
       Damage Assessment After Action Report (DAAR)
       Emergency Management Coordinator (EMC)
       Emergency Management Operations Team* (EMOT)
       Emergency Operations Center (EOC)
       Emergency Response plan (ERP)
       Executive Policy Group of the UHM Emergency Management Team (EPG-EMT)
       Facilities Management Office (FMO)
       Hawaii Department of Health (HDOH)
       Hawaii State Civil Defense (SCD)
       Human Resources (HR)
       Honolulu Department of Emergency management (HDEM)
       Incident Command system (ICS)
       Incident Commander (IC)
       Information Technology (IT)
       Laboratory Animal Service (LAS)
       National Incident Management System (NIMS)
       Pandemic Continuity of Operations Plan (P-COOP)
       Pandemic Influenza (PI)
       Pandemic Response Plan (PRP)
       Pandemic Preparedness Work Group (PPWG)
       Quarantine Pay (Q Pay)
       Student Affairs (SA)
       Student Health Services (SHS)
       United States Department of Health and Human Services (HHS)
       University of Hawaii at Manoa (UHM)
       University of Hawaii at Manoa Campus Security (UHMCS)
       University of Hawaii at Manoa - Study Abroad Center (UHM SAC)
       University Health Services - Manoa (UHSM)
       World Health Organization (WHO)
       Vice Chancellor for Administration, Finance and Operations (VCAFO)
       Vice Chancellor for Research and Graduate Education (VCRGE)

* Note: the EMOT is the team that is appointed by the UHM Chancellor to direct implementation
of the PRP during an epidemic).

** Note: these phases map to the phases as outlined by the HDOH, CDC and the WHO




                                              5
I. INTRODUCTION The World Health Organization (WHO)1 and the Centers for Disease
Control (CDC)2 has warned that there is a high risk of the H5N1 Avian Influenza (AI)
virus becoming the next human influenza pandemic. While there is ambiguity about
whether H5N1 will mutate into a virus capable of causing a worldwide pandemic, the
U.S. Health and Human Services (HHS) Secretary, Michael Leavitt, has urged
preparedness and said at the March 2006 California Pandemic Planning Summit:
“Pandemics happen. Let me acknowledge this is a hard thing to talk about. Anything we
say in advance of a pandemic happening is alarmist; anything we say afterwards is
inadequate.”

Because most natural and man-made disasters tend to be site-specific, traditional
Emergency/Disaster Response and Recovery plans focus on damage to property,
equipment and machinery with limited loss of personnel. The greatest operational issue
in a pandemic-type event will be the effects of absenteeism. The focus of this
Pandemic Response Plan (PRP) is to prepare the University of Hawaii at Manoa (UHM)
to respond to a pandemic, along with the potential curtailment of activities and return to
normal operations as quickly as possible. Pandemics are about people and the
interruptions in their everyday life. It is expected that a pandemic will have world-wide
impact, as well as a serious impact on Hawaii, with an unpredictable timeline,
comprising multiple outbreaks or waves and spreading quickly from one location and
island to another. Major disruptions are likely for health care, transportation,
infrastructure, education, suppliers and other public services. Higher education is
especially at risk because of the large numbers of people in close proximity to each
other, frequent international travel by students, faculty and staff, and because the UHM
campus is open and accessible to the local community at large.

Once a pandemic virus emerges, it is too late to begin planning or to begin
collaboration. While no organization will be immune from the effects of a global
pandemic, we are presented with the opportunity to plan ahead and develop our
response in a caring, compassionate and prudent manner, and continue the delivery of
essential services that will allow UHM to continue its important and vital missions of
education, service and research.

The UHM is committed to doing its best to protect the health of its students and
employees at all times. In the event of an influenza epidemic, UHM will work with the
Hawai„i Department of Health (HDOH)3 to implement recommended strategies to
respond to the event to the fullest extent possible. The UHM has developed a PRP
which will be continually updated as new recommendations are issued from the HDOH,
WHO and CDC. All PRP activities at UHM are coordinated through the HDOH and
Hawai„i State Civil Defense (SCD)4. This PRP is an ongoing work in progress.



1
  World Health Organization - WHO www.who.int
2
  Center for Disease Control - CDC www.cdc.gov
3
  Hawai‘i Department of Health – HDOH http://hawaii.gov/health/
4
  Hawai‘i State Civil Defense - SCD www.scd.state.hi.us


                                                      6
1. Assumptions upon which this PRP is based:
a. All contents of this plan are subject to review and approval by the UHM Chancellor or
her designee(s);

b. As per Federal regulation, all PRP activities will be designed and executed utilizing
the National Incident Management System (NIMS) Incident Command System (ICS).
See Figure 1. Under such circumstances, the Chancellor has the ultimate authority to
designate an Incident Commander for the response (which may be herself or any other
designee);

c. UHM will coordinate all PRP planning and response in cooperation with the HDOH,
SCD, and Honolulu Department of Emergency Management (HDEM)5.

d. As recommendations regarding PRP are revised by key agencies such as the HDOH,
CDC and WHO, the plan will be updated.6

e. The PRP will be based upon the realistic projection of available resources in the
event of an influenza pandemic.

f. The UHM PRP will be consistent with – and complement the HDOH PRP. UHM has
modeled its PRP according to phases outlined by the HDOH and WHO (box 1 below).

    Phases of planning and response
    The phases of pandemic planning and response are as follows:

       Interpandemic Period
           Phase 1: Risk of human infection with animal virus is considered to be low
           Phase 2: Animal virus poses a threat to human health

       Pandemic Alert Period
          Phase 3: Human infection with new subtype but minimal human-to-human
          transmission
          Phase 4: Small clusters of human-to-human transmission, highly localized
          Phase 5: Large clusters of human-to-human transmission, but still highly localized

       Pandemic Period
          Phase 6: Increased and sustained transmission in the general population

       Post-Pandemic Period
          Recovery and return to normal operations.




5
 Honolulu Department of Emergency Management – HDEM www.honolulu.hi.us/ocda/
6
 US Centers for Disease Control. CDC Guidance for Responses to Influenza for Institutions for Higher Education
during the 2009-2010 Academic Year. www.cdc.gov/h1n1flu/institutions/guidance/


                                                       7
Figure1. UHM EOC Table of Organization for Pandemic Response*


                                Incident Commander
                                  (Chancellor or her
                                      designee)




            Executive Policy                              Liaison Officer
          Group - Emergency                            (Liaison with external
           Management Team                             agencies, i.e. HDOH.
             (Key executive                              HDEM, and SCD)
          leadership staff; Vice
          Chancellors, other key                     (UHM EM Coordinator)
               advisors)


           Public Information                             Safety Officer
                 Officer
                                                           (Director of
              (Director of                            Environmental Health
            Communications)                            and Safety Office)




     Planning            Operations               Logistics            Finance and
                                                                      Administration
   Collects data        Carries out the         Procures, and
 makes projections     plans as directed         distributes            Provides HR
        and                by the IC           supplies, space,        policy guidance
 recommendations                                 equipment            and tracks costs,
     for the IC                                manages and IT            authorizes
                                                   assets.              expenditures




*May be expanded or contracted as needed.




                                           8
2. Objectives
This plan is guided by the following principles:

    To protect and support the health, safety and welfare of our faculty, staff and
    students, as well as the assets and property of UHM;

    Maintain our commitment to fulfilling the university mission to provide teaching,
    research and service, as long as possible;

    If any of our operations must be suspended, interrupted or in any way affected,
    recover from these disruptions as quickly and efficiently as possible;

    Establish a multi-modal method to communicate with the UHM campus and the
    community;

    Maintain ongoing contact with HDOH and SCD regarding potential epidemic threats
    at UHM.

    To the extent feasible, extend the services or expertise of the UHM campus to our
    community neighbors, in ways that provide mutual aid, recovery, service, and benefit
    to the region.

3. Pandemic Continuity of Operations Plan (P-COOP)
Concurrently with the development of this plan, each unit on the UHM campus will
develop an internal pandemic plan to address specific response issues and continuity of
operation planning within that unit related to the threat of excessive absenteeism or
inability to continue education, services or research (Appendix A).

4. Relationship to Current Plans
This UHM PRP is consistent with the HDOH PRP7 (Appendix B) as well as the UH
System Emergency Operation Plan8 (Appendix C), and the UHM Emergency Response
Plan (Appendix D), - specifically the section regarding Biological Outbreaks. It is
intended to guide the response and recovery actions of the UHM establishment. Table
1, provides a summary of PRP actions for key individual units at UHM.

5. Plan Testing and Revision
Once pandemic response emergency operation plans are developed, training and
exercising ensures that all faculty, staff and students are aware of the plan, how it is
activated and how it is managed. On an annual basis, training will be scheduled for
various units of UHM, including the EOC team, and specific departments and schools.
Seminars, meetings and similar sessions on personal preparedness will be made

7
 Hawaii Department of Health, Pandemic Influenza Plan. Available at:
http://hawaii.gov/health/family-child-health/contagious-disease/communications/pandemicflu.html
8
 University of Hawaii Emergency Management Office. Available at:
http://manoa.hawaii.edu/emergency/management


                                                       9
available to all faculty members, staff and students in accordance with the P-COOP as
described in Appendix A. This PRP is a dynamic document and will be revised as
dictated by circumstances or necessity. In the absence of outbreaks, this plan will be
reviewed annually by the campus Emergency Management Coordinator (EMC) as well
as the Vice Chancellor for Administration, Finance and Operations (VCAFO).


II. GOVERNANCE, COMMAND AND CONTROL
The manner in which UHM conducts emergency operations on campus is governed by
state and federal legislation. The ability to declare a campus state of emergency is
governed by University of Hawaii policy. The Chancellor, Vice Chancellor, Deans or
Directors (or their designee) maintain a delegation of authority for decision making
within the campus and individual schools, colleges and units. Activation of the campus
emergency plans and the EOC is to be done by the Chancellor or her designee.

Should a pandemic occur, it would be the responsibility of the HDOH to issue isolation
or quarantine orders, direct or recommend closure of facilities, and provide critical
information designating key healthcare facilities as well as distribution of anti-viral
medications. This authority encompasses all private citizens, businesses and campus
operations. The UHM operates in multiple locations on Oahu as well as the other
neighbor islands. All segments of UHM will work closely with the HDOH offices, the
SCD as well as the HDEM, and neighbor island county civil defense agencies to comply
with all guidance and recommendations. All pandemic influenza response activities for
UHM will be coordinated and directed through the UHM EOC.

1. Authority

The authority of UHM to respond to emergencies and disasters is governed by:
      Authority granted from the Regents of the University of Hawaii 9(BOR Bylaws
      Section 2-2 B 4&5)
      Hawai„i Revised Statutes10: HRS 2006/Vol03_Ch0121-0200D/HRS0128/HRS_0128-0010
      The National Incident Management System (NIMS), as prescribed by Homeland
      Security Presidential Directive-5 – Management of Domestic Incidents11.

2. Declaration of an Emergency
The Chancellor of UHM has the authority to declare a state of emergency on campus
when:
     a. Emergent conditions exist on or within the vicinity of the main campus (or off
      campus UHM sites) as a result of a natural or man-made disaster, a civil disorder
      which poses the threat of serious injury to persons or damage to property, or
      based on other seriously disruptive events; and


9
  University of Hawai„i Board of Regents Bylaws Section 2-2 B 4&5
10
   Hawai„i Revised Statutes HRS 2006/Vol03_Ch0121-0200D/HRS0128/HRS_0128-0010
11
   Homeland Security presidential Directive – 5
http://training.fema.gov/EMIWeb/IS/ICSResource/assets/HSPD-5.pdf


                                            10
    b. Extraordinary measures are required immediately to avert, alleviate, or repair
      damage to UHM property or to maintain the orderly operation of the campus.

3. Delegation of Authority
Each Vice Chancellor, Dean and Director is required to maintain copies of the
authorities that have been delegated to them by the Chancellor's Office and the
authorities they have re-delegated elsewhere. The list should include all authorities that
have been delegated to them, the individual who holds the authority, and the assigned
back-up in the event of absence. While it may not be necessary to have the actual
written authority in hand during a crisis, it is essential that units know who holds the
authority to make the decision or sign the paperwork in question. Units should also
prepare written delegations that assign the authority to another individual in the event of
the prolonged absence of the individual who normally holds the authority. Each Vice
Chancellor, Dean and Unit Director must utilize the P-COOP to designate authority in
their absence during a period of pandemic response.

4. Activation
Activation of this PRP at UHM will be done by the Chancellor or her designee. Once
activated, the Vice Chancellors, Deans and Directors will activate their individual unit
pandemic plans. A declaration of a UHM emergency would transfer authority for
activation of all plans to the Chancellor. It is anticipated that the EOC will be placed on
alert and/or activated as needed.

a. Notification to the Campus
While the nature of a pandemic suggests that advance notice of its arrival in our
community will be made by the media, official public health notices will be made to UHM
through the HDOH or SCD.

b. Notification within the Campus
Responsibility for communicating response or recovery actions and intentions begins
with the EOC and continues into each college, school and unit as described in the P-
COOP located in Appendix A.

5. Coordination
Every effort will be made to coordinate the actions and functions as described within this
plan with the University of Hawai„i Office of the President, HDOH, SCD, HDEM as well
as any other affected jurisdictions or entities.

6. Operational Roles and Responsibilities

a. Emergency Operations Center (EOC)
The UHM EOC is activated when any event, emergency or disaster overwhelms the
day-to-day ability of UHM to manage its response and subsequent recovery. EOC staff
is assigned to their roles by the Chancellor. A typical EOC organization chart is
illustrated on figure 1 (p. 8)




                                             11
b. Office of the Chancellor
The Office of the Chancellor will provide executive level direction and authority for all
emergencies and appoints staff to serve as part of the Executive Policy Group in the
Emergency Management Team (EPG-EMT).

c. Vice Chancellors, Deans and Directors
The Vice Chancellors, Deans and Directors for each of the UHM schools, colleges and
units will be responsible for maintaining the individual Unit PRP and activating them as
necessary, defining the decision making hierarchy, and assuring communication and
information flow between the UHM EOC and their staff, faculty and students.

d. Emergency Responders
During a pandemic situation, the disaster response will be different than other types of
and levels of emergency response. Emergency response activities may be assumed by
the University Health Services Mānoa (UHSM), University of Hawai„i Campus Security
(UHMCS), Environmental Health & Safety Office (EHSO), as well as UHM Human
Resources (HR), etc.

e. Staff and Faculty
It is important for our staff and faculty to keep themselves informed of the progress of
any emergency situation. Personal planning and being prepared at home is also
important to being able to provide assistance and support to the University as it deals
with an emergency such as a pandemic. General emergency preparedness information
for families and individuals is available from this location: http://www.pandemicflu.gov
(Appendix E illustrates a family/personal emergency plan that may be used by
employees). A template for this plan will be kept posted on the UHM emergency
management website (Available at: http://manoa.hawaii.edu/emergency/management)

f. Students
Providing safety and security for students is the primary concern for UHM. Students
also have a responsibility to participate in their own safety and security by staying
informed of current events and taking the necessary precautions. As a potential
pandemic situation develops, students are expected to follow all recommendations
issued by various departments within Student Affairs (SA), including the UHSM, the
registrar‟s office and campus housing as well as appointed officials. During a PI event,
students may be required to comply with social distancing, the need to switch to
distance based education or other measures as directed by authorities.




                                             12
III. RISK ASSESSMENT
An influenza pandemic occurs when a new influenza virus emerges for which people
have little or no immunity and for which there is no vaccine. These were the
assumptions used in this planning process.

1. Planning Assumptions

          A pandemic is a public health emergency that has significant political, social
          and economic dimensions, and will be governed by factors that cannot be
          known in advance;

          An influenza pandemic could last from 18 months to several years with at
          least two peak waves of activity. In an affected community, a pandemic wave
          will last about 6 to 8 weeks, or even longer due to a variety of societal factors,
          including modern transit capabilities and increased overseas travel;

          Vaccinations and antiviral treatment are anticipated to be the most effective
          medical treatment, but they may be non-existent or in limited supply;

          Non-medical containment measures (i.e.: social isolation) will be the principal
          means of disease control until vaccinations are available.

          Based on previous pandemics, the clinical attack rate (those persons
          becoming ill) is likely to reach thirty (30) percent in the overall population;

          If the pandemic is severe, the economic impact for Hawaii is likely to be
          significant, though predictions are subject to a high degree of uncertainty;

          A severe pandemic will have serious disruptive effect on the economy of the
          State as well as the University, even after it has run its course ;

          Operational risks (high absenteeism rates) constitute the greatest challenge
          to the global financial system, as well as Hawaii and UHM.

2. Campus Planning Process
The UHM overall strategy for the PRP is:

       Under direction from the Chancellor's office, each of the schools, colleges
       and units will maintain PI-COOP policies and procedures, namely:
       identification of the mission; personnel chain of authority; delegation of
       authority; essential services; critical functions and internal communication
       modes.

3. Critical and Essential Functions - Defined
While it is impractical to consider a complete “closure” of the University, the nature of a
pandemic emergency indicates the very real potential of ceasing social activities (i.e.:


                                             13
face to face classes, public activities) for some period of time. For example, during the
1918-19 pandemic, some universities in the US postponed classes and pushed the end
of the semester back several weeks because of absent students, faculty and staff due
to illness. This plan and each unit plan is based on how to maintain critical and essential
functions during a period of excessive absenteeism, while giving consideration to what
other functions could be delayed or postponed. Essential functions center around:
education, service and research. Some of the essential functions of UHM (and the
responsible parties) during an event are illustrated on Table 1.

Table 1. Specific essential functions for UHM:
   Critical and Essential Functions                         Responsible Groups
 Incident Command and Control               Chancellor‟s Office
                                            Executive Policy Group – Emergency Management
                                            Team
 Safety and Security of the students,       Offices of the Vice Chancellor for Administration,
 staff, faculty, visitors and or the        Finance and Operations and Vice Chancellor for
 campus facilities                          Student Affairs:
                                                    Emergency Management Program
                                                    Campus Security Department
                                                    Environmental Health and Safety Office
                                                    Auxiliary Enterprises and Services
                                                        o Main Campus Dining
                                                        o Transportation
                                                        o Parking
                                                        o Duplicating Services
                                                    Facilities Management Office (FMO)
                                                    Student Affairs: Student Housing
 Human Health, which includes               Office of Student Health Services
 students, staff, faculty and visitors;     UHM Human Resources
 this also includes essential staff         Office of Student Affairs: Health, Housing, Dining
 required to stay on campus
 Communications                             UHM Director of Communications
 • Campus, community and media
 information                                UHM Information Technology Services
 • Information infrastructure
 Physical Plant and Facilities, and         Facilities Management Office (FMO)
 maintenance of infrastructure, utilities   Buildings and Grounds Department
 Essential administrative functions,        Human Resources
 which include employee leave,              Office of Vice Chancellor Administration, Finance and
 benefit and employment questions,          Operations
 establishing a labor pool to maintain
 critical functions, purchasing, payroll.
 Animal/Plant Health, which includes        Office of Research
 the health and safety of all animals       UHM Chief Veterinarian
 that are the responsibility of UHM on      Dean for CTAHR
 and off campus , and the viability of
 all agricultural resources




                                                 14
 Critical and Essential Functions     Responsible Groups

 Internal Support for all units       Human Resources
                                      Finance / Fiscal
 Regional Support to our              UH System: Office of the President
 counterparts in the UH system        Hawaii Department of Health
                                      Hawai„i State Civil Defense
                                      Honolulu Department of Emergency Management



IV. SPECIAL CONSIDERATIONS – CAMPUS WIDE ISSUES

1. Academic Instruction
The UH Senior Administration will work with the UH Faculty Senate to develop
procedures for making emergency decisions, alternative methods to deliver educational
services, waivers of regulations regarding examinations and required days of
instructions as relevant to an event that would require postponing or cancelling classes.
Faculty will be asked to develop alternatives for classroom instruction and materials in
the event of a campus shut-down. Implementation of these policies and procedures will
be coordinated with the Dean‟s office in each school and college, as well as with the
Registrar‟s office. Information as available will be distributed to the UHM community and
posted online by the IT department and or individual schools.

2. Critical research
While work in many research laboratories or studies can be postponed or delayed, there
are some critical areas where research must be maintained. The Vice Chancellor of
Research & Graduate Education (VCRGE) will work with the Faculty Senate to develop
directives and guidance for all critical research and facilities that must be continued.
During an event that requires activation of the campus EOC, the VCRGE will assist the
EOC management in prioritizing response to those research areas and facilities. The
VCRGE will work with the principal investigators to ensure plans for absenteeism issues
are developed for critical personnel. EHSO will implement guidelines for “laboratory
hibernation”.

3. Animal Care
Animals that depend on the UHM staff, faculty and students for their care and shelter
must be considered in any emergency plan. There are a number of facilities housing
animals and there is a coordinated plan through the campus UHM Laboratory Animal
Service (LAS) office to ensure proper animal care during an emergency. The complete
plan will be maintained by the Chief Veterinarian.

4. Human Resource issues
The primary effects of a pandemic are on staffing and student levels. Unlike natural
disasters, pandemics do not damage property or equipment; the effects are mainly
human resource oriented. Absenteeism may be for a variety of reasons:
illness/incapacity; caring for other family members, or school closures. The UHM will


                                           15
follow the directives as outlined in the State of Hawaii Human Resources Development
Guidance document (Disaster Response Manual for Managers)12 (Attachment F).
Senior management from the UHM Office of Human Resources and the Vice
Chancellor‟s Office for Academic Affairs will issue human resource procedures to follow
during the pandemic event.

Each of the UHM schools, colleges and units has an internal system for tracking and
recording employee absences. During a pandemic situation, these systems would be
used to determine individual and campus absenteeism rates, and provide the basis for
decisions made within the campus EOC in conjunction with the HDOH for implementing
social distancing procedures (postpone or delay classes and other public activities).

Each college, school and unit will need to strategize independently how to manage and
plan for absences among faculty, staff and students, and be prepared to coordinate
their efforts with the rest of UHM through the UHM EOC. As indicated in those
documents, specific answers to many HR questions depends on the existence of a unit
pandemic plan and the information provided in each unit‟s P-COOP, i.e.: critical
functions that must be maintained, staffing required to maintain those functions, where
those functions can be performed, and internal unit communication procedures.

The UHM will initiate and maintain a UHM Medical Reserve Corp (MRC) unit, which will
function under the auspices of the HDOH, and under the direct supervision of the Office
of the Vice Chancellor for Administration, Finance and Operations. The UHM-MRC will
be responsible for assisting with all public health initiatives and disaster response
programs as needed.

5. Information Technology Infrastructure
Our business and personal lives depend to a great deal on the availability of an
information technology infrastructure for voice and data communications. During a
pandemic event, it is likely that those systems will become less reliable as they are
likely to become overloaded with increased volume. If public health plans call for social
isolation – i.e.: directing the closure of schools and public events and encouraging the
public to stay home – more staff, students and faculty will be trying to “telecommute”
and this may result in a change in normal network traffic patterns and increased
demand placed upon network equipment and communication links to the internet.

The UHM Director of Communications will work in concert with the VP for Information
Technology & CIO for all communication activities. This will be done through the UHM
EOC.




      12
        State of Hawaii Disaster Response Manual for Managers:
      http://www.hawaii.edu/ohr/download/disaster.pdf


                                                  16
6. Travel
A global pandemic will severely limit both domestic and international travel. The
National Strategy for Pandemic Influenza: Implementation Plan13 anticipates that the
public will voluntarily limit personal travel, and that significant portions of business travel
will also be curtailed. While it is unlikely that travel restrictions will be imposed on a
local, state or Federal level, they will certainly be advised and strongly encouraged. It is
expected that each UHM unit, school or college will be aware of students, staff and
faculty traveling on University business. When UHM Phase 4 or 5 is confirmed, unit
actions include activating plans for travelers and making decisions about future travel
based on the situation. Those decisions could include recalling from travel, restricting
or limiting current travel and cancelling future travel. In all situations, assistance for
international students, scholars and researchers and visa management will be part of
the campus-wide response, and coordinated by their respective School, College or
Department. Assistance may be provided by the UHM Study Abroad Center.

7. Public Health/Hygiene Etiquette:
As access to vaccines and antiviral drugs during a pandemic will be extremely limited,
non-medical interventions may be the only way to delay the spread of the disease. Non-
medical interventions would include social distancing (i.e.: prohibition of mass
gatherings), and infection control measures to avoid spreading the disease. On a
routine basis, it is strongly recommended that all students, faculty and other employees
of the University who fit the CDC criteria14 for annual influenza vaccination do so. These
include:
        Age: 6 months to 19 years of age or older than 50
        Pregnant woman
        Persons with a chronic medical condition
        Persons who live in nursing homes or long term facilities
        Persons who live with or care for those at high risk for complications from the flu,
         including health care workers, household contacts of persons at risk, caregivers
         or children less than 6 months of age
  It should be noted that yearly flu vaccinations should begin as soon as the vaccine is
  available (Sept. / Oct) and continue throughout the winter).

The following information condenses the best current guidance available. In the event of
a pandemic, the CDC (www.cdc.gov) and WHO (www.who.int) websites may offer more
updated information. The following are guidelines provided by the CDC in the event of
any infectious disease outbreak.15

            Avoid close contact with people who are sick.


13
   National Strategy for pandemic Influenza: Implementation Plan
http://www.whitehouse.gov/homeland/pandemic-influenza-implementation.html
14
  Key Facts About Seasonal Flu Vaccine. CDC. Available at; http://www.cdc.gov/flu/protect/keyfacts.html
15
   Pandemic Flu Planning Checklist for Individuals and Families
http://www.pandemicflu.gov/plan/individual/checklist.html


                                                      17
          Stay home and away from work or errands when you are sick.

          Cover your mouth and nose with a tissue, handkerchief, or the sleeve of your
          clothing when coughing or sneezing.

          Clean your hands – schools/colleges/units should consider providing
          waterless antibacterial hand cleansing solutions to individuals.

          Avoid touching your eyes, nose or mouth.

          Persons with respiratory infection symptoms can use a disposable surgical
          mask to help prevent exposing others.

8. Personal Protective Equipment
During a pandemic event, personal protective equipment PPE) that is needed will be
supplied to each unit and/or designated personnel by the University, as needed. The
level and type of PPE utilized will be based upon current recommendations from the
HDOH and the CDC. As a pre-event preparedness measure, and as needed, key
designated personnel will be fit tested for respiratory PPE by UHM EHSO. On an
annual basis additional personnel who have been designated will also receive PPE fit
testing.

9. Frequently Asked Questions
It is not expected that this plan will answer all questions from faculty, staff and students
about the campus response to a pandemic situation. In the event of an Influenza
Pandemic, the UHSM will activate a frequently asked questions website. This will
be coordinated through the EOC and the Director of Communications.


V. COMMUNICATION
Communication strategies are an important component in managing any infectious
disease outbreak and are essential in the event of a pandemic. Accurate, timely, and
consistent information at all levels is critical in order to minimize unwanted and
unforeseen social disruption and economic consequences and to maximize the effective
outcome of the response.

In the event of a pandemic, a campus pandemic information website will be established,
and posted at: http://manoa.hawaii.edu/emergency/ and available via the Campus
Emergency information telephone number (808) 956-0001.

The UHM ITS will be responsible for posting communication notices, information and
instructions during an epidemic. The messages will be composed by the appropriate
party and vetted through the EOC. For instance self care instructions for those who are
ill will be vetted by UHSM, in consultation with the HDOH. Instructions regarding
housing and dining services will be composed and vetted by the Housing staff.



                                             18
VI. RESPONSE

1. Activation of Emergency Operation Plans
In accordance with SCD and NIMS any campus-wide emergency beyond the campus‟
ability to manage with day-to-day operations would result in activation of all applicable
emergency operations plans and the EOC for centralized coordination of response,
relief and recovery efforts. A campus state of emergency could be declared by the
Chancellor and or her designee at the time the EOC is activated. The Chancellor will be
in charge of UHM, and will communicate with the UH System President as needed.

Within UHM the National Incident Management System (NIMS) will serve as the
structure to plan for and manage a contagious disease outbreak of significant
magnitude. Once open, all UHM actions will be coordinated through the UHM EOC.
Specific information on how to contact and communicate with the EOC will be provided
to all UHM units through all available means of communication.

2. Personnel Assignment/Reassignment
The UHM HR department has established policies and procedures that guide
assignment and reassignment. It is important to remember that during an emergency, it
is not business as usual, and all employees will be subject to reassignment. All persons
who are reassigned will be given a job or responsibility for which they are currently
competent or capable of performing with a minimal amount of training. As state
employees, all UHM personnel are considered to be emergency responders 9. Once the
EOC is activated, there will be various methods by which staff and faculty can contact
HR with specific questions. In addition, HR will implement a system to account for and
reassign staff to areas needing assistance.

3. UHM Phases – Action Table
Table 2, illustrates the pandemic response phases as outlined by the HDOH, and
corresponding UHM actions.
9.
     Hawai„i Revised Statutes HRS 2006/Vol03_Ch0121-0200D/HRS0128/HRS_0128-0




                                           19
Table 2. UHM ACTIONS for Pandemic Influenza by Phase

      WHO Phases                 Federal Government                                  UHM Actions
                                  Response Phases
INTER-PANDEMIC PERIOD
     No new influenza virus                                • Develop comprehensive unit plans
     subtypes have been                                    • Develop and test unit and UHM campus communication plans
     detected in humans. An                                • Conduct operations test during staff or safety meetings
     influenza virus subtype
1    that has caused human
     infection may be present
     in animals. If present in
     animals the risk of
     human disease is low.
                                                           • Check the UHM emergency management website regularly for
                                                             updates and new information
                                                           • Communicate developments with staff/faculty/students via UHM
                                     New domestic animal
                                                             Emergency Information website:
     No new influenza virus
                                 0   outbreak in at-risk
                                     country
                                                             http://manoa.hawaii.edu/emergency
                                                           • Refer general questions from staff/faculty/students to
     subtypes have been
                                                             http://www.hawaii.edu/shs
     detected in humans.
                                                            • Encourage adoption of hygiene etiquette behavior across the
     However a circulating
2    animal influenza virus
                                                              campus
                                                           • Encourage personal preparedness plans for staff/faculty/students
     subtype poses a
                                                           • Conduct special training/exercises for EOC team as well as
     substantial risk of human
                                                             individual school/college/units
     disease.
                                                           • Pre-plan for Pandemic Continuity of Operations Plan (P-COOP)
                                                           • Develop and implement campus-wide Communication Plan for
                                                             schools, colleges and units
                                                           • Alert EOC and Executive Policy Group (EPG) / Emergency
                                                           Management Team (EMT)
PANDEMIC ALERT PERIOD
     Human infection(s) with a       New domestic animal   • Coordinate with HDOH, HI SCD and HNL DEM agencies
     new subtype, but no         0   outbreak in at-risk   • Implement appropriate part of Communication Plan
     human-to-human spread,          country               • EPG and EMT meet as needed
3    or at most rare instances       Suspected human       • EOC personnel placed on alert
     of spread to a close        1   outbreak overseas
     contact.



                                                           20
       WHO Phases        Federal Government                                                 UHM Actions
                          Response Phases
PANDEMIC ALERT PERIOD (cont.)
      Small cluster(s) with                                     • Implement plans for staff/students on travel in or near affected areas
      limited human-to-human
      transmission but spread
4     is highly localized,
      suggesting that the virus
      is not well adapted to
      humans.
      Larger cluster(s) but                                     • EOC coordinates all campus response activities
                                        Confirmed human
      human-to-human spread
      still localized, suggesting
                                    2   outbreak overseas
                                                                • Surveillance: Monitor daily absenteeism reports of staff / faculty /
                                                                  students
      that the virus is                                              Maintain lines of communication with the UH System and the
      becoming increasingly                                          Hawai„i DOH for information regarding the need to increase
5     better adapted to                                              intensity of pandemic monitoring or response
      humans, but may not yet
      be fully transmissible
      (substantial pandemic
      risk)
PANDEMIC PERIOD
                                        Widespread human             Full activation of PRP and UHM EOC
                                    3   outbreaks in multiple   • Prepare to activate campus and individual unit response plans
                                        locations overseas      • Coordinate with HDOH, SCD and other agencies
                                        First human case in     • Activate student/staff support plans
                                    4   North America           • In consultation with Public Health, consider:
      Pandemic phase:                   Spread throughout       Implementing social isolation (cease some or all campus activities)

6     increased and sustained
      transmission in general
                                    5   United States           • Activation of labor pool/reassign staff
                                                                • Implement Pan flu Communication Plan
                                        Recovery and
      population
                                    6   preparation for
                                                                • Damage Assessment
                                                                • Resumption of education, research, business activities
                                        subsequent waves.
                                                                • EOC moves into Recovery mode
                                                                • Surveillance for subsequent waves of infection
                                                                • Prepare to deactivate the EOC
                                                                • Debriefing and After-Action Reports

Table 3 (pgs. 23-30) provides further detail regarding key activities of each of the major units within UHM by pandemic
phases.

                                                                21
VII. RECOVERY
Recovery begins immediately and continues throughout the response phase of any
emergency/disaster. With a pandemic, recovery efforts may be thwarted by an unknown
duration of the actual event and the unknown number of faculty, staff and students
affected. Planning for recovery before an event occurs will assist available faculty, staff
and students to make the transition as seamless as possible.

1. Business Resumption
Based on information as developed by the EOC and ongoing reviews of the
international/national/local situation and discussions with each UHM School, college
and unit, the EOC will direct partial, incremental or total return to normal operations. Any
such decisions would be communicated to and coordinated with each school, college
and unit. Questions that will have to be considered include:

       Adjustments necessary to the academic calendar;
       Resumption or rescheduling of education, research & service activities;
       Rescheduling special events that were cancelled or postponed;
       Evaluation of event response and preparation of after action reports
       Computation of resources expended and costs related to the event
       Preparation and submission of reimbursement claims to appropriate agencies

2. Support for Staff, Faculty, Students
After a pandemic wave is over, it can be expected that many people will be affected in a
variety of ways. They may have lost friends and relatives, suffer from fatigue, or have
financial losses as a result of the interruption of work. Services available to the staff,
faculty and students through campus resources will be communicated through all
available means.

3. Analysis and After Action Reports
Once the business resumption is underway, debriefings will be convened to discuss the
response and recovery, changes necessary to current plans, and opportunities for
improvement to future disasters. A formal after action report will be developed and
distributed to the campus by the UHM Pandemic Preparedness Work Group.




                                            22
                                                       University of Hawaii at Manoa
                                     VIII. Summary of PRP Actions for Key Individual and Units at UHM

 Key Individuals               Phase 1 & 2                       Phase 3, 4 and 5                          Phase 6                    Post-Pandemic Period
   and Units             Inter-pandemic Period                Pandemic Alert Period                  Pandemic Period                         (Recovery)
       1.             Participate in development,          Based on guidance from              Where indicated, implement          Begin demobilization, and
   Chancellor       review and approval UHM              PPWG, advise University Deans       plan to alter academic              activities of EOC for recovery
                    Pandemic Response Plan               to consider cancellation of all     schedules, modes of instruction,    mode operations
   V. Hinshaw       (PRP).                               travel programs to endemic          and suspension of non-essential       Direct damage assessment
                      Assure appropriate personnel       areas.                              services and continuity of          activities
   Incident         training and resources are in          Develop policy for suspension     essential services.                   Oversee resumption of
  Commander         place to execute plan when           of classes, sporting events, and      Plan to implement restriction     rescheduling key events that
                    needed.                              other large gatherings.             on social gathering and advise      were cancelled
                      Plan for appointment of                                                community on need to suspend
  (Chancellor's     Incident Commander (IC) and                                              classes, public events, and other
     Office)        two back up persons to fill the                                          large gatherings.
                    role if necessary.                                                         Appoint a designee for
                                                                                             ongoing communication with the
                                                                                             HDOH and HI SCD.
       2.             Deans of Students and                Provide Student Health              Implement telecommuting of          Begin resumption of education,
Vice-Chancellors,   Schools develop and maintain         Service with list of students,      non-essential personnel in          research and service activities
   Deans, and       email/phone lists of students        faculty, and staff traveling to     conjunction with HR, PPWG and         Assess backlog of education,
   Department       and faculty completing academic      endemic areas.                      as directed by IC through the       research and service activities,
     Chairs         work abroad.                           Notify SHS of any students,       EMOT.                               and, develop and implement
                      Identify personnel necessary/      faculty, and staff returning from     Provide ongoing support and       plans to "catch-up" deferred
  {Chancellor's     essential in an emergency.           endemic areas.                      information to students on          work to return to normalcy.
     Office}          Enhance communications and           Formally review PRP in detail     campus.                               Communicate to students the
                    information technology to            with department staff.                Stay in communication with        availability of psychological and
                    support telecommuting (if later        Inform (essential and non-        EOC, report updates to EOC;         social counseling services
                    needed) and instructor utilization   essential) personnel of their       problems or unusual situations.       Reschedule special events
                    of Laulima and other online          potential roles in event of a                                           that might have been cancelled
                    learning systems in use.             pandemic in the city.                                                     Assess full impact and costs
                      Assess IT capacity and                                                                                     associated with the event
                    enhance as needed.
                      Assure that each school and
                    department has an emergency
                    plan that includes:
                    1. Chain of command plan
                    2. Communication plan
                    3. ID essential services and
                    develop business continuity
                    plan. Utilize COOP format.



                                                                                 23
Key Individuals                Phase 1 & 2                       Phase 3, 4 and 5                         Phase 6                  Post-Pandemic Period
   and Units             Inter-pandemic Period                Pandemic Alert Period                 Pandemic Period                       (Recovery)
       3.             Develop Pandemic Response           Convene PPWG, Incident               When necessary, recommend         Damage Assessment After
UHM Pandemic       Plan (PRP).                          Commanders to assess                to the Chancellor activation of      Action Reports (DAAR)
 Preparedness         Monitor international, national   potential impact of global          the EOC the EOC                      distributed to units, schools
Working Group      disease trends, and identify         situation on UHM community.            Convene PPWG and                  and colleges.
    (PPWG)         appropriate sources of                 Update PRP based on current       Emergency                            Collect and analyze
                   information                          influenza information from             Management Operations              completed DAAR's
  K. Qureshi          Network and coordinate with       HDOH and CDC, to include            (EMOT) teams across all              Formulate recommendation to
  A. Nichols       HDOH and SCD as appropriate.         identification and use of PPE for   campuses of UHM                       Chancellor for revision of
  H. Nielsen          Communicate with relevant         designated disaster response           Convene and activate Incident      plan
  J. Lagunero      University departments;              workers.                            Command System for Pandemic          Evaluate personnel response
                   coordinate and integrate               Recommend commencement            Flu incident.                         and recovery actions
                   response initiatives.                of travel assessment protocol          Review U.S. Public Health and
  Office of           Delegate responsibility for       required for students, faculty,     HDOH recommendations and
 Emergency         developing strategies,               and staff traveling to and          liaison with HDOH and SCD.
 Management        procedures, and policies on          returning from affected regions     Develop “vaccination plan” when
                   public information, vaccinations,    of the world.                       vaccine is available in
  J. Lagunero      respiratory protection, isolation      Develop updated prevention        consultation with the HDOH
Asst. Emergency    of suspect cases and work.           information (infection control,
 Management           Brief Chancellor on pandemic      i.e., hand hygiene, “respiratory
  Coordinator      plans, and on IC roles and           etiquette”, social distancing,
                   responsibilities, Serve as           stay-at-home when ill) for use by
                   technical advisors to the            public relations.
                   Chancellor.                            Assist Departments and Units
                      Schedule annual training          with the development of their P-
                   programs, table top and drill        COOP and the identification of
                   exercises.                           designated disaster response
                   Identify and Train MRC and           workers.
                   designated Response Workers
      4.              Create web link from UHM for        Develop information                 Implement webpage                  Communicate demobilization
UHM Community      pandemic flu information.            dissemination strategy (hotline,    announcement and general           plan and steps to appropriate
 & Govt. Affairs      Post information on webpage       web page, print, elevator           press release to reflect current   people, schools, colleges, and
                   about hygiene and hand               notices, and electronic mail).      state.                             or units
 G. Takayama       washing (“hand hygiene” and            Update University Webpage in        Prepare / disseminate              Assess status of
   Director        “respiratory etiquette”), flu        collaboration with PPWG as          communiqué to UHM                  communication system, resume
                   prevention, basic flu facts, and     appropriate.                        community.                         normal maintenance which may
Communications     links to appropriate websites                                              Prepare and disseminate          have been deferred during event
                   (e.g., Centers for Disease                                               press releases and prevention        Continue to post risk
 Diane Chang       Control and Prevention (CDC)                                             information                        communication messages and
   Director        HDOH                                                                       Update website info.             ongoing information to faculty,
     (PIO)                                                                                    Establish media relations        students and the community
                                                                                            center with EOC.

                                                                               24
Key Individuals               Phase 1 & 2                       Phase 3, 4 and 5                          Phase 6                    Post-Pandemic Period
  and Units             Inter-pandemic Period                Pandemic Alert Period                  Pandemic Period                          Recovery
      5.             People exposed will be              Initiate pandemic educational       Initiate screening of students       Maintain contact with the
Student Health     managed according to HDOH           outreach to students and faculty.   with possible contact with a         HDOH and HSCD for updates
   Services        recommendations.                      Assess need for activation of     verified case.                       and directives
                     Plan for staffing of designated   flu-related health information        Activate pandemic information        Assess health impact on
 Dr. A. Nichols    “Social Isolation” floor, as        phone line.                         telephone line.                      students, faculty and staff
Medical Director   appropriate).                         Initiate required pre-travel        Initiate HDOH quarantine or          Assess resources used and
                     Develop contingency staffing      education and required re-          social isolation                     costs associated with the event
                   plan for essential health           entrant travel assessment           recommendations.                     and communicate such to the
                   personnel.                          protocol for students traveling       Coordinate with EMOT               Planning Section Group in the
                     Provide psychological support     abroad.                             regarding quarantine and social      EOC
                   and counseling for University         Coordinate pandemic-related       isolation.                             Assess backlog of usual SHS
                   employees affected by the           activities with SHS, HDOH and         Implement mental health            activities, and, develop and
                   pandemic.                           UHM-EMOT.                           support plan.                        implement plans to "catch-up"
                     Develop mental health support       Initiate pandemic outreach to       Supply Resident Advisors           deferred work to return to
                   plan                                students, appropriate faculty and   disposable thermometers, and         normalcy
                     Work with the HDOH to             staff.                              surgical masks as appropriate          Begin resumption of usual
                   develop a case reporting system       Provide flu awareness training      Distribute masks and/or            SHS activities
                                                       to Residence Life Personnel.        respiratory packets to residential     Communicate to campus
                                                                                           facilities, as appropriate           community the availability of any
                                                                                             People exposed will be             special services such as
                                                                                           managed according to HDOH            psychological and social service
                                                                                           recommendations.                     counseling
                                                                                             Begin staffing designated            Reschedule special events
                                                                                           “Social Isolation” floor, as         that might have been cancelled
                                                                                           appropriate.                           Report statistics to the HDOH
                                                                                             Activate contingency staffing      as requested
                                                                                           plan.                                  Assure safeguarding of
                                                                                             Provide psychological support      personal / confidential health
                                                                                           and counseling for University        information for students, faculty
                                                                                           students and employees               and staff
                                                                                           affected by the pandemic.
                                                                                             Visitation by parents or friends
                                                                                           will be determined by HDOH
                                                                                           policy / directives at the time.
                                                                                           Initiate case reporting system.




                                                                              25
Key Individuals              Phase 1 & 2                        Phase 3, 4 and 5                       Phase 6                        Post-Pandemic Period
  and Units            Inter-pandemic Period                Pandemic Alert Period                 Pandemic Period                              Recovery
       6.           Review Respiratory Protection        Identify & recommend               Disseminate Education                 Assess full impact and costs
Environmental     Plan.                                Personal Protection Equipment.     Program to selected personnel         associated with the event and
 Health Safety      Evaluate Personal Protection         Review and update                (public safety, facilities, housing   communicate such to the
     Office       Equipment (PPE) needs                educational training program.      and dining).                          Planning Section Group in the
                  (respirators, masks, gloves).          Respirator fit-testing and         Continue to assess PPE and          EOC
R. Takekawa        Develop education program for       training for selected personnel.   engineering controls and                Assess backlog of usual
Safety Officer      selected (front-line) personnel.                                      conjunction with HDOH.                EHSO activities, and, develop
                                                                                                                                and implement plans to "catch-
                                                                                                                                up" deferred work to return to
                                                                                                                                normalcy
                                                                                                                                  Begin resumption of usual
                                                                                                                                EHSO activities
                                                                                                                                Provide advice regarding
                                                                                                                                terminal disinfection of affected
                                                                                                                                facilities (if indicated)
      7.           Assess IT capacity and               Review IT plan.                     Commence implementation of            Assess full impact and costs
 Information      develop IT plan for PRP.                                                IT plan.                              associated with the event and
 Technology       Plan to support increased                                                 Make adjustments to IT plan         communicate such to the
   Services       capacity for distance based                                             as necessary; provide ongoing         Planning Section Group in at the
                  education and telecommuting                                             support for communication and         EOC
  D. Lassner                                                                              education functions of the              Assess backlog of usual ITS
  VP-IT / CIO                                                                             University.                           activities, and, develop and
                                                                                                                                implement plans to "catch-up"
                                                                                                                                deferred work to return to
                                                                                                                                normalcy
                                                                                                                                  Begin resumption of usual IT
                                                                                                                                activities
                                                                                                                                  Continue with ongoing risk
                                                                                                                                communication to the campus
                                                                                                                                community as per directives
                                                                                                                                from the EOC
                                                                                                                                  Maintain UHM website for
                                                                                                                                communication updates




                                                                              26
 Key Individuals              Phase 1 & 2                       Phase 3, 4 and 5                            Phase 6                   Post-Pandemic Period
   and Units            Inter-pandemic Period               Pandemic Alert Period                     Pandemic Period                       Recovery
       8.            Identify communication               Review and assess                    Initiate flu awareness training     Assess full impact and costs
Campus Security    methods to reach Incident            personnel/staffing plans.            for Public Safety personnel.        associated with the event and
                   Commander and PPWG.                  Update Pandemic Flu training           Selected personnel to receive     communicate such to the
   D.Dawson          Develop plans to enforce           plan for selected personnel.         respirator training and             Planning Section Group in the
    Captain        restriction of movement orders                                            respirators by EHSO.                EOC
                   Develop and initiate Pandemic                                               Secure access to campuses           Open areas of the Campus
                   Flu training for selected                                                 and buildings as directed by        that may have been closed
                   personnel.                                                                UHM-EMOT.                             Begin resumption of usual
                                                                                               Provide security to quarantine    Security activities
                                                                                             and isolation areas.
       9.            Develop contingency plans to        Assess use of shuttle services.       Identify essential personnel to     Assess resources used and
 Transportation    assist staff to get to work.                                              maintain shuttle service and        costs associated with the event
                     Assess Parking capacity (note                                           assist Public Safety as may be      and communicate such to the
                      rd
    R. Shito       1/3 of workforce may be out                                               required.                           Planning Section Group in the
    Parking        which may free up parking                                                   As needed, suspend or             EOC
  Operations &     spots).                                                                   augment schedules of shuttle          Assess backlog of usual
 Transportation                                                                              services                            transportation activities, and,
    Services                                                                                                                     develop and implement plans to
    Manager                                                                                                                      "catch-up" deferred work to
                                                                                                                                 return to normalcy
                                                                                                                                   Begin resumption of
                                                                                                                                 transportation services
                                                                                                                                   Communicate via EOC the
                                                                                                                                 availability of resumed
                                                                                                                                 transportation services, such as
                                                                                                                                 the Campus shuttle.
      10.            Formulate plans for                   Monitor and report suspect          Implement flu awareness             Assess full impact and costs
   University      quarantine, isolation, and “social   illness to Student Health            training for housing and dining     associated with the event and
Student Housing    distancing” of students.             Services.                            personnel.                          communicate such to the
   and Dining        Identify necessary supplies for       Review plans for quarantine         Deliver respirator training to    Planning Section Group in the
                   quarantine/isolation housing         and isolation of students.           selected personnel                  EOC
   L. Furutani     (e.g., bedding, disposable paper        Initiate flu awareness training     Implement Toilet / Housing          Assess backlog of usual
Acting Assoc Dir   products, and tissues).              for housing and dining               Facility Plan.                      housing and dining activities,
 of Operations     Formulate plan for                   personnel.                             Implement Food Service Plan.      and, develop and implement
Student Housing    accommodation of essential              Selected personnel to receive       Activate quarantine & isolation   plans to "catch-up" deferred
                   personnel                            respirator training and              plans with SHS and HDOH.            work to return to normalcy
  A. Lachman                                            respirators.                                                               Begin resumption of usual
 Food Services                                             Develop Toilet Facility Plan.                                         housing and dining activities
   Manager                                                 Develop Food Service Plan.



                                                                                 27
Key Individuals             Phase 1 & 2                         Phase 3, 4 and 5                      Phase 6                       Post-Pandemic Period
  and Units           Inter-pandemic Period                  Pandemic Alert Period              Pandemic Period                            Recovery
      11.          Review Telecommuting                  Assist Deans, Vice                Communicate Telecommuting             Assess full impact and costs
   Human          Policy.                              Chancellors, and Department       Plan.                                 associated with the event and
  Resources        Assist in definition of essential   Chairs with identification of       Assess when to implement            communicate such to the
                  personnel.                           essential personnel.              telecommuting and Q pay plans.        Planning Section Group in at the
   P. Hong         Review Sick Leave Policies.           Develop implementation plan       Assist Deans, Vice                  EOC
   Director        Develop Quarantine (Q) Pay          for telecommuting and Q pay.      Chancellors and Department              Assess backlog of usual
   Human          Policy.                                    Assist with monitoring of   Chairs in redeployment of             human resource activities, and,
  Resources        Cross-training.                         personnel traveling abroad.   personnel to maintain business        develop and implement plans to
                   Worker‟s Compensation.                                                continuity and essential              "catch-up" deferred work to
                                                                                         services.                             return to normalcy
                   Family and Medical Leave
                    Act.                                                                                                         Begin resumption of usual
                                                                                                                               human resource activities
                                                                                                                                 Communicate to campus
                                                                                                                               community the availability of any
                                                                                                                               special services such as
                                                                                                                               psychological and social service
                                                                                                                               counseling
                                                                                                                               Reschedule special events that
                                                                                                                               might have been cancelled
     12.            Develop plan for continuity of      Review and update plan             Prepare to activate plan.             Assess full impact and costs
   Finance        payroll services.                                                        Assure payroll, purchasing,         associated with the event
                    Secure necessary                                                     contract and procurement              through analysis of data from
   OVCAFO         contingency funds.                                                     procedures are in place.              specific units, and communicate
                    Establish appropriate                                                  Activate plan at the direction of   such to the Chancellor
                  purchasing contingency plans                                           the IC.                                 Assess backlog of usual
                  with essential vendors.                                                  Keep track of costs incurred        finance activities, and, develop
                    Evaluate options to expand                                           and expenditures                      and implement plans to "catch-
                  use of “P-card”.                                                                                             up" deferred work to return to
                    Develop a plan for tracking of                                                                             normalcy
                  expenditures                                                                                                   Begin resumption of usual
                    Develop a plan for rapid                                                                                   finance activities
                  issuance of contracts                                                                                          Begin to prepare documents
                                                                                                                               for cost reimbursement from
                                                                                                                               State or Federal agencies
                                                                                                                                 Submit claims to appropriate
                                                                                                                               agencies




                                                                               28
Key Individuals             Phase 1 & 2                     Phase 3, 4 and 5                      Phase 6                   Post-Pandemic Period
  and Units           Inter-pandemic Period              Pandemic Alert Period               Pandemic Period                       Recovery
      13.          Modify plans for regulated          Review all PRP plans and        At direction of the Incident     Assess resources used and
  Facilities      medical waste if needed.           procedures, report gaps to the   Commander, implement the        costs associated with the event
 Management        Assess Ventilation Plan,          Chancellor's Office              PRP                             and communicate such to the
     Office       Design and Operation with SHS                                                                       Planning Section Group in the
                  assistance as needed.                                                                               EOC
   D. Hafner       Identify available dormitory                                                                         Assess backlog of usual
                  space and inventory supplies                                                                        Facilities activities, and, develop
  Asst VC for     such as cots.                                                                                       and implement plans to "catch-
Campus Services    Review parking and transit                                                                         up" deferred work to return to
                  options.                                                                                            normalcy
                  Develop contingency plans for                                                                        Make arrangements for
                  essential services with reduced                                                                     disposal of any accumulated
                  personnel.                                                                                          waste
                                                                                                                       Begin resumption of usual
                                                                                                                      facilities activities.
      14.           Develop plan for care of           Review plan, stay in             At direction of the IC          Assess health of animals for
  Animal Care     animals for which the University   communication with the HDOH      implement PRP                   which UHM has responsibility
                  has responsibility (both off and   regarding animal handling.                                         Assess full impact and costs
  S. Kondo        on UHM campus).                                                                                     associated with the event and
UH Veterinarian     Maintain a roster of all                                                                          communicate such to the
                  animals that are the                                                                                Planning Section Group in at the
                  responsibility of the UHM.                                                                          EOC
                                                                                                                        Assess backlog of usual
                                                                                                                      animal care activities, and,
                                                                                                                      develop and implement plans to
                                                                                                                      "catch-up" deferred work to
                                                                                                                      return to normalcy
                                                                                                                        Begin resumption of usual
                                                                                                                      animal cared activities
                                                                                                                        Continue to monitor health of
                                                                                                                      animals and report unusual
                                                                                                                      events to the HDOH




                                                                            29
Key Individuals              Phase 1 & 2                 Phase 3, 4 and 5                         Phase 6                   Post-Pandemic Period
  and Units            Inter-pandemic Period          Pandemic Alert Period                 Pandemic Period                         Recovery
      15.           Become familiar with           Students/Faculty/Staff traveling     Consult University influenza     Faculty and staff will assess
  Students/       University plan, and remain    to and returning from affected       updates at least daily.          the backlog of usual work, and
   Faculty/       informed.                      areas are expected to complete         Comply with all University     develop and implement plans to
     Staff          Comply with all University   Travel Assessment with SHS.          recommendations regarding        "catch-up" deferred work to
                  recommendations regarding                                           pandemic flu response.           return to normalcy
                  pandemic flu response.                                                                                 Faculty will communicate with
                                                                                                                       students regarding plans for
                                                                                                                       makeup work, and return to
                                                                                                                       usual mode of instruction
                                                                                                                         Students will communicate
                                                                                                                       with faculty regarding
                                                                                                                       accommodations required as a
                                                                                                                       result of the event
                                                                                                                         All groups will monitor the
                                                                                                                       UHM and their School or
                                                                                                                       College website for additional
                                                                                                                       information or instructions and
                                                                                                                       follow as directed




                                                                         30
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APPENDIX A-1
                          UNIVERSITY OF HAWAII AT MANOA
        [ INSERT YOUR SCHOOL, COLLEGE OR DEPARTMENT NAME HERE_________]

POLICY/PROCEDURE: Pandemic Continuity of Operations Plan (P-COOP)

OVERVIEW:
In the state of Hawaii, during or following a disaster, every state employee is considered
a civil defense worker and may be assigned response or recovery duties.1 At the
University of Hawaii at Manoa, in the event that there is a community level or campus
wide disaster, the Chancellor‟s Office will be responsible for directing all disaster
response efforts for the University; and the Schools, Colleges and Departments will take
direction from and coordinate efforts through the Chancellor‟s Office.

DEFINITION OF TERMS:
Disaster: Any event, (whether it be from natural, technological or deliberate-human
caused occurrences) which causes significant disruption to the community and/or the
university and requires unusual efforts to (1) assure the safety of students or personnel,
or (2) maintain operations such as education, research or service.

I.     INTRODUCTION: The core mission of the [<Insert your school, college or
department name here_________>], includes [<identify which of these apply:
education, research and service>]. Therefore, it is essential that plans be in place for
continuity of operations (relative to this core mission) in the event of an influenza
pandemic.

II.     PURPOSE: The purpose of this policy / procedure is to assure that there is a
mechanism in place to maintain or rapidly maintain or resume essential operations
within the [<Insert your school, college or department name here_________ >], during
or after an influenza pandemic.

III.  DEFINITIONS:
OPERATIONS: those activities that are sponsored by the [<Insert your school, college or
department name here_________ >], and may include: [<Identify which of these apply-
education, research and service>].

MAJOR PANDEMIC DISASTER: Any biological event that results in any of the following for
the University of Hawaii at Manoa students, faculty or staff:
   Significant disruption in societal functions or implementation of quarantine or
   isolation orders that require restriction of travel to or from the university or limitation
   of social gathering.
   Large number of students, faculty or employees who are rendered ill due to the
   pandemic illness.
   The HDOH declares an actual or impending pandemic situation.




                                              1
1.
  Governor Linda Lingle, http://capitol.hawaii.gov/hrs2006/Vol03_Ch0121-
0200D/HRS0128/HRS_0128-0010.HTM
CONTINUITY OF OPERATIONS: maintenance of essential services

ESSENTIAL SERVICES: those services that must be maintained continually, or resumed
after a defined period of time. Failure to maintain such services would significantly
affect the education, research or service mission of the schools, colleges and
departments of the UHM in an adverse way.

IV.      POLICY:
      1. In the event that the HDOH issues a notice that there is a potential, actual or
         impending influenza pandemic threat, the University of Hawaii at Manoa Office of
         the Chancellor will implement the UHM influenza pandemic response plan. Once
         this occurs, the [<Insert your school, college or department name
         here_________ >] will activate its unit specific influenza pandemic plan.
      2. Annually, (during the month of October) the [<Insert your school, college or
         department name here_________ >] will identify which of their core mission
         responsibilities are to be considered essential, and review this continuity of
         operations plan for an influenza pandemic disaster.
         3. In all instances the safety of the faculty, students and staff take priority over all
         other considerations when implementing the UHM influenza pandemic plan.

V.         PROCEDURE:
      1.   Annual review and update workplace operations and responsibilities will be
           conducted. Services / operations will be identified and categorized according to:
           which of these can be postponed, or which must be maintained in the event of an
           influenza pandemic. .
      2.   For those operations responsibilities that can be postponed, the maximum length
           of time for postponement will be indicated.
      3.   For those operations responsibilities that must be maintained, a procedure will be
           identified ahead of time that outlines the level / extent of operations to be
           maintained, and the procedures for such will be recorded.
      4.   Once the UHM Pandemic Influenza plan is activated, the unit will review the
           State of Hawaii Disaster Response Manual for Managers document, which
           summarizes key human resource polices during times of disasters, for the State
           of Hawaii employees. This can be accessed at:
           http://www.hawaii.edu/ohr/download/disaster.pdf

VI.     CORE MISSION of the [<Insert your school, college or department name here>] is :
[Insert your core mission here]
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________




                                                 2
VII.    CHAIN OF AUTHORITY AND DELEGATION OF AUTHORITY:
The following people can make operational decisions in the absence of: (Insert the
correct title here: Vice Chancellor, Dean, Director,].

                                       Name / Title         Phone and    Alt phone and
                                                            email        email
             <Key leader title here>
             First Successor
DELEGATION




             Second Successor

             Third Successor



VIII. EMPLOYEES WITH SPECIAL SKILLS/ KNOWLEDGE
The following employees have special knowledge or skills which can be utilized during
and pandemic emergency.

              Name             Skills/ knowledge      Current position     Contact
                                                                         information




                                                      3
IX.   ESSENTIAL SERVICES PROVIDED BY THE UNIT AND DECISION REGARDING OPERATION
VS. SUSPENSION:

Examples of methods to maintain continuity of operations may include:
     Education: change the method of delivery of classes (i.e. from face-to-face to
     online, or from online to face-to-face or via direct mail assignments)
     Research: notification of research subjects that their participation in the project
     will be deferred; initiation of plans to relocate research animals to a pet shelter
     Service: temporary closure of a clinic with referral of acute cases to another
     facility/agency in the healthcare system

            Operation      If yes,        Plan/procedures for      On-Site     Other
            can be         maximum        continuity of                        location
            suspended:     amount of      operations
            yes or no?     time it can
                           be
                           suspended
Education




Research




Service




                                            4
X.     CRITICAL FUNCTIONS OF [INSERT NAME OF SCHOOL, COLLEGE OR DEPARTMENT HERE]
FOR PANDEMIC INFLUENZA RESPONSE:
Critical Function:

People             Primary                 Alternate            Second Alternate
Responsible
Phone numbers
Critical Function:

People             Primary                 Alternate            Second Alternate
Responsible
Phone numbers
Critical Function:

People             Primary                 Alternate            Second Alternate
Responsible
Phone numbers
Critical Function:

People             Primary                 Alternate            Second Alternate
Responsible
Phone numbers
Critical Function:

People               Primary               Alternate            Second Alternate
Responsible
Phone numbers


XI.   COMMUNICATIONS:

XI.1. INTRODUCTION TO COMMUNICATIONS DURING A PANDEMIC EMERGENCY
In the event of a pandemic emergency disaster that affects the UHM campus, the
Chancellor‟s Office will be responsible for crafting and disseminating information to the
university faculty, staff and students. Methods for communication used may include:
group e-mail, posting on the University web site, radio or television messages, or
telephone calls or other means. The (<Vice Chancellor, Dean or Director or their
designee) will be the spokesperson for their respective unit.

XI.2 PURPOSE: The purpose of this policy is to delineate the procedures that the
(school, college or department _______) will use to communicate to faculty, staff and
students during an emergency.




                                            5
XI.3 POLICY:
1. Each semester, all faculty, staff and student workers will be asked to provide and
   update as needed their personal emergency contact information. (attachment A)
2. A master emergency contact list will be collected by each department secretary. This
   emergency contact list will be sorted by functional groups, and specific personnel will
   serve as group call down list communication leaders. These leaders will be assigned
   to conduct and coordinate contact efforts for their assigned group. (attachment B)
3. Emergency contact information is to be treated confidential, stored in a secure area,
   and used ONLY for emergency contact situations.
4. Both direct and indirect contact methods may be used.
5. The emergency communication efforts will be directed by the (<Insert correct title
   here for School, college or Department>). In his/her absence, the highest available
   person in the (Insert your school, college or department here>) chain of authority will
   assume this responsibility (see section VII.).

Only the Chancellor or his/her designee has the authority to speak to the media or
general public behalf of the University. The University will appoint one designated
person to serve as a spokesperson for UHM.


XI.4 PROCEDURE:
The (Insert the correct title here for your unit>) (or his/her designee) decides that an
emergency communication needs to be sent to faculty, staff, or students.
Communication can be sent to all, or some of these groups.

DIRECT CONTACT PROCEDURE
1. Appoint a person to direct the emergency contact efforts.
2. Initiate the process for contacting the appropriate personnel.
3. Craft the message (and have approved by unit leader) to be given to each person
   contacted.
4. Based upon the number of persons to be contacted, an appropriate number of
   personnel will be assigned to begin contacting those on the list and deliver the
   approved message. The emergency communication tree will be used to organize the
   contact efforts. People will be called on the telephone: at home, work, cell, by email,
   or by another emergency contact number or route provided.

INDIRECT CONTACT (THIS WILL BE USED IN THAT MASS DISTRIBUTION OF THE INFORMATION IS
REQUIRED)
1. A technical person will be appointed to coordinate these efforts and post the
   message.
2. The Chancellor or her designee will craft and approve any message to be delivered
   via a mass communication system, which may include: the University website, group
   text message if available, memo posted on doors, public radio, email, and radio or
   television announcement.




                                             6
3. The Dean or her designee will craft and approve any message to be delivered via a
   mass communication system, that is specific only to the School, which may include:
   the School website, group text message if available, memo posted on doors, public
   radio, email, radio or television announcement. All such messages must be
   approved by the UHM Director of Communications.

ACKNOWLEDGEMENT OF RECEIPT OF MESSAGE:
  1. A person will be appointed to collate all information regarding who has and who
     has not been contacted.
  2. Faculty, staff and students may be asked to call into a specific telephone number
     to ascertain need for their services and report their availability to work or assist
     the university community.

APPROVAL:

____________________________________
(<Insert name here>)
(<Insert title here>) (Vice Chancellor, Dean, or Director)
(<Insert School, College or Department here>)

Approval Date:              ____________________________

Review Date:                ____________________________

Review Date:                ____________________________

Revised/ Amended:           ____________________________




                                             7
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APPENDIX A-2
                             UNIVERSITY OF HAWAII AT MANOA
                             SCHOOL / COLLEGE DEPARTMENT
                          EMERGENCY CONTACT INFORMATION SHEET

INSTRUCTIONS: This form must be completed upon initial employment in the School,
college or Department, and reviewed and where necessary updated each year.

NAME: _________________________ TITLE: ________________________________

CURRENT MAILING ADDRESS:         ____________________________________________

                                 ____________________________________________

Phone numbers with area code:
HOME                       CELL                                     PAGER / OTHER
(      )                          (      )                          (      )

EMAIL ADDRESSES:
UH                                                                  @HAWAII.EDU
OTHER

********************************************************************************************
PERSONAL CONTACT INFORMATION: IN THE CASE OF EMERGENCY, PRIMARY CONTACT:

NAME: _________________________ RELATIONSHIP TO YOU: ________________

MAILING ADDRESS:       ________________________________________________

                       ________________________________________________

PHONE NUMBER:        _________________________________________________

IN THE CASE OF EMERGENCY, SECONDARY CONTACT:

NAME: __________________________ RELATIONSHIP TO YOU: ________________

MAILING ADDRESS: ___________________________________________________

                    ___________________________________________________

PHONE NUMBER:        (_______) __________________________________________

DATE INITIALLY COMPLETED: _________________


                                                 8
DATE REVIEWED:   : ________________ ACTION: ___ NO CHANGE ___
AMENDED
DATE REVIEWED:   : ________________ ACTION: ___ NO CHANGE ___
AMENDED
DATE REVIEWED:   : ________________ ACTION: ___ NO CHANGE ___
AMENDED
DATE REVIEWED:   : ________________ ACTION: ___ NO CHANGE ___
AMENDED
DATE REVIEWED:   : ________________ ACTION: ___ NO CHANGE ___
AMENDED
DATE REVIEWED:   : ________________ ACTION: ___ NO CHANGE ___
AMENDED
DATE REVIEWED:   : ________________ ACTION: ___ NO CHANGE ___
AMENDED
DATE REVIEWED:   : ________________ ACTION: ___ NO CHANGE ___
AMENDED




                               9
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APPENDIX A-3
                                          COLLATED GROUP CALL DOWN LIST

GROUP #         NAME*          UH TEL       HOME TEL       UH EMAIL        UH OFFICE        DEPT.            POSITION
                                                                           LOCATION




* = Those person who have an * next to their name will serve as the group call down communication leaders.
They will contact all of those persons of their assigned group call down list.


                                                          10
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Hawaii Department of Health




  PANDEMIC INFLUENZA
PREPAREDNESS & RESPONSE
         PLAN




          January 2008
          Version 08.1
                   Past and Present Contributors to the
             Pandemic Influenza Preparedness & Response Plan1
                                                  (in alphabetical order)

Bart Aronoff, MPH                 Department of Health
Tracy L. Ayers, MS                Department of Health
Morgan Barrett, MD, MPH           Department of Health
Michael Brummage, Col, MC         Tripler Army Medical Center
Catherine C. Chow, MD, MPH        Centers for Disease Control & Prevention, assigned to
                                  Hawaii
Carl Chu, PharmD                  Department of Health
Toby Clairmont, RN, CEM           Healthcare Association of Hawaii
Jean T. Conger                    Department of Health
Sharon Dellinger                  Department of Health
Paul V. Effler, MD, MPH           Department of Health
Ryan Endo, JD, MPH                Department of Health
Chiyome L. Fukino, MD             Department of Health
Adrienne Gardner                  Department of Health
Blair Goto, JD                    Hawaii Department of the Attorney General
Jan Harada, JD                    Department of Health
Konrad E. Hayashi, Capt           Force Health Protection & Public Health, Surgeon's Office,
                                  Pacific Command
Lisa Hendrickson, MD, MPH         Department of Health
David Horio, MD                   Department of Health
Todd Inafuku, RPh                 Department of Health
Thomas Klewin                     Department of Health
Gail Kunimoto                     Department of Health
Julie Kushima                     Hawaii State Civil Defense
Laura M. Lott                     Department of Health
Ralene M. Markowitz, RN           Department of Health
Marcia Nagao, MD, MPH             Department of Health
Michele N. Nakata                 Department of Health
Janice Okubo                      Department of Health
Ruth Ota, RN                      Department of Health
Walter Ozawa                      Hawaii State Judiciary
Sarah Y. Park, MD                 Department of Health
Ranjani Rajan                     Department of Health
Rita B. Richardson, Col, USAR, NC Office of the Command Surgeon, Pacific Command
Linda M. Rosen, MD, MPH           Department of Health
Rebecca Sciulli                   Department of Health
Edward Teixeira                   Hawaii State Civil Defense
Glenn M. Wasserman, Col, MC       Tripler Army Medical Center
A. Christian Whelan, PhD          Department of Health
Barbara Yamashita                 Department of Health

1
    Affiliations reflect those at time of contribution.
                                                            ii
                                                                 HDOH Pandemic Influenza Preparedness & Response Plan / V08.1
                                Table of Contents
Executive Summary……………………………………………………………….…...........…..iv

Introduction…………………………………………………………………………..........…...vii

World Health Organization Pandemic Influenza Phases ……………………...………...….xii

Hawaii Pandemic Influenza Preparedness & Response Plan At-A-Glance...……................xv

Section 1. Public Health Continuity of Operations……………..……………………...….......1

Section 2. Influenza Surveillance: Routine and Pandemic...…..……. ………………...……15

Section 3. Pandemic Influenza Vaccines ……….…………..…………………………..…......24

Section 4. Antiviral Medications………….......…………….………………………….............35

Section 5. Community Mitigation…………………….....………….………………….………45

Section 6. Health Care Delivery……………………………………………………..................57

Section 7. Communications………………………………………………………...…………..66

Appendices

      Appendix A:       Glossary

      Appendix B:       List of Acronyms

      Appendix C:       Concept of Hawaii Department of Health Operations Center

      Appendix D:       Key HDOH Areas Contact Information

      Appendix E:       Pandemic Influenza Preparedness & Response Ad Hoc Advisory
                        Group

      Appendix F:       Pandemic Vaccine Clinics Set-up and Flow Concept

      Appendix G:       Guidelines for Recognizing Influenza (Flu) Symptoms and
                        Management




                                               iii
                                             HDOH Pandemic Influenza Preparedness & Response Plan / V08.1
i. EXECUTIVE SUMMARY

      iv
           HDOH Pandemic Influenza Preparedness & Response Plan / V08.1
The Hawaii State Department of Health (HDOH) is the State agency entrusted with leading the
medical and public health disaster response. The Hawaii Department of Health Pandemic
Influenza Preparedness & Response Plan augments the State Plan for Emergency Preparedness,
Disaster Response and Assistance, Version 3, and the State Continuity of Operations Plan. It
guides coordination and execution of medical and public health activities required to respond to a
potential influenza pandemic. As the pandemic escalates, the State government’s response will
likely include support from agencies with responsibilities outside of medicine and public health.
When interagency cooperation is required, HDOH will coordinate all medical and public health
activities through State Civil Defense (SCD) under the direction of the Governor.

This plan is organized into seven major activities as follows:

   Public Health Continuity of Operations
   This section describes the chain of authority and its basis in Hawaii law for response to an
   influenza pandemic and ensuing emergency. The plan describes the real and potential
   responsibilities of HDOH and partner agencies during an influenza pandemic, and it
   describes HDOH policies and operations to maintain critical functions during the various
   stages of an influenza pandemic.

   Influenza surveillance: routine and pandemic
   Currently, this is the most active portion of the plan as early detection and understanding of
   disease activity, whether regular seasonal influenza, avian influenza, or a potential pandemic
   influenza is necessary to trigger response activities to attempt to contain and control spread
   as well as to appropriately direct support and resources.

   Influenza surveillance is comprised of routine and enhanced activities. Routine or usual
   surveillance involving primarily sentinel physician reporting has long been established in the
   State to monitor circulating and/or new viral strains. Enhanced or extended activities beyond
   those recommended by the Centers for Disease Control and Prevention (CDC), such as
   surveillance targeting ill travelers, have recently been added or are anticipated to help ensure
   early detection of increasing or new influenza activity.

   Pandemic influenza vaccines
   Immunization by vaccination against the pandemic influenza virus will be the single best
   method of disease prevention and control. However, because a pandemic influenza virus will
   be a novel virus and current manufacturing processes are lengthy and limited, any pandemic
   vaccine is likely to be delayed by months, well after the first wave and potentially even into
   or after the second wave of a pandemic. When it does become available, quantities are likely
   to be limited. Prioritization will be required and likely focus on groups with specific societal
   roles or responsibilities.

   Antiviral medications
   An insufficient supply of anti-influenza medications will require: 1) use directed at treatment,
   not prophylaxis and 2) prioritization of groups with specific societal roles or responsibilities.
   Evolving issues and understanding of efficacy and antiviral resistance will affect expert
                                                     v
                                                   HDOH Pandemic Influenza Preparedness & Response Plan / V08.1
                                                                                            Executive Summary
   recommendations during a pandemic for adequate dose and course duration for treatment of
   the novel influenza virus.

   Community Mitigation
   This section encompasses pivotal non-medical public health interventions to contain and
   control an influenza pandemic. Three major concepts are critical to understanding these
   interventions. The primary strategy during a response is social distancing, widely thought to
   be the most critical for people to understand and accept. Social distancing involves
   awareness and prevention of potential exposure to a contagious disease. Isolation, the most
   straightforward and readily accepted concept, involves the restriction of movement and
   separation of ill, contagious people from the well population. Quarantine, however, involves
   complex points of public health, law, and policy, and involves the restriction of movement
   and separation of healthy people, who have presumably been exposed to someone with the
   disease, for a period of time as recommended by experts to determine that those quarantined
   have not been infected. Enforcement may be necessary, but public education prior to any
   event may help alleviate much of the need for such.

   Health care delivery
   The capacity to deliver effective health care will be exceeded throughout the State. There are
   not sufficient manpower, medical supplies, resources, or facilities for the scale that is
   predicted. However, HDOH is collaborating closely with the Healthcare Association of
   Hawaii (HAH), the representative agency for all health care centers in Hawaii. HAH is
   working to improve surge capacity in all these areas. This section outlines the major
   activities of HAH and health care centers during the various pandemic phases that will be
   necessary to ensure appropriate health care delivery.

   Communications
   Constant and clear communications among HDOH and all partners (public health officials,
   State agencies, government, health care professionals, industry, public, etc.) across the State
   as well as with Federal level agencies will be critical. Public health education will be a
   necessary foundation for all activities to enhance understanding and cooperation with
   guidance issued by HDOH during an influenza pandemic. This section outlines the major
   communications activities and relationships throughout the State, but especially via HDOH.

This plan is intended to assist all agencies, organizations, and individuals in the State, County,
and the private sector with the coordination and integration of resources required to efficiently
respond to an influenza pandemic. Planning efforts require everyone and every agency or
organization to communicate with each other and identify critical skilled people, equipment,
facilities, resources, and operations. To be successful in our response, everyone must take
responsibility and work together in preparing for a potential pandemic or other similar infectious
disease emergency.




                                                    vi
                                                  HDOH Pandemic Influenza Preparedness & Response Plan / V08.1
                                                                                           Executive Summary
ii. INTRODUCTION

  vii
        HDOH Pandemic Influenza Preparedness & Response Plan / V08.1
 I.    PURPOSE

       A. This plan describes policies and procedures for interagency cooperation, incident
          command and control, disease surveillance, vaccine and antiviral medication
          distribution, health care delivery, social distancing, and communications activities
          that will be implemented in response to the threat of an influenza pandemic.

       B. If confronted with an influenza pandemic, the priorities of HDOH will be to assure
          continuity of essential public health services while providing assistance to meet the
          emergency needs of the affected population.

II.    SCOPE

       This plan provides operational and logistical guidance for planning and coordinating a
       statewide response and/or recovery effort to manage a major public health event
       involving an influenza pandemic. It also identifies the necessary interactions between
       those primary and secondary Federal, State, County, and private agencies and
       organizations that may be called upon to support this response.

III.   BACKGROUND

       The influenza (flu) epidemics that occur nearly every year are important events.
       Influenza is a respiratory illness to which hundreds of thousands of people succumb each
       year. Duration of typical primary influenza illness is about one week and is characterized
       by an abrupt onset of fever, muscle aches, sore throat, and nonproductive cough.
       Occasionally, severe malaise and cough can persist for several days or weeks. Serious
       complications leading to hospitalization and even death can develop in the elderly, the
       very young, and those with chronic diseases, such as diabetes or heart, lung, or other
       immunocompromising disease.

       One of the most important features about influenza viruses is that their structure changes
       slightly but frequently over time (a process known as “drift”), and that this process results
       in the appearance of different strains of influenza that circulate each year. The
       composition of the influenza vaccine is changed annually to help protect people from the
       influenza virus strains expected to be most commonly circulating during the coming
       influenza season.

       In contrast to the more gradual process of drift, a pandemic influenza virus represents a
       unique public health emergency and community disaster. The influenza virus changes
       dramatically and unexpectedly through a process known as “shift.” Shift results in the
       appearance of a novel influenza virus to which few (if any) people are immune. There
       may be little warning, but experts believe that there will be one to six months between
       identification of a novel virus and widespread outbreaks in the United States. If this new
       virus were to spread easily from person to person, it could quickly travel around the
       world and affect millions of people as it caused serious illness and death.
                                                   viii
                                                   HDOH Pandemic Influenza Preparedness & Response Plan / V08.1
                                                                                                   Introduction
      There is no simple answer to the question of how serious a pandemic might be. The
      impact of a pandemic will depend upon the virulence (severity) of the virus, the rapidity
      of its spread or transmission, and the effectiveness of pandemic prevention and response
      efforts. The 1918 Spanish flu is an example of a worst-case scenario with a highly
      contagious and deadly strain. This pandemic killed more Americans than all the wars of
      the 20th century. Since our world today is more densely populated and people travel the
      globe with ease, the spread of the next pandemic could be more rapid and perhaps more
      devastating than previous ones.

IV.   ASSUMPTIONS

      A. While Federal, State, and Local governments maintain overall responsibility for
         managing preparedness and response efforts, the nature of any public health
         emergency, especially that of an influenza pandemic, requires that a key component
         of a successful response be individual responsibility and accountability. Each
         individual and private company or other organization/entity, from all sectors of the
         community (education, banking, tourism/visitors, business, utilities, information
         technology, health care, long-term care, special needs, etc.) will need to develop their
         own internal response plans consistent with Federal and State guidelines.

      B. HDOH will provide guidance to County governments on health-related issues during
         a pandemic. By law, the District Health Officers will be the County health authorities
         over health care and will be integral in the health care response efforts.

      C. Vaccine assumptions include the following:

         1. Because of the substantial lead time required for vaccine production once a novel
            strain has been identified, it is likely that vaccine will not be available, especially
            during the early phases of the pandemic, and when available, may be in limited
            supply.

         2. As of April 2007, the Federal Government approved the first vaccine for humans
            against the H5N1 avian influenza virus. Currently there is enough pre-pandemic
            H5N1 vaccine for approximately 6 million people, with plans to stockpile enough
            pre-pandemic vaccine for 20 million people. If the H5N1 influenza virus evolves
            into a pandemic virus, this vaccine might provide early limited protection in the
            months before a vaccine tailored to the pandemic strain of virus could be
            developed and produced.

         3. Federal funds will continue to be earmarked for advanced development of cell-
            based influenza vaccine production methods, with the goal of being able to
            acquire 300 million treatment courses within six months after the emergence of a
            pandemic virus.

                                                   ix
                                                  HDOH Pandemic Influenza Preparedness & Response Plan / V08.1
                                                                                                  Introduction
D. Antiviral assumptions include the following:

   1. As of June 1, 2007, the Strategic National Stockpile (SNS) contains over 27.8
      million regimens of oseltamivir and 5.1 million regimens of zanamivir for use in
      the event of a pandemic influenza response. Procurements of over 3 million
      additional regimens of oseltamivir and 1.3 million additional regimens of
      zanamivir are expected. CDC has outlined a process for states to receive the
      limited quantity of antiviral and other medical supplies from the SNS in response
      to a pandemic influenza emergency.

   2. While the Federal government will provide overall guidance and
      recommendations, ultimate responsibility for individualized distribution plans
      adapted to each State’s unique needs and resources, will be the responsibility of
      the States.

   3. Unless antiviral supply issues change such that supply is virtually unlimited
      (unlikely), antivirals will chiefly be available for treatment purposes. Worldwide
      shortages will not allow antivirals to be used for prophylaxis (prevention) for the
      general population.

E. A successful response to an influenza pandemic will depend on nonpharmaceutical as
   much as or more than pharmaceutical measures.

F. The Federal government will maintain responsibility for coordinating national and
   international surveillance.

G. Susceptibility to the virus will be universal.

H. At least 50% of those who are ill will seek outpatient-care.

I. There will be successive outbreaks (i.e., one following another with a short time
   interval between each) that last up to a year or even a few years.

J. States must be ready to respond to liability and other legal procedural and policy
   issues during all pandemic phases.

K. Liability and other legal procedural and policy issues will be a significant concern to
   which States must be ready to respond in all pandemic phases.

L. For the purposes of consistency and coordination between National, State, and Local
   planning and response efforts, the Federal government has developed “stages” for
   their response actions and coordinated them with the pandemic “phases” using World
   Health Organization (WHO) criteria as follows:

   Interpandemic Period
                                             x
                                            HDOH Pandemic Influenza Preparedness & Response Plan / V08.1
                                                                                            Introduction
       Phase 1: Risk of human infection with animal virus is considered low
       Phase 2: Animal virus poses threat
   Pandemic Alert Period
      Phase 3: Human infection with new subtype but minimal human-to-human
         transmission
      Phase 4: Small clusters of human-to-human transmission, highly localized
      Phase 5: Larger clusters of human-to-human transmission, but still highly
         localized
   Pandemic Period
      Phase 6: Increased and sustained transmission in the general population
   Postpandemic Period: Return to interpandemic period

       Refer to the table on page xiii for further details.

M. At the time of an influenza pandemic, Hawaii will have approximately 300,000
   visitors within the State whose status as visitors will present unique logistical and
   policy challenges including treatment, travel limitations/restrictions, and social
   distancing requirements.

N. Given Hawaii’s geographic separation from the continental United States and other
   available resources, it is anticipated that Hawaii will likely rely solely on resources
   existing within the State, at least during the initial stages of a pandemic.




                                              xi
                                            HDOH Pandemic Influenza Preparedness & Response Plan / V08.1
                                                                                            Introduction
           iii. WORLD HEALTH
                ORGANIZATION
 PANDEMIC INFLUENZA PHASES
   AND FEDERAL GOVERNMENT
PANDEMICE INFLUENZA STAGES

             xii
                   HDOH Pandemic Influenza Preparedness & Response Plan / V08.1
           WHO Pandemic Influenza Phases                                                   Federal Government
                               May 2005. 2                                                       Stages 3

Pandemic Phases                                       Overarching Goals               Pandemic Stages

Interpandemic period.                                 Strengthen influenza                  New domestic animal outbreak in
                                                      pandemic preparedness at              at-risk country.
Phase 1. No new influenza virus subtypes have         the global, regional,
been detected in humans. An influenza virus           national, and subnational
subtype that has caused human infection may           levels.
be present in animals. If present in animals, the
risk of human infection or disease is considered
to be low.


Phase 2. No new influenza virus subtypes have         Minimize the risk of
                                                                                       0
been detected in humans. However, a                   transmission to humans;
circulating animal influenza virus subtype poses      detect and report such
a substantial risk of human disease.                  transmission rapidly.

Pandemic alert period.                                Ensure rapid                          New domestic animal outbreak in
                                                      characterization of the new           at-risk country.
Phase 3. Human infection(s) with a new                virus subtype and early          0
subtype, but no human-to-human spread, or at          detection, notification, and
most, rare instances of spread to a close             response to additional
contact.                                              cases.                                Suspected human outbreak
                                                                                            overseas.
                                                                                       1

Phase 4. Small cluster(s) with limited human-         Contain the new virus
to-human transmission, but spread is highly           within limited foci or delay
localized, suggesting that the virus is not well      spread to gain time to
adapted to humans.                                    implement preparedness
                                                      measures, including
                                                      vaccine development.
                                                                                       2    Confirmed human outbreak
Phase 5. Larger cluster(s) but human-to-              Maximize efforts to contain           overseas.
human spread still localized, suggesting that the     or delay spread, to
virus is becoming increasingly better adapted to      possibly avert a pandemic,
humans, but may not yet be fully transmissible        and to gain time to
(substantial pandemic risk).                          implement pandemic
                                                      response measures.




       2
         WHO. WHO Global Influenza Preparedness Plan. Available from:
       http://www.who.int/csr/resources/publications/influenza/WHO_CDS_CSR_GIP_2005_5.pdf. Accessed 13 Jun
       2005.
       3
         To view corresponding federal actions go to the National Strategy for Pandemic Influenza, Implementation Plan.
       Available from: http://www.whitehouse.gov/homeland/nspi_implementation.pdf. May 2006.
                                                                  xiii
                                                                 HDOH Pandemic Influenza Preparedness & Response Plan / V08.1
                                                                                           Pandemic Influenza Phases & Stages
Pandemic period.                                Minimize the impact of the   3    Widespread human outbreaks in
                                                pandemic.                         multiple locations overseas.
Phase 6. Pandemic phase: increased and
sustained transmission in general population.
                                                                             4    First human case in North America.


                                                                             5    Spread throughout the United
                                                                                  States.

                                                                             6    Recovery and preparation for
                                                                                  subsequent waves.

Postpandemic period. Return to
interpandemic period.




                                                           xiv
                                                          HDOH Pandemic Influenza Preparedness & Response Plan / V08.1
                                                                                    Pandemic Influenza Phases & Stages
iv. PUBLIC HEALTH PANDEMIC
  INFLUENZA PREPAREDNESS &
             RESPONSE PLAN
               AT-A-GLANCE


           xv
                HDOH Pandemic Influenza Preparedness & Response Plan / V08.1
                                                                                                                                                           Post-
                                                                                                                                  Pandemic
                    Interpandemic Period                                    Pandemic Alert Period                                                        pandemic
                                                                                                                                   Period
                                                                                                                                                          Period
                                                                                    WHO Phase 4               Phase 5
  Component                                                                                                                         Phase 6
                                      WHO Phase 2           WHO Phase 3             Highly localized,      Large infection
   Activity     WHO Phase 1                                                                                                       Sustained,
                                                                                                                                                           Return to
                                     Animal virus with      Novel (Human)            small infection      clusters but only
                  Minimal or no                                                                                                   widespread
                                     potential human          Virus Alert           clusters; limited         localized                                 Interpandemic
                      risk                                                                                                       transmission
                                      risk circulating    (Fed. Stages 0 and           human-to-             human-to-                                      Period
                 (Fed. Stage 0)                                                                                                 (Fed. Stages 3-
                                      (Fed. Stage 0)              1)                human infection       human infection
                                                                                                                                       6)
                                                                                     (Fed. Stage 2)        (Fed. Stage 2)
                                                                                   Activate HDOH Department Operations Center (DOC).
                                                                                                                                                       HDOH DOC will
                                                                                   HDOH DOC may be activated in part or full at any time
                Establish and clarify HDOH’s authority during a pandemic.                                                                              gradually stand
                                                                                   depending upon events in Hawaii, but the DOC is expected
                                                                                                                                                       down.
                                                                                   to be fully activated during Phase 6.
                Identify contacts in and establish                                                                                                     Evaluate DOC
                                                          Activate surge capacity for epidemiology, laboratory, and health care delivery as
                liaisons between HDOH and partner                                                                                                      operations and
                                                          necessary to facilitate medical and public health response.
                agencies.                                                                                                                              actions.
Public Health                                                                                                                                          Modify DOC
                Establish roles and responsibilities of
Continuity of   HDOH and partner agencies during a        Ensure liaison is established with State Civil Defense (SCD) Emergency Operations
                                                                                                                                                       protocol as
                                                                                                                                                       necessary to
Operations      pandemic, and identify personnel in all   Center (EOC), when activated.
                                                                                                                                                       improve
                areas for surge capacity.
                                                                                                                                                       effectiveness.
                Train HDOH personnel in ICS and
                NIMS.
                Conduct exercises/tabletops to prepare
                HDOH and partner agencies and to
                identify and address any deficiencies.
                                                                                                                                                       Evaluate
                                                                                                                                Maintain all
                                                          Fully implement enhanced surveillance to target patients who                                 resources (people
                Conduct routine sentinel influenza                                                                              enhanced
                                                          meet criteria for highly suspect infection with pandemic                                     and supplies) to
                surveillance and continue to recruit                                                                            surveillance
                                                          influenza and to ensure identification of novel virus as soon as it                          determine
                sentinel physicians.                                                                                            activities to extent
                                                          appears in Hawaii.                                                                           surveillance
                                                                                                                                feasible.
Influenza                                                                                                                                              capacity.
Surveillance                                                                                                                    Monitor capacity       Continue limited
                                                          Conduct active surveillance for severe respiratory illness and        and usefulness of      enhanced
                Continue year-round influenza             unexplained deaths by regularly contacting health care facilities     activities to          surveillance until
                surveillance.                             and the Medical Examiner; investigate these illnesses to              determine when to      certain that
                                                          determine etiology.                                                   narrow and focus       transmission has
                                                                                                                                surveillance.          ceased.


                                                                                xvi
                                                                                                        HDOH Pandemic Influenza Preparedness & Response Plan / V08.1
                                                                                                                                                        At-a-Glance
                                                                                                                                                            Post-
                                                                                                                                     Pandemic
                        Interpandemic Period                                   Pandemic Alert Period                                                      pandemic
                                                                                                                                      Period
                                                                                                                                                           Period
                                                                                        WHO Phase 4               Phase 5
   Component                              WHO Phase 2                                                                                  Phase 6
                                                                 WHO Phase 3            Highly localized,      Large infection
    Activity       WHO Phase 1              Animal virus                                                                             Sustained,
                                                                                                                                                            Return to
                                                                 Novel (Human)           small infection      clusters but only
                     Minimal or no          with potential                                                                           widespread
                                                                   Virus Alert          clusters; limited         localized                              Interpandemic
                         risk                human risk                                                                             transmission
                                                               (Fed. Stages 0 and          human-to-             human-to-                                   Period
                    (Fed. Stage 0)           circulating                                                                           (Fed. Stages 3-
                                                                       1)               human infection       human infection
                                           (Fed. Stage 0)                                                                                 6)
                                                                                         (Fed. Stage 2)        (Fed. Stage 2)
                   Identify methods to enhance influenza                                                                           Continue data
                                                               Monitor CDC bulletins regarding the novel virus, establish                               Evaluate
                   surveillance and establish when                                                                                 collection and
                                                               regular communications with Federal partners, and disseminate                            surveillance
                   possible. For example:                                                                                          analyses to refine
                                                               information to District Health Offices (DHOs), health care                               activities and
                    - Airport surveillance for ill travelers                                                                       epidemiology of
                                                               facilities, health care providers, and partner agencies to update                        modify protocols
                    - Targeted surveillance for severe                                                                             pandemic and
                                                               them as needed.                                                                          as needed.
                      lower respiratory tract disease                                                                              guide measures.
Influenza                                                      Convene the Ad Hoc Advisory Group as needed to consult
                                                                                                                                                        Revert to
Surveillance                                                                                                                                            interpandemic
                   Ensure SLD capacity for timely and          regarding enhanced surveillance activities, establish
                                                                                                                                                        surveillance if
(continued)        accurate laboratory testing in Hawaii.      communications with partners, and seek other potential
                                                                                                                                                        transmission has
                                                               recommendations.
                                                                                                                                                        ceased.
                                                               Analyze data collected to define epidemiological characteristics
                   Investigate any localized influenza         of the pandemic including population at risk, mode of
                   outbreaks.                                  transmission, the effectiveness of treatments and other
                                                               countermeasures.
                   Promote routine (i.e., non-pandemic)        Confirm representation/availability for Ad
                                                                                                                                                        Evaluate overall
                   influenza vaccination and increase          Hoc Advisory Group to facilitate expert
                                                                                                                                                        response.
                   routine vaccine coverage.                   consultation as needed.
                                                                                                                                                        Assess remaining
Pandemic           Promote pneumococcal vaccination
                                                               Re-establish and confirm priority groups                                                 resources
Influenza          among ‘high-risk’ groups to decrease
                                                               for pandemic influenza vaccination.                                                      (supplies and
                   risk for secondary bacterial infection.
Vaccine Delivery                                                                                                                                        people).
                   Establish priority groups for pandemic                               Periodically reassess priority groups and modify as
                   influenza vaccination based on Federal                               pandemic characterized and as needed to ensure most
                   guidelines.                                                          societal benefit to limit and end transmission.




                                                                                    xvii
                                                                                                            HDOH Pandemic Influenza Preparedness & Response Plan / V08.1
                                                                                                                                                            At-a-Glance
                                                                                                                                                             Post-
                                                                                                                                     Pandemic
                        Interpandemic Period                                   Pandemic Alert Period                                                       pandemic
                                                                                                                                      Period
                                                                                                                                                            Period
                                                                                                                 Phase 5
                                                                                        WHO Phase 4
   Component                               WHO Phase 2                                                        Large infection          Phase 6
                                                                 WHO Phase 3            Highly localized,
    Activity                                Animal virus                                                        clusters but         Sustained,
                    WHO Phase 1                                   Novel (Human)          small infection                                                     Return to
                                            with potential                                                     only localized        widespread
                   Minimal or no risk                               Virus Alert         clusters; limited                                                 Interpandemic
                                             human risk                                                          human-to-          transmission
                    (Fed. Stage 0)                              (Fed. Stages 0 and         human-to-                                                          Period
                                             circulating                                                           human           (Fed. Stages 3-
                                                                        1)              human infection
                                           (Fed. Stage 0)                                                         infection               6)
                                                                                         (Fed. Stage 2)
                                                                                                              (Fed. Stage 2)
                                          Review/update pandemic influenza
                                          vaccine distribution plans. Coordinate
                                          through SCD EOC to ensure security for
                                          the vaccines.
                                          Develop vaccine management tracking           Track all pandemic influenza vaccine doses
Pandemic                                  system.                                       distributed/administered as well as remaining supply.
Influenza          Pre-identify sites
Vaccine Delivery   statewide for
                                                                Activate pandemic influenza vaccine distribution plans if and when candidate
(continued)        possible
                                                                pandemic vaccine becomes available.
                   vaccination
                   centers.
                                                                                        Monitor for and record adverse events to vaccine
                                                                                        administration.
                                                                                                                                                         Assess antiviral
                                                                                        Disseminate updated information
                   Planning and development period; no distribution of antivirals for                                                                    effectiveness
                                                                                        regarding antiviral use to health care
                   pandemic purposes.                                                                                                                    through analyses
                                                                                        providers. (may start earlier)
                                                                                                                                                         of data.
                   Establish priority groups for treatment.                                                                                              Assess
                                                                Gather updated data regarding antivirals
Antiviral          Also establish for prophylaxis if supplies                                                                                            effectiveness of
                                                                (numbers and locations) in Hawaii.
                   ample enough to justify such use.                                                                                                     operations.
Medication
                   Identify, inventory, and coordinate with
Distribution       pharmaceutical distributors,                 Review current
                                                                                        Direct pharmaceutical warehouse distributors to halt
                                                                                        distribution of antivirals - may occur during phases 4 or 5 if
                   pharmacies/pharmacists, and health           prophylaxis and
                                                                                        pandemic has reached Hawaii, but definitely during phase 6.      Assess remaining
                   care providers to determine estimated        treatment guidelines
                                                                                        Antivirals will be collected to HDOH depot(s) for directed       resources.
                   quantities of antivirals in Hawaii and to    and monitor CDC
                                                                                        dispensation in consultation with pharmacists, health care
                   establish contacts for future lines of       updates.
                                                                                        providers, and Healthcare Association of Hawaii (HAH).
                   communication.

                                                                                    xviii
                                                                                                           HDOH Pandemic Influenza Preparedness & Response Plan / V08.1
                                                                                                                                                           At-a-Glance
                                                                                                                                                           Post-
                                                                                                                                  Pandemic
                    Interpandemic Period                                       Pandemic Alert Period                                                     pandemic
                                                                                                                                   Period
                                                                                                                                                          Period
                                                                                        WHO Phase 4
                                                                                                               Phase 5
   Component                                                                                 Highly                                  Phase 6
                                        WHO Phase 2            WHO Phase 3                                  Large infection
    Activity   WHO Phase 1                                                              localized, small                           Sustained,
                                                                                                                                                           Return to
                                       Animal virus with       Novel (Human)                                   clusters but
                 Minimal or no                                                              infection                              widespread
                                       potential human           Virus Alert                                  only localized                            Interpandemic
                     risk                                                               clusters; limited                         transmission
                                        risk circulating     (Fed. Stages 0 and                                 human-to-                                   Period
                (Fed. Stage 0)                                                             human-to-                             (Fed. Stages 3-
                                        (Fed. Stage 0)               1)                                     human infection
                                                                                        human infection                                 6)
                                                                                                             (Fed. Stage 2)
                                                                                         (Fed. Stage 2)
                                                                                                                                                      Allocate and
                                                                                                                                                      distribute antivirals
               Establish legal authority of HDOH
                                                                                                                                                      to each County.
               Director to order cessation of further
                                                                                                                                                      HDOH will
               antiviral distribution and collection of
                                                             Review and update SNS and distribution plans.                                            coordinate directed
               antivirals from pharmaceutical
                                                                                                                                                      treatment with
               distributors in State for redistribution to
                                                                                                                                                      health care
               yield the most public health benefit.
                                                                                                                                                      providers through
                                                                                                                                                      the DHOs.

Antiviral      Maintain limited supply of oseltamivir
                                                             Coordinate through State Civil Defense EOC to ensure security for the antivirals and
               (Tamiflu) for use in localized outbreaks
Medication     of annual influenza.
                                                             persons dispensing.
Distribution
                                                                                     Treat ill patients with probable or confirmed influenza who
(continued)    Establish State stockpile of oseltamivir
                                                                                     are at high risk for complications. Consider limited and
               (Tamiflu; and/or other antiviral) to treat
                                                                                     directed prophylaxis only if antiviral supplies considered
               high-risk individuals during pandemic.
                                                                                     sufficient.
               Identify centralized accessible re-
               distribution points for medication                                    Track all antivirals distributed, patient outcomes, and adverse effects.
               dispensation.
                                       Develop antiviral medication tracking                                Request and secure resupply of antivirals as needed and as
                                       system.                                                              available.
                                                                                     Monitor pandemic virus susceptibility to antivirals and review CDC updates and
                                                                                     other scientific data to quickly address any changes in recommendations.




                                                                                  xix
                                                                                                        HDOH Pandemic Influenza Preparedness & Response Plan / V08.1
                                                                                                                                                        At-a-Glance
                                                                                                                                                   Post-
                                                                                                                             Pandemic
                   Interpandemic Period                                 Pandemic Alert Period                                                    pandemic
                                                                                                                              Period
                                                                                                                                                  Period
                                                                                   WHO Phase 4            Phase 5
  Component                                                                                                                    Phase 6
                                    WHO Phase 2            WHO Phase 3             Highly localized,   Large infection
   Activity   WHO Phase 1                                                                                                    Sustained,
                                                                                                                                                   Return to
                                   Animal virus with       Novel (Human)            small infection       clusters but
                Minimal or no                                                                                                widespread
                                   potential human           Virus Alert           clusters; limited     only localized                         Interpandemic
                    risk                                                                                                    transmission
                                    risk circulating     (Fed. Stages 0 and           human-to-            human-to-                                Period
               (Fed. Stage 0)                                                                                              (Fed. Stages 3-
                                    (Fed. Stage 0)               1)                human infection     human infection
                                                                                                                                  6)
                                                                                    (Fed. Stage 2)      (Fed. Stage 2)
              Identify sites, facilities, equipment, and
              other resources that may be used for                                                                                             Assess
                                                          Coordinate through State Civil Defense to ensure potential necessary security and
              control measures in case of highly                                                                                               effectiveness of
                                                          enforcement.
              communicative novel respiratory virus                                                                                            operations.
              outbreak.
              Ensure that HDOH and all partner                                                                                                 Assess remaining
                                                                                  Activate community-based control measures as needed
              agencies (including epidemiology            Be prepared to close                                                                 resources and
                                                                                  once pandemic influenza virus has reached Hawaii – In a
              investigators, first responders, health     necessary venues                                                                     replenish as
                                                                                  phased approach, close schools, auditoriums, and other
              care, and law enforcement) have             and events.                                                                          needed and
                                                                                  areas with potential for large public gatherings.
              adequate PPE supplies.                                                                                                           possible.
              Identify necessary support services and     Be prepared to          Activate plans and supports for isolation according to       Modify plans as
Community     supplies in the event of activation of      activate quarantine     CDC/WHO recommendations (depends on what is learned          necessary to
Mitigation    social distancing, isolation, and/or        plans; also isolation   about the novel virus as pandemic progresses) and as         improve
              quarantine plans.                           plans.                  necessary to limit spread of infection from ill persons.     operations.
              Educate the public on social distancing, signs & symptoms of influenza, and appropriate influenza prevention practices such as
              hand, cough, and sneeze hygiene.
              Monitor current recommendations and collaborate with HAH and        Activate plans and supports for quarantine according to
              other partners in reviewing and updating plans for isolation and    CDC/WHO recommendations and as necessary to limit
              quarantine measures.                                                potential transmission from exposed healthy persons.
              Encourage and discuss with all partners to consider methods to
              facilitate self-quarantine and other measures (e.g.,
              telecommuting for work and/or school) should such become
              necessary.




                                                                              xx
                                                                                                   HDOH Pandemic Influenza Preparedness & Response Plan / V08.1
                                                                                                                                                   At-a-Glance
                                                                                                                                                          Post-
                                                                                                                                  Pandemic
                   Interpandemic Period                                  Pandemic Alert Period                                                          pandemic
                                                                                                                                   Period
                                                                                                                                                         Period
                                                                                    WHO Phase 4              Phase 5
  Component                                                                                                                         Phase 6
                                     WHO Phase 2          WHO Phase 3               Highly localized,    Large infection
   Activity   WHO Phase 1                                                                                                         Sustained,
                                                                                                                                                          Return to
                                    Animal virus with     Novel (Human)              small infection        clusters but
                Minimal or no                                                                                                     widespread
                                    potential human         Virus Alert             clusters; limited      only localized                              Interpandemic
                    risk                                                                                                         transmission
                                     risk circulating   (Fed. Stages 0 and             human-to-             human-to-                                     Period
               (Fed. Stage 0)                                                                                                   (Fed. Stages 3-
                                     (Fed. Stage 0)             1)                  human infection      human infection
                                                                                                                                       6)
                                                                                     (Fed. Stage 2)       (Fed. Stage 2)
                                                                                                                                                      Ensure
                                                                                                                                                      decontamination of
              Develop and solidify all health care
                                                                                                                                                      all health care
              delivery plans and resources/supports     Maintain regular communications between HDOH and all key health care partners.
                                                                                                                                                      facilities and
              needed to implement such.
                                                                                                                                                      proper disposal of
                                                                                                                                                      infectious waste.
                                                        Institute infection control precautions (for respiratory disease) in health care facilities   Assess
              Identify and establish health care
                                                        as necessary, per HDOH recommendations, updated regularly as data are made                    effectiveness of
              delivery surge capacity.
                                                        available from CDC/WHO.                                                                       operations.
                                                                                                                                                      Assess remaining
Health Care                                             Engage focused screening and triaging of patients seeking care at any health care             resources and
Delivery                                                facility; collaborate with HDOH to report and submit specimens from any patients              replenish as
                                                        fulfilling criteria for suspect pandemic influenza.                                           needed and
                                                                                                                                                      possible.
                                                                                                                                                      Modify plans as
                                                        Activate health care delivery plans to ensure such operations as soon as first Hawaii         necessary to
                                                        case identified and to ensure that operations keep pace as pandemic escalates.                improve
                                                                                                                                                      operations.
              Educate and conduct drills and training exercises to prepare          Activate health care delivery surge capacity as needed,
              HDOH, health care providers, and all key partners.                    including requests to Federal government for assistance.
              Identify and establish antemortem care and morgue capacity and        Activate plans for antemortem care and morgue capacity as
              plans.                                                                needed.




                                                                              xxi
                                                                                                      HDOH Pandemic Influenza Preparedness & Response Plan / V08.1
                                                                                                                                                      At-a-Glance
                                                                                                                                                         Post-
                                                                                                                                     Pandemic
                      Interpandemic Period                                       Pandemic Alert Period                                                 pandemic
                                                                                                                                      Period
                                                                                                                                                        Period
                                                                                           WHO Phase 4            Phase 5
  Component                                                                                                                            Phase 6
                                        WHO Phase 2              WHO Phase 3               Highly localized,   Large infection
   Activity      WHO Phase 1                                                                                                         Sustained,
                                                                                                                                                         Return to
                                       Animal virus with         Novel (Human)              small infection       clusters but
                   Minimal or no                                                                                                     widespread
                                       potential human             Virus Alert             clusters; limited     only localized                       Interpandemic
                       risk                                                                                                         transmission
                                        risk circulating       (Fed. Stages 0 and             human-to-            human-to-                              Period
                  (Fed. Stage 0)                                                                                                   (Fed. Stages 3-
                                        (Fed. Stage 0)                 1)                  human infection     human infection
                                                                                                                                          6)
                                                                                            (Fed. Stage 2)      (Fed. Stage 2)
                 Establish contact between HDOH and all
                 partner agencies through public
                                                               Activate JIC and utilize the JIS as needed to facilitate effective communications.
                 information officers (PIOs) and other
                 communication contacts.
                 Develop, review, and update press
                                                               Facilitate and coordinate communications between HDOH and Governor’s and County offices.
                 relevant materials and messages.
                 Conduct training exercises with all
                 partner PIOs to ensure familiarity with       Maintain regular contact with all partner agencies through PIOs and other communication representatives
                 JIS and JIC operations and readiness to       and exchange updates on situation.
                 manage demands during pandemic.
Communications   Identify spokespersons and coordinate         Keep public informed and educated by distributing timely and necessary information from HDOH and
                 media interviews as necessary.                coordinating media briefings.
                                                                                                                                                     Evaluate
                                                                                                                                                     effectiveness of
                 Conduct and facilitate public health education.
                                                                                                                                                     communication
                                                                                                                                                     operations.
                                                                                                                                                     Modify protocols
                                       Facilitate training of hotline staff, who will                                                                and incorporate
                                       help provide information to the public                                                                        improvements and
                                       throughout the pandemic phases.                                                                               identified
                                                                                                                                                     resources.




                                                                                        xxii
                                                                                                           HDOH Pandemic Influenza Preparedness & Response Plan / V08.1
                                                                                                                                                           At-a-Glance
 Section 1. PUBLIC HEALTH
CONTINUITY OF OPERATIONS

          1
              HDOH Pandemic Influenza Preparedness & Response Plan / V08.1
I.   INTRODUCTION

     A. OBJECTIVE

       This section describes how mission-critical operations and services will be
       maintained in response to an influenza pandemic and discusses the following:

       1. Authority for the required actions

       2. An incident command system (ICS) that is compliant with the National Incident
          Management System (NIMS).

       3. Role of HDOH as the lead State agency in the State’s medical and public health
          response to an influenza pandemic.

       4. Method of coordination between HDOH and its partner agencies at the Federal,
          State, and County levels, including indication of specific responsibilities where
          appropriate.

     B. ASSUMPTIONS

       1. There may be less than six weeks of warning from the time the pandemic is
          announced until it reaches Hawaii, and the time interval between alert stages may
          be rapid (ranging from days to weeks to months).

       2. The pandemic may last as long as 18 months and may have spikes in incidence
          rates in several waves, each lasting 1-4 months, with mortality and morbidity
          increasing and decreasing sporadically.

       3. The Hawaii Department of Health will be the lead State agency in the State’s
          medical and public health response to an influenza pandemic.

       4. Government services will be stressed but will remain functional.

       5. Up to 20–50% absenteeism from work by staff, vendors, and services within the
          community may occur.

          a. Absenteeism will be the result of workers becoming ill, staying home to care
             for children or family members, or refusing to go to work.

          b. Absences may be temporary and range from days to weeks to months, or they
             may be permanent, by choice or because of death.

       6. Critical goods and services provided by contractors, consultants, and vendors may
          be erratic.

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                                               HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                                     Public Health Continuity of Operations
  7. Hawaii may not be able to rely on mutual aid resources from state or federal
     agencies to support local response efforts.

  8. Pharmaceutical interventions may be delayed and likely inadequate to meet
     demands; tiered prioritization will be required.

  9. Control of the spread of infection will rely heavily on nonpharmaceutical
     interventions such as infection control (e.g., respiratory etiquette, hand hygiene)
     and social distancing strategies (e.g., closing schools, postponing public
     gatherings) that reduce physical contact in both the community and the workplace
     and will require alternate methods of providing education, accomplishing work
     responsibilities, and delivering essential services in the community.

C. AUTHORITY

  1. The cornerstone of Hawaii’s ability to respond to emergencies and disasters is the
     State Plan for Emergency Preparedness, Disaster Response and Assistance,
     Version 3. This plan:

     a. Outlines the mechanism for providing State assistance to County governments
        dealing with significant disasters.

     b. Defines policies, concept of operations, organizational structure, and Federal-
        State-County interfaces when resources outside of HDOH are needed in order
        to adequately respond to the pandemic or when the infrastructure of the State
        is being negatively impacted.

     c. Outlines the provision of health and medical services in response to
        emergencies and disasters.

  2. Under the authority granted the Director of Health, as the lead public health
     authority in the State, in Hawaii Revised Statutes (HRS) Chapters 321 and 325:

     a. The Director of Health will be responsible for officially activating the Hawaii
        Department of Health Pandemic Influenza Preparedness & Response Plan.

     b. HDOH has overall responsibility for management of any public health
        emergency in the State, including an influenza pandemic, and is the lead in
        coordinating the medical response in collaboration with medical care partners
        during a public health emergency.

  3. Hawaii Law – Emergency Powers and Isolation/Quarantine

     a. The emergency powers embodied in chapters 127 and 128, Hawaii Revised
                                          3
                                          HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                                Public Health Continuity of Operations
                 Statutes, as vested in the civil defense system are adequate to enable the State
                 to respond to potential or actual public health emergencies.

             b. Section 5 presents information about Hawaii law including definitions of
                isolation and quarantine, due process, and procedural issues.

             c. Hawaii law allows isolation of an individual who has been informed by
                HDOH or a health care provider that he or she has been diagnosed with a
                communicable disease. Any person who has been a contact of someone
                diagnosed with a communicable disease must comply with the specified
                restrictions.

             d. Hawaii law allows the restriction of movement and separation of individuals
                or groups believed to have been exposed (quarantine) or known to be infected
                (isolation) with a communicable disease of public health significance or that
                poses a risk to the public’s health.

                 i. The Director of Health and the Governor have the authority to declare
                    quarantine/isolation.
                ii. Quarantine/isolation will be terminated once the Director of Health
                    determines that it is no longer needed to protect the public health.
               iii. Violation by someone subject to quarantine/isolation of the requisite
                    provisions is a misdemeanor.
               iv. The HDOH has the authority to engage police authorities to assist in
                    enforcing quarantine/isolation.

II.   USE OF THE NATIONAL INCIDENT MANAGEMENT SYSTEM (NIMS)

      A. In a significant public health emergency requiring activation of the State Emergency
         Operations Center (State EOC), HDOH will activate its Department Operations
         Center (DOC) in support of the State EOC operated by SCD.

      B. HDOH will work to fulfill Emergency Support Function #8 (ESF 8; Public Health
         and Medical Services).

      C. All requests for Federal, State, and County assistance will be through the State EOC.

      D. The response will follow a NIMS-compliant ICS. Refer to Appendix C for the
         Concept of HDOH Operations organizational chart and to Appendix D for Key
         HDOH Areas Contact Information.

         1. During a pandemic, HDOH will establish a DOC, which will communicate with
            the State EOC to manage the pandemic and request resources, via the HDOH
            SCD Liaison (Branch Chief of HDOH Emergency Medical Services).

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                                                  HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
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   a. The HDOH Disease Outbreak Control Division (DOCD) will manage the
      overall pandemic response effort until such time that the DOC is activated.

   b. The HDOH DOC will coordinate, when activated and as appropriate, all
      public health support requirements for the response effort.

2. Based on decisions made previously for preparedness plans (as in this document),
   current event information, and any existing or new national guidelines, HDOH
   DOC will establish indications for use and prioritize preventive and treatment
   medications or vaccines to be dispensed, if available.
.
3. HDOH leadership will designate personnel required to provide support to HDOH
   DOC activities and liaise with other partner response agencies.

4. HDOH DOC Positions

   a. DOC Manager (Incident Commander)

        i. The DOC Manager will collaborate with the SCD Director on health and
           medical matters related to the pandemic.
       ii. The DOC Manager will, via the DOC, support the activities of the District
           Health Offices (DHOs) on the Neighbor Islands.
      iii. The DOC Manager will, as needed, facilitate the coordination of activities
           with partner agencies including the Counties and DHOs, the Disaster
           Medical Assistance Team (DMAT), the Healthcare Association of Hawaii
           (HAH), the American Red Cross, and the Hawaii Pharmacists Association.

   b. Liaison Officer – Civil Defense Coordinator

       i. Will coordinate reciprocal updates between HDOH and Civil Defense
           regarding ongoing response activities.
       ii. Will identify HDOH resource requirements for the implementation of the
           Pandemic Influenza Preparedness & Response Plan.

   c. HDOH Public Information Officer (PIO)

       i. Will be the point of contact for media interview and information requests
            through the Department of Health Information Center (DOHIC) or
            the DOC and therefore responsible for coordinating all public information
            messages and coordinating with the news media.
       ii. Will be responsible for implementing the HDOH Communications Plan.
       iii. Will either lead or assist with monitoring the flow of real-time information
            from and among the different response partners in a Joint Information
            Center (JIC) setting.

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                                        HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                              Public Health Continuity of Operations
                    d. Planning Chief

                         i.    Will head the planning section.
                        ii.    Responsible for the planning and delegation of roles and responsibilities
                               for multi-agency support to effectively manage the pandemic influenza
                               response effort.

                    e. Operations Chief 4

                        i. Will head the operations section.
                        ii. Responsible for coordination of all environmental health, clinic services
                            (including ambulatory services, hospital services, and psychological first
                            aid), and epidemiology/surveillance activities (including surveillance,
                            investigations, contact tracing, and field response efforts).

                    f. Logistics Chief

                        i. Responsible for ensuring the availability of adequate supplies, facilities,
                            ground support, and communications and information technology
                            hardware and software.
                        ii. Oversees the services requested of and provided by the State Laboratories
                            Division (SLD and other clinical laboratories supporting the response) and
                            the collection and maintenance of vital records.

                    g. Finance Administration Chief

                        i. Responsible for coordinating all human resources support for HDOH
                             personnel assigned to the response effort.
                        ii. Responsible for tracking labor costs such as payroll or contractors, if
                             applicable.
                        iii. Responsible for logging all expenditures to substantiate claims for
                             possible future Federal funding reimbursement.
                        iv. Oversees volunteer management and resources.

III.       PARTNER AGENCIES

           A. Federal partners

               1. The availability of Federal, military, and related support during a response to an
                  influenza pandemic in Hawaii will not be certain until the time of the event and
                  will depend on a Federal decision to approve allocation of resources during a
                  response in support of the State and County effort.

   4
    During an influenza pandemic, the operations section will be under county-specific/area command. As such, each
   county will have an Operations Chief.
                                                              6
                                                              HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                                                    Public Health Continuity of Operations
   2. Request for Federal assistance will be through SCD and the State EOC. A HDOH
      DOC request will be communicated through the HDOH Liaison Officer/Civil
      Defense Coordinator.

B. State and County partners

   1. Support from other State agencies and the Governor will mirror what is outlined
      in the State Plan for Emergency Preparedness, Disaster Response and Assistance,
      Vol. 3.

   2. State and County partners include but are not limited to, the Hawaii Department
      of Defense (includes Civil Defense and National Guard), Office of the Attorney
      General (AG), State Judiciary, Department of Accounting and General Services,
      Department of Transportation, Department of Education, Department of Public
      Safety, Department of Land and Natural Resources, Department of Agriculture,
      Mayors of all Counties and their respective police, fire, emergency medical
      services, parks and recreation, and public works departments.

C. Other agencies

   1. Healthcare Association of Hawaii (HAH). HAH is a private, not-for-profit
      organization operated by Hawaii hospitals, long-term care, home health, and
      hospice organizations for their mutual benefit and serves as the point of contact
      and coordination for all such facilities in the state.

   2. American Red Cross

      a. Will establish phone bank with published number for Red Cross services:
         family reunification, home delivery services for meals or materials, and crisis
         support.

      b. Feeding and logistical support for quarantine or isolation areas.

      c. Spontaneous volunteer processing and placement.

      d. Will provide support to vaccine clinics (if held), assuming workers can be
         adequately protected.

   3. Hawaii Pharmacists Association

      a. Assists with coordinating and providing continuing education and facilitates
         training of pharmacists and pharmacy technicians in their potential capacities
         as providers of vaccinations at clinics or antiviral distribution for treatment
         purposes.
                                            7
                                           HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                                 Public Health Continuity of Operations
           b. Assists with a pre-event campaign to educate the public on preventive
              measures.

           c. Will assist in actively recruiting their membership to provide assistance during
              any large scale public health/all hazards response where surge capacity for
              those licensed and trained as health care providers is needed.

           d. Will coordinate with the HDOH DOC Manager in the management and
              limitation of community pharmacy dispensing in the event that antiviral
              supplies need to be centrally coordinated and rationed to ensure sufficient
              supply of doses for appropriate use.

        4. Aloha United Way. Based on pre-event agreements, will work with HDOH on
           setting up and implementing information hotlines for the public.

IV.   HDOH RESPONSE BY PANDEMIC PHASES

      1. Interpandemic period

        1. Protocols

           a. HDOH chain of authority, including alternates, will be established.

           b. The HDOH All Hazards Planner will be responsible for HDOH’s Continuity
              of Operations Plan, which will augment existing public health and State
              functional plans.

           c. Each branch or office in HDOH will ensure complete and accurate record
              keeping as it pertains to maintaining essential operations during plan
              activation.

           d. The HDOH Pandemic Influenza Preparedness & Response Plan will be tested
              regularly in accordance with the Homeland Security Exercise and Evaluation
              program, using a pandemic scenario and measurable objectives.

        2. Operations assessment

           a. HDOH will assess its essential operations including departmental
              requirements for expediting purchasing due to unforeseen events.

           b. HDOH will assess critical supplies and services required to maintain
              departmental operations; also assess departmental requirements for security.

           c. Alternate methods for clients (i.e., public and partners) to access HDOH
                                                8
                                               HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                                     Public Health Continuity of Operations
      products and services (e.g., expand on-line and self service options) will be
      identified.

3. Job functions

   a. Essential job functions will be established based on determination of
      departmental critical tasks.

   b. Primary and alternate staff to accomplish essential job functions will be
      identified by each departmental branch. Personnel contact information,
      including after hours and emergency numbers, will be updated at branch level.

   c. Upon employment, HDOH employees are notified that they are emergency
      workers. They will be reminded to report to work during a pandemic once
      Stage 3 (beginning of Pandemic Period) is reached. Employees have been
      encouraged to develop a personal/family disaster plan to care for family
      members.

   d. Staff may need to be reassigned to alternate work locations to maintain
      continuity of critical services; all HDOH personnel will be briefed on this
      option. Where and when possible, HDOH personnel will be cross-trained to
      ensure surge capacity to complete essential functions. Programs will establish
      just-in-time training protocols for critical job functions.

   e. Job functions that can be completed remotely during a pandemic will be
      identified at branch level, and resources to support telecommuting will be
      identified and secured. Telecommuting will commence upon activation of
      Stage 3.

4. Pandemic policies

   a. Leave policies will be developed collaboratively by the Human Resources
      Office (HRO), the Department of Human Resources Development (DHRD),
      and the public employee unions for those personnel who will require leave
      due to such factors as school closures, personal illness, family member illness,
      trauma, isolation, quarantine, and/or public transportation closures.

   b. Flexible work hours policies will be developed collaboratively by HRO,
      DHRD, and the public employee unions to address the need for alternate work
      conditions.

   c. Each branch and/or program will develop additional social distancing
      strategies to help prevent spread of infection (i.e., infection control) but also
      maintain critical functions with a decreased work force.

                                         9
                                         HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                               Public Health Continuity of Operations
     d. HDOH protocols for appropriate office disinfection and immediate sanitation
        of work stations where staff report illness will be established based on current
        infection control recommendations and standards.

     e. Information for department staff on how to prevent infection at home and at
        work will be provided by the Communications Office in collaboration with
        DOCD on the department intranet.

     f. Each branch and/or program will ensure that supplies of hygiene products are
        available in all HDOH offices.

     g. All branches and/or programs that require use of personal protective
        equipment (PPE) by their staff to complete job assignments, whether routinely
        or on occasion, will ensure that a sufficient PPE supply is available.

  5. Product and service vendors

     a. Vendors of critical products and services required to maintain essential
        department operations will be identified. Vendor plans for ongoing services
        and/or shipments in the event of absences, shortages, or disruptions in
        transportation systems will be verified and alternate vendors identified as
        needed.

     b. HDOH programs will augment existing inventory with sufficient critical
        supplies to keep essential services functioning for 7 days or more.

B. Pandemic period

  1. Activation and command
     a. HDOH will follow its Pandemic Influenza Preparedness & Response Plan
        protocol for activating its emergency response capacity. Department leaders
        will be notified via the BioTerrorism Readiness Suite (BTRS) web-based
        notification system of the changes in the stages. Leaders and alternates will
        be refamiliarized with their duties.

     b. At the beginning of the Pandemic Period (stage 3), HDOH will notify the
        State Emergency Operations Center.

     c. HDOH will likely activate its DOC upon identification of potential case(s) of
        pandemic influenza within the State of Hawaii regardless of the pandemic
        stage. The degree to which the DOC is activated initially (i.e., limited vs.
        moderate vs. full) will be determined by the extent and severity of the
        situation.

     d. The HDOH DOC will provide internal briefings by disseminating daily
                                         10
                                         HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                               Public Health Continuity of Operations
      briefings to appropriate personnel.

   e. External briefings will be provided by HDOH-appointed Subject Matter
      Experts or liaisons to appropriate government and other partner agencies.

   f. The department’s Continuity of Operations Plan will be reviewed periodically,
      and HDOH operations will be revised as necessary to augment the State’s
      Continuity of Operations Plan (the latter developed and established by SCD).

2. Operations

   a. Individual branches or programs within HDOH will continually assess: 1) the
      ability to provide regular services with available human and material
      resources; 2) increases and decreases in demand of existing services; and 3)
      the need for new or alternate services. This information shall be reported to
      the DOC.

   b. As needed, HDOH leadership may reallocate resources to provide services
      that are critical, in high demand, and/or are new or alternative.

   c. HDOH leadership may suspend nonessential operations as human resources
      become limited and/or material resources (e.g., gasoline) must be rationed.

3. Job functions

   a. Individual branches within HDOH shall identify absent employees and job
      functions. Personnel shortfalls and absences shall be reported to the DOC,
      which will inform HRO.

   b. In the event of personnel shortages in critical task areas, HDOH leadership
      may reassign personnel to essential or prioritized job functions and provide
      job action sheets.

   c. Just-in-time training for staff taking over new job functions will be provided
      by each program to which alternate or surge staff are assigned.

4. Pandemic policies

   a. All leave and social distancing strategies (i.e., alternate work
      conditions/telecommuting/teleworking) will be activated department-wide
      during the pandemic period. Initial activation may be limited and may
      progress in stepwise fashion depending on the current situation in the State of
      Hawaii.

   b. All employees will report to their immediate supervisor if they feel ill during
                                       11
                                       HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                             Public Health Continuity of Operations
                the workday, and supervisors shall follow the protocol for managing staff who
                become ill at work and will keep records of affected staff.

            c. A process for formerly exposed/at-risk or ill employees to return to work will
               be developed based on current recommendations regarding quarantine and
               isolation.

     C. Postpandemic period

        1. Recovery. Alert leaders and staff to change in pandemic status and gradually
           return to routine operations.

        2. Operations

            a. The DOC members will assess HDOH operations during the event and write
               an after action report on the impact of the pandemic on the department’s
               operations, personnel, clients (i.e., public), partners, and vendors.

            b. Branch chiefs will manage the gradual return to routine HDOH operations
               based on human and material resources.

            c. HDOH leaders and program heads will identify community recovery needs
               and provide assistance as capable.

        3. Process assessment

             a. HDOH leaders and program heads will conduct an in internal after action
                evaluation of the department’s pandemic response. Additionally, a
                department liaison will participate in the SCD evaluation of the overall event.

             b. The department’s Continuity of Operations Plan, Pandemic Influenza
                Preparedness and Response Plan, and all other pertinent emergency plans
                will be reviewed and updated as appropriate.

V.   NOTIFICATION AND INFORMATION FLOW

     A. Communication is critical throughout all pandemic phases. The following illustrates
        the expected flow of information. Refer to Section 7 for further details regarding
        communication.

     B. Reports of increased or unusual influenza activity in the State will come from a
        number of different sources including, for example:

        1. HDOH District Health Offices
        2. Hospitals
                                                12
                                                HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                                      Public Health Continuity of Operations
             3.   Physicians
             4.   Community clinics
             5.   Concerned members of the public
             6.   Clinical laboratories in the state
             7.   Other states
             8.   CDC

          C. This information will be reported to DOCD and its Disease Investigations Branch
             (DIB). If, pursuant to surveillance and epidemiological activities described in later
             sections, a potential pandemic is identified, HDOH will activate its own internal
             notification protocols starting with the Director of Health and key staff.

          D. The following is an example of the multiple mechanisms for notification and
             information sharing that may occur between HDOH and external partners. Not all
             partner agencies are listed. In the event of an influenza pandemic, these mechanisms
             will need to be flexible and be able to adapt to changing circumstances.

               Hospitals               Physicians

                                                           Aloha United Way

                   HAH


                                       HDOH                          American Red Cross
Clinical Laboratories
                                                                        Department of
                                                                         Agriculture

    Department of Land                        State Civil Defense                     Military
   and Natural Resources                                                              Partners

             Hawaii
         National Guard
                                                       County Civil Defense Agencies

           Department of
            Public Safety                                                        County Emergency
                                       County Police        County Fire           Medical Services
                                       Departments          Departments

             1. Health and Medical Partners Hospitals, physicians, and HAH will all be
                communicating with each other and with HDOH, including the HDOH DHOs in
                the Counties of Maui, Kauai, and Hawaii. In addition, private clinical laboratories
                that may be called upon to provide laboratory surge capacity, will be in direct
                                                      13
                                                      HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                                            Public Health Continuity of Operations
   communication with HDOH.

2. State Emergency Preparedness Partners Hawaii SCD is the hub of
   information in the event of a statewide emergency and reporting to SCD will be
   consistent with the State Plan for Emergency Preparedness, Disaster Response
   and Assistance, Version 3. Additional direct lines of communication with HDOH
   may include, depending on the nature of the pandemic, the Department of
   Agriculture and the Department of Land and Natural Resources.

3. Community Emergency Partners The American Red Cross will be a
   significant part of any response to an influenza pandemic. Consistent with that
   role, they will be in direct communication with HDOH regarding volunteers,
   resources, and other needs.




                                       14
                                       HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                             Public Health Continuity of Operations
 Section 2. INFLUENZA
SURVEILLANCE: ROUTINE
        AND PANDEMIC


      15
           HDOH Pandemic Influenza Preparedness & Response Plan / V08.1
I.    OBJECTIVE

      This section describes the activities that are used in Hawaii to detect and characterize
      circulating strains of influenza virus and generate epidemiologic information. This
      information will be used to guide the actions of public health officials during a pandemic.

II.   INTERPANDEMIC PERIOD: Phases 1 and 2

      A. An effective influenza surveillance system should:

         a.      Provide epidemiologic information during the annual influenza epidemics
              regarding distribution, magnitude, and severity of influenza illness.

         b.      Facilitate monitoring of antigenic changes in circulating viruses.

         c.      Detect the introduction of new viruses that have the potential to cause a
              pandemic and identify low-level spread of any novel virus.

         d.       Provide information (including patterns of viral transmission, populations at
              risk, the effect of treatments, and the effectiveness of interventions) to guide
              public health actions.

      B. The existing influenza surveillance system consists of routine activities that are
         ongoing in most states and enhanced activities implemented in Hawaii:

         1. Routine activities:

              a. Virologic surveillance. Characterizes circulating viral strains and attempts to
                 identify new viral strains if introduced.

              b. Influenza-like-illness (ILI) sentinel surveillance. Quantifies the level and
                 location of influenza-compatible illnesses being treated in the community.

              c. Pneumonia and influenza mortality surveillance. Compares cause specific
                 death rates in Honolulu with national and historical data.

              d. Illness cluster/absenteeism surveillance. Identifies clusters of ILI or reports
                 of school absenteeism for additional investigation.

         2. Enhanced activities:

              a. Port of entry ILI surveillance. Identifies and characterizes influenza viruses
                 causing illness among travelers.

              b. Year-round influenza surveillance. Seeks to identify viral isolates that may be
                                                   16
                                                   HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                                                         Influenza Surveillance
          circulating in Hawaii during periods outside the typical influenza season for
          North America.

C. To prepare for a potential pandemic DOCD and SLD will maintain and enhance the
   existing influenza surveillance infrastructure.

   1. Virologic Surveillance:

      a. Approximately 700 physicians across the State submit specimens to HDOH
         throughout the year for influenza testing.

      b. Two pharyngeal/throat swab specimens per patient with ILI are submitted: a
         commercial laboratory performs rapid testing on one, and SLD performs
         culture or real-time reverse transcriptase polymerase chain-reaction (RT-PCR)
         testing on the other.

      c. The three major private commercial laboratories in Hawaii (Clinical
         Laboratories of Hawaii, Diagnostics Laboratory Services, and Kaiser
         Permanente) perform approximately 9,000 rapid influenza tests per year.

      d. SLD analysis capacity includes the following:

           i. Provides viral isolation (with routine typing and sub-typing) from
              specimens submitted by both sentinel and non-sentinel sites. SLD tests
              3000-6000 specimens annually.
          ii. Isolates by culture and identifies other respiratory viruses (e.g.,
              adenovirus, parainfluenza types 1-3, enterovirus, echovirus, herpes
              simplex, cytomegalovirus, and coxsackie) that may cause ILI.
         iii. Conducts real-time RT-PCR as a rapid and sensitive screen to determine
              the presence or absence of influenza to streamline specimen testing.

      e. The specific process for virologic laboratory surveillance and analysis is as
         follows:

           i. The DIB Influenza Surveillance Coordinator actively solicits the
              submission of respiratory specimens and the results of any rapid testing
              for influenza at regular intervals from all commercial laboratories in the
              State.
          ii. SLD staff performs RT-PCR testing on all priority specimens to detect
              influenza virus. Priority specimens include those submitted by sentinel
              physicians, specimens related to suspected influenza outbreaks, airport
              surveillance specimens, and samples from severely ill hospitalized patients
              with unexplained respiratory illness or patients with a travel history to any
              international destination.
         iii. Providers who frequently encounter “high priority” specimens submit
                                           17
                                           HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                                                 Influenza Surveillance
          reports electronically through a specific web-based specimen management
          system.
      iv. SLD staff can perform real time RT-PCR to detect Severe Acute
          Respiratory Syndrome (SARS) coronavirus and/or avian influenza in
          specimens from patients with clinically and epidemiologically compatible
          illness.
       v. SLD provides weekly cumulative reports of submissions and findings to
          DIB and WHO, and periodically sends selected culture-confirmed
          influenza isolates to CDC for sub-typing confirmation and possible
          molecular analysis.

   f. The DIB Influenza Surveillance Coordinator maintains a database containing
      information on all specimens tested, demographic, travel, and exposure
      history of patients from whom specimens were collected.

2. ILI Sentinel Surveillance

   a. HDOH participates in national ILI surveillance through the U.S. Influenza
      Sentinel Surveillance Project, which is jointly coordinated by CDC and the
      individual States.

       i. This project provides a central repository for influenza morbidity and
          virologic surveillance data that can be rapidly analyzed.
      ii. As of December 2006, Hawaii has 68 influenza sentinel surveillance sites
          enrolled across the State, well over CDC recommended standards.

   b. Sentinel sites report ILI data directly to CDC via the internet during the
      traditional influenza season (October – mid-May). Each site reports the
      number of patients seen for ILI by age group and the total number of patients
      seen for all medical problems by week.

   c. CDC compiles morbidity data submitted by sentinel sites across the nation
      and provides weekly reports on the percent of visits due to ILI on the national,
      regional, and state level.

        i. This percent is compared to a baseline of 0-3%.
       ii. The weekly reports also include influenza activity as assessed by state and
           territorial epidemiologists as “sporadic”, “local”, “regional”, or
           “widespread.”
      iii. National reports are available on CDC’s website
           (http://www.cdc.gov/flu/weekly/fluactivity.htm), and state specific reports
           on DIB’s website (http://www.hawaii.gov/health/family-child-
           health/contagious-disease/influenza/Flu_Glance.htm).

3. Pneumonia and Influenza (P&I) Mortality Surveillance
                                       18
                                       HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                                             Influenza Surveillance
                a. The Office of Health Status Monitoring/Vital Statistics reports to CDC weekly
                   numbers of deaths due to P&I in Honolulu.

                b. This information is compiled with data from 122 U.S. cities to determine if
                   death rates due to P&I are unusually high.

                c. Findings are published in the Morbidity and Mortality Weekly Report
                   (http://www.cdc.gov/mmwr/) and reviewed by DIB investigators.

            4. Illness Cluster/Absenteeism Surveillance

                a. Specimen collection kits are sent to DHOs at the beginning of the influenza
                   season (and as needed) for rapid investigation of outbreaks or suspect novel or
                   avian influenza cases.

                b. Kits are also rapidly deployed to schools and long-term care facilities on an
                   as-needed basis to facilitate diagnosis and outbreak control.

                c. Schools are requested to report absenteeism of >15% in any one classroom or
                   >10% in any school. These absences are investigated to determine if the
                   cause is ILI and, if so, appropriate virologic testing ensues.

                d. DIB staff also investigate reported clusters of ILI at long-term care facilities
                   and other institutions.

            5. Port of Entry ILI Surveillance

                a. Hawaii receives approximately 2.5 million international visitors annually with
                   a large proportion from East and Southeast Asia, where novel viruses are
                   expected to emerge. 5

                b. Current protocols require commercial airlines to report incoming ill
                   passengers to the CDC Honolulu Quarantine Station.

                c. Through a collaboration among the CDC Honolulu Quarantine Station, the
                   airport medical group, and DIB, specimens are collected from travelers
                   meeting clinical criteria for ILI (a fever or history of fever of 38˚C [100.4˚F]
                   or greater plus one or more of the following symptoms: headache, body aches,
                   sore throat, cough, chills, malaise, and/or vomiting) and sent to SLD for
                   influenza testing.


5
 Hawaii State Department of Business, Economic Development & Tourism, Research and Economic Analysis
Division, 2000 Annual Visitor Research Report (2001), pp 58-60.
                                                       19
                                                       HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                                                             Influenza Surveillance
          6. Year-round Influenza Surveillance

              a. Sentinel sites are encouraged to submit specimens during the ‘inter-season’
                 (April through September). Sites that include patient populations likely to
                 travel to or visit from other countries, particularly Asia and the Southern
                 Hemisphere, are solicited more heavily.

              b. The Influenza Surveillance Coordinator maintains a list of Influenza
                 Coordinators for all states for rapid notification in the event of an emergency
                 or high priority alert.

III.   PANDEMIC ALERT: Phases 3, 4, and 5

       When augmented surveillance is needed to respond to a growing threat of pandemic
       influenza, DIB will enlist the assistance of sentinel providers and other health care
       facilities to rapidly identify illnesses that warrant investigation.

       A. Novel virus alert. Defined as a virus that has never previously infected humans or
          has not infected humans for many years, such that no one, or very few, will have
          antibodies, or immunity, to protect them against such a virus. Novel virus alert
          occurs when two or more human infections (with a novel virus) have been confirmed.
          The ability of the virus to spread from human-to-human and cause serious disease,
          however, is still questionable.

       B. Human infection confirmed

          1. Continue routine and enhanced surveillance activities as established during the
             Interpandemic period and consider implementation of enhanced laboratory
             surveillance.

          2. Update public health and health care providers of the region(s) where the novel
             influenza virus has been detected.

          3. Consult the Department of Agriculture regarding animal surveillance.

          4. Implement expanded laboratory surveillance to include the following:

              a. Notification of public health and health care providers to collect respiratory
                 specimens from patients who meet one of the following criteria:

                  i. Present with ILI and had recent travel to a region where the novel
                      influenza strain has been identified.
                  ii. Present with unusually severe symptoms of ILI regardless of their travel
                      history.

                                                   20
                                                   HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                                                         Influenza Surveillance
       b. Two respiratory specimens, from separate anatomical sites, should be
          submitted directly to SLD to test for the novel influenza virus.

   5. Monitor CDC bulletins regarding virologic, epidemiologic, and clinical findings
      associated with new variants isolated within or outside the United States.

   6. Distribute these bulletins to DHOs, health care facilities, providers, and other
      agencies as appropriate.

   7. Meet with the SLD Chief and staff and other partners to review major elements of
      enhanced surveillance activities and modify and update plans as needed.

   8. Investigate cases of severe respiratory illness and unexplained deaths associated
      with respiratory illness to determine etiology.

   9. Explore and establish potential laboratory diagnostic capacity through private
      clinical laboratories to work in concert together with SLD.

C. Human transmission confirmed. Once a pandemic influenza strain has been
   identified as circulating internationally, the goal of Pandemic Alert surveillance is to
   identify the appearance of the novel virus in Hawaii. Activities to be implemented
   during this stage will include the following:

   1. The State Epidemiologist and DOCD staff will review existing surveillance
      activities, assess their findings, and evaluate possible enhanced surveillance plans.

   2. HDOH Communications staff will coordinate with the State Epidemiologist and
      DOCD to determine media requirements.

   3. Routine meetings between DIB and SLD will be established to assess resources,
      specimen submissions, and prioritizations.

   4. Fully operationalize active surveillance activities (e.g., daily calls to hospital
      contacts for updates regarding ILI visits and admissions).

   5. Establish regular communication with HAH to receive reports and discuss status
      of isolation capacity and overall bed capacity of hospitals and other health care
      institutions.

   6. DIB, in consultation with CDC Division of Quarantine and Global Migration, will
      implement active ILI surveillance among travelers returning from novel virus
      activity areas.

   7. Implement laboratory surge capacity plans statewide for laboratory personnel,
      equipment, and supplies.
                                             21
                                             HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                                                   Influenza Surveillance
         8. Convene the Pandemic Influenza Preparedness & Response Ad Hoc Advisory
            Group from agencies and organizations listed in Appendix E to initiate contact
            and communication with HDOH partners. This advisory body will serve to make
            recommendations to the DOH Director based on the combined diverse
            background and experience of the representative members.


IV.   PANDEMIC PERIOD: Phase 6

      A. Pandemic onset. Implement surveillance enhancements developed in earlier stages
         as follows:

         1. Maintain and monitor, in collaboration with CDC, local health officials,
            clinicians, and academicians, enhanced surveillance activities.

         2. Continue analysis of incoming patient data to determine populations at greatest
            risk.

         3. Document population-specific influenza outbreaks.

         4. Determine population-specific attack rates, morbidity, and mortality.

         5. Describe any unusual clinical syndromes (including risk factors and appropriate
            treatment).

         6. Describe any unusual pathological features of fatalities.

         7. Assess effectiveness of vaccination or treatment (and chemoprophylaxis, if such
            is possible).

         8. Assess health care (e.g., hospitals and outpatient clinics) capacity and delivery.

         9. Maintain active port of entry ILI surveillance system.

      B. Regional and multiregional epidemics. Describe the epidemiology of pandemic
         influenza in Hawaii to develop preventive action recommendations, allocate medical
         resources, and respond to public and media questions and concerns.

         1. Assess all current surveillance activities to eliminate or modify those lacking
            support due to limited resources.

         2. When the large numbers of patients meeting clinical criteria exceed laboratory
            capacity to test and/or case categorization may be established based on conclusive
            clinical and epidemiological history, consider limiting specimen collection to a
                                                  22
                                                  HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                                                        Influenza Surveillance
            representative sampling of patients. Such sampling will be representative of age,
            gender, and geographic location.

        3. Focus laboratory surveillance on detection of antigenic drift variants by
           submitting specimens to CDC for molecular analysis.

        4. Monitor surveillance reports on national and international morbidity and mortality
           for dissemination.

     C. End of first pandemic wave. Assess remaining resources, evaluate surveillance
        data, and prepare for a likely second wave of influenza activity. Consider return to
        any enhanced surveillance activities that had been suspended prior to this phase.

     D. Second or successive pandemic waves. Consider necessity and feasibility of
        surveillance activities which may consist of the following:

        1. Continued surveillance as described in III.B above.

        2. Continued limited enhanced influenza surveillance until the novel influenza virus
           has been identified in all regions of the State or when transmission of the novel
           virus has ceased.

V.   POSTPANDEMIC PERIOD: Evaluation Stage

     A. Surveillance activities will revert at this point, if not sooner, back to DIB/DOCD, and
        the HDOH DOC may be deactivated.

     B. The primary objective will be to assess the following:

        1. Availability and readiness of all HDOH and external staff to maintain surveillance
           and to what level.

        2. Detailed retrospective characterization of the pandemic.

        3. Effectiveness of recommended prevention and control measures and emergency
           management responses

        4. The need to prospectively continue pandemic surveillance activities.




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                                                 HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                                                       Influenza Surveillance
Section 3. PANDEMIC INFLUENZA
                     VACCINES

              24
                   HDOH Pandemic Influenza Preparedness & Response Plan / V08.1
I.   INTRODUCTION

     A. Objective. To outline the plan to procure, secure, distribute, and administer vaccine
        applicable to prevent and control infection by a pandemic influenza virus when/if
        such vaccine becomes available.

     B. Background. Vaccination is the primary intervention to decrease the health impacts
        of an influenza pandemic. The overall impact of vaccination during a pandemic
        depends on how rapidly a pandemic influenza vaccine becomes available; its
        effectiveness in preventing infection and disease; its supply; and the ability to allocate
        and administer it.

     C. Assumptions
        In addition to the vaccine assumptions identified in the Introduction, ii-IV-B:

        1. The overall target population will encompass Hawaii’s resident and visitor
           population.

        2. It will be impossible to predict when a pandemic virus will arrive. However,
           because of Hawaii’s unique location and high volume of visitors, travelers, and
           immigrants relative to the resident population, a pandemic virus may arrive in the
           islands sooner than in some parts of the continental United States.

        3. Due to the time needed to appropriately scientifically identify and characterize a
           novel virus and the current influenza vaccine manufacturing processes, a
           pandemic influenza vaccine will not be available for a minimum of six to eight
           months after identification of the pandemic virus. It is also possible that no
           pandemic influenza vaccine will be available, or that only a vaccine that
           potentially offers development of partial immunity at best may be available (e.g.,
           avian H5N1 specific vaccine may be useful for a pandemic virus which originated
           from this virus).

        4. Given the probability of limited pandemic influenza vaccine supply during the
           early months of a pandemic, the Federal government will be responsible for
           procurement and determining the number of doses distributed to each State health
           department.

        5. If and when pandemic influenza vaccine supplies become available, Hawaii will
           not initially receive sufficient doses to vaccinate the entire population. A tiered
           system, based on current federal recommendations, that prioritizes the recipients
           receiving the initial doses of pandemic influenza vaccine and adherence to this
           tiered system will be necessary.

        6. Should a vaccine that offers partial immunization (i.e., partial match influenza
           vaccine) become available, distribution and prioritization will be applied in the
                                                  25
                                                  HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                                                 Pandemic Influenza Vaccines
              same manner as would be applied to a pandemic vaccine.

         7. Based on current and past targeted mass vaccination programs such as the school
            influenza vaccination program during the 2007-2008 influenza season and mass
            vaccination of the elderly and medically compromised during the flu vaccine
            shortage in the 2004-2005 season, multiple clinics (range 5-20) may be operated
            throughout the state such that up to 1,000 vaccine doses (injectable formulation)
            may be administered per hour with at least 200 vaccinators required during peak
            hours.

         8. Security measures will be needed to safeguard the supply of pandemic influenza
            vaccine and to ensure the safety of the staff administering the vaccine and the
            people receiving it.

         9. The public, including the health care community, must be educated on the
            rationale for a tiered system. Hot lines for calls from the public must be
            established. Mental health/crisis workers must assist with distressed callers.

         10. Because immunologic responses following a single vaccination of serologically
             negative individuals is often suboptimal, the emergence of a pandemic strain will
             likely require two doses of pandemic influenza vaccine, given an appropriate time
             (usually several weeks) apart.

II.   ROLES

      A. Federal roles

         1. Development of reference strains for pandemic influenza vaccine

         2. Pandemic influenza vaccine or a partial match influenza vaccine evaluation and
            licensure

         3. Distribution of tiered system for vaccine prioritization and recommendations for
            strategies for vaccine use

         4. Deployment of federally purchased vaccine to control an influenza pandemic

         5. Evaluation of pandemic influenza vaccine or a partial match influenza vaccine
            safety

      B. Hawaii Department of Health roles

         1. Receive, store, and distribute a pandemic influenza vaccine (and/or a partial
            match influenza vaccine) within the State.

                                                 26
                                                 HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                                                Pandemic Influenza Vaccines
          2. Based on current information and any existing or new national guidelines,
             implement a tiered system for persons to receive available pandemic influenza
             vaccine (or a partial match influenza vaccine).

          3. Conduct statewide distribution of a pandemic influenza vaccine (or a partial
             match influenza vaccine) consistent with the standard HDOH procedures for
             vaccine administration.

          4. Provide standing orders for administration of a pandemic influenza vaccine (or a
             partial match influenza vaccine).

          5. As necessary, conduct vaccination clinics at previously determined sites (potential
             site list maintained under separate cover by the HDOH Public Health Emergency
             Preparedness [PHEP, formerly Bioterrorism Preparedness and Response]
             Branch).


III.   RESPONSE BY PANDEMIC PHASES

       A. Interpandemic period

          1. Promote seasonal influenza vaccination in traditional high risk groups as well as
             general population to increase vaccination coverage levels.

          2. Increase vaccine demand and coverage before annual influenza epidemics by:

             a. Increasing vaccine acceptability through public education targeted at
                familiarizing people with the safety profile and benefits of vaccination.

             b. Strengthening the vaccine delivery system.

          3. Promote pneumococcal vaccination in traditional high risk groups to reduce the
             incidence and severity of secondary bacterial pneumonia (potential serious
             complication of influenza infection) at the time of a pandemic.

       B. Pandemic alert period: early phases – isolated cases to small, localized
          cluster

          1. Confirm representation on the Pandemic Influenza Preparedness & Response Ad
             Hoc Advisory Group (Refer to Appendix E).

          2. Begin identifying those groups in the first tier for receipt of the limited supply of
             pandemic influenza vaccine (or a partial match influenza vaccine) when available
             and deemed necessary.

                                                   27
                                                   HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                                                  Pandemic Influenza Vaccines
               a. Although during annual influenza epidemics more than half of the
                  hospitalizations and more than 90% of deaths occur in persons who are age 65
                  years and older, the age distribution of severe disease in a pandemic may
                  differ. In previous pandemics, young adults were just as likely to be affected.

               b. One of the population groups most responsible for community spread of
                  infections or germs are young children. Control of a pandemic may depend
                  on controlling infection especially in this group.

               c. Because of uncertainties regarding who will be most susceptible and most at
                  risk for severe disease, strategies for pandemic vaccination will need to be
                  flexible and probably modified at the time of the pandemic, based on the
                  epidemiology of the disease.

               d. As information about the impact of a pandemic influenza virus becomes
                  available, recommendations regarding prioritizing limited supplies of a
                  pandemic influenza vaccine will be formulated at the national level with
                  development and implementation of a tiered system from the U.S. Department
                  of Health & Human Services (DHHS) as outlined in the DHHS Pandemic
                  Influenza Plan.

               e. Hawaii specific circumstances will be considered in adaptation of the tiered
                  system for distribution of vaccine here in Hawaii.

          3. Determine numbers of doses for each island based on proportions of tiered system
             groups and total available vaccine.

          4. Review, execute, and modify, as needed, pandemic influenza vaccine (or a partial
             match influenza vaccine) distribution and administration plans (based on
             previously developed SNS and Smallpox Response distribution plans) to account
             for updates, such as: a recommended tiered system for distributing limited
             supplies of vaccine, projected vaccine supply, and available human resources.

2007 Hawaii Tiered System Tier 1 estimates* are:
                                                                                           Estimated HI
 Tier   Priority         Category                           Target Group
                                                                                            Numbers
                   Health Care and           Front Line inpatient and Hospital based
           1                                                                                      12,000
                   Community Support         health care workers
                                             Front line Emergency Medical Service
           2       Critical Infrastructure                                                           500
                                             Personnel
                   Health Care and
  1        3                                 Front line outpatient health care providers           4,700
                   Community Support
                                             Front line fire and law enforcement
           4       Critical Infrastructure                                                         4,500
                                             personnel
                                             Pregnant women and infants 6-11 months
           5       General Population                                                             38,000
                                             old

                                                       28
                                                       HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                                                      Pandemic Influenza Vaccines
                6        Multiple                      Other Tier 1 personnel                                            55,155
                                                                                                      Total             114,855
*Based on available numbers and federal government total estimates (multiplied by 0.42%, which is Hawaii’s portion of the
total U.S. population)


                    a. The following table shows the number of pandemic vaccine doses, vials, and
                       100 vial master packs that Hawaii could receive under 3 hypothetical
                       pandemic vaccine planning scenarios (note that the first shipment will be
                       larger as it will represent 10 weeks of production) provided by CDC in 2007.

                                                                                                   Number of 100 vial
  Dose (microgram)* and                 Number of doses              Number of vials
                                                                                                      master packs
       Formulation                     Initial/Subsequent           Initial/Subsequent
                                                                                                   Initial/Subsequent
        90 / 5 dose vial                  28,140 / 2,814                 5,628 / 563                       57 / 6
       15 / 10 dose vial                 369,600 / 36,960              36,960 / 3,696                     370 / 37
       7.5 / 20 dose vial              1,092,000 / 109,200             54,600 / 5,460                     546 / 55
*The seasonal influenza antigen dose is 15 mcg; however, given the pandemic influenza virus will be a novel virus, it is currently
unclear what dose amount is required to provoke a sufficiently protective immune response.


                    b. Considerations for vaccination should also include:

                         i. Vaccination of at-risk/hard to reach populations.
                         ii. Possibility of distributing vaccine to public and private providers for
                              administration to their patients.
                         iii. If previous occurs, then HDOH may reserve vaccination clinics targeted at
                              the uninsured and those without physicians.

                    c. Specify procedures to ensure secure receipt, transport, storage, delivery, and
                       administration of pandemic influenza vaccine (or a partial match influenza)
                       through the HDOH Immunization Branch (IMB).

                    d. Review Standing Orders for pandemic influenza vaccine (or a partial match
                       influenza vaccine) administration in designated clinics (maintained by HDOH
                       DOCD in the Vaccination Clinic Operations Manual).

                    e. Activate personnel from surge capacity lists (e.g., Medical Reserve Corps,
                       contract nursing, etc.) maintained by HDOH. Lists will be County-specific and
                       will contain personnel with a variety of needed skill sets and from various
                       occupational backgrounds including personnel from government, private health
                       care, community organizations, and others. Note, must not rely solely on one
                       primary source for surge capacity personnel, as allowances must be made for
                       illness and other pandemic related barriers to activation.

                    f. Additional contingency plans may be required depending upon how the
                       vaccine supply is delivered (i.e., enough doses to immunize Hawaii’s
                       population all at once vs. receiving vaccine spread over a period of time) and
                                                                    29
                                                                    HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                                                                   Pandemic Influenza Vaccines
         depending upon the pandemic situation in Hawaii and the rest of the world.

   5. Coordinate with the State Department of the AG to ensure that legal issues are
      addressed. Some issues may be addressed in advance of any pandemic.
      Examples of such issues that may arise include:

      a. The type (i.e., professionals and/or trained lay public) of volunteers legally
         allowed to administer vaccine

      b. Mandated vaccine for school attendance (students and staff)

      c. Mandated vaccine in a health care setting

      d. Liability of regular health care worker and volunteers to provide emergency
         care and vaccines to patients during a pandemic

      e. Medical/legal implications of administering pandemic influenza vaccine only
         to priority groups

      f. Quarantine and Isolation

   6. Monitor adverse events post-vaccination through the Vaccine Adverse Events
      Reporting System (VAERS; http://vaers.hhs.gov/). The IMB pediatrician will
      serve as the HDOH Vaccine Safety Coordinator and will be the HDOH liaison
      with CDC regarding vaccine safety related issues in Hawaii.

   7. Develop a data management system to track vaccine supply, distribution,
      administration, adverse reactions, and recall for second doses.

   8. Ensure redundancy of knowledge and responsibility for pandemic activities
      through pre-event training.

C. Pandemic alert period: late phase – large, localized cluster

   1. Review Pandemic Influenza Preparedness & Response Plan with stakeholders.

   2. HDOH will review and modify the tiered vaccine priority system as necessary
      using Federal guidelines and in collaboration with outside partners from the
      Pandemic Influenza Preparedness & Response Ad Hoc Advisory Group.

   3. Update the Pandemic Influenza Vaccine Standing Orders, based on any new
      recommendations from the Federal government, as needed.

   4. Order supplies necessary for vaccine administration.

                                           30
                                           HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                                          Pandemic Influenza Vaccines
   5. Ensure that human resources, equipment, supplies, security, and sites necessary
      for vaccination clinics are in place.

   6. Obtain Vaccine Information Statement, including translations for non-English
      readers, from CDC.

D. Pandemic period. Proposed mass vaccination plan based on 3 hypothetical, CDC-
   provided vaccine allotment scenarios and to be enacted depending on when vaccine is
   made available.

   1. Confer with CDC and SNS on the number of pandemic influenza vaccine (and/or
      partial match influenza vaccine) doses Hawaii will receive and date of receipt.

   2. Notify SCD to coordinate all aspects of mass vaccination plan, especially with
      respect to logistics and security.

   3. The HDOH SNS Pharmacist will be responsible for maintaining the centralized
      depot for receipt of the pandemic influenza vaccine and keeping the location
      identity secure.

   4. Receive and distribute pandemic (or partial match) influenza vaccine, and
      stockpile sufficient vaccine administration supplies in the secure centralized depot
      to support administering approximately 15,000 doses.

       a. The SNS Pharmacist will oversee receipt and storage of the pandemic
          influenza vaccine in the centralized depot on Oahu.

       b. The SNS Pharmacist will oversee distributing pre-determined, specified doses
          via contract courier services to neighbor island DHOs under the responsibility
          of the respective PHEP Planners or their equivalents. Neighbor Island
          distribution will be according to the proportion of the total Hawaii State
          population represented by the respective island.

       c. Deliver vaccine and supplies on Oahu to pandemic vaccine clinics (note
          III.B.4.b and the table in III.D.5.c below) by designated HDOH IMB or other
          DOCD staff and contracted courier service as needed.

       d. Deliver vaccine and supplies on neighbor islands as coordinated by respective
          PHEP Planners via designated DHO staff and contracted courier service as
          needed.

       e. Request additional supplies through SNS and/or replenish supplies through
          medical supply distributors.

       f. Communicate with healthcare partners regarding the process for pandemic
                                           31
                                           HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                                          Pandemic Influenza Vaccines
                     vaccine administration.

                  g. Notify the general public through public service announcements coordinated
                     with the HDOH Communications Office regarding pandemic vaccine clinics.

              5. Pandemic vaccine clinics, staffing, and operations.

                  a. The number of pandemic vaccine clinic (or point of distribution [POD]) sites
                     will be based on the number of pandemic influenza vaccine doses allotted to
                     the State of Hawaii.

                  b. Potential POD sites have been identified, and the list is securely maintained
                     by the HDOH PHEP Branch.

                  c. The following table uses the 3 hypothetical, CDC-provided vaccine allotment
                     scenarios for Hawaii to provide potential clinic requirements.

                                  SMALL (28,140        MEDIUM (369,600         LARGE (1,092,000
         Islands/Staff            doses or 14,070      doses or 184,800         doses or 546,000
                                     persons)             persons)                 persons)
                                 Number of Clinics     Number of Clinics      Number of Clinics per
                                      per day              per day                   day*
Oahu                                     3                     4-5
                                                                             * Vaccine doses will be
Hawaii                                   2                      2            distributed to providers
Maui                                     2                      2               and health centers.
Kauai                                    1                      1              HDOH to hold mass
Molokai                                  1                      1               clinics for persons
                                                                             without a medical home.
Lanai                                    1                      1
                                   Clinic Staffing       Clinic Staffing          Clinic Staffing
                                   Requirements          Requirements             Requirements*
Clinic Manager                           1                      1             *Vaccine doses will be
Clinic Manager (asst.)                   3                      5            distributed to providers
                                                                                and health centers.
Registrar                               8-13                  8-16
                                                                               HDOH to hold mass
Flow Controller                         8-13                  8-16              clinics for persons
Vaccinators                             8-16                  10-24          without a medical home.


                  d. Staffing resources for pandemic vaccine clinics/PODs will be drawn from
                     HDOH staff, Medical Reserve Corps volunteers, contract nursing staff, and
                     surge capacity lists maintained by HDOH PHEP Branch.

                  e. Job Action Sheets for each clinic role will be available on site for just-in time
                     training for:


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                                                       HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                                                      Pandemic Influenza Vaccines
        i.   Clinic Manager
       ii.   Clinic Manager Assistant
      iii.   Vaccinator
      iv.    Registrar
       v.    Flow Controller

   f. Each clinic staffing will follow an ICS structure with appropriate badge
      identification to ensure efficient and secure operations.

   g. A basic concept of the physical set-up and flow of a pandemic vaccine clinic
      (see Appendix F) has been developed.

        i. Based on current and past experience with targeted mass vaccination
           programs (e.g., 2004 mass flu vaccination of elderly and medically
           compromised and 2007-08 school flu vaccination program).
       ii. Average transit time (time from sign-in to exit) expected to be
           approximately 8 minutes (i.e., Registration [form completion, addressing
           questions]=6 min, Vaccination=1min, Exit=1min)

6. Administer pandemic influenza vaccine (and/or partial match influenza vaccine)
   according to Hawaii’s adapted tiered system with prioritization of first tier.

7. Monitor for adverse reactions post-vaccination.

   a. Emergency Kits will be provided at each clinic site to respond to emergent
      adverse events.

   b. Events occurring outside of clinic hours will be referred to person’s primary
      care provider.

   c. A hot line will be available for primary care providers for reporting adverse
      events post-vaccination to HDOH.

   d. VAERS forms filed by primary care providers will be submitted to VAERS
      via HDOH.

8. Data collection and transfer.

   a. Use the Pandemic Information Management System (PIMS) and CDC RITS
      (Receiving, Storing & Staging Inventory Tracking System) to track all
      vaccine supply and distribution information.

   b. Tracking individuals vaccinated.

       i. Hard copy clinic registration forms will be completed at clinic sites.
                                        33
                                        HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                                       Pandemic Influenza Vaccines
                     ii. Data entry for each vaccinee will be completed at a separate location
                         directly into the Hawaii Immunization Information System (IIS) or
                         designated stand alone program (e.g., PIMS).
                    iii. Aggregate data will be transmitted to CDC.

             9. If decision has been made to administer second dose to prioritized group, recall
                patients at the appropriate time for second dose of vaccine.6

             10. Prepare for subsequent waves as follows:

                 a. Inventory pandemic influenza vaccine, pharmaceuticals, and supplies.

                 b. Evaluate vaccination protocols and procedures.

                 c. Critique and improve vaccination and distribution sites.

                 d. Inventory personnel available to work in subsequent pandemic wave
                    vaccination clinics.

        E. Postpandemic period. HDOH with assistance from partner agencies will develop
             an After Action Report (AAR) to evaluate overall success of vaccination effort and
             identify any areas for improvement/modification. The report will be made available
             to all partner agencies and the public.




6
 Management information systems (e.g., IIS or PIMS) that may be able to track the information necessary to recall
patients at the appropriate times for a second dose of the pandemic influenza vaccine are being developed by HDOH
but are not yet operational.
                                                           34
                                                           HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                                                          Pandemic Influenza Vaccines
Section 4. ANTIVIRAL
        MEDICATIONS

    35
         HDOH Pandemic Influenza Preparedness & Response Plan / V08.1
I.   INTRODUCTION

     A. Objective. To outline the plan to secure and monitor the supply of influenza-
        specific antiviral medications as well as allocate, distribute, and administer these
        medications to the public based on availability as well as known or theoretical
        effectiveness.

     B. Background. When WHO/DHHS/CDC declare that an influenza pandemic is
        “deemed imminent,” programmed actions may necessitate the need for distributing
        antiviral pharmaceuticals throughout Hawaii. During Stage 2 of the Federal response,
        Hawaii must be prepared to receive distributions from SNS.

        1. In the likelihood that an effective vaccine is unavailable, antiviral agents
           potentially could play a valuable role as the only virus-specific intervention
           during the initial response to an influenza pandemic.

        2. However, the overarching limitation to antiviral use in a pandemic is inadequate
           availability. The initial wave or waves of a pandemic would create a high global
           demand and quickly deplete antiviral supplies unless stockpiles are in place or
           manufacturers are able to markedly enhance surge production capacity.

        3. There are four licensed prescription medications with antiviral activity against
           influenza viruses that are commercially available in the United States. Based on
           their chemical properties and activities against influenza viruses, these four drugs
           are classified into two categories:

            a. Adamantane derivatives or M2 ion channel inhibitors, which include the
               antivirals amantadine and rimantadine.

            b. Neuraminidase inhibitors, which include the antivirals oseltamivir (Tamiflu)
               and zanamivir (Relenza).

     C. Assumptions

        1. The points in Section 3, I.C.1-4 (Assumptions) apply here as well.

        2. Antivirals may lessen the total burden of the disease (morbidity and mortality).
           They may also reduce viral shedding or transmission of the virus and severe
           complications.

        3. During a pandemic, antivirals could have a significant beneficial impact in
           reducing morbidity, hospitalizations, other demands on the health care system,
           social disruption, and economic loss caused by an influenza pandemic.

        4. Protection afforded by antivirals is virtually immediate, last only as long as the
                                                  36
                                                  HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                                                         Antiviral Medications
                    antiviral is taken (as prescribed), and do not interfere with the response to
                    influenza vaccine. However, depending on the nature of the pandemic influenza
                    virus, such protection may not be complete.

               5. Due to the limited amount of antivirals in the pharmaceutical distribution system
                  at any given time, there will likely be only sufficient antivirals available to treat
                  individuals. Although chemoprophylaxis would be desirable to help control the
                  pandemic and is discussed in various parts of this Plan, this measure is unlikely.
                  Therefore, this Plan focuses, by necessity, on using antivirals for treatment.
                  Antivirals will be administered as prophylaxis only under extremely limited
                  circumstances, and as determined by the Ad Hoc Advisory Group.

               6. Adequate security measures are needed to safeguard the limited supply of
                  antivirals and to ensure the safety of all personnel involved in the distribution of
                  the antivirals.

               7. Additional resources and timely replenishment of antivirals may be difficult
                  because of Hawaii’s geographic location.

               8. In the absence of sensitivity testing, a neuraminidase inhibitor (oseltamivir) is the
                  drug of choice since current indications are that the virus will be less likely to be
                  resistant to this class of antiviral drugs than to the adamantane derivatives
                  (amantadine and rimantadine).

               9. Oseltamivir and rimantadine may be requested through the SNS, if supplies are
                  available.

               10. All sources of external aid may be compromised during a pandemic. 7

               11. An influenza pandemic would likely spread to the United States within one to two
                   months after the first emergence elsewhere in the world. 8

               12. The “forward” placement of antiviral assets in various locations throughout the
                   State will expedite delivery of additional antivirals to locations that require them
                   in the event of a non-routine emergency.

               13. During Stage 5 (Spread throughout the United States) of the National Pandemic
                   Plan, persons presenting with findings consistent with the clinical and
                   epidemiological case definition as established by CDC will be presumptively
                   managed as being infected with the pandemic influenza virus.

               14. It will take up to seven days for SNS antiviral assets to arrive in Hawaii from

7
    Implementation Plan for the National Strategy for Pandemic Influenza, page 8
8
    Implementation Plan for the National Strategy for Pandemic Influenza, page 75
                                                              37
                                                              HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                                                                     Antiviral Medications
                   CDC.

               15. Hawaii will receive its full share of 186,093 regimens of antivirals from SNS
                   when requested.

II.       CONCEPT OF OPERATIONS

          A. The intent of this operation is to efficiently deliver antiviral medication to
             predetermined distribution channels to allow them to treat residents and visitors of the
             State of Hawaii. HDOH will work with pharmaceutical wholesale distributors and
             pharmacies to maintain control of all major stocks of antiviral agents that have yet to
             be distributed to individual pharmacies throughout the state.

          B. Consistent with the request and distribution mechanisms in place as a part of the State
             SNS Plan, 9 the distribution of antiviral medication will use commercial
             shipping/delivery agencies for all necessary locations throughout the State. In the
             event that commercial agencies are unavailable when an influenza pandemic occurs,
             SCD assistance will be requested via the HDOH Civil Defense Liaison.

          C. State-controlled antiviral medications will be maintained at a central storage location
             and shipped as needed to locations around the State. The Distribution Phase of using
             stockpiled antiviral medication will only occur during an actual emergency that
             exceeds local response capabilities with on-hand antiviral medication. The decision
             to distribute antiviral medication from the stockpile will reside with State leadership
             or their designated representatives.

          D. During Stage 4 (first human case in North America) of the National Pandemic Plan,
             we will use antiviral medications to treat individuals with confirmed infection, and
             when appropriate under very limited circumstances, prophylax immediate contacts
             from local stocks. HDOH will be looking at a diverse group of potential locations for
             dispensing of treatment dosages to affected individuals.

          E. When Stage 5 (Spread throughout the United States) is declared, antiviral medication
             will only be used for treatment. During Stage 5, HDOH will distribute antiviral
             medication to hospital pharmacies and alternative care centers to fill prescriptions
             written by physicians legally authorized to do so. HDOH will also distribute to
             hospitals for use in treating admitted individuals and will stage emergency stocks of
             antivirals on neighbor islands under the control of the DHOs.

          F. Upon a decision to distribute antiviral assets, HDOH will contact SCD to coordinate
             actions statewide. HDOH will assign individuals to report to the storage site to
             control packaging and distribution operations. HDOH will alert distribution partners
             to assist in the distribution efforts. There will not be a need for immediate,

9
    The State SNS Plan is maintained by the HDOH Bioterrorism Preparedness and Response Branch.
                                                           38
                                                           HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                                                                  Antiviral Medications
          simultaneous distribution to all dispensing locations at this point, so alternate
          distribution means may be used. Antiviral medication will not be repackaged; the
          original manufacturers’ packaging will be maintained.

       G. When the antiviral medications are distributed to dispensing locations, an authorized
          individual(s) at the receiving organization will be required to sign for the contents.
          All antiviral deliveries will be tracked by amount and lot number. A chain of custody
          for antiviral assets must be documented. Dispensing organizations will be required to
          keep records of dispensing.

       H. HDOH officials will work to determine the need for extended or long term-dispensing
          efforts or for follow-up resupply of required medications. Resupply operations will
          be accomplished through HDOH. Organizations will request additional assets
          through the on-line HDOH request system. Requests for additional Federal antiviral
          assets will be coordinated through HDOH and SCD to CDC.

III.   ROLES

       A. Federal

          1. Maintains a supply of antivirals in SNS as recommended by national agencies.

          2. Determines populations at highest risk and develops antiviral use strategies for
             prophylaxis and treatment of influenza.

          3. Deploys and distributes SNS assets upon request.

       B. HDOH

          1. Advises and coordinates with SCD or with the State EOC for an effective
             response.

          2. Determines prophylaxis and treatment options.

          3. Utilizes data derived from local surveillance to prioritize and time the use of
             antivirals during a pandemic.

          4. Procures and maintains a limited cache of antivirals to be used during the early
             event until additional resources can be requested and deployed from outside of
             Hawaii.

          5. Ensures that proper storage requirements are met for antiviral medications
             including proper environmental conditions and proper security as coordinated
             with SCD. This will be monitored by DOCD.

                                                  39
                                                  HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                                                         Antiviral Medications
        6. Will be responsible to request, receive, store, allocate, and distribute the antivirals
           within the State.

        7. Coordinates with health care and pharmacy communities regarding antiviral usage
           directives during an influenza pandemic.

        8. Educates the public regarding availability, use, and effectiveness of antiviral
           medications.

        9. Provides standing orders for distribution of antivirals in medication clinics (only
           if supply is sufficient for dispensing vs. treatment priority) and provides
           guidelines for health care providers for antiviral prescribing/dispensing.

        10. Determines appropriate medication protocols specific for adults, children and
            adolescents, and special populations based on CDC recommendations.
            Information regarding contraindications and adverse affects will also be
            developed.

        11. Assists the Counties by providing protocols for distribution, adverse event
            monitoring, and other support as coordinated or requested.

IV.   ANTIVIRAL RECOMMENDATIONS

      A. Interpandemic period

        1. Antivirals will not be distributed or administered for pandemic purposes during
           this period; the only action during this time is that plans for such will be reviewed
           and developed further as needed.

        2. The actual antiviral supply in the State will be known at the start of a pandemic
           and will be based on what has been amassed by the State and the supply available
           in pharmacies, health care facilities, and pharmaceutical distributor facilities.

           a. State supply of antivirals:

               i. Maintain a supply of oseltamivir and zanamivir that includes shelf life
                  extension, if possible, to avoid outdating of the antivirals. This limited
                  supply may be used for treatment and for public health intervention during
                  the initial stages of a pandemic until resources can be received or
                  requested and obtained from SNS, if available.

               ii. Maintain a State stockpile of oseltamivir and zanamivir. At a minimum,
                   the number of treatment courses in stock should be enough to account for
                   a 25% symptomatic attack rate (per guidelines in the Federal Plan) among
                   those persons in the State who are at high risk for complications from
                                                 40
                                                  HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                                                         Antiviral Medications
                          influenza. Using the CDC Flu-Aid software, this population in Hawaii is
                          estimated to be 49,783 individuals.

                  b. Antiviral supply in pharmacies, health care facilities, and with distributors.

                      i. Identify and inventory pharmaceutical warehouse distributors to determine
                         the estimated quantities and time-line of re-supply of antivirals in Hawaii.

                      ii. Coordinate with the pharmaceutical warehouse distributors on a plan to
                          shut-down further commercial/private distribution of antivirals within 8
                          hours of official notification regarding a pandemic and person-to-person
                          transmission nationwide.

                      iii. Establish legal authority and protocol such that the Director of Health can
                           hold existing inventory, control the point of distribution once a pandemic
                           has been identified, and invoke the emergency stockpile statute to
                           centrally locate and distribute existing supplies of antivirals not already in
                           the supply chain/not already located at individual pharmacies.

              3. Given current limited world supply of oseltamivir and the cost, prioritization for
                 treatment may be required. Such prioritization in Hawaii will be guided by CDC
                 recommendations current as of the time of a pandemic. Any extension of the
                 prioritization or other related issues should be addressed by the Ad Hoc Advisory
                 Group 10 , which will forward recommendations to the Director of Health.

              4. Conduct training programs on the Hawaii SNS Plan to prepare HDOH staff who
                 will be involved in antiviral distribution protocols and procedures.

              5. Review and modify antiviral distribution plans as needed to account for updates,
                 if any, on recommended target groups, projected antiviral supply, and human
                 resources.

          B. Pandemic alert period: no human-to-human spread

              1. This is also a planning period with no pandemic-specific distribution or
                 administration of antivirals.

              2. As stated in III-A-2 of this section, the actual antiviral supply in the State will be
                 known at the start of a pandemic and will be based on what has been amassed by
                 the State and the supply available in pharmacies, health care facilities, and
                 pharmaceutical distributor facilities. HDOH will review current CDC prophylaxis
                 and treatment guidelines for antivirals and based on these guidelines and supply
                 estimates, HDOH will determine options for antiviral use, including treatment of

10
     An updated list of Ad Hoc Advisory Group members is maintained by HDOH DOCD.
                                                         41
                                                         HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                                                                Antiviral Medications
                    ill individuals for whom treatment can be initiated within the first 48 hours of
                    their illness

                3. Review and update, if needed, the Hawaii SNS Plan, which will be utilized to
                   request, receive, store, distribute, and manage the antivirals and other SNS
                   material deployed to Hawaii.

                4. Review and update, if needed, the total number of antiviral doses and days supply
                   that may be requested from SNS for treatment. This review shall be based upon
                   the following estimates for each County. (Note, it is understood that it is highly
                   unlikely that there will be sufficient doses for every single person in the
                   population; hence, the need for prioritization.).

                                                                                             Estimated population
                             Resident          Visitor                                       that will be used to
                                                                 5%
        County               Census            Census                              Total     calculate the total
                                                               Factor 11
                              2004              2003                                         number of doses to
                                                                                             be requested.
Oahu                         899,593          76,776            48,818         1,025,187          1,025,200
Maui County                  138,221          44,510             9,137           191,868            191,900
Kauai County                  61,929          17,828             3,988            83,745              83,800
Hawaii County                162,971          21,934             9,245           194,150            194,200
Total State                1,262,714         161,048            71,188         1,494,950          1,495,100

           C. Pandemic alert period: person-to-person transmission

                1. As stated in III-A-2 of this section, the actual antiviral supply in the State will be
                   known at the start of a pandemic and will be based on what has been amassed by
                   the State and the supply available in pharmacies, health care facilities, and
                   pharmaceutical distributor facilities.

                2. Notify the medical community of the status of antiviral availability and
                   disseminate antiviral use guidelines using HDOH broadcast fax and email alerting
                   systems and protocols.

                3. Utilize MedWatch (http://www.fda.gov/medwatch/index.html), the Federal Drug
                   Administration drug safety information and adverse event reporting program, to
                   assist in the monitoring and tracking of adverse reactions to antivirals.

                4. Confer with CDC and SNS to determine if antivirals will be available through the
                   Federal government. Ensure that human resources and logistics are in place to
                   begin antiviral distribution; must consider need for staff surge capacity due to
                   illness and effects of social distancing measures.

                5. If antivirals are severely limited in supply, priority for treatment within the first
11
     This is an arbitrary factor to account for assumed underestimates of census data.
                                                                42
                                                                HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                                                                       Antiviral Medications
     48 hours of illness onset will be given to the groups identified through the process
     outlined in III.A at the time of a Pandemic Alert Period. HDOH will re-examine
     and revise the priority as needed.

D. Pandemic period

  1. Request antiviral drugs, as needed, from previously identified sources, including
     SNS.

  2. Utilize local oseltamivir (and any other antiviral or adjunct medication indicated
     by CDC for treatment) supplies to provide an early response prior to the arrival of
     SNS. Activate State-based plans for targeting antiviral drugs to priority groups
     for treatment and possibly limited prophylaxis.

  3. Control access to antiviral pharmaceuticals throughout the State by working with
     pharmaceutical wholesalers to shut off the distribution mechanism within 8 hours
     of notification of a pandemic.

  4. Notify pharmacies of this action and coordinate with them to address any public
     concerns and complaints when antiviral prescriptions are unable to be filled due to
     the State-coordinated stoppage of distribution of any further antiviral supply from
     the pharmaceutical wholesalers.

  5. Confer with CDC and SNS on the number of antiviral doses Hawaii will receive
     (if available) and date of receipt.

  6. Assist hospitals in implementing procedures for early detection and treatment of
     influenza in health care workers.

  7. Identify and activate, as needed and if possible (given limited supplies),
     mobile/field treatment centers.

  8. Notify SCD of antiviral arrival date and coordinate with SCD to ensure secure
     transport, storage, delivery, and distribution.

  9. Distribute allocated doses to Counties; HDOH will coordinate with health care
     providers through DHOs for directed treatment.

  10. Track all antiviral doses distributed.

  11. Provide antiviral treatment according to the priority list approved by the Director
      of Health in consultation with the State Epidemiologist and the Ad Hoc Advisory
      Group.

  12. Continue to work with health care partners to ensure appropriate use of antiviral
                                               43
                                               HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                                                      Antiviral Medications
     medication in the medical management of early cases and contacts.

  13. Monitor the susceptibility of the circulating influenza strain to the available
      antivirals.

  14. Work with federal partners to begin monitoring the safety and effectiveness of
      drugs and ensure that available antiviral medications are used in accordance with
      federal and local recommendations.

  15. Monitor for adverse reactions to antivirals administered for treatment.

  16. Request re-supply of antivirals and supplies, if needed and available, from SNS.

  17. Regularly review and confer with CDC on the rapidly changing scientific
      evidence to provide updated public health information, recommendations, and
      options for treatment with antivirals.

E. Postpandemic period

  1. Deactivate operations associated with the pandemic.

  2. Recover assets from the operations.

  3. Conduct post-evaluation of the pandemic response with all agencies.

  4. Assess the effectiveness of antiviral treatment.

  5. Revise Hawaii Pandemic Influenza Preparedness & Response Plan based on the
     above evaluation.




                                           44
                                           HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                                                  Antiviral Medications
SECTION 5. COMMUNITY
          MITIGATION

      45
           HDOH Pandemic Influenza Preparedness & Response Plan / V08.1
I.      INTRODUCTION

        A. Objective. To outline the plan to limit the transmission of pandemic influenza virus
           with primary focus on methods of social distancing, and to identify pre-established
           procedural mechanisms in place for the use of isolation and quarantine if needed to
           ensure control of disease transmission.

        B. Definitions

            1. Social distancing measures will be utilized to reduce the risk of disease
               transmission by limiting the potential for social interactions (e.g., canceling public
               events, closing schools, limiting public transportation, and restriction of
               movement of segments of the community) and by preventing inadvertent
               exposures in public or common daily experiences (e.g., fever monitoring before
               entering place of congregation such as schools, use of masks, and community-
               wide voluntary quarantine).

                 a. The effectiveness of these community measures are being evaluated, and
                    initial studies 12,13,14 of measures implemented during the 1918 influenza
                    pandemic indicate that they may be effective in controlling the spread of a
                    pandemic.

                 b. Social distancing measures may be used to delay the spread of disease and
                    allow more time for the development and production of vaccines and antiviral
                    drugs.

            2. Isolation is the separation and restriction of movement of persons who have a
               specific infectious illness from those who are healthy to stop the spread of that
               illness.

                 a. Usually put into practice in a hospital setting but may also be implemented at
                    home or in a dedicated isolation facility.

                 b. May be applied at the individual, group, or community level.

            3. Quarantine is the separation and restriction of movement of persons who are not
               ill but have been exposed to an infectious agent or person and therefore may have
               become infected.

12
   Markel H, Lipman HB, Navarro JA, Sloan A, Michalsen JR, Stern AM, Cetron MS. Nonpharmaceutical
interventions implemented by US cities during the 1918-1919 influenza pandemic. JAMA. 2007;298:644-654.
13
   Hatchett RJ, Mecher CE, Lipsitch M. Public health interventions and epidemic intensity during the 1918
influenza pandemic. PNAS. 2007;104:7582-7587.
14
   Bootsma MCJ, Ferguson NM. The effect of public health measures on the 1918 influenza pandemic in U.S. cities.
PNAS. 2007;104:7588-7593.
                                                          46
                                                          HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                                                                Community Mitigation
     a. May be applied at the individual, group, or community level and may be
        implemented in the home setting or in a dedicated quarantine facility.

     b. Quarantine requires a clear definition of the term close contact or what
        constitutes an exposure to determine when a person is to be quarantined.

C. Assumptions

  1. After the initial detection of the pandemic virus, the public will likely be faced
     with vaccine unavailability for an undetermined, but conceivably, prolonged
     length of time.

  2. Also faced with an extremely limited supply of available antivirals, public health
     measures of social distancing, isolation, and quarantine may be the best options
     for slowing the spread of pandemic influenza virus.

  3. Nationally, empirical studies and disease modeling efforts have shown that social
     distancing will be as effective, if not more effective, in limiting the spread of an
     infectious disease such as a pandemic influenza virus, than the processes of
     isolation and quarantine alone.

  4. In the State of Hawaii, in contrast to public health and health care terminology
     and usage, pursuant to existing statutory language (i.e., legal issues), any
     reference to “quarantine” automatically includes “isolation” within the scope.

  5. Controlling exposure to influenza may be difficult due to:

     a. Today’s highly mobile society

     b. The likely short incubation period of 1-3 days for the virus

     c. The period of communicability (i.e., ability to transmit infection) beginning
        prior to onset of symptoms

  6. While Federal law has authority to prevent interstate and international travel and
     importation, government at the State level in Hawaii has the primary
     responsibility for the implementation of social distancing and mandatory isolation
     and quarantine measures within its jurisdiction.

  7. If a large proportion of the population becomes ill during an influenza pandemic,
     and a likely shortage of personnel to monitor and enforce mandatory containment
     measures occurs, CDC may recommend voluntary home quarantine when
     possible, with exposed persons checking themselves for fever and reporting early
     symptoms to public health authorities.
                                           47
                                           HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                                                 Community Mitigation
            8. Personal hygiene measures such as handwashing and recommendations for
               personal protective equipment (PPE) such as masks will likely also be included in
               recommendations to the community to help limit transmission.

            9. Most people will likely follow self-quarantine and home quarantine
               recommendations provided by HDOH and CDC, especially when they understand
               that those in quarantine will be more accessible to receive supplies and necessary
               health care.

            10. If, however, individuals are unwilling to isolate or quarantine themselves
                voluntarily when requested, Hawaii Revised Statute (HRS) 325-9 makes it clear
                that State law enforcement entities have the authority and duty to enforce isolation
                and quarantine orders. They have the authority to use such force as is “reasonably
                necessary.”

            11. Public health and law enforcement responders involved in enforcement of
                quarantine orders will be provided appropriate PPE and related training by their
                respective agencies as recommended by CDC.

            12. By law, all isolation and quarantine orders must include the length of time for the
                isolation and quarantine periods.

            13. The Director of Health is responsible for determining and justifying the isolation
                and quarantine time periods.

II.     SOCIAL DISTANCING MEASURES

        A. Background

            1. Based on recent studies, 15 while children and teenagers represent only 29% of the
               population, they are responsible for the majority of infectious contacts because
               they are present in most “infectious contact networks” (i.e., schools,
               neighborhoods, and households). In addition, most of their infectious contacts are
               within their same age classes.

            2. Children who go to preschool or school are also more likely to contract influenza
               and transfer it to their family/household members. 16

            3. When considering adults, there is a need to define what constitutes a public
               gathering and what situations would create opportunities for “close contact.”
15
   Glass RJ, Glass LM, Beyeler WE, Min HJ. Targeted social distancing design for pandemic influenza. Emerg
Infect Dis. 2006 Nov. Available from http://www.cdc.gov/ncidod/EID/vol12no11/06-0255.htm
16
   Germann TC, Kadau K, Longini IM, Macken CA. Mitigation strategies for pandemic influenza in the United
States. Proc Natl Acad Sci U S A. 2006; 103:5935-40.
                                                          48
                                                          HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                                                                Community Mitigation
   4. Implementation of aspects of social distancing should take into consideration
      these determinations and be consistent with the severity and phase of the
      pandemic.

   5. There are a myriad of situations and settings that could constitute a public
      gathering, including:

       a.   Childcare situations
       b.   Schools and other educational settings
       c.   Workplaces
       d.   The public transit system
       e.   Places of worship
       f.   Community events
       g.   Homeless shelters
       h.   Other enclosed areas where people potentially congregate

   6. Depending on the severity and the pandemic phase, general public health
      containment strategies could range from recommendations to the public to remain
      at home or avoid crowds to mandatory closure of schools and public buildings
      and cancellation of public activities and events.

B. Initial strategies. To appropriately advise the public as to the impact of an
   influenza pandemic and to prepare them for the possibility of large-scale social
   distancing activities, the following should take place:

   1. Basic education of all individuals regarding recognition of potential signs and
      symptoms of influenza, measures for management of illness, and steps for
      notification of appropriate public health and health care authorities. (Refer to
      Appendix G.)

   2. Education of government, private sector, response partners/stakeholders, and the
      media regarding the nature of influenza pandemics, how it spreads, the impact it
      has on individual health and daily life, and what can be done to contain it.

   3. Coordination with these same groups as to specific processes for communicating
      the need for social distancing and support of development of their own Continuity
      of Operations plans to address the impact large-scale social distancing measures
      will have on their operations.

   4. Confirm the threshold and criteria for various levels of social distancing
      recommendations with key public health and government officials.

C. Specific strategies. Consistent with the stages in the National Implementation

                                           49
                                           HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                                                 Community Mitigation
             Plan 17 , the Director of Health in consultation with the State Epidemiologist, other
             advisors in the HDOH DOC, and other key emergency response partners in the State
             EOC, will specify the time period within which the following strategies will take
             place:

             1. Communicate public education messages that address:

                  a. Postponement of non-essential travel.

                  b. Avoidance of crowds and other public gatherings.

                  c. Reinforcement and/or local adaptation of federal travel advisories.

             2. Cancellation/postponement of public events/large public gatherings as defined by
                the HDOH DOC in consultation with advisors (through the State EOC). 18

             3. Potential limitation or modification of Federal, State, County, and private work
                environments and hours (e.g., recommendations to utilize internet commuting).

             4. Closure of schools 19 /childcare centers, non-essential government offices, and
                other functions within the community that could act as a barrier to an effective
                response (through the State EOC).

             5. Issuance of public and private transportation recommendations and guidelines

                  a. Restriction of mass transit schedules (through the State EOC)

                  b. Closure of major access roads/routes (through the State EOC)

                  c. Restriction of use of private vehicles (through the State EOC)

III.     ISOLATION – CONCEPT OF OPERATIONS

         If social distancing efforts are successful, the need for isolation becomes less critical.
         The reason for isolation is clear: there is a need to keep separate an ill and contagious
         person from the well population. Isolation facilities may include homes, hospitals, and/or
         alternative facilities in the community such as nursing homes, public auditoriums, hotels,
         or tents.


17
   National Strategy for Pandemic Influenza, p. 8 – www.whitehouse.gov/homeland/nspi_implementation.pdf
18
   This and the following strategies are likely to be highly controversial at the time as studies have indicated that to
be effective, a number of strategies will need to be employed early when morbidity and mortality ratios are still low
(i.e., societal awareness and concern may be low).
19
   The Department of Education will implement its pandemic influenza response plan when it is decided to close
schools.
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            A. Levels of isolation

                1. The first patients presenting in Hawaii with the novel influenza virus most likely
                   will be isolated in isolation rooms in a hospital setting.

                2. When hospital isolation beds have reached capacity and pandemic influenza cases
                   continue to increase, the next level of isolation may be in alternative care modules
                   established near hospitals and staffed by hospital and/or other medical surge
                   personnel to provide surge capacity.

                3. The third level of isolation will take place in cohort facilities 20 that will provide
                   living quarters for a number of people all ill with the same disease, in this case,
                   the novel influenza virus.

                4. The increasing levels of isolation will provide for the increasing numbers of ill
                   patients. However, the added complexity may compromise effectiveness of
                   isolation and quality of medical attention.

                5. When the number of influenza cases increases to the point where cohort facilities
                   are needed, HDOH will remind the public that they may receive more attentive
                   care, be less likely to be exposed to other infections, and be less likely to infect
                   others if they remain at home after becoming ill and notify public health
                   authorities from home.

            B. Isolation facility requirements

                1. Isolation rooms should conform to guidelines from the CDC and its Healthcare
                   Infection Control Practices Advisory Committee.

                2. Although airborne precautions are not currently recommended for influenza-
                   infected persons, it is possible that characteristics of a novel virus may require
                   some level of airborne precautions due to potential localized aerosolization of
                   respiratory droplets (e.g., as during a medical procedure such as intubation for
                   mechanical ventilation). Therefore, facilities with negative pressure capacity are
                   desirable.

                3. When persons requiring isolation cannot be accommodated either at home or in a
                   health care facility, a community-based facility for isolation will be required.

                     a. The availability of a community-based facility will be particularly important
                        during a large outbreak.

                     b. Potential sites for isolation should be identified and evaluated in advance of an

20
     Location and logistics of these cohort facilities are not yet fully in place (as of January 2007).
                                                                   51
                                                                   HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
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       outbreak as part of preparedness planning.

   c. An assessment team will identify appropriate locations and resources for
      community isolation facilities, establish procedures for activating them, and
      coordinate activities related to patient management.

   d. The team should consider the use of both existing and temporary structures.

       i. Options for existing structures include community health centers,
          gymnasiums, auditoriums, nursing homes, apartments, schools,
          dormitories, and hotels.

      ii. Options for temporary structures include trailers, barracks, tents, and
          “bubble systems.”

   e. Features to consider in site and facility selection include:

         i. Size of facility and rooms
        ii. Ability to provide strict standard contact and droplet isolation precautions
      iii. Ventilation system separate from all other buildings (therefore, capacity
            for airborne precautions if necessary)
       iv. Restroom facilities
        v. Onsite showers for patients
       vi. Provision of infection control facilities for hospital staff, such as
            gowning/de-gowning areas, changing rooms, shower facilities, and widely
            available hand-washing basins or waterless hand sanitizers
      vii. Controlled access
     viii. Food service
       ix. Laundry service
        x. Telephone to allow patients contact with family and friends
       xi. Waste disposal procedures
      xii. Procedures to monitor staff’s health

4. When ill persons are asked to isolate themselves at home, these additional
   recommendations will be made to both the ill and their family members:

   a. Persons should remain at home during their illness (usually 7-10 days after
      their symptom onset).

   b. Restrict visitors to the home.

   c. Ill persons should cover their nose and mouth when coughing or sneezing,
      dispose of any used tissues immediately after use, and should wash their
      hands after using tissues. Use of surgical type mask for the ill person to limit
      spread of respiratory droplets may be useful (recycling/reuse of a used
                                        52
                                        HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
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          surgical mask is not recommended).

      d. Family members should immediately wash their hands after any contact with
         the ill person, linens from the ill person, or any tissues or handkerchiefs.

      e. Persons entering the homes of suspected influenza infected persons should
         restrain from coming within six feet of the ill person and should wash their
         hands after any contact with the patient and before leaving the home.

C. Authority

   1. Pursuant to the provisions of HRS 325-8, the Director of Health and HDOH have
      authority, separate from the Governor’s authority identified in HRS 128-8, to
      require isolation of an individual in this situation.

   2. The Director of Health will have primary authority for implementation of the
      Hawaii Pandemic Influenza Preparedness & Response Plan, including
      recommendations and request for social distancing, isolation, and quarantine, with
      guidance from the State Epidemiologist.

   3. From the beginning, HDOH will advise and inform the Governor and SCD as to
      the progression (or non-progression) of the pandemic threat. As the pandemic
      threat escalates and in the event that it becomes a civil defense emergency
      requiring resources outside of the control of the Director of Health, the Governor
      and SCD will be asked to actively support the response.

   4. In a civil defense emergency period, HRS 128-8 applies and provides for the
      suspension of any law that “tends to impede or be detrimental to the expeditious
      and efficient execution of, or to conflict with, civil defense or other emergency
      functions…”

D. Notification and communication

   1. Notification and communication of isolation (and quarantine) requirements will
      follow the same protocols between HDOH and other State agencies.

   2. HDOH will reach clinicians through HDOH broadcast fax and email system used
      for health notifications.

   3. Multiple media sources, such as television, radio, newspapers, and the HDOH
      website will be used to send announcements to the public.

E. Enforcement. Enforcement mechanisms would be the same as those identified in
   section IV.E. below.

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                                           HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
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      F. Additional planning considerations. HDOH and other State and Federal
         partners must address and plan for possible human cases of influenza on board
         international transport (airplanes and boats).

IV.   QUARANTINE – CONCEPT OF OPERATIONS

      If ill or symptomatic individuals, or contacts of those individuals, refuse to comply with
      recommended voluntary social distancing, isolation, and quarantine measures, the
      government will have to resort to mandatory quarantine orders. Mandatory quarantine is
      a very complex measure as it raises a number of serious issues concerning public health,
      public health law, and public policy. It can be resource and labor intensive, taxing the
      reserves of virtually every area within the State such as health care, public health, social
      service, and law enforcement.

      A. Types of quarantine

         1. The primary strategy will be social distancing and voluntary home quarantine.
            However, alternative quarantine sites may be needed if contacts do not have an
            available and appropriate home environment.

         2. Work quarantine may also be considered as was used in Toronto during the SARS
            epidemic of 2003.

             a. Applies mainly to health care workers or other essential personnel who have
                been exposed to cases, but whose services are critical and are therefore needed
                to continue working.

             b. Quarantined either at home or in a designated facility during off-duty hours.

         3. If needed, the HDOH DOC Manager, will identify alternative quarantine sites
            based on a number of considerations (many of which are similar to isolation
            considerations) including:

             a.   Scope of pandemic
             b.   Size of facility/room/site
             c.   Controlled access
             d.   Restroom facilities
             e.   On-site showers
             f.   Food service
             g.   Laundry service
             h.   Telephone to allow individuals contact with family and friends
             i.   Waste disposal procedures
             j.   Procedures to monitor staff’s health

      B. Authority. The authority is the same as that provided for Isolation needs and is
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                                                   HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
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            described in section III.C.

        C. HDOH due process plan

            1. A significant concern during any situation where mandatory quarantine is
               required and necessary to stop the spread of an infectious disease is the protection
               of individual rights.

            2. HRS 325-8 lays out in detail the steps that will be taken should a need arise to
               quarantine an individual or group of individuals who do not want to be
               quarantined voluntarily but need to be.

            3. All actions will be coordinated with the Counties via the DHOs and County
               EOCs.

            4. The HDOH legal counsel at the Department of the AG will be responsible for all
               matters related to these court proceedings. They have drafted a template for an
               “Ex Parte Petition for Order of Quarantine” to have available should the need
               arise.

        D. Support services

            1. During quarantine, movement will be restricted to the area of quarantine.

            2. Physical as well as mental health is a concern.

            3. In anticipation of the need for basic necessities and mental health support, a
               Memorandum of Agreement between HDOH and the American Red Cross-
               Hawaii Chapter has been established. Coordination will also need to occur with
               and through SCD.

            4. HDOH will discuss and collaborate with various nonmedical officials to
               encourage their planning for the implementation of measures to facilitate
               adherence to quarantine (e.g., tele/internet commuting for work and/or school).
               Such has been shown to be integral to ensuring effective quarantine measures. 21

        E. Enforcement

            1. As part of the quarantine instructions provided to an affected individual, an
               HDOH representative may make at least two randomly timed phone calls to the
               quarantined person each day.


21
  DiGiovanni C, Bowen N, Ginsberg M, Giles G. Quarantine Stressing Voluntary Compliance. Emerg Infect Dis.
2005;11(11):1778-1779.
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                                                         HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
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2. When phone calls fail to reach the quarantined individual, an HDOH response
   member or member of the Medical Reserve Corps, trained in the use of
   appropriate PPE and related equipment, will be sent to make an in-person visit to
   the quarantined individual for the purpose of ensuring compliance or confirming
   non-compliance.

3. If an in-person visit confirms non-compliance by the absence of the individual,
   pursuant to HRS 325-9, law enforcement has the authority to locate and confine
   individuals in violation of the quarantine order, using reasonable force.




                                       56
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Section 6. HEALTH CARE
              DELIVERY


      57
           HDOH Pandemic Influenza Preparedness & Response Plan / V08.1
I.   INTRODUCTION

     A. Objective. To outline the actions that will be undertaken by Hawaii hospitals and
        other major clinical facilities when faced with an influenza pandemic and the
        resulting overwhelming demand for services. The specific goals of the health care
        delivery system during an influenza pandemic include:

        1. Early detection of new and existing cases will be enhanced by rapidly
           transitioning from passive to active surveillance.

        2. Hospitals will take prompt and well-coordinated initial actions designed to reduce
           the potential for institutional disease transmission and focused on protecting the
           health care workforce.

        3. Clinical care and services to existing (non-influenza) and influenza patients will
           be prioritized and provided within the context of available resources.

        4. Active management of critical resources will be initiated including staffing,
           equipment, supplies & pharmaceuticals, and clinical venues.

        5. Operational and doctrinal alignment will be established and maintained between
           public and private hospitals with HDOH in the lead role.

        6. Public information and other communications shall be coordinated by HDOH
           with input from community practitioners and hospitals.

     B. Background

        1. Organization. Hawaii hospitals maintain a collaborative relationship via HAH
           with HDOH on matters of public health emergency preparedness. The full detail
           of health care emergency preparedness and response is articulated in the Hospital
           Services Coordinating Plan, also known as Annex ‘H’ of the HDOH Emergency
           Preparedness Plan and a component (known as ‘Volume I’) of the Emergency
           Management Plans of all hospitals.

        2. Perspective. From the perspective of public health emergency preparedness,
           Hawaii and its unique, remote geography suggests a large, highly vulnerable
           population that is physically remote from traditional sources of mutual assistance.

            a. There are no nearby large cities or Border States that are capable of providing
               timely emergency assistance.

            b. Given the State is comprised entirely of individual Island-Counties separated
               by open ocean, even mutual assistance among neighboring Counties requires
               innovative strategies, detailed planning, and a high degree of self-sufficiency.
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                                                 HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
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             3. Routine health care operations. Hawaii hospitals operate year round with average
                daily census (ADC) often exceeding 90%.

                  a. The majority of acute care hospitals with specialty services are located on the
                     island of Oahu resulting in a significant dependence on aero medical
                     transportation for even routine, non-emergent specialty care.

                  b. The Queens Medical Center is the only Level II 22 trauma center in the State
                     (as defined by the American College of Surgeons).

             4. Threat and Impact. Of the many high-risk, high-vulnerability hazards identified
                by the 2005 Hazard Vulnerability Analysis, none appears to present a greater risk
                to the population and to Hawaii hospital services than an influenza pandemic.

                  a. Using the CDC Flu-Surge hospital bed capacity planning tool, HDOH and
                     HAH were able to model the consequences to hospitals of an influenza
                     outbreak at the local (County area) and State levels.

                  b. Using parameters 23 recommended by CDC influenza planners 24 , Flu-Surge
                     demonstrated that Hawaii hospitals would experience severe adverse
                     consequences during the course of an 8-week outbreak:
                                       State of Hawaii Flu-Surge findings, July 2005




22
   There are multiple trauma center designation levels. Level I: regional resource trauma center that is a tertiary care
facility central to the trauma care system; all patients who require the resources of such a center should have access
to it; must have capability of providing leadership and total care, from prevention through rehabilitation; must have
adequate depth of resources and personnel; most are university-based teaching hospitals. Level II: also expected to
provide initial definitive care, regardless of injury severity; may not be able to provide same comprehensive care as
Level I; however, may be most prevalent facility in a community and where a Level I center does not exist, takes
responsibility for education and system leadership. Level III: serves communities with no immediate access to
Level I or II centers; can provide prompt assessment, resuscitation, emergency operations, and stabilization and also
arrange possible transfer to a facility that can provide definitive trauma care. Level IV: provides advanced trauma
life support before patient transfer in remote areas where no higher level care is available; may be a clinic rather
than a hospital and may or may not have a physician.
23
   25% attack rate over an 8-week period. Hospital input values (beds, ventilators) were updated in May 2005 and
reflect a maximum ± 5% margin of error
24
   CDC Pandemic Influenza Planning Conference, Denver, Colorado, February, 2005
                                                                59
                                                                HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
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                        i. Nearly 1,000 in-hospital deaths
                       ii. Nearly 5,000 additional hospital admissions
                      iii. 85% of all intensive care unit (ICU) beds and half of all mechanical
                           ventilators would be dedicated to care of influenza patients. Counties of
                           Maui (132%) and Kauai (158%) would experience much higher rates

                   c. While the timing and true extent of a potential pandemic event are unclear, the
                      resulting data are compelling. The findings of the Flu-Surge tool and related
                      planning factors are carefully considered when preparing the Hospital
                      Services Coordinating Plan, and the Hawaii Bioterrorism Hospital
                      Development Plan 25 .

           C. Assumptions.

               1. During an influenza pandemic, there will be an increased demand for hospital-
                  based clinical services due to the large number of patients who will present with
                  severe illness.

                   a. Patient demand will slowly emerge and progressively saturate clinical venues
                      and resources (beds).

                   b. Given that the design of hospital facilities and services is based on typical
                      non-emergency patterns of utilization, extraordinary demand could easily
                      result in an inability to meet expected levels of access and care.

               2. Up to 25% of health care workers will be lost due to illness and other factors.

               3. Adjustments in the standard of care will be necessary to optimize the balance
                  between available resources and patient demand.

               4. As hospital ICUs saturate with high-acuity, ventilator-dependent patients, non-
                  ICU spaces in hospitals will need to increase to meet patient load.

               5. The early actions of hospitals to cope with increasing demand will likely become
                  ineffective entering the second week of the outbreak.

               6. Antiviral medication will not be available in sufficient amounts to mitigate the
                  demand for hospital care and services.

               7. Neighbor island hospital facilities will experience a greater gap between patient
                  demand and available resources.


25
     Prepared annually in response to HRSA National Bioterrorism Hospital Preparedness Program guidance.
                                                            60
                                                            HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
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         8. Mortality from the novel pandemic influenza virus is likely to be high. Therefore,
            the mortality rate may exceed the routine capacity to appropriately inter bodies.

         9. Augmentation from the mainland United States will be either significantly
            reduced or unavailable as the pandemic reaches into large urban mainland cities.

II.   PREPARATION AND RESPONSE

      A. Basic organization. The response of hospitals and other major clinical facilities is
         phased and functions within the context and organization of HDOH.

         1. Operationally, hospitals are coordinated by a qualified representative of HAH
            under the authority of HDOH within the structure of the HDOH Department
            Operations Section (Hospital Coordination).

         2. This coordination is an on-going, continuous process escalated from a virtual to a
            physical entity when directed by the Director of Health.

      B. Interpandemic period. The interpandemic period (phases 1 and 2) represents the
         ‘resting’ state of emergency operations. Hospitals and other health care agencies will
         focus on aggressive public health emergency preparedness planning, preparation, and
         training. Current, ongoing activities include:

         1. Integration of the influenza pandemic threat into existing and new emergency
            management plans in hospitals and other major clinical facilities.

         2. Enhancement of the surveillance activities of hospitals, Emergency Medical
            Services, major outpatient clinical facilities, and community health centers.

         3. Regular education of hospital leaders and clinical staff on matters of public health
            emergency preparedness with a focus on acts of terrorism and pandemic influenza
            emergency response operations.

         4. Aligning the development efforts articulated in the Hawaii Bioterrorism Hospital
            Development Plan. Specifically, this includes the acquisition of emergency
            supplies such as disposable PPE, equipment such as ventilators, and facility
            upgrades such as increasing the quality and quantity of negative airflow, HEPA-
            filtered isolation rooms.

         5. Deliberate and concerted efforts to increase the rate of annual health care worker
            influenza vaccination.

         6. Development of a volunteer health professional recruitment, screening and
            credentialing, and assignment program that includes Hospital Emergency

                                                 61
                                                 HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
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                Response Team members, the Hawaii DMAT, and the Medical Reserve Corps26 .

            7. Professional education and training of Hospital Emergency Response Team
               members.

        C. Pandemic alert period. Once a Pandemic Alert is issued by CDC through
           HDOH, hospitals and other major clinical facilities will immediately initiate
           emergency operations at Level I; such operations will ensure maintenance of their
           physical (critical) infrastructure.

            1. During Level I operations, hospitals are brought to a specified level of readiness
               in anticipation of casualty care operations.

            2. Activities initiated and sustained include:

                a. Maintaining all of the activities outlined for the interpandemic period (see
                   II.B).

                b. Providing frequent briefings to hospital leaders, clinical staff, and response
                   teams regarding situation and operational options.

                c. Providing just-in-time education to clinical staff and distributing literature
                   describing clinical manifestations, diagnosis, and management of the
                   pandemic influenza.

                d. Transitioning from passive to active surveillance.

                e. Posting of HDOH-provided case definitions in all patient intake areas.

                f. Reviewing plans and procedures.

                g. Updating notification and recall lists of volunteer health professionals.

                h. Providing information to health care workers regarding family emergency
                   preparedness.

                i. Initiating focused screening and triage of all patients seeking care at hospital
                   Emergency Departments, urgent care centers, outpatient primary care offices,
                   and community health centers.

                j. Managing all suspect cases in accordance with hospital procedures for
                   infectious (respiratory) disease patients including the use of isolation, PPE,

26
 Health Resources and Services Administration’s Emergency Systems for Advance Registration of Volunteer
Health Professionals (ESAR-VHP) program.
                                                         62
                                                         HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
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           and respiratory hygiene.

       k. Providing influenza vaccination to all high-risk health care workers and others
          integral to the pandemic influenza response plan, as is available. (Antiviral
          prophylaxis, as stated previously in this Plan, is unlikely to be possible, but in
          the event that a limited amount is available for such, it will be administered on
          a case-by-case basis through HDOH.)

       l. Cooperating with State and Federal officials regarding necessary actions to
          contain and prevent the transmission of pandemic influenza in institutional
          and community settings.

       m. Conducting a physical inventory of all HAH-managed equipment and supply
          caches.

D. Pandemic period. Hospitals and other major clinical facilities will escalate their
   operations to Level II – full contingency operations. The following activities will be
   initiated and maintained:

   1. Maintaining all appropriate activities outlined in the interpandemic and pandemic
      alert periods (II.B and II.C, respectively).

   2. Activating the HAH EOC on a 24/7/365 basis and providing a qualified, decision-
      making representative to the HDOH DOC.

   3. Requesting the activation of all Hospital EOCs (HEOCs) statewide.

   4. Coordinating facility access policies and procedures with County law
      enforcement agencies to enhance facility (critical) infrastructure protection.

   5. Recommending that all acute care hospitals establish and maintain a ‘managed
      corridor’ to their facilities with fully-staffed patient, staff, and visitor screening
      procedures.

   6. Mobilizing one or more 20-bed acute care modules or ACMs as staffing permits
      to augment neighbor island inpatient services and provide cohort isolation.

   7. Mobilizing the Hawaii DMAT either as a State team or request Federal
      authorization to mobilize as a Federal National Disaster Medical System team.
      The team would be pre-positioned in the Honolulu area and deployed where
      needed.

   8. Recommending all hospitals and long-term care facilities restrict non-essential
      access to their facilities.

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                                             HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
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   9. Initiating a once-daily conference call with all HEOCs and maintaining real-time
      communication using WebEOC.

   10. Distributing elements of the HAH-managed hospital caches as needed.

   11. Adjusting hospital standard of care in accordance with current and future patient
       demand.

   12. Implementing family and caregiver just-in-time education as needed.

   13. Augmenting telephone advice processes of hospitals and outpatient facilities to
       maximum degree.

   14. Coordinating the medical support of home-isolated individuals by providing
       essential pharmaceuticals and access to their family physician.

   15. Coordinating all public information through the HDOH DOC PIO.

   16. Facilitating the disposition of the dying and dead by:

       a. Anticipating the need for additional palliative antemortem care and morgue
          space.

       b. Facilitating the rapid interment of dead bodies after appropriate samples are
          collected and/or autopsies performed. Refer to the State Plan for Emergency
          Preparedness, Disaster Response, and Assistance for details. HRS 338-23
          requires a written permit for the removal, burial, or other disposition of dead
          bodies. Should the mortality rate exceed the routine capacity to inter bodies,
          this law may be suspended should the Governor decide to, under HRS 128-
          8D, suspend all laws due to the emergency.

   17. Coordinating access to the assets of the SNS and national laboratories with the
       HDOH DOC.

   18. Preparing and publishing a Hospital Situation Report or SITREP; providing
       copies to Chief of Operations and all hospital facilities by 2400 hours each day.
       This report may be prepared and published on WebEOC.

   19. Taking other actions as requested or directed by the Director of Health.

E. Postpandemic period. This period defines the return to the interpandemic period.
   It is characterized by the activities necessary to restore normal clinical operations and
   prepare for future events. The following activities will be initiated and maintained
   during this period:

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                                             HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
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1. Demobilizing HAH EOC, Hospital EOCs, and all response teams.

2. Providing opportunities for staff and physician rest and personal restoration
   including indicated post-traumatic stress management.

3. Decontaminating essential facilities and disposing of infectious waste.

4. Progressively re-establishing non-essential medical and surgical services
   beginning with primary care and outpatient pharmacy services.

5. Completing an accounting of all extraordinary costs and time.

6. Honoring and recognizing all appropriate staff and physicians for their courage
   and sacrifice – formally and officially.

7. Maintaining a ‘fire watch’ surveillance program to watch for reemergence of
   pandemic activity.

8. Repairing and restoring all damaged, modified, or abandoned facilities to pre-
   operational state.

9. Conducting after-action reviews of key facilities, staff, and other groups.

10. Preparing and publishing a comprehensive operations management report.




                                        65
                                        HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
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Section 7. COMMUNICATIONS


          66
               HDOH Pandemic Influenza Preparedness & Response Plan / V08.1
I.      INTRODUCTION

        A. Purpose. 27 This communications and outreach plan aims to define:

             1. Background for Communications activities

             2. Communications goals

             3. Key messages

             4. Communications and outreach activities in each of the pandemic phases

        B. Background

             During any public health emergency or natural disaster, timely and continuous
             communication among key agencies and partners is critical to ensure a rapid and
             appropriate response. Communication between HDOH and the general public is just
             as critical to encourage community cooperation and prevent misunderstandings that
             could impede an effective public health response.

             Those who have accurate information can make informed decisions and choices that
             may be life preserving or even life saving. Changes in community behavior are
             required to control disease. In the case of Hawaii’s pandemic preparedness plan, the
             goal is to create a “culture of preparedness.”

        C. Assumptions

             1. In an emergency situation, accurate, consistent, and timely messages are key in
                notifying and educating the public.

             2. Assuring adequate communication systems will be a joint responsibility of
                Federal, State, and County agencies.

             3. The public will likely encounter some unreliable and possibly false information in
                the media and on the Internet. The HDOH will communicate accurate and
                reliable information regarding the influenza pandemic.

             4. Mechanisms for communication with the public will vary depending on the phase
                of the pandemic and its impact on Hawaii communities statewide.

             5. The HDOH will strive to communicate with all essential partners. Keeping all
                essential partners completely informed throughout the pandemic may be difficult.


27
     See Appendix F for user-friendly 9-step brochure developed by HDOH.
                                                         67
                                                         HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
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D. Goals

   1. Develop and maintain a reliable system for communicating timely and accurate
      information among all stakeholders as part of the prevention and/or containment
      response to an influenza pandemic.

   2. Conduct outreach to media outlets to ensure media-government partnership in
      serving the public during a public health emergency.

   3. Notification and/or awareness of planning and preparation steps/techniques
      should reach 100% of the State’s residents, visitors, and other population.

   4. Increase local expertise on pandemic influenza threat and related public health
      issues and make expertise publicly accessible.

   5. Integrate awareness of pandemic influenza and prevention behavior into school
      settings at all levels K-12.

E. Duties and responsibilities

   1. Maintain a system to effectively communicate with public health officials, health
      care professionals, and other target audiences to ensure consistent information and
      messages to the public.

   2. Develop and regularly distribute informational updates to the media and all
      appropriate partners.

   3. Advise the Director of Health on public information matters.

   4. Develop a list of appropriate media spokespersons from areas of expertise and
      maintain current contact information.

   5. Monitor and analyze media coverage and correct any inaccurate information
      reported to the public.

   6. Coordinate with SCD and County Civil Defense (CCD) agencies to provide
      accurate and timely information to the media via the State EOC/Joint Information
      Center (JIC) when activated.

   7. Regularly update and maintain the HDOH website with current and useful
      information.

   8. Be prepared to coordinate and maintain an emergency public hotline for public
      health information and referral.
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                                          HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
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         9. Utilize the Health Alert Network to notify health partners of new developments
            and share treatment protocols and other relevant information.

         10. Translate written information for non-English speaking populations as needed.

         11. Provide assistance and support to the Counties in statewide public information
             planning and in development and dissemination of health and public safety
             information.

      F. Coordination with DHOs. As the situation gradually escalates to a full-scale
         pandemic, reliable, coordinated communications between HDOH main operations
         and DHOs will be critical. To facilitate this, DHO activities will include:

         1. Developing a communication plan in conjunction with CCD, response agencies,
            and hospitals in their area.

         2. Coordinating media messages with the HDOH Communications Office.

         3. Developing a list of local media contact names and numbers and methodology to
            quickly send them information.

         4. Developing internal protocols on how to gather and distribute information from
            HDOH main operations to appropriate DHO staff and County agencies.

         5. Establishing a local public health information hotline and developing a plan to
            staff a call center.

         6. Conducting daily briefings with local spokespersons and clinic/health care leaders
            to determine new information to be relayed to the public. This information should
            also be relayed to HDOH for State communications.

         7. Developing a system to post current information on the HDOH website.

         8. Developing plans for communicating with special populations in the local area.

         9. Designating spokespeople for local media.

         10. Monitoring and evaluating local media for accuracy and effectiveness.

II.      CONCEPT OF OPERATIONS

      A. The HDOH Communications Office

         1. Responsible for informing the public via the media throughout the pandemic.
                                                69
                                                HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                                                           Communications
  2. Will inform and update all public information partners through a web-based
     notification/Joint Information System (JIS).

  3. During the initial stages of a pandemic, will brief the Governor’s
     Communications staff.

  4. Once the EOC is activated, will work with SCD to implement a JIC.

B. Template press releases and Q&As

  1. The HDOH Communications Office will work with DOCD to prepare talking
     points for the Director of Health and Governor as needed.

  2. Template releases will be prepared to provide information and disseminate it
     quickly.

  3. Timely releases will be sent to the media and all JIS partners for distribution.

C. Key Messages

  1. Influenza (flu) is a threat to the health and safety of Hawaii residents.
     Pandemic influenza could infect 25-35% of the population and kill hundreds of
     thousands nationwide. It is a much more serious threat than seasonal influenza,
     because people have little or no immunity to a virus that can cause a pandemic.

  2. Pandemic preparedness begins with good health and good habits for
     disease prevention. Every single person should take steps to prepare for a
     potential pandemic or public health emergency. Good hygiene practices
     including proper cough etiquette and vigorous hand-washing should be second
     nature. Maintaining one’s general health and well-being can also reduce
     susceptibility to viruses, helping both the individual and our community.

  3. Spread your aloha, not your germs. Stay home from work or school when
     sick and avoid close contact with others who are sick.

  4. Get that flu vaccine. Public health authorities urge Hawaii residents
     to receive an annual vaccine for regular seasonal influenza.

  5. Every family should develop and establish an emergency plan for
     their family.

  6. Get connected and stay informed.

  7. The Hawaii State Department of Health is working to keep Hawaii
     pandemic free.
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                                           HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
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                   8. Messages specific to birds and handling of birds must be coordinated
                      with the Hawaii State Department of Agriculture and other related
                      partners. 28

                   9. Messages specific to tourism must be coordinated with input from the
                      Hawaii Tourism Authority, the Governor, and other related
                      stakeholders.

III.           ACTIVITIES DURING PANDEMIC PERIODS

               A. Interpandemic period

                   1. Communications staff will notify partner agencies through public PIOs or other
                      designated contacts using JIS or the Response Manager web-based notification
                      system.

                   2. Press materials on current surveillance activity will be developed and
                      disseminated.

                   3. Communications staff will work with DOCD to develop and maintain messages
                      pertaining to pandemic influenza.

                   4. Pandemic informational materials/templates will be developed and provided to
                      DHOs.

                   5. Health educators will be provided with community outreach materials and
                      presentations for community meetings.

                   6. The HDOH Communications offices has maintained and will update and confirm
                      a list of spokespersons.

                   7. Website information will be updated and accessible.

                        a. HDOH pandemic influenza website: http://hawaii.gov/health/elder-
                           care/health-assurance/health/health/health/health/family-child-
                           health/contagious-disease/communications/pandemicflu.html

                        b. HDOH brochures for emergency preparedness available at:
                           http://hawaii.gov/health/about/pr/brochures.html

                   8. Media interview(s) conducted as needed.

                   9. Media and JIS contact information will be updated.

   28
        Specific messages pending discussion with appropriate partners/stakeholders.
                                                                  71
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   10. Hotline staff will be trained and provided with informational materials.

B. Pandemic alert period: early phase - isolated cases to small, localized
   cluster

   1. Communications staff will be updated regularly on developments by the DOCD
      Chief or designate. (Note, if the HDOH DOC has been activated, this role will be
      fulfilled by the designate of the Director, although most likely the Operations
      Chief.)

   2. Communications staff will identify appropriate public information contacts to be
      notified of influenza pandemic activities through JIS, to include: State agencies
      through PIOs or other designated contacts, health care agencies, DHOs, Federal,
      State, and County officials.

   3. The HDOH Communications staff will contact the Governor’s communications
      staff and coordinate press conferences and media briefings.

   4. Communications staff will consult with the State Epidemiologist (or HDOH DOC
      equivalent), to identify and maintain a list of specific target audiences for
      messages that pertain to pandemic influenza.

   5. Communications staff will consult with the State Epidemiologist (or HDOH DOC
      equivalent) to develop and maintain messages appropriate to specific audiences.
      Separate packages of issues/messages may be developed around areas including:

      a.   Vaccine development and supply
      b.   Isolation and quarantine recommendations
      c.   Antiviral use
      d.   Social distancing measures
      e.   Prevention and infection control methods
      f.   Contact investigations

   6. Communications staff will consult with the State Epidemiologist (or HDOH DOC
      equivalent), to develop a disease fact sheet and other informational materials
      specific to an influenza pandemic.

   7. Communications and HDOH PHEP (or HDOH DOC equivalent) staff will
      maintain a system to effectively communicate with public health officials, health
      care professionals, and other targeted audiences that will include securing venues
      for holding:

      a. News conferences
      b. Media briefings
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                                           HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                                                      Communications
      c. Teleconferencing
      d. Other related activities as needed

   8. Information (such as brief situation updates, advisories regarding infection control
      and preventive measures, general informative communications regarding disease,
      basic information regarding care and comfort needs, any relevant instructions to
      the community, etc.) will be distributed by:

      a.   Emergency Medical Services Communications System
      b.   SCD warning system
      c.   Hawaii Warning System
      d.   Law enforcement telecommunications systems
      e.   Nextel cellular phones
      f.   Global Secure Systems/Response Manager
      g.   HDOH media fax and e-mail lists
      h.   HDOH resource contact inventory lists for special needs groups
      i.   HDOH Physicians Alert System
      j.   Aloha United Way 2-1-1
      k.   American Red Cross


C. Pandemic alert period (late phase - large, localized cluster) to Pandemic
   period

   1. The HDOH Communications Office will issue JIS updates via phone, web, e-
      mail, and fax, weekly and/or daily as needed. Media updates will take place
      regularly.

   2. The State Epidemiologist will issue alerts to physicians as needed.

   3. The HDOH emergency website pages will be activated and updated daily or as
      needed.

   4. Hotline resources will be activated and identified staff assigned to internal public
      phone bank.

   5. When the State EOC is activated, the EOC’s JIC will be activated.

      a. Initial State-level media briefings will be held at the EOC or at the State
         Capitol, depending upon the Governor’s involvement.

      b. Assigned JIC staff are divided into teams focusing on specific public
         information areas.

      c. Functions of the communication teams will include:
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                                            HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                                                       Communications
         i. Message content and clearance
         ii. Government and media communications
         iii. Website and hotline management
         iv. Public health partner and stakeholder communication
         v. Identification of spokespersons
         vi. Monitoring and analysis of media reports

     d. Team leaders will meet twice daily to share information and determine
        communication priorities.

     e. Team leaders will report to the PIO at the HDOH DOC and update partners
        through JIS.

  6. Activities when the EOC is not activated include:

     a. The HDOH DOC may activate a DOHIC, and HDOH Communications and
        other staff will be divided into teams focusing on specific
        audience/communication methods.

     b. Team leaders will be public health educators and risk communication
        specialists from HDOH.

     c. Team leaders will meet daily to share information and determine
        communication priorities.

     d. Team leaders will report to the HDOH Public Information Office.

  7. In preparation for potential subsequent pandemic waves, the following activities
     will continue:

     a. Public awareness and communications strategy effectiveness measured
        through surveillance and evaluations

     b. Public education through media and community outreach activities

D. Postpandemic period

  1. The HDOH Communications Office will work with mental health professionals to
     craft messages to aid in the recovery efforts.

  2. Communications Office will participate in the evaluation of the pandemic
     response.

  3. Public awareness and communications strategy effectiveness will be measured
                                         74
                                         HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                                                    Communications
   through surveillance and evaluations.

4. Public education through media and community outreach activities will continue.

5. Planning for future influenza public information campaigns will begin.




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                                       HDOH Pandemic Influenza Preparedness & Response Plan/V08.1
                                                                                  Communications
                 APPENDICES


HDOH Pandemic Influenza Preparedness & Response Plan / V08.1
                                Appendix A
                            Glossary of Terms

Antibody                 A protein produced by the body's immune system that recognizes and
                         helps fight infections and other foreign substances in the body.

Antigen                  A substance, foreign to the body, that stimulates the production of
                         antibodies by the immune system. Antigens include foreign proteins,
                         bacteria, viruses, pollen, and other materials.

Antigenic drift          The capacity of influenza viruses to undergo gradual change in their
                         two surface antigens is known as antigenic “drift”. This minor
                         change leads to the emergence of new variant strains. Antigenic drift
                         may result in epidemics, since incomplete protection remains from
                         past exposures to similar viruses.

Antigenic shift          Influenza A viruses, including subtypes from different species, can
                         reassort or swap genetic materials and merge. This reassortment
                         process, known as antigenic “shift,” results in a novel subtype
                         different from both parent viruses. As populations will have no
                         immunity to the new subtype, and as no existing vaccines can confer
                         protection, antigenic shift has historically resulted in highly lethal
                         pandemics. For this to happen, the novel subtype needs to have genes
                         from human influenza viruses that make it readily transmissible from
                         person to person for a sustainable period.

Antiviral                These are medicines that specifically target viruses. There are
                         currently four antiviral drugs that target influenza (amantadine,
                         rimantadine, zanamivir and oseltamivir). Indications, mechanisms of
                         action, and efficacy differ for each and depend upon the situation for
                         use. All require physician consultation and prescription.

Avian influenza          Also referred to as bird flu, is a disease of birds (e.g., ducks and
                         chickens). Since 2003, the H5N1 avian influenza virus has infected
                         millions of birds globally. Although it is primarily a disease of birds,
                         a small number of people have also been infected after having close
                         contact with birds.
Communicability          Transmissibility; ability to spread from infected to susceptible hosts.

Contact                  A term used to refer to someone who has been in close proximity with
                         an individual who is or is suspected of being infected with an
                         infectious disease like influenza.

Epidemic                 Any disease, infectious or chronic, occurring at a greater frequency
                         than usually expected. The term “outbreak” is sometimes used
                         synonymously.

General public health The restriction of movement of certain segments of the community to

                                            A-1
                                            HDOH Pandemic Influenza Preparedness & Response Plan / V08.1
containment           decrease social contact.

Hand hygiene          Applies to the cleaning of one’s hands. This is usually done with
                      soap and water, hand sanitizer, or hand wipes. To kill an influenza
                      virus, hands must be washed with soap and water for at least 15
                      seconds and hand sanitizers or wipes must be used for 10 seconds and
                      have an alcohol content of at least 60%.

Human-to-human        Refers to the ability of an infectious disease to be passed continuously
transmission          from one person to another. Some viruses can be transmitted between
                      animals (animal-to-animal), some can be transmitted from animal-to-
                      human (and vice versa), and some can be transmitted from human-to-
                      human.

Infection control     A broad term used to describe a number of measures designed to
                      detect, prevent, and contain the spread of infectious disease. Some
                      measures include hand washing, respiratory etiquette, use of personal
                      protective equipment (PPE), prophylaxis, isolation, and quarantine.

Influenza pandemic    Occurs with the appearance of a novel influenza virus, against which
                      the human population has no immunity, resulting in multiple,
                      simultaneous epidemics worldwide with high morbidity and
                      mortality.

Isolation             The restriction of movement and separation of the sick or person(s)
                      infected with a contagious disease. This is usually done in a hospital
                      setting but may also be implemented at home or in a dedicated
                      isolation facility. Isolation may be applied at the individual level or
                      may be implemented with groups.

Morbidity             A diseased condition or state.

Mortality             Death.

Novel virus           A virus that has never previously infected humans or has not infected
                      humans for a long time.

Personal Protective   Specialized clothing or equipment worn to protect someone against a
Equipment (PPE)       hazard including an infectious disease. It can range from a mask or a
                      pair of gloves to a combination of gear that might cover some or all of
                      the body.

Prophylaxis           An infection control measure whereby antimicrobial, including
                      antiviral, medications are taken by a healthy individual (e.g., nurse,
                      contact) to prevent illness before or after being exposed to an
                      individual with an infectious disease (e.g., influenza).

Quarantine            The restriction of movement and separation of well person(s)
                      presumed exposed to someone who has a contagious disease (i.e.,
                                       A-2
                                         HDOH Pandemic Influenza Preparedness & Response Plan / V08.1
                        confirmed case of the disease). This may be applied at the individual
                        or community level and may be implemented in the home setting or
                        in a dedicated quarantine facility. The objective is to reduce the
                        incidence of new cases. Quarantine, in turn, also requires a clear
                        definition of the term close contact or what constitutes an exposure to
                        determine when a person is to be quarantined.

Respiratory etiquette   Good coughing and sneezing manners are one way of minimizing the
                        spread of viruses, which are passed from human-to-human in the tiny
                        droplets of moisture that come out of the nose or mouth when
                        coughing, sneezing, or talking. Healthy and sick people should cover
                        their nose and mouth when sneezing, coughing, or blowing their nose
                        and then put the used tissue in the trash to prevent the spread of
                        germs.

Seasonal influenza      An infectious disease that is commonly referred to as the flu. In the
                        United States, flu season usually occurs between December and
                        March. The influenza virus is one that has the ability to change
                        easily; however, there is usually enough similarity in the virus from
                        one year to the next that the general population is partially immune
                        from previous infection or vaccination. Each year experts monitor the
                        influenza virus and create a new vaccine to address changes in the
                        virus. For this reason people are encouraged to get vaccinated against
                        flu each year.

Social Distancing       A voluntary method of infection control that requires people to reduce
                        the frequency and closeness of contact with others in large
                        social/community gathering places (i.e. malls, schools, parks,
                        theatres, etc.) and to avoid contact with anyone who may have been
                        infected.

Vaccine                 A preparation that contains an antigen, consisting of whole disease-
                        causing organisms (killed or weakened) or parts of such organisms,
                        that is used to confer immunity against the disease that the organisms
                        cause.

                        About influenza vaccine: Every year the WHO Influenza Program
                        convenes meetings to analyze global data on circulating influenza
                        strains and make recommendations, based on degree of difference
                        from previous strains and epidemiologic significance, for the three
                        strains to be used in the vaccine for the coming influenza season. The
                        current method for production of the influenza vaccine requires
                        months and large numbers of embryonated hens’ eggs (required to
                        grow and sufficiently expand the number of virions that will be
                        inactivated and used as antigens in the vaccine).




                                         A-3
                                           HDOH Pandemic Influenza Preparedness & Response Plan / V08.1
                     Appendix B
                 List of Acronyms
AAR        After Action Report
AG         Attorney General
APSTPHLD   Association of State and Territorial Public Health Laboratory
           Directors
CDC        Centers for Disease Control and Prevention
CSTE       Council of State and Territorial Epidemiologists
DHO        District Health Office
DIB        Disease Investigations Branch
DMAT       Disaster Medical Assistance Team
DOC        Department Operations Center
DOCD       Disease Outbreak Control Division
DOHIC      Department of Health Information Center
EFS        Emergency Support Function
EOC        Emergency Operations Center
HEOC       Hospital Emergency Operations Center
HAH        Healthcare Association of Hawaii
HDOH       Hawaii Department of Health
DHHS       U.S. Department of Health & Human Services
HPhA       Hawaii Pharmacists Association
HQS        Honolulu Quarantine Station
HRO        Human Resources Office
HRS        Hawaii Revised Statute
IC         Incident commander
ICS        Incident command system
ICU        Intensive care unit
IIS        Immunization Information System
ILI        Influenza-like illness
IMB        Immunizations Branch
JIC        Joint Information Center
JIS        Joint Information System
NACCHO     National Association of County and City Health Officials
NIMS       National Incident Management System
PIMS       Pandemic Information Management System
PIO        public information officer
PHN        Public Health Nursing
PHEP       Public Health Emergency Preparedness
PPE        Personal protective equipment
RITS       Receiving, Storing & Staging Inventory Tracking System
RT-PCR     Reverse transcriptase-polymerase chain reaction
SARS       Severe Acute Respiratory Syndrome
SITREP     Situation Report
SCD        State Civil Defense
SLD        State Laboratories Division
SNS        Strategic National Stockpile
                               B-1
                               HDOH Pandemic Influenza Preparedness & Response Plan / V08.1
WHO   World Health Organization




                        B-2
                        HDOH Pandemic Influenza Preparedness & Response Plan / V08.1
Appendix C. Concept of HDOH Operations Center




                    C-1
                                HDOH Pandemic Influenza Preparedness & Response Plan / V08.1
                    APPENDIX D
         Key HDOH Areas Contact Information
Director’s office                                  586-4410
   Deputy Director                                 586-4412
   Deputy, Health Resources                        586-4433
   Deputy, Environmental Health                    586-4424
   Deputy, Behavioral Health                       586-4416

Communications                                     586-4442

Disease Outbreak Control Division                  587-6845
   Disease Investigation Branch                    586-4586
   Immunization Branch                             586-8300
   Bioterrorism Preparedness & Response            587-6569

Community Health Division                          587-4748
  Public Health Nursing Branch                     586-4618
  Bilingual Health Services                        832-5685

Emergency Medical Service System                   733-9210

Environmental Health Services Division             586-4576

State Laboratories Division                        453-6655
    Medical Microbiology                           453-6700
       Bacteriology/Parasitology                   453-6706
       Mycobacteriology/Mycology                   453-6707
       Virology                                    453-6705
    Bioterrorism Response Laboratory               453-5990
    Environmental Health Analytical Services       453-6671
    Environmental Microbiology                     453-6601

District Health Office of Hawaii                   808-974-6006

District Health Office of Kauai                    808-241-3614

District Health Office of Maui                     808-984-8200




                                         D-1
                                         HDOH Pandemic Influenza Preparedness & Response Plan / V08.1
                 APPENDIX E
 Pandemic Influenza Preparedness & Response
      Ad Hoc Advisory Group* Members
District Health Offices
   Hawaii
   Kauai
   Maui

HDOH Communications Office
Public Health Nursing

Hawaii Medical Association
American College of Physicians
American Academy of Pediatricians
American Academy of Family Physicians
American College of Emergency Physicians
Medical Examiner's Office

Healthcare Association of Hawaii
Association for Professionals in Infection Control
Emergency Medical Services
American Red Cross

Dept of Agriculture, State Veterinarian

Bioethicist

State Government
    (including one representative for the Governor and each house of the State
    Legislature)
Representatives for each County Mayor

State Attorney General

Tripler (TAMC)
Pacific Command (PACOM)

CDC/PHS Quarantine Station
State Civil Defense
County Civil Defense

County Police Department
County Fire Departments

*Each group or organization would provide one chief representative to attend ad-hoc

                                           E-1
                                          HDOH Pandemic Influenza Preparedness & Response Plan / V08.1
meetings and one alternate in the event that the chief representative is unavailable.

Other groups that may be consulted/asked to participate as needed:
   Infectious Diseases (Adult and Pediatric)
   Hawaii Primary Care Association
   Hawaii Medical Services Association
   Kaiser Permanente
   Hawaii Pharmacists Association
   Hawaii Nursing Association
   Hawaii Visitors Association
   Dept of Education
   Dept of Parks and Recreation (State and County)
   Dept of Accounting and General Services, Public Works Division (State)
       Dept of Public Works (County)
   Dept of Transportation




                                           E-2
                                           HDOH Pandemic Influenza Preparedness & Response Plan / V08.1
                                APPENDIX F
                   Pandemic Vaccine Clinics Set-up and Flow
                                  Concept
              I. Staff will assist and direct participants to proper stations
             II. Station A [Registration check]
                   A. Consent form and informational materials
                   B. If there are uncertainties or questions, participants to proceed to “station B,”
                       otherwise proceed to “station C” or “station D”
           III. Station B [Problem Area]
                   A. Clinic manager and/or clinic manager assistant(s) to review and assess
                       problematic issues (i.e., contraindications, etc.)
                   B. Area where vaccinee may be assessed if medical or other problem occurs at any
                       time during vaccinee’s time in clinic
           IV.     Station C [Waiting Area]. Area where vaccinees may wait if vaccination tables are
                   occupied.
            V. Station D [Vaccination Stations]
                   A. Administration of pandemic influenza vaccine to participants
                   B. Participants to proceed to exit (or waiting area) as designated by staff



                                                                                                                     NURSE



                                                                                                                 D   NURSE
                                           REGISTRATION
                                   A




                                                                                          Vaccination Stations




                                                                                                                        NURSE
                                                                                                                 D
ENTRANCE




                                                                  Waiting Area




                               .
                                                              C




                                                                                                                                      EXIT
                                       REGISTRATION
                               A




                                                                                                                 D




                                                                                                                     NURSE




                                                                                                                     NURSE
                                                                                                                 D




                                                                                                                     NURSE

                                               PROBLEM AREA
                                                          B

                                                                           F-1
                                                                       HDOH Pandemic Influenza Preparedness & Response Plan / V08.1
                      APPENDIX G
       Guidelines for Recognizing Influenza (Flu)
              Symptoms and Management
Signs and Symptoms of Influenza (Flu)
Infection with the influenza virus typically causes:
    • fever (temperature >101º F)
    • cough
    • sore throat
    • tiredness
    • headache
    • muscle aches.

People infected with the current strain of the avian influenza virus (H5N1) or with a new
human pandemic influenza strain may show typical human influenza-like symptoms such
as those listed above, but some will have more serious symptoms such as pneumonia,
severe respiratory diseases, and other life-threatening complications.


Other Facts about Influenza Infection
                   The influenza virus is spread by the tiny droplets expelled when an
                   infected person coughs or sneezes. These respiratory droplets do not
                   usually remain airborne as they are heavy enough to quickly fall out of
                   the air; however, they can spread approximately 3-6 feet from the
infected individual. Infection can result from breathing in these droplets before they fall
or by touching a surface on which the droplets landed (such as a doorknob or computer
keyboard) and then touching the mucous membranes of the mouth, nose, or eyes.
Depending on conditions, the virus may live for 1-2 days on hard surfaces.

A person infected with influenza can spread the virus in their respiratory droplets for
about 24 hours before they begin to feel ill and will continue to expel the virus in
respiratory secretions for about 3-5 days after they develop symptoms.


How to Limit the Spread of Infection
   •    Stay healthy – eat, rest, drink plenty of fluids, exercise, and get vaccinated yearly
        against seasonal flu
   •    Wash your hands frequently or use alcohol-based
        hand sanitizing gel
   •    Clean hard surfaces such as doorknobs and
        telephones with disinfecting wipes
   •    Cover your nose and mouth with the inside of
        your elbow or a tissue when you cough or
        sneeze and encourage others to do the same

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                                            HDOH Pandemic Influenza Preparedness & Response Plan / V08.1
   •   Put used tissues in the trash
   •   Stay home from work if you are ill, and keep your children home from school if
       they are ill
   •   Practice social distancing (for example, work from home, bank on the internet, or
       avoid unnecessary travel)
   •   Be prepared if you are asked to voluntarily remain at home – have an emergency
       supply kit for your home including water, food, and medications (both basic non-
       prescription medications like ibuprofen and at least a 2 week supply of
       prescription medications.)


What to Do if You Are Ill
A fever may indicate infection with influenza. Have a thermometer at home and know
how to use it properly.
   • Place the thermometer bulb under the tongue for at least two minutes
   • Wait more than 10 minutes after eating or drinking before taking your
       temperature
   • A temperature 101º F or higher indicates a fever

If you have a fever and have recently traveled to a country where avian influenza is
present, or if you have been in contact with someone who has, you should contact your
doctor immediately and avoid contact with other persons to whom you could spread
infection. Putting on a surgical-type mask may be helpful to decrease the chance of
spreading infectious respiratory droplets.

If you have not recently traveled or been in contact with anyone who has, you may still
wish to see your doctor for seasonal influenza treatment or to exclude other illnesses
(including leptospirosis or dengue fever). In general, healthy persons with seasonal flu
may remain at home and care for themselves as described in the next section.

If the pandemic phase increases, meaning there is human-to-human transmission of a
pandemic influenza virus, persons with fever should follow the directions issued by
HDOH to obtain treatment from the appropriate hospital, clinic, or alternate health care
facility.


Caring for a Person Infected with Influenza at Home
The ill person should:
   • Avoid contact with healthy family members
   • If possible, stay in a separate room with the door closed
   • Cover coughs and sneezes with a tissue and dispose of the tissue in the trash
   • Wear a surgical-type mask, if available
   • Not go out to go to work, school, the store, or anywhere else
   • Drink plenty of fluids and eat a healthy diet as possible
   • Get plenty of rest
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                                           HDOH Pandemic Influenza Preparedness & Response Plan / V08.1
   •   Take over the counter medications (e.g., to treat fever, congestion, cough) as
       needed to support you through the illness

Other people in the house should:
   • Discourage visitors
   • Try to stay away from the ill person, or at least stay more than 3 feet away
   • Encourage the ill person to drink plenty of fluids and a nourishing diet and get
       plenty of rest.
   • Not use the ill person’s plates, silverware, towel, or toothbrush
   • Wash the ill person’s sheets and clothing in warm water and soap
   • Wash any other items touched by the ill person with soap and water or clean with
       disinfectant wipes
   • Monitor the ill person for signs of potential need for specialized health care at an
       appropriate facility. Such signs may include:
           Shortness of breath or increasing difficulty breathing
           Persistently high fever (temperature greater than 102º F) despite taking
           appropriate medications (e.g., acetaminophen [e.g., Tylenol] or ibuprofen
           [e.g., Advil or Motrin])
           Mental confusion
           Lethargy (i.e., not alert or responding to normal stimuli)
   • If the ill person shows signs of worsening or if uncertain, contact your primary
       care physician and/or public health authorities (contact information will be made
       available during a pandemic)
   • Stay at home until at least three days after the ill person has recovered




                                          G-3
                                          HDOH Pandemic Influenza Preparedness & Response Plan / V08.1
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EMERGENCY RESPONSE PLAN


      DECEMBER 2008
                UNIVERSITY OF HAWAI’I AT MĀNOA
           EMERGENCY RESPONSE PLAN DISTRIBUTION LIST

President, University of Hawai‘i                                         1
Secretary of the Board of Regents                                        1
Vice President for Administration                                        1
Vice President for Budget and Finance and Chief Financial Officer        1
Vice President for Research                                              1
Vice President for Student Affairs                                       1
Vice President for Academic Affairs and Policy                           1
Vice President for Community Colleges                                    1
Associate Vice President for External Affairs and University Relations   1
System Director, Human Resources                                         1
System Director, Financial Management Office                             1
System Director, Procurement, and Real Property Management               1
Chancellor, University of Hawai‘i at Mānoa                               1
UHM Vice Chancellor for Administration, Finance and Operations           1
UHM Vice Chancellor for Academic Affairs                                 1
UHM Vice Chancellor for Students                                         1
UHM Director of Communications                                           1
Assistant Vice Chancellor for Campus Services                            1
Director, Facilities and Grounds                                         2
Director, Auxiliary Enterprises                                          2
Director of Safety and Security                                          1
Chief of Campus Security                                                 3
Director, Environmental Health and Safety                                1
Emergency Management Coordinator                                         2
Director, Student Housing                                                1
Director, University Health Services Mānoa                               1
Director, Campus Center                                                  1
Athletic Director, Intercollegiate Athletics                             1
Dean, School of Architecture                                             1
Dean, College of Arts and Humanities                                     1
Dean, Colleges of Arts and Sciences                                      1
Dean, College of Business Administration                                 1
Dean, College of Education                                               1
Dean, College of Engineering                                             1
Dean, School of Hawaiian, Asian and Pacific Studies                      1
Dean, College of Languages, Linguistics and Literature                   1
Dean, William S. Richardson School of Law                                1
University Librarian                                                     1
Dean, John A. Burns School of Medicine                                   1
Dean, College of Natural Sciences                                        1
Dean, School of Nursing and Dental Hygiene                               1
Dean, School of Ocean and Earth Sciences and Technology                  1
Dean, Outreach College                                                   1
Dean, College of Social Sciences                                         1


                                               iii
Dean, School of Social Work                                                        1
Dean, Student Affairs                                                              1
Dean, School of Travel Industry Management                                         1
Dean, College of Tropical Agriculture and Human Resources                          1
President, East-West Center                                                        1
Executive Director, Research Corporation of the University of Hawai‘i              1
Director, Cancer Research Center of Hawai‘i                                        1
Director, Lyon Arboretum                                                           1
Director, Waikīkī Aquarium                                                         1
Vice Director, State Civil Defense                                                 1
Administrator, O‘ahu Civil Defense Agency                                          1


Total Copies Issued                                                               60




Note: The Official Copy of the University of Hawai‘i at Mānoa Emergency Response Plan is
electronically filed and can be accessed via the Mānoa Campus Emergency Management
Program website at manoa.hawaii.edu/emergency. All changes and corrections will be made to
the electronic copy and indicated on page ii, Record of Revisions. All Offices on the distribution
list will receive notices of changes and revisions.




                                                iv
                               TABLE OF CONTENTS


                                                           Page


I.    INTRODUCTION
        A. Purpose                                            1
        B. Authority                                          1
        C. Statewide Responsibilities                         1-2
        D. Emergency Plan Concept of Operations               2

II.   SITUATIONAL REQUIREMENTS
        A. Campus Priorities                                  2
        B. Emergency Classifications                          2-4
        C. Hazard Categories                                  4-6
        D. Mass Casualty Events                               6

III. OPERATIONAL REQUIREMENTS
      A. Emergency Operations                                 6
      B. Emergency Management                                 6-7
      C. Emergency Response Center                            7-8

IV. EMERGENCY MANAGEMENT TEAM (EMT)
     A. Mānoa EMT Responsibilities                            8-10
     B. Campus Emergency Response Team (CERT)                 10
     C. Alert Roster                                          10
     D. Mānoa EMT Organization and Leadership                 10-11

V.    DE-ACTIVATION AND PLAN RE-ASSESSMENT
       A. ERP and ERC De-Activation                           12
       B. ERP Re-Assessment                                   12

VI. EMT Standard Operating Procedures
    (To be completed and filed with this Plan)
      A. EMT Operations and Finance                           12
      B. EMT Plans                                            12
      C. EMT Logistics                                        13
      D. EMT Campus Personnel                                 13

VII. TABS
      A. UHM Alert Roster
      B. Campus and Facilities Maps
      C. Action Plans for Specific Emergencies/Disasters
            1. Hurricanes and Severe Storms
            2. Waterspouts


                                                 v
 3.   Tsunami and Coastal Flooding
 4.   Earthquakes
 5.   Volcanic Activity
 6.   Landslides and Mudslides
 7.   Fire
 8.   Hazardous Materials
 9.   Bomb Threats and ExplosionsC9
10.   War and Terrorist Attack
11.   Biological Outbreak
12.   Utility Outages
13.   Civil Disturbance and Labor Strikes
14.   Aircraft and Fallen Object Accidents




                                  vi
     EMERGENCY RESPONSE PLAN

I.   INTRODUCTION
     A. PURPOSE – The University of Hawai‘i at Mānoa Emergency Response Plan (ERP)
     provides procedures for managing and responding to major emergencies that may
     threaten the health and safety of the Campus community or disrupt its programs and
     activities. The ERP outlines necessary emergency preparedness requirements and
     identifies organizations and individual positions that are directly responsible for
     emergency preparedness, response and recovery.

     B. AUTHORITY – This ERP is promulgated under the authority of the Chancellor of
     the University of Hawai‘i at Mānoa and University of Hawai‘i Executive Policy E2.203
     Emergency Preparedness and Response Responsibilities.

     C. STATEWIDE RESPONSIBILITIES – The State of Hawai‘i, Plan for Emergency
     Preparedness, Volume III provides the overall plan for the State and specifies the support
     required from the University of Hawai‘i and other State agencies. The University has
     specific requirements to provide the following support under the State Plan for
     Emergency Preparedness:




                                             1
         1. Supporting County governments in identifying and meeting the health and
         medical needs of disaster victims.

         2. Supporting the State Department of Health in providing technical assistance on
         disease and injury control measures.

         3. Providing shelters for evacuees and/or victims during or after a disaster occurs.

         4. Supporting the State Department of Health in providing assistance for any
         hazardous materials disaster.

      D. EMERGENCY PLAN CONCEPT OF OPERATIONS – This plan is designed to
      provide an organized management system for the Mānoa Campus to follow during
      emergencies. The system is flexible where parts of or the entire plan may be activated, as
      appropriate to the situation. It is based on a worst-case scenario and is a management
      tool for providing critical functions and roles during an emergency. The plan complies
      with the Incident Command System, the management structure identified in guidance
      provided by the National Incident Management System of the U.S. Department of
      Homeland Security. Emergency response leadership at Mānoa will be provided by the
      Emergency Management Team (EMT), drawn from the University’s senior
      administrative and academic leadership. The EMT Executive for Mānoa shall be the
      Chancellor. Under the Incident Command System, the EMT leader is the Incident
      Commander, who under the Mānoa Emergency Response Plan shall be the EMT
      Executive or Chancellor.


II.   SITUATIONAL REQUIREMENTS
      A. CAMPUS PRIORITIES – The University of Hawai‘i at Mānoa (UHM) emergency
      response organization shall respond to an emergency situation in an organized, safe,
      effective and timely manner. UHM personnel and equipment will be utilized to
      accomplish the following priorities:

             Priority I     Protect Life and Safety

             Priority II    Assess Critical Infrastructure and Facilities

             Priority III   Restore/Maintain Campus Operations and Resume
                            Education/Research Programs

      B. EMERGENCY CLASSIFICATIONS - Each incident will be classified by Type
      according to its potential impact, severity and response requirement.




                                              2
1. Type 1 (Minor Incident)

   a. A Type 1 minor incident is localized or in a small area. It can be quickly
   resolved with existing UHM resources or limited outside help. A Type 1 incident
   has little or no impact on personnel or normal operations outside the locally
   affected area.

   b. Type 1 incidents do not require activation of the UHM ERP. Impacted
   personnel, departments or offices coordinate directly with operational personnel
   from the UHM Office of Safety and Security and the Office of Facility and
   Grounds or other units to resolve Type 1 incidents. In certain incidents, the
   Mānoa Director of Communications will be asked to provide necessary media
   releases.

   c. Examples: Odor complaints, localized chemical spill, plumbing failure or
   water leak.

2. Type 2 (Emergency)

   a. A Type 2 emergency disrupts sizable portions of the Campus community.
   Type 2 emergencies require assistance from external organizations. These events
   can escalate quickly and have serious consequences for mission-critical functions
   and/or life and safety.

   b. The Mānoa Emergency Management Team (EMT) Executive (Chancellor) or
   an authorized representative receives intelligence from responding operational
   departments or from the Campus Security Call Center and determines whether the
   ERP and Emergency Response Center (ERC) should be activated.

   c. Senior members of the Mānoa EMT, the President of the University of
   Hawai‘i, and State Civil Defense may be alerted depending on the nature and
   severity of the emergency.

   d. Examples: Building fire or explosion, biological or terrorist threat, major
   chemical or hazardous material spill, severe windstorm or flooding, and extensive
   utility outage. Also includes external emergencies that may affect Campus
   personnel or operations.

3. Type 3 (Disaster)

   a. A Type 3 disaster involves a large part of the Campus and its surrounding
   community. Normal Campus operations are curtailed or suspended. The effects
   of the disaster are wide-ranging and complex. A timely resolution of disaster
   conditions requires Campus-wide cooperation and extensive coordination and
   support from external jurisdictions.




                                    3
     b. The Chancellor is notified and the ERP and ERC are activated. State Civil
     Defense is notified and communications opened. Mānoa EMT members and
     other key personnel are alerted to report to Campus and the Campus Emergency
     Response Teams (CERTs) are activated and engaged in the Campus emergency
     response. Operations and Finance units activate plans to respond with facilities
     personnel and resources and provide the necessary financial, contracting and
     claims support. Plans and Logistics units activate plans to provide intelligence,
     record keeping and distributes material and equipment and assigns personnel
     where needed. The Mānoa EMT Executive activates the Public Information Plan
     and requests support from the System Joint Information Office.

     c. The President is notified and the System EMP and Emergency Operations
     Center (EOC) may be activated. System EMT members may be alerted to report
     to Campus.

C. HAZARD CATEGORIES

  1. METEOROLOGICAL HAZARDS – This is the most common category of hazard
  that can cause disasters in the State of Hawai‘i. Meteorological hazards may threaten
  any part of the State or the entire State at the same time.

     a. Storms – Pose the most frequent threat to life and property and may occur
     many times during the winter months. Disaster agents associated with storms
     include high winds, high surf, and heavy rains resulting in floods. Storms have
     caused the most property damage in Hawai‘i.

     b. Hurricanes – Are potentially very serious threats to life and property as they
     occasionally threaten the State during the hurricane season from June to
     November. Disaster agents associated with hurricanes include extremely high
     winds, storm surge, damaging surf, heavy rains and flooding.

     c. Waterspouts – Rarely occurs over land, but can cause heavy damage.

  2. GEOLOGICAL HAZARDS – This category of hazard is always a potential risk
  as the Hawaiian Islands are situated on both a volcanic and tectonically active region
  in the Pacific Ocean. Geological hazards causing disasters are less frequent, but can
  be more severe than other hazards.

     a. Earthquakes – Pose a continuing threat to life and property as they occur
     frequently. Although most earthquakes in Hawai‘i are of low magnitude,
     damaging earthquakes have occurred in the past.

     b. Tsunami – Pose a very serious threat to life and property as they have caused
     the most disaster related deaths in the State. A high magnitude earthquake in
     other areas of the Pacific may generate a tsunami that could threaten any shore in




                                       4
   Hawai‘i. Locally generated tsunamis pose a greater problem as they can strike in
   a matter of minutes with little or no warning.

   c. Volcanic Activity – Poses a minimal threat on O‘ahu, but occurs on the island
   of Hawai‘i and could break out on any island or surrounding ocean. If it occurs
   on O‘ahu, it could be a threat to populated areas.

3. OTHER NATURAL HAZARDS – Most other natural hazards in the State are
associated with weather or geologic hazards.

   a. Landslides – Usually associated with meteorological hazards, but can be
   caused by a combination of weather and man’s development activities.

   b. Mudslides – Associated with meteorological hazards and/or geologic events
   and are rare in Hawai‘i.

   c. Forest/Brush Fires – Frequently occurs during dry weather, but are more often
   associated with the careless acts of man or arson.

4. MAN CAUSED INCIDENTS – The incidents listed here are due to the actions
and activities of man.

   a. War (Nuclear or Conventional Attack) - Poses a threat because of the military
   presence in Hawai‘i, but could occur in another part of the world and affect
   Hawai‘i. The hazards of nuclear attack include blast and radioactive fallout and
   its damaging effect on life and property.

   b. Terrorist Attack – Always poses a potential threat to people and facilities in
   the United States. Terrorist activity can take various forms with the most
   devastating being the use of bombs, chemical or biological weapons.

   c. Bomb Threat/Explosion – Poses a potential threat due to the relative ease in
   obtaining the material to make bombs and man’s activities where material that can
   cause explosions are used on a regular basis.

   d. Biological Outbreak - Always poses a potential threat and can occur naturally,
   through man’s activities, terrorist attack or through biological warfare.

   e. Pandemic – Poses a potential threat through the spread of infectious disease.
   Due to the seriousness of this hazard, the State will be issuing a separate
   pandemic plan.

   f. Hazardous Material Spill – Poses a potential problem at University facilities
   where hazardous materials and chemicals are used on a regular basis. The
   establishment and adherence to operational procedures and safety standards are
   important factors in keeping spills to an absolute minimum.



                                    5
              g. Fire – Always poses a potential problem at University facilities. The use of
              fire retardant materials and the establishment and adherence to fire safety codes
              and procedures are important factors in minimizing the potential for building
              fires.

              h. Aircraft Accident – Poses a potential problem, as University facilities are
              located under aircraft flight paths.

              i. Major Utility Outage – Always poses a potential problem at University
              facilities due to the size and amount of personnel that work at, attend or visit our
              Campus and facilities. Electricity and water are the primary utilities where
              outages can cause problems and seriously affect the University’s daily operations.

              j. Civil Disturbance – Poses a potential problem at University facilities because
              we are a public institution and civil rights activities often occur on the University
              Campus.

       D. MASS CASUALTY EVENTS – May be the result of any of the hazard and incident
       categories listed above. Mass casualty events may occur on Campus, at an off-campus
       facility or in the general area of the University. University assets, including personnel,
       supplies, equipment and facilities, identified in the State Emergency Operations Plan may
       be requested to support mass casualty events.


III.   OPERATIONAL REQUIREMENTS
       A. EMERGENCY OPERATIONS – UHM operational responsibilities for emergency
       preparedness, response and recovery include all Campus and off-Campus facilities.
       UHM Deans and Directors and all other activities on Campus will be assigned
       responsibilities for emergency preparedness and response requirements as identified in
       this Plan, associated Emergency Action Plans, the Hawai‘i State Plan and Standard
       Operating Procedures. Emergency Action Plans for Specific Emergencies/Disasters are
       located in Tab C of this Plan. Action Plans for the EMT are being worked on and will
       identify the functional responsibilities for individuals, groups, and areas. EMT Action
       Plans will be added to this ERP when completed.

       B. EMERGENCY MANAGEMENT – The Chancellor has the overall responsibility for
       emergency preparedness and response for the Mānoa Campus and shall be the EMT
       Executive when the Mānoa ERP and ERC are activated. The Chancellor shall be the
       point of contact with the President who in turn is the point of contact with State Civil
       Defense, Oahu Civil Defense and other Federal, State and County agencies. Depending
       on the requirements of the emergency, the President may delegate point of contact
       responsibilities to the Chancellor and the Mānoa EMT to improve and expedite
       communications and operational support. In some instances, Action Plans and Standard
       Operating Procedures will indicate that contact points with outside agencies have been


                                                6
pre-delegated to the Mānoa EMT. The Chancellor or an authorized representative is
responsible for determining the following emergency actions:

   1. ALERT – Initiated via siren alert tone from the O‘ahu Civil Defense Agency and
   followed with alert information over the Emergency Alert System (EAS). The EAS
   includes local TV and Radio stations and the alert is used to advise personnel to
   prepare for an impending emergency or natural disaster. May also include Shelter-In-
   Place requirement to remain on Campus in an effort to eliminate traffic gridlock and
   keep people out of the danger zone.

   2. TAKE COVER – Normally initiated via a SIREN WARNING from the O‘ahu
   Civil Defense Agency. The President or Chancellor or their representatives may
   order it for natural disasters such as sudden windstorms and earthquakes.

   3. SUSPEND CLASSES – Issued by Chancellor or authorized representative and
   used to keep students, faculty and staff away from Campus, UHM facilities or nearby
   community. A directive to Suspend Classes may also be used to expedite removal of
   personnel during an alert, emergency or disaster.

   4. EVACUATE BUILDING(S) - Issued by Chancellor or an authorized
   representative and used if a catastrophe or emergency situation is imminent or has
   occurred and the building(s) must be evacuated to protect lives.

   5. EVACUATE CAMPUS – Issued by Chancellor or authorized representative and
   used to begin orderly evacuation of a Campus by all persons except for personnel
   with emergency operations and security duties.

   6. CONVERT CAMPUS – Only initiated upon order of the President or Governor to
   provide temporary shelter for people affected by emergencies/disasters and/or
   relocation of State government offices.

C. EMERGENCY RESPONSE CENTER (ERC) – Plans are currently underway to
construct a new Information Technology Services (ITS) Building that will house a
permanent ERC. In the interim, the temporary ERC will be in Conference Room 309,
Hawai‘i Hall. The ERC will serve as the central command center with dedicated
telecommunications capability and operational resources. Plans are in place to provide
the ERC with emergency generator power in the event of power outage. An alternate
Mānoa ERC will be located in Keller 204, which is the designated ITS Coordination
Center.

   1. The responsibility for planning, setting up and maintaining the ERC is assigned to
   UHM Emergency Management Coordinator. The position is presently in the Office
   of Auxiliary Enterprises, but will be transferred to the Office of Safety and Security
   when that office is staffed.




                                        7
         2. When activated, response activities and work assignments will be planned,
         coordinated and delegated from the ERC. The Mānoa EMT will report to the ERC as
         required in this Plan and associated Action Plans and Standard Operating Procedures.

         3. The ERC and other locations will also be used for emergency preparedness
         training, meetings and exercises.

         4. The President and the System EMT may request and use the Mānoa ERC when
         circumstances require it.


IV.   EMERGENCY MANAGEMENT TEAM (EMT)

      A. MANOA EMT RESPONSIBILITIES – The EMT is drawn from UHM’s senior
      administrative and academic leadership. They direct, coordinate and provide the
      necessary support for emergency preparedness and response activities. As much as
      possible, emergency response and recovery responsibilities are assigned to Campus
      personnel relative to their normal work responsibilities.

         1. EMT EXECUTIVE – The Chancellor is the Mānoa EMT Executive and has the
         authority and responsibility for emergency preparedness and response for the UHM
         Campus and assigned Facilities. The EMT Executive authorizes activation of the
         Mānoa ERC upon recommendation of the Chief of Operations and Finance and the
         Emergency Management Coordinator.

         2. CHIEF OF PLANS – The Vice Chancellor for Academic Affairs is the designated
         Chief of Plans. He/she is responsible for assuring that there are functional and
         operational Action Plans and Standard Operating Procedures for all units of the EMT.
         Other responsibilities include intelligence gathering, preparation, coordination and
         dissemination of data requested or provided by other supporting units and other State,
         Federal and County agencies, documentation of the emergency event, record keeping
         of all operations during the activation of the ERC, and for demobilization of the ERC.
         He/she will also be the first Alternate to take the place of the EMT Executive, if the
         EMT Executive cannot be present during the activation of the ERC.

         3. CHIEF OF OPERATIONS AND FINANCE - The Vice Chancellor for
         Administration, Finance and Operations is the designated Chief of Operations and
         Finance. The Chief of Operations and Finance is responsible for the plans and daily
         operations of the ERC and manages the operational and financial support units.
         Operational responsibilities include security, safety, health, and facilities response
         and support and animal care. Financial responsibilities include procurement, risk
         management, accounting and claims support. He/she will be the second alternate if
         both the EMT Executive and the first alternate cannot be present during the activation
         of the ERP and ERC.




                                             8
4. CHIEF OF LOGISTICS – The Vice Chancellor for Research and Graduate
Research is the designated Chief of Logistics. He/she is responsible for planning all
supply, legal, human resources, telecommunications and transportation support prior
to emergencies and disasters and for the provision of logistics support during
recovery operations.

5. CHIEF OF CAMPUS PERSONNEL – The Vice Chancellor for Students is the
designated Chief of Campus Personnel. He/she is responsible for the safety and
welfare of students, faculty and staff during emergencies and disasters. Other
responsibilities include dissemination of information to the Campus community,
assuring that emergency preparedness and response plans, training and exercises
include participation of the Campus community, and for the establishment and
execution of evacuation plans.

6. PUBLIC INFORMATION OFFICER - The Mānoa Director of Communications
is the designated Public Information Officer. He/she is responsible for all official
media announcements and press releases related to emergencies on Campus,
coordinating media releases with the System Joint Public Information Officer,
updating the Mānoa Campus website with emergency information during
emergencies and keeping a historical record of the emergency event.

7. CAMPUS SERVICES OFFICER – The Assistant Vice Chancellor of Campus
Services is the designated Campus Services Officer. The position is presently under
recruitment, but will be responsible for assuring that all services from the Offices of
Facilities and Grounds and Auxiliary Enterprises are provided on an emergency basis
and all designated personnel perform their emergency duties. He/she also coordinates
all services for the EMT and will be the first alternate for the Chief of Operations and
Finance. In the interim, the Director of Facilities and Grounds will serve in this
position.

8. CAMPUS SAFETY AND SECURITY OFFICER – The Director of Safety and
Security is designated the Campus Safety and Security Officer. The position is
presently vacant, but will be responsible for assuring that all safety, environmental
and security responsibilities are provided during any emergency and will coordinate
these services during the emergency and recovery periods. In the interim, a
representative from the Office of the Director, Auxiliary Enterprises will serve in this
position.

9. HEALTH SERVICES OFFICER – The Director, University Health Services
Mānoa is the designated Health Services Officer. He/she is responsible for the
operations of the University Health Center during an emergency, for the provision of
emergency health service at different locations on Campus, and for the continuation
of health services during the recovery period. He/she is also responsible for planning
for and stocking medicines and other health provisions for emergencies.




                                     9
   10. EMERGENCY MANAGEMENT COORDINATOR – The Mānoa Emergency
   Management Coordinator is a fulltime position in the Office of Safety and Security
   that provides preparedness, recovery and training support to the Mānoa and System
   EMTs. The position is responsible for updating the Mānoa ERP and coordinating
   training and exercises. The position is also responsible for planning, establishing,
   equipping, and maintaining the Mānoa ERC. The Emergency Management
   Coordinator also acts as the Civil Defense Coordinator in coordinating and
   communicating with State Civil Defense.

B. CAMPUS EMERGENCY RESPONSE TEAM (CERT)

   1. Several CERTs will be established to perform immediate response and reporting
   of any emergency on Campus. The CERT may also be used to provide emergency
   response to off Campus UHM facilities as specified in the Operations Action Plan.
   They will provide initial assessments of the emergency and remain at or near the
   emergency location to provide continuous reports of the event. They will make
   recommendations and request additional support from the EMT as they deem
   appropriate to assure safety, save lives and protect property. Their duties also include
   video and digital photographic documentation of the event.

   2. CERT members will be a combination of staff personnel and volunteers
   recommended by the Emergency Management Coordinator and selected by the Chief
   of Operations and Finance. CERT members will be selected for their expertise and
   experience in various security, safety, health and facilities professions. They will be
   responding to specific emergency events such as hazardous material spills, fires,
   earthquakes, hurricanes, floods, terrorist activities, mass casualties and civil
   disturbances.

   3. The first CERT to respond to an emergency will be led by the Campus Security
   Sergeant on duty at the time of the emergency event. Other unit members may
   include personnel from Facilities and Grounds, Environmental Health and Safety and
   University Health Services Mānoa. The leadership and make-up of other CERTs may
   vary, but all members will receive initial training in their specific duties and will be
   required to obtain continuous training on an annual basis.

C. ALERT ROSTER – The UHM Alert Roster of key personnel is provided in Tab A of
this Plan. The office telephone numbers and email addresses will be listed on public
documents while the home and cellular telephone numbers will only be listed on “For
Official Use Only” publications. The Chief of Operations and Finance shall obtain the
necessary telephone numbers and control the distribution and use of “For Official Use
Only” Alert Rosters. The Mānoa Emergency Management Coordinator shall be
responsible for updating the Alert Roster on a monthly basis or as changes occur.

D. MĀNOA EMT ORGANINZATION AND LEADERSHIP

   Mānoa EMT Organization Chart on next page.



                                        10
                                              Mānoa EMT Organization Chart
                                                         EMT EXECUTIVE

                                                        CHANCELLOR


                                           PUBLIC
                                        INFORMATION
                                         Dir. of Comm.


OPERATIONS &                                          PLANS                            LOGISTICS                        CAMPUS
  FINANCE                                        V.C. for Academic                  V.C. for Research &              PERSONNEL
V.C. for Admin..                                       Affairs                      Graduate Research               V. C. for Students


             Safety and Security                              Plan Implementation                 Facilities & Grounds              Student Housing




                                 Safety & Health                     Intelligence                   Auxiliary Services               Faculty Housing




                                     Security                    Documentation                      Transportation &                 Other Personnel
                                                                                                        Parking



                               Campus Emergency                  Demobilization                   Telecommunications
                                Response Teams



                     Finance




                                    Accounting




                                   Procurement




                                     Claims




               Health Services




             Facilities & Grounds




                   Animal Care




                                                                       11
V.    DE-ACTIVATION AND PLAN RE-ASSESSMENT
      A. ERP AND ERC DE-ACTIVATION – When emergency conditions are stabilized and
      normal Campus operation can resume, the ERP and ERC will be de-activated by the
      EMT Executive.

         1. A formal announcement will be disseminated using emergency notification and
         information systems.

         2. The Chief of Plans is responsible for planning and implementing the
         demobilization of system support units. If the nature of the emergency requires an
         extension of certain emergency services, special work groups will be assigned by the
         Chief of Operations and Finance to coordinate and/or complete continuing recovery
         or support requirements. Continuing assignments may include:

             a. Ongoing repairs and relief efforts.

             b. Academic or administrative space adjustments.

             c. Support services for impacted students, faculty or staff.

             d. Cost recovery and claim support.

      B. PLAN RE-ASSESSMENT

         1. Immediately following the cessation of Type 2 Emergency or Type 3 Disaster
         operations and exercises, a survey of EMT members, support participants and
         Campus constituents will be conducted to evaluate the effectiveness of the emergency
         effort.

         2. The survey response will be collected and evaluated by the Mānoa Emergency
         Management Coordinator and will be forwarded with recommendations to the EMT
         Executive via the Chief of Operations and Finance.

         3. The Mānoa EMT Executive will call a meeting of EMT senior staff and key
         subordinates to discuss the survey results and recommendations. Written directions
         will then be made to individual members of this group to coordinate operational
         improvements and/or ERP and Action Plan revisions.


VI.   EMT STANDARD OPERATING PROCEDURES
      (EMT Standard Operating Procedures to be completed and filed with this Plan)

      A. EMT Operations and Finance

      B. EMT Plans


                                              12
    C. EMT Logistics

    D. EMT Campus Personnel


VII. TABS
    A. UHM ALERT ROSTER

    B. CAMPUS AND FACILITIES LOCATION MAPS

       1. UHM Mānoa Campus.

       2. O‘ahu Map with UHM Facilities Locations.

    C. ACTION PLANS FOR SPECIFIC EMERGENCIES/DISASTERS

       1. Hurricanes and Severe Storms

       2. Waterspouts

       3. Tsunami and Coastal Flooding

       4. Earthquakes

       5. Volcanic Activity

       6. Landslides and Mudslides

       7. Fire

       8. Hazardous Materials

       9. Bomb Threats and Explosions

      10. War and Terrorist Attack

      11. Biological Outbreak

      12. Utility Outages

      13. Civil Disturbance and Labor Strikes

      14. Aircraft and Fallen Object Accidents




                                         13
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TAB A                                                                   Rev. 8 – 7/1/09
                               Mānoa Emergency Team
                               (listserv: uhm-emt@hawaii.edu)

                         CONTACT                   OFFICE        HOME             CELL
OFFICE                   PERSON/EMAIL              PHONE         PHONE*           PHONE*

Chancellor               Virginia Hinshaw          956-7651
                         vhinshaw@hawaii.edu

V.C. for Administration Kathy Cutshaw              956-9190
Finance and Operations cutshaw@hawaii.edu

V.C. for Academic        Reed Dasenbrock           956-8447
Affairs                  rdasenbr@hwaii.edu

V.C. for Research and    Gary Ostrander            956-7837
Graduate Education       gko@hawaii.edu

V.C. for Students        Francisco Hernandez       956-3290
                         fjh@hawaii.edu

Executive Assistant to   Debra Ishii               956-2967
The Chancellor           debrai@hawaii.edu

Director, Community      Gregg Takayama            956-9836
& Govt. Affairs          greggt@hawaii.edu

Director,                Diane Chang               956-0391
Communications           dianec@hawaii.edu

V.P., Information        David Lassner             956-3501
Technology Services      david@hawaii.edu
& CIO

Assist. V.C. for Campus David Hafner               956-4636
Services                hafner@hawaii.edu

Director, Facilities     Thomas Katsuyoshi         956-4801
and Grounds              tkatsuyo@hawaii.edu

Director of Safety       Functions covered by Director of Auxiliary Enterprises
and Security (Vacant)

Director, Auxiliary      Wayne Fujishige           956-4307
Enterprises              wfujishi@hawaii.edu

Asst. Emergency          Jimmy Lagunero            956-0773
Mgmt. Coordinator        lagunero@hawaii.edu
                                               1
                         Mānoa Emergency Team (cont’d)

                       CONTACT                   OFFICE     HOME        CELL
OFFICE                 PERSON/EMAIL              PHONE      PHONE*      PHONE*

Campus Security        Donald Dawson             956-9858
                       ddawson@hawaii.edu

Director, Human        Peggy Hong                956-3028
Resources              peggyh@hawaii.edu

Director, Environ.     Roy Takekawa              956-3200
Health and Safety      takekawa@hawaii.edu

Director, Student      Mike Kaptik               956-4011
Housing                kaptik@hawaii.edu

Director, University   Dr. Andrew Nichols        956-8965
Health Services        nicholsa@hawaii.edu

Director, Counseling and Allyson Tanouye         956-7927
Student Development Ctr. atanouye@hawaii.edu

JABSOM                 Jerris Hedges             692-0881
                       jerris@hawaii.edu

                       William Haning            692-0877
                       haning@hawaii.edu         586-7436

Nursing                Kristine Qureshi          956-2638
(Plan Rep)             kqureshi@hawaii.edu


*Home and Cellular Phone Numbers will be listed on Mānoa Emergency Team and System
Team member copies marked “For Official Use Only” and will not be listed in published
emergency plan.




                                             2
                      System Team (for notification purposes)
       (listserv: uhm-emtall@hawaii.edu includes Mānoa and System teams)

                        CONTACT                   OFFICE     HOME       CELL
OFFICE                  PERSON/EMAIL              PHONE      PHONE*     PHONE*

President               M R C Greenwood      956-8207
                        mrcgreenwood@hawaii.edu

V.P. Academic Plans     Linda Johnsrud            956-7075
& Policy                johnsrud@hawaii.edu

V.P. Budget & Finance   Howard Todo               956-8903
                        htodo@hawaii.edu

V.P. Legal Affairs      Darolyn Lendio            956-9901
                        lendio@hawaii.edu

V.P. Information        David Lassner             956-3501
Technology Services     david@hawaii.edu
& CIO

V.P. Administration     vacant

V.P. Student Affairs    Karen Lee                 956-8753
(Interim)               karenlee@hawaii.edu

Assoc. V.P. External    Carolyn Tanaka Wilson 956-9803
Affairs                 carolynt@hawaii.edu

Assoc. V.P. Capital     Brian Minaai              956-9373
Improvement             bminaai@hawaii.edu

System Director         Brenna Hashimoto          956-3950
Human Resources         hbrenna@hawaii.edu


*Home and Cellular Phone Numbers will be listed on Mānoa Emergency Team and System
Team member copies marked “For Official Use Only” and will not be listed in published
emergency plan.




                                              3
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TAB C ACTION PLANS FOR SPECIFIC
      EMERGENCIES/DISASTERS


               C-1 HURRICANES AND SEVERE STORMS

I.     The National Weather Service can usually forecast high winds, heavy rain, flooding,
       damaging surf and hurricanes with a high degree or accuracy.

II.    Warning

       A. A Hurricane Watch means that hurricane conditions are possible within 36 hours.
       During a watch, listen to radio and television (TV) broadcasts and check the University
       of Hawai‘i Website.

       B. A Hurricane Warning is issued when sustained winds of 74 mph or higher associated
       with a hurricane is expected within 24 hours. County Civil Defense sirens will sound.
       Continue to listen to radio and TV broadcasts and check the University of Hawai‘i
       Website.

       C. Hurricanes also produce coastal flooding. Therefore, all should plan for and be
       prepared to respond to coastal flooding as described in the Action Plan for Tsunami and
       Coastal Flooding.

III.   Required Actions

       A. If time and conditions permit, the University will convene its EMT and issue
       instructions via local radio, TV, email and telephone tree on whether classes and/or work
       schedules will be suspended. Designated and essential employees may be asked to report
       to their work site to implement emergency preparation and emergency/security duties.

       B. If severe winds or a flood watch occurs while class is in session, employees or visitors
       are on site, the following Emergency Actions should be followed:

              1. Seek shelter in designated buildings on Campus. A list of designated buildings
              with the specific rooms and areas that can be used will be made available after
              shelter surveys and requirements are completed in 2006.

              2. If a designated shelter is not available or shelter locations are unknown,
              students, staff and visitors should go to a designated County Civil Defense shelter.
              In the case of hurricanes or high winds where no known shelters are available,
              seek shelter in a large building and stay away from windows and exterior doors.


                                                1
In the case of possible flooding, leave basements or low lying buildings and go to
designated shelters or to the upper floors for shelter. Do not seek shelter in
basements of buildings unless it has been designated as a shelter.

3. Persons responsible for buildings, classrooms or laboratories shall ensure that
all handicapped persons have been assisted to reach a shelter or cover.

4. Avoid gymnasiums and other structures with large roof spans. If in a best
available building instead of a designated shelter, evacuate rooms subject to full
force wind and remain near an inside wall away from windows. Close all
windows and blinds.

5. If available, check out mobile emergency pumping equipment. If time
permits, check and clean out all building walkways and catch basins to keep
debris to a minimum and permit free flow of water.

6. Prior to an event, secure any latches and skylights. Remove or secure all
outside staging/scaffolding/planking and other material that can blow away.
Facilities shop personnel have trucks and equipment available to assist and can be
reached at 956-7134. During or after the event, notify Facilities of any break,
damage or suspected problem in any utility system.

7. After winds have abated and an all clear notification has been given, secure
damaged buildings to prevent further weather damage. If possible remove fallen
trees, branches and debris from roads. This will allow safe access for emergency,
fire and maintenance personnel. Call Facilities maintenance at 956-7134 or
Campus Security at 956-6911 for assistance if necessary.

8. Keep tuned to a local Emergency Alert System (EAS) radio station for the
latest advisories.




                                 2
                                C-2 WATERSPOUTS

I.     A waterspout is a tornado like whirlwind occurring over water that can move inland near
       the body of water where it occurs. The whirling wind and water in a waterspout can
       reach high speeds and cause severe damage. University facilities and vessels at or near
       the ocean are subject to damage from waterspouts.

II.    Warning.

       A. Since waterspouts cannot be predicted, warnings can only occur after a waterspout is
       sighted.

       B. Once sighted, Coast Guard, State and County Civil Defense Agencies should be
       notified. These agencies will take the necessary actions to provide warnings and keep the
       public informed via radio and TV.

III.   Required Actions

       A. Affected University facilities and vessels should take the necessary actions to plan for
       and prepare emergency procedures for waterspouts.

       B. Report waterspout sightings and/or damage to the Coast Guard, State and County
       Civil Defense Agencies.

       C. If a waterspout is reported in your area, take the necessary actions to close windows,
       doors, portholes and hatches. Remove or secure loose equipment and material at exterior
       and outside areas.

       D. Remain inside vessels at sea or take shelter in the best available building on shore.
       Evacuation may be necessary depending on the severity of the waterspout and the
       availability of shelters on site. Take the same precautions within buildings as with
       hurricanes and high winds.




                                                3
               C-3 TSUNAMI AND COASTAL FLOODING

I.     The island of O‘ahu is highly susceptible to tsunami and coastal flooding as these events
       have occurred many times in the past. Coastal areas where University facilities and
       vessels are located may be affected. Coastal flooding is also associated with hurricanes,
       high surf and severe storms.

II.    Warning

       A. A local earthquake of high magnitude in the Hawaiian area may generate a tsunami
       where no warning is provided.

       B. The Pacific Tsunami Warning Center on O‘ahu provides the initial warning to the
       public via State and County Civil Defense Agencies and their EAS radio and television
       stations.

       C. When a Tsunami Warning is issued, the County Civil Defense Agency will sound
       emergency sirens. The EAS will carry official tsunami advisories and provide shoreline
       evacuation instructions.

       D. Coastal flood and storm surge warnings associated with hurricanes may be issued by
       the National Weather Service.

III.   Required Actions

       A. Tsunami - The estimated time of arrival will dictate the course of action to be taken.
       The University will convene its EMT and issue instructions to its facilities. The person in
       charge at the affected facility shall initiate the following emergency actions:

              1. For facilities on the shoreline or low-lying coastal areas – If the ground shakes
              or the ocean suddenly withdraws or surges inland unusually, move to high ground
              immediately. Do not delay egress to listen to radio, TV or EMT instructions

              2. Order alert warning and/or evacuation of John A. Burns School of Medicine,
              Waikīkī Aquarium, University Marine Center (Pier 45, Snug Harbor), Hawai‘i
              Institute of Marine Biology (Coconut Island), Kewalo Basin, and Hawai‘i
              Undersea Research Laboratory (Makai Pier).

              3. Implement local emergency plans. Assure that safety of all personnel and
              animals are considered.

              4. Remove or secure loose equipment and material.




                                                4
B. Coastal Flooding – The magnitude and location of possible tsunami, storm surges or
hurricanes that result in coastal flooding will dictate the course of action to be taken. The
person in charge at the affected facility shall initiate emergency actions.

       1. Implement local emergency plans. Assure that safety of all personnel and
       animals are considered.

       2. Remove or secure loose equipment and material.

       3. Travel to and from all University facilities must be carefully considered if
       roads are flooded. It may be safer to stay at home or at the facility if flooding has
       already occurred or flash flood warnings have been issued.




                                          5
                                C-4 EARTHQUAKES

I.     Earthquakes are unpredictable and strike without warning. Damage to buildings,
       structures and infrastructure can range from negligible to severe depending on the
       magnitude of the earthquake. Possible severe outcomes of an earthquake are a tsunami,
       wave damage, coastal flooding and fires.

II.    Warning

       A. Since earthquakes are unpredictable, warnings are not usually given.

       B. Earthquake advisories may be provided by State and County Civil Defense Agencies
       due to increased seismic activity.

III.   Required Actions

       A. Inside buildings.

              1. The instructor or person in authority directs students to stand against the wall
              away from windows or get under desks or tables. Special attention shall be given
              for the safety of handicapped persons.

              2. Avoid glass and falling objects by moving away from windows or large panes
              of glass and from under suspended light fixtures or objects.

              3. Implement local emergency plan to EVACUATE BUILDING when instructed
              to or when the earthquake is over.

                     a. EVACUATE to a pre-designated open area to assemble and conduct
                     accountability check.

                     b. DO NOT BLINDLY RUN OUTSIDE as parts of the building may still
                     be falling. Move to a clear area away from the building and large trees.

                     c. DO NOT RETURN to any building for any reason until the building is
                     declared safe. Subsequent shocks may follow initial tremor.

                     d. Building monitors or guards will be posted a safe distance from
                     building entrances to keep people from re-entering building.

              4. Put out all flames or fires. Do not light any fires after quake has hit.




                                                6
       5. Avoid touching fallen electrical wires and stay away from damaged utilities
       and unidentified spilled liquids.

       6. Move injured persons to a safe area and render First Aid if necessary.

       7. Request assistance, as needed, from the UHM Emergency Response Center via
       Campus Security by calling 956-6911.

       8. Notify Facilities at 956-7134 or Campus Security of any break or suspected
       break in any utility.

B. On Campus outside of buildings and structures.

       1. DO NOT PANIC OR RUN. The safest place during an earthquake is in the
       open. Stay in the open away from buildings and large trees until the earthquake is
       over.

       2. Follow procedures A.5 through A.9 under “Inside buildings” above.

C. In car or bus.

       1. DO NOT PANIC. If possible, pull to the side of the road, away from any
       building and crouch or lie down in the vehicle.

       2. On a mountain road, such as the Pali Highway, the side of the road may not be
       safe due to overhanging structures, large trees or boulders. The driver should
       determine if the terrain is safe before deciding to stop.

       3. Stay away from fallen and/or exposed wires and damaged utilities and
       structures.

       4. If parked and in a safe location, set brakes and turn off ignition.

       5. Wait until earthquake is over to resume driving or exiting from vehicle.

D. Walking to or from Campus.

       1. DO NOT PANIC OR RUN. The safest place during an earthquake is in the
       open. Look for and stay in the open until the earthquake is over.

       2. Stay away from damaged utilities, structures and fallen wires.

       3. After the earthquake, if you are on the way to school and closer to school,
       continue to school. If home is closer, go home.

       4. After the earthquake, if you are on the way home, continue home



                                         7
                           C-5 VOLCANIC ACTIVITY

I.     Volcanic activity occurs in areas of seismic activity. It can involve the release of noxious
       gas and eruptions of molten rock that may occur as lava flows or be airborne. Volcanic
       activity on O‘ahu is very rare.

II.    Warning

       A. Seismic activity can be measured and any suspicious increase will result in action by
       the responsible State Departments and the State and County Civil Defense Agencies.
       Information, advisories, alerts and warnings will be issued by the State and County via
       the EAS.

       B. Should any volcanic activity start, State or the County Civil Defense Agencies may
       issue evacuation orders depending on the severity and location of the volcanic activity or
       eruption.

III.   Required Actions

       A. The UHM EMT will contact SCD and take appropriate action depending on the
       severity of the problem.

              1. The EMT may activate the ERC and will issue information and pass on
              advisories, alerts and warnings to the University community.

              2. The EMT will pass on all evacuation orders issued by SCD or the County and
              assure that evacuation plans are executed and completed.

              3. The EMT will assure that lines of communication are opened with the State
              and County and reports of any problems encountered are promptly reported.

       B. If classes are in session and alerts or warnings are issued, the following emergency
       actions should be followed:

              1. Keep tuned to a local EAS radio or TV station for the latest advisories.

              2. Check the UHM Campus Security website for the latest instructions for the
              University community.

              3. Seek shelter in designated buildings on Campus if instructed to do so. Persons
              responsible for buildings, classrooms or laboratories shall ensure that all
              handicapped persons have been assisted to reach a shelter.




                                                8
                    C-6 LANDSLIDES AND MUDSLIDES

I.     Landslides normally occur due to wet weather, earthquakes and other conditions that
       destabilize the soil or rock formations. Mudslides normally occur due to a combination
       of wet weather and volcanic activity. Landslides occur frequently on the island of O‘ahu
       due to the age and condition of its mountains and geologic structures.

II.    Warning

       A. Landslides and mudslides cannot be predicted and warnings can only occur after an
       event occurs.

       B. Should a landslide occur, the Police should be notified via 911. They will inform the
       local County Civil Defense Agency who will decide if the EAS will be used to issue
       alerts and warnings.

III.   Required Actions

       A. University facilities located in areas where landslides and mudslides can occur should
       take the necessary actions to plan for and prepare emergency procedures.

       B. University facilities should report any areas where landslides and mudslides can occur
       to the UHM EMT via Campus Security. The EMT will take the necessary action to
       survey and research potential problems and make a report concerning possible problems
       and mitigation if necessary.

       C. University facilities should report any landslides or mudslides to Campus Security if
       they occur on their property or near their property if it affects access to their facility.

       D. If the EMT determines it is necessary, they will report landslides and mudslides to the
       State and County Civil Defense Agencies. The EMT will also determine if alert and
       warnings will be issued via the Campus Security website.




                                                9
                                          C-7 FIRE

I.     Fire can occur in buildings, rubbish bins, mechanical equipment and surrounding brush
       and forests. Early detection and reporting of fires are keys to limiting the fire, containing
       it and putting it out.

II.    Warning

       A. Most University facilities have installed automated fire alarm systems which will
       produce a fire alarm should smoke or fire occur. Some of these systems are wired to
       Campus Security.

       B. All University facilities have fire alarm stations located on every floor of every
       building and can be used to sound an alarm and alert occupants that a fire or smoke has
       occurred in that building.

III.   Required Actions

       A. For fires within buildings, the following steps should be taken:

              1. Activate the building fire alarm. This will immediately notify building
              occupants who should immediately evacuate the building.

              2. Call Campus Security at 956-6911 and provide information on the location and
              severity of the fire and if any casualties are known. Campus Security will
              immediately dispatch a Campus Security Officer (s) to the location to aid in
              evacuation, crowd control and reporting of casualties and utility damage.

              3. Fight fire only if not life endangering and if an appropriate fire extinguisher for
              the type of fire is available.

              4. Persons responsible for a building, classroom or laboratory shall maintain
              control of students and staff at a safe distance from the fire and shall insure that
              all handicapped persons are assisted to safety.

              5. Campus Security will notify the EMT who will determine whether classes will
              be suspended or any further actions are necessary. All required directions for
              students and staff will be posted on the Campus Security website.

              6. Students and staff shall not return to the building until Fire Department
              officials declare the building and area safe. Persons in charge of the building with
              the aid of Campus Security will ensure that no one enters the building until the
              building is declared safe.



                                                10
B. For fires near buildings, the following steps should be taken:

       1. Call 911 and Campus Security at 956-6911 to report the fire. Provide location
       and severity of fire. Campus Security will immediately dispatch a Campus
       Security Officer to aid in evacuation and reporting to the EMT.

       2. If the fire poses an immediate threat to the building or occupants, activate the
       fire alarm and evacuate the building to a safe location away from the fire.

       3. Persons in charge of the building, classroom or laboratory shall maintain
       control of students and staff at a safe distance from the fire and assure that all
       handicapped persons are assisted to safety.

       4. The EMT will issue directions to students and staff via the Campus Security
       website on the status of the buildings affected and continuance of classes.

       5. Students and staff should not return to the building until Fire Department
       officials declare the area safe.

C. Mechanical equipment, brush and forest fires.

       1. Call 911 and Campus Security at 956-6911. Campus Security will determine
       if University facilities or operations are affected and whether a Campus Security
       Officer should be dispatched to the fire location. All determinations to cancel
       classes or evacuate are made by the EMT.

       2. If a determination is made by an outside agency such as SCD to evacuate, then
       the persons in charge of the facilities affected will be notifed via phone tree and
       email. The EMT will post information concerning the fire on the Campus
       Security website.




                                         11
                        C-8 HAZARDOUS MATERIALS

I.     Hazardous materials include chemicals, gases, flammable liquids, radioactive substances
       and biological substances. Hazardous materials are used for normal operations, research
       or instruction. Should a spill, accident, inadvertent release or dumping of any hazardous
       materials occur at any University facility, immediate action is required.

II.    Warning

       A. Environmental, safety and health warnings are required on all container labels.
       Hazardous materials have been identified and listed by the Environmental Protection
       Agency, the Department of Transportation, OSHA and the State Health Department.
       Regulations by these agencies also requires area and compartment signs providing
       identification and warnings concerning the location, transportation, use and disposal of
       hazardous materials.

       B. No warnings are given when accidents or spills occur and users must have written
       emergency plans to handle these problems

III.   Required Actions

       A. Users of hazardous materials must follow all Federal, State and County regulations.
       Users must also read and understand the producer/manufacturers instructions and have
       written instructions or procedures on the use and disposal of hazardous materials.

       B. Written emergency plans for spills and accidents are required for all users of
       hazardous materials. These plans shall include actions required to insure safety of
       personnel and immediate notification of building/area occupants, the Office of
       Environmental Health and Safety ( 956-8660/8591), Campus Security (956-6911), the
       EMT and other State and Federal Agencies as required.

       C. The senior person in charge will evaluate the need and if necessary, start actions to
       evacuate building and the surrounding area.

       D. Persons in charge of classrooms and laboratories shall direct students and other
       building occupants to a safe location to avoid exposure. They will maintain control of
       evacuated personnel and keep unauthorized personnel from entering the building or area.

       E. The Office of Environmental Health and Safety is responsible for determining
       whether building or area is safe to re-enter and will notify the senior person in charge,
       Campus Security and the EMT.

       D. Render first aid as necessary.

       E. The EMT will determine if classes will be cancelled or the Campus evacuated.


                                                12
                 C-9 BOMB THREATS AND EXPLOSIONS

I.     Bomb threats can occur on government facilities. Universities and other schools have
       gotten bomb threats in the past and will have to handle bomb threats in the future. A
       bomb threat can turn into an explosion and precautionary plans are necessary to prevent
       or minimize damage.

       Excessive heat, leaking gas, faulty equipment, ignitable material and chemical reactions
       can cause explosions. Explosions on University facilities can occur as a result of
       operations or research. The extent of damage, destruction, fire, casualties and operational
       disruptions depends on the type and magnitude of the explosion

II.    Warning

       A. Emergency plans are necessary to handle bomb threats and potential explosions.
       Plans should include procedures that may include warning signs where potential
       explosions may occur as a result of normal operations or research.

       B. In most cases, there are no warnings of impending explosion as the cause cannot be
       controlled and will normally occur without notice.

III.   Required Action

       A. Bomb threat.

              1. If a bomb threat is received by telephone, use the Checklist provided by
              Campus Security and immediately notify them at 956-6911.

              2. Inform supervisor or department head.

              3. Campus Security will immediately dispatch Officers to the location and assist
              in building evacuation if necessary.

              4. If a suspicious package, container or object is found, report it immediately to
              Campus Security. Do not touch, move or open it and keep others from doing
              same. Campus Security will determine if assistance from the Honolulu Police
              Department Bomb Squad is necessary.

              5. If instructed to move away from the building/location, move a safe distance
              away or into another building. Do not return or re-enter building until instructed
              that it is safe to do so.

       B. Explosion.



                                               13
1. If an explosion occurs or has possibility of occurring, the person in charge or
person in authority will activate the fire alarm and immediately order the
evacuation of the building. Evacuate to a pre-designated open area to assemble
and conduct accountability check.

2. The person in charge will notify Campus Security immediately by calling 956-
6911 and provide information on the location and problem encountered. Campus
Security will dispatch a Security Officer to the scene to assist in evacuation,
crowd control and provide status reports back to Campus Security. Campus
Security will immediately notify the EMT and request medical assistance if
necessary.

3. Do not attempt rescue as additional explosions may occur. Render first aid if
necessary.




                                 14
                  C-10 WAR AND TERRORIST ATTACK

I.     War is a state of open, armed conflict between nations, states and parties. The
       constitution requires Congress to officially declare war for our country to be at war.
       Hawai‘i is located in a strategic and vulnerable location in the Pacific Ocean and could be
       seriously affected if war was declared.

       Terrorism is the use of violence, terror and intimidation by a nation, state or party. It is
       an activity that can occur anywhere in the United States as terrorist attacks in Oklahoma
       and New York have shown. It has become a costly and difficult task for government
       agencies to protect themselves from the threat of terrorism. The University of Hawai‘i is
       responsible for improving its campus security program and emergency preparedness
       plans to address the possibility of terrorist attack at its facilities.

II.    Warning

       A. The declaration of war and its activities will be widely reported in the media.
       Advisories and warnings will be provided by Federal, State and County governments
       hrough the media and EAS.

       B. The Federal Government has set up a homeland warning system based on threat level.
       Hawaii State Civil Defense (SCD) has modified the Federal System and established a
       Hawai‘i Homeland Security Advisory System and has it printed in the each County
       telephone book. Both systems use similar color coded threat levels to aid in the warning
       process.

       C. Changes in threat levels are announced by the Federal Government via the media.
       Any State changes to or differences from the Federal threat level warnings will be
       announced via the media by the Governor.

III.   Required Actions

       A. All students and employees of the University should read and understand the Hawai‘i
       Homeland Security Advisory System printed in the telephone book. It also provides
       advice on household and neighborhood preparedness. Information on this system can
       also be found on the SCD website at hawaii.scd.gov.

              1. Hawai‘i Homeland Security Advisory System.

                      a. Green – Low risk of terrorist attacks.

                      b. Blue – Guarded general risk of terrorist attacks.

                      c. Yellow – Elevated significant risk of terrorist attacks.


                                                15
              d. Orange – High risk of terrorist attacks.

              e. Red – Severe risk of terrorist attacks.

              f. Black – A terrorism incident has occurred in Hawai‘i.

       2. Listen for the O‘ahu Civil Defense Agency alarm system and turn on radio or
       television to the EAS and listen to the advisories and precautions given by
       County, Federal and State authorities.

B. The EMT will consult with SCD and the Governor to decide what advisory and
precautionary actions should be taken. The EMT Executive will issue directives via the
University website, Campus Security website and through the Director of
Communications to the media.

       1. Put Emergency Action Plans into effect.

              a. If required, suspend classes, operations and research.

              b. Personnel that are required to work and/or remain on campus are
              identified in UHM and Departmental Action Plans.

              c. Activate procedures to minimize injury and the possibility of being
              struck by flying glass and debris.

       2. Ensure that all handicapped persons are apprised of the nature of the activity or
       threat and are provided assistance if evacuation or sheltering is necessary.

       3. Activate Campus Shelters as required.

              a. Assure that all activated shelters have Shelter Managers on site.

              b. Assure that all Shelter Managers complete their required reports to the
              EMT.

       4. Provide UHM Status Reports to the SCD at 6 AM and throughout the day at
       every 6th hour.

C. Fallout Shelters

       1. Fallout shelters are identified in the UHM ERP and may be used if radiation
       fallout or a nuclear blast occurs.

       2. The Action Plan for fallout shelters will be activated when directed by the
       EMT Executive.




                                        16
                       C-11 BIOLOGICAL OUTBREAK

I.     Biological outbreak can be caused by natural occurrence or accidental release of biologic
       agents, introduced viruses and diseases brought into Hawai‘i via humans or animals and
       through bioterrorism which is the intentional release of biologic agents that can cause
       illness and death. The State has a plan for biological outbreak and the University is an
       integral part of the State’s Plan to combat any type of biological outbreak.

II.    Warning

       A. Federal and State agencies will issue advisories and warnings of biological outbreak
       in the United States and in Hawaii. Advisories and warnings are issued via the media.

       B. Should any local biological outbreaks occur that affects the UHM Community, the
       University Health Services Mānoa (UHSM) Office will issue an advisory or warning via
       their website, the EMT and the Director of Communications.

III.   Required Actions

       A. When the University Community is affected, Vice Chancellors will assure that all
       students and employees are informed of the advisories and warnings.

       B. All students and employees should take the necessary precautions and actions advised
       by UHSM, State Health Department and Federal Health agencies. This may include
       isolation or quarantine orders.

       C. If infected, go to your medical care giver or the UHSM Office for medical treatment.

       D. Report all cases and incidences of contact with the various types of biological
       outbreak to the appropriate State Health agency as instructed in advisories.




                                               17
                               C-12 UTILITY OUTAGES

I.     Electricity and water utilities are essential to the operation of all campus facilities and
       any disruption will require immediate remediation by the Office of Facilities and
       Grounds. Prolonged outages in part or all of the campus will negatively affect students
       and personnel and may result in an emergency situation where classes and operations
       may be suspended. Outages or interruptions of gas/LPS and telecommunications services
       are usually not serious and usually can be rectified in a short period of time. Outages of
       this type will not result in suspension of classes or operations.

II.    Warning

       A. There are no warnings for utility outages, except for planned outages, and outages
       usually occur as the result of other disasters such as hurricanes, earthquakes and fires.

III.   Required Actions

       A. Electrical outage.

              1. Report all electrical outages to the Office of Facilities and Grounds at 956-
              7134. The Campus telephone system will work as the telephone central office has
              back-up power, however be patient as there may not be any ring tone at the
              receiving phone. Also, use a cell phone to contact Facilities or the Campus
              Security Office at 956-6911. In the case of a complete power outage, the EMT
              and Departmental Response Teams should report to their designated locations.

              2. Disconnect all equipment that could be damaged by a power surge before
              electricity is restored. Turn off lights, appliances, window air conditioners and
              other devices to reduce the power requirements for restoration. Facilities will
              take action to turn off large electrical equipment at all the facilities on the Mānoa
              campus.

              3. Evacuate the building or facility if safety of personnel is a problem.

       B. Water Outage.

              1. Report all water outages or pipe breaks to the Office of Facilities and Grounds
              at 956-7134. Facilities will send their maintenance personnel to investigate the
              problem and will fix any problem within their capability. Facilities will report
              major line breaks to the City and coordinate repairs with them.

              2. Turn off all water faucets and taps. Conserve remaining water resources until
              restored.



                                                18
      3. Facilities, through their Office of Building Services, may restrict the use of
      restrooms in affected buildings. Personnel will be directed to the closest building
      where restrooms are operational.

      4. Should the water outage affect large sections of the campus or the entire
      campus, classes and operations, except for essential workers, may be suspended.

C. Gas/LPS Outage.

      1. Close all outlets and shut off all flame or heat producing equipment and
      devices as a leak may have occurred.

      2. If the smell of gas is strong, immediately notify all personnel in the area and
      vicinity to evacuate. Always evacuate any area where air exchange is poor if any
      kind of leak in your building is detected or announced.

D. Telecommunications Outage.

      1. Should both telephone and computers go down, contact the Office of
      Information and Technology Services via wireless connection or by cell phone at
      956-8111.

      2. If all forms of electronic communications are down, prepare to send messages
      via personnel who are able to walk or drive from office to office.




                                       19
        C-13 CIVIL DISTURBANCE AND LABOR STRIKES

I.     Civil disturbance and labor strikes in Hawai‘i are usually non-violent. The University is
       an open campus and has a reputation as an institution for freedom of thought by
       recognizing rights for peaceful civil disobedience and labor disagreements. This plan
       will be enforced should any violence occur and/or violence is anticipated.

II.    Warning

       A. University administrators may receive intelligence and warnings from State and
       County agencies that civil disobedience or strikes will occur and make appropriate plans
       to handle any violent situations that may occur. Planned civil disturbances such as
       meetings and rallies require permission from campus authorities. Marches on city streets
       require permission from the City and County of Honolulu.

       B. Civil disturbance and labor strikes may also occur without warning or notice. A “sit-
       in” is an example of a civil disturbance that can occur without warning.

III.   Required Actions

       A. Civil Disturbance.

              1. Campus Security and the EMT will be notified to stand-by or implement
              emergency procedures.

              2. Campus Security will provide surveillance and be responsible for providing
              reports to the EMT.

              2. The EMT Executive or Representative will decide whether no action is
              required, action must be taken to persuade the demonstrators to stop the
              disturbance voluntarily or police must be called for assistance.

              3. Campus Security will attempt to limit the civil disturbance to a specific
              location and seal other areas off from the demonstrators. They will also be
              responsible for crowd control.

              4. Students and employees should stay away and not confront any of the
              demonstrators.

       B. Labor Strike.

              1. Campus Security and the EMT will be notified to stand-by or implement
              emergency procedures.



                                               20
2. Campus Security will provide surveillance and assist in access control if picket
lines are set-up. Reports will be sent to the EMT providing status and any
violations by striking employees or their representatives.

3. The EMT Executive will make the decision to request police assistance should
access control problems, violence or physical confrontations occur.

4. Departments should have emergency plans for maintenance or essential
services if labor strikes occur.




                                21
       C-14 AIRCRAFT AND FALLEN OBJECT ACCIDENTS

I.     There is always a potential for aircraft, satellites, meteorites and other objects from the
       sky to crash or fall on the Mānoa Campus and its remote facilities. We need to plan for
       these types of disasters and occurrences as the University and its remote facilities may be
       located under aircraft flight paths.

II.    Warning

       A. There are no warnings for aircraft crashes and accidents.

       B. Warnings on possibilities of satellite and meteors entering the earth’s atmosphere will
       be provided by the national and local media. Serious warnings for the Hawaiian Island
       will be issued by SCD if warranted.

III.   Required Actions

       A. Aircraft crashes and accidents.

              1. Anyone seeing an aircraft crash or accident should call Campus Security at
              956-6911. Provide the exact location of the crash/accident and if any fire,
              explosions or casualties were observed.

              2. All students and personnel should keep a safe distance from any aircraft crash.

              3.Campus Security will contact CERT members and be immediately dispatched
              as the lead CERT to the scene of the accident on campus or at any of the remote
              facilities.

              4. The CERT will take all necessary actions as specified in CERT Plans.

                      a. Provide first aid and call 911 for medical, fire and police assistance as
                      required.

                      b. Ensure the safety of students and personnel. Evacuate buildings and/or
                      area to protect people from fire, fumes and possible explosions.

                      c. Request assistance from campus organizations such as Facilities and
                      Grounds, Auxiliary Services and UHMS.

                      d. As soon as time permits, report status to the EMT.

                      e. Responsible persons in buildings where an aircraft accident occurs will
                      request for or provide assistance to handicapped persons.


                                                22
               f. The EMT Executive will decide if classes and/or operations will be
               suspended.

B. Fallen satellites, meteorites and other objects.

       1. The EMT will receive advisories and warnings from national and local
       agencies concerning potential objects falling from the sky.

       2. The EMT Executive will decide if classes and/or operations will be suspended.

       3. If any objects falls on the campus or its facilities, Campus Security will be
       dispatched to the scene to determine if any emergency measures are necessary.

       4. Personnel on the scene should stay away from the object until it is inspected by
       Campus Security. Campus Security will provide status report to the EMT.

       5. The EMT will contact other government agencies for assistance as required.




                                         23
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             State of Hawai`i


 DISASTER RESPONSE
      MANUAL
            For Managers




               Prepared by the
Department of Human Resources Development
                 April 2004
PAGE INTENTIONALLY LEFT BLANK
                                                 Contents
INTRODUCTION ............................................................................................................. 1

         Purpose
         Definitions
         Disaster Preparation Checklist


PART 1 - EXISTING EMPLOYEES
     Identification of Disaster Response Workers .................................................. 5
     Pay Provisions.................................................................................................... 6
            Overtime
            Stand-by Pay
            Per Diem
            Temporary Hazard Pay
     Leave Issues ....................................................................................................... 8
            Administrative Leave
            Military Leave With Pay
            Military Leave Without Pay
            Disaster Leave
     Safety/Workers’ Compensation....................................................................... 12
     Other Benefits and Support Programs ........................................................... 13
            Employee Counseling
            Island $avings Plan (Deferred Compensation Plan)
            Assistance to Co-Workers


PART II - NEW HIRES FOR EMERGENCY WORK
      Recruitment Procedures .................................................................................16


PART III - INTERRUPTION OF USUAL HRD SERVICES
      Civil Service Applications and Examinations ............................................... 19
      Civil Service Interviews................................................................................... 19
      Training ............................................................................................................ 19

ATTACHMENTS ........................................................................................................... 20
     Application for Leave to Provide Disaster Relief Services
     REACH
     Island $avings Plan (Deferred Compensation Plan)
     Disaster Hire Form/Instructions
     Suggested Pay Rates for Persons Hired in Emergencies
..........
INTRODUCTION

PURPOSE

      When a disaster strikes, we know that program managers need to have certain
      personnel-related information at their fingertips. So this reference manual was
      developed to help you make quick, important personnel decisions to meet the
      needs of your employees and help provide ready answers to common questions.

      In cases of an emergency, the State Civil Defense will alert all Departmental Civil
      Defense Coordinators about the emergency situation and brief them about
      appropriate actions that need to be taken to prevent or remove an immediate
      threat to life and property; including instructions to provide for recovery
      assistance.

      This manual applies to the Executive Branch civil service system and is not
      intended to serve as your department’s disaster response plan, as required
      under the State of Hawai’i Plan for Emergency Preparedness issued by the State
      Civil Defense.



Important Disclaimer: This manual has been prepared for your convenience. It is
intended as a reference guide and contains general descriptions and summaries
of various policies, benefits, procedures, and rules. This manual is not a contract
or binding agreement. It does not supersede laws, rules, collective bargaining
agreements, policies and procedures, and benefit plan documents pertaining to
the various subject matters covered. Pay provisions and benefits vary by type of
employment appointment and collective bargaining agreement, and are subject to
change.

Please note that if the circumstances following any disaster require appropriate
action, pursuant to Chapter 128, Hawaii Revised Statutes (HRS), the Governor is
authorized to proclaim that a disaster has occurred and, if necessary, suspend
any law, which impedes or tends to impede or is detrimental to the expeditious
and efficient execution of, or to conflict with, disaster relief or other emergency
functions. This authority to suspend any law includes, but is not limited to, laws
relating to procurement and civil service.

You should also be aware that pursuant to Chapter 128, HRS, the Governor may
also order and direct government agencies, officers, and employees, state or
local, to take such action and employ such measures for law enforcement,
medical, health, fire fighting, traffic control, warnings and signals, engineering,
rescue, construction, emergency housing, and other welfare, hospitalization,


                                                                                       1
transportation, water supply, public information, training, and other civil defense
and emergency functions as may be necessary, and utilize the services,
materials, and facilities of the agencies and officers. All such agencies and
officers are required to cooperate with and extend their services, materials, and
facilities to the Governor as the Governor may request. Therefore, you should be
prepared, should you be called upon, to provide civil defense and emergency
functions outside of your normal employment duties. Of course, pursuant to
Chapter 128, HRS, you will retain your salary and all of your employment benefits
while engaged in civil defense function.

For further information, please contact your Departmental Personnel Office or
refer to the applicable laws, rules, collective bargaining agreements, policies and
procedures, or benefit plan documents.




DEFINITIONS

      DISASTER

      A disaster is any destructive event resulting in significant physical damage, loss
      or destruction, and social disruption caused by natural or human-caused
      hazards.

      …     Natural hazards include storms, high winds, flash floods, high surf,
            hurricanes, tornadoes, droughts, earthquakes, tsunamis, volcanic
            eruptions, landslides, mudslides, and fires.

      …     Human-caused hazards include, but are not limited to, explosions,
            massive transportation or industrial accidents, utility failures, hazardous
            materials incidents, terrorist incidents and health, or other disruptive
            domestic crises.

      DISASTER RESPONSE WORKERS

      Disaster response workers are generally pre-identified State Civil Service
      employees whose services are critical to continuing vital operations and for
      responding to various emergencies (e.g., road crews when roads might become
      impassable). Disaster response workers need to report to work in accordance
      with their disaster response plan such as: (1) Prior to or at the height of a
      disaster (e.g., impending hurricane or tsunami), even if others are told to stay at
      home; (2) Immediately following a disaster; and/or, (3) During the recovery
      period. Depending on the severity of the disaster, extent of damage or
      magnitude of response or recovery requirements, additional employees may be
      designated as Disaster Response Workers.


                                                                                       2
DISASTER PREPARATION CHECKLIST

BEFORE a disaster strikes, do a “Quick-Check”:

      Review your department’s responsibilities outlined in the State of Hawai`i
      Plan for Emergency Preparedness manual. Contact your departmental
      civil defense coordinator for information.

      Identify the disaster response workers within your office. (See page 5 for
      more information.)

      Meet with identified disaster response workers to discuss their disaster
      response duties. Solicit suggestions.

      Know your facility’s emergency evacuation plan and regularly review the
      plan with your employees. Inform your new employees of the emergency
      evacuation plan.

      When orienting new employees, inform them as to whether or not they are
      considered disaster response workers and explain your office’s disaster
      response plan.

      Review telephone trees at least twice a year. Update whenever you have
      new hires and when employees’ phone numbers change.

      Inform your employees to listen to instructions from the Emergency Alert
      System (EAS) and wait for word through your telephone tree as to
      whether or not to report to work.

      If you anticipate that a disaster would require additional personnel, you
      should plan how you will obtain those workers, in advance, and discuss
      the options with your Departmental Personnel Office. (Also see Part II,
      Recruitment Procedures.)



            Reminder:

            State departments and agencies shall assist the State Civil
            Defense, as requested, in the event of an emergency.

            Each department and agency shall prepare plans necessary to
            carry out its assigned responsibilities under the State of Hawai`i
            Plan for Emergency Preparedness and provide public protection
            to the maximum extent possible.

            All State employees are considered as an extension of the civil
            defense system. (See Page 5, Q1 & A1)


                                                                                 3
       Part I:
EXISTING EMPLOYEES




                     4
..........
IDENTIFICATION OF DISASTER RESPONSE WORKERS

   When a disaster occurs, it is vital that relief services are provided to the disaster
   victims, and that clean-up services are provided to ensure the public’s health and
   safety. It takes special people to meet these challenges.

   Disaster response workers must be designated by each department and should
   be promptly notified where, when, how and to whom they should report in the
   event of a disaster. Designate alternate workers too, in case your primary
   disaster response workers are sick, out-of-state, etc., when you need them.

   Q1: What if an employee refuses to be a disaster response worker?

   A1: Under the State of Hawai`i Plan for Emergency Preparedness, each
          department is charged with certain emergency duties and responsibilities.
          Each department must prepare plans necessary to carry out these
          assigned responsibilities. Chapter 128, HRS, provides that all State
          employees are considered as an extension of the civil defense system.
          Therefore, each department head has the authority to take appropriate
          action to ensure that these responsibilities are carried out. In such cases,
          confer with your Departmental Personnel Officer.


          Note: To avoid having to deal with a situation like this in the midst of
                an emergency, where you have no time to waste, try to
                determine beforehand if any employee is reluctant to be a
                disaster response worker.       Respond to the employee’s
                concerns. If the employee remains reluctant, decide whether
                you should designate another employee to be a disaster
                response worker, who would be willing and able to help and
                who can carry out the necessary civil defense responsibilities.




                                                                                      5
..........
PAY PROVISIONS

       For requirements on overtime, stand-by pay, temporary hazard pay, etc., refer to
       the applicable collective bargaining agreements for employees in Bargaining
       Units 01, 02, 03, 04, 09, 10, 11, and 13.

       For employees who are excluded from collective bargaining, refer to the
       Executive Orders.

       Be sure to keep detailed records of overtime, per diem, and any other disaster-
       related expenses incurred in case you can seek partial reimbursement from the
       Federal Emergency Management Agency (FEMA).


OVERTIME

       Q1: Are there special overtime provisions for disaster situations?

       A1: Overtime provisions shall be applied in the same manner as in any other
               normal situation.1

       Q2: What if I don’t have enough monies in my budget to cover payment
               of overtime that’s necessary due to an unexpected disaster?

       A2: Employees2 have the option of electing either cash or Compensatory Time
               Off (CTO) for overtime work performed,3 as provided by collective
               bargaining agreements or executive order. Therefore, explain the budget
               situation with your employees and ask if any of them would be willing to
               work overtime for CTO only. If you have any budget concerns, discuss
               the matter with your supervisor.




1
 However, as noted on page 1 of this manual, the Governor may suspend any State law pursuant to
Chapter 128, HRS, in certain disaster situations.
2
  For BU 13, this choice is limited to “regular” employees. “Regular” employees are those employees
who have passed their probationary period in a permanent appointment.
3
  However, as noted on page 1 of this manual, the Governor may suspend any law pursuant to Chapter
128, HRS, in certain disaster situations.


                                                                                                      6
STAND-BY PAY

    Stand-by pay is to be given when employees are required to remain at home or
    at any other designated place for a specific period, for the purpose of responding
    to calls for immediate service after the employees’ normal hours of work, on the
    employees’ scheduled day off, or on holidays. Employees shall be paid in
    accordance with applicable collective bargaining agreements or Executive
    Orders.

    Q1: Are there any special provisions for stand-by pay, which would be
           applicable during disaster situations, other than in the collective
           bargaining agreements and Executive Orders?

    A1: No.

PER DIEM

    Employees who are required to travel on official business to another island, or
    who are required to work on the same island in locations which make it
    impracticable and undesirable to return home after more than 24 hours shall be
    paid in accordance with applicable collective bargaining agreements or Executive
    Orders.


TEMPORARY HAZARD PAY

    Employees may be eligible for temporary hazard pay differential if they are
    temporarily exposed to unusually hazardous conditions, provided that the
    unusually hazardous working conditions have not already been considered in the
    pricing of the class. Temporary hazard pay requests require approval from the
    Department of Human Resources Development (HRD) and will be reviewed on a
    case-by-case basis. All temporary hazard pay requests should be processed
    through regular departmental channels to the Departmental Personnel Office,
    before submittal to HRD.




                                                                                    7
..........
LEAVE ISSUES

    General guidelines on leaves are provided below. Additional special guidelines
    on leaves and other personnel matters for a disaster-related incident will be
    issued by HRD after the disaster, which may need to be determined on a case-
    by-case basis.


ADMINISTRATIVE LEAVE

    Administrative leave can only be granted by the Governor.

    In the event the Governor authorizes administrative leave, State employees,
    including disaster response workers, will receive their straight pay. The decision
    on whether disaster response workers shall be granted equivalent administrative
    time off for hours actually worked on the day of the disaster can only be made by
    the Governor on a disaster-by-disaster basis.

    Employees who were on approved leaves such as sick leave or scheduled
    vacation leave on a day the Governor grants administrative leave shall be
    continued on leave status and shall not have their leave records adjusted nor be
    given equivalent time off at later dates.

    Administrative leave for hourly paid workers shall be determined on a disaster-
    by-disaster basis by the Governor.




                                                                                    8
MILITARY LEAVE WITH PAY

       An employee who is called to active duty to assist with disaster relief efforts is
       entitled to fifteen (15) working days of Military Leave4, with pay, provided he/she
       is:

       •       In a State civil service or exempt position and the appointment is for at
               least six (6) months, and

       •       Serving in the Hawai`i National Guard or other Reserve component under
               call of the President of the United States or the Governor of Hawai`i.

       The Military Leave with pay shall not exceed fifteen (15) working days in any
       calendar year, unless the employee is called to active duty a second time within
       a calendar year.

       If called to active duty a second time within the same calendar year, he/she is
       permitted to use advance Military Leave with pay from the next calendar year.

       •       To be eligible for advance leave, the employee must have exhausted the
               fifteen (15) working days for the current year.

       •       Any advance leave shall not exceed fifteen (15) working days. Any
               advanced leave days “borrowed” will be cancelled from the succeeding
               calendar year and must be agreed to by the employee, in writing. Should
               the employee leave State service before December 31 of the succeeding
               year, he/she will be required to reimburse the State for the entire amount
               of the advance leave taken.

       •       The request for Military Leave with pay should be submitted on an
               Application for Leave of Absence, Form G-1, and be accompanied by an
               official military order for active duty. If this is not possible, the employee
               must verbally inform his/her supervisor and Departmental Personnel
               Office of the Military Leave plans, and follow up by submitting the
               necessary documents and forms.

       For more information regarding Military Leave, please contact your Departmental
       Personnel Office.




4
  See §78-16.5, HRS (Act 109, SLH 2003); collective bargaining agreements; or Executive Orders, as
applicable.


                                                                                                     9
MILITARY LEAVE WITHOUT PAY

       If an employee who is called to active duty:

       •       Is not eligible for paid leave benefits (e.g., Military Leave, Vacation Leave),
               or

       •       Is eligible for paid leave benefits but chooses not to use such paid leave
               benefits,

       he/she may be placed on Military Leave without pay5. The duration of the
       Military Leave without pay shall be for no more than five (5) years. Upon
       conclusion of the Military Leave without pay, the employees shall have
       reemployment rights in accordance with Chapter 43 of Title 38 of the United
       States Code and any applicable collective bargaining agreements or Executive
       Orders.

       For more information regarding Military Leave without pay, please contact your
       Departmental Personnel Office.




5
  See §78-16.5, HRS (Act 109, SLH 2003); collective bargaining agreements; or Executive Orders, as
applicable.



                                                                                                     10
DISASTER LEAVE

         Up to thirty (30) days of Disaster Leave6, with pay, may be granted to a State
         employee to perform disaster relief services for the American Red Cross.

         To receive Disaster Leave:

         •       The employee must be a certified American Red Cross disaster volunteer,

         •       The employee must receive prior authorization, utilizing the Application for
                 Leave to Provide Disaster Relief Services Form (See Attachment 1), and

         •       The leave of absence must not impose hardship on State operations.

         In addition, the disaster must be:

         •       Designated as level III or higher by American Red Cross regulations,

         •       Officially declared by the President of the United States, or

         •       Declared a state of emergency by the Governor.




6
    See §78-23.5, HRS (Act 24, SLH 2003).


                                                                                          11
..........
SAFETY/WORKERS'
SAFETY/WORKERS' COMPENSATION

SAFETY

    Health and safety requirements under Hawai`i Occupational Safety and Health
    (HIOSH) standards are not suspended because of a disaster. Employers are still
    bound by law to ensure workers’ protection.

    Q1: What kinds of precautions can be taken to protect disaster response
          workers or staff deployed to disaster-affected areas?

    A1: If practicable, a planned disaster preparation training and exercise should
          be conducted by your department's civil defense coordinator so that
          disaster response workers are prepared mentally and physically to
          perform tasks safely.

          Employees required to engage in civil defense functions should also be
          properly attired for the work they will be engaging in. This includes
          wearing appropriate clothing such as pants, jackets, and footwear if
          needed to provide appropriate protection.


WORKERS’ COMPENSATION BENEFITS

    State employees who are on duty and are injured during or after a disaster will be
    covered in one of two ways, depending on their work status at the time of injury.
    In general, if an employee was receiving salary payment for the work being
    performed at the time of the injury, then the employee would be entitled to all
    benefits provided under the workers' compensation law (Chapter 386, HRS), in
    the event of injury.

    If the employee, while on a leave of absence (e.g., vacation leave), volunteers
    to assist in the State's preparedness or clean-up efforts, he/she would be entitled
    to medical benefits only, pursuant to the volunteer provision under the workers'
    compensation law (Chapter 386-171, HRS). These benefits are secondary to the
    individual's private medical insurance and are limited to reimbursement for
    related, out-of-pocket expenses. In the unlikely event that the volunteer does not
    have medical insurance, the employing agency may pay for related medical
    expenses only.




                                                                                    12
..........
OTHER BENEFITS AND SUPPORT PROGRAMS

    It can be traumatic for an employee after a disaster to "pick up the pieces" at
    his/her home and cope with special family and financial needs. Here are some
    benefits that can help your employees.

EMPLOYEE COUNSELING

    Employee counseling is a way to help employees cope with any post-traumatic
    feelings that can result from such a stressful situation as a disaster, and help
    return their lives to normalcy.

    RESOURCE FOR EMPLOYEE ASSISTANCE AND COUNSELING HELP (REACH)

    REACH is a program which provides diagnostic assessment, information,
    referral, and short-term counseling services for State employees. The services
    are free, up to three one-hour visits, for a total of three hours, subject to available
    funds. Attachment 2 provides phone number and location information for the
    organization contracted by the State to provide REACH services.

    CRITICAL INCIDENT STRESS DEBRIEFINGS (CISD's)

    CISD's are group debriefing sessions that are provided after stressful, traumatic
    incidents. They give employees a chance to sit together and talk about their
    experiences.

    In the event of a presidential-declared disaster or a larger scale state-declared
    disaster, the Department of Health (DOH) may be able to deploy State mental
    health disaster response personnel for CISD's when REACH services alone are
    not sufficient to take care of immediate needs. In such case, the DOH will
    coordinate additional crisis counseling services or CISD’s with appropriate
    county, State, Federal, and private agencies, to help employees, supervisors,
    and managers manage their emotional conflicts.


ISLAND $AVINGS PLAN (DEFERRED COMPENSATION PLAN)

    Employees who are participants in the Island $avings Plan and who suffer
    serious financial loss due to a disaster can apply for an emergency withdrawal of
    funds through the unforeseeable emergency (UE) withdrawal provision; or may
    choose to reduce/stop their contributions to free up some money from their
    paychecks. UEs must be pre-approved by the Deferred Compensation Plan
    Board of Trustees.       Attachment 3 provides phone number and location
    information for the plan administrator contracted by the State to oversee the
    Island $avings Plan.

                                                                                        13
ASSISTANCE TO CO-WORKERS

    Because of the extremely difficult times and circumstances for families during the
    aftermath of a disaster, assistance from fellow employees provides welcome
    relief.


    Leave Donation Program

    When a disaster has been declared by the Governor, a leave donation program
    such as “Give-A-Day,” established by HRD following Hurricane Iniki, may be
    activated by the Governor. Such a program may allow employees to donate their
    accumulated vacation credits to co-workers to help them deal with personal
    emergencies and other needs arising from the disaster. HRD will provide further
    guidance if and when a leave donation program is activated.


    Cash and Other Donations

    Cash donations and “care packages” can be collected and coordinated by
    departments to help affected co-workers. If cash donation arrangements are
    made after a disaster, information will be provided by the Department of
    Accounting and General Services (DAGS) and HRD for the disposition of the
    donations.




                                                                                   14
     Part II:
 NEW HIRES FOR
EMERGENCY WORK




                 15
..........
RECRUITMENT PROCEDURES

   Some offices may need additional staff to assist in the clean-up and relief efforts.
   In addition, some offices may be short-staffed if a number of employees are
   deployed. Pursuant to Section 128-10(11), HRS, the Governor may authorize
   the hiring of workers to provide disaster relief assistance and supersede other
   directives which may have been issued controlling the establishment and filling of
   positions.

   Q1: Recruitment of additional staff usually takes a long time. Is there a
         faster way to hire?

   A1: Short-term positions can be created to speed up the hiring of additional
         staff. Although the hiring of State personnel for temporary services is
         normally done through the civil service process, Section 76-16(b)(17),
         HRS, allows temporary, exempt positions to be established under certain
         circumstances which will allow for faster recruitment.

   Q2: How do I process the new temporary hires so they can get paid?

   A2: Use the attached Disaster Hire Form (Attachment 4) to manually process
         temporary employees being hired for disaster relief work. The form must
         be sent to your Payroll Office by their payroll processing deadlines, via
         your personnel office.

   Q3: How much should I pay these new hires?

   A3: Attachment 5 provides suggested pay rates for persons likely to be hired
         in emergencies, in various types of occupations.

   Q4: Finding enough workers with specialized skills to do essential work
         in my area would be difficult. Can I contract with a company that
         provides “fee-for-service” employees?

   A4: Generally, yes. However, you should identify the potential sources and
         discuss the options with your supervisor, Departmental Personnel Office,
         and Department Fiscal Officer as soon as practical – do not wait until the
         disaster occurs.




                                                                                    16
Q5: I know I would need additional workers but I do not have any money
      in my budget to pay for them. What should I do?

A5: Discuss this issue, in advance, with your supervisor. Note: Following a
      presidential emergency declaration, FEMA may reimburse 75% of
      reasonable wages paid to temporary employees who perform eligible
      emergency and restoration work.

Q6: Individuals may volunteer to assist with the clean-up and recovery
      efforts. Would we be required to verify their I-9 status to ensure their
      identity and their eligibility to work in the U.S.?

A6: No. According to the Bureau of Citizenship and Immigration Services
      (formerly known as the Immigration and Naturalization Service), if the
      individual is strictly a volunteer and is not compensated, the employer
      would not be required to have the volunteer complete an I-9 form.




                                                                           17
      Part III:
 INTERRUPTION OF
USUAL HRD SERVICES




                     18
..........
              APPLICATIONS
CIVIL SERVICE APPLICATIONS AND EXAMINATIONS

   The State Recruiting Office will attempt to announce the cancellation of an
   examination through available means such as the radio or through telephone
   contact. At all times, however, the applicants must use their own judgment and
   should not report to an examination if it poses a risk or hazard to themselves.
   Applicants should contact the State Recruiting Office on the next working day to
   inquire about re-scheduling an examination.



..........
CIVIL SERVICE INTERVIEWS

   Departmental Personnel Offices shall coordinate the canceling of selection
   interviews for their own departments as determined by the disaster at hand.
   Eligibles should contact the interviewing program and/or Departmental Personnel
   Office on the next working day to reschedule their interviews.



..........
TRAINING

   In the event of a disaster, all HRD-sponsored classes will be cancelled in the
   areas affected.

   Since there may not be sufficient time to notify departments of cancellations in
   advance, employees should listen to the EAS communications for notification
   that non-essential government operations will be shut down.

   Departments should assume that classes will resume as scheduled when the
   disaster is over, unless notified otherwise by HRD or by the training provider.




                                                                                19
ATTACHMENTS




              20
                                                                                Attachment 1




                                   STATE OF HAWAII

           Application for Leave to Provide Disaster Relief Services


Name:______________________________Department:___________________

Division:_____________________________Branch:______________________

I request a leave of absence with pay for __________ working days during the
following periods to provide disaster assistance to the American Red Cross.

From:__________________, 20___                To:_____________________, 20___

1)     Attached is a request for my services from the American Red Cross.
2)     Attached is a copy of my membership card indicating that I am a
       registered member of the American Red Cross Disaster Services Human
       Resources System.

____________________________________________                         ________________
                       Signature                                             Date
********************************************************************************************

Division recommendation:

( )    Recommend approval. The requested leave of absence imposes no
       undue hardship on operations. The American Red Cross (739-8112/8114)
       confirms that the disaster is of the category described under §78-23.5,
       HRS (Act 024, SLH 2003).

( )    Recommend disapproval. This employee’s absence during the period
       requested will impose undue hardship on operations.


                       _________________________________________
                            Signature (Division Head or representative)

********************************************************************************************
Department action:

( )    Approved                       ( )     Disapproved


                                              ____________________________________
                                                             Director
                                                                           Attachment 2




                  RESOURCE FOR EMPLOYEE ASSISTANCE
                        AND COUNSELING HELP
                               (REACH)


   Hawai`i Employee Assistance Services (HEAS) has been contracted by the State
   to provide REACH services. Call the HEAS office on your island and ask for an
   Employee Assistance Program counselor.

   Office Hours: Monday-Friday, 8 a.m. - 5 p.m. Appointments are also available
   evenings and Saturday mornings. After business hours, call 1-800-994-3571. A
   copy of your current pay stub will be required at the initial counseling session to
   verify that you are an active State employee.


OAHU                           HILO                             KAUAI
200 N. Vineyard Blvd.,         460 Kilauea Ave., Ste. 103       2970 Kele Street #203
Bldg. B                        Hilo, HI 96720                   Lihue, HI 96766
Honolulu, HI 96817             935-2188                         245-5914
543-8445

WEST OAHU                      KONA                             MAUI
91-1841 Ft. Weaver Road        81-6587 Mamalahoa Hwy.           333 Dairy Road, Ste 200
Ewa Beach, HI 96706            Kealakekua, HI 96750             Kahului, HI 96732
543-8445                       323-2664                         877-6888

        To schedule an appointment with an HEAS counselor on MOLOKAI or LANAI,
                                       call 1-800-994-3571

                                  Website: heas.org
                                                                      Attachment 3




                     ISLAND $AVINGS PLAN
                (DEFERRED COMPENSATION PLAN)



CitiStreet has been contracted by the State to oversee the Island $avings Plan.

                     FOR MORE INFORMATION, CALL:

                     1-888-71A-LOHA (1-888-712-5642)

                                 OR WRITE:

                            Island $avings Plan
                                 CitiStreet
                       1001 Bishop Street, Suite 1160
                               Pauahi Tower
                          Honolulu, Hawai`i 96813

                   Website: islandsavings.csplans.com
Please type or write legibly.                                                              DISASTER HIRE FORM                                                                               Attachment 4

Completed by the Hiring Unit:
                                                                                           Employee Information

        Department/Division:                                                                                          Birthdate:

                                SSN:                                                                                          Sex:                Female                Male
                                                                                                                        Check One:
                      Last Name:
                                                                                                                Marital Status:                   Single                Married
                      First Name:                                                                                       Check one:                Divorced              Widowed


                  Middle Name:                                                                                             Island:                Oahu                  Molokai
                                                                                                                        Check one:                Hawaii                Maui
                            Suffix:                                                                                                               Kauai                 Niihau
                                                                                                                                                  Lanai
     Home/Mailing Address:
                                                              Street                           Apartment #

                                                                                                                  Leave the below fields blank ("Federal Exempt" and "State Exempt").
                                                                                                                  Complete the forms indicated and attach them to the Disaster Hire
                                                            City                   State         Zip Code         Form.

                       Phone No:          (            )                                                         Federal Exempt:
                                                                                                                                              Requires Form W4
           HI Residency Date:
                                        Date individual claims as date of legal residency.                          State Exempt:
Form I-9 Verification Date:                                                                                                                   Requires Form HW4
                                        Leave Blank, your department's personnel office will complete.


Completed by the Department Personnel Office or Payroll Office:
                                                                                     Exempt Position Information

                         Job Title:                                                                                                                                           Payrate:
                                        Enter the "Title" from the column that is most reflective of the work assigned to the hired disaster response worker. See
                                        Attachment 5.                                                                                                                        Enter the rate shown in
                                                                                                                                                                             the "Hourly" column.
                                                                                                                                                                             See Attachment 5.
                                                                                                                                                                             Complete D-55 form.
         Occupational Group:                                                               FICA Code:    N                      Retirement Code:           N
                                                       Code
               Payroll Number:                                                                Warrant Distribution:                                                     Program ID:
                                                       Code                                                                            Code                                                      Code

                                UAC:                                                                  UAC Percent:
                                UAC:                                                                  UAC Percent:
                                UAC:                                                                  UAC Percent:
                                UAC:                                                                  UAC Percent:
                                UAC:                                                                  UAC Percent:

Completed by the Appointing Authority:
                                                                                           Action / Authorization

                           Action:            New Hire                  Employee Termination Date (COB)                   Employee Info Change                  Exempt Position Info Change
              Enter a checkmark next to the desired action.


  Effective Date of Action:                                                                                                    End Date (if known):
                                                           Date of the action indicated.


     Appointing Authority:                                                                                                     Date:
                                                                       Signature                                                                   Enter the date the Disaster Hire Form was signed.



                                                               Type or Print name

Submit to Departmental Payroll Office in accordance with department's payroll due dates.
                                                                                                       Attachment 4
                                    Instructions to Disaster Hire Form
General Instructions

Use this single page Disaster Hire Form to communicate hire information to your Departmental Personnel
Office when you receive authorization to hire disaster response workers to provide general and specific disaster
mitigation services immediately following the occurrence of a disaster.

Please ensure that all entries are legible and type the information whenever possible. The forms will be used to
collect and organize the information before entering it into the HRD HRMS at a later date as knowledgeable
personnel authorized to access the HRMS may be impacted by the disaster or the HRD HRMS may not be
operational due to affects of the disaster.

If the HRD HRMS is not available and the payroll processing due dates will be missed, the completed Disaster
Hire Form is to be forwarded for attachment to the Payroll Change Schedule pursuant to your department’s
fiscal/payroll office instructions.

Disaster response workers shall be hired as exempt employees pursuant to Hawai`i Revised Statutes, Section
128-10 (11). These exempt employees shall be paid on an hourly basis and their pay periods shall be the same
as hourly paid employees.


Specific Instructions

The Disaster Hire Form is divided into three parts and is designed for manual hand-written or type-written
entry. All entries must be completed, unless otherwise stated in these instructions. The following specific
instructions describes by part, the information that is to be entered.


Part I. Employee Information—to be completed by the Hiring Unit

“Department/Division”                  Type or print employee’s department and division.

“Social Security Number”               Type or print employee’s social security number.

“Last Name”                            Type or print employee’s last name.

“First Name”                           Type or print employee’s first name.

“Middle Name”                          Type or print employee’s middle name or initial(s).

“Suffix”                               Type or print Jr, Sr, Dr, II, III, if applicable.

“Home/Mailing Address”                 Type or print employee’s home or mailing address.

“Phone Number”                         Type or print employee’s area code in the parenthesis ( ) then employee’s
                                       home or mailing address.

“HI Residency Date”                    Type or print the date of legal residency.

“Form I-9 Verification Date”           Leave Blank, the department’s personnel office will complete.
“Birth Date”                             Type or print employee’s birth date.

“Sex”                                    Enter a check mark (√ ) in the applicable box.

“Island”                                 Enter a check mark (√ ) in the applicable box where
                                         employee resides.

“Marital Status”                         Enter a check mark (√ ) in the applicable box.

“Federal Exempt”,                        Leave Blank. Employee to complete Federal Form W-4 and State Form
Tax Credit”, and                         HW-4 and staple to the Disaster Hire Form.
“State Exempt”


Part II. Exempt Position Information—to be completed by the Personnel Office or Payroll Office, as appropriate.

“Job Title”                              See the attached ‘Suggested Pay Rates for Persons Hired in Emergencies”
                                         table (Attachment 5). Enter the “Title” from column two that is most
                                         reflective of the work that is assigned to the hired disaster response
                                         worker.

“Payrate”                                Type or print the rate shown in the “Hourly” column that is located next to
                                         the “Title” that was selected for the hired disaster response worker.

“Occupational Group”                     Type or print the code shown in the “Code” column that is located before
                                         the “Title” that was selected for the hired disaster response worker.

“FICA Code”                              “N” is the defaulted FICA code.

“Retirement Code”                        “N” is the defaulted Retirement code.

“Payroll Number”                         Type or print the appropriate payroll number code assigned by your
                                         department.

“Warrant Distribution”                   Type or print the appropriate warrant distribution code assigned by your
                                         department.

“Program ID”                             Type or print the appropriate program ID code assigned by your
                                         department.

“UAC”                                    Type or print the uniform accounting code assigned to your department.
                                         There are five UAC fields available for those departments with multiple
                                         funding codes.

“UAC Percent”                            Type or print the uniform accounting code percent. There are five UAC
                                         percent fields available for those departments with multiple funding
                                         percents.
Part III. Action/Authorization—to be completed by the Appointing Authority

“Action”                                Enter a check mark (√ ) next to the action indicated.

“Effective Date of Action”              Type or print the date of the action.

“End Date”                              Type or print the end date of the appointment, if known.

“Appointing Authority”                  Signature of the individual authorized to take the indicated actions. If
                                        there is no one at your location authorized to take such actions, leave
                                        blank for follow up by your department’s personnel office. Type or print
                                        the appointing authority’s name.

“Date”                                  Type or print the date the Disaster Hire Form was signed. Leave the field
                                        blank if no one is authorized to sign at your location.


NOTE: Submit to Departmental Payroll Office in accordance with department’s payroll deadline dates.
                                                                                                                                                                                       Attachment 5
                                                                              Suggested Pay Rates for Persons Hired in Emergencies

         Additional temporary personnel may be needed to provide services during an emergency situation and subsequent recovery efforts. Such temporary employees will be
hired through special emergency procedures and, therefore, will not occupy regular positions nor will they receive the pay and benefits available to other state employees.

         The titles and pay rates on this page are provided only as guidelines to assist in the recruitment/hiring of individual temporary employees. They are based on average
market pay rates, where such data is available. Actual rates to be offered by program managers to individuals may differ, depending on factors such as the availability of qualified
persons in the labor market, the urgency of the situation and the fact that these temporary personnel receive no benefits.

         Departments may hire other temporary employees with other titles to perform other necessary work.

       Departments may also find it necessary to contract for services with companies that provide fee for service employees or contract services in these and other areas.
Departments that can anticipate the need for a significant number of specialized workers may wish to identify such sources in advance of the need.

               Code                                      Title                                     Hourly          Code                                   Title                      Hourly
              21.006     Office Assistant                                                           $11            27.002   Licensed Architect                                        $30
              21.006     Senior Office Assistant (Claims Exam, etc)                                 $14            27.002   Licensed Engineer                                         $30
              21.003     IT Technician (Computer Operator, etc.)                                    $16            28.002   Investigator                                              $18
              22.002     IT Specialist                                                              $25            28.003   Construction Inspector                                    $15

              22.002     Administrative Professionals (Fiscal, Procurement, Personnel,              $19            28.004   Firefighter (24-hour Shift)                               $13
                         Insurance Examination, etc.)

              22.002     Professional Supervisors                                                   (a)            28.004   Firefighter (40 hour)                                     $16
              26.005     Health Care Assistant                                                      $12            28.004   Security Officer                                          $13
              26.003     Practical Nurse                                                            $15            29.008   Janitor                                                   $11
              26.002     Register Nurse                                                             $27            29.008   Laborer                                                   $12
              26.002     Pharmacist                                                                 $37            29.008   Crew Leader                                               $14
              26.002     Dentist                                                                    $40            29.008   Warehouse Worker                                          $13
              26.002     Physician                                                                  $50            29.008   Cook                                                      $13
              26.002     Psychiatrist                                                               $50            30.008   Trades Helper                                             $13
              26.002     Other Health Care Professional (Physical Therapist, Nutritionist, etc.)    $24            30.007   Automotive Mechanic                                       $18
              23.002     Social Worker                                                              $22            30.007   Electrician                                               $20
              23.005     Caregiver                                                                  $11            30.007   Other Skilled Trades Worker (Carpenter, Plumber, etc.)    $18
              23.005     Outreach Worker                                                            $12            30.008   Truck Driver                                              $12
              23.002     Psychologist                                                               $35            30.008   Equipment Operator                                        $13
                       (a) Professional Supervisors – pay rates that are 10 to 15% higher
                                                                                                                   30.007   Heavy Equipment Operator                                  $16
                         than professional employees being supervised are suggested.

         Note: Federal Emergency Management Agency (FEMA) may reimburse 75% of reasonable wages paid to temporary employees who perform eligible emergency and restoration work.
               Work that may be eligible for FEMA reimbursement includes: Emergency debris removal; emergency protective measures; and permanent restoration.
PAGE INTENTIONALLY LEFT BLANK
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  Pandemic Flu Planning
    Checklist for Individuals & Families
  You can prepare for an influenza pandemic now. You should know both the magnitude
  of what can happen during a pandemic outbreak and what actions you can take to help
  lessen the impact of an influenza pandemic on you and your family. This checklist will
  help you gather the information and resources you may need in case of a flu pandemic.

  1. To plan for a pandemic:
  q   Store a two week supply of water and food. During a pandemic, if you cannot get
      to a store, or if stores are out of supplies, it will be important for you to have extra
      supplies on hand. This can be useful in other types of emergencies, such as power
      outages and disasters.
  q   Periodically check your regular prescription drugs to ensure a continuous supply in
      your home.
  q   Have nonprescription drugs and other health supplies on hand, including pain re-
      lievers, stomach remedies, cough and cold medicines, fluids with electrolytes, and
      vitamins.
  q   Talk with family members and loved ones about how they would be cared for if they
      got sick, or what will be needed to care for them in your home.
  q   Volunteer with local groups to prepare and assist with emergency response.
  q   Get involved in your community as it works to prepare for an influenza pandemic.

  2. To limit the spread of germs and prevent infection:
  q   Teach your children to wash hands frequently with soap and water, and model the
      current behavior.
  q   Teach your children to cover coughs and sneezes with tissues, and be sure to model
      that behavior.
  q   Teach your children to stay away from others as much as possible if they are sick.
      Stay home from work and school if sick.




www.pandemicflu.gov
3. Items to have on hand for an extended stay at home:
Examples of food and non-perishables       Examples of medical, health, and
                                           emergency supplies

q   Ready-to-eat canned meats, fish,       q Prescribed medical supplies such as
    fruits, vegetables, beans, and soups      glucose and blood-pressure monitoring
                                              equipment
q   Protein or fruit bars
                                           q Soap and water, or alcohol-based
q   Dry cereal or granola                     (60-95%) hand wash

q   Peanut butter or nuts                  q Medicines for fever, such as
                                              acetaminophen or ibuprofen
q   Dried Fruit
                                           q Thermometer
q   Crackers
                                           q Anti-diarrheal medication
q   Canned juices
                                           q Vitamins
q   Bottled water
                                           q Fluids with electrolytes
q   Canned or jarred baby food and
    formula                                q Cleansing agent/soap
q   Pet food                               q Flashlight
q   Other nonperishable foods              q Batteries
                                           q Portable radio
                                           q Manual can opener
                                           q Garbage bags
                                           q Tissues, toilet paper, disposable diapers




                                                          A Guide for Individuals and Families
PAGE INTENTIONALLY LEFT BLANK
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                      Centers for Disease Control and Prevention
                      http://www.cdc.gov/h1n1flu/institutions/guidance/


CDC Guidance for Responses to Influenza for Institutions of
Higher Education during the 2009-2010 Academic Year
August 26, 2009 10:00 AM ET

This document provides guidance to help decrease the spread of flu among students, faculty, and staff of
institutions of higher education (IHE) and post-secondary educational institutions during the 2009-2010
academic year. The guidance expands upon earlier guidance for these settings by providing a menu of tools
that IHE and health officials can choose from based on conditions in their area. It recommends actions to
take now (during this academic year), suggests strategies to consider if the flu starts causing more severe
disease than during the spring/summer 2009 H1N1 outbreak, and provides a checklist for making decisions.
Detailed information on the reasons for these strategies and suggestions on how to use them is included in
the Technical Report. Based on the severity of 2009 H1N1 flu-related illness thus far, this guidance also
recommends that students, faculty, and staff with flu-like illness remain home until 24 hours after resolution
of fever without the use of fever-reducing medications. For the purpose of this guidance, IHE will refer to
public and private, residential and nonresidential, degree-granting and non-degree-granting institutions
providing post-secondary education in group settings regardless of the age of their students. Portions of this
guidance pertaining to dormitories and residence halls may serve as a useful supplement to residential
(boarding) schools providing primary and secondary education, with adaptations as needed for their younger
population. This guidance represents the CDC’s current thinking on this topic. It does not create or confer
any rights for or on any person or operate to bind the public.
IHEs should tailor the guidance to account for the size, diversity, and mobility of their students, faculty, and
staff; their location and physical facilities; programs; and student and employee health services. Decisions
about strategies should balance the goal of reducing the number of people who become seriously ill or die
from flu with the goal of minimizing educational and social disruption.


Although the severity of flu outbreaks during the fall and winter of 2009-10 is unpredictable, more
communities may be affected than were affected in spring/summer 2009, reflecting wider transmission and
possibly greater impact. CDC is working with state and local health departments to continually monitor the
spread of flu, the severity of the illness it is causing, and changes to the virus. If this information indicates
that flu is causing more severe disease than during the spring/summer 2009 H1N1 outbreak, or if other
developments require more aggressive mitigation measures, CDC may recommend additional
strategies. Since severity may vary from community to community, IHEs should also look to their state and
local health officials for information and guidance specific to their location.


The recommendations below are divided into two groups: 1) recommendations to use now, during this
academic year, assuming a similar severity to the spring/summer H1N1 flu outbreak, and 2)
recommendations to consider adding if the flu begins to cause more severe disease.
Recommended responses to influenza for the 2009 – 2010 academic
year
Recommended strategies under current flu conditions (similar severity as in Spring/Summer
2009)
Facilitate self-isolation of residential students with flu-like illness
       Those with flu-like illness should stay away from classes and limit interactions with other people
       (called “self-isolation”), except to seek medical care, for at least 24 hours after they no longer have a
       fever, or signs of a fever, without the use of fever-reducing medicines. They should stay away from
       others during this time period even if they are taking antiviral drugs for treatment of the flu. (For
       more information, visithttp://www.cdc.gov/h1n1flu/guidance/exclusion.htm.)

       Review and revise, as needed, policies, such as student absenteeism policies and sick leave policies
       for faculty and staff, that make it difficult for students, faculty, and staff to stay home when they are
       ill or to care for an ill family member,. Do not require a doctor’s note to confirm illness or recovery.
       Doctor’s offices may be very busy and may not be able to provide such documentation in a timely
       way.

       If possible, residential students with flu-like illness who live relatively close to the campus should
       return to their home to keep from making others sick. These students should be instructed to do so
       in a way that limits contact with others as much as possible. For example, travel by private car or
       taxi would be preferable over use of public transportation.

       Students with a private room should remain in their room and receive care and meals from a single
       person. Students can establish a “flu buddy scheme” in which students pair up to care for each other
       if one or the other becomes ill. Additionally, staff can make daily contact by e-mail, text messaging,
       phone calls, or other methods with each student who is in self-isolation.

       If close contact with others cannot be avoided, the ill student should be asked to wear a surgical
       mask during the period of contact. Close contact includes things like caring for or living with the ill
       person.

       For those who cannot leave campus, and who do not have a private room, IHEs may consider
       providing temporary, alternate housing for ill students until 24 hours after they are free of fever.

       Instruct students with flu-like illness to promptly seek medical attention if they have a medical
       condition that puts them at increased risk of severe illness from flu, are concerned about their illness,
       or develop severe symptoms such as increased fever, shortness of breath, chest pain or pressure, or
       rapid breathing.

Promote self-isolation at home by non-resident students, faculty, and staff

       Non-residential students, faculty, and staff with flu-like illness should be asked to self-isolate at home
       or at a friend’s or family member’s home until at least 24 hours after they are free of fever, or signs
       of a fever, without the use of fever-reducing medicines.

       Review, and revise if needed, sick leave policies to remove barriers to faculty and staff staying home
       when they are ill or caring for an ill family member. For students, consider altering policies on missed
       classes and examinations and late assignments so that students’ academic concerns do not prevent
       them from staying home when ill or prompt them to return to class or take examinations while still
       symptomatic and potentially infectious.

       Do not require a doctor’s note for students, faculty, or staff to validate their illness or to return to
       work, as doctor’s offices and medical facilities may be extremely busy and may not be able to provide
       such documentation in a timely way.

       Distance learning or web-based learning may help students maintain self-isolation.

       Visit http://www.cdc.gov/h1n1flu/guidance/exclusion.htm for more information on staying home
       while sick.
Considerations for high-risk students and staff

       People at high risk for flu complications who become ill with flu-like illness should speak with their
       health care provider as soon as possible. Early treatment with antiviral medications often can prevent
       hospitalizations and deaths. Groups that are at higher risk of complications from flu if they get sick
       include: children younger than age 5; people age 65 or older; children and adolescents (younger than
       age 18) who are receiving long-term aspirin therapy and who might be at risk for experiencing Reye’s
       syndrome after flu virus infection; pregnant women; adults and children who have asthma, other
       chronic pulmonary, cardiovascular, hepatic, hematological, neurologic, neuromuscular, or metabolic
       disorders such as diabetes; and adults and children with immunosuppression (including
       immunosuppression caused by medications or by HIV). People age 65 and older, however, appear to
       be at lower risk of 2009 H1N1 infection compared to younger people. But, if older adults do get sick
       from flu, they are at increased risk of having a severe illness.

       One of the best ways to protect against the flu is to get vaccinated against the flu. People under age
       25 are one of the key groups recommended by CDC’s Advisory Committee on Immunization Practices
       (ACIP) to be among the first to receive the 2009 H1N1 flu vaccine. For more information,
       visit http://www.cdc.gov/h1n1flu/vaccination .

       Communicate with local health officials to determine where vaccine will be administered and to
       discuss the possibility of a vaccination clinic at the IHE.

Discourage attendance at campus events by ill persons: Events such as football games or concerts
that bring large groups together may pose a high risk of exposure and transmission of flu. Use a variety of
communication methods such as e-mail, posters, flyers, and media coverage to discourage people with flu-
like illness from attending these events until they have been free of fever for at least 24 hours and to
encourage hand hygiene and respiratory etiquette. Explore ways to modify events to reduce close contact
and increase distances between participants. IHEs may need to consider cancelling some events if
modification is not possible and there is a high level of influenza activity in the community.
Encourage hand hygiene and respiratory etiquette of both people who are well and those that
have any symptoms of flu: Emphasize the importance of the basic foundations of flu prevention: stay
home when sick, wash hands frequently with soap and water when possible, and cover noses and mouths
with a tissue when coughing or sneezing (or a shirt sleeve or elbow if no tissue is available).

Routine cleaning

       Establish regular schedules for frequent cleaning of high-touch surfaces (for example, bathrooms,
       doorknobs, elevator buttons, and tables).

       Provide disposable wipes so that commonly used surfaces (for example, doorknobs, keyboards,
       remote controls, desks) can be wiped down by students before each use.

       Encourage students to frequently clean their living quarters, including high-touch surfaces.

Considerations for specific student populations

       Review policies for study abroad programs, including accessing health services abroad and reporting
       illness to the IHE.

       Communicate plans, policies, and strategies to partner K-12 schools regarding “early/middle college”
       students, prospective student tours, and other K-12 students regularly on campus.

       Determine if special communication strategies are needed to meet the needs of students with
       disabilities.
       Review policies for sports teams, bands, and other large groups of students who spend a lot of time
       together in close quarters. IHE may need to consider cancelling travel to off-campus activities.

       Remind health-care profession students to follow infection control guidance for health-care
       workers. Visit http://www.cdc.gov/h1n1flu/clinicians for guidance for health care settings.

Under conditions with increased severity compared to spring/summer
2009
CDC may recommend additional strategies to help protect IHE students, faculty, and staff if global, national,
or regional assessments indicate that flu is causing more severe disease. In addition, local health or IHE
officials may choose to use additional strategies. Although the following strategies have not been
scientifically tested in the IHE setting, they are grounded on basic principles of infection control.
Implementing these strategies is likely to be more difficult and to have more disruptive effects than the
previously described strategies. These strategies should be considered if influenza severity increases and are
meant for use in addition to the strategies outlined above.

Permit high-risk students, faculty, and staff to stay home when flu is
spreading in the community
       If flu severity increases, people at high risk of flu complications may consider staying home while a
       lot of flu is circulating in their community. Such people should make this decision after consulting
       with their doctor.

       IHEs should plan now for ways to continue educating students who stay home through distance
       learning methods. IHEs should also examine policy accommodations that might be necessary such as
       allowing high-risk students to withdraw for the semester, tailoring sick leave policies to address the
       needs of faculty and staff, or modifying work responsibilities and locations.

Increase social distances: Explore innovative ways to increase the distances between students (for
example, moving desks apart or using distance learning methods). Ideally, there should be at least 6 feet
between people at most times.
Campus events: Consider whether to suspend or modify public events such as films, sporting events, or
commencement ceremonies.
Extend the self-isolation period: If flu severity increases, people with flu-like illness should stay home for
at least 7 days after the onset of their symptoms, even if they have no more symptoms. If people are still
sick after 7 days, they should stay home until 24 hours after they have no symptoms. See information
above for self-isolation in different types of housing.

Consider suspending classes
       IHE and health officials should work closely to balance the risks of flu in their community with the
       disruption that suspending classes will cause in both education and the wider community.

       Use multiple channels to communicate a clear message about the reasons for suspending classes and
       the implications for students, faculty, staff, and the community.

       Reactive class suspension might be needed when IHEs cannot maintain normal functioning.
       To decrease the spread of flu, CDC may recommend preemptive class suspension if the flu starts
       to cause severe disease in a significantly larger proportion of those affected than occurred during the
       spring/summer 2009 outbreak.
       If classes are suspended preemptively, large gatherings (for example, sporting events, dances,
       commencement ceremonies) should be cancelled or postponed.

       IHEs with only nonresidential students should consider whether they can allow faculty and staff to
       continue use of their facilities while classes are not being held. This may allow faculty to develop
       lessons and materials and engage in other essential activities.
       IHEs with residential students should plan for ways to continue essential services such as meals,
       custodial services, security, and other basic operations for students who remain on campus. When
       possible, dismiss students who can get home – or to the home of a relative, friend of the family, or
       host family – by private car or taxi. International students and others without easy access to
       alternative housing should stay on campus, but increase the distance between people as much as
       possible.

       The length of time classes should be suspended will vary depending on the goal of class suspension
       as well as the severity and extent of illness. IHEs that suspend classes should do so for at least five
       to seven calendar days. Before the end of this period, the IHE, in collaboration with public health
       officials, should reassess the epidemiology of the disease and the benefits and consequences of
       continuing the suspension or resuming classes.

Deciding on a course of action
CDC recommends a combination of strategies applied early and simultaneously. Strategies should be
selected a) based on trends in the severity of disease, virus characteristics, feasibility, and acceptability and
b) through collaborative decision-making with public health agencies, IHE faculty and staff, students,
students’ families, and the wider community. CDC and its partners will continuously look for changes in the
severity of flu-like illness and will share what is learned with state and local agencies. However, states and
local communities can expect to see a lot of differences in disease patterns from community to community.

Every IHE has to balance a variety of objectives to determine the best course of action to help decrease the
spread of flu. Decision-makers should identify and communicate their objectives, which might be one or
more of the following: (a) protecting overall public health by reducing community transmission; (b) reducing
transmission in students, faculty, and staff; and (c) protecting people with high-risk conditions. Some
strategies can have negative consequences in addition to their potential benefits. The following questions
can help begin discussions and lead to decisions.

Decision-Makers and Stakeholders
Are all of the right decision-makers and stakeholders involved?

       Local and state health, education, and homeland security agencies

       Campus health services and mental health services

       Campus emergency managers and security staff

       Student affairs and residential life staff

       Communications staff

       Physical plant staff

       Food services staff

       Students

       Faculty

       Community representatives
       Students’ families

Information Collection and Sharing
Can local or state health officials determine and share information about the following?

       Numbers of and trends in outpatient visits, hospitalizations, and deaths for flu-like illness

       Percent of hospitalized patients requiring admission to intensive care units (ICUs)

       Groups being disproportionately affected

       Ability of local health care providers and emergency departments to meet increased demand

       Availability of antiviral drugs, hospital beds, staff, ICU space, and ventilators for flu patients

What does the IHE know about the following?

       Student, faculty, and staff absenteeism rates

       Number of visits to the campus health service

       Bed availability for student self-isolation

       Severity of illness among affected staff and/or students

Feasibility
Do you have the resources to implement the strategies being considered?

       Funds

       Personnel

       Equipment

       Space

       Time

       Legal authority or policy requirements

       Communication channels

Acceptability
Have you determined how to address the following challenges to implementing the strategies?

       Public concern about flu

       People who do not feel empowered to protect themselves

       Lack of public support for the strategy

       Secondary effects of strategies (for example, job security, financial support, health service access,
       and educational progress)
                     Centers for Disease Control and Prevention
                     http://www.cdc.gov/h1n1flu/masks

Interim Recommendations for Facemask and Respirator Use
to Reduce Novel Influenza A (H1N1) Virus Transmission
August 5, 2009 5:00 PM ET

This document has been updated in accordance with the CDC Recommendations for the Amount of Time
Persons with Influenza-Like Illness Should be Away from Others . This document provides interim guidance
and will be updated as needed
This document provides updated interim guidance on the use of facemasks and respirators for decreasing
the exposure to novel influenza A (H1N1) virus. This guidance replaces other CDC guidance on mask and/or
respirator use that may be included in other CDC documents in regards to the outbreak of novel H1N1 virus.
No change has been made to guidance on the use of facemasks and respirators for health care settings. This
document includes guidance on facemask and respirator use for a wider range of settings than was included
in previous documents and includes recommendations for those who are at increased risk of severe illness
from infection with the novel H1N1 virus compared with those who are at lower risk of severe illness from
influenza infection.For more information about human infection with novel influenza A (H1N1) virus, visit
the CDC H1N1 Flu website. Other CDC novel H1N1 guidance will be updated with the information contained
in this document as soon as possible.
Detailed background information and recommendations regarding the use of facemasks and respirators in
non-occupational community settings can be found on PandemicFlu.gov in the document Interim Public
Health Guidance for the Use of Facemasks and Respirators in Non-Occupational Community Settings during
an Influenza Pandemic. Information on the use of facemasks and respirators in health care settings can be
                                     found at http://www.cdc.gov/h1n1flu/guidelines_infection_control.htm.
                                     Information on the effectiveness of facemasks and respirators for
                                     decreasing the risk of influenza infection in community settings is
                                     extremely limited. Thus, it is difficult to assess their potential
                                     effectiveness in decreasing the risk of novel influenza A (H1N1) virus
                                     transmission in these settings. In the absence of clear scientific data,
                                     the interim recommendations below have been developed on the basis
                                     of public health judgment, the historical use of facemasks and
                                     respirators in other settings for preventing transmission of influenza
and other respiratory viruses, and on current information on the spread and severity of the novel influenza A
(H1N1) virus.
In areas with confirmed human cases of novel influenza A (H1N1) virus infection, the risk for infection can
be reduced through a combination of actions. No single action will provide complete protection, but an
approach combining the following steps can help decrease the likelihood of transmission. These
recommended actions are:
       Wash hands frequently with soap and water or use alcohol-based hand cleaner* when soap and water
       are not available.

       Cover your mouth and nose with a tissue when coughing or sneezing.

       Avoid touching your eyes, nose and mouth

       People who are sick with an influenza-like illness (ILI) (fever plus at least cough or sore throat and
       possibly other symptoms like runny nose, body aches, headaches, chills, fatigue, vomiting and
       diarrhea) should stay home and keep away from others as much as possible, including avoiding
       travel, for at least 24 hours after fever is gone except to get medical care or for other necessities.
       (Fever should be gone without the use of fever-reducing medicine).

       Avoid close contact (i.e. being within about 6 feet) with persons with ILI.

In addition, influenza antiviral medications are an important tool for the treatment and prevention of
influenza, including novel H1N1. Also see Guidance on the use of antiviral medications.


Facemasks and Respirators
Recommendations for the uses of facemasks and/or respirators are listed in Table 1 below for different
settings where a person may be exposed to novel H1N1 virus. These recommendations also differ based on
whether the person exposed to novel H1N1 is in a group at increased risk for severe illness from influenza
infection. More information on preventing influenza transmission in health care settings can be found in
the Interim Guidance for Infection Control for Care of Patients with Confirmed or Suspected Novel Influenza
A (H1N1) Virus Infection in a Healthcare Setting.
In community and home settings, the use of facemasks and respirators generally are not recommended.
However, for certain circumstances as described in Table 1, a facemask or respirator may be considered,
specifically for persons at increased risk of severe illness from influenza.
Use of N95 respirators or facemasks generally is not recommended for workers in non-healthcare
occupational settings for general work activities. For specific work activities that involve contact with people
who have ILI, such as escorting a person with ILI, interviewing a person with ILI, providing assistance to an
individual with ILI, the following are recommended:

       workers should try to maintain a distance of 6 feet or more from the person with ILI;

       workers should keep their interactions with ill persons as brief as possible;

       the ill person should be asked to follow good cough etiquette and hand hygiene and to wear a
       facemask, if able, and one is available;

       workers at increased risk of severe illness from influenza infection (see footnote 3 of table 1) should
       avoid people with ILI (possibly by temporary reassignment); and,

       where workers cannot avoid close contact with persons with ILI, some workers may choose to wear a
       facemask or N95 respirator on a voluntary basis.

In the occupational healthcare setting, respiratory protection is recommended. Because infection control
precautions, including respiratory protection, are imperfect, workers who are at increased risk of severe
illness from influenza, and who are caring for a patient with known, probable, or suspected novel H1N1 or
ILI, may consider temporary reassignment to avoid exposure.
Additional recommendations for use of facemasks by people who have ILI that may be due to novel H1N1
infection are included in Table 2.
There are important differences between facemasks and respirators. Facemasks do not seal tightly to the
face and are used to block large droplets from coming into contact with the wearer’s mouth or nose. Most
respirators (e.g. N95) are designed to seal tightly to the wearer’s face and filter out very small particles that
can be breathed in by the user. For both facemasks and respirators, however, limited data is available on
their effectiveness in preventing transmission of H1N1 (or seasonal influenza) in various settings. However,
the use of a facemask or respirator is likely to be of most benefit if used as early as possible when exposed
to an ill person and when the facemask or respirator is used consistently. (Ref. 1. MacIntyre CR, et al. EID
2009;15:233-41. 2. Cowling BJ, et al. Non-pharmaceutical interventions to prevent household transmission
of influenza. The 8th Asia Pacific Congress of Medical Virology, Hong Kong, 26-28 February 2009.)


Facemasks: Unless otherwise specified, the term ”facemasks” refers to disposable facemasks cleared by
the U.S. Food and Drug Administration (FDA) for use as medical devices. This includes facemasks labeled as
surgical, dental, medical procedure, isolation, or laser masks. Such facemasks have several designs. One
type is affixed to the head with two ties, conforms to the face with the aid of a flexible adjustment for the
nose bridge, and may be flat/pleated or duck-billed in shape. Another type of facemask is pre-molded,
adheres to the head with a single elastic band, and has a flexible adjustment for the nose bridge. A third
type is flat/pleated and affixes to the head with ear loops. Facemasks cleared by the FDA for use as medical
devices have been determined to have specific levels of protection from penetration of blood and body
fluids. Facemasks help stop droplets from being spread by the person wearing them. They also keep
splashes or sprays from reaching the mouth and nose of the person wearing the facemask. They are not
designed to protect against breathing in very small particle aerosols that may contain viruses. Facemasks
should be used once and then thrown away in the trash.
Respirators: Unless otherwise specified, "respirator" refers to an N95 or higher filtering face piece
respirator certified by the CDC/National Institute for Occupational Safety and Health (NIOSH). A respirator is
designed to protect the person wearing the respirator against breathing in very small particle aerosols that
may contain viruses. A respirator that fits snugly on the face can filter out virus-containing small particle
aerosols that can be generated by an infected person, but compared with a facemask it is harder to breathe
through a respirator for long periods of time. Respirators are not recommended for children or people who
have facial hair.
Where respirators are used in a non-occupational setting, fit testing, medical evaluation and training are
recommended for optimal effectiveness.


When respiratory protection is required in an occupational setting, respirators must be used in the context of
a comprehensive respiratory protection program as required under OSHA’s Respiratory Protection standard
(29 CFR 1910.134). This includes fit testing, medical evaluation and training of the worker. When required in
the occupational setting, tight-fitting respirators cannot be used by people with facial hair that interferes
with the face seal.


When respirators are used on a voluntary basis in an occupational setting, requirements for voluntary use of
respirators in work sites can be found on the OSHA website.
Employers should continue to evaluate workplace hazards related to the novel H1N1 influenza A situation in
accordance with CDC and OSHA guidance. Mandatory use of respiratory protection may be required when
work activities in occupational settings confer risk that is task/function based, and risk analyses conducted
by the employer could identify hazardous work activities. For example, performing activities which generate
large amounts of aerosols require respiratory protection regardless of the setting in which it is performed
(i.e. in a hospital, an outpatient setting, a prison).


For additional information on facemasks and respirators, see the CDC/NIOSH website, the Food and Drug
Administration website, and the Occupational Safety and Health Administration website.


Groups at Higher Risk for Severe Illness from Novel Influenza A (H1N1)
Infection
Groups of people at higher risk for severe illness from novel influenza A (H1N1) infection are thought to be
the same as those people at higher risk for severe illness from seasonal influenza. These groups include:

       Children younger than 5 years old

       Persons aged 65 years or older

       Children and adolescents (younger than 18 years) who are receiving long-term aspirin therapy and
       who might be at risk for experiencing Reye syndrome after influenza virus infection

       Pregnant women

       Adults and children who have asthma, chronic pulmonary, cardiovascular, hepatic, hematological,
       neurologic, neuromuscular, or metabolic disorders such as diabetes;

       Adults and children who have immunosuppression (including immunosuppression caused by
       medications or by HIV)

       Residents of nursing homes and other chronic-care facilities.


 Table 1. CDC Interim Recommendations for Facemask
    and Respirator Use for Home, Community, and
  Occupational Settings for Non-Ill Persons to Prevent
             Infection with Novel H1N1 1 2
           Setting                Persons not at increased risk of        Persons at increased risk of
                                   severe illness from influenza          severe illness from influenza
                                     (Non-high risk persons)                 (High-Risk Persons) 3
Community
No novel H1N1 in                 Facemask/respirator not                Facemask/respirator not
community                        recommended                            recommended
Novel H1N1 in                    Facemask/respirator not                Facemask/respirator not
community: not crowded           recommended                            recommended
setting
Novel H1N1 in                   Facemask/respirator not                  Avoid setting.
community: crowded              recommended                              If unavoidable, consider facemask
setting                                                                  or respirator 4 5
Home
Caregiver to person with        Facemask/respirator not                  Avoid being caregiver. If
influenza-like illness          recommended                              unavoidable, use facemask or
                                                                         respirator 4 5
Other household members Facemask/respirator not                          Facemask/respirator not
in home                 recommended                                      recommended
Occupational (non-health care)
No novel H1N1 in         Facemask/respirator not                         Facemask/respirator not
community                recommended                                     recommended
Novel H1N1 in                   Facemask/respirator not                  Facemask/respirator not
community                       recommended but could be                 recommended but could be
                                considered under certain                 considered under certain
                                circumstances 4 5                        circumstances 4 5
Occupational (health care) 6
Caring 7 for persons with       Respirator                               Consider temporary reassignment.
known, probable or                                                       Respirator
suspected novel H1N1 or
influenza-like illness
1 The effectiveness of respirators and facemasks in preventing transmission of novel H1N1 (or seasonal
influenza) in various settings is not known. Use of a facemask or respirator is likely to be of most benefit if
used correctly and consistently when exposed to an ill person. (Ref. a) MacIntyre CR, et al. EID
2009;15:233-41. b) Cowling BJ, et al. Non-pharmaceutical interventions to prevent household transmission
of influenza. The 8th Asia Pacific Congress of Medical Virology, Hong Kong, 26-28 February 2009.)
2 For the purpose of this document, respirator refers to N95 or any other NIOSH-certified filtering face piece
respirator.
3 Persons at increased risk of severe illness from influenza (i.e. high-risk persons) include thosegroups at
higher risk for severe illness from seasonal influenza, including: children younger than 5 years old; persons
aged 65 years or older; children and adolescents (younger than 18 years) who are receiving long-term
aspirin therapy and who might be at risk for experiencing Reye syndrome after influenza virus infection;
pregnant women; adults and children who have pulmonary, including asthma, cardiovascular, hepatic,
hematological, neurologic, neuromuscular, or metabolic disorders, such as diabetes; adults and children who
have immunosuppression (including immunosuppression caused by medications or by HIV); and, residents
of nursing homes and other chronic-care facilities.
4 The optimal use of respirators requires fit testing, training and medical clearance. Proper use is
recommended to maximize effectiveness. The use of facemasks may be considered as an alternative to
respirators, although they are not as effective as respirators in preventing inhalation of small particles,
which is one potential route of influenza transmission. There is limited evidence available to suggest that
use of a respirator without fit-testing may still provide better protection than a facemask against inhalation
of small particles. Respirators are not recommended for children or persons who have facial hair (see FDA
website).
5 Use of N95 respirators or facemasks generally is not recommended for workers in non-healthcare
occupational settings for general work activities. For specific work activities that involve contact with people
who have influenza-like illness (ILI) (fever plus at least either cough or sore throat and possibly other
symptoms like runny nose, body aches, headaches, chills, fatigue, vomiting and diarrhea), such as escorting
a person with ILI, interviewing a person with ILI, providing assistance to an individual with ILI, the following
are recommended: a) workers should try to maintain a distance of 6 feet or more from the person with ILI;
b) workers should keep their interactions with the ill person as brief as possible; c) the ill person should be
asked to follow good cough etiquette and hand hygiene and to wear a facemask, if able, and one is
available; d) workers at increased risk of severe illness from influenza infection (see footnote 3) should
avoid people with ILI (possibly by temporary reassignment); and, e) where workers cannot avoid close
contact with persons with ILI, some workers may choose to wear a facemask or N95 respirator on a
voluntary basis (See footnote 1). When respirators are used on a voluntary basis in an occupational work
setting, requirements for voluntary use of respirators in work sites can be found on the OSHA website.
6 See case definitions of confirmed, probable, and suspected novel influenza A (H1N1). Also seeinfection
control in the health care setting. When respiratory protection is required in an occupational setting,
respirators must be used in the context of a comprehensive respiratory protection program as required
under OSHA’s Respiratory Protection standard (29 CFR 1910.134). This includes fit testing, medical
evaluation and training of the worker.
7 “Caring” includes all activities that bring a worker into proximity to a patient with known, probable, or
suspected novel H1N1 or ILI, including both providing direct medical care and support activities like
delivering a meal tray or cleaning a patient’s room.

Table 2. CDC Interim Recommendations For Facemask
  Use For Persons Ill With Confirmed, Probable, Or
   Suspected Novel Influenza A (H1N1)1To Prevent
           Transmission Of Novel H1N1 2
                 Setting                                              Recommendation
Home (when sharing common spaces with               Facemask preferred, if available and tolerable, or
other household members)                            tissue to cover cough/sneeze
Health care settings (when outside of               Facemask, if tolerable
patient room)
Non-health care setting                             Facemask preferred, if available and tolerable, or
                                                    tissue to cover cough/sneeze
Breastfeeding                                       Facemask preferred, if available and tolerable, or
                                                    tissue to cover cough/sneeze
1 See definitions for confirmed, probable, and suspect novel influenza A (H1N1) infection. Also
seeinformation on infection control in health care settings.
2 Ill persons should be placed in well ventilated areas when possible and placed in areas where at least 6
feet distance can be maintained between the ill person and other well and ill persons. Selected references:
a) Blumenfeld HL, et al. J Clin Invest 1959;38:199-212. b) Bridges CB, et al. Clin Infect Dis
2003;37:1094-1101. c) Foster MG and Cookson AH. Lancet 1918 (Nov. 2): 588-90. d) Gregg MB. Ann NY
Acad Sci 1980;353:45-53. e) WHO. Infection prevention and control of epidemic- and pandemic-prone
acute respiratory diseases in health care. June 2007. f) Fabian P, et al. Plos One 2008;3:e2691.

Related Media
 CDC Podcast: General Instructions for Disposable Respirators
PAGE INTENTIONALLY LEFT BLANK
  Preparing for the Flu
  (Including 2009 H1N1 Flu)

A Communication Toolkit for Institutions of Higher Education
Preparing for the Flu:
A Communication Toolkit for Institutions of Higher Education

The purpose of “Preparing for the Flu: A Communication Toolkit for Institutions of Higher
Education” is to provide information and communication resources to help students, faculty,
and staff implement recommendations from CDC’s Guidance for Responses to Influenza for
Institutions of Higher Education during the 2009-2010 Academic Year.

The toolkit includes:

         	Questions and Answers about the CDC’s Guidance for Responses to Influenza
           for Institutions of Higher Education during the 2009-2010 Academic Year.

         	1 Fact Sheet for Institutions of Higher Education
              Action Steps for Institutions of Higher Education to Prevent the Spread of Flu

         	1 Fact Sheet for Students, Faculty, and Staff
              Action Steps for Students, Faculty, and Staff to Prevent the Spread of Flu

         	1 Poster for Institutions of Higher Education to Remind Sick People to
           Go Home
              STOP! Do You Feel Sick?

         	1 Template Letter (or E-mail) for Students, Faculty, Staff, and Parents
              Letter to Students, Faculty, Staff, and Parents during Current Flu Conditions

         	2 Template Announcements for Students, Faculty, Staff, and Parents
              If You are Sick with the Flu
              Classes Remain in Session during Current Flu Conditions

         	Text Messages for Students, Faculty, Staff, and Parents

         	Additional Communication Resources for Institutions of Higher
           Education
Questions and Answers about
the CDC’s Guidance for Responses to
Influenza for Institutions of Higher Education
during the 2009–2010 Academic Year

About the Guidance for Institutions of Higher Education

Q. How does CDC’s new guidance differ from the previous guidance
   for institutions of higher education?
This new guidance applies to any flu virus circulating during the 2009–2010 academic
year, not only 2009 H1N1 flu. It recognizes the need to balance risks of illness among
faculty, students, and staff with the benefits of keeping students in classes. It offers
strategies and guidance for current flu conditions and for more severe flu conditions.
This guidance recommends that, based on current flu conditions, faculty, students,
and staff with flu-like illness should stay in their home, dormitory, or residence hall
until at least 24 hours after they no longer have a fever (100 degrees Fahrenheit or
38 degrees Celsius) or signs of a fever (have chills, feel very warm, have a flushed
appearance, or are sweating). This should be determined without the use of fever-
reducing medications (any medicine that contains ibuprofen or acetaminophen).
This is a shorter time period than outlined in previous CDC guidance, which
recommended that sick faculty, students, and staff remain at home 7 days after
symptoms begin.
The recommendation to stay away from classes and from work for 7 days will be
made only under more severe flu conditions. Under more severe conditions, a longer
period will be recommended for healthcare settings and anywhere a high number of
people at higher risk for complications from flu may be exposed.


Q. What are institutions of higher education?
For the purpose of this guidance, the term “institutions of higher education” refers to
places of learning that include:
	 u universities and colleges,
	 u public and private institutions,
	 u residential and nonresidential institutions,
	 u degree-granting and non-degree-granting institutions,
	 u educational or training programs that last from a few weeks to 4 or more years,
	 u student population sizes ranging from fewer than one hundred to tens of thousands,
	 u community colleges,
	 u vocational education and training programs, and
	 u students from across the country and around the world.




                                                                                           1 of 13
          Q. Why should institutions of higher education be concerned
             about the flu?
          Students, faculty, and staff can get sick with flu, and institutions may act as a
          “point of spread.” Students, faculty, and staff can easily spread flu to others in their
          institutions as well as in the larger community. To date, the highest number of cases
          of 2009 H1N1 flu have been confirmed among people 5–24 years old. They are also at
          risk of getting seasonal influenza.


          Q. How will CDC help institutions and communities decide what
             steps to take?
          CDC and other public health agencies will be monitoring national data on the number
          of people seeking care for flu-like illness as well as the number of flu hospitalizations
          and deaths. CDC will also look at the geographic spread of flu-like illness and changes
          in the virus. By comparing data with historical seasonal flu trends and trends during
          the H1N1 flu situation in spring 2009, CDC will be able to provide advice to state
          and local agencies on appropriate steps to take. The impact of flu in the fall and
          winter 2009 will likely vary from state to state and community to community. States,
          communities, and institutions should consider:
             u who needs to be involved in the decision-making process, and include those
                people in regular communications,
             u severity of the flu and its impact in the community, schools, and institutions of
                higher education,
             u capacity of the healthcare system to respond to local outbreaks, and
             u the goals, feasibility, and community’s acceptability of action steps being
                considered.


          Q. What are the most effective methods to communicate with
             students, faculty, and staff about the flu?
          	 u Consider all possible channels to reach these audiences. In addition to
                traditional media such as local news, radio, and newspapers, consider using
                the institution’s Web site as well as new media channels such as Facebook,
                MySpace, and Twitter. For more information about social media tools visit:
                www.cdc.gov/SocialMedia/Campaigns/H1N1.
             u Consider placing “on hold” messages on your institution’s telephone system
                and changing the information frequently. “On hold” messages are pre-recorded
                messages that play while someone is waiting for the phone to be answered.
             u Determine if there is a need to translate any of the communication materials
                into other languages.
             u Provide regular briefings for staff who interact with media, parents/guardians,
                the community, legislators, etc. Make sure staff have access to the most up-
                to-date information regarding the flu and the institution’s flu response plan,
                including suspension of any classes and the cancellation of any events.




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Q. How should institutions communicate with parents of students
   attending the institution or participating in study abroad
   programs sponsored by the institution?
Develop specific information targeted to students’ parents and provide it through
communication channels that they use, such as the institution’s Web site. Parents will
be concerned about issues at institutions ranging from their child’s safety and health
to the possibility of classes being suspended. Consider creating a special section or
page on the Web site for information specifically for parents.
Parents of students in a study abroad program will want to stay informed of
situations affecting their child and the program. Encourage parents to advise their
child to use good judgment and to take precautions against getting the flu in the
country where they are studying and living, as well as in any countries to which they
may travel.
Institutions should continuously assess the flu situation in countries where they
have students in study abroad programs. Review policies for study abroad programs,
including how students can access health services abroad, how illness will be reported
to the institutions, resources for students abroad who are unable to travel back to
the U.S., and any legal liability issues. Health information for travelers, including
students studying abroad can be found at www.cdc.gov/travel.


Q. What other populations should institutions take into
   consideration when preparing for the flu season?
Institutions should review their policies and consider the special needs of certain
student populations such as students studying abroad, high school students taking
college classes, special education students, and health-care professional students.


Q. As a parent of a student who attends an institution,
   should I bring them home?
If possible, residential students with flu-like illness whose families live relatively
close to the campus should go home to self-isolate. They should return home in a
way that limits contact with others as much as possible. For example, travel by
private car or taxi would be preferable over use of public transportation. They
should stay away from other people until at least 24 hours after they no longer
have a fever (100 degrees Fahrenheit or 38 degrees Celsius) or signs of a fever (have
chills, feel very warm, have a flushed appearance, or are sweating). This should
be determined without the use of fever-reducing medications (any medicine that
contains ibuprofen or acetaminophen). If flu severity increases, students at higher
risk for flu complications including students, faculty, and staff with certain chronic
medical conditions like heart disease, diabetes, or asthma, or who are pregnant may
consider staying home while flu transmission is high in their institution community.
Currently, the CDC is not recommending removing healthy students from their
institutions.




                                                                                         3 of 13
          Q. Should my child who is a student at an institution get antiviral
             medicine if they get sick?
          Parents should make sure their child knows if he or she is at higher risk for flu
          complications. People at higher risk for flu complications including students, faculty,
          and staff with certain chronic medical conditions (such as asthma, heart disease, or
          diabetes) who become sick with flu-like illness should call their health care provider
          as soon as possible to determine if they need antiviral treatment. Early treatment
          with antiviral medicines often can prevent hospitalizations and deaths. Parents
          should encourage sick students who are at higher risk for flu complications to seek
          early treatment. Antiviral medicines are not given to all people during flu season
          because most people get better on their own, over-use can promote antiviral-resistant
          viruses, and administration of antiviral medicines can cause adverse reactions in
          some people.


          Steps for Institutions of Higher Education to Help Keep Students,
          Faculty, and Staff Healthy during Current Flu Conditions

          Q. What steps can institutions take to keep students, faculty,
             and staff healthy?
          	 u Separate people who are sick from those who are well as soon as possible.
             u Encourage good hand hygiene and respiratory etiquette through direct
                education, communication materials such as posters and flyers, and other
                methods including e-mail, text messaging, or phone calls.
             u Establish a method for maintaining contact with students who are sick. If
                resources permit, student affairs staff, housing staff, or health care providers
                could be assigned to make daily contact with each student.
             u Encourage sick people to stay at home or in their residence except to talk with
                a health care provider about whether they have flu, appropriate treatment, and
                what actions to take if they have severe symptoms.
          	 u Encourage students, faculty, and staff living off campus to stay at home if they
                are sick with flu-like illness. They should stay home until they are free of fever
                for at least 24 hours.
          	 u Discourage visitors with flu-like illness from attending institution-sponsored
                events until they are free of fever for at least 24 hours.
          	 u Examine and revise, as necessary, current flu (or crisis) response plans and
                procedures, and update contact information.
          	 u Communicate with vendors who supply critical products and services, including
                hygiene supplies, food service, and personal protective equipment for staff, to
                address the continuation of these products and services throughout the flu
                season.
          	 u Encourage any students, faculty, and staff who want protection from flu to get
                vaccinated for seasonal flu. Also encourage students, faculty, and staff who are at




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      higher risk for flu complications from 2009 H1N1 flu to receive the H1N1 vaccine
      when it becomes available. People at higher risk for 2009 H1N1 flu complications
      include pregnant women and people with chronic medical conditions (such as
      asthma, heart disease, or diabetes). For more information about priority groups
      for vaccination, visit www.cdc.gov/h1n1flu/vaccination/acip.htm.


Q. What steps can students, faculty, and staff take to stay healthy
   and keep from spreading the flu?
Here are four important ways faculty, students, and staff can stay healthy and keep
from getting sick with flu or spreading the flu. They can:
	 u Practice good hand hygiene. They should wash their hands often with soap and
      water, especially after coughing or sneezing. Alcohol-based hand cleaners are
      also effective.
	 u Practice respiratory etiquette. The main way flu spreads is from person to
      person in droplets produced by coughs and sneezes, so it’s important that people
      cover their mouth and nose with a tissue when they cough or sneeze. If they
      don’t have a tissue, they should cough or sneeze into their elbow or shoulder,
      not their hands.
	 u Stay home if they are sick. Stay home or in their place of residence for at least
      24 hours after they no long have a fever.
	 u Talk to their health care providers about whether they should be vaccinated.
      Students, faculty, and staff who want protection from the flu can be
      encouraged to get vaccinated for seasonal flu. Also students, faculty, and
      staff who are at higher risk for flu complications from 2009 H1N1 flu, should
      consider getting the H1N1 vaccine when it becomes available. People at
      higher risk for 2009 H1N1 flu complications include pregnant women and
      people with chronic medical conditions (such as asthma, heart disease, or
      diabetes).
      For more information about priority groups for vaccination, visit
      www.cdc.gov/h1n1flu/vaccination/acip.htm.
Students, faculty, and staff should take personal responsibility to help slow the spread
of the flu virus. By practicing these steps, they can keep from getting sick from flu and
help protect others from getting the flu.


Q. What are some ways institutions can encourage good
   hand hygiene?
	 u Make soap, paper towels, and alcohol-based hand cleaners readily available.
	 u Educate all students, faculty, and staff about good hand hygiene through direct
      education and communication materials such as posters and flyers.




                                                                                            5 of 13
          Q. What are some ways institutions can encourage good
             respiratory etiquette?
          The main way flu spreads is from person to person in droplets produced by coughs
          and sneezes. Institutions can encourage good respiratory etiquette through
          	 u direct education and by posting and disseminating communications materials
                such as flyers and posters, and
          	 u making sure tissues and no-touch wastebaskets are readily available.


          Q. What does CDC recommend regarding routine cleaning
             of institutions?
          	 u Establish regular schedules for frequent cleaning of commonly touched surfaces,
                including:
                 • doorknobs, handrails, elevator buttons,
                 • desks, tables, chairs, sofas, and
                 • counters and surfaces in cafeterias, meeting rooms, and offices.
          	 u Provide disposable wipes so that commonly used surfaces can be wiped down
                prior to each use. These surfaces include:
                 • chairs, study carrels,
                 • remote controls,
                 • keyboards,
                 • headphones shared in language laboratories, and
                 • telephone receivers and touchtone pads in common areas.
          	 u Encourage students to frequently clean their living quarters. Students living
                together should regularly clean frequently used surfaces.
          	 u Routinely clean surfaces and items that people frequently touch with their
                hands with cleaning agents that are usually used in these areas. Additional
                disinfection beyond routine cleaning is not recommended.


          Q. Who should receive a flu vaccination?
          Vaccines will be available this year to protect against seasonal flu. Children 6 months
          through 18 years of age, people of any age with chronic medical conditions (such
          as asthma, heart disease, or diabetes), and everyone age 50 and older should be
          vaccinated against seasonal flu as early as possible.
          The 2009 H1N1 flu vaccine should be available in the fall of 2009. Certain groups at
          higher risk for complications from this flu are recommended to get the 2009 H1N1 flu
          vaccine when it first becomes available. These groups include:
          	 u pregnant women,
          	 u people who live with and care for children younger than 6 months of age,
          	 u healthcare and emergency medical services personnel,
          	 u people between the ages of 6 months and 24 years (this includes most students
                attending institutions of higher education), and
          	 u people ages 25–64 years of age who have chronic health conditions (such as
                asthma, heart disease, or diabetes) or compromised immune systems.



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Q. Should institutions provide vaccinations for seasonal and
   2009 H1N1 flu?
Institutions should consider working with their local public health partners to have
on-site vaccination clinics for seasonal and 2009 H1N1 flu, when available. Information
about 2009 H1N1 flu vaccination can be found at: www.cdc.gov/h1n1flu/vaccination.
Information about seasonal flu vaccine can be found at www.cdc.gov/flu/protect/
keyfacts.htm.


People at Higher Risk for Complications

Q. Which students, faculty, and staff are at higher risk for
   complications from flu?
Anyone can get the flu (even healthy people) and anyone can have serious problems
from the flu. Students, faculty, and staff should be encouraged to talk with their
health care provider to determine if they are at higher risk for flu complications,
especially if they have been in close contact with others who are sick with flu or
flu-like illness.
Some groups are at higher risk for complications from the flu. These include children
younger than 5 years of age, pregnant women, people of any age with chronic health
conditions (such as asthma, diabetes, or heart disease) and people 65 years of age
and older.


Q. What actions should pregnant students, faculty, or staff take to
   protect themselves from the flu?
Pregnant women should follow the same guidance as the general public related to
staying home when sick, hand hygiene, respiratory etiquette, and routine cleaning.
Pregnant women are at higher risk of complications from flu and, like all people
at higher risk, should speak with their health care provider as soon as possible
if they develop flu-like symptoms. Early treatment with antiviral flu medicines
is recommended for pregnant women who have the flu; these medicines are most
effective when started within the first 48 hours of feeling sick.
Pregnant women should know that they are part of the first priority group to
receive the 2009 H1N1 flu vaccine when it becomes available. Seasonal flu vaccine
is also recommended for pregnant women and can be given at any time during
pregnancy.




                                                                                          7 of 13
          Symptoms

          Q. What are the symptoms of seasonal flu and the 2009 H1N1 flu?
          Symptoms of flu include fever or chills and cough or sore throat. In addition,
          symptoms of flu can include runny nose, body aches, headache, tiredness, diarrhea,
          or vomiting.


          Q. How do I recognize a fever or signs of a fever?
          A fever is a temperature that is equal to or greater than 100 degrees Fahrenheit or
          38 degrees Celsius when taken with a thermometer. Look for these possible signs
          of fever: if he or she feels very warm, has a flushed appearance, or is sweating or
          shivering.


          Q. How do I know if someone has 2009 H1N1 flu or seasonal flu?
          It will be very hard to tell if someone who is sick has 2009 H1N1 flu or seasonal flu.
          Public health officials and medical authorities will not be recommending laboratory
          tests. Anyone who has the symptoms of flu-like illness should stay home and not go
          to work.
          Symptoms of flu include fever or chills and cough or sore throat. In addition,
          symptoms of flu can include runny nose, body aches, headache, tiredness, diarrhea, or
          vomiting.


          Q. What fever-reducing medications can students, faculty, and staff
             take when sick?
          Fever-reducing medications are medicines that contain acetaminophen (such as
          Tylenol) or ibuprofen (such as Motrin). These medicines can be given to people
          who are sick with flu to help bring their fever down and relieve their pain. Aspirin
          (acetylsalicylic acid) should not be given to anyone younger than 18 years of age
          who have flu; this can cause a rare but serious illness called Reye’s syndrome.




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Steps for Institutions of Higher Education to Prevent the Spread
of Flu under Current Flu Conditions

Q. What steps can institutions take to keep sick students, faculty,
and staff from spreading flu?
There are several steps that institutions can take during current flu conditions:
	 u Encourage sick students, faculty, and staff to stay home and away from other
      people until at least 24 hours after they no longer have a fever (100 degrees
      Fahrenheit or 38 degrees Celsius) or signs of a fever (have chills, feel very
      warm, have flushed appearance, or are sweating). This should be determined
      without the use of fever-reducing medications (any medicine that contains
      ibuprofen or acetaminophen).
   u If possible, sick students, faculty, and staff members who live in campus-
      sponsored housing should return to their family’s home.
   u Ask sick students with private rooms to remain in their own rooms and receive
      care and meals from one person, if possible.
   u Consider providing temporary, alternate housing for sick people who cannot
      leave campus where they can stay until 24 hours after they are free of fever.
   u Establish a method for maintaining contact with students who are sick. If
      resources permit, student affairs staff, housing staff or health care providers
      could be assigned to make daily contact with each student.
   u Communicate and instruct students to promptly seek medical attention if
      they have a medical condition that places them at higher risk of flu-related
      complications, are concerned about their illness, or develop severe symptoms.
      Severe symptoms include increased fever, shortness of breath, chest pain or
      pressure, fast breathing, bluish skin color, vomiting, dizziness or confusion.


Q. What is self-isolation?
Self-isolation is when sick people stay home and away from other people until they no
longer have a fever (100 degrees Fahrenheit or 38 degrees Celsius) or signs of a fever
(have chills, feel very warm, have flushed appearance, or are sweating). This should be
determined without the use of fever-reducing medications (any medicine that contains
ibuprofen or acetaminophen). During the period of self-isolation, sick people should
limit contact with others and try to maintain a distance of at least 6 feet from people.
If close contact cannot be avoided, sick people should wear a surgical mask when they
are around other people, if they can tolerate it.
During current flu conditions, people who are sick should stay home and away from
other people until at least 24 hours after they no longer have a fever or signs of a
fever. If flu conditions become more severe, those who are sick should stay at their
home, dormitory, or residence hall for at least 7 days, even if symptoms go away
sooner. People who are still sick after 7 days should continue to stay home until at
least 24 hours after symptoms have gone away.




                                                                                           9 of 13
           Q. What can institutions do to encourage students, faculty, and
              staff to stay in their homes, dormitories, or residence halls when
              they’re sick?
           For faculty and staff, consider adjusting sick leave policies to ensure they do not return
           to work or class while sick. For students, consider similarly altering policies to ensure
           that there are no academic consequences for staying home while sick (i.e., no punishment
           for missed classes and examinations, turning in assignments late, etc.). Institutions also
           should consider providing distance-based learning options, such as Web courses.


           Q. What should students or faculty members living on campus do if
              they get the flu?
           CDC recommends that people with flu-like illness remain at home and away from
           other people until at least 24 hours after they no longer have a fever (100 degrees
           Fahrenheit or 38 degrees Celsius) or signs of a fever (have chills, feel very warm, have
           a flushed appearance, or are sweating). This should be determined without the use of
           fever-reducing medications (any medicine that contains ibuprofen or acetaminophen).
           For those who cannot leave campus and return to their family’s home, if they live in
           a private room they should remain in their room and receive care from one person.
           Institutions may consider providing temporary, alternate housing where sick people
           can stay until 24 hours after they are free of fever.


           Q. What steps should I take if my roommate is sick with the flu?
           	 u You should limit your contact with your sick room and try to maintain a
                 distance of 6 feet from him or her.
               u If close contact cannot be avoided, your sick roommate should wear a surgical
                 mask, if tolerable, when he or she is around you and other people.
               u You should frequently clean commonly-touched surfaces.


           Q. How long should a student, faculty member, or staff member
              with the flu stay at home or in their residence?
           Under current flu conditions, faculty, students, and staff with flu-like symptoms should stay
           home for at least 24 hours after they no longer have a fever (100 degrees Fahrenheit or 38
           degrees Celsius) or signs of a fever (have chills, feel very warm, have a flushed appearance,
           or are sweating). This should be determined without the use of fever-reducing medications
           (any medicine that contains ibuprofen or acetaminophen). The sick person may decide to
           stop taking fever-reducing medicines as he or she begins to feel better. This person should
           continue to monitor his or her temperature until it has been normal for 24 hours.
           If flu conditions become more severe, the sick person should stay home or in their
           residence for 7 days. A person who is still sick after 7 days should stay home until 24
           hours after the symptoms have gone away. In addition, this longer period should be
           used in healthcare settings and may be considered anywhere a high number of people
           at higher risk for complications from flu may be exposed, such as childcare facilities.
           Sick people should stay at home or in their residence, except to go to the health care
           provider’s office, and they should avoid contact with others. Keeping people with a




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fever at home may reduce the number of people who get infected with the flu virus.
Because high body temperatures are linked with higher amounts of virus, people with
a fever may be more contagious.


Steps for Institutes of Higher Education under Severe Flu Conditions

Q. How will institutions of higher education know if the flu is more
   severe and they should consider taking additional action steps?
CDC and its partners will continue to monitor the spread of flu, the severity of
the illness it’s causing, and whether the virus is changing. State and local health
departments will also be on the lookout for increases in severe illness in their areas
and will provide guidance to their communities. Intuitions should work closely with
state and local public health officials to guide their flu response. Public health agencies
will communicate changes in severity and the extent of flu-like illness to ensure that
institutions have the information they need to choose the right steps to reduce the
impact of flu.


Q. What additional steps should institutions take to keep students,
   faculty, and staff from getting sick in the event that the flu
   becomes more severe?
If flu conditions become more severe, CDC may recommend the following additional
strategies and actions for institutions of higher education.
	 u Permit students, faculty, and staff at higher risk of complications from flu to
      stay home while there is a lot of flu in the community.
	 u Explore innovative methods to increase social distances between students while
      continuing to meet their educational needs. A few examples of increasing social
      distances include moving desks farther apart, leaving empty seats between
      students, holding outdoor classes, and using distance learning methods.
	 u Encourage students, faculty, and staff who are sick to stay at their home,
      dormitory, or residence hall for at least 7 days, even if symptoms go away
      sooner. People who are still sick after 7 days should continue to stay home until
      at least 24 hours after symptoms have gone away.
	 u Cancel, postpone, or discourage all institution-related and non-institution-
      related mass gatherings. These include sporting events, performances,
      commencement ceremonies, fraternity and sorority parties, and other events
      that bring large groups of people into close contact with one another.
	 u Suspend classes. Some institutions may choose to suspend classes when they
      cannot maintain normal functioning. And, CDC may recommend suspending
      classes if the flu starts causing severe disease in a lot of people. Institution
      administrators should work closely with their local and state public health
      officials when deciding whether or not to suspend classes. The length of time
      classes should be suspended depends on the goal of suspending classes and
      the severity of existing illness. If the decision is made to suspend classes, CDC
      recommends doing so for at least 5–7 calendar days.




                                                                                              11 of 13
           Q. What can institutions do to increase social distance during a
              more severe flu outbreak?
           Institution officials should think creatively about ways to increase the space between
           people, while keeping students in class. Not every method will be feasible for all
           institutions. However, it is important to consider options for social distancing if
           classes remain open.
           Options include:
           	 u holding classes outdoors,
           	 u distance-learning methods,
           	 u leaving vacant seats between students,
           	 u moving desks farther apart, and
           	 u moving classes to larger spaces to allow more space between students.



           Class Suspension

           Q. What does suspending classes mean during a flu outbreak?
           When classes are suspended at institutions, they are temporarily discontinued to slow
           or decrease the spread of flu. Institutions may choose to keep offices open for faculty
           and staff; however, students are directed to stay at home or in their residence.


           Q. What are the different types of class suspension?
           There are two types of class suspension:
           	 u Reactive class suspension is used when a majority of students and staff are sick
                 and are not attending classes, or the institution cannot maintain normal operations.
           	 u Preemptive class suspension is used early on during a community flu
                 response to decrease the spread of the flu before many students, faculty, and
                 staff get sick. This is based on information about the spread of severe flu in the
                 region. Class suspension is likely to be more effective when used early after flu
                 appears.
           If classes are suspended preemptively, all institution-related large gatherings should
           be canceled or postponed. This includes events such as lectures, films, concerts,
           sporting events, worship services, commencement, or other events that bring large
           groups of people into close contact with one another.




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Q. What should international students do if classes are suspended
   at a U.S. institution of higher education they are attending?
International students should follow all flu recommendations their institutions make
for students. During severe flu conditions if classes are suspended, international
students and others who do not have easy access to alternative housing should stay
on campus. Students should try to limit contact with other people. Institutions should
plan to continue education through distance-based learning methods for students who
remain on campus as well as those who leave to go home.


Q. Are there different recommendations for residential and
   non-residential students when an institution of higher
   education suspends classes?
Institutions with residential students should plan for ways to continue essential
services such as meals, custodial services, security, and other basic operations. When
possible, dismiss students, faculty, and staff who can drive home or who can go to the
nearby home of a relative, close friend of the family, or an international student’s host
family. Students who stay on campus should increase the distance between people
and minimize crowding.
Institutions with only non-residential students, such as commuter schools, should
consider allowing faculty and staff to continue using facilities while classes are not
being held. Keeping facilities open may allow faculty to develop lessons and materials,
to advise students through distance-based learning methods such as by telephone
calls and e-mail, and to engage in other essential activities, such as research projects.




                                                                                            13 of 13
 Fact Sheet for
 Institutions of
Higher Education
Action Steps for Institutions of Higher
Education to Prevent the Spread of Flu
Take the following steps to help keep students, faculty, and staff
from getting sick with flu.

During current flu conditions:
 Advise sick students, faculty, and staff to stay at home or in their residence

    until at least 24 hours after they no longer have a fever (100 degrees Fahrenheit or
    38 degrees Celsius) or signs of a fever (have chills, feel very warm, have a flushed
    appearance, or are sweating). This should be determined without the use of fever-
    reducing medications (any medicine that contains ibuprofen or acetaminophen).
 Establish a method for maintaining contact with students who are sick. If

    resources permit, student affairs staff, housing staff or health care providers could
    be assigned to make daily contact with each student.
 Encourage students and staff at higher risk of complications from flu to

 check with their health care provider about their options. People at higher
    risk of flu complications who get sick will benefit from early treatment with
    antiviral medicines.
 Encourage students, faculty, and staff to find out if they should get

 vaccinated against seasonal flu and 2009 H1N1 flu. Institutions should also
    consider offering opportunities for students, faculty, and staff to get vaccinated on
    campus for seasonal flu and 2009 H1N1 flu when vaccines are available.
 Discourage sick members of the public and sick visitors from attending

 institution-sponsored events until they are free of fever for at least 24 hours.
 Encourage students and staff to cover their mouths and noses with a

 tissue when they cough or sneeze. Also, provide them with easy access to tissues
    and running water and soap or alcohol-based hand cleaners. Remind them to cover
    coughs or sneezes using their elbow or shoulder instead of their hands when a
    tissue is not available.
 Establish regular schedules for frequent cleaning of surfaces and items

    that are more likely to have frequent hand contact such as desks, door knobs,
    keyboards, or counters, with cleaning agents that are usually used in these areas.
    Promote frequent cleaning of bathrooms and ensure adequate supplies of soap and
    paper towels.
 Provide disposable wipes so that commonly used surfaces such as chairs,

    remote controls, and keyboards shared by students can be wiped down prior to each
    use.
 Encourage students to frequently clean their living quarters. Students

    living together should frequently clean commonly-used surfaces such as doorknobs,
    refrigerator handles, remote controls, and countertops.




                                                                                            1 of 3
         If the flu conditions are MORE severe, institutions should
         consider adding the following steps:
          Allow students, faculty, and staff at higher risk for complications to stay
         
          home. These students, faculty, and staff should make this decision in consultation
             with their health care provider. Try to come up with ways for work or study to
             continue from home.
          Find
          ways to increase social distances (the space between people) in
             classrooms such as moving desks farther apart, leaving empty seats between
             students, holding outdoor classes, and using distance learning methods.
          Extend the time sick students, faculty, or staff stay home or in their
         
          residence to at least 7 days, even if they feel better sooner. Those who are still sick
             after 7 days should continue to stay home until at least 24 hours after symptoms
             have gone away. Symptoms of flu include fever or chills and cough or sore throat. In
             addition, symptoms of flu can include runny nose, body aches, headache, tiredness,
             diarrhea, or vomiting.
          Consider how and when to suspend classes by working closely with your local
         
             and state public health officials. The length of time classes should be suspended
             depends on your goal for suspending classes and the severity and extent of illness.




2 of 3
Follow these steps to prepare for the flu during
the 2009-2010 academic year:

 Review and revise current flu (or emergency) response plans and procedures,
    including plans protect to higher risk students, faculty, and staff.

 Collaborate with the local health department, community organizations, local
    businesses, and social services on a plan for flu response.

 Communicate with vendors who supply critical products and services, to ensure
    this will continue when flu conditions are more severe.

 Update student, faculty, and staff contact information as well as emergency contact
    lists.

 Identify and establish points of contact with the local public health and education
    agencies.

 Develop a plan to cover key staff positions at your institution’s health clinics.

 Encourage good hand hygiene and respiratory etiquette through direct education,
    communication materials such as posters and flyers, and other methods including
    e-mail, text messaging, or phone calls.

 Develop communication materials (e.g., letters to parents, Web site postings) that
    can be used to inform students, faculty, staff, and parents about your institution’s
    flu response. Check out Preparing for the Flu: A Communication Toolkit for
    Institutions for Higher Education for basic information and communication
    resources such as letters and announcements. The toolkit is available at
    www.flu.gov/plan/school/higheredtoolkit.html.

 Consider adjusting sick leave policies so sick faculty and staff can stay home.
    Review policies for students to ensure that there are no negative academic
    consequences for staying home while sick.

 Develop a plan and options for how work can be continued at home (e.g., homework
    packets, Web-based lessons, phone calls), if institutions suspend classes.
 students, faculty, and staff understand the important roles they can play in
 Help
    reducing the spread of flu.




                           For more information:
                           	       	Visit: www.flu.gov
                           	       	Contact CDC 24 Hours/Every Day
                                       1 (800) CDC-INFO (232-4636)
                                       TTY: (888) 232-6348
                                       cdcinfo@cdc.gov




                                                                                           3 of 3
  Fact Sheet for
    Students,
Faculty, and Staff
Action Steps for Students, Faculty, and Staff
to Prevent the Spread of Flu
The Centers for Disease Control and Prevention (CDC)
recommends 4 main ways you may keep from getting sick
with the flu:
1.    Practice good hand hygiene by washing your hands often with soap and
      water, especially after coughing or sneezing. Alcohol-based hand cleaners are also
      effective.
2.    Cover your mouth and nose with a tissue when you cough or sneeze. If
      you don’t have a tissue, cough or sneeze into your elbow or shoulder; not into your
      hands.
3.    Stay home or at your place of residence if you are sick for at least 24 hours
      after you no longer have a fever (100 degrees Fahrenheit or 38 degrees Celsius)
      or signs of a fever (have chills, feel very warm, have a flushed appearance, or
      are sweating). This should be determined without the use of fever-reducing
      medications (any medicine that contains ibuprofen or acetaminophen). Staying
      away from others while sick can prevent others from getting sick too. Ask a
      roommate, friend, or family member to check up on you and to bring you food and
      supplies if needed.
4.    Talk to your health care provider to find out if you should be vaccinated for
      seasonal flu and/or 2009 H1N1 flu. Information about 2009 H1N1 flu vaccination
      can be found at: www.cdc.gov/h1n1flu/vaccination. Information about seasonal flu
      vaccine can be found at: www.cdc.gov/flu/protect/keyfacts.htm.

If flu conditions become MORE severe, students, faculty,
and staff should consider the following steps:
 Extend the time you stay home or at your residence to at least 7 days, even if

     you feel better sooner. If you are still sick after 7 days, continue to stay home until
     at least 24 hours after your symptoms have completely gone away. Symptoms of flu
     include fever or chills and cough or sore throat. In addition, symptoms of flu can
     include runny nose, body aches, headache, tiredness, diarrhea, or vomiting.
 Prepare for the possibility suspension of classes by planning to continue your

     work at home (e.g., homework packets, Web-based lessons, phone calls), and find a
     place where you can stay either by going to your home, home of a relative, or close
     friend of the family.




                                                                                               1 of 2
         Follow these steps now to prepare for the flu during the
         2009-2010 flu season:
          your mouth and nose with a tissue when you cough or sneeze. Cover coughs
          Cover
             or sneezes using your elbow or shoulder instead of your hands when a tissue is not
             available.
          your hands often with soap and water, especially after coughing or sneezing.
          Wash
             Alcohol-based hand cleaners are also effective.
         
          Frequently clean your living quarters. If you live together with other students, you
             should frequently clean commonly-used surfaces such as doorknobs, refrigerator
             handles, remote controls, computer keyboards, countertops, faucet handles, and
             bathroom areas.
          to monitor your health by checking for fever and other symptoms of flu.
          Plan
          with your health care provider if you are at higher risk for complications from
          Talk
             flu.
         
          Update emergency contact lists.
         
          Learn more about your institution’s pandemic response plan.




                                    For more information:
                                    	       	Visit: www.flu.gov
                                    	       	Contact CDC 24 Hours/Every Day
                                                1 (800) CDC-INFO (232-4636)
                                                TTY: (888) 232-6348
                                                cdcinfo@cdc.gov




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Stop! Do You Feel Sick?
        Poster
Do you feel sick?



You may have the flu if you have fever or chills
                     AND
           a cough or sore throat
        You may also have a runny nose, body aches,
        a headache, tiredness, diarrhea, or vomiting

       If you think you have the flu,
     stay home or in your residence,
       except to get medical care.
For more information visit www.flu.gov
or call 1 (800) CDC-INFO (232-4636)
                                                       CS206260-B
Template Letter (or E-mail)
  for Students, Faculty,
    Staff, and Parents
Template Letter (or E-mail) to
Students, Faculty, Staff, and Parents during
Current Flu Conditions
 Coordinate efforts with your local health department before distributing

    this letter or e-mail to ensure that all information is timely, relevant, and
    accurate.
 Advise students, faculty, staff, and parents on where to obtain specific

    information about your institution’s flu response.
 Visit
 www.flu.gov/plan/school/higheredtoolkit.html to download a Microsoft
    Word version letter of this letter or e-mail that you can modify with
    additional flu information for these important audiences.

Dear students, faculty, staff and parents,

As you may know, flu can be spread easily from person to person. Therefore, we are
taking steps to prevent the spread of flu at [name of institution] for as long as possible,
but, we need your help to accomplish this.
We are working closely with the [County/State] health department to monitor flu
conditions and make decisions about the best steps to take concerning our institution.
We will keep you updated with new information as it becomes available to us.
For now, we are doing everything we can to keep our institution operating as usual.
Here are a few things you can do to help:
 Practice good hand hygiene by washing your hands with soap and water,

    especially after coughing or sneezing. Alcohol-based hand cleaners also are
    effective.
 Practice respiratory etiquette by covering your mouth and nose with a tissue

    when you cough or sneeze. If you don’t have a tissue, cough or sneeze into your
    elbow or shoulder, not into your hands. Avoid touching your eyes, nose, or mouth;
    germs are spread this way.
 Know the signs and symptoms of the flu. A fever is a temperature taken with a

    thermometer that is equal to or greater than 100 degrees Fahrenheit or 38 degrees
    Celsius. Look for possible signs of fever: if the person feels very warm, has a flushed
    appearance, or is sweating or shivering.
 Stay
 home if you have flu or flu-like illness for at least 24 hours after you
 no longer have a fever (100 degrees Fahrenheit or 38 degrees Celsius) or signs of
    a fever (have chills, feel very warm, have a flushed appearance, or are sweating).
    This should be determined without the use of fever-reducing medications (any
    medicine that contains ibuprofen or acetaminophen). Don’t go to class or work.
 Talk
 with your health care providers about whether you should be
 vaccinated for seasonal flu. Also if you are at higher risk for flu complications
    from 2009 H1N1 flu, you should consider getting the H1N1 vaccine when it
    becomes available. People at higher risk for 2009 H1N1 flu complications include
    pregnant women and people with chronic medical conditions (such as asthma,
    heart disease, or diabetes). For more information about priority groups for
    vaccination, visit www.cdc.gov/h1n1flu/vaccination/acip.htm.
If this year’s flu season becomes more severe, we may take the following additional
steps to prevent the spread of the virus:
 Allow students, faculty, and staff at higher risk for complications to stay

 home. These students, faculty, and staff should make this decision in consultation
    with their health care provider.
 Find
 ways to increase social distances (the space between people) in
    classrooms such as moving desks farther apart, leaving empty seats between
    students, holding outdoor classes, and using distance learning methods.
 Extend the time sick students, faculty, or staff stay home or in their

 residence. During severe flu conditions sick people should stay home for at least
    7 days, even if they feel better sooner. Those who are still sick after 7 days should
    continue to stay home until at least 24 hours after symptoms have gone away.
    Symptoms of flu include fever or chills and cough or sore throat. In addition,
    symptoms of flu can include runny nose, body aches, headache, tiredness, diarrhea,
    or vomiting.
 Suspend classes. This decision will be made together with local and state public

    health officials. The length of time classes should be suspended will depend on the
    goal of suspending classes as well as the severity and extent of illness.
For more information about flu in our community and what our institution is doing,
visit [institution’s Website] or call [appropriate phone number].
[If your institution has a study abroad program, include information on where students
and parents can go to get more information about flu response while abroad. Include
your institution Web site and also www.cdc.gov/travel for health information for students
studying abroad.]
For the most up-to-date information on flu, visit www.flu.gov, or call 1-800-CDC-INFO
(232-4636).
We will notify you by [e-mail, institution’s Web site, text message, Facebook, Twitter,
campus information center, etc.] of any additional changes to our institution’s strategy to
prevent the spread of flu on our campus.


Sincerely,


[Institution administrator’s name and signature]
Template Announcements
  for Students, Faculty,
    Staff, and Parents
Announcement 1: If You are Sick with the Flu

u This template can be customized and used as an announcement via e-mail, Web
  site, institution newsletter or newspaper, or other creative ways to reach students,
  faculty, staff, and parents.
            Primary Audience: Students, Faculty, and Staff
            Secondary Audience: Parents of Students and the Community
u Coordinate efforts with your local health department before distributing this
  letter or e-mail communication to ensure that all information is timely, relevant,
  and accurate.
u Visit www.flu.gov/plan/school/higheredtoolkit.html to download and customize
  a Microsoft Word version of this letter and to view more flu information to share
  with students, faculty, staff, and parents.


If you are sick with the flu, below are some tips on how to take care of yourself
and to keep others healthy.
       Know the signs and symptoms of flu. Symptoms of flu include fever
        or chills and cough or sore throat. In addition, symptoms of flu can
        include runny nose, body aches, headache, tiredness, diarrhea,
        or vomiting.

       Stay home or at your place of residence if you are sick for at
        least 24 hours after there is no longer a fever (100 degrees Fahrenheit
        or 38 degrees Celsius) or signs of a fever (have chills, feel very warm,
        have a flushed appearance, or are sweating). This should be determined
        without the use of fever-reducing medications (any medicine that
        contains ibuprofen or acetaminophen). Staying away from others while
        sick can prevent others from getting sick too. Ask a roommate or friend
        to check up on you and to bring you food and supplies if needed.

       [Insert information here if your institution has a plan for temporary or
        alternate housing for sick students who cannot leave campus and do not
        have a private room.]

       Cover you mouth and nose with a tissue when coughing or
        sneezing.
       Wash your hands often with soap and water, especially after
        coughing or sneezing. Alcohol-based hand cleaners are also effective
        if soap and water are not available.

       Avoid touching your eyes, nose, or mouth. Germs spread this
        way.

       Sick people should stay at home or in their residence, except
        to go to the health care provider’s office.

       Stay in a separate room and avoid contact with others. If
        someone is caring for you, wear a mask, if available and tolerable,
        when they are in the room.

       Drink plenty of clear fluids (such as water, broth, sports drinks,
        and electrolyte beverages for infants) to keep from becoming
        dehydrated.

       Contact your health care provider or institution’s health
        services if you are at higher risk for complications from flu
        for treatment. People at higher risk for flu complications include
        children under the age of 5 years, pregnant women, people of any age
        who have chronic medical conditions (such as asthma, diabetes, or
        heart disease), and people age 65 years and older.

       Contact a healthcare provider [or go to the health services clinic]
        right away if you are having difficulty breathing or are getting worse.


For specific information on how to take care of someone who is sick, visit:
www.cdc.gov/h1n1flu/guidance_homecare.htm


For more information about flu, call 1-800-CDC-INFO or visit www.flu.gov.
Announcement 2: Classes Remain in Session during
Current Flu Conditions

u This template can be customized and used as an announcement via e-mail, Web
  site, institution newsletter or newspaper, or other creative ways to reach students,
  faculty, staff, and parents.
            Primary Audience: Students, Faculty, and Staff
            Secondary Audience: Parents of Students and the Community
u Coordinate efforts with your local health department before distributing this
  letter or e-mail communication to ensure that all information is timely, relevant,
  and accurate.
u Visit www.flu.gov/plan/school/higheredtoolkit.html to download and customize
  a Microsoft Word version of this letter and to view more flu information to share
  with students, faculty, staff, and parents.


The flu season will last through the fall and winter. More than one kind of flu
virus will be spreading this season, including seasonal flu and the 2009 H1N1 flu.
We encourage all students, faculty, and staff to follow these recommendations to
stay healthy.

      Practice good hand hygiene by washing your hands often with soap
       and water, especially after coughing or sneezing. Alcohol-based hand
       cleaners are also effective.

      Cover your mouth and nose with a tissue when you cough or
       sneeze. If you don’t have a tissue, cough or sneeze into your elbow or
       shoulder; not into your hands.

      Talk with your health care providers about whether you should
       be vaccinated for seasonal flu. Also if you are at higher risk for flu
       complications from 2009 H1N1 flu, you should consider getting the
       H1N1 vaccine when it becomes available. People at higher risk for
       2009 H1N1 flu complications include pregnant women and people with
       chronic medical conditions (such as asthma, heart disease, or diabetes).
       For more information about priority groups for vaccination, visit
       www.cdc.gov/h1n1flu/vaccination/acip.htm.
At this time, students, faculty, and staff who are NOT sick can safely
come to class and to work. We are working closely with the [County/
State] health department and will keep you updated with any
important information regarding the current flu conditions.

We will continue to monitor the flu situation as it develops and will keep you
informed of any changes.

For updates, call the [insert name of institution] information center at
[INSERT NUMBER], visit our Web site at [INSERT WEB SITE ADDRESS] or
follow us on Twitter at [INSERT WEB ADDRESS]. For more information about
flu, call 1-800-CDC-INFO or visit www.flu.gov.
Text Messages for
Students, Faculty,
Staff, and Parents
Text Messages for Institutions of Higher Education to
Send to Students, Faculty, and Staff
The following messages can be sent from institutions of higher education to students,
faculty, and staff through cell phone text messaging, Twitter, Facebook, and other social
network channels.



Status of Classes Classes continuing in session. Call campus information center at
                      [XXX-XXXX] or visit our Web site for more info.

                      Classes suspended due to flu. Call campus information center at
                      [XXX-XXXX] or visit our Web site for more info.

                      Classes resuming on [INSERT DATE/TIME]. Call campus
                      information center at [XXX-XXXX] or visit our Web site for
                      more info.


      Prevention Wash hands often or use alcohol-based hand cleaner. Wipe
                      commonly touched surfaces such as doorknobs, keyboards,
                      telephone, etc.


 If You Are Sick If you’re sick with fever or chills AND a cough or sore throat -
                      don’t come to class.

                      If you’re sick, stay home for 24 hrs after your fever has gone away.


       Symptoms You may have the flu if you have fever or chills
                      AND a cough or sore throat.

                      What to Do If You Get Flu-Like Symptoms http://bit.ly/hvsaS


       More Flu Get important 2009 H1N1 flu info from the mobile CDC Website
    Information at http://m.cdc.gov [If sent through Twitter add “ReTweet this!”]

                      2009 H1N1 Flu and You. Q&A from CDC
                      www.cdc.gov/h1n1flu/qa.htm
  Additional
Communication
  Resources
Additional Communication Resources for
Institutions of Higher Education
to Share with Students, Faculty and Staff

CDC Posters about Flu Prevention for Institutions
Use the following posters and fact sheets in your classrooms, hallways, and around
campus to educate students, faculty, and staff about ways to prevent the spread of flu.
www.cdc.gov/germstopper/materials.htm (available in different sizes and
languages)




                                                                                          1 of 4
         Other Posters about Flu Prevention for Institutions
         www.publichealth.va.gov/flu/materials (includes other posters, brochures,
         buttons, stickers, and other materials)




2 of 4
CDC Fact Sheets and Other Materials about Flu Prevention
for Students, Faculty, and Staff

Stopping Germs at Home, Work and School
www.cdc.gov/germstopper/home_work_school.htm (available in English and other
languages)


2009 H1N1 Flu: Flyers & Other Print Materials
www.cdc.gov/h1n1flu/flyers.htm (includes brochures, flyers, fact sheets, and other
materials about 2009 H1N1 flu and seasonal flu)




                                                                                     3 of 4
         Widgets
         A widget is an application that displays the featured content directly on your Web
         page. Once you’ve added the widget to your Web site, there’s no maintenance. When
         CDC.gov updates content, your site will be updated automatically. You will have up-
         to-date, credible health information on your Web page.
         You can easily add a CDC widget to your Web page. Use CDC widgets to keep your
         students, faculty, and staff informed about flu. When they click on the widget, your
         Web page displays the featured, up-to-date content.


         CDC’s flu widgets are available at www.cdc.gov/widgets. For more CDC social media
         tools, go to: www.cdc.gov/socialmedia/h1n1.


         Flu.gov widgets are available at www.hhs.gov/web/library/hhsfluwidgets.html.
         For more Flu.gov social media tools, go to www.flu.gov/news/socialmedia.


         Sample Widgets




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