Be it with regard to natural, accidental or intentional means, public health has always been under threat. As is the case with the current COVID 19 pandemic, public health preparedness to prevent, respond to and recover is key for securing country’s overall development and growth.

1. 2020
Public Health Preparedness Planning for Strengthening
Capabilities During Pandemics
A Plan – Do – Checklist Guiding Document
Eco Endeavourers Network
Striving for the Planet in Peril
Dr. Prachi Ugle Pimpalkhute,
Founder, Eco Endeavourers Network
Sachin Pimpalkhute,
Co-Founder, Eco Endeavourers Network
Email : prachiugle@gmail.com
Contact Number: 9819098068

2. This guidance document is an update prepared based upon current
pandemic COVID 19. It is prepared with the aim to plan, prepare and
prioritize public health emergencies of such sudden and intense
intensity and action needed to tackle it, from India’s perspective
Lockdowns are not the solution to stop the surge of COVID 19 Pandemic, a strategic,
timely and robust method of preparedness planning and implementation shall steer
through good health, economic progress and wellness everywhere

3. Plan, Do, Checklist Guiding Document – for strategic planning –
Strengthening Public Health Preparedness Capabilities
Be it with regard to natural, accidental or intentional means, public health has always been under
threat. As is the case with the current COVID 19 pandemic, public health preparedness to
prevent, respond to and recover is key for securing country’s overall development and growth.
To work upon public health preparedness at the local and state level basis, the following public
health capabilities are of utmost importance:
 Surveillance
o Public Health Laboratory Testing
o Public Health Surveillance and Epidemiological Investigation
 Community Resilience
o Community Preparedness
o Community Recovery
 Measures and Mitigation
o Medical countermeasures and dispensing
o Medical resource/material management and distribution
o Non- Pharmaceutical Interventions
o Safety and Health Response
 Incident /Event Management
o Emergency Operations Coordination
 Information Management
o Emergency public health information, risks and warning
o Information sharing
 Surge Management
o Fatality management
o Mass care and medical surge
o Volunteer management
 Let’s align public health preparedness across all national programmes
 Focus on strengthening the capabilities and capacities most applicable
 Let’s make it an everyday use document and with systematic approach

4. Key Resource Elements for Preparedness
Suggestive Actions for Preparedness Planning – Systematic Model Approach
Source: Centre for Disease Control and Prevention (CDC) Model
Planning : Shall include existing operational plans, standard
operating procedures and/or emergency operations plans.
Skills and Training : The baseline know-how and skills
required to develop core competencies among staff /employees
Equipment and Technology: Priority critical resource
equpiment and its requisite technology
Assess current status
Assessing
organizational role
and responsibilities
Assessing
Resource Element
Assessing
Performance
Determing
Goals/Targets
Review
jurisdictional
inputs
Prioritize
capabilities and
functions
Develop short
term and long
term goals
Developing Plans
Plan
organizational
initiatives
Plan capability
building and
sustain activities
Plan capability
evaluation and
demonstrations

5. Can we move ahead towards generic preparedness planning?
The current COVID 19 pandemic and the subsequent future threats have made countries to review,
adapt, learn from the current situation and execute planning strategies for preparing towards large
scale health emergencies. Most often earlier plans were confined to handle or tackle a particular
calamity or with regard to particular disease and the health coverage too was restricted to the
treatment pertaining to it. In recent times with the advent of SARS, there was growing realization
of increased pandemic incidence which shall render huge mortalities, loss of livelihood and incur
huge economic losses. Also influenza pandemic / (H1N1 pandemic) too raised cause of concern and
alarm for health authorities all over the world and proved the need of a coordinated approach and
well defined strategy to implement control measures. The focus of action under such strategies is
on conducting comparisons, drawing up plan do checklists, goals or milestones to reach which shall
provide mechanism for undertaking reviews, validations and tests and making recommendations
for improvements in national level preparedness planning. European Union (EU) have had
procedures in place to prepare for epidemics and pandemics, to reduce vulnerabilities and
incompatibilities, however what was unique in COVID 19 case was its sudden onset and surge
leading to huge losses. Drawing comparisons and review of European Union procedures could lead
to a more coordinated approach and stronger communication system of preparedness planning
With the advent of SARS, there came the realisation of the possibility of new, previously unknown
agents causing many casualties and huge economic losses. Extensive flooding and heat waves were
demonstrating the impact of climate change on health. Moreover, an influenza pandemic is a
permanent cause of concern for health authorities all over the world, and the recent pandemic
(H1N1) has shown the importance of a coordinated approach and well defined and thoroughly
developed structures for the success of any control measures taken.
A question raised via this primer is can move ahead towards generic preparedness planning? A
definite yes was the answer to it, the reasoning is explained as follows: We have had emergency or
contingency or crisis management plans (including how to steer through business continuity plans)
which were applied for general purposes or applicable to situations such as natural disasters, man-
made disasters major fires, industrial accidents. However, the current requirement is of generic
emergency management plan which shall include range of activities to protect communities,
properties and assets, environment – having a comprehensive multi-sectoral and intersectoral
approach that encompasses elements relevant in ensuring a vigilant and prepared community. The
multi-sectoral approach means involvement of various levels of government and expertise with
different areas of skill sets, including policy development, legislative review and drafting, human
population, patient health care, laboratory diagnosis, laboratory test development, communication
expertise and disaster management. Community involvement means optimal use of knowledge,
expertise, resources and networks at the local level. It is the simplest yet effective way to enhance
support for policy decisions. Preparedness planning for health emergencies forms an essential
prerequisite component of generic emergency management plan. Generic approach shall help
reduce burden associated with health threat in terms of mortality and morbidity, hospitalization,
maintaining essential services, protecting vulnerable groups, minimizing economic and social
disturbances and return to near normal or normal once unlocking of lockdown is done. Generic
approach also provides an outline for developing core elements on the different types of health
threats and checklists of good preparedness practice.

6. Information Management
Before initiating know-how on how to strengthen capacities and capabilities during pandemics,
information management is an important prerequisite. Information management includes gathering,
handling, use and dissemination of information related to medical emergency: pre- and post-event
surveillance, risk analysis, clinical, laboratory and analysis of samples, monitoring the side-effects
etc. The pre-surveillance pre-requisites include: collection, collation, analysis and interpretation of
data and dissemination of information to taking necessary action and its implementation.
Pre-Surveillance
For early detection of potential public health emergencies of concern which may turn out to be a
major crisis, it is of utmost importance to have pre-surveillance tools and mechanisms in place to
decide whether the sudden onset of outbreak if it happens needs full priority across at all levels.
Plan Do Checklist: on pre- surveillance for incidents with public health consequences
Are the following basic requirements being fulfilled as per the criteria of pre-surveillance:
 Is the system for early recognition by medical practitioners and health care providers and
organizations in place?
 Is detection and verification of threat to public health in place?
 Is collation, survey, analysis, evaluation, screening of information provided by media and
other sources, and reporting of epidemic intelligence and disease surveillance data, with
detection capability for ‘suspicious’ events in place?
 Is the system for ‘rumour checking’ / fake news and alerts to assess and verify events of
potential public health threats in place?
 Is access to high-quality laboratory facilities to confirm or exclude diagnosis (e.g. of biological,
chemical and radio-nuclear origin) provided?
 Are guidelines for investigation and case reporting, investigation and appropriate follow-up
including criteria requirements included?
Status
Assessment
Threat
EventDamage
Impact
Prepare and Respond
Mitigate
Follow up and plan
Prevent
Recover
Respond

7.  Is access to expertise for collation and interpretation of reports, and initiation of further
investigations provided?
 Is liaison between and with national public health structures to ensure that reports trigger
appropriate and timely responses for decision makers to resolve the emergency in place?
 Who are the competent authorities and is the availability of the authorities known to citizens
at large to approach?
 Are public health issues integrated in handling of an incident?
 Are operational links available and used with authorities, competent for epidemiological
surveillance?
 Are operational links available and used with civil protection services?
 Are operational links available and used with WHO and other international public health
organisations?
 Are operational links required with law enforcement structures and authorities?
Risk assessment using pre-surveillance data from medical intelligence, surveillance and other
information sources
 Are contacts with agencies in charge of intelligence analysis on routine basis in place?
 Are threat assessment principles for all types of health threats in place?
 Whether an inventory of resources for risk analysis and a structure to coordinate their
activities in place?
 Are resources for timely national risk analysis in place?
 Whether identification of appropriate contact points for different types of health threats in
place?
 Whether collaboration with national and international partners for exchange of necessary
information and analysis in place?
 Establishment of procedures (contact network and declaration process) for collaboration
with a wide range of actors in the risk analysis field, to cover all types of health threat
 Threat assessment principles are agreed and best practice is shared
 Operational links with WHO (including IHR NFP) and other appropriate international
organisations.
Post Surveillance:
Once the outbreak event is identified, epidemic intelligence and surveillance activities will have
to become more focussed and adapt its priorities to the nature of the threat identified, and the
needs evolving (e.g. detection of cases, monitoring of spread, severity, risk groups, etc.)
Plan Do Checklist: post-event surveillance: are the following minimum requirements in
place?
 Whether established links with surveillance in other-than-human area done?
 Whether contacts with agency and military allowing fast and adequate dispersal assessment
done?
 Whether procedures allowing quick changes of the surveillance (adaptation to the situation)
provided?
 Whether Clinical surveillance of human cases including age-specific morbidity and mortality,
and rates of hospitalisation taking account of biological, chemical, radio-nuclear and other
agents done?
 Whether epidemiological surveillance including field investigation capacity and contact-
tracing done?

8.  Whether the impact of prevention programmes e.g. vaccination (including adverse effects) or
other prevention programmes is assessed regularly?
 Whether flexibility to change from special reporting to normal (changes of surveillance /
reporting over time) provided?
Clinical and Laboratory Diagnostics
It is essential with every public health threat to rapidly identify and confirm the agent involved.
Every plan should address the identification of unknown agents, confirmation of known agents, and
provision of surge capacity.
Plan Do Checklist:
 Is Network, exchange between labs (who is doing what) done?
 What are the resources available?
 Whether established structures to communicate with laboratories and medical practitioners
and health care providers to ensure that laboratories report diagnosed cases to their
authorities provided?
 Whether procedures for rapid identification of unknown pathogens/agents during an
outbreak event in clinical and environmental samples provided?
 Whether clinical syndrome description: agreement on further analyses and investigations
such as the search for pathogens and antibodies in body fluids (e.g. blood, serum, plasma,
liquor, stool, lavage fluids, material from biopsies, or urine) provided?
 Whether detailing on possibility during an outbreak event to quickly establish and distribute
guidelines among laboratories, medical practitioners and health care providers for diagnosis
of cases and isolation of pathogens provided?
Sampling
National plans and procedures to obtain samples should be in place. These plans should include
protection measures for the public and the investigating personnel, a list of the necessary minimum
equipment and protocols for sending and analysing samples in laboratories.
Plan Do Checklist: Are the following minimum requirements in place?
 Is the Sampling strategy provided?
 Whether goal of sampling strategy is defined as regard to purpose, sampling method and
number of samples provided?
 Whether access to relevant information provided
 Are the risk limits defined?
 Whether geographical dispersion areas and mobile sources in the area to be sampled defined?
Monitoring side effects of action to counter the health threat
A legal framework and procedures allows real-time data collection. Measures taken to counter the
health threat should cover different areas, possibly including containment strategies, contact
tracing, isolation of cases, decontamination, as well as medical treatment, and vaccination.
Depending on the nature of the different measures, possible negative effects and adverse events
need to be carefully and timely monitored and evaluated.

9. Plan Do Checklist:
Whether national plans that include the setting up or extension of systems to provide adverse
outbreak event monitoring provided?
Filing, documentation management:
Any health crisis (such as an outbreak, mass human exposure etc.), information evolves very fast
and keeping track of responses becomes a major problem. Fact-finding committees are established
after recovery, requiring proper record-keeping practices during the event outbreak. Plans should
describe the arrangements for ensuring that relevant information (including sources) is recorded
and retained for use in evaluations after the emergency, and for long-term health monitoring and
follow-up of medical emergency.
Plan Do Checklist:
 Whether information on routine and systematic recording of incoming data and response
provided?
 Whether local, national, and interregional coordination is described?
SECTION: I STRENGTHENING CAPABILITIES
(The points mentioned in the capabilities section are as per Centre for Disease Control and Prevention)
Capability 1: Community Preparedness
Community preparedness is the ability of communities to prepare for, withstand, and recover —
in both the short and long term — from public health incidents. Engaging and coordinating with
emergency management, health care organizations, health care providers (private and
government), local, state and country level public health planners the following plan do checklist
are provided to:
 Support the development of health systems that support recovery of public health.
 Participate in awareness training with community partners on how to prevent, respond to,
and recover from outbreak that are critical to public health
 Promote awareness of and access to health resources that help protect the community’s
health and address the functional needs (i.e., communication, medical care, independence,
supervision, transportation) of at-risk individuals
 Engage with public and private organizations in preparedness activities that represent the
functional needs of at-risk individuals as well as the cultural and socio-economic,
demographic components of the community
 Identify those populations that may be at higher risk for adverse health outcomes
 Integrate the health needs of populations who have been displaced due to incident
outbreak.
Functions and Associated Performance Measures:
Function 1: Determine risks to the health of the jurisdiction
Function 2: Build community partnerships to support health preparedness
Function 3: Engage with community organizations to foster public health, medical, and
mental/behavioural health social networks
Function 4: Coordinate training or guidance to ensure community engagement in preparedness
efforts

10. Capability 2: Community Recovery
Community recovery is the ability to collaborate with community partners, (e.g., healthcare
organizations, business, education, and emergency management) to plan and advocate for the
rebuilding of public health, medical, and health systems to at least a level of functioning
comparable to pre-incident levels, and improved levels where possible.
Function 1: Identify and monitor public health, medical, and health system recovery needs
Function 2: Coordinate community public health, medical, and health system recovery operations
Function 3: Implement corrective actions to mitigate damages from future incidents
Capability 3: Emergency Operations Coordination Definition: Emergency operations coordination
is the ability to direct and support an event or incident with public health or medical implications
by establishing a standardized, scalable system of oversight, organization, and supervision
consistent with jurisdictional standards and practices and with the National Incident Management
System
Capability 3: Emergency Operations Coordination:
Emergency operations coordination is the ability to direct and support an event or incident with
public health or medical implications by establishing a standardized, scalable system of oversight,
organization, and supervision consistent with jurisdictional standards and practices and with the
National Incident Management System.
Function 1: Conduct preliminary assessment to determine need for public activation
Function 2: Activate public health emergency operations
Measure 1: Time for pre-identified staff covering activated public health agency
incident management lead roles (or equivalent lead roles) to report for immediate duty.
Performance Target: 60 minutes or less
Function 3: Develop incident response strategy
Measure 1: Production of the approved Incident Action Plan before the start of the
second operational period
Function 4: Manage and sustain the public health response
Function 5: Demobilize and evaluate public health emergency operations
Measure 1: Time to complete a draft of an After Action Report and Improvement Plan
Capability 4: Emergency Public Information and Warning
Emergency public information and warning is the ability to develop, coordinate, and
disseminate information, alerts, warnings, and notifications to the public and incident
management responders about the outbreaks.
Functions and Associated Performance Measures:
Function 1: Activate the emergency public information system
Function 2: Determine the need for a joint public information system
Function 3: Establish and participate in information system operations
Function 4: Establish avenues for public interaction and information exchange
Function 5: Issue public information, alerts, warnings, and notifications
Measure 1: Time to issue a risk communication message for dissemination to the public

11. Capability 5: Fatality Management
Fatality management is the ability to coordinate with other organizations (e.g., law enforcement,
healthcare, emergency management, and medical examiner/coroner) to ensure the proper
recovery, handling, identification, transportation, tracking, storage, and disposal of human
remains and personal effects; certify cause of death; and facilitate access to mental/ behavioural
health services to the family members, responders, and survivors of an incident.
Functions and Associated Performance Measures:
Function 1: Determine role for public health in fatality management
Function 2: Activate public health fatality management operations
Function 3: Assist in the collection and dissemination of ante mortem data
Function 4: Participate in survivor mental/behavioural health services
Function 5: Participate in fatality processing and storage operations
Capability 6: Information Sharing
Information sharing is the ability to conduct multijurisdictional, multidisciplinary exchange of
health-related information and situational awareness data among state, local, government, and
public- private sector.
Functions and Associated Performance Measures:
Function 1: Identify stakeholders to be incorporated into information flow
Function 2: Identify and develop rules and data elements for sharing
Function 3: Exchange information to determine a common operating picture
Capability 7: Mass Care
Mass care is the ability to coordinate with collaborating agencies about the need to address public
health, medical, and mental/ behavioural health needs of those impacted by the incident
/outbreak at a congregated location with dense population. This capability includes the
coordination of ongoing surveillance and assessment to ensure that health needs continue to be
met as the outbreak surges.
Functions and Associated Performance Measures:
Function 1: Determine public health role in mass care operations
Function 2: Determine mass care needs of the impacted population
Function 3: Coordinate public health, medical, and mental/behavioural health services
Function 4: Monitor mass care population health
Capability 8: Medical Countermeasure Dispensing
Medical counter measure dispensing is the ability to provide medical counter measures
(including vaccines, antiviral drugs, antibiotics, antitoxin, etc.) in support of treatment or
prophylaxis (oral or vaccination) to the identified population in accordance with public health
guidelines and/or recommendations.

12. Functions and Associated Performance Measures:
Function 1: Identify and initiate medical countermeasure dispensing strategies
Function 2: Receive medical countermeasures
Function 3: Activate dispensing modalities
Measure 1: Composite performance indicator from the Division of Strategic National
Stockpile in CDC’s Office of Public Health Preparedness and Response
Function 4: Dispense medical countermeasures to identified population
Measure 1: Composite performance indicator from the Division of Strategic National
Stockpile in CDC’s Office of Public Health Preparedness and Response
Function 5: Report adverse events
Capability 9: Medical Resource Management and Distribution
Medical materiel management and distribution is the ability to acquire, maintain (e.g., cold
chain storage or other storage protocol), transport, distribute, and track medical resources
(example: pharmaceuticals, gloves, masks, and ventilators) during an outbreak or incident and to
recover and account for unused medical materiel, as necessary, after an incident.
Function 1: Direct and activate medical materiel management and distribution
Measure 1: Composite performance indicator from the Division of Strategic National
Stockpile in CDC’s Office of Public Health Preparedness and Response
Function 2: Acquire medical materiel
Measure 1: Composite performance indicator from the Division of Strategic National
Stockpile in CDC’s Office of Public Health Preparedness and Response
Function 3: Maintain updated inventory management and reporting system
Measure 1: Composite performance indicator from the Division of Strategic National
Stockpile in CDC’s Office of Public Health Preparedness and
Function 4: Establish and maintain security
Measure 1: Composite performance indicator from the Division of Strategic National
Stockpile in CDC’s Office of Public Health Preparedness and Response
Function 5: Distribute medical materiel
Measure 1: Composite performance indicator from the Division of Strategic National
Stockpile in CDC’s Office of Public Health Preparedness and Response
Function 6: Recover medical materiel and demobilize distribution operations
Measure 1: Composite performance indicator from the Division of Strategic National
Stockpile in CDC’s Office of Public Health Preparedness and Response
Capability 10: Medical Surge
Medical surge is the ability to provide adequate medical evaluation and care during events that
exceed the limits of the normal medical infrastructure of an affected community. It encompasses
the ability of the healthcare system to survive impact and maintain or rapidly recover operations.
Function 1: Assess the nature and scope of the incident
Function 2: Support activation of medical surge
Function 3: Support jurisdictional medical surge operations
Function 4: Support demobilization of medical surge operations

13. Capability 11: Non-Pharmaceutical Interventions
Non-pharmaceutical interventions include the ability to recommend to the applicable lead
agency (government, or if not public health providers) and implement, if applicable, strategies for
disease and exposure control. Strategies include the following:
 Isolation and quarantine
 Restrictions on movement and travel advisory/warnings
 Social distancing
 External decontamination
 Hygiene
 Precautionary protective behaviours
Functions and Associated Performance Measures:
Function 1: Engage partners and identify factors that impact non-pharmaceutical interventions
Function 2: Determine non-pharmaceutical interventions
Function 3: Implement non-pharmaceutical interventions
Function 4: Monitor non-pharmaceutical interventions
Capability 12: Public Health Laboratory Testing
Public health laboratory testing is the ability to conduct rapid and conventional detection,
characterization, confirmatory testing, data reporting, investigative support, and laboratory
networking to address actual or potential exposure to -threats.
Functions and Associated Performance Measures:
Function 1: Manage laboratory activities
Measure 1: Time for sentinel clinical laboratories to acknowledge receipt of an urgent
message from the CDC Public Health Emergency Preparedness (PHEP)-funded Laboratory
Response Network biological (LRN-B) laboratory
Measure 2: Time for initial laboratorian to report for duty at the CDC PHEP-funded laboratory
Function 2: Perform sample management
Measure 1: Percentage of Laboratory Response clinical specimens without any adverse
quality assurance events received at the CDC laboratory for confirmation or rule-out testing
from sentinel clinical laboratories
Measure 2: Percentage of non-clinical samples without any adverse quality assurance events
received at the CDC laboratory for confirmation or rule-out testing from first responders
Measure 3: Ability of the CDC Laboratory Response Network laboratories to collect relevant
samples for clinical chemical analysis, package, and ship those samples
Function 3: Conduct testing and analysis for routine and surge capacity
Measure 1: Proportion of proficiency tests (core methods) successfully passed by CDC
laboratories
Measure 2: Proportion of proficiency tests (additional methods) successfully passed by CDC
funded laboratories
Measure 3: Proportion of proficiency tests successfully passed by CDC funded laboratories
Function 4: Support public health investigations
Measure 1: Time to complete notification between CDC, on-call laboratorian, and on-call
epidemiologists
Measure 2: Time to complete notification between CDC, on-call epidemiologist, and on-call
laboratorian

14. Function 5: Report results
Capability 13: Public Health Surveillance and Epidemiological Investigation
Public health surveillance and epidemiological investigation is the ability to create, maintain,
support, and strengthen routine surveillance and detection systems and epidemiological
investigation processes, as well as to expand these systems and processes in response to
outbreaks of public health significance.
Functions and Associated Performance Measures:
Function 1: Conduct public health surveillance and detection
Measure 1: Proportion of reports of selected reportable diseases received by a public health
agency within the jurisdiction-required time frame
Function 2: Conduct public health and epidemiological investigations
Measure 1: Percentage of infectious disease outbreak investigations that generate reports
Measure 2: Percentage of infectious disease outbreak investigation reports that contain all
minimal elements
Measure 3: Percentage of acute environmental exposure investigations that generate
reports
Measure 4: Percentage of acute environmental exposure reports that contain all minimal
elements
Function 3: Recommend, monitor, and analyse mitigation actions
Measure 1: Proportion of reports of selected reportable diseases for which initial public
health control measure(s) were initiated within the appropriate time frame
Function 4: Improve public health surveillance and epidemiological investigation systems
Capability 14: Responding to Safety and Health
Responding to safety and health capability describes the ability to protect public health agency
staff responding to an incident and the ability to support the health and safety needs of hospital
and medical facility personnel, if requested.
Functions and Associated Performance Measures:
Function 1: Identify responder safety and health risks
Function 2: Identify safety and personal protective needs
Function 3: Coordinate with partners to facilitate risk-specific safety and health training
Function 4: Monitor responder safety and health actions
Capability 15: Volunteer Management
Volunteer management is the ability to coordinate the identification, recruitment, registration,
credential verification, training, and engagement of volunteers to support the jurisdictional public
health agency’s response to incidents of public health significance.
Functions and Associated Performance Measures:
Function 1: Coordinate volunteers
Function 2: Notify volunteers
Function 3: Organize, assemble, and dispatch volunteers
Function 4: Demobilize volunteers

15. Communication
Before addressing section 2 of community recovery, an important aspect to work out is
communication:
The distribution of accurate and timely information at all levels is critical in order to minimise
unforeseen social disruption and economic consequences and to maximise the effective outcome
of the response. Effective communication is an essential element of medical emergency
management. Empowering public to adopt protective behaviour, pro-active communication can
facilitate case reporting and awareness among frontline responders, reduce confusion and allow
for best use of resources. All of these are necessary for an effective response. Good communication
also helps maintain the public’s trust among health authorities during an event, minimising the
potential for social and economic disruption.
Reporting systems and procedures
Who reports what to whom, and along which hierarchical lines? It includes flow of data input, flow
of information and data transfer, and responsibilities of each to collect, analyze and report the
surveillance and/or control data. SOPs (Standard Operating Procedures), IT based tools and
agreements are likely outcomes included in reporting systems and procedures.
A common web-based platform or dashboard for crisis management must be mandatorily
available where health authorities will find situation and activity reports, situation maps and any
pertinent information likely to help in decision making.
A three system approach must be considered in reporting systems and procedures:
 Rapid alert and notification systems
 Early warning systems
 Crisis management supporting systems
Recording systems must be reliable, flexible, secured and available on a 24×7 basis. It shall include
following principles:
 Identification of the authorities / structures / services for reporting. Inclusion of public
health component in the other systems and vice versa;
 Standard Operating Procedures, including relevant algorithms, must be developed at an
early stage and they must be implemented and respected by all the parties involved, with
outlines for passing alerts and warning messages from local to national government and
beyond (as is the case at EU and WHO level).
 Back-up facilities must be available;
 Intervention times should be set depending on the target and scope of the network
involved;
 Facilities for transmitting very sensitive information must be considered when developing
the system. This refers to the various types of information such as unclassified information
about events (sensitive information) or classified information.
 All systems must provide confidentiality, integrity, accountability, availability,
sustainability and reliability in communication protocols (certainty that the messages
arrive).

16. Obligation for information transmission and prior consultation / information on
countermeasures
Communication on health threats /alerts between authorities/structures in public health should
occur in a timely way, directed to the proper authorities so that they can activate preparedness
plans.
Whether agreement on and implementation of:
 Guidelines on levels and scales of threat and common methods and terminology.
 A list of (mandatory notification / to be communicated) counter measures.
 Procedure on communication and consultation of countermeasures (relevant work in
progress: Commission Decisions on Stand-by Declaration and Countermeasures).
 Algorithms for each situation, if possible.
 Setting up of legal framework – 1. Proposals for a Commission decision setting up a
consultation and information procedure and cooperation, 2. Commission decision on a
procedure declaring rapidly community alert, requiring extraordinary and temporary
concerted actions at Community level under the Community Network for epidemiological
surveillance.
 Setting up arrangements with the competent commission services to allow decisions on
countermeasures that may affect trade, economy, social life etc.
 The competent Commission services receive notification of the countermeasures to be
taken and ensure follow-up with their stakeholders.
 Inclusion of WHO and revised IHR, when appropriate.
Data communication and management
Whether basic requirements to be met by communication tools and procedures provided?
 Whether pre-established notification forms for faster communication provided?
 Whether establishment of secure communication channels for sensitive or classified
information.
 Whether Authentication of the sender is done?
 Whether Validation of the content done?
 Whether Verification of in receipt messages done?
 Whether Security measures to ensure availability of services and data, integrity of data,
authentication of nodes and security maintenance provided?
 Whether Standards in electronic reporting of collected lab data and results provided?
 Whether Standards in routing and security of data done?
 Whether Development of common metadata descriptions provided?
 Whether Integration of information from multiple data sources, preserving linkages
between entities, objects and events provided?
 Whether Presentation of structured information, including situation reports, activity
reports, calendars for upcoming events, with fixed daily procedures for recurrence of
actions provided?
 Whether managing access to the platform for agencies such as National Public Health
Authorities, National Competent Authorities and Commission directorates etc. is
provided?

17. Communicating among team expertise or panel
Communication procedures among the team expertise or panel provide accurate and timely
information at all levels. Good communication among team expertise or panel in the event of a
public health threat will require that a mechanism exists for timely and consistent distribution
of information.
 Is the information between national bodies and regional authorities, i.e. all information
available, especially health information, for all essential services provided?
 Whether detailing from the regional level to the local level and to individual healthcare
facilities, including emergency facilities that may be established in the community to
pass on information provided?
 Whether Specific websites with restricted access for health professionals and other
groups (decision makers) is provided.
 Whether SOPs to analyse and inform the competent structures and authorities in order
to guarantee exchange of information provided.
 Whether detailing on Regular updates for all relevant stakeholders provided?
Risk / crisis communication with media and public groups
Risk communication is the exchange and dissemination of appropriate information about risks
to enable decision makers, stakeholders and the public to make appropriate decisions. It helps
define the risk more systematically, assesses and considers stakeholder behaviours.
Crisis communication involves communicating in a situation that somehow challenges the
public’s sense of appropriateness, tradition, values, safety, health, security or the integrity of the
government.
Emergency communication is when there is a time-sensitive urgency to communicate to a
select group of people as a result of an outbreak that requires prompt action, beyond normal
procedures, in order to limit damage or death to persons, property and economy.
Risk communication promotes transparency and builds trust, credibility for authorities and
mutual respect.
It is important to involve the news media from an early stage in the planning of emergency
preparedness. With good established relationships, the media can provide significant
professional assistance during the response phase. Media are essential to:
• Inform citizens quickly in everyday language
• Help citizens to reduce risks
• Mobilise society • Explain and build support for simplest of control measures
• Represent the voice of citizens
• Provide perspective and context.
Endorse the communication guidelines developed by WHO (trust, announcing early,
transparency) and agree to act accordingly.
Create a list of key messages and how these will be used in a crisis.
Draft media releases and statements (related to key messages).
Generate frequently asked questions and answers (related to key messages)
Create web-based information that can be released immediately

18. Political advocacy
Communication is necessary from the team or subject expertise or panel members to their
political authorities to provide accurate and timely information. The political authorities will
know the plan and request information on events through the indicated channels before taking
decisions or before responding on political issues related to the event – like protocols setting up,
lockdown decision etc.
Detailing on whether the political hierarchy is informed provided or not questionnaire as
follows:
 Is informed and regularly updated about the plan(s), the role and competence of different
players and the contact points?
 Whether the political hierarchy has identified the key members of emergency response team.
 Whether the hierarchy understands existing systems and processes for dealing with crisis
events?
 Whether uses the channels providing timely and accurate information to decide?
Scientific/Evidence-based advice
Scientific or evidence-based advice is the process of integrating the information through rapid
consultation and identifying vulnerability and possible response through risk assessment,
including support to determine appropriate action and countermeasures, and to identify the
resources needed and ways to implement action.
Checklist on rapid consultation about outbreaks with public health consequences:
 Are lists available of individual expertise?
 Are lists available of contact points?
 Do urgent procedures exist for rapid consultation of experts?
 Do these procedures include public health experts with different specialisations (such as
threat and risk assessment, preparedness and response)?
 Toxicology experts?
 Do operational links exist to consult experts in epidemiology, laboratories?
Quantitative Assessment - Modelling
Checklist on modelling for outbreaks with public health consequences:
 Modelling (infectious diseases, climate change-, chemical events) included in planning
at national level
 Identification of the existing capacity for modelling health threats at national level
(within risk and crisis management bodies, academia or other research institutions)
 Identification of level of expertise in quantitative assessment at national level
 Implementation of existing (and development of new) models and methods for
quantitative assessment of emerging health threats
 Identification of options for training in mathematical modelling and quantitative
assessment.
 Identification of appropriate data sets needed for the running of existing and possible
new models. This may require substantial research and collaboration between various
sectors at national level
 Systems ready for obtaining and sharing the data before and during outbreaks

19.  Facilities for communicating results and sharing knowledge and methods with public
health authorities
 Satisfactory level of expertise in quantitative assessment
 Reliability and applicability of existing tools for threats of harmful agents under
consideration and the conditions
 Capacity building for validation of near-real-time modelling to support response actions
and modelling of dispersion
Vulnerability assessment
National plans for pandemics should include the capacity to assess the vulnerability of national
structures and systems according to common standards prepared at Community level.
Checklist on vulnerability assessment for incidents with public health consequences:
 States shall designate their experts and they should participate in a system for consultation
and use of their expertise.
 States develop vulnerability assessment processes taking account of the different variables,
including security and safety issues.
 States has included in its national plans the capacity to assess the vulnerability of their
national structures and systems. Each national assessment be mutually accepted at
Community level based on common prepared standards of vulnerability assessment.
 Accreditation system
 Interlinking between and cooperation with public health structures, authorities and other
structures and services.
Risk assessment and options for countermeasures (control principles)
Public health (counter) measures for disease control is different in different countries depending
on the health infrastructures and depending on the nature of the event. They could include
identification and quarantine of contacts; measures to increase social distance; measures to
decrease the interval between onset of symptoms and isolation of ill patients; disinfection; limits
to travel; entry and exit screening
Checklist on risk assessment and countermeasures for incidents with public health
consequences:
 Decision process for public health countermeasures based on scientific and
epidemiological evidence;
 Include public health structures;
 Linking social, economic and logistical considerations to sustain implementation of public
health measures;
 Legal back-up in areas other than public health for the implementation of
countermeasures;
 International commitments for notification and cooperation
Determine corresponding action, resources for action, and ways to implement action
Checklist for outbreak with public health consequences:
 List of relief (consequence) management authorities and structures;
 List of contact points (CP)

20.  List describing mandatory action to take, step-by-step according to the extent of the event
(e.g. sample taking requires CP outfit;
 Include link of 1, 2 and 3 points in this checklist with public health structures and
authorities
 Lists of organisations working in the Community, with information on their capacity to
assist with emergency response and recovery activities,
 Lists of recovery items not available in the local community that would need to be
obtained abroad or could be supported by Community initiative
 Information on customs and taxation regulations covering the importation and transit of
response and recovery (and other) items.
Health Crisis Management Structures
In principle, States will be responsible, for the management of health crisis on its territory,
especially from communicable diseases. The specific modalities they shall put in place to
coordinate the necessary urgent controls in crisis situations shall remain with assistance from
intervention teams, if so required.
Health emergency planning
State should have one ‘focal point’ responsible for administrative matters regarding health
emergency planning.
Command and Control Structures Checklist
 Well-established SOPs allow optimum team performance and lead to swift action during
crisis management.
 All SOPs have to be prepared with and tested in consultation with all relevant stakeholders
 The responsibilities and tasks of each function should be clearly described (strategic,
operational, logistical, administrative, financial and media communication)
 The hierarchical structure for stakeholders should be described
 The relation between hierarchical sectors should be described
 The decisional flowchart and measures to be taken by each department should be in place
 The relation/connections between health and other emergency sectors (national /
international level) should be described
 Arrangements for phone / video-conferences should include: who is attending
(procedures), where does it take place (rooms), which system is used (tools) should be
made available.
 SOPs should include the steps for an increasingly or decreasingly resource-intensive
response (alternate staff, equipment, facilities, finance)
 SOPs should include reassignment of staff (same department or not) according to needs,
and ensure continuity of core activities.
 SOPs for granting access to the CCS should be known by the 24 × 7 maintenance team.
Surge Capacity
 The health care infrastructure has become increasingly dependent on other infrastructure
systems, so preparedness within the health care sector must cover dependencies. The risk
and vulnerability analysis should include preparedness for disruption in various

21. infrastructure systems externally and internally (safe hospital aspects) and need to provide
services in a timely and 24-hour manner in lieu of pandemics.
 Robustness in managing surge capacity can be achieved by including aspects in the risk and
vulnerability analysis, the planning of facilities for medical care, the preparedness plans for
external and internal disasters and the activities following disturbances.
 The checklist should include questions that stimulate assessment and dialogue with key
stakeholders both within the facilities and at the local level and beyond.
Plan Do Checklist
Are the following minimum requirements fulfilled?
 Whether Health care facilities’ emergency preparedness plans match national guidelines
 Whether Disaster committee exists.
 Whether a risk and vulnerability analysis has been conducted for the preparation of the
plan?
 Whether the hospital has ongoing, mandatory disaster training programs?
 Whether Reserve supplies exist for electricity, heating, water and all pharmaceutical and
logistical needs?
 Whether ventilation systems are adjusted avoiding contamination from toxic agents
(chemicals, biological)?
 Whether plan is provided for clearance of all non-emergency patients and visitors from the
emergency department, cancellation of all elective admissions and surgery, determination
of rapidly available or open beds.
 Whether the whole hospital and each of its department have developed standard operating
procedures for continuing to provide services in a timely and 24-hour manner (despite the
crisis), including over a prolonged period during pandemics
 Whether Medical records and admissions departments are organised to handle an influx of
surge during pandemics and whether alternatives planned for their intake or other place
provided?
 Whether Debriefing of personnels, patients done?
 Whether contact with other hospitals done?
 Whether list of isolation room/negative pressure room provided?
Checklist on treatment capacity:
Are the following minimum requirements fulfilled?
 Whether guidelines for surge capacity established?
 Whether identified area treatment centres most likely to care for symptomatic patients
provided.
 Whether identified alternative treatment facilities to care for symptomatic patients
provided.
 Whether a system to allow prompt ongoing reporting of the numbers of diagnosed and
suspected cases to the local authority provided?

22. References:
1. Public Health Preparedness Capabilities www.cdc.gov/phpr/capabilities
2. CDC’s preparedness and emergency response activities, website of the
Office of Public Health Preparedness and Response at www.cdc.gov/phpr
3. Centre for Disease Control and Prevention and University of Washington’s Centre for
Public Health Informatics. Competencies for Public Health Informaticians. Atlanta, GA: U. S.
Department of Health and Human Services, Centre for Disease Control and Prevention.
2009. This document is available online at http://www.cdc.gov/InformaticsCompetencies
and at http://cphi.washington.edu/resources/competencies.html
4. Building Community Resilience for Children and Families:
http://www.nctsnet.org/nctsn_assets/pdfs/edu_materials/BuildingCommunity_FINAL_0
2-12-07.pdf