Level A
Situation
Non-Flu Like
Symptoms
Dispatch
Flu Like
Symptoms
Non-Flu Like
Symptoms
Treatment
Flu Like
Symptoms
Non-Flu Like
Symptoms
Transport
Flu Like
Symptoms
Level B
Level C
Level D
Level E
Pandemic outbreak
in North America.
Human Transmissibility
demonstrated.
Pandemic outbreak identified
in Region 6.
911 communications and/
or pre-hospital response
systems and/or hospitals at
or near capacity.
911 communications and/
or pre-hospital response
systems and/or hospitals
beyond capacity.
911 communications and/or
pre-hospital response systems
and/or hospitals and surge
systems beyond capacity.
Triage/Response Guidelines
Triage/Response Guidelines
Triage/Response Guidelines
Triage/Response Guidelines
Triage/Response Guidelines
Standard operating
procedures unchanged
Standard operating
procedures unchanged
No priority 3 responses
Priority 1 ambulance if
available < 20 min.
Priority 2 MFR only.
No priority 3. No dispatch for
cardiac or respiratory arrest.
Priority 1 ambulance or
MFR as available.
Priority 2 MFR as available.
No dispatch for cardiac or
respiratory arrest.
Standard operating
procedures unchanged
Standard operating
procedures unchanged
No response for A-Omega
Priority 1 ambulance if
available < 20 min.
Priority 2 MFR only.
No priority 3. No dispatch for
cardiac or respiratory arrest.
Priority 1 ambulance or MFR
as available.
Priority 2 MFR as available.
No dispatch for cardiac or
respiratory arrest.
Standard operating
procedures unchanged
Standard operating
procedures unchanged
Standard operating
procedures unchanged
See protocol 1
See protocol 2
Standard operating
procedures unchanged
Standard operating
procedures unchanged
Standard operating
procedures unchanged
See protocol 1
See protocol 2
Standard operating
procedures unchanged
Standard operating
procedures unchanged
Transport priority 1 or 2 only
Transport priority 1.
Transport priority 2 only
if alternate transport
unavailable.
Transport priority 1
to hospital.
Transport priority 2 by
alternate methods.
Standard operating
procedures unchanged
Standard operating
procedures unchanged
Transport to hospital
MAFS >= 20
Transport to ACS if MAFS >=
20 <= 60.
Transport to hospital if MAFS
> 60.
Transport to ACS if MAFS
> 20 <= 60.
Transport to hospital if MAFS
> 60.
This document is approximately 100 percent funded by the U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Essential Healthcare Services Project (Award 1U90TP000218-01).
Modified Avian Flu Score (MAF SCORE)
Adults
Pediatric Ages 2-14
Characteristics
Score
Altered Mental Status
20
Respirations > 30
20
Systolic BP < 90 20
Pulse > 125
20
Pulse Oximetry < 92 percent (room air)
20
Infant Ages 0-2
Characteristics
Score
Characteristics
Score
Altered Mental Status
20
Altered Mental Status
20
Respirations > 40
20
Respirations > 60
20
Systolic BP < 80 20
Systolic BP < 70 20
Pulse < 70 or > 130
20
Pulse < 80 or > 150
20
Pulse Oximetry < 92 percent (room air)
20
Pulse Oximetry < 92 percent (room air)
20
Protocol 1
Protocol 2
MFR, Basic, Specialists, Paramedics
In addition to protocol 1, patients at skilled nursing facilities will be sheltered in place.
Evaluate patients pulse, blood pressure, respirations and skin color (PO if available).
If vital signs are within normal limits, transport by other means.
No field intubations.
Transport to hospital if patient is priority 1. If patient is in cardiac or respiratory arrest,
attach AED. If no shock is advised after two minutes of CPR, terminate resuscitation
attempts. If no AED is available and there is no return of palpable pulses within five
minutes, terminate resuscitation attempts.
No resuscitation attempts for trauma arrests. Contact local medical control for
questionable cases.
Transport expectant patients to ACS.
RMD2544 ©09.2009
Do NOT transport expectant patients.
Adults
Pediatric
•Respiratory distress with resp rate
•Respiratory distress with resp rate
< 8 or > 40 with altered mental status.
< 8 or > 60 with altered mental status.
• B/P < 75 with altered mental status.
•Heart rate < 50 with altered mental status
• Glasgow Coma Scale < 9
• B/P < 50 with altered mental status.
•Heart rate < 50 with altered mental status
• Glasgow Coma Scale < 9