2009-2010 H1N1 Influenza Response
April 27, 2009- ?
AFTER ACTION REPORT/IMPROVEMENT PLAN
March
, 2010
Note! Instructions are highlighted in grey- delete these when you
are done. Information that needs your input is in red- fill in your
information and un-highlight these when you are done. Also, update the page numbers in the Table of Contents when you are done.
Report Template Version 12-01-09
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HANDLING INSTRUCTIONS
1. The title of this document is “____ County 2009-2010 H1N1 Influenza Response After Action Report/Improvement Plan.”
2. The information gathered in this AAR/IP is classified as For Official Use Only (FOUO) and
should be handled as sensitive information not to be disclosed. This document should be
safeguarded, handled, transmitted, and stored in accordance with appropriate security directives. Reproduction of this document, in whole or in part, without prior approval from ___
County Health Department is prohibited.
3. At a minimum, the attached materials will be disseminated only on a need-to-know basis and
when unattended, will be stored in a locked container or area offering sufficient protection
against theft, compromise, inadvertent access, and unauthorized disclosure.
4. Points of Contact:
Contact Name:
Name of Agency:
Address:
City/State/Zip:
Phone and Extension:
Email Address:
Contact Name:
Name of Agency:
Address:
City/State/Zip:
Phone and Extension:
Email Address:
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CONTENTS
Administrative Handling Instructions ......................................................2
Contents ......................................................................................................3
Executive Summary ...................................................................................4
Section 1: Response Overview .................................................................5
Response Details ............................................................................. 5
Response Team Leadership ............................................................... 6
Participating Organizations ................................................................ 6
Section 2: Response Summary.................................................................7
Scenario Summary ........................................................................... 7
Section 3: Response Analysis ..................................................................8
[Observation 1] .............................................................................. 8
[Observation 2] .............................................................................. 9
[Observation 3] ............................................................................ 10
Section 4: Conclusion ............................................................................. 11
Appendix A: Improvement Plan ............................................................. 12
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EXECUTIVE SUMMARY
[When writing the Executive Summary, keep in mind that this section may be the only part of the
AAR/IP that some people will read. Introduce this section by stating the full name of the response and providing a brief overview of the response. This brief overview should discuss why
the response was conducted, plans that were used and activities to achieve the objective. All of
these areas will be discussed in more detail in the subsequent chapters of the AAR/IP. In addition, the Executive Summary may be used to summarize any high-level observations that cut
across multiple capabilities.]
The purpose of this report is to analyze response results, identify strengths to be maintained and
built upon, identify potential areas for further improvement, and support development of corrective actions.
[In general, the major strengths and primary areas for improvement should be limited to three
each to ensure the Executive Summary is high-level and concise.]
This After-Action Report/Improvement Plan pertains to the 2009/2010 H1N1 Influenza Response by the ____ County Health Department. The response to this real pandemic influenza
event encompassed many target capabilities and public health functions, such as mass vaccination distribution and administration, Strategic National Stockpile (SNS) delivery and distribution,
and public information and communication. The cumulative response encompassed many
months of planning and response as well as communication and work with numerous partner
agencies. This response was guided by previously written Pandemic Influenza and SNS Plans,
though this specific incident proved the need for more flexible development of these plans. The
major identified strengths of the response are (refer to strengths identified in Section 3- pick the
top 3 or most overreaching):
1)
2)
3)
The most critical potential areas for further improvement are (refer to areas of improvement
identified in Section 3- pick the 3 most critical or overreaching):
1)
2)
3)
The identified strengths will be maintained and built upon by……. The areas for further improvement will be addressed through the corrective actions of …..
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Major Strengths
The major strengths identified during this response are as follows (refer to ALL strengths identified in Section 3:
 [Use complete sentences to describe each major strength.]
 [Additional major strength]
 [Additional major strength]
Primary Areas for Improvement
Throughout the response, several opportunities for improvement in [jurisdiction/organization
name]’s ability to respond to the incident were identified. The primary areas for improvement,
including corrective action recommendations, are as follows (refer to ALL areas of improvement
identified in Section 3)::



[Use complete sentences to state each primary area for improvement and its associated key recommendation(s).]
[Additional key recommendation]
[Additional key recommendation]
[End this section by describing the overall response as successful or unsuccessful, and briefly
state the areas in which subsequent responses conducted by these jurisdictions and/or organizations should focus.]
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SECTION 1: RESPONSE OVERVIEW
Response Details
Response Name
2009/2010 H1N1 Influenza Response
Type of Response
Full-scale response
Response Start Date
April 27, 2009
Response End Date
?
Duration
Multi-month- incorporating numerous waves of pandemic
Location
[Insert all applicable information regarding the specific location of the response; including any city, State, Federal region, international country, or military installation.]
Mission
Protect and Response
Capabilities
1. Planning
2. Communications
3. Community Preparedness and Participation
4. Emergency Public Information and Warning
5. Epidemiological Surveillance and Investigation
6. Public Health Laboratory Testing
7. Isolation and Quarantine
8. Responder Health and Safety
9. Medical Supplies Management and Distribution
10. Command and Event Management
Scenario Type
Pandemic influenza outbreak including surveillance of disease, public education and
communication, planning, isolation and quarantine, and receipt and distribution of SNS
supplies and vaccine.
Section 1: Response Overview
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Response Team
[The name of each member of the response team leadership should be listed along with their (1)
role in the response, (2) organizational affiliation, (3) job title, (3) mailing address, (4) phone
number, and (4) e-mail address. This is not a listing of all personnel involved in the response.]
Contact Name/Title: Health Director?
Response Role:
Name of Agency:
Address:
City/State/Zip:
Phone and Extension:
Email Address:
Contact Name/Title: Nursing Director?
Response Role:
Name of Agency:
Address:
City/State/Zip:
Phone and Extension:
Email Address:
Contact Name/Title: Preparedness Coordinator?
Response Role:
Name of Agency:
Address:
City/State/Zip:
Phone and Extension:
Email Address:
Contact Name/Title: PIO?
Response Role:
Name of Agency:
Address:
City/State/Zip:
Phone and Extension:
Email Address:
Contact Name/Title: CD/Immunization Supervisor?
Response Role:
Name of Agency:
Address:
Section 1: Response Overview
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City/State/Zip:
Phone and Extension:
Email Address:
Participating Organizations
[Insert a list of the individual participating organizations or agencies, including Federal, State,
Tribal, non-governmental organizations (NGOs), local and international agencies, and contract
support companies as applicable.] Emergency Management? Hospital? Community Health
Center? EMS? Public Schools?
Number of Participants
[Insert a list of the total number of each of the following response participants, as applicable.
Listing numbers by agency is particularly helpful if available. This will reinforce the fact that
representatives from other jurisdiction committed resources to this response.]
Section 1: Response Overview
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SECTION 2: RESPONSE SUMMARY
Response Summary
[For an operations-based response, this section should summarize the situation, subsequent key
events, and the time in which these events occurred. ]
During this response, and in accordance with target capabilities, most jurisdictions probably tested four key response components:
 Isolation and Quarantine (tested plan and procedures)
 Responder Health and Safety
 Epidemiological Surveillance and Investigation (perhaps part of local response plan)
 SNS and Pan Flu:
o Planning
o Mass Prophylaxis
o Critical Resource Logistics and Distribution
o Laboratory Testing
o Crisis and Tactical Communication
o Command and Event Management
o Emergency Public Information and Warning
 Community Preparedness and Participation (education)
The functions in the TAR that must be trained/exercised are the following- pick which ones you
did and if included here, will count towards fulfilling that part of the TAR:
 Overall SNS planning elements (we probably all did this)
 Management of SNS operations (probably all did as opening of LRS and mass clinics)
 Local to state requesting procedures (you may have done if requested more antivirals,
esp. suspension)
 POD to local requesting procedures (probably didn’t do)
 Tactical communications plan (probably all did to an extent)
 Public information and communication (all did)
 Security (you may have done with first SNS shipment)
 Inventory Management System (probably all did- at least paper/pencil)
 Dispensing (all did through mass clinics and distribution to providers of vaccine and
PPE)
 Hospitals and ACF coordinator (you probably did through meetings and distribution of
PPE/antivirals to hospitals)
 LRS Plan (all did)
 Distribution methods (all did)
Therefore, if you want to include all 4 response components, including SNS, you could use this
AAR and response to meet multiple exercise requirements. All of these need to be at least discussed in this section in a general narrative.
Section 2: Response Design Summary
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SECTION 3: RESPONSE ANALYSIS
This section of the report reviews the performance of the response.
Remember, the Target Capabilities for this AAR are list below. You must have one “section” for
each TC:
1. Planning
2. Communications
3. Community Preparedness and Participation
4. Emergency Public Information and Warning
5. Epidemiological Surveillance and Investigation
6. Public Health Laboratory Testing
7. Isolation and Quarantine
8. Responder Health and Safety
9. Medical Supplies Management and Distribution
10. Command and Event Management
Observation 1: [Begin this section with a heading indicating whether the observation is a
”Strength” or an “Area for Improvement” related to a Target Capability identified for your realworld incident. A strength is an observed action, behavior, procedure, and/or practice that is
worthy of recognition and special notice. Areas for improvement are those areas in which the
evaluator observed that a necessary task was not performed or that a task was performed with
notable problems. Following this heading, insert a short, complete sentence that describes the
general observation.]
Strength or Areas for Improvement (pick one) related to Target Capability “Planning”:
(i.e. area for improvement may be that existing pandemic flu plan was built upon WHO Pandemic Phases which was not flexible enough for this response, etc.)
References: [List relevant plans, policies, procedures, laws, and/or regulations, or sections of
these plans, policies, procedures, laws, and/or regulations. If no references apply to the observation, it is acceptable to simply list “N/A” or “Not Applicable.”]
Based on earlier knowledge and federal/state planning guidance, the current XXXX County Pandemic Influenza Plan has each section broken down by WHO Pandemic Phase.
Analysis: [The analysis section should be the most detailed section of Chapter 3. Include a description of the behavior or actions at the core of the observation, as well as a brief description of
what happened and the consequence(s) (positive or negative) of the action or behavior. If an action was performed successfully, include any relevant innovative approaches utilized by the response participants. If an action was not performed adequately, the root-causes contributing to
Section 4: Conclusion
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the shortcoming must be identified.] I.e. WHO Phases were not applicable for this response as
XXX County did not have any cases when Phase 6 was declared, for example. The plan was also based on “worst case scenario” and not flexible enough to address a pandemic of its actual
scale. This made the plan hard to follow for this response.
Recommendations: [Insert recommendations to address identified areas for improvement,
based on the judgment and experience of the evaluation team. If the observation was identified
as a strength, without corresponding recommendations, insert “None.]
1. [Complete description of recommendation] I.e. Review notes and collect tools
from H1N1 response to include in new pandemic plan.
2. [Complete description of recommendation] I.e. Working with regional PCs, base
the new plan on the latest guidance from NCDPH.
3. [Complete description of recommendation]
Observation 2:
Strength or Areas for Improvement (pick one) related to Target Capability “Communications”:
(i.e. area for improvement may be that there was not good cell phone reception at LRS and plan
needs to be modified to include radios at that site, etc.)
References:
Section 4 of the ____ County SNS Plan describes mechanisms for tactical communications during mass prophylaxis/distribution events.
Analysis: I.e. used VIPER radios and problems you may have had or used Blackberry’s/cell
phones to communicate between counties of when SNS truck may arrive, etc.
Recommendations:
1. [Complete description of recommendation] I.e. Conduct a more complete “survey” of where tactical communications equipment will work for identified sites
(PODs, LRS, etc.)
2. [Complete description of recommendation]
3. [Complete description of recommendation]
Observation 3:
Strength or Areas for Improvement (pick one) related to Target Capability “Community Preparedness and Participation”:
I.e. Information on flu prevention and vaccination locations were quickly put on a county flu
Section 4: Conclusion
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webpage with references and links to CDC, NCDPH, hospital, etc. offering a “one-stop shop” for
county citizens to get accurate information.
References: The Communications Section of the XXXX County Pandemic Flu Plan and Section 5: Public Information and Communication of the SNS Plan discusses community education
and ways to communicate important health information to the public.
Analysis: I.e. Though websites existed at CDC and NCDPH, a county website was deemed
necessary by officials in order to incorporate local information along with links to NCDPH and
CDC (so constantly changing information from them wouldn’t have to be constantly changed).
The website was given a site name similar to federal and state websites in order to make remembering the site easy. Local partner agencies information and links were also included and they
were asked to link back to the county website as well. The information on community vaccination clinics, who could come, etc. was easily changed throughout the response. Important and
accurate prevention information was also included.
Recommendations: If the observation was identified as a strength, without corresponding
recommendations, insert “None.]
None.
Observation 4:
Strength or Areas for Improvement (pick one) related to Target Capability “Emergency Public
Information and Warning”:
I.e. Utilized Reverse 911 system to inform citizens of flu clinics.
References:
Section 5: Public Information and Communication of the XXX County SNS Plan details how
citizens would be notified of mass prophylaxis events.
Analysis: In addition to traditional means of notifying the public of vaccination clinics (website, newspaper/radio announcements), the county reverse 911 system sent a message before
mass clinics so that a far-reaching number of citizens were aware of the clinic. Though some
persons were probably not contacted for varying reasons (did not have a phone, etc.), the system
is an easy and effective way to reach a large portion of the population who may not utilize more
traditional means of access to information.
Recommendations:
None
Section 4: Conclusion
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Observation 5:
Strength or Areas for Improvement (pick one) related to Target Capability “Epidemiological
Surveillance and Investigation”:
(i.e. School system was asked to conduct active surveillance of absenteeism early in the outbreak
response. HD was notified when a school’s absenteeism was above 10%).
References:
The Surveillance Section of the ____ County Pandemic Influenza Plan describes pandemic disease surveillance tools and procedures.
Analysis: Increased absenteeism can be seen as a “proxy” for increases in disease activity,
though current systems in Pitt County for why a student was absent does not exist. Once a
school had reached absenteeism of 10%, school nurses investigated as much as possible to determine if the increase might be due to flu-like symptoms. If so, a letter was sent to parents from
that school.
Recommendations:
4. [Complete description of recommendation] I.e. Continue to gather information on
plans for a state or local system for a better surveillance system for absenteeism in
schools.
5. [Complete description of recommendation] I.e. Develop a system to better gather
absenteeism information from private schools.
6. [Complete description of recommendation]
Observation 6:
Strength or Areas for Improvement (pick one) related to Target Capability “Public Health Laboratory Testing”
(i.e. local physicians were able to be updated immediately by local public health about changes
in testing guidelines).
References:
The Laboratory Diagnostics Section of the ____ County Pandemic Influenza Plan describes procedures for laboratory testing for pandemic influenza.
Analysis: Guidelines on what patients should be tested and how was constantly changing
throughout the pandemic. Though this could have led to great confusion in the medical community, the ability of the health department to maintain constant communication through email
listservs/faxes to push out the latest testing guidance was extremely beneficial.
Section 4: Conclusion
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Recommendations:
None
Observation 7:
Strength or Areas for Improvement (pick one) related to Target Capability “Isolation and
Quarantine”:
(i.e. early in the response, persons were isolated without testing or indication of true symptoms)
References:
The Disease Containment Section of the ____ County Pandemic Flu Plan describes procedures
for isolation and quarantine. A copy of laws/regulations and draft orders are located in the Appendix.
Analysis: (i.e. Information early in the response on persons potentially exposed to cases was
often inaccurate based on the unknown epi of the virus. However, quick isolation of potentially
infected persons was deemed necessary in order to “quench” the outbreak in the early phase.
Therefore, persons were isolated/quarantined unnecessarily.
Recommendations:
7. [Complete description of recommendation] I.e. Revise Pandemic Flu Plan to incorporate more flexibility for when to isolate/quarantine.
8. [Complete description of recommendation]
9. [Complete description of recommendation]
Observation 8:
Strength or Areas for Improvement (pick one) related to Target Capability “Responder Health
and Safety”:
(i.e. though N-95 PPE was available through SNS shipments, most local physician offices did
not have a sufficient Respiratory Protection Plan or fit-testing of staff)
References:
OSHA Regulation 1910:134 Respiratory Protection Standard requires employers that use N-95s
in their practice to have medical screening, fit-testing, and annual training for staff in order to use
respirators.
Analysis: PPE, including N-95s were sent to LHDs via two shipments. LHDs were encouraged to share PPE with local physician offices who might be in short supply. However, upon
inquiry at those offices, most did not have fit-tested staff or a proper Respiratory Protection Plan
upon which to use N-95s. While offices and the LHD was surged, just-in-time fit-testing at mulSection 4: Conclusion
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tiple offices was not feasible and therefore offices either did not use the indicated PPE or used it
against OSHA regulation.
Recommendations:
10. [Complete description of recommendation] I.e. Offer a fit-testing/development of
Respiratory Protection Plan training for local physician offices/EMS, etc. through
with the help of the PHRST IH.
11. [Complete description of recommendation] Use PHER Response funds to purchase fit-testing equipment for local provider offices.
12. [Complete description of recommendation]
Observation 9:
Strength or Areas for Improvement (pick one) related to Target Capability “Medical Supplies
Management and Distribution”
(i.e. since children were an initial target group for vaccination, we partnered with the local school
system to provide vaccinations in-school for children).
References:
None.
Analysis: Using earlier experience with providing seasonal vaccinations in the schools, the
LHD partnered with the school system to offer H1N1 vaccinations during school. This made
vaccination easy and affordable to parents who wouldn’t seek out vaccination for their children
another way and eased some of the burden off community clinics.
Recommendations:
None
Observation 10:
Strength or Areas for Improvement (pick one) related to Target Capability “Command and
Event Management”
(County partners met in a series of meetings/exercises in August to discuss the best ICS structure
for this outbreak; though not fully used due to the mildness of the pandemic, all partners were on
board and receptive.
References:
The Command and Control Section of the ____ County Pandemic Influenza Plan describes how
event management and ICS should function in a pandemic flu event.
Section 4: Conclusion
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Analysis: Much of the work on ICS structures for pandemic flu in the county had been health
department specific and was not very scalable for a mild pandemic. Through a series of meetings/exercises in August of 2009, a county-wide ICS Area Command structure was developed
with extensive partner input. The structure was scalable and able to be applied well to this mild
outbreak.
Recommendations:
None
SECTION 4: CONCLUSION
[This section is a conclusion for the entire document. It provides an overall summary to the report. It should include the demonstrated target capabilities, lessons learned, major recommendations, and a summary of what steps should be taken to ensure that the concluding results will
help to further refine plans, policies, procedures, and training for this type of incident.
Subheadings are not necessary and the level of detail in this section does not need to be as comprehensive as that in the Executive Summary.]
The 2009/2010 H1N1 Influenza Response by the XXXX County Health Department was a multi-month and integrated response that addressed the Target Capabilities of Planning, Communication, Community Preparedness and Participation, Emergency Public Information and Warning,
Epidemiological Surveillance and Investigation, Isolation/Quarantine, Responder Health and
Safety, and Medical Supplies Management and Distribution. The major lessons learned were
(from Section 3) ……. The major recommendations and corrective actions (from Section 3)
planned for the future are….
Section 4: Conclusion
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APPENDIX A: IMPROVEMENT PLAN
CORRECTIVE ACTION PLAN MATRIX
Improvements
(List all “Areas for Improvement” from Section 3)
Actions to Be Completed
Parties Responsible (Position or
Designee)
Dates for
Completion
(MM/DD/YY)
List all “Recommendations” from Section 3
Appendix A: Improvement Plan/CAP
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FOR OFFICIAL USE ONLY (FOUO)
FEDERAL EMERGENCY MANAGEMENT AGENCY
AFTER ACTION REPORT/IMPROVEMENT PLAN
[Full Response Name]
Appendix B: Lessons Learned
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