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Pandemic Influenza Resources & Guidelines

Avian Influenza Viruses | Recent Contagion-Related Resource Links
Resources & Information on H1N1 Influenza A
Introduction | What All Citizens Should Do
Resources & Guidelines: Federal | State | National | International
Online Resources: Information | Tools

The National EMS Pandemic Influenza Preparedness Index (NASEMSO Monograph, November 2010)
H1N1 Preparedness: What States Are Doing

Avian Influenza Viruses


Recent Contagion-Related Resource Links:

Resources & Information on H1N1 Influenza A

1. U.S. Department of Health and Human Services: one-stop access to U.S. Government swine, avian and pandemic flu information. Web site: www.pandemicflu.gov

2. The Centers for Disease Control and Prevention Home Page on Swine Flu: The outbreak of disease in people caused by a new influenza virus of swine origin continues to grow in the United States and internationally. The CDC reports additional confirmed human infections, hospitalizations and the nation’s first fatality from this outbreak. The more recent illnesses and the reported death suggest that a pattern of more severe illness associated with this virus may be emerging in the U.S. Most people will not have immunity to this new virus and, as it continues to spread, more cases, more hospitalizations and more deaths are expected in the coming days and weeks. Web site: http://www.cdc.gov/swineflu/

3. Interim Guidance on Case Definitions to be Used For Investigations of Swine Influenza A (H1N1) Cases: This document provides interim guidance for state and local health departments conducting investigations of human cases of swine-origin influenza A (H1N1) virus (S-OIV). The following case definitions are for the purpose of investigations of suspected, probable, and confirmed cases of S-OIV infection. Acute febrile respiratory illness is defined as a measured temperature of 37.8 degrees Celsius (100.4 degrees Fahrenheit) and recent onset of at least one of the following: rhinorrhea or nasal congestion, sore throat, or cough.
Posted April 29, 2009 2:00 AM ET at http://www.cdc.gov/swineflu/casedef_swineflu.htm (Please check the CDC page for the most current update.)

4. Interim Guidance for Cleaning Emergency Medical Service (EMS) Transport Vehicles during an Influenza Pandemic: EMS agencies should define mechanisms of rapidly modifying infection control and decontamination procedures based on the most recent research and scientific information, including federal, state and local pandemic influenza guidelines. State, local, tribal and territorial EMS agencies, in coordination with federal, state and local public health departments, 911 programs, and emergency management and health care officials should ensure that EMS pandemic influenza plans define a process for gathering and developing updated pandemic influenza information, including clinical standards, treatment protocols and just-in-time training and disseminate it to local EMS medical directors and EMS agencies.  Following are general guidelines for cleaning or maintaining Emergency Medical Service (EMS) Transport Vehicles after transporting a suspected influenza patient during a pandemic1. This guidance may be modified or additional procedures may be recommended by the Centers for Disease Control and Prevention (CDC) as part of the evaluation of an ill traveler, when an influenza pandemic becomes widespread in the United States, or as new information about a pandemic strain becomes available.
Web site: http://www.pandemicflu.gov/plan/healthcare/cleaning_ems.html

5. Interim Guidance for Emergency Medical Services (EMS) Systems and 9-1-1 Public Safety Answering Points (PSAPs) for Management of Patients with Confirmed or Suspected Swine Influenza A (H1N1) Virus Infection:
Web Site: http://www.cdc.gov/swineflu/guidance_ems.htm
This document provides interim guidance for 9-1-1 Public Safety Answering Points (PSAPs), the EMS system and medical first-responders and will be updated as needed at http://www.cdc.gov/swineflu/guidance/. The information contained in this document is intended to complement existing guidance for healthcare personnel, “Interim Guidance for Infection Control for Care of Patients with Confirmed or Suspected Swine Influenza A (H1N1) Virus Infection in a Healthcare Setting,” at http://www.cdc.gov/swineflu/guidelines_infection_control.htm.

6. “What Is All the Fuss?  A “Just-in-Time” Primer on H1N1 Influenza A and Pandemic Influenza” is now available as a self-learning module to help state EMS officials educate EMS practitioners about the current influenza disease outbreak dominating the media.  It is being provided in a MS PowerPoint 2003 compatible format for those who wish to insert their own instructional materials. The file has been expanded and organized into sections as follows:

Please note: The first five slides in each smaller set are the same with the title slide, table of contents, link to the NHTSA EMS and 9-1-1 pan flu guidelines, and a disclaimer.

7. National Strategic Plan for Emergency Department Management of Outbreaks of Novel H1N1 Influenza. The National Strategic Plan For Emergency Department Management of Outbreaks of Novel H1N1 Influenza was produced under contract to the Office of the Assistant Secretary for Preparedness and Response (ASPR) and the Emergency Care Coordination Center (ECCC). This document was developed in collaboration with ASPR, ECCC and the American College of Emergency Physicians (ACEP). download national strategic plan

8. 2009-2010 Influenza Season Triage Algorithm for Adults (>18 Years) With Influenza-Like Illness. This algorithm is designed to assist physicians and those under their supervision in identifying indicators of and responses to symptoms of flu-like illness (i.e., fever with cough or sore throat). (NOTE: this guidance is not intended for use by the general public and is not a substitute for sound clinical judgment.) download algorithm

9. ASM Heard Evidence from Researchers on Respiratory Protection for Health Care Workers. During its recent annual meeting, the American Society of Microbiology heard evidence from researchers in Beijing, China about the usefulness of respiratory protection and fit-testing for health care workers. Downloads: Summary | Abstract

10. New AMA Student on Respiratory Protection for Health Care Workers. The Journal of the American Medical Association on Oct. 1, 2009, published a new study on respiratory protection for health care workers. ADA article | CDC response

11. OSHA Statement re: H1N1-related Inspections. The Occupational Safety and Health Administration announces plans to conduct H1N1compliance visits in upcoming months. In response to complaints, OSHA inspectors will ensure that healthcare employers implement a hierarchy of controls, including source control, engineering, and administrative measures, encourage vaccination and other work practices recommended by the CDC. download OSHA statement

12. FEMA Releases Updated Policy and FAQ on Guidelines for Requesting Assistance Under the Stafford Act During a Pandemic Influenza Outbreak (01 Dec 2009) On Oct. 27, the U.S. Dept. of Homeland Security's Federal Emergency Management Agency (FEMA) released a fact sheet that shared FEMA guidelines for requesting assistance under the Stafford Act during a pandemic influenza outbreak. These guidelines will assist States in assessing impacts and evaluating the need for Federal assistance. To ensure consistency, FEMA on Dec. 1 has released an update of the policy and FAQs related to the fact sheet. The policy outlines the four primary evaluation criteria and factors to be used in granting a declaration, including:

  • Whether the State has directed execution of its State Emergency Plan;
  • Whether the requesting State has demonstrated that the incidence of influenza is, at a minimum, significantly higher than the State's seasonal average;
  • Whether the State can demonstrate that effective response to the pandemic event is beyond the capability of the State and affected local governments; and
  • Whether the State has identified specific direct federal assistance that is required to save lives, protect property and public health and safety, or to lessen or avert the threat of a disaster.

The President continues to reserve the right to approve all requests and agree or disagree with recommendations made for disaster declarations. Other federal agencies, such as the U.S. Department of Health and Human Services (HHS), also have authority to provide assistance to support jurisdictions during pandemic events.  If an emergency declaration is declared, FEMA cannot duplicate assistance provided under the authority of another federal agency.

13. Key Pandemic Influence Resource Links - courtesy of Greg Banner, MS, CEM, Regional Emergency Coordinator, Region I (New England) US Department of Health and Human Services, Boston, MA.

In addition, you can follow up-to-date swine flu information via Twitter—


  • NEW from the American Health Lawyers Association - NASEMSO is pleased to provide Community Pan-Flu Preparedness: A Checklist of Key Legal Issues for Healthcare Providers, published by the American Health Lawyers Association. The Checklist is a scalable tool designed to assist providers along the continuum of care as well as the broader healthcare and public health communities in taking concrete steps to prepare for an influenza pandemic. Appendix A addresses “Special Considerations for Pre-hospital Providers.” Copyright © 2008 by the American Health Lawyers Association and reproduced for the benefit of and to promote the health of the community served by the distributing organization.

  • NEW from the World Health Organization - WHO Global Influenza Preparedness Plan: This April 2009 guidance is an update of WHO Global Influenza Preparedness Plan, The role of WHO and recommendations for national measures before and during pandemics, published by WHO March 2005. The information and recommendations contained in this guidance is the product of expert opinion, derived from several international consultations which included examination of available information and modeling studies, input from public health experts on lessons learned from SARS and both animal and human influenza responses, and consolidation of recommendations in existing WHO guidance. The Global Influenza Programme will revise this guidance in 2014, or sooner in the event of significant developments which impact pandemic preparedness and response planning.

  • NEW from the World Health Organization - Swine Flu FAQ: Frequently asked questions related to swine flu and the current outbreak.

Definition of Pandemic:

Pandemic is a worldwide epidemic; an epidemic occurring over a wide geographic area and affecting a large number of people.

Three essential conditions must be met for an outbreak to begin:

  • A new flu virus must emerge from the animal reservoirs that have produced and harbored such viruses — one that has never infected human beings and therefore one for which no person has developed antibodies.
  • The virus has to make humans sick (most do not).
  • It must be able to spread efficiently, through coughing, sneezing, or a handshake.
  • Seasonal influenza viruses:
    • Are a public health problem every year.
    • Circulate throughout the human population.
    • Spread easily from person to person.
  • Avian influenza A (H5N1) viruses:
    • Devastating global outbreak in poultry.
    • Cause severe but rare human infections.
    • Do not spread easily from person to person.
  • Pandemic influenza viruses :
    • Appear in the human population periodically.
    • H5N1 is a likely candidate, but it is not a pandemic virus yet.
  • The likelihood of mutation or reassortment leading to efficient person-to-person transmission is unknown.
  • Spread of avian H5N1 infections increases risk.
    • Recent evolutionary changes in the virus make control among birds more difficult and continued spread likely.
  • Other avian influenza A subtypes (H7N3, H7N7, H9N2) also have caused human infections
Only the THREAT of a pandemic currently exists; a viral strain capable of producing a pandemic in the human population has not been identified!
  • Store extra food and other daily supplies to make it easier to stay home for a prolonged period of time;
  • Learn and practice proper hand washing;
  • Use safe cough and sneeze techniques to limit the spread of illnesses; and
  • Stay home and avoid others if you are sick.


U.S. Dept. of Health & Human Services
The U.S. Department of Health and Human Services (DHHS) is the lead federal agency responsible for pandemic influenza planning. All federal agencies in compliance with the President’s Implementation Plan for Pandemic Influenza are required to link resources on a single Web page at www.pandemicflu.gov.

National Highway Traffic Safety Administration (NHTSA) Office of Emergency Medical Services (OEMS)

Occupational Health and Safety Administration

Centers for Disease Control and Prevention

Office of Public Health Emergency Medical Countermeasures (OPHEMC)


State Pandemic Influenza Plans
In order to compete for federal funding for pandemic influenza, individual states are required to file a pandemic influenza plan with DHHS. All 50 states, including 3 U.S. territories, have pandemic influenza plans included on the DHHS web site. Because states were provided the flexibility to create plans to best meet their own needs, each plan is unique in addressing the range of issues facing states and territories during an influenza pandemic. Many state health officials report these resources are “living documents” and under continuous review and revision. While newer versions may be available at individual state web sites, all state pandemic influenza resources provided to DHHS are included here.

In a survey conducted by NASEMSO in 2006, the following states reported the availability of specific statewide EMS pandemic influenza plans: CO, DC, HI, MD, MN, NC, PA, TX, and UT.  The following states reported the inclusion of EMS objectives within the state pandemic influenza plan: AL, AK, DE, GA, IL, IA, ME, MT, NJ, NM, ND, TN, WV, and WY.

Sample Influenza Like Illness Tracking Report
Jenny Gong, MPH, Research Statistician, Emergency Medical Services & Injury Prevention System Branch, Hawaii State Department of Health, provided a sample tracking report using EMS data for influenza surveillance. Download sample report.


National Association of State EMS Officials
Through a cooperative agreement with the National Highway Traffic Safety Administration, the National Association of State EMS Officials coordinated the efforts of national stakeholders to identify statewide guidelines for EMS and 9-1-1 call centers on pandemic influenza. These documents will become available in an electronic format on the DHHS and NHTSA web sites. Individuals wishing to obtain a pre-publication version of these resources should contact NASEMSO Program Advisor Kathy Robinson.

Association of State and Territorial Health Officials
State Pandemic Influenza Summits: Building Partnerships for Pandemic Preparedness

Federal Communications Commission
Archived recording of the Federal Communications Commission’s Public Safety and Homeland Security Bureau Summit on Pandemic Preparedness titled “Enhancing Communications Response for Health Care and First Responders in which NASEMSO participated as a panelist.

ISDA and the Trust for America’s Health
Pandemic Influenza: The State of the Science

National Association of County and City Health Officials
Local Health Department Guide to Pandemic Influenza Planning

National Governors Association Center for Best Practices

Trust for America’s Health


WHO Pandemic Preparedness
WHO is coordinating the global response to human cases of H5N1 avian influenza and monitoring the corresponding threat of an influenza pandemic. Information on this page tracks the evolving situation and provides access to both technical guidelines and information useful for the general public and provides the most up-to-date info on avian influenza.



American Public Health Association
Fact Sheet on Pandemic Influenza: “It’s Not the Flu You’re Used To"

Australian Centre for Prehospital Research
The Australian Prehospital Pandemic Risk Perception Study and an Examination of New Public Health Roles in Pandemic Response for Ambulance Services

Centers for Disease Control and Prevention

National Academies of Sciences
http://www.nas.edu (Search for “pandemic influenza” to access multiple reports.)

Occupational Safety & Health Administration (OSHA)

  • 2009 GAO Report: INFLUENZA PANDEMIC Sustaining Focus on the Nation’s Planning and Preparedness Efforts at http://www.gao.gov/new.items/d09334.pdf This report is largely based on GAO’s prior work (GAO-07-1257T) on influenza pandemic preparedness, reporting the efforts that have been implemented since the previous findings.
  • Protect Yourself Avian Flu Healthcare Workers Quick Card [PDF* - 28 KB]. OSHA Publication (2006, October).
  • OSHA Guidance Update on Protecting Employees From Avian Flu (Avian Influenza) Viruses [PDF* - 1 MB]. OSHA Publication. (2006, October).

World Health Organization


Promising Practices: Pandemic Preparedness Tools

  • This project aims to enhance public health preparedness for an influenza pandemic and conserve resources by sharing promising practices. CIDRAP and the Pew Center on the States (PCS) launched this initiative to collect and peer-review practices that can be adapted or adopted by public health stakeholders. This project is sponsored by the Association of State and Territorial Health Officials (ASTHO), the national non-profit organization representing the 57 state and territorial public health agencies of the United States, US Territories, and the District of Columbia. Promising Practices Web Site

Sample Pandemic Influenza Virulent Infectious Disease Protocol for EMS

  • The “Sample Pandemic Influenza Virulent Infectious Disease Protocol” and “Dynamic System Severity Score” are for illustrative purposes only. This document is one example of how resources may be evaluated and reallocated within the system during an influenza pandemic. Whenever possible, a patient should be managed as clinically appropriate as possible, regardless of their case status. Download Sample Pandemic Influenza Virulent Infectious Disease Protocol for EMS.

Centers for Disease Control and Prevention

  • FluAid is a test version of software created by programmers at the Centers for Disease Control and Prevention (CDC). It is designed to assist state and local level planners in preparing for the next influenza pandemic by providing estimates of potential impact specific to their locality. Learn more and download software.
  • FluSurge is a spreadsheet-based model which provides hospital administrators and public health officials estimates of the surge in demand for hospital-based services during the next influenza pandemic. Learn more and download software.
  • CDC Public Health Information Rapid Exchange (PHIRE)