Community-Based Planning

In a smallpox emergency, the entire community will need to respond in a coordinated and planned manner. No single organization can take care of the sick, stop the spread of disease, deliver supplies, give vaccinations, and handle everything else that will be required. Partnerships within communities and across regions will be essential to a successful response. The specific make-up of these partnerships will vary by community.

Include people and organizations who bring specialized knowledge about the community or about laws, regulations, and other issues that may affect emergency response efforts. Some examples of people and organizations to include are those who:

• Will diagnose and treat sick patients
  • Hospitals
  • Urgent-care clinics
  • Federally Qualified Health Centers
  • Independent medical providers, especially primary care providers
• Can help the entire community cope with the emergency
  • Mental and behavioral health providers
  • Faith-based leaders and organizations
• Will provide initial and ongoing response
  • Emergency response organizations, emergency medical technicians (EMTs), local 911 service providers
  • First responders, including local volunteer groups
• Currently work with people who may need functional, language, or cognitive assistance in an emergency
  • Social service non-profit organizations
  • Community leaders
  • Outreach and community health workers
  • Schools for the deaf and blind
  • Travelers' aide groups
  • Group homes
• Will help with logistic and security needs
  • Local schools and universities
  • State and local transportation representatives
  • Law enforcement
  • Local government, including those responsible for overall emergency planning
• Provide expert guidance
  • State and federal public health preparedness officials
  • Infectious disease specialists

Begin planning by assessing the community's existing resources. Identify resource gaps and needs the community might face in a smallpox emergency. The scope of the outbreak will determine the level of response each community will need to mount. Communities with smallpox patients will have different response needs than those without smallpox patients.

Depending on the severity of the outbreak, local response teams may need to:

• Isolate and care for suspect cases.
• Institute enhanced surveillance of acute, febrile rash illnesses.
• Coordinate with state public health officials and CDC to diagnose patients with smallpox and receive shipments of medical countermeasures.
• Activate an Emergency Operations Center, following jurisdictional standards and practices within the National Incident Management System.
• Designate one or more healthcare facilities to treat only patients with confirmed smallpox. This may require designating other facilities to monitor suspected, febrile patients, and others to handle routine medical care.
• Launch contact tracing efforts and contact monitoring systems.
• Work with law enforcement if the emergency is considered a deliberate act.
• Rapidly vaccinate healthcare workers, first responders, public health officials, and other people who will interact with smallpox patients.
• Execute vaccination strategy or strategies, depending upon the circumstances of the event.
• Monitor and report adverse events that may have resulted from vaccination.
• Communicate effectively and regularly with the media and the public.
• Provide information and data to state and federal public health officials to inform state and national response decisions.

Identify circumstances that will affect local response plans:

• Review state and local laws and regulations that govern different aspects of an emergency response to smallpox, including, but not limited to:
  • Quarantine laws
  • Hazardous waste disposal and transportation regulations
  • Credentialing requirements for healthcare workers in vaccination clinic
• Identify the availability of healthcare facilities with Airborne Infection Isolation Rooms (AIIRs) to isolate smallpox patients.
  • Encourage healthcare facilities to enter into Memoranda of Understanding (MoU) to allow for easy patient transfers. Review existing MoUs to ensure they would be effective in a smallpox emergency.
  • If the community is small and does not have multiple healthcare facilities, seek out regional partnerships in order to give community members clear instructions on where to seek care in an emergency.
• Determine the number and type of staff required to conduct different response activities, such as:
  • Managing the response and leading the Incident Management team
  • Contact tracing and monitoring
  • Vaccination, both ring and community-wide vaccination efforts
  • Collecting, reporting, and analyzing data
  • Communicating with the public and with other authorities involved in the response
  • Lab testing

Some individuals may need assistance getting care, learning about response efforts, or getting to a vaccination clinic. Community partnerships and working relationships formed prior to an emergency will be crucial for reaching as many people as possible. Work with organizations and individuals in the community who have frequent interaction with community members who may not be served as easily during an emergency.

Some situations to consider:

• People experiencing homelessness or who have unstable housing may be difficult to reach for vaccination and follow-up to determine the vaccination "take." They may also be difficult to reach for contact tracing or for fever surveillance if they have been exposed.
• Tourists or other travelers may not be able to return home if they are exposed to smallpox and require vaccination or quarantine, or if travel restrictions are instituted.
• Individuals who do not speak English as their first language may not easily understand public health messages or other important information not given in their native language.
• People with hearing or visual impairments or other physical challenges may need help at a vaccination clinic, or may need alternative methods for reporting their temperatures during fever surveillance. They may also need extra help with vaccination site care.
• Older adults may need help getting to vaccination clinics, or may need alternative arrangements for vaccination.
• People in rural or remote areas may also be difficult to reach for contact tracing, vaccination, or monitoring for symptoms after exposure to smallpox.
• Institutionalized individuals will not be able to travel to vaccination clinics and may not have the information or resources they need to protect themselves from exposure. Work with medical and administrative staff at these institutions to ensure they know how to protect the people under their care.
• Seasonal farm workers may be unfamiliar with a community's resources or may not have the ability to travel to receive healthcare or vaccinations.