Mitigation Journal: How to Write your Biologic Plan

The first step in creating a workable biologic plan is to realize that a biologic plan is not the same as a pandemic plan. Plans written for a specific disease rather than for a biologic situation will fail. Plans should be guidance documents for a spectrum of events addressing the commonalities among disease outbreaks and the reasonable steps needed to respond to the situation. Labeling your plan a Pandemic Plan or Avian Flu Plan implies that the plan will only be activated if the situation becomes a pandemic or a specific pathogen is discovered. This will delay plan activation resulting in further escalation of the situation. Planning for generalities allows for greater flexibility and integration of action into a variety of situations. Your plan should be established for seasonal events as well as an intentional acts of bio terrorism. Although the risk of a true biological terrorism event is small, the impact will be huge. One way to prepare for low-frequency, high impact events is to look for other similar events to hone our skills.

Seasonal influenza is an often overlooked opportunity to test our biologic planning. Expected seasonal outbreaks of various diseases provides us with the opportunities to review plans, test communications and public information, and even exercise “what if” scenarios with tabletop exercises. The added benefit of this real-world exercise is enhanced preparedness for large scale biological event as well as improved response to seasonal or expected biologic events.

Keys for workable Pandemic Biologic Plan

Follow a planning process. Every community and organization must follow a planning process. Establishing a consistent planning process helps reduce error in critical situations and supports positive outcomes.

Planning in stages or granular planning allows for mistakes and ideas to be identified and explored.
Identify a planning team and team leader. Written authority should be given.
The planning team should conduct a threat assessment and hazard analysis identifying not only the probability of a biologic event, but the consequences as well.

Conduct a threat and hazard assessment. Every jurisdiction should have conducted a threat assessment in hazard vulnerability assessment as part of their general preparedness planning. Our vulnerability to that hazard requires a bit of detail:

Loss of personnel - Personnel may not report to work due to direct or indirect impact of a biologic event. Personnel may become ill and not able to report (direct impact) or may remain away from the work environment resulting from indirect impact such as school or day care closure, ill family members, or fear. These losses apply to uniformed and civilian employees in public service organizations as well as clinical and non-clinical staff in health care.
Loss of surge capacity - surge capacity is a function of physical space, resources and personnel. Loss of personnel will limit ability to manage surge even when plenty of bed space exists.
Need for decontamination and personal protective equipment - if not properly decontaminated, the environment of care can act as a reservoir of disease and cause infection of otherwise healthy persons. Personal protective equipment (PPE) may be scarce and vendors may not be able to keep up with demand or deliver as needed. PPE should be appropriately stockpiled and not subject to just-in-time inventory.
Impact of surrounding communities on your operation - Are neighboring jurisdictions and facilities as prepared as well as you are? If not, expect an influx of people into an area that is prepared and operating well. This influx from surrounding areas can collapse even the best prepared organizations.

Conduct a review of existing infrastructure and systems. A proactive and constructive review of existing infrastructure will provide the framework for good planning. Assuming your systems will be viable if they haven’t been assessed or tested invites disaster.

Do you have robust planning, training and preparedness activities?
What is your ability to manage surge capacity measured by physical space, numbers of victims, and ability to provide treatment?
Have you established protocol for triage of limited critical services during a community-wide event? Are the triggers identified for making the change from standard response to sufficiency of response?
Has the preparedness of partner agencies, suppliers and vendors been evaluated? Without your partner agencies or contractors you may not be able to continue to provide service or carry out your mission.

Summary - your biologic plan should be: