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Adapting Community Call Centers for Crisis Support

Public Health Emergency Preparedness

This resource was part of AHRQ's Public Health Emergency Preparedness program, which was discontinued on June 30, 2011, in a realignment of Federal efforts.

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Appendix 1: National Planning Scenarios Analysis Matrix

Scenario Number Scenario Title Scenario Description Executive Summary Mission Areas Activated
Casualties Infrastructure Damage Evacuations/Displaced Persons Evacuation and Shelter Victim Care
1 Nuclear Detonation—10 Kiloton Improvised Nuclear Device This scenario postulates a 10-kiloton improvised nuclear device (IND) detonation in a large metropolitan area. Hundreds of thousands Total destruction within radius of 0.5 to 3 miles 100,000 seek shelter in safe areas (decontamination required for all before entering shelters); 250,000 told to shelter-in-place as plume moves across region; 1 million+ self-evacuate from major cities. Evacuation and/or sheltering of downwind populations required. Actions needed: monitor/decontaminate evacuees, protect schools and day care facilities, provide shelter/reception facilities. Decontamination and both short-term and long-term treatment; hospitals overwhelmed; level of care may be lower than normally expected
2 (a) Biological Attack—Aerosol Anthrax (a) Dispersal of the anthrax takes place in a densely populated urban city with a significant commuter workforce. The exposed population will disperse widely before the incident is detected. (a) 13,000 fatalities and injuries (a) Minimal, other than contamination (a) 25,000 seek shelter (decontamination required); 10,000 instructed to shelter-in-place; 100,000 self evacuate out of affected areas (a) Evacuation and treatment will be required; provide warnings to the population-at-large and the population-at-risk; need to notify people to shelter-in-place and/or evacuate (a) Care to the ill must be provided and should include disbursing PEP/vaccinations and establishing treatment/distribution centers (a)
3 (a) Biological Disease Outbreak—Pandemic Influenza (a) Pandemic Influenza strikes locations across the country. All entities must use pre-existing resources. Available medical supplies will be distributed as available. Health care systems will not be able to activate MOUs with neighboring locales. (a) 15% attack rate: 87,000 fatalities; 300,000 hospitalizations (a) None (a) No evacuation required; shelter-in-place or quarantine instructions given to certain highly affected areas (a) Evacuations not necessary; quarantine has not typically been used with much success to stop the spread of influenza (a) Antiviral drugs for treatment of most ill; ventilators may be necessary for many; at-home care and OTC medications for most (a)
4 (a) Biological Attack—Plague (a) Pneumonic plague is released into three main areas of a major metropolitan city. Included is rapid dissemination to distant locations through foreign and domestic travel. (a) 6,000 illnesses, unknown fatalities (a) None (a) No evacuation needed; shelter-in-place or quarantine to certain highly affected areas; possible large-scale self-evacuation from affected communities (a) Transport and treatment of some victims will be required; self-quarantine through shelter-in-place may be instituted (a) Treatment or prophylaxis with ventilators and antibiotics, as well as information measures to prevent spread of disease; advanced treatment for those with pneumonia (a)
5 Chemical Attack—Blister Agent A light aircraft sprays chemical agent YELLOW into a packed college football stadium. The agent directly contaminates the stadium and the immediate surrounding area, and generates a downwind vapor hazard. 150 fatalities, 70,000 hospitalizations Minimal More than 100,000 evacuated; 15.000 seek shelter in immediate area (decontamination required) Evacuation and/or sheltering of downwind populations in a 360 degree arc around release site required until contained Decontamination for tens of thousands of people and short-term and long-term medical treatment
6 Chemical Attack—Toxic Industrial Chemicals Grenades and IEDs cause significant explosions at at fixed facility petroleum refineries. Simultaneously multiple cargo containers at a nearby port explode aboard or near several cargo ships with resulting fires. 350 fatalities; 1,000 hospitalizations 50% of structures in area of explosion 10,000 evacuated; 1,000 seek shelter in safe areas; 25,000 instructed to temporarily shelter-in-place as plume moves across region; 100,000 self-evacuate out of region Evacuation/sheltering/protection of downwind populations will be required Injuries to be treated will include trauma, burns, smoke inhalation, severe respiratory distress, seizures, and/or comas; short- and long-term treatment will be required, as well as decontamination
7 Chemical Attack—Nerve Agent Sarin vapor is released into the ventilation systems of three large commercial office buildings in a metropolitan area. The agent kills 95% of the people in the buildings, and kills or sickens many of the first responders. In addition, some of the agent exits through rooftop ventilation stacks, creating a downwind hazard. 5,700 fatalities (95% of building occupants); 300 injuries Minimal, other than contamination Temporary shelter-in-place instructions are given for 50,000 people in adjacent buildings Evacuation/sheltering/protection of downwind populations will be required; large numbers of worried well swamping the medical system Decontamination and monitoring of individuals as they are allowed to leave their buildings; hundreds will require hospital treatment
8 Chemical Attack—Chlorine Tank Explosion Using a low-order explosive a storage tank man-way is ruptured, releasing a large quantity of chlorine gas downwind of the site. Secondary devices are set to impact first responders. 17,500 fatalities; 10,000 severe injuries; 100,000 hospitalizations Immediate explosion area and metal corrosion in areas of heavy exposure 100,000 instructed to temporarily shelter-in-place as plume moves across region; 50,000 evacuated to shelters in safe areas; 500,000 self-evacuate out of region Evacuation/sheltering/protections of downwind populations will be required Injuries to be treated will include respiratory difficulty or severe distress and trauma; short- and long-term treatment may be required
9 Natural Disaster—Major Earthquake A 7.2-magnitude earthquake, with a subsequent 8.0 earthquake following, occurs along a fault zone in a major metropolitan area of a city, greatly impacting a six-county region with a population of approximately 10 million people. 1,400 fatalities; 18,000 hospitalizations 150,000 buildings destroyed; 1 million buildings damaged 300,000 homes destroyed; 250,000 seek shelter in safe areas; 250,000 self evacuate the area Structural engineers inspect critical buildings, bridges, freeways, waste facilities, etc; inspection teams deployed to inspect hundreds of homes for safe habitability Activation of task forces for delivery of mass care and health and medical services; temporary housing strategies considered
10 Natural Disaster—Major Hurricane A Category 5 hurricane hits a Major Metropolitan Area (MMA). Sustained winds are at 160 mph with a storm surge greater than 20 feet above normal. Massive evacuations are required. Certain low-lying escape routes are inundated by water anywhere from 5 hours before the eye of the hurricane reaches land. 1,000 fatalities; 5,000 hospitalizations Buildings destroyed, large amounts of debris 1 million evacuated; 150,000 seek shelter in safe areas; 200,000 homes destroyed State and local officials have time to execute evacuation plans; roads leading from the area are overwhelmed and massive traffic jams hinder the evacuation efforts; need to provide for temporary shelter and interim housing; permanent housing support will also be required Medical assistance; shelter and temporary housing assistance; emergency food, water and ice provision; sanitary facility provision
11 Radiological Attack—Radiological Dispersal Devices Dirty bombs containing cesium chloride (CsCl) are detonated in three separate, but regionally close, moderate-to-large cities. 180 fatalities, 270 hospitalizations, 20,000 needing decontamination Structures affected by blast, up to 0.5 square mile of contamination Evacuation of 100,000 downwind will be required after plume has passed, a localized area will need to be relocated until area is cleaned up. Sheltering and/or evacuation of downwind populations will be required and must occur quickly; hospitals inundated by 50,000 "worried well" Decontamination of injured persons prior to hospital admission; superficial decontamination needed for most; short- and long-term followup for injured
12 Explosives Attack—Bombing Using Improvised Explosive Devices Improvised explosive devices (IEDs) to detonate bombs at a sports arena, parking lot, and underground transportation. More IEDs detonated in the lobby of the nearest hospital emergency room (ER). 100 fatalities; 450 hospitalizations Structures affected by blast and fire Evacuation of immediate area around each explosion results in approximately 5,000 people seeking shelter in safe areas. Evacuation is required as well as additional threat assessment; area must be cordoned Injuries range from "walking wounded" to multiple systems trauma, burns, some fatalities; potential loss facilities at target hospital will require other facilities to receive all patients from blast sites
13 (a) Biological Attack—Food Contamination (a) Ground beef is tainted in California with an agent, following retail distribution, the tainted ground beef is in three cities. (a) 500 fatalities; 650 hospitalizations; 1,800 illnesses (a) None (a) None (a) Not Applicable (a) Victim care will require diagnosis and treatment of affected population and distribution of prophylaxis for potentially exposed populations (a)
14 Biological Attack—Foreign Animal Disease (Foot & Mouth) Farm animals at specific locations are infected with hoof and mouth disease. None Huge loss of livestock None Not Applicable It will be necessary to euthanize and dispose of infected and exposed animals; impact on farmers and farm communities should be considered
15 Cyber Attack In a cyber attack, credit-card processing facilities are hacked and numbers released to Internet, causing mass credit card cancellation, nationwide failure of ATMs; also payroll and pension malfunctions. None Cybernetworks None Not Applicable Economic assurance

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Appendix 1: National Planning Scenarios Analysis Matrix (continued)

Scenario Number Scenario Title Potential Health Call Center Response Capabilities1 Community Response
Health Information (a) Disease/Injury Surveillance1b Triage/ Decision Support1c Quarantine and Isolation Support1d Outpatient Drug Info/Adverse Event Reporting1e Mental Health Assistance/Referral1f Mass Risk Communication1g
1 Nuclear Detonation—10 Kiloton Improvised Nuclear Device (c (d (c (g (d (e (f
2 Biological Attack—Aerosol Anthrax (b (c (c (g (b (e (f
3 Biological Disease Outbreak—Pandemic Influenza (b (b (b (b (d (e (f
4 Biological Attack—Plague (b (c (c (b (b (e (f
5 Chemical Attack—Blister Agent (c (c (c (g (g (e (f
6 Chemical Attack—Toxic Industrial Chemicals (c (c (c (g (g (e (f
7 Chemical Attack—Nerve Agent (c (c (c (g (g (e (f
8 Chemical Attack—Chlorine Tank Explosion (c (c (c (g (g (e (f
9 Natural Disaster—Major Earthquake (d (c (c (g (g (e (f
10 Natural Disaster—Major Hurricane (c (c (c (g (g (e (f
11 Radiological Attack—Radiological Dispersal Devices (c (c (c (g (d (e (f
12 Explosives Attack—Bombing Using Improvised Explosive Devices (d (c (c (g (g (e (f
13 Biological Attack—Food Contamination (b (c (c (d (d (e (f
14 Biological Attack—Foreign Animal Disease (Foot & Mouth) (c (c (c (g (g (e (f
15 Cyber Attack (g (g (g (g (g (e (f

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Definitions for Potential Health Call Center Response Capabilities

Health Information1a Providing disaster and/or disease information to the public during and after the crisis. This information is provided to the public and providers to support their ability to care for themselves and others.
Disease/Injury Surveillance1b Collecting specific data or utilizing already established databases to identify disease/illness/injury, emerging health trends or sentinel events.
Triage/Decision Support1c Utilizing clinical algorithms or decision trees to support the management of caller reported symptoms. There are varying levels of clinical decision support depending upon the scope of practice of the person answering the phone. This can also include non-clinicians providing information to callers to allow them to make their own healthcare decisions.
Quarantine and Isolation Support1d Monitoring the compliance, health status and resource needs of those assigned to home quarantine and isolation.
Quarantine applies to people who have been exposed to a contagious illness and may be infected but are not yet ill. Separating exposed people and restricting their movements is intended to stop the spread of that illness. Quarantine can be highly effective in protecting the public from disease.
Isolation is the separation and restriction of movement of ill people to stop the spread of that illness to others. People in isolation may be cared for in their homes, in hospitals or at designated health care facilities.
Outpatient Drug Information/Adverse Event Reporting1e Providing drug information including pill identification and collection of adverse drug events, especially needed with large-scale prophylaxis or immunization without standard medical supervision (i.e., Cities Readiness Initiative).
Mental Health Assistance/Referral1f Recognizing individuals with mental health needs, providing referrals to community resources where appropriate and incorporating any post-event government agency directives (i.e., surveying community mental health status per the Centers for Disease Control and Prevention [CDC]).
Mass Risk Communication1g Utilizing general informational messages distributed by government and community leaders via the media (i.e., public service announcements, radio bulletins, television "crawlers," Emergency Alert System) to alert and inform the greatest number of the public.

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Grading Scale for Scenarios and Health Call Center Response Capabilities

(a) Scenarios identified as most applicable for integration with health call center capabilities and that are specifically addressed in this task order.
  (b) Capabilities that correspond best with the expertise of health call centers and the expected response needs of the community. These capabilities are addressed within this task order with proposed strategies, tools and models.
  (c) Other capabilities that correspond with the expertise of health call centers and the expected response needs of the community.
  (d) Capabilities that may exist in health call centers though there may not be a great response need in the community.
  (e) Capabilities that health call centers would need to refer to more appropriate resources within the community.
  (f) Primarily a community response capability that health call centers would need to integrate with.
  (g) Capabilities that are not well-suited to expected community needs for this scenario.

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