Pandemic Influenza Plan - Questar III

More documents

Recommendations

Info

NYSDOH Novel <strong>Influenza</strong> Case Report Form State case ID: ___________________ Appendix 2-B 6. Did the patient receive antiviral medication? If YES, Antiviral Name: ______________________ Dosage: ______________ Route: _______________ Date started: _______/ _______/ ________ Date ended: _______/ _______/ ________ Yes No Unknown Existing Medical Conditions and Medication History 1. Did the patient have any underlying medical conditions? Yes No Unknown 2. IF YES, please check all that apply: Asthma/reactive airway disease Other chronic lung disease (specify) _______________________ Cardiac disease (specify) _________________________ Immunosuppressive condition (specify) ____________________ Cystic fibrosis Pregnant (specify gestational age in weeks) _________________ Developmental delay (moderate to severe) History of febrile seizures before current illness Diabetes mellitus (Insulin dependent) Seizure disorder requiring anti-seizure medications Hemoglobinopathy (e.g. sickle cell disease, not trait) Renal disease (specify): _________________________________ Metabolic disorder (specify) _______________________ Neuromuscular disorder (including cerebral palsy) (specify) Other (specify) __________________________________ _______________________________________________________ 3. Was the patient receiving any of the following medications when influenza illness started? (check all that apply): Aspirin or aspirin-containing products Systemic steroids (not inhaled) Radiation therapy Chemotherapy for cancer Other immunosuppressive medications (specify): __________________________ Isolation Location 1: Isolation Location: Home Hospital School Campus Unknown Other (specify): _____________________ Isolation Start Date: ( mm/dd/yyyy) _____/ _____/ _______ Isolation Discontinuation Date (mm/dd/yyy) _____/ _____/ _______ Location 2: Isolation Location: Home Hospital School Campus Unknown Other (specify): _____________________ Isolation Start Date: (mm/dd/yyyy) _____/ _____/ _______ Isolation Discontinuation Date (mm/dd/yyy) _____/ _____/ ______ Contact and Travel During Infectious Period 1. Did the patient travel while ill? Yes No Unknown 2. Was the patient symptomatic during travel? Yes No Unknown 3. List all travel either by public conveyance (airplane, train, bus) or with a tour group, 24 hours before onset of fever or symptoms thereafter. (List each portion of leg of the trip as a separate record): Trip 1: Depart Date: ______/ ______ / _________ Arrival Date: ______/ ______ / _________ Departure City: ______________________________________ Arrival City: ______________________________________ Transport Type: Airline Auto Bus Cruise Other Subway Tour Group Train Trip 2: Depart Date: ______/ ______ / _________ Arrival Date: ______/ ______ / _________ Departure City: ______________________________________ Arrival City: ______________________________________ Transport Type: Airline Auto Bus Cruise Other Subway Tour Group Train February 7, 2006 5
NYSDOH Novel <strong>Influenza</strong> Case Report Form State case ID: ___________________ Appendix 2-B Submitter Contact Information LHD: _________________________________ Last name: ____________________________________________________________ Title: _________________________________ Institution: ____________________________________________________________ City: _________________________________ State: ____________________________________________________________ Phone: _________________________________ Fax: ____________________________________________________________ E-mail: _________________________________ Report Date: ______/ ______ / _________ February 7, 2006 6
Page 1 and 2:
February206 Pandemic Plan NewYorkSt
Page 3 and 4:
Introduction Pandemic influenza occ
Page 5 and 6:
example, at this time, it is realis
Page 7 and 8:
Acronyms (cont.) IND IHANS IRB ISHS
Page 9 and 10:
Section 1: Command and Control I. O
Page 11 and 12:
Section 1: Command and Control pers
Page 13 and 14:
February 7, 2006 Appendix 1-A
Page 15 and 16:
Appendix 1-B The Public Health Law
Page 17 and 18:
Appendix 1-B communicable diseases
Page 19 and 20: Appendix 1-C Management Office or t
Page 21 and 22: Appendix 1-E Suspension of Public M
Page 23 and 24: Appendix 1-G A Guide to New York St
Page 25 and 26: Appendix 1-G health commissioner. P
Page 27 and 28: Appendix 1-G 8. State Institutions
Page 29 and 30: Appendix 1-G b. Governor May Invoke
Page 31 and 32: Appendix 1-G may direct, pursuant t
Page 33 and 34: Appendix 1-G c. Commissioner of Gen
Page 35 and 36: Appendix 1-G Designation of emergen
Page 37 and 38: Appendix 1-G physician’s assistan
Page 39 and 40: Appendix 1-H Summary of Public Offi
Page 41 and 42: Section 2: Surveillance and Laborat
Page 63 and 64: Appendix 2-A • Surveillance Crite
Page 65 and 66: Appendix 2-A • In New York City,
Page 67 and 68: NYSDOH Novel Influenza Case Report
Page 69: NYSDOH Novel Influenza Case Report
Page 73 and 74: Appendix 2-C to health care provide
Page 75 and 76: Virus Detection History NYS Lab Num
Page 77 and 78: Section 3: Healthcare Planning and
Page 121 and 122:
Section 3: Healthcare Planning and
Page 123 and 124:
Section 3: Healthcare Planning and
Page 125 and 126:
Section 4: Infection Control I. Ove
Page 127 and 128:
Section 4: Infection Control I. Ove
Page 129 and 130:
Section 4: Infection Control A. Bas
Page 131 and 132:
Section 4: Infection Control Drople
Page 133 and 134:
Section 4: Infection Control • Pe
Page 135 and 136:
Section 4: Infection Control o Noti
Page 137 and 138:
Section 4: Infection Control E. Coh
Page 139 and 140:
Section 4: Infection Control If wid
Page 141 and 142:
Section 4: Infection Control • En
Page 143 and 144:
Section 4: Infection Control should
Page 145 and 146:
Section 4: Infection Control Policy
Page 147 and 148:
Section 4: Infection Control o Staf
Page 149 and 150:
Section 4: Infection Control • De
Page 151 and 152:
Section 4: Infection Control • Pr
Page 153 and 154:
Section 4: Infection Control The ma
Page 155 and 156:
Section 4: Infection Control • Up
Page 157 and 158:
Section 4: Infection Control Health
Page 159 and 160:
Appendix 4-A Soiled linen and laund
Page 161 and 162:
Appendix 4-B Respiratory Hygiene/Co
Page 163 and 164:
Section 5: Clinical Guidelines I. O
Page 165 and 166:
Section 5: Clinical Guidelines incu
Page 167 and 168:
Section 5: Clinical Guidelines 1) N
Page 169 and 170:
Section 5: Clinical Guidelines infe
Page 171 and 172:
Section 5: Clinical Guidelines Alth
Page 173 and 174:
Section 5: Clinical Guidelines Infe
Page 175 and 176:
Section 5: Clinical Guidelines •
Page 177 and 178:
Appendix 5-B Clinical Evaluation of
Page 179 and 180:
Appendix 5-C Special Situations and
Page 181 and 182:
Appendix 5-D handling soiled laundr
Page 183 and 184:
DRAFT Appendix 5-E Footnotes to App
Page 185 and 186:
Appendix 5-F February 7, 2006 1
Page 187 and 188:
Appendix 5-F 7. Guidance on the eva
Page 189 and 190:
Appendix 5-H Source: U.S. Departmen
Page 191 and 192:
February 7, 2006 2 Appendix 5-I
Page 193 and 194:
Appendix 5-J Clinical Presentation
Page 195 and 196:
Appendix 5-J diabetes mellitus), re
Page 197 and 198:
Appendix 5-J resistant S. aureus (M
Page 199 and 200:
Appendix 5-K eight patients—all o
Page 201 and 202:
Appendix 5-L Guidelines for Managem
Page 203 and 204:
Appendix 5-L testing should be perf
Page 205 and 206:
Appendix 5-L February 7, 2006 5
Page 207 and 208:
Section 6: Vaccine Procurement, Dis
Page 209 and 210:
Page 211 and 212:
Page 213 and 214:
Page 215 and 216:
Page 217 and 218:
Page 219 and 220:
Appendix 6-A Vaccine Priority Group
Page 221 and 222:
Appendix 6-B Mass Clinic Planning O
Page 223 and 224:
Appendix 6-C Vaccine and Antiviral
Page 225 and 226:
Appendix 6-C 1. Request Phase The r
Page 227 and 228:
Appendix 6-C 3. Receipt and Sign-of
Page 229 and 230:
Appendix 6-C • Work with local he
Page 231 and 232:
Section 7: Antiviral Medication Pro
Page 233 and 234:
Page 235 and 236:
Page 237 and 238:
Page 239 and 240:
Page 241 and 242:
Page 243 and 244:
Page 245 and 246:
Page 247 and 248:
Page 249 and 250:
Appendix 7-A Characteristics of Ant
Page 251 and 252:
Appendix 7-B a The drug package ins
Page 253 and 254:
Appendix 7-C 7 HCWs in emergency de
Page 255 and 256:
Section 8: Travel-Related Disease C
Page 257 and 258:
Page 259 and 260:
Page 261 and 262:
Page 263 and 264:
Page 265 and 266:
Page 267 and 268:
Appendix 8-A Home or Community-Base
Page 269 and 270:
Appendix 8-B Contact Identification
Page 271 and 272:
Appendix 8-B • Determine the time
Page 273 and 274:
Appendix 8-C Administrative Data: S
Page 275 and 276:
Appendix 8-D CONTACT DAILY TEMPERAT
Page 277 and 278:
Appendix 8-F Definitions: Intervent
Page 279 and 280:
Appendix 8-F facility. No specific
Page 281 and 282:
Appendix 8-F • Resources Required
Page 283 and 284:
Appendix 8-G Business Pandemic Infl
Page 285 and 286:
Appendix 8-G 4. Allocate resources
Page 287 and 288:
Appendix 8-H CDC guidelines suggest
Page 289 and 290:
Appendix 8-H If I am not masked I
Page 291 and 292:
Appendix 8-H NYSDOH Model Influenza
Page 293 and 294:
Appendix 8-H I understand that if
Page 295 and 296:
Section 9: Communications I. Overvi
Page 297 and 298:
Section 9: Communications and commu
Page 299 and 300:
Section 9: Communications web pages
Page 301 and 302:
Section 9: Communications Local Hea
Page 303 and 304:
Section 9: Communications • A JIC
Page 305 and 306:
Section 9: Communications backup to
Page 307 and 308:
Section 9: Communications • In th
Page 309 and 310:
Appendix 9-A Public Health Risk Com
Page 311 and 312:
Appendix 9-C New York State Departm
Page 313 and 314:
Appendix 9-C PRE-EVENT MESSAGE MAP:
Page 315 and 316:
Appendix 9-C PROTECTIVE MESSAGE MAP
Page 317 and 318:
Appendix 9-C TREATMENT MESSAGE MAP:
Page 319 and 320:
Appendix 9-C BUSINESS CONTINUITY PR
Page 321 and 322:
Section 10: Training and Education
Page 323 and 324:
Page 325 and 326:
Page 327 and 328:
Appendix 10-A NYSDOH STAFF PRIVATE
Page 329 and 330:
Page 331 and 332:
Page 333 and 334:
Page 335 and 336:
FACILITY- BASED RNs FACILITY- BASED
Page 337 and 338:
Page 339 and 340:
Page 341 and 342:
Section 11: Workforce Support I. Ov
Page 343 and 344:
Section 11: Workforce Support Pande
Page 345 and 346:
Section 12: Highly Pathogenic H5N1
Page 347 and 348:
Section 12: H5N1 in Non-Human Anima
Page 349 and 350:
Page 351 and 352:
Page 353 and 354:
Page 355 and 356:
Section 13: Public Health Preparedn
Page 357 and 358:
Page 359 and 360:
Page 361 and 362:
Page 363 and 364:
Page 365 and 366:
Page 367 and 368:
Page 369 and 370:
Page 371 and 372:
Page 373 and 374:
Page 375 and 376:
Page 377 and 378:
Page 379 and 380:
Page 381 and 382:
Page 383 and 384:
Page 385 and 386:
Page 387 and 388:
Page 389 and 390:
Appendix 13-A NYSDOH Roles Notified
Page 391 and 392:
Appendix 13-B Notifications sent by
Page 393 and 394:
Appendix 13-B HAN posting is used a
Page 395 and 396:
Appendix 13-B notification system t
Page 397 and 398:
Appendix 13-C Overview of the Healt
Page 399 and 400:
Appendix 13-C • Ongoing surveilla
Page 401 and 402:
Table 1. Summary of HERDS Use To da
Page 403 and 404:
Appendix 13-D Commerce Access and A
Page 405 and 406:
Appendix 13-D Table 3. Organization
show all

Pandemic Influenza Plan - Questar III

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?