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Story from the Field

Name of Health Department/Agency: Alexandria Health Department
State: VA
Date Added: 04/01/2010
Themes: State and Local Coordination
Issue Summary: Unified Command for H1N1 Response in Alexandria
Description of Issue(s):
In the last days of April 2009, most Health Departments in the U.S. and around the world became quickly overwhelmed in monitoring and responding to the growing pandemic of H1N1 influenza. Even before cases were identified, localities were busy responding to calls from the public, educating providers on the latest CDC guidance, monitoring respiratory illness through surveillance systems and operationalizing their pandemic flu plans.  Once cases were identified in an area, efforts focused on preventing spread of the infection, assuring availability of healthcare and working closely with the media, schools and other partners to assure that rapidly changing CDC guidelines were understood and being followed.
The Alexandria Health Department implemented Incident Command to coordinate all public health response activities as soon as the outbreak of H1N1 influenza was recognized; within the first week, it was clear that health department staff could not maintain H1N1 response activities, other public health activities and Incident Command without additional assistance. The leadership of the City of Alexandria determined that the health department could best be helped by initiating a collaborative response effort using Unified Command as part of ICS and the National Incident Management System.  Our Unified Command consists of the Health Director, Fire Chief, Emergency Manager, Police Captain, School Superintendent and the City Manager. This has been a valuable experience, for both first responders who use ICS for shorter, more acute incidents and also for public health staff, who have been able to delegate many operational and planning activities to others within and outside city government, enabling the health department to focus on public health response.


Actions taken to address the issue(s): The structure created involved not only Health Department staff but representatives from City Departments of Communications, Human Services, Human Resources, Finance, Mental Health, Emergency Management, Fire/EMS, Police, and Sheriff, as well as the Alexandria City Public Schools, Hospital partners and the private healthcare and business communities. City staff quickly became educated about ICS, with even the City Manager attending a 3-day course in Advanced ICS. Meetings of Unified Command were every two weeks, then weekly, throughout the summer, with frequently revised Incident Action Plans including vaccine planning and planning for resurgence of disease in the fall.
Outcomes that resulted from actions taken: ICS was designed for managing acute emergencies and is used mainly by fire and other first responder communities. For the prior 8 years, public health has been working to adopt ICS to respond to public health emergencies. Using ICS and Unified Command that incorporates a broad range of city departments, schools, healthcare providers and private business for a pandemic flu response is a new concept and has not previously been documented for such an extensive public health event. This process strengthens community partnerships, communication and information sharing and provides public health with essential additional resources to manage a long duration event. Pandemic flu affects all aspects of a community, and the entire community should be involved in the planning and response.

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