STLT Ebola-Related Activities

Form approved

OMB No. 0920-0879

Expiration date: 04/30/2017

Attachment B: Ebola Virus Disease: Preparedness Actions Assessment (Word Version)

This assessment is designed to assist state and local public health officials in assessing their jurisdictions’ level of readiness and priorities for a potential response in the event of a case of Ebola Virus Disease (EVD) in the United States. The information collected in the assessment will assist CDC in knowing which capability-based response activities are being undertaken throughout the course of the response and will help shape CDC's technical assistance and guidance.

If you have comments or questions about the assessment, please send an email to CDC IMS State Coordination Task Force (SCTF) Field Services Unit at [email protected].

1. Please select your jurisdiction (PHEP Awardees) [DROP DOWN BOX]

• OR -

Please tell us the name of the organization you represent [OPEN TEXT FIELD]

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Public reporting burden of this collection of information is estimated 10 minutes to complete this assessment, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0879)

Healthcare System Preparedness

1. Are you working with your jurisdiction’s hospitals, inpatient and outpatient healthcare facilities, clinical practices, and other clinical settings to ensure appropriate infection control practices of identified EVD patients using the following infection prevention and control recommendations?

• Infection Prevention and Control Recommendations for Hospitalized Patients with Known or Suspected Ebola Hemorrhagic Fever in U. S. Hospitals http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html

• CDC HAN: Guidelines for Evaluation of U. S. Patients Suspected of Having Ebola Virus Disease http://emergency.cdc.gov/HAN/han00364.asp

• Interim Guidance for Specimen Collection, Transport, Testing, and Submission for Patients with Suspected Infection with Ebola Virus Disease http://www.cdc.gov/vhf/ebola/hcp/interim-guidance-specimen-collection-submission-patients-suspected-infection-ebola.html

• Ebola Virus Disease Information for Clinicians in U.S. Healthcare Settings http://www.cdc.gov/vhf/ebola/hcp/clinician-information-us-healthcare-settings.html

• COCA call- What U.S. Hospitals Need to Know to Prepare for Ebola Virus Disease http://emergency.cdc.gov/coca/calls/2014/callinfo_080514.asp

• FAQ: Safe Management of Patients with Ebola Virus Disease in U. S. Hospitals http://www.cdc.gov/vhf/ebola/hcp/patient-management-us-hospitals.html

• Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus http://www.cdc.gov/vhf/ebola/hcp/environmental-infection-control-in-hospitals.html

☐ Recognized need, prepared

☐ Recognized need, preparing

☐ Recognized need, not prepared

☐ No need identified

Emergency Public Information and Warning

2. Are you preparing risk communication messages for the public including general information on EVD, risk to the public, risk of transmission, protective measures, etc.?

• CDC Digital Press Kit: 2014 Ebola Outbreak http://www.cdc.gov/media/dpk/2014/dpk-ebola-outbreak.html

• CDC Q &A on Ebola http://www.cdc.gov/vhf/ebola/outbreaks/guinea/qa.html

• Podcasts http://www2c.cdc.gov/podcasts/player.asp?f=8633481

☐ Recognized need, prepared

☐ Recognized need, preparing

☐ Recognized need, not prepared

☐ No need identified

Information Sharing

3. Are you working with appropriate personnel to ensure they are enrolled in CDC’s EpiX system?

http://www.cdc.gov/epix/

☐ Recognized need, prepared

☐ Recognized need, preparing

☐ Recognized need, not prepared

☐ No need identified

4. Are you working with appropriate personnel to ensure that they receive CDC HANs?

http://emergency.cdc.gov/han/

☐ Recognized need, prepared

☐ Recognized need, preparing

☐ Recognized need, not prepared

☐ No need identified

5. Are you working with appropriate personnel to ensure that they maintain situational awareness within the jurisdiction by regularly visiting the CDC EVD website (http://www.cdc.gov/vhf/ebola/) for the latest EVD information, guidance documents, current case counts, maps of impacted areas, and other CDC resources?

☐ Recognized need, prepared

☐ Recognized need, preparing

☐ Recognized need, not prepared

☐ No need identified

6. Are you able to quickly push out information to state and local response partners including hospitals, healthcare systems, primary care associations, provider organizations, local public health partners, emergency management partners?

☐ Recognized need, prepared

☐ Recognized need, preparing

☐ Recognized need, not prepared

☐ No need identified

Non-Pharmaceutical Interventions

7. Are you working with state and local epidemiological and medical staff to ensure that they review the CDC Interim Guidance for Monitoring and Movement of Persons with EVD Exposure?

http://www.cdc.gov/vhf/ebola/hcp/monitoring-and-movement-of-persons-with-exposure.html

☐ Recognized need, prepared

☐ Recognized need, preparing

☐ Recognized need, not prepared

☐ No need identified

8. Are you working with state and local epidemiological and medical staff to ensure that systems are in place to effectively isolate a patient(s), and quarantine an individual(s) with suspected exposure?

☐ Recognized need, prepared

☐ Recognized need, preparing

☐ Recognized need, not prepared

☐ No need, not prepared

Public Health Lab Testing

9. Are you working with clinical labs to ensure that they review the CDC Interim Guidance for Specimen Collection, Transport, Testing, and Submission for Patients with Suspected Infection with Ebola Virus Disease?
http://www.cdc.gov/vhf/ebola/hcp/interim-guidance-specimen-collection-submission-patients-suspected-infection-ebola.html

☐ Recognized need, prepared

☐ Recognized need, preparing

☐ Recognized need, not prepared

☐ No need, not prepared

10. Are you working with clinical labs to ensure that they review their lab safety protocols and procedures and have appropriate and sufficient quantities of personal protective equipment?
http://www.cdc.gov/vhf/ebola/hcp/environmental-infection-control-in-hospitals.html http://www.cdc.gov/HAI/pdfs/ppe/ppeposter1322.pdf

☐ Recognized need, prepared

☐ Recognized need, preparing

☐ Recognized need, not prepared

☐ No need, not prepared

Public Health Surveillance and Epidemiology Investigation

11. Can you share EVD case definitions across public health jurisdictions? http://www.cdc.gov/vhf/ebola/hcp/case-definition.html

☐ Recognized need, prepared

☐ Recognized need, preparing

☐ Recognized need, not prepared

☐ No need, not prepared

11. Are you working with state and local epidemiology staff to ensure that the following investigation tools are available and that the staff have a plan for implementation?

• Interim Guidance for Monitoring and Movement of Persons with Ebola Virus Disease Exposure http://www.cdc.gov/vhf/ebola/hcp/monitoring-and-movement-of-persons-with-exposure.html

• Interim Guidance for Specimen Collection, Transport, Testing, and Submission for Patients with Suspected Infection with Ebola Virus Disease http://www.cdc.gov/vhf/ebola/hcp/interim-guidance-specimen-collection-submission-patients-suspected-infection-ebola.html

☐ Recognized need, prepared

☐ Recognized need, preparing

☐ Recognized need, not prepared

☐ No need, not prepared

Responder Safety and Health

13. Have you ensured that state and local stockpiles of personal protective equipment are adequate?

☐ Recognized need, prepared

☐ Recognized need, preparing

☐ Recognized need, not prepared

☐ No need, not prepared

14. Are you working with responders and clinicians to ensure that they have been trained on the appropriate use of personal protective equipment?

http://www.cdc.gov/HAI/pdfs/ppe/ppeposter1322.pdf

☐ Recognized need, prepared

☐ Recognized need, preparing

☐ Recognized need, not prepared

☐ No need, not prepared

15. Are you working with responders and clinicians to ensure that they have reviewed the following CDC guidance documents on worker safety?

• Sequence for Putting on and Removing Personal Protective Equipment

http://www.cdc.gov/HAI/pdfs/ppe/ppeposter1322.pdf

• Tools for Protecting Healthcare Personnel

http://www.cdc.gov/HAI/pdfs/ppe/ppeposter1322.pdf

• FAQ: Safe Management of Patients with Ebola Virus Disease in U. S. Hospitals

http://www.cdc.gov/vhf/ebola/hcp/patient-management-us-hospitals.html

☐ Recognized need, prepared

☐ Recognized need, preparing

☐ Recognized need, not prepared

☐ No need, not prepared

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