HEADQUARTERS UNITED STATES MARINE CORPS … 6220.1.pdf · headquarters united states marine corps...

DEPARTMENT OF THE NAVYHEADQUARTERS UNITED STATES MARINE CORPS

3000 MARINE CORPS PENTAGONWASHINGTON, DC 20350-3000

MCO 6220.1PS

NOV 0 6 2009MARINE CORPS ORDER 6220.1

Ref: (a)

(b)

(c)

(d)

(e)

(f)

(g)

(h)(i)

(j )

(k)

From:To:

Subj:

Commandant of the Marine CorpsDistribution List

USMC PANDEMIC INFLUENZA (PI) RESPONSE PLAN

CJCS Planning Order (PLANORD), 14 November 2005(NOTAL)Strategic Planning Guidance (SPG) , Fiscal Years 20082013, 1 March 2006 (NOTAL)CDRUSNORTHCOM Concept Plan (CONPLAN) 3551-09,Pandemic Influenza, 19 March 2009 (NOTAL)National Strategy for Pandemic InfluenzaImplementation Plan, May 2006DOD Implementation Plan for Pandemic Influenza, May2006CDRUSNORTHCOM CONPLAN 3591-07, Pandemic Influenza25 July 2007 (NOTAL)CDRUSNORTHCOM Global Synchronization PlanningDirective (NOTAL)CJCS PLANORD, 20 April 2007 (NOTAL)DOD Directive 6200.3, "Emergency Health Powers onMilitary Installations," May 12, 2003DOD Directive 6200.04, "Force Health Protection(FHP) ," October 9, 2004BUMEDINST 3440.10, "Navy Medicine Force HealthProtection (FHP) Emergency Management Program (EMP),"November 20, 2008

(1) BUMEDINST 6200.17, "Public Health Emergency Officers(PHEO) ," October 17, 2006

(m) CDRUSNORTHCOM Plan Review and Evaluation Matrix(NOTAL)

(n) SECNAV M-5210.1(0) UnderSecretary of Defense (Policy) Memorandum dtd

16 Jun 09

DISTRIBUTION STATEMENT A: Approved for public release;distribution is unlimited.

MCO 6220.1NOV 0 6 2009

Encl: (1)(2 )(3)

(4 )

(5)

(6)(7 )

(8)

(9)

Installation Disease Containment Plan TemplateOperational ReportingDuties and Responsibilities Checklist, Public HealthEmergency Officer (PHEO)Medical Treatment Facility (MTF) PI Preparedness andResponse ChecklistContinuity of Operations (COOP) PI Preparedness andResponse ChecklistWorkplace PI Preparedness and Response ChecklistIndividual and Family PI Preparedness and ResponseChecklistPersonal Protective Equipment (PPE) MatrixPI Handbook for Commanders and Managers

1. Situation

a. General

(1) Background on Pandemic Influenza (PI)

(a) The threat of PI has serious national securityimplications for the United States. Because humans have littleor no immunity to a new virus, PI occurs with substantiallyhigher sickness and mortality rates than normal influenza.Three human pandemics occurred in the 20 th century, eachresulting in illness in approximately 30% of the worldpopulation and death in 0.2% to 2% of those infected. Usingthis historical information and current models of diseasetransmission, it is projected that a modern pandemic could leadto the deaths of 200,000 to 2 million Americans and could cause30-40% work absenteeism.

(b) Influenza viruses with pandemic potential arenovel or new influenza viruses with the followingcharacteristics: the virus is easily spread among humans; itspreads globally in a short period of time; and a majority ofthe human population is susceptible to infection and severedisease. According to the World Health Organization (WHO), itis only a matter of time before the emergence of a highly lethalPI virus is possible, with significant health, economic, andsecurity ramifications.

(c) No currently developed influenza vaccine can bedepended upon to immunize against the next pandemic strain andan effective vaccine could take six months to develop.

2

MCO 6220.1

NOV 0 6 2009

(d) A pandemic differs from most natural or manmadedisasters in nearly every respect. The impact of a severepandemic is more comparable to a global war than an isolateddisaster such as a hurricane, earthquake or an act of terrorism.PI will affect all communities. Exact consequences aredifficult to predict in advance because the biologicalcharacteristics of the virus are not known. Similarly, the roleof the federal government in a pandemic response will differbased on the pandemic's morbidity and mortality rates.

(e) Secondary effects of a PI could causesignificant health, economic, and security ramifications;potentially including large-scale social unrest due to fear ofinfection or concerns about safety among individuals, theirfamilies, and their associates.

b. Strategic Guidance

(1) Reference (a) directed Combatant Commanders (CCDRs)to conduct execution-level planning for Department of Defense(DOD) response to PI. The planning order directs CCDRs toaddress Force Health Protection (FHP) and defense support ofcivil authorities (DSCA) in each Geographic CombatantCommander's (GCC) Area of Responsibility (AOR) , as well assupport to Humanitarian Assistance/Disaster Relief (HA/DR)operations to prepare and respond to the effects of PI.

(2) Reference (b) directed Commander, United StatesNorthern Command (CDRUSNORTHCOM) and the other CCDRs to developindividual plans to respond to PI. Chairman of the Joint Chiefsof Staff Instruction (CJCSI) 3110.01F, Joint StrategicCapabilities Plan Fiscal Year 2006, of 1 September 2006(superseded by CJCSI 3110.01G) directed CDRUSNORTHCOM to preparea Concept Plan (CONPLAN) to synchronize worldwide planning tomitigate and contain the effects of PI. Reference (c) directlysupports references (d) and (e) for PI. It is designed tocoordinate the DOD PI planning effort and synchronize thedecentralized execution of the GCCs' theater campaign CONPLANsas the supported commanders. The functional CCDRs, Services,and DOD Agencies are supporting commanders or agencies.Reference (f) outlines overarching guidance for mitigating andcontaining the effects of PI. Specific tasks, based on the tasklist in reference (e), are listed in reference (g).

active,(3) Preparing andlayered defense.

responding to PI will require anThis active, layered defense is global,

3

MCO 6220.1

NOV 0 6 2009

and integrates u.s. capabilities seamlessly in the forwardregions of the world, the approaches to the u.s. territory, andwithin the United States. It is a defense in depth whichincludes assisting partner countries to prepare for and detectan outbreak, and to respond and manage the key second-ordereffects that could lead to an array of challenges. The toppriorities are the protection of DOD forces (comprised of themilitary, DOD civilians, and contractors performing criticalroles) as well as the associated resources necessary to maintainmission readiness and the ability to meet our strategicobjectives. Priority consideration is given to protect thehealth of DOD beneficiaries and dependents. Reference (e)assigns tasks to primary and supporting offices within theDepartment of Defense to accomplish tasks specified in reference(d). The Marine Corps will incorporate references (c and f)tasks appropriate to their respective geographical andfunctional responsibilities in their planning efforts.

(4) Reference (h) designated CDRUSNORTHCOM as the leadCCDR responsible for planning and synchronizing the DOD globalresponse to an influenza pandemic, in conjunction with CCDRs,Services, and DOD Agencies.

c. WHO Phases. WHO phases reflect virus driven triggerpoints. Reference (c) has defined six phases, before and duringPI, that are linked to the characteristics of a new influenzavirus and its spread throughout the population. Thischaracterization represents a useful starting point fordiscussion about Federal Government actions, and true to itsinternational acceptance, links overseas DOD networks to partnernation understanding of the virus. DOD's relationship with WHOis primarily unofficial and indirect. WHO phasing constructsare:

(1) Inter-Pandemic Period (period of time betweenpandemics)

(a) WHO Phase 1. In Phase 1, no viruses circulatingamong animals have been reported to cause infections in humans.

(b) WHO Phase 2. In Phase 2, an animal influenzavirus circulating among domesticated or wild animals is known tohave caused infectipn in humans, and is therefore considered apotential pandemic threat.

4

Meo 6220.1

NOV 0 6 2009

(2) PI Alert Period

(a) WHO Phase 3. In Phase 3, an animal or humananimal influenza reassortant virus has caused sporadic cases orsmall clusters of disease in people, but has not resulted inhuman-to-human transmission sufficient to sustain communitylevel outbreaks. Limited human-to-human transmission may occurunder circumstances, for example, when there is close contactbetween an infected person and an unprotected caregiver.However, limited transmission under such restrictedcircumstances does not indicate that the virus has gained thelevel of transmissibility among human necessary to cause apandemic.

(b) WHO Phase 4. Phase 4 is characterized byverified human-to-human transmission of an animal or humananimal influenza reassortant virus able to cause "communitylevel outbreaks". The ability to cause sustained diseaseoutbreaks in a community marks a significant upwards shift inthe risk for a pandemic. Any country that suspects or hasverified such an event should urgently consult with WHO so thatthe situation can be jointly assessed and a decision made by theaffected country if implementation of a rapid pandemiccontainment operation is warranted. Phase 4 indicates asignificant increase in risk of a pandemic but does notnecessarily mean that a pandemic is a foregone conclusion.

(c) WHO Phase 5. Phase 5 is characterized by humanto-human spread of the virus into at least two countries in oneWHO region. While most countries will not be affected at thisstage, the declaration of Phase 5 is a strong signal that apandemic is imminent and that the time to finalize theorganization, communication, and implementation of the plannedmitigation measures is short.

(3) PI Period (pandemic period)

(a) WHO Phase 6. Phase 6 is characterized bycommunity level outbreaks in at least one other country on adifferent WHO region in addition to the criteria defined in WHOPhase 5. Designation of this phase will indicate that a globalpandemic is under way.

d. u.s. Government (USG) Stages. USG Stages are triggerpoints that reflect geography driven triggers tied to whenpotential federal responses will take effect:

5

MCO 6220.1

NOV 0 6 2009

(1) Stage 0 - New domestic animal outbreak in at-riskcountry.

(2) Stage 1 - Suspected human outbreak from animalsoverseas.

(3) Stage 2 - Confirmed human outbreak overseas.

(4) Stage 3 - Widespread human outbreaks at multiplelocations overseas.

(5) Stage 4 - First human case in North America

(6) Stage 5 - Spread throughout the United States.

(7) Stage 6 - Recovery and preparation for subsequentwaves.

e. CONPLAN 3551. Reference (c), identifies six phases thatdelineate when DOD actions will occur in response to PI. Thefollowing phase descriptions reflect USNORTHCOM response to PI:

(1) Phase 0 - Shape - Incorporates planning,surveillance, and engagement activities to shape perceptions andinfluence behavior.

(2) Phase 1 - Prevent - Support USG efforts to preventor limit the spread of the virus.

(3) Phase 2 - Contain - Take measures to protectUSNORTHCOM population in the localized region(s) whilemaintaining the freedom of action to conduct assigned missions,and as directed, support USG efforts to contain the new viruswithin a limited area in order to prevent a pandemic and gaintime for implementation of additional pandemic preparednessmeasures.

(4) Phase 3 - Interdict - Take broader measures toprotect the USNORTHCOM population while maintaining the freedomof action to conduct assigned missions, and as directed, supportUSG efforts to delay or halt a PI wave.

(5) Phase 4 - Stabilize - Protect the USNORTHCOM keypopulation, maintain freedom of action to conduct assigned

6

MCO 6220.1

NOV 0 6 2009

missions and within capabilities, and as directed, support USGin mitigating the pandemic effects in order to ensuregovernments and communities are capable of maintaining socialorder, maintain critical infrastructure, and minimize humansuffering.

(6) Phase 5 - Recover - Conduct force reconstitutionoperations and as directed support USG efforts to re-establishnormal support conditions with key partners.

f. Potential Impact of PIon the u.s. Marine Corps

(1) Potential impact of PIon operations may besignificant. If 40% of personnel are absent because they areeither sick, caring for the sick, or unwilling to risk exposure,there would be a tremendous impact on the ability to executecurrent plans. It can be assumed that military movements willbe constrained and host countries may limit or prevent freedomof movement of sick personnel or transit through their country.However, throughout PI outbreak, forces must remain dominantacross the full spectrum of military operations, preservingcombat capabilities in order to deter and/or engage adversariesin any theater around the world. If directed, support of civilauthorities during PI will be accomplished using. forcesavailable and not committed to other priorities providing forthe nation's defense.

(2) Environment. PI must be viewed as an environment tooperate within, vice an event or a traditional enemy. Thisenvironment, which may last more than a year, will havesignificant operational consequences. The impacts of PI acrossthe nation and the world· will limit support usually provided bythe Federal Government and DOD to nations, states andcommunities, especially when balanced with protection ofmilitary capabilities through FHP.

(3) Personnel. Large portions of the overall keypopulation may contract the influenza virus over the lifespan ofthe pandemic. Competing demands for low-density units (e.g.,medical, mortuary) will decrease the range of options availablefor support. Limited civilian and military medical care optionsfor military forces and their dependents (both CONUS and OCONUS)will increase the stress.

(4) Transportation. There will likely be a significantreduction in transportation capacity affecting

7

MCO 6220.1

NOV 0 6 2009

acquisition/distribution capabilities. Civil aviation supportto strategic deployment will be reduced. Interstate transportof material and equipment to aerial ports or seaports ofdebarkation (Airport of Debarkation/Seaport of Debarkation(APOD/ SPOD» and international land crossings may decrease.

Access to goods OCONUS may be reduced. Therefore, assets may beasked to offset private sector shortfalls at ports, intransportation, or providing security. Movement restrictionsimposed by national, State or local public health/medicalpersonnel or national policies to slow the spread of a PI mayhave the potential to impact operations.

(5) U.S. Marine COrps Support. The first priority forthe Marine Corps in the event of PI is to protect and preservethe operational effectiveness of our forces worldwide. We willprevent/inhibit an overwhelming epidemic within the Marine Corpsby providing sufficient personnel, equipment, facilities,materials, and pharmaceuticals to care for forces, civilianpersonnel, dependents, and beneficiaries (including contractorsoverseas). The second priority is to sustain mission assurancefor Marine Corps missions and to maintain the ability to meetour strategic objectives. Additionally, we will respond quicklyand effectively to the requests of civil authorities in theevent of PI to save lives, prevent human suffering, -and providesecurity, within capabilities, when directed by the President ofthe United States (POTUS) or the Secretary of Defense (SecDef).In foreign areas, Marine Corps elements will plan, prepare, andsupport as directed by Geographical-Combatant Commanders (GCCs)in accordance with existing procedures to include applicableinternational agreements.

g. Threat. The primary threat for this plan is theemergence of PI with effects similar to the 1918 Pandemic.These effects will have negative impacts on Marine Corpsreadiness (e.g., training, manning, equipping and deploying theforce) potentially allowing opportunistic adversarialaggression. WHO has identified H5N1 (avian influenza) and H1N1(swine influenza) as potential candidates for the next PI. PIis analogous to a traditional environmental hazard except thatit is global in scope. Just as a chemical, biological,radiological, and nuclear (CBRN) environment is a hazard to bedealt with while accomplishing an assigned mission; PI will posea similar challenge with the potential for producing a greaternumber of casualties.

(1) The primary characteristics of the threat during PIis the virus' ability to reproduce within a host, its relatively

8

Mca 6220.1

NOV 0 6 2009

indiscriminate attack rate and ability to exploit the abundantnatural hosts, its ability to mutate quickly, and its ability toeasily transmit human-to-human. The high transmissibility andrapid onset of severe morbidity can result in large numbers ofpeople becoming sick or absent simultaneously.

(2) Impact of the pandemic threat may cause political,social, economic instability and degradation of militaryreadiness. While adversarial forces will be infected, theirreadiness and operational capability may not be impacted in thesame manner or at the same time as u.s. and allied forces. Thedegree to which countries can mitigate morbidity and mortalityduring the PI and reintegrate recovering individuals intosociety will have a considerable impact on military forcecapabilities. Countries with more advanced and robust healthcare systems will be better able to mitigate many of the PIeffects.

(3) Key security concerns that would arise from thepolitical, social and economic instabilities as discussed aboveinclude opportunistic aggression, opportunities for violentextremists to acquire WMD, reduced partner capacity during andafter PI, instability resulting from a humanitarian disaster,and decreased production and distribution of essentialcommodities. The prevalence of PI coupled with political,social and economic instability may result in reduced securitycapabilities, providing an opportunity for internationalmilitary conflict, increased terrorist activity, internalunrest, political and or economic collapse, humanitarian crises,and dramatic social change.

h. Assumptions. Pandemics are unpredictable. Whilehistory offers useful benchmarks, there is no way to know thecharacteristics of a pandemic virus before it emerges.Nevertheless, we must make assumptions to facilitate planningefforts. Marine Corps planning efforts assume the following:

(1) Susceptibility to the PI virus will be universal.

(2) Efficient and sustained person-to-persontransmission signals are indication of an imminent pandemic.

(3) PI in the United States will result in 20-35 percentof the population becoming ill, 3 percent of those infectedbeing hospitalized, and a case fatality rate of 0.2 to 2.0percent over the course of the pandemic.

9

MCO 6220.1

NOV 0 6 2009

(4) Some persons will become infected but not developclinically significant symptoms. Asymptomatic or minimallysymptomatic individuals can transmit infection and developimmunity to subsequent infection.

(5) While the number of patients seeking medical carecannot be predicted with certainty, in previous pandemics abouthalf of those who became ill sought care. With the availabilityof effective antiviral medication for treatment, this proportionmay be higher in the next pandemic.

(6) A vaccine (PI specific strain) will not be availablefor distribution for a minimum of 4-6 months after the clinicalconfirmation of sustained human-to,-human PI transmission. Oncea vaccine is developed, current production capability is limitedto 1% per week of the total U.S. vaccine required. Foreignmanufacturers are not expected to support U.S. demand.Prioritization will be required.

(7) Rates of serious illness, hospitalization, anddeaths will depend on the virulence of the pandemic virus anddiffer by order of magnitude between more and less severescenarios. Risk groups cannot be predicted with certainty.

(8) Rates of absenteeism will depend on the severity ofthe pandemic. In a severe pandemic, absenteeism attributable toillness, the need to care for ill family members, and .the fearof infection may reach 40 percent during the peak weeks of acommunity outbreak, with lower rates of absenteeism during theweek before and after the peak. Certain public health measures(closing schools, quarantining household contacts of infectedindividuals, "snow days") are likely to increase rates ofabsenteeism.

(9) The influenza incubation period (time from exposureto signs and symptoms of disease) is typically 2 days.

(10) Persons who become infected may shed virus and cantransmit infection for one-half to one day before the onset ofillness. Viral shedding and the risk of transmission will begreatest during the first 2 days of illness.

(11) Children w111 playa major role in the transmissionof infection as their illness rates are likely to be higher,they shed more virus over a longer period of time, and theycontrol their secretions less well.

10

Mea 6220.1

NOV 0 6 2009

(12) On average, infected persons will transmitinfection. to approximately two other people.

·(13) Epidemics will last 6 to 8 weeks in affectedcommunities.

(14) Multiple waves (periods during which communityoutbreaks occur across the country) of illness are likely tooccur with each wave lasting 2 to 3 months. Historically, thelargest waves have occurred in the fall and winter, but theseasonality of a pandemic cannot be predicted with certainty.

(15) An efficient human-to-human outbreak will mostlikely occur outside of the United States and may not becontained effectively.

(16) Not all parts of the world will be affected at thesame time or affected to the same degree.

(17) Developed countries will be quicker in preparingfor, detecting, and responding to outbreaks than less developedcountries.

(18) If PI starts outside the United States, it willenter the United States at multiple locations and spread quicklyto other parts of the country.

(19) Some coalition partners, allies, and Host Nation(HN) governments will request military assistance and trainingfrom the USG for PI preparedness, surveillance, detection, andresponse.

(20) HN support to U.S. forces will be impacted by PI ata rate proportional to the impact of PIon the HN's generalpopulation.

(21) DOD can expect requests from interagency partnersto support civilian mortuary affairs operations.

(22) State, Local, tribal and HN jurisdictions will beoverwhelmed and unable to provide or ensure the provision ofessential commodities and services.

(23) Infected people, confirmed (when possible) orsuspected, will not be transported to any facilities beyond theaffected area unless their medical condition demands movement.

11

MCO 6220.1

NOV 0 6 2009

(24) International and interstate transportation will berestricted to contain the spread of the virus.

(25) A layered mix of voluntary and mandatoryindividual, unit and installation-based public health measures,such as limiting public gatherings, closing schools, socialdistancing, protective sequestration, personal hygiene measures,and masking can limit transmission and reduce illness and deathif implemented before or at the onset of the event. Quarantine,isolation and other movement restrictions are essential for asuccessful containment operation.

(26) The provision of routine security services for theprotection of critical infrastructure will require Federal .augmentation.

(27) DOD will support security and possibly staffing ofnational critical infrastructure at all levels (e.g., airtraffic control, security for national critical infrastructure,etc. ) .

(28) Medical Treatment Facilities (MTF) will potentiallybe overwhelmed by DOD patients, dependents, and beneficiaries,necessitating outsourcing and alternate care facilities afteroutsourcing. DOD treatment of military personnel and otherbeneficiaries may be prioritized, with changes in priorities andaltered standards of medical care during the PI.

(29) MTF and other installation support functions willbe short staffed due to the use of some uniformed providersproviding support elsewhere.

(30) DOS will request DOD support for selective NonCombatant Evacuation (NEO) of designated non-infectedindividuals from areas abroad experiencing outbreaks. This willonly be conducted after all other methods of extraction havebeen exhausted by DOS and only when directed by the SecDef. Asstated in the DOD Implementation Plan this will only cover areasexperiencing outbreaks. Outbreaks being defined in the NationalImplementation Plan as an epidemic limited to a localized area.

(31) Some military movements, basing, over flight aswell as support to coalition operations, may be restricted byother countries. If DOS is going to request DOD support of NEOoperations, DOS will obtain diplomatic clearances and countryaccess required for military support of NEO operations.

12

MCO 6220.1

NOV 0 6 2009

(32) DOD will be called upon to assist in thetransportation of AMCITS living abroad if deemed necessary by

'public health officials or the DOS.

(33) In accordance with existing agreements, and inlimited circumstances, under Immediate Response Authority, DODwill provide support to local communities' medical efforts withpersonnel, equipment, pharmaceuticals, supplies, and facilitieswithin DOD capabilities, as requested.

(34) Under applicable authorities, DOD will assist civilauthorities in the event of a pandemic.

(35) DOD reliance on "just-in-time" procurement willcompete adversely with U.S. and foreign civilian businesses foravailability of critical supplies.

(36) DOD Title 10 Reserve Component forces will need tobe quickly mobilized to provide surge capabilities, especiallyin the areas of transportation, command and control,communications, engineering, logistics, force protection,maintenance, aviation and security.

(37) DOS Shelter-in-Place policy will be followed unlessother conditions (e.g., civil disturbance or politicalinstability force an evacuation). If a Shelter-in-Place policyis not feasible, DOD, will be called upon to assist in thetransportation of AMCITS living abroad if deemed necessary.

(38) DOS/United States Agency for InternationalDevelopment (USAID) will request support from DOD to provideHumanitarian Assistance/Disaster Relief support to theinternational community.

(39) NGB forces, minus those subject to the needs ofnational security (e.g., CCMRF units called to Title 10 status),will remain in place to provide support to the Governors of theindividual states.

(40) OCONUS operational commitments will continue atcurrent levels through the next several years and trooprotations will be impacted.

(41) There will be no increase in overall programmed DODforce structure.

(42) A surge in private demand for consumer goods(stockpiling) will cause DOD shortfalls.

13

MCO 6220.1

NOV 0 6 2009

(43) There will be a significant reduction in civiliantransportation capacity that could affect DODacquisition/distribution.

(44) A PI environment will minimize the patientevacuation effectiveness of National Disaster Medical System(NDMS) due to limited movement and a wide range of pandemicimpact.

i. Friendly. The potential scope of PI is enormous, andthe response to PI will involve many organizations.Accordingly, it is critical to establish communicationslinkages, liaison requirements, authorities, and agreementsnecessary to facilitate a rapid, coordinated interagency andinternational response to PI. Further, these roles andcoordination must be in effect in advance of a PI event.Federal Departments and Agencies include:

(1) U.S. Department of Health and Human Services (HHS).The Secretary of HHS will be the primary agency coordinating theoverall public health and medical response efforts across allfederal departments and agencies and serve. as the principalfederal spokesperson for the U.S. Government PI health issues.

(2) U.S. Department of Homeland Security (DHS). TheSecretary of Homeland Security, will coordinate the Federalresponse to save lives, maintain confidence in the government,sustain critical infrastructure, and recover from PI in the 54States, territories, and possessions.

(3) U.S. Department of Agriculture (USDA). TheSecretary of USDA is responsible for overall coordination ofveterinary response to a domestic animal outbreak of PI virus orvirus with PI potential and ongoing surveillance for influenzain domestic animals and animal products.

(4) U.S. Department of State (DOS) The Secretary ofState is responsible for the coordination of the internationalpreparation and response, including persuadingother nations to join our efforts to contain or slow the spreadof PI virus, helping to limit the adverse impacts on trade andcommerce, coordinating our efforts to assist other nations thatare impacted by the PI, and interdiction with all official andnon-official American Citizens (AMCITs) overseas.

14

MCO 6220.1

NOV 0 6 2009

j. Legal and Policy Considerations. Significant legal andpolicy issues could arise during operations in a PI environment.

(1) Emergency Health Powers (EHP). To protect militaryand civilian personnel and DOD property, EHP, reference (i),enables the restriction of movement, the use of containmentstrategies (e.g., .isolation, quarantine, social distancing) aswell as medical evacuation and treatment. InstallationCommanders are authorized upon consultation with theirdesignated Public Health Emergency Officer (PHEO) to invokethese powers. Commanders at OCONUS locations may be restrictedin the execution of these powers by HN laws and applicableinternational agreements. GCCs and the Marine Corps will ensureunity of effort in the implementation of EHP in the GCCs AORsand that the implementation of EHP does not violate applicablelaw and/or policy.

(2) Force Health Protection (FHP). Under existing FHPpolicy, reference (j), a CCDR's responsibility/authority for FHPis limited to assigned or attached forces under the currentforces for and to its subordinate commands/headquarters.COCOMs, Services, and DOD Agencies will ensure unity of effortin the implementation of FHP in the GCC's AOR. Under currentFHP policy, Services retain existing FHP authorities andresponsibilities. SecDef may, under extreme circumstances,choose to transfer to a CCDR authority for FHP over all DODpersonnel within their AOR.

(3) Defense Support of Civil Authorities (DSCA). Asdirected by SecDef, CCDR will provide support to civilauthorities. CCDRs in coordination with their Staff JudgeAdvocate will ensure that the support complies with applicablelegal authorities and/or policy.

(4) International Support. COCOMs tasked to provideforeign humanitarian assistance or disaster relief to foreigncountries within their AOR will, in coordination with theirStaff Judge Advocate, ensure that it is done in accordance withapplicable international agreements, laws and policies.

(5) Standing Rules of Engagement (SROE) and StandingRules for the Use of Force (SRUF) will apply during a responseto PI. In addition, any COCOM theater specific ROE and SecDefapproved mission specific RUF will remain in effect. GCCs mayaugment the SROE/SRUF as necessary by submitting a request formission specific ROE/RUF to the CJCS. National Guard Forces

15

MCO 6220.1NOV 0 6 2009

performing in a non-federalized status are governed by theirrespective State's ROE/RUF. These will probably differ from therules governing Title 10 forces.

(6) The Federal Government has legal authority toprioritize distribution of vaccines and antivirals.

(7) Defense Production Act authorizes the FederalGovernment to require manufacturers to give priority for goodsand services necessary or appropriate to promote the nationaldefense.

(8) Commander USNORTHCOM will provide assessments andrecommendations to the SecDef through the Joint Staff on PIrelated resource and policy decisions in other AORs that mayimpact Homeland Defense (HLD) and DSCA within the USNORTHCOMAOR.

k. Limitations. Reference (0) provides implementinginstructions for release and sharing of unclassified portions ofPI and DSCA plans with non-DOD planning partners, to includeFederal, State (including the National Guards of the severalStates), local, and tribal agencies as well as private sectorentities and Host Nation agencies.

2. Mission. The U.S. Marine Corps prepares for, responds to,and recovers from PI in order to ensure continuity of Title 10United States Code (U.S.C.) responsibilities, and providescombat ready forces worldwide. When directed, the U.S. MarineCorps supports the·USG PI efforts.

3. Execution

a. Commander's Intent and Concept of Operations

(1) Commander's Intent. Minimize the impact of PIonthe Marine Corps while simultaneously supporting, withincapabilities, the USG domestic and international PI efforts.

(a) Key Tasks

1. Medical surveillance, analysis &reporting/dissemination.

2. Force Health Protection.

3. Assure capability to project & sustaincombat power.

16

MCO 6220.1

NOV 0 6 2009

4. Support the USG PI response.

5. Coordinate and synchronize PI planning.

(b) Essential Tasks

1. Force Health Protection.

2. Assure capability to project & sustaincombat power.

3. Coordinate and synchronize PI planning.

(c) End State. MARFORS maintain operationaleffectiveness.

(d) Strategic Objectives. The effects of PI aremitigated, forces maintain freedom of movement worldwide andU.S. partners have assurance of support.

(e) Desired.Effects. The effects of PI aremitigated and contained, and MARFORS are able to continue tooperate in support of national interests.

(2) Concept of Operations

(a) The center of gravity (COG) will be theinstallation. Installation Commanders will plan and execute incoordination with HN, State, local, tribal and private sectorentities. Installations will initiate coordination with othermilitary installations within a 100 mile radius.

(b) The Marine Corps executes this plan inaccordance with reference (f).

(c) DOD Global Synch Phases. This plan follows asix-phased construct: Shape, Prevent, Contain, Interdict,Stabilize, and Recover. The Marine Corps executes this planbased upon observable and verifiable WHO conditions rather thanWHO Pandemic phase declarations which may degrade rapid MarineCorps responses within a PI environment. Simultaneous executionof tasks from different phases may occur.

!. Shape Phase (0): Phase 0 occurs in aninter-pandemic period (WHO phase 1 and 2 conditions) and is acontinuous phase incorporating adaptive planning, routine

17

MCO 6220.1

NOV 0 6 2009

surveillance and engagement activities to assure and solidifycollaborative relationships, shape perceptions, and influencebehavior in order to be prepared for a new influenza viralsubtype. Phase 0 includes education and training for the MarineCorps key population and in coordination with GCCs, HNs,interagency, .and international partners.

a. Key Tasks

(l) Develop and exercise plans incoordination with external planning partners, both DOD and nonDOD, synchronize plans with GCCs.

(~) Conduct threat surveillance insupport of Marine Corps activities, facilities, and KeyPopulation.

b. Priority of Effort. Surveillance.

c. Secondary Effort. Plan development andcoordination.

d. Triggers (Phase 0 > Phase 1)

(l) Indications and warnings of humaninfection{s) with a new subtype with no human-to-human spread,or at most, rare instances of human-to-human spread to a closecontact.

(~) WHO declares its Phase 3 conditions.

~. Phase 0 ends upon receipt of informationof human infection{s) with a new influenza viral subtype but nohuman-to-human spread, or at most rare instances of spread to aclose contact (similar to WHO Phase 3 and USG Stage 1conditions) .

~. Prevent Phase (I): Phase 1 begins uponreceipt of information of human infection(s) with a newinfluenza viral sub-type but no human-to-human spread, or atmost, rare instances of spread to a close contact (similar toWHO phase 3 conditions). During Phase 1, the Marine Corpssupports GCC and USG efforts to prevent or limit the spread ofthe virus.

18

MCO 6220.1

NOV 0 6 Z009

a. Key Tasks

(!) Continue to monitor globalinfections to identify PI.

(~) Train the force on protectivemeasures for PI.

(l) Equip the force with appropriate PPE.

(!) Equip the force to facilitateshelter-in-place requirements.

(~) Educate and rehearse PI FHPmitigation actions and response plans.

(~) Enhance external coordination toinclude Public Affairs.

b. Priority of Effort. Actions to preparefor and respond to potential pandemic, to include:

(!) Training / equipping.

(2) Educate Key Population.

(l) Planning.

(!) Opening Strategic Communication.

c. Secondary Effort. Actions to maintainsituational awareness, to include:

(!) Interagency / internationalcoordination.

(2) Surveillance


(1) Indications and warnings identifysmall cluster(s) with limited human-to human transmission butspread is highly localized, suggesting virus is not well adaptedto humans.

(~) WHO declares its Phase 4 conditions.

19

MCO 6220.1

NOV 0 6 2009

~. Phase 1 ends upon receipt of informationof small cluster(s) with limited human-to-human transmissionsbut the spread is highly localized suggesting the virus is notwell adapted to humans (WHO Phase 4 conditions) .

2. Contain Phase (2): Phase 2 begins uponreceipt of information of small cluster(s) with limited humanto-human transmission but the spread is highly localizedsuggesting the virus is not well adapted to humans (similar toWHO phase 4 conditions). During Phase 2', Marine Corpsorganizations will take measures to protect the Marine Corps keypopulation in the localized region(s) while maintaining thefreedom of action to conduct assigned missions. As directed,Marine Corps organizations will support GCC and USG efforts tocontain the new virus within a limited area in order to preventa pandemic and gain time for implementation of additionalpandemic preparedness measures.

a. Key Tasks

(!) Pre-position key capabilities toprotect MARFORS.

(~) Support USG PI mitigation efforts tocontain the virus.

(3) Continue medical surveillance.

(i) In coordination with GCCs, implementFHP and community mitigation measures in affected regions.

(~) Sustain external coordination toinclude Public Affairs (PA).

£. Priority of Effort. Support USGcontainment efforts while maintaining freedom of movement toconduct assigned missions.

c. Secondary Effort. Preparation forpotential pandemic by initiating release and distribution of PImedical stockpile material.


(!) Indications and warnings of largercluster(s) but human-to-human spread still localized suggesting

20

MCO 6220.1

NOV 0 6 2009

the virus is becoming increasingly better adapted to humanefforts, not yet fully transmissible.

(~) WHO declares or moves to its Phase 5.

e. Triggers (Phase 2 > Phase 1). No newcluster(s) identified with decrease in cases in identifiedcluster(s)

f. Phase 2 ends when indications andwarnings identify large clusters of human-to-human transmissionor when the outbreak is contained with no additional cases in an(the) identified region(s) (similar to WHO phase 5 conditions)

i. Interdiction Phase (3): Phase 3 begins whenindications and warnings identify large clusters of human-tohuman transmission in (the) affected region(s) (similar to WHOphase 5 conditions). During Phase 3, Marine Corps organizationstake broader measures to protect the Marine Corps key populationwhile maintaining the freedom of action to conduct assignedmissions. As directed, Marine Corps organizations will supportthe GCC and USG efforts to delay or halt a pandemic influenzawave.,

a. Key Tasks

(!) Continue to support GCC and USG PImitigation efforts.

(~ Continue medical surveillance.

(l) In coordination with GCCs continueand refine FHP and community mitigation measures in affectedregions.

(i) Continue and refine externalcoordination to include PA.

b. Priority of Effort. Necessarypreparations to ensure freedom of action to conduct assignedmissions in face of impending pandemic.

c.efforts and preparationOperations (COOP).

Secondary Effort. Support to USGactions to ensure Continuity of

21

MCO 6220.1

NOV 0 6 Z009


(!) Indications and warnings ofincreased and sustained transmission in general population.

(~) WHO declares Phase 6.

~. Triggers (Phase 3 > Phase 2). Decreasein reported cases in identified clusters or no new clusters.

!. Phase 3 ends upon receipt of informationthat highly lethal, influenza virus is spreading efficientlyfrom human-to-human, signaling a failure of containment andinterdiction actions within a region{s) (similar to WHO phase 6conditions) or when the outbreak is contained with no additionalcases in the identified region(s) .

5. Stabilize Phase (4): Phase 4 begins uponreceipt of information the PI virus is spreading globally fromhuman-to-human signaling a failure of containment andinterdiction actions (similar to WHO phase 6 conditions) .During Phase 4, Marine Corps organizations will protect MarineCorps key population in order to maintain freedom of action toconduct assigned missions and within capabilities, as directed,support USG in mitigating the pandemic effects in order toensure governments and communities are capable of maintainingsocial order, maintain critical infrastructure, and to minimizehuman suffering.

a. Key Tasks

(!) Maintain mission assurance.

(2) Continue to support GCC and USG PImitigation efforts.

(~) Increase medical surveillance andanalysis.

(i) Enhance protection and treatment ofkey population.

(~) Maintain COOP in PI environment.

(~) Continue and refine externalcoordination to include PA.

22

MCO 6220.1

NOV 0 6 2009

~. Priority of Effort. Protect KeyPopulation while maintaining mission assurance and protection ofUSG vital national interests.

c. Secondary Effort. Support to other USGPI efforts and actions to maintain COOP.


(!) Declining case incident rates.

(~) Indications of pandemic wave slowing.

(~) Conditions that allowreestablishment of USG / HN functions without Marine Corpssupport.

e. Phase 4 ends upon receipt of informationthat case incidence is decreasing, indicating the slowing of thepandemic wave and conditions begin to allow reestablishment ofgovernments' functions without Marine Corps support.

6. Recover Phase (5): Phase 5 begins uponreceipt of information that case incidence is decreasing,indicating the slowing of the pandemic wave. During Phase 5,Marine Corps conducts force reconstitution operations and asdirected will support GCC and USG efforts to re-establish normalsupport conditions with key partners.

a. Key Tasks

(1) Prepare for next wave (3 waves in 18months)

(~) Posture MARFORS and capabilities toexecute Title 10 responsibilities.

(3) Capture and implement lessonslearned.

(!) Continue and refine externalcoordination to include PA.

~. Priority of Effort. Redeploy Marineresponse forces as directed.

c. Secondary Effort. Redeploy andReconstitute.

23

MCO 6220.1

NOV 0 6 2009

d. Triggers

(1) Conditions set for return tointerpandemic phase.

(~) Indications for subsequent wave.

e. Phase 5 ends when normal supportrelations are in place, Marine Corps PI response forces arereconstituted and reset,and conditions allow for a return tothe inter-pandemic conditions or back to a previous phase.

b. Tasks

(1) Deputy Commandant, Plans Policies and Operations

(a) Serve as the lead office on PI planning andresponse matters for the Marine Corps. Appoint a full-time PIPlanner to serve as the POC for all PI issues.

(b) Provide policy and planning guidance to enablethe development of Regional and Installation Disease ContainmentPlans (DCP) with PI annexes.

(c) Provide policy and planning guidance to enablethe development and maintenance of a Pandemic Response annex tothe HQMC Continuity of Operations (COOP) Plan.

(d) Provide policy and procedural guidance for PIreporting to include:

(1) Immediate OPREP-3/SIR

(2) Monthly SITREP during phases 0/1

(3) Weekly SITREP during phase 2

(4) Daily SITREP during phases 3/4/5

(e) In coordination with Health Services (HS) , HQMC,provide policy and planning guidance for the implementation ofthe Novel Influenza Vaccine Immunization Program (NIVIP).

(f) In coordination with Health Services (HS) , HQMC,provide policy and planning guidance for the implementation ofNovel Influenza Pre-Deployment Screening.

24

MCO 6220.1

NOV 0 6 Z009

(g) In coordination with Manpower and ReserveAffairs (M&RA) , establish guidelines and procedures for therecall of Reserve personnel with critical skill sets inaccordance with policy guidance from the Office of the AssistantSecretary of Defense Reserve Affairs (OSD(RA)).

(h) Assist MARFORNORTH in coordinating withUSNORTHCOM to ensure that policy and plans are developed andsynchronized with reference (f).

(i) Assist MARFORS and Installations insynchronizing their DCP with corresponding GCC PI CONPLANs.

(j) Review MARFORS and Installation DCP every sixmonths in accordance with reference (s) with an emphasis onrefinements necessary due to significant changes in strategy,risk or tolerance of risk, assumptions, u.s. capabilities, enemyand/or adversary intent or capabilities or resources.

(2) Director of Health Services HQMC

(a) Advise the Commandant of the Marine Corps (CMC)and his operational and medical staff concerning PI FHPpriorities necessary to ensure COOP throughout PI.

(b) Coordinate policies, plans, procedures, andguidelines with the Bureau of Medicine and Surgery (BUMED) asprovided in references (k) and (1), to fully employ theresources of Navy Medicine and mitigate the PI impacts uponMarine Corps Installations and Operations. Specifically, PIcoordination must address Marine Corps dependencies upon BUMEDcoritrolled assets, such as garrison MTF and public healthsupport, to ensure:

1. Public Health Emergency Officers (PHEOs) areproperly allocated and trained to support Marine CorpsInstallation Commanders.

2. FHP program elements are consistent with FHPmeasures aligned by phase, in accordance with reference (j).

~. Community mitigation guidance is provided toaffected Marine Corps installations, including the proceduresand guidelines for using PPE, imposing quarantine or isolation,and screening and/or transporting patients with ILl.

25

MCO 6220.1NOV 0 6 2009

4. Access to healthcare resources is providedfor affected and eligible military/DOD personnel and familymembers at all Marine Corps installation MTFs.

~. MTFs that operate on Marine Corpsinstallations perform daily influenza surveillance and trendanalysis in accordance with DOD policy, and report evidence ofpotentially emerging pandemic threats to all affectedinstallation commanders and higher headquarters.

6. Immunization of military units and keycritical personnel is initiated once a licensed vaccine isavailable and supplies and distribution are adequate.

7. Occupational Environmental Health Survey(OEHS) assessments are conducted, as appropriate.

~. Theater distribution and tracking plans forantivirals, vaccines, ventilators, and other medicalsupplies/equipment for the GCCs is appropriately developed andexecuted.

2. Adequate stocks and sourcing of medicalmaterial are maintained in accordance with Annex Q, ofreference (f).

10. Plans are in place to activate and deploymedical personnel to augment/support appropriate PI relatedmedical operations as directed by higher authority. Plans mustinclude provisions for mental health, mortuary affairs, andscreening criteria at aero-medical evacuation hubs and ports ofdebarkation.

11. A 3D-day supply of antivirals and otheressential medical supplies are pre-positioned at eachinstallation MTF to support key populations.

12. Adverse events following a vaccine and/orantiviral administration are tracked and reported.

(3) Deputy Commandant, Manpower and Reserve Affairs

(a) Develop military/civilian personnel policy andguidance to address the following in the event of PI:

1. Wounded Warrior care.

2. Telework.26

MCO 6220.1

NOV 0 62009

3. Child care.

4. Financial assistance.

5. Educational needs.

6. Locator assistance.

7. Family employment.

8. Recall from TAD/Leave.

9. Retiree recall.

10. Stop Loss.

11. Stop Movement.

12. Implementation of Safe Haven.

(b) Conduct a formal review of all USMCR Units andIndividual Augmentees to determine which personnel would not beavailable for activation during a pandemic due to the criticalnature of their civilian occupations. At a minimum this studyshall be broken out by state, category of recall, skills set andshall specifically address the impact on anticipated PIoperations. This study is due 180 days after OSD(RA) releasesits policy for utilization of the National Guard and Reservesduring a pandemic. Results of this analysis will be provided tothe Joint Staff, United States Joint Forces Command (USJFCOM),National Guard Bureau (NGB) and Marine Forces Reserve.

(c) In coordination with OSD and OPM, develop policyand advise Marine Corps leadership on civilian (appropriatedfund and non-appropriated fund) personnel work flexibilities,limitations, and responsibilities during preparation for,response to, and recover from PI. Scope of task includes, but isnot limited to; work hours, telework, social distancing, liberalleave (with or without pay), and other non-pharmaceutical FHPmeasures.

(d) In coordination with the Deputy Commandant,Installation and Logistics, authorize emergency hiring andcontracting authorities to fill critical personnel shortagesduring and after PI.

27

MCO 6220.1

NOV 0 6 2009

(e) Conduct PI reporting in accordance withenclosure (2) of this Order to include:

1. Immediate OPREP-3/SIR

2. Monthly SITREP during phases 0/1

3. Weekly SITREP during phase 2

4. Daily SITREP during phases 3/4/5

(4) Director, Intelligence

(a) Develop and disseminate policies regardingintelligence support to PI.

(b) Track global influenza spread.

(c) Provide threat indications, warning andassessments relating to PI.

l. Intelligence efforts will be focused byPriority Intelligence Requirements (PIRs), and associatedEssential Elements of Information (EEl) and Observables (OBS) .

~. Assigned and attached units will submitinformation of intelligence value as soon as possible and passcritical information via the most expeditious means available.

(d) Monitor secondary and tertiary effects of PIonstate and non-state actors.

(e) Develop and maintain interagency andinternational relationships to share PI information, includingcommunications.

(5) Deputy Commandant, Installations and Logistics

(a) In coordination with Deputy Commandant, PP&O,operate as integral partners to define, develop, and implementappropriate PI preparedness and response capabilities.

(b) Analyze and provide support for criticalinfrastructure protection of critical maintenance, supply, andlogistics process, facilities, and assets against PI.

28

MCO 6220.1

NOV 0 6 2009

(c) In conjunction with DLA, identify criticalsupplies, goods or services that require priority delivery fromindustry/suppliers to ensure COOP and sustainment of keypopulation.

(d) Ensure Mortuary Affairs (MA) plans addressfatality management assistance in the collection of ante-morteminformation and Deoxyribonucleic Acid (DNA) samples in order toinsure proper identification of remains, and advise personneland families as needed regarding the process.

(e) Ensure guidance exists to address temporaryhousing during PI.

(f) In coordination with the Deputy Commandant,Manpower and Reserve Affairs, authorize emergency hiring andcontracting authorities to fill critical personnel shortagesduring an~ after PI.

(6) Director, C4. Be prepared to provide Command,Control, Communication and Computers (C4) assets, personnel andexpertise upon request to COCOMs, Joint Task Forces (JTF), JointCommunications Control Centers (JCCC), MARFORs, andInstallations in the event of a PI.

(7) Deputy Commandant, Combat Development andIntegration/Commanding General, Marine Corps Combat DevelopmentCommand

(a) Identify the roles and responsibilitiesregarding how studies, analysis, assessments and lessons learnedfor PI will be requested, the reporting format required and theappropriate recipients; as well as, how the information will beused to improve plans and response capabilities.

(b) Conduct PI reporting in accordance withenclosure (2) of this Order to include:

1. Immediate OPREP-3/SIR.

2. Monthly SITREP during phases 0/1.

3. Weekly SITREP during phase 2.

4. Daily SITREP during phases 3/4/5.

29

MCO 6220.1

NOV 0 62009

(8) Chaplain of the Marine Corps

(a) Provide religious activity support and guidancein the event of a PI.

(b) Identify areas in the DCP that require orrecommend Chaplain Service (CS) support, such as MA and MedicalServices. Describe procedures to ensure religious supportduring emergency situations.

(c) Clearly identify the boundaries of service inthe event of PI so as to avoid inadvertent spread of the disease.

(d) Within existing capabilities, surge pastoralcare and religious support for both living and deceased MarineCorps personnel.

(9) Deputy Commandant, Program and Resources

(a) Identify resource shortfalls to OSD, asapplicable, to ensure execution of Shape Phase (Phase 0) andPrevent Phase (Phase 1), and to begin preparation of remainingphases.

(b) Capture costs during all PI phases for theultimate reimbursement from the primary agency.

(10) Staff Judge Advocate to the CMC

(a) In coordination with GCCs, ensure unity ofeffort in the implementation of Emergency Health Powers (EHP) ineach GCC AOR and that the implementation of EHP does not violateapplicable law and/or policy.

(b) Advise the CMC regarding policy and legislativeissues and changes that will affect support to affected activeand reserve component personnel and family members.

(c) Ensure compliance with annex E, appendix 4 ofreference (c).

(11) Director, Headquarters, U.S. Marine Corps PublicAffairs

(a) Develop a comprehensive internal and externalpublic affairs (PA) strategy (as directed) that supports the DODobjectives and is synchronized'with reference (c).

30

MCO 6220.1NOV 0 6 2009

(b) Ensure clear, effective and coordinated riskcommunication, before and during a pandemic. Communicate/disseminate public health advisories, strategic communicationthemes and other messages consistent with Assistant Secretary ofDefense for Public Affairs (ASD(PA» and Assistant Secretary ofDefense for Homeland Defense and Americas' Security Affairs(ASD(HD&ASA» guidance, National and DOD policy and guidance.

(12) Commander, Training and Education Command. Incoordination with Health Services HQMC, develop and disseminatespecific training materials that stress preventive measuresduring PI. Ensure these training materials are used duringInitial Entry Level Training for both officer and enlistedstudents.

(13) Commanding Officer, Headquarters Battalion, HQMC.Conduct PI reporting in accordance with enclosure (2) of thisOrder to include:

(a) Immediate OPREP-3/SIR.

(b) Monthly SITREP during phases 0/1.

(c) Weekly SITREP during phase 2.

(d) Daily SITREP during phases 3/4/5.

(14) Commander, Marine Forces North

(a) Coordinate with USNORTHCOM in its execution ofUSNORTHCOM CONPLAN 3551-09, "Pandemic Influenza Plan", viareference (f), to ensure synchronization with reference (c).

(b) Synchronize staff actions with USMC SupportingEstablishment Commands and all USMC attached and assigned forcesto USNORTHCOM, in support of reference (c).

(15) Commanders, Marine Forces

(a) Be advised that installations may be challengedto sustain mission and life support operations in an environmentof degraded civil infrastructure and limited external supportfor three separate 90-day periods irregularly interspersed overa time frame of 18 to 24 months.

(b) Establish installation level PI working group.Appoint appropriate core membership (to include tenants) .

31

MCO 6220.1NOV 0 6 2009

(c) Conduct situational assessment and gap analysisto identify mitigations, shortfalls and vulnerabilities.

(d) In coordination with supporting MTF, develop aDCP with PI Annexs conforming in scope and format to enclosure(1), to prevent, protect against" respond to and recover from PIaffecting the installation and its key population and criticalinfrastructures. Ensure DCP is coordinated and synchronizedwith USNORTHCOM and other GCCs, other geographically proximate{100 mile radius} service installations, and regional, State andlocal first responder emergency planning, and health authorities.Ensure installation plans prepare and exercise PI prevention,response and recovery with external partners.

(e) In coordination with DC PP&O, develop andmaintain a Pandemic Response annex I enclosure within existingCOOP plans to include:

1. Risk communications.

2. Alternative work schedules.

3. Telework.

4. Social distancing.

5. Isolation I quarantine.

6. Geographic dispersion.

7. Alternate operating locations.

8. Personal protective equipment {PPE}.

9. Delegations of authority.

10. Orders of succession.

11. Cross training of personnel.

12. Travel restrictions.

13. Personnel accountability.

14. Vaccinations I antivirals.

32

MCO 6220.1

NOV 0 62009

(f) Conduct PI reporting in accordance withenclosure (2) of this Order to include:





(g) Program and budget (to include POM inputs)necessary resources to maintain and execute the DCP. Ensurefunding is requested and allocated for external coordinationconsistent with desired external coordination effects andcorresponding capabilities shortfalls. Ensure installationtenants program and budget necessary resources to maintain andexecute their internal PI Plans.

(h) Establish and maintain appropriate Memorandumsof Understanding (MOUs) and Mutual Aid Agreements (MAAs) with HN,local, State, tribal, Federal and HN civil authorities, privatesector organizations and other federal facilities to addresslocal support that either party might provide for immediateresponse to homeland emergencies. Ensure that Marine Corpscommitments under MOUs/MAAs are consistent with relevantregulatory and statutory requirements, including specificfunding authorities. Coordinate all new or re-validatedMOUs/MAAs with appropriate organizations.

(i) Develop and actively provide PI preparednessinformation tailored to Key Population in the local area.Ensure PREO provides guidance for developing and implementingmovement restrictions, individual protection, and socialdistancing strategies (including unit shielding, vessel sortie,cancellation of public gatherings, drill, ceremonies, training,etc.) within their installations, and stations. Advise DODpersonnel and beneficiaries living off-installation shouldcomply with local community containment guidance with respect toactivities not directly related to the installation.

(j) When directed, receive, store, secure, maintain,and distribute PPE/vaccines and anti-virals for a pandemicthreat in coordination with GCC and ASD(HA) prioritizationguidance.

33

MCO 6220.1

NOV 0 6 2009

(k) Be prepared to conduct as situationalappropriate, DSCA or HA/DR including but not limited to thefollowing activities:

1. General Public Safety and Security, toinclude but not limited to:

a. Assist with building evacuations andshelter-in-place notifications.

£. Assist with the protection of emergencyresponder and other workers operating in a high-threatenvironment.

£. Conduct surveillance to assist in publicsafety and security efforts, and provide technology support, asappropriate.

~. Determine security support requirementsand jointly determine resource priorities.

e. Execute security measures for quarantineand certain public health laws, including but not limited toisolation and other restriction of movement measures perapproved ROE.

!. Provide expertise and coordination forsecurity planning efforts and conducting technical assessments(e.g., vulnerability assessments, risk analyses)

2. Food and Water Security, to include but notlimited to:

~. Assist in determining the location andstatus of suspected contaminated food supplies (may includeconducting epidemiological investigations).

£. Assist in mobilization and staging offood supplies, including facilities and personnel to offload,store, allocate, and reload for shipment to foodpreparation/distribution sites within the disaster area.

~. Pharmaceutical Security, to include but notlimited to providing physical security for vaccines and antivirals in support of civil authorities.

34

Mca 6220.1NOV 0 6 2009

4. Emergency Management, to include but notlimited to:

a.reports and assessmentsa disaster/emergency.

Alert, notify, and assist with situationto regional and field components during

£. Identify and implement compatibleresource tracking systems when possible.

c. Provide CBRNE subject matter experts andtechnical resources for planning and decision-making.

5. Mass Care Housing and Human Services, toinclude but not limited to:

a. Assist in establishing priorities andcoordinating the transition of mass care operations withrecovery activities.

b. Ensure water, ice, and other emergencycommodities and services requirements are delivered toappropriate entities.

c. Provide assistance for the short andlong-term housing needs of victims.

d. Provide assistance in constructingtemporary shelter facilities in the affected area,as required.

~. Provide mass care functions includingoverall coordination, shelter, feeding, emergency first aid,disaster welfare information, bulk distribution, and otheractivities to support emergency needs of victims.

!. Support various services impactingindividuals and households, including a coordinated system toaddress victims' incident related recovery efforts throughcrisis counseling and other supportive services.

6. Public Health and Medical Services, toinclude but not limited to:

~. Health Surveillance (Conduct fieldstudies and investigations; Enhance surveillance systems tomonitor the health of the general population and special

35

MCO 6220.1

NOV 0 6 Z009

high-risk populations; and identify diseases for whichquarantine is appropriate).

b. Medical Care Personnel (Provideavailable personnel for support in hospital care and outpatientservices to victims who become seriously ill or injured; andProvide available personnel with immediate medical responsecapabilities) .

c. Provide Health/Medical Equipment andSupplies and Behavioral Health Care.

d. Patient Evacuation and Patient CareServices (Provide available personnel to support inpatienthospital care and outpatient services to victims who becomeseriously ill or injured regardless of location and providecontagious casualty support, including isolation, quarantine,and restriction of movement) .

7. Support mass fatality management.

i. Support USDA animal eradication.

(1) On order, restrict travel and personnel movementto areas experiencing PI outbreak. Ensure mission essentialpersonnel entering such areas are provided with antiviralprophylaxis and vaccines, when available, and individual PPE.Personnel restriction is necessary to avoid moving unexposedpersonnel into an area experiencing an outbreak and/or to avoidallowing potentially infectious personnel to return to a PI-freearea.

(m) On order, cancel or postpone all non-criticaloperations, exercises, or activities in areas with confirmed,sustained, human-to-human transmission of PI.

(n) On order, implement policy and procedures forthe NIVIP.

(0) On order, implement policy and procedure forNovel Influenza Pre-Deployment Screening.

(16) Commander, Marine Forces Reserve

(a) Develop DCPs with PI Annexs conforming in scopeand format to enclosure (1), to prevent, protect against,respond to and recover from PI affecting the Reserve Centers,Reserve Support Units and its key population and critical

36

MCO 6220.1

NOV 0 6 2009

infrastructures. Ensure DCP is coordinated and synchronizedwith USNORTHCOM and other GCCs, other geographically proximate(100 mile radius) service installations, and regional, State andlocal first responder emergency planning, and health authorities.Ensure plans prepare and exercise PI prevention, response andrecovery with external partners.

(b) In coordination with DC PP&O, develop andmaintain a Pandemic Response Annex / Enclosure within existingCOOP plans to include:

1. Risk communications.

2. Alternative work schedules.

3. Telework.

4. Social distancing.

5. Isolation / quarantine.

6. Geographic dispersion.

7. Alternate operating locations.

8. Personal protective equipment (PPE)

9. Delegations of authority.

10. Orders of succession.

11. Cross training of personnel.

12. Travel restrictions.

13. Personnel accountability.

14. Vaccinations / antivirals.

(c) Conduct PI reporting in accordance withenclosure (2) of this Order to include:




37

MCO 6220.1

NOV 0 6 Z009


(d) Prepare for HQMC submission to USNORTHCOM, anassessment based upon OSD(RA) policy of which Marine CorpsReserve forces should not be available for activation given a PIsituation, under appropriate authorities, due to the criticalnature of their civilian occupations (first responders, healthand medical professionals, transportation industry, criticalinfrastructure sustainment, etc.). At a minimum this studyshould be broken out by State, category of recall, skills setand specifically address the impact on anticipated DOD PIresponse operations.

(e) Be prepared to provide Marine Corps Reserveforces to conduct the following types of operations within a PIenvironment:

1. Transportation

2. Command and control

3. Communication

4. Engineer

5. Logistics

6 . Force Protection

7 . Maintenance

8. Aviation

9. Security

(f) On order, implement policy and procedure forNovel Influenza Pre-Deployment Screening.

c. Coordinating Instructions

(1) This plan is effective for planning upon receipt,and for execution on order.

(2) Enclosures (3) - (9) provide PI preparedness andresponse checklists, evaluation matrix, and handbooks to enhancePI planning efforts and facilitate execution of this Order.

38

MCO 6220.1

NOV 0 6 2009

(3) HQMC agencies COOP PI response roles andresponsibilities are outlined in Annex E to HQMC COOP Plan Pandemic Response.

(4) All PI DSCA will be provided on a reimbursable basisunless the operation was ordered by the POTUS or reimbursementis waived by the SecDef. Support provided under ImmediateResponse Authority should be on a cost-reimbursable basis, ifpossible. Marine Corps organizations will capture costs duringall phases of the PI for possible reimbursement from the PrimaryAgencies.

(5) CDRUSNORTHCOM and CDRUSPACOM shall be thecoordinating authorities for any PI DSCA operations in theirrespective Joint Operations Areas (JOAs).

(6) MARFORS shall become OPCON to GCCs upon arrival.All MARFORS allocated to COCOM JOAs can expect to undergo theJRSOI process.

(7) Commanders responding under Immediate ResponseAuthority or Imminently Serious Condition Authority will notifyMarine Corps Operations Center within 1 hour. For responseswithin the NORTHCOM JOA, Marine Corps Operations Center will,within 1 hour of receipt, notify the NORAD-USNORTHCOM OperationsCenter and the National Military Command Center (NMCC) inaccordance with reference (c).

(8) Director, HQMC PA is the HQMC agent and delegatingauthority for the Marine Corps response to all media inquiriesconcerning Marine Corps PI operations. Any Marine Corpsresponse must take into account possible media contribution toGCCs mitigation efforts in support of the Primary Agencies.

(9) Direct Liaison Authority (DIRLAUTH). DIRLAUTH isauthorized with Marine Corps organizations listed in plan forthe purposes of planning, synchronizing, and execution of thisplan. Within USNORTHCOM JOA, Commanders, MARFORS are authorizedDIRLAUTH with State, local, -tribal and private sector planningpartners. Outside of USNORTHCOM JOA, Marine Corps defersDIRLAUTH with HNs to CCDRs. In all cases, keep HQMC informed.

4. Administration and Logistics

a. Commanders/Commanding Officers shall ensure adequatestaff and budget are provided to implement a comprehensive PIplan to meet the requirements of this Order.

39

MCO 6220.1

NOV 0 6 2009

b. Commanders shall publish local implementing guidance andappropriate supplemental policies. Such guidance must beconsistent with this Order, but commanders may implement moredetailed rules to meet their needs. CCDR Concept Plans andguidance shall be integrated into appropriate orders, training,educational programs, SOPs and deployment checklists.

c. Installations arepreparation and planning.the supporting commands.

the supported commands for PITenant units and organizations are

d. Installation DCP are not authorized for destruction.Per reference (n), Commanders/Commanding Officers shall maintainall plans until a records disposition is established.

5. Command and Signal

a. Command. This Order is applicable to the Marine CorpsTotal Force.

b. Signal. This Order is applicable the date signed.

cYT. D. WALDHAUSERDeputy CommandantPlans, Policies and Operations

DISTRIBUTION: PCN 10209391000

40

MCO 6220.1

NOV 0 62009

Standard Format and Attachments for an Installation DiseaseContainment Plan (DCP) in Support of the DOD Global Pandemic

Influenza Concept Plan (CONPLAN 3551)

1. General. The installation DCP should provide detailedprocedures, information and guidance to prepare for and respondto disease outbreaks, whether naturally occurring or due tobiological attacks, to protect installation personnel andcritical resources. This DCP will support sustainment ofmission operations during disease outbreaks, if required. TheDCP should be maintained in an executable state via periodicupdates. When available, lessons learned from exercises andreal-world events, should be incorporated into the plan.

2. Plan Components. Three specific components are generallynecessary for the DCP: the table of contents, the basic plan,and the attachments (annexes, appendices and/or tabs) .

3. The Basic Plan. Installation plans will follow the formatas outlined below. The basic plan will contain, at a minimum,nine sections: references, tasked organizations, situation,threat, key assumptions, mission, execution, administration andlogistics, and command and control. Installation planners mayadd additional sections as required. Keep the basic plan brief;save the detailed information for the attachments. Whereapplicable, the DCP may reference other installation plans (e.g.,installation security plan, medical contingency response plan)rather than restate the information.

3.1. References. List applicable DoD, Services, andinstallation-specific guidance, as well as any other referencesrequired to execute the plan.

3.2 Tasked Organi·zations. Identify installation organizationstasked to support this plan. Identify the size and breakout ofthe installation population. Include assigned Services units,tenant units, geographically-separated units, joint or coalitionforces, military civilians, civilian contractors, militarydependents, host nation or third country civilians, and guests.

3.2.1. Supporting Forces. Identify military units ororganizations outside of the installation that support this plan.

3.2.2. Supporting Organizations. Identify non-militaryorganizations identified for support via memorandums ofagreement (MOAs) or mutual aid agreements (MAAs).

1-1 Enclosure (1)

MCO 6220.1

NOV 0 6 2009

3.3. Situation. Describe the most probable conditions forimplementing this plan. Identify other plans that are likely tobe implemented concurrently with this plan.

3.3.1. Threat. Identify the biological threat to theinstallation. Consider enemy and terrorist use of biologicalagents as well as naturally occurring disease outbreaks.

3.3.2. Key Assumptions. Outline major planning assumptionsused in DCP development.

3.4. Mission. Outline the basic purpose of the plan. Includethe mission of the installation. Address the likelihood andcircumstances that may require the installation to continueoperations during a biological attack or disease outbreak. Ifassigned, attached, or transitioning forces must sustain missionoperations, address impacts to the plan.

3.5. Execution. Identify the authority to execute the plan andthe general process for implementation. Highlight the majortasks each installation organization and/or functional communitymust perform to carry out the plan.

3.5.1. Phasinq Structure. Identify distinct transition pointsin the plan where significant changes occur (e.g., threat, leadorganization, level of effort). Include information as to howtransitions will take place, to include reporting requirements.

3.5.2. Limiting Factors (LIMFACs). Identify factors that maysignificantly impact execution of the plan. Specify how oftenLIMFACs will be reviewed and updated.

3.6. Administration and Logistics. Identify how keyinstallation organizations are to be supported and what supportthey must provide for themselves, or to others. In generalterms, outline the sources for equipment and supplies requiredfor plan execution and sustainment. Address organic resources,those available via MOAs/MAAs, and those available via othermeans (e.g., Time Phase Force Deployment Data (TPFDD)).Additionally, identify local support conditions that adverselyaffect plan implementation. Resources required for planexecution but not currently available should be identified asLIMFACs.

3.7. Command and Control (C2). Identify command relationshipsboth internal and external to the installation. Listinstallation control centers used in the plan along with theindividual or organization responsible for their operation.Outline the succession of command and provisions for continuity

1-2 Enclosure (1)

MCO 6220.1

NOV- 0 6 2009

of command. Include provisions for C2 of supporting forces andorganizations. Outline methods of communications to be used.

4. Annexes. The DCP will include, at a minimum, the followingannexes. Installation planners may add additional annexes asrequired. Where applicable, annexes may reference otherinstallation plans (e.g., installation security plan, medicalcontingency response plan) rather than restate the information.

4.1. Detection, Sampling and Identification of BiologicalAgents

4.1.1. Identify detection, sampling and identificationresources available on the installation as well as resourcesassumed to be available through MOA/MAAs. Identifyvulnerabilities in the detection and identification capabilitiesbased on the installation specific threat. Suggested areas offocus include:

4.1.2. Create procedures for the revision of detectoroperations mode and sampling tempo lAW the force protectioncondition, trigger event, or outbreak.

4.1.3. Create threat-specific environmental sampling plan.

4.1.4. Create threat-specific water surveillance and testingplan.

4.1.5. Create threat-specific food surveillance and testingplan.

4.1.6. Identify laboratories (national, reference, and sentinel)available for presumptive and confirmatory analysis. Outlinetheir capabilities and limitations. Include documentationrequirements for identified labs, and the anticipated timelinebetween installation submission of samplers) and receipt ofresults.

4.2. Medical Surveillance

4.2.1. Outline installation medical surveillance procedures.

4.2.2. Include generic templates for use during contact tracingand epidemiological investigations that address specificsymptoms/diseases.

4.2.3. Specify team composition for contact tracing andepidemiological investigation teams.

1-3 Enclosure (1)

MCO 6220.1

NOV 0 6 2009

4.2.4. Identify training requirements for non-Public Healthpersonnel assisting with rapid contact tracing andepidemiological investigation teams.

4.2.5. Outline procedures for conduct of epidemiologicalinvestigations.

4.2.6. Outline the self-monitoring plan for installationpersonnel. Consider required supplies, educational materials orother types of aid necessary for personnel self-monitoring todetermine onset of symptoms and guidance on when and how to use.

4.2.7. Outline medical surveillance capabilities of locallaboratories and hospitals.

4.2.8. Outline procedures and limitations on providing and/orrequesting information from the local medical communities.

4.3. Medical Intervention and Treatment

4.3.1. Identify the planning factors to estimate·the number ofinstallation personnel requiring medical intervention and/ortreatment in the event of a biological incident.

4.3.2. Describe the installation vaccination and prophylaxesdistribution and administration plan. Include requiredstockpiles for vaccines and prophylaxes. Consider follow-onmonitoring of the effects to personnel after administration.

4.3.3. Identify PPE requirements for healthcare providers andpatients in medical treatment facilities.

4.3.4. Address the update of immunization records.

4.3.5. Plan for behavioral casualty triage and management.

4.3.6. Outline the biological triage plan.

4.4. Individual and Collective Protection

4.4.1. Address Individual Protective Equipment (IPE) andPersonal Protective Equipment (PPE) requirements and thedistribution plan for installation population. Consider uniquerequirements for forces transiting the installation (TPFDD)

4.4.2. Specify collective or shelter-in-place protectionmeasures applicable to the biological threat(s).

1-4 Enclosure (1)

MCO 6220.1NOV 0 6 2009

4.4.3. Identify tasked organizations to support shelteroperations, to include roles and responsibilities, resourcesrequired, etc.

4.5. Security

4.5.1. Identify the steps to enhance perimeter surveillance inresponse to biological intelligence warning or actual event.

4.5.2. Outline contacts and procedures for conduct ofinvestigation if outbreak is suspected to be the result of aterrorist attack. Address chain of custody requirements.

4.5.3. Identify procedures to collaborate with local lawenforcement/military authorities.

4.5.4. Consider possible FPCON adjustments based on biologicalthreats or events.

4.5.5.control

Identify the procedures that will be used to secure andaccess into and out of quarantine/isolation facilities.

4.5.6. Specify the procedures that will be used to providesecurity for transfer of laboratory samples/specimens.

4.5.7. Describe the steps to conduct an installation water andfood vulnerability assessment. Develop associated plan for theprotection of installation food and water supplies.

4.5.8. Outline rules for the use of force for enforcement ofsecurity requirements during response to biological incidents.

4.6. Logistics and Supply

4.6.1. Outline the steps taken to ensure availability ofsupplies and laboratory test kits for performing epidemiologicalinvestigations.

4.6.2. Identify logistic requirements necessary to support eachphase of a biological response and identify sources available tosupport taskings.

4.6.3. Outline procedures for the expeditious access to theStrategic National Stockpile (SNS) or War Reserve Materiel (WRM)supplies.

4.7. Decontamination

4.7.1. Provide decontamination capabilities and recommendationsbased on threat biological agents.

1-5 Enclosure (1)

MCO 6220.1NOV 0 6 2009

4.7.2. Identify contamination avoidance and contaminationcontrol measures available to reduce the requirement fordecontamination.

4.7.3. Identify resources required to execute decontaminationactivities. Address decontamination requirements for patients,medical personnel, responders, mission equipment, and facilities.

4.7.4. Outline contamination control procedures,for the MTF andall identified quarantine/isolation facilities.

4.8. Restriction of Movement

4.8.1. General

4.8.1.1. Identify anticipated installation-specific applicationof ROM (i.e., use of facilities for quarantine and isolationoperations, lock down the installation and allow individuals tomove freely within the fence, sector the installation and limitmovement between sectors, etc.).

4.8.1.2. Identify roles and responsibilities for implementingand maintaining ROM.

4.8.2. Quarantine and Isolation

4.8.2.1. Identify facilities for use in quarantine andisolation operations. Identify additional resources requiredonce quarantine/isolation is initiated. Include procedures forinitiating quarantine/isolation operations.

4.8.2.2. Identify the steps to provide monitoring, medicine andmedical care to personnel in isolation.

4.8.2.3. Identify the steps to provide monitoring, medicine andmedical care to personnel in quarantine.

4.8.2.4. Outline a working quarantine plan for use when missionoperations must continue. Address the active monitoring ofpersonnel in working quarantine.

4.8.2.5. Identify IPE/PPE requirements for occupants ofquarantine/isolation facilities.

4.8.2.6. Identify appropriate infection control measures withinisolation facilities (Standard Precautions, Airborne Precautions,Contact Precautions, Droplet Precautions), Ref: CDCRecommendations for Isolation Precautions in Hospitals.

1-6 Enclosure (1)

MCO 6220.1NOV 0 6 2009

4.8.2.7. Describe the procedures to distribute basic needsmaterials and services during quarantine and/or isolation.Address food and water needs (consider unique nutritionalrequirements for ill personnel), shelter needs, social needs,religious requirements, and sanitary needs to include laundry,bathing, and waste management requirements. Consider specialrequirements for contaminated laundry and waste.

4.8.2.8. Describe the plan to secure and control access intoand out of quarantine/isolation facilities.

4.8.3. Other

4.8.3.1. Outline the steps required for dispersion of missionessential personnel to alternate housing facilities/shelters.

4.8.3.2. Describe the procedure to implement social distancingmeasures to reduce risk of person-to-person transmission ofdisease (e.g., minimize personal contact with others).

4.8.3.3. Describe the process to limit ingress and/or egress tothe installation or limit access to certain sectors of theinstallation. Consider who will be permitted access to andfrom the installation or sector.

4.8.3.4. Identify non-essential installation facilities such asschools, commissary, exchange, gymnasiums, and movie theaters.Prioritize these facilities for closure or transition toquarantine/isolation facilities.

4.9. Emergency Communications. Both the medical community andpublic affairs have responsibilities in communicating biologicalwarfare information to select audiences on an ongoing basis andduring a biological crisis. Include both medical community andpublic affairs products in this attachment describing, at aminimum:

4.9.1. Medical Community Emergency Communications. Note:Medical community will coordinate emergency communications plansand procedures with installation functional experts, as required.

4.9.1.1. Preparation and Pre-Event Communications

4.9.1.1.1. Include plan to produce, coordinate, and disseminatematerials to inform installation population on biologicalthreats, possible mitigation actions, and recommended readinessactivities. Consider the following information:

4.9.1.1.1.1. Overview of medical support available in the eventof a biological incident. Items to address include mass

1-7 Enclosure (1)

MCO 6220.1NOV 0 6 2009

prophylaxis, triage, and referral for specialty care throughTRICARE resources, clinic capabilities, and support from localcommunity medical facilities.

4.9.1.1.1.2. Creation of flyers, trifolds, website information,posters, and Command information materials that describe thehealth effects of biological weapons and agents and medicalmeasures to mitigate risk.

4.9.1.1.1.3. Medical facility contact information and reportingprocedures.

4.9.1.1.1.4. Biological-unique medical precautions that mayoccur including possible decontamination stations, quarantine,isolation, and restriction of movement options.

4.9.1.1.1.5. The need for all personnel and families to remaincalm post-event and to not panic. Medical personnel will expandservices on base to meet requirements. The Medical Community ishere to serve and support them.

4.9.1.1.1.6. Psychological information regarding individuals'stress-related responses to biological incidents to include whatpeople should expect and best practice recommendations formitigation.

4.9.1.1.1.7. Importance of self-monitoring procedures during abiological incident.

4.9.1.1.2. Establish a telecommunications plan for hotlines andother services (Ref CDC SARS Appendix D5) .

4.9.1.1.3. Coordinate with public affairs to ensure medicalaccuracy of counter-biological risk communications materials.

4.9.1.1.4. Support installation Unit Commander's Calls, asrequired, to provide general information on biological threatsand anticipated installation response.

4.9.1.1.5. Create and maintain emergency notification rostersfor appropriate national, state, and local medical agencies(FEMA, CDC, host nation, USAMRIID, local hospitals, etc.).

4.9.1.2. Trans-Event Communications

4.9.1.2.1. Outline plan to keep installation populationinformed throughout the biological event(s). Address:

4.9.1.2.1.1. Biological agent of interest with associatedsymptoms, persons at risk, health impacts, and suggested actions.

1-8 Enclosure (1)

Mca 6220.1

NOV 0 6 2009

4.9.1.2.1.2. Expected incident/outbreak duration.

4.9.1.2.1.3. Expected length of stay for quarantined/isolatedpersonnel.

4.9.1.2.1.4. Disease containment principles and procedures.

4.9.1.2.1.5. Appropriate protective equipment and medical selftreatments options.

4.9.1.2.1.6. Mass prophylaxis plan execution.

4.9.1.2.1.7. Triage plan.

4.9.1.2.2. Include procedures to notify personnel subject toquarantine and/or isolation.

4.9.1.2.3. Include procedures to notify families of thosesubject to quarantine and/or isolation.

4.9.1.2.4. Include procedures for the expeditious contact andnotification of installation personnel. Consider the nonmilitary base population (visitors, civilians, dependents, hostnationals) .

4.9.1.2.5. Address unique communications requirements forforces transitioning through the installation.

4.9.1.2.6. Identify numbers and specialties of medicalpersonnel required to support the installation public affairseffort.

4.9.1.2.7. Include procedures to coordinate with public affairsto ensure accuracy of medical information in risk communications.

4.9.2. Public Affairs Emergency Communications. Attach thepublic affairs C-BW Risk Communication Plan that includes, at aminimum:

4.9.2.1. Preparation and Pre-Event Communications

4.9.2.1.1. Address requirements and procedures to educate PApersonnel on crisis communications fundamentals for biologicalemergencies.

4.9.2.1.2. Identify activities, with associated themes andmessages, to build installation and community confidence thatthe installation is prepared for a biological attack ornaturally occurring disease outbreak. Consider:

1-9 Enclosure (1)

MCO 6220.1NOV 0 6 2009

4.9.2.1.2.1. Media engagement activities.

4.9.2.1.2.2. Public briefings.

4.9.2.1.2.3. Installation newspaper articles.

4.9.2.1.2.4. Commander's calls.

4.9.2.1.3. Establish a telecommunications plan for hotlines andother services.

4.9.2.2. Trans-Event Communications

4.9.2.2.1. Include emergencytemplates/notices that can bethe specifics of the crisis.

4.9.2.2.1.1. Press releases.

public affairstailored basedConsider:

biologicalon key audience and

4.9.2.2.1.2. Command Information products.

4.9.2.2.1.3. Public Service announcements.

4.9.2.2.1.4. Web content.

4.9.2.2.2. Outline procedures to coordinate information withinstallation medical experts to ensure accuracy of information.

4.9.2.2.3. Outline procedures to track public requests forinformation.

4.9.2.2.4. Include procedures for the stand up and sustainmentof the Public Affairs Operations Center to support a biologicalcrisis. Address number and expertise requirements for staffing.

4.9.2.2.5. Include installation procedures for public releaseof information during a biological event. Address expectedmedia queries and releasable information. Consider:

4.9.2.2.5.1. Information regarding the cause of the event.

4.9.2.2.5.2. Actions the installations is undertaking inresponse.

4.9.2.2.5.3. Numbers of personnel affected.

4.9.2.2.5.4. Potential impact to the local community.

4.9.2.2.5.5. Recommended actions to mitigate the threat andreduce risk.

1-10 Enclosure (1)

Mca 6220.1NOV 0 6 2009

4.9.2.2.6. Include procedures for the stand up and sustainmentof the installation Public Affairs Center to support abiological crisis. Address numbers and expertise requirementsfor staffing. Address plan to inform affected population thatthe center is operational.

4.9.2.2.6.1. Include procedures to initiate the ServicesHotline. Address information content for dissemination during abiological incident.

4.9.2.2.6.2. Provide talking points to Services spokespeople asnecessary.

4.9.2.2.6.3. Refresh installation leadership on biological RiskCommunication procedures.

4.10. Transportation Support

4.10.1. Describe the plan for the transport of samples/specimens to appropriate laboratories for presumptive andconfirmatory identification (Ref. CDC, Laboratory Network forBiological Terrorism). Include personnel protection andtransportation security requirements. Address anticipatedtimeline requirements. Address laboratory documentation andhandling requirements.

4.10.2. Address the transport of those subject toquarantine/isolation, medical personnel providing care, securitypersonnel, and resupply requirements. Consider specialrequirements for the transport of exposed, symptomatic, andcontagious personnel.

4.10.3. Describe procedures for the transport of contaminatedwaste.

4.10.4. Identify transportation requirements associated withcontamination avoidance and decontamination activities.

4.11. Mortuary Affairs

4.11.1. Describe procedures for handling remains that wereexposed to biological agents or contamination. Addresspotential requirements to inter biologically contaminated bodiesusing proper handling procedures.

4.11.2.such as

Identify agencies tasked to support mortuary affairschaplain, legal, etc.

4.12. Reporting Requirements.procedures for the reporting of

Identify requirements andbiological events. Consider

1-11 Enclosure (1)

MCO 6220.1NOV 0 6 2009

development of pre-formatted or pre-addressed messages forOPREP-3 and NBC Warning and Reporting System (NBCWRS). Considerdeveloping templates with agent-specific information for warningand notification messages in advance of an actual event. At aminimum, address:

4.12.1. Higher headquarters.

4.12.2. Lateral units.

4.12.3. Local public health officials.

4.13. Mental Health

4.13.1. Describe procedures to identify and manage individualswho are behavioral casualties.

4.13.2. Identify the process to provide assistance to mitigatethe psychological impact of quarantine / isolation onindividuals.

4.14. Legal Considerations

4.14.1. Address legal requirements for placing personnel inquarantine/isolation. Consider all installation population toinclude civilians, dependents, and visitors on the base.

4.14.2. Identify areas of the plan that require or recommendlegal be involved in decision making or plan execution. Includethings such as treatment of civilian casualties, notification todifferent populations, etc.

4.15. Personnel Augmentation

4.15.1. Identify pool of medical augmentees (consider: vaccinesupport, contact tracing, active monitoring of quarantine,isolation support).

4.15.2. Identify pool of security augmentees (consider:enforcement of quarantine and/or isolation, installationsecurity) .

4.15.3. Develop procedures to request augmentation through DoDor local, state, or federal agencies, as necessary.

5, Disease Specific Annexes. Identify disease-specificrequirements based on unique characteristics of specificdiseases, such as contagiousness and infectivity.

1-12 Enclosure (1)

MCO 6220.1

NOV 0 6 2009

5.1. Pandemic Influenza. This Annex should provide detailedprocedures, information and guidance to prepare for and respondto Pandemic Influenza (PI). Develop this Annex lAW CONPLAN 3551,applicable COCOM/Service Component supporting PI plans, andother applicable HHQ guidance. Reference items in the base IPBB,where applicable. The PI Annex must undergo periodic updates,as required, to maintain synchronization with CONPLAN 3551,applicable AOR plans, and other HHQ policy and guidance. Whenavailable, lessons learned from exercises and real-world events,should be incorporated into the plan.

5.1.1. References. List applicable PI-specific referencesrequired for the planning and execution of installation PIresponse.

5.1.2. Situation

5.1.2.1. Threat.

5.1.2.1.1.backgroundplans.

Background on Pandemic Influenza. Includeinformation from CONPLAN 3551 and applicable AOR

5.1.2.1.2. Potential Impact of a PIon the DOD. Include impactinformation from CONPLAN 3551 and applicable AOR plans.

5.1.2.1.3. Potential Impact of a PIon Service Forces in theAOR. Include impact information as identified in applicableCOCOM and Service Component CONPLANs.

5.1.2.1.4. Potential Impact of a PIon the Installation.Identify the possible impacts to the military installation basedon location, population, mission, and infrastructure. Considerhow the impact might change based on differing pandemicseverities.

5.1.2.2. Key Assumptions. Outline major planning assumptionsused in installation PI preparedness.

5.1.2.2.1. Include all assumptions from DOD CONPLAN 3551.

5.1.2.2.2. Include any additional assumptions from theapplicable COCOM PI CONPLAN.

5.1.2.2.3. Include any additional assumptions from theapplicable Service Component supporting plan.

5.1.2.2.4. Installation-level planning factors. Identifyspecific planning factors, taken from key assumptions and HHQ

1-13 Enclosure (1)

MCO 6220.1NOV 0 6 Z009

guidance, that were used in developing the installation PI plan.The following will be included as a minimum:

5.1.2.2.4.1.PI outbreak.minimum of 90

5.1.2.2.4.2.ill.

5.1.2.2.4.3.

The installation will be faced with two waves ofEach wave will last 12 weeks. There will be adays between waves.

30% of the installation key population will become

40% of the installation will be absent from work.

5.1.2.2.4.4. 50% of the ill will seek treatment.

5.1.2.2.4.5. 3% of the ill will require hospitalization.

5.1.2.2.4.6. 1% of the ill will die.

5.1.2.2.4.7. The incubation period for PI (time from when anindividual is exposed to when he begins to show symptoms) is 48hours. Infected adults can shed virus (infect others) 24 hoursbefore they become symptomatic. Infected adults remaincontagious for 5 days.

5.1.2.2.4.8. Infected children (age x and below) can shed virusxx hours before they become symptomatic. Infected childrenremain contagious for xx days.

5.1.3. Mission. Outline the purpose and goals of installationPI preparedness and response. Ensure the mission issynchronized with the DOD Global PI CONPLAN and applicableCOCOM/Service Component PI plans.

5.1.4. Execution

5.1.4.1. Concept of Operations.methodology the installation willrespond to a PI outbreak.

Describe the generalfollow to prepare for and

5.1.4.1.1. Commander's Intent. The commander's intent is abroad vision, stated succinctly of how the commander intends toconduct the operation. Must state Purpose, Method and desiredEnd State.

5.1.4.1.1.1. Purpose. Outline the "why" of the installation PIplan.

5.1.4.1.1.2.installationplan.

Method. Outline, in general terms, how thecommander visualizes achieving success with the PI

1-14 Enclosure (1)

MCO 6220.1

NOV 0 6 2009

5.1.4.1.1.3. End State. Outline the expected outcomeenvironment for the installation based on successful executionof the PI plan.

5.1.4.1.1.4. Objectives. Describe the overarching objectivesguiding the development and implementation of the installationPI plan.

5.1.4.1.1.5. Priority Effects List. Outline the identifiedpriority effects to achieve the installation objectives. At aminimum, the following priority effects will be included:

5.1.4.1.1.5.1. Effect 1. Virus does not impair key population.The PI virus does not adversely impact active duty militarypersonnel and their dependents, DOD civilians, mission essentialcontractors, and DOD beneficiaries such that overallinstallation readiness falls below established thresholds.Factors influencing absenteeism in a PI environment includemember illness, concern for families, and worried well. Ofparticular concern is loss of special skill sets required tosustain critical installation missions. An included nestedeffect requires prioritization of installation key populationfor Force Health Protection measures to ensure the virus doesnot impair the operational readiness of units.

5.1.4.1.1.5.2. Effect 2. Virus does not preclude execution ofcritical installation missions. The PI virus does not degradeinstallation critical capabilities beyond that required formission accomplishment. Forces are adequate in number,sufficiently healthy, and possess the requisite training/skillsets to perform all assigned critical missions.

5.1.4.1.1.5.3. Effect 3. Virus does not negate installationcritical capabilities or supporting infrastructure. The PIvirus does not degrade installation critical capabilities andsupporting infrastructure enough to prevent installation forcesfrom being deployable, sustainable, and available to protect thenation's vital interests, as directed. Installation criticalcapabilities and supporting infrastructures are not degradedenough to compromise mission assurance or mission execution.Critical capabilities are mission dependent. Degradation doesnot prevent expedient reconstitution of installation assets.

5.1.4.1.1.5.4. Effect 4. Installation, HHQ, state, tribal, andlocal partners synchronize planning, response, andcommunications. In support of the DOD objectives, theinstallation synchronizes its efforts with HHQ, state, tribal,and local partners in mitigating the impact of the PI virus.Installation response measures, taken in concert with the local

1-15 Enclosure (1)

MCO 6220.1

NOV 0 6 2009

community, will aggressively protect the key population and gaintime for implementation of additional measures. Theinstallation will harmonize its strategic and riskcommunications with HHQ. The installation maintains freedom ofaction to conduct assigned critical missions.

5.1.4.2. Phasing Structure. Identify the various phasingstructures that affect installation PI preparedness and response.

5.1.4.2.1. World Health Organization (WHO) Phases.

5.1.4.2.2. U. S. Government (USG) Stages.

5.1.4.2.3. DOD Phases.

5.1.4.2.3.1. Phase 0 - Shape Phase. Include a description ofPhase o.

5.1.4.2.3.1.1. Commander's Intent

5.1.4.2.3.1.2. SECDEF Intent. Include SECDEF's intent forPhase 0 from CONPLAN 3551.

5.1.4.2.3.1.3. Combatant Commander's Intent. Includecommander's intent for Phase 0 from applicable COCOM PI CONPLAN.

5.1.4.2.3.1.4. Service Component Commander's Intent.commander's intent for Phase 0 from applicable ServicePI supporting plan.

IncludeComponent

5.1.4.2.3.1.5. Installation Commander's Intent. Includeinstallation commander's intent for Phase o.

5.1.4.2.3.2. Timing. Describe when this phase will occur andhow the installation will determine the need to be in this phase.Include guidance on what drives a change from Phase 0 to Phase 1.

5.1.4.2.3.3. Phase Objective and Desired Effects. Includeinformation from HHQ plans, as required. Outline installationobjectives and desired effects for Phase o.

5.1.4.2.3.4. Execution. Insert applicable execution summaryinformation from HHQ plans. Supplement, as required, to includeinstallation-specific information.

5.1.4.2.3.5. Key Tasks. Identify key installation tasks forPhase o. Consider identifying an OPR for each task andreference section of the installation plan that outlines thedetails for task accomplishment. Based on HHQ guidance, the

1-16 Enclosure (1)

MCO 6220.1

NOV 0 6 2009

following tasks will be included as a minimum. Supplement asrequired based on AOR plans and installation commander guidance.

5.1.4.2.3.5.1.minimum) Public10-2603.

Identify and train a primary and alternate (at aHealth Emergency Officer in accordance with AFI

5.1.4.2.3.5.2. Establish/maintain communications with local,state, federal/host nation, military and public healthofficials/providers and other agencies/organizations asappropriate.

5.1.4.2.3.5.3. Conduct routine health surveillance to enhancesituational awareness (e.g., determine baseline and normalperturbations) .

5.1.4.2.3.5.4. Model, develop, review and evaluate installationforce health protection plans and. community mitigation measures(including isolation, quarantine, protective sequestration,social distancing, restriction of movement, directly observedtherapy protocols for antiviral medications and riskcommunication) .

5.1.4.2.3.5.5. Identify installation requirements for essentialsupplies and personnel.

5.1.4.2.3.5.6.installation PI

Review legal/policy issues relating toresponse.

5.1.4.2.3.5.7. Conduct Emergency Medical Services (EMS)/firstresponder coordination and planning.

5.1.4.2.3.5.8. Perform screening and testing for influenza andother respiratory pathogens.

5.1.4.2.3.5.9. Incorporate veterinary assets with thesurveillance and response activities associated with avianoutbreaks, as applicable.

5.1.4.2.3.5.10. Identify any PI-unique modifications requiredfor the installation incident command and response structure.

5.1.4.2.4. Phase 1 - Prevent Phase.Phase 1.

5.1.4.2.4.1. Commander's Intent

Include a description of

5.1.4.2.4.1.1. SECDEF Intent.Phase 1 from CONPLAN 3551.

Include SECDEF's intent for

1-17 Enclosure (1)

MCO 6220.1

NOV 0 6 2009



IncludeCOlUponent

5.1.4.2.4.1.4. Installation Commander's Intent.installation commander's intent for Phase 1.

Include

5.1.4.2.4.2. Timing. Describe when this phase will occur andhow the installation will determine the need to be in this phase.Include guidance on what drives a change from Phase 1 to asubsequent phase (0 or 2) .

5.1.4.2.4.3. Phase Objective and Desired Effects. Includeinformation from HHQ plans, as required. Outline installationobjectives and desired effects for Phase 1.


5.1.4.2.4.5. Key Tasks. Identify key installation tasks forPhase 1. Consider identifying an OPR for each task andreference section of the installation plan that outlines thedetails for task accomplishment. Based on HHQ guidance, thefollowing tasks will be included as a minimum (in addition toapplicable Phase 0 key tasks). Supplement as required based onAOR plans and installation commander guidance.

5.1.4.2.4.5.1. Refine, expand, evaluate and exercise existingPI plans, guidance and programs, to include force healthprotection (FHP) measures, to evaluate and identify personalprotective equipment (PPE) requirements, targeted layeredcontainment/community mitigation strategies, potentiallogistical gaps/excesses and potential disconnects within andamong the installation, HHQ, and state, tribal, and localpartners.

5.1.4.2.4.5.2. Acquire, maintain and rotate sufficient suppliesand material needed to maintain a healthy force (i.e. food,potable water, fuel, etc.) during a pandemic.

5.1.4.2.4.5.3. Assess availability of installation vaccines,antivirals, antibiotics, supplies and equipment and reportshortfalls/gaps to HHQ.

1-18 Enclosure (1)

MCO 6220.1NOV 0 6 Z009

5.1.4.2.4.5.4. Identify/report number of personnel in each DODantiviral/vaccine prioritized tier group to higher headquartersin order to establish requirements for anti-virals/vaccines.

5.1.4.2.4.5.5. Hold PI-related educational and informationalsessions for health/medical and other response personnel.

5.1.4.2.4.5.6. Develop plans and procedures for receipt,transport, storage, security and distribution of PPE, prepandemic vaccines, vaccines (when available), anti-virals,antibiotics, supplies and equipment.

5.1.4.2.4.5.7. Conduct daily public health surveillance andcommunications/reporting routines, to include monitoring ofsuspected human-to-human transmission cases, as applicable.

5.1.4.2.4.5.8. Develop and conduct limited awarenessinformation/education targeting base populace.

5.1.4.2.4.5.9. Identify alternate medical treatment facilities

5.1.4.2.4.5.10. Identify quarantine facilities.

5.1.4.2.4.5.11. Verify and test surveillance reporting networksand procedures and confirm/update points of contact.

5.1.4.2.5. Phase 2 - Contain Phase.Phase 2.






5.1.4.2.5.1.3. Service Component Commander's Intent.comm~nder's intent for Phase 2 from applicable ServicePI supporting plan.

IncludeComponent

5.1.4.2.5.1.4. Installation Commander's Intent.installation commander's intent for Phase 2.

Include

5.1.4.2.5.2. Timing. Describe when this phase will occur andhow the installation will determine the need to be in this phase.Include guidance on what drives a change from Phase 2 to asubsequent phase (1 or 3).

1-19 Enclosure (1)

MCO 6220.1

NOV 0 6 2009



5.1.4.2.5.5. Key Tasks. Identify key installation tasks forPhase 2. Consider identifying an OPR for each task andreference section of the installation plan that outlines thedetails for task accomplishment. Based on HHQ guidance, thefollowing tasks will be included as a minimum (in addition toapplicable key tasks from earlier phases). Supplement asrequired based on AOR plans and installation commander guidance.

5.1.4.2.5.5.1. Prepare to receive DOD established stockpiles.Ensure adequate security to prevent loss or pilferage

5.1.4.2.5.5.2. Prepare to provide mass immunization and carefor potentially large numbers of patients.

5.1.4.2.5.5.3. Prepare to implement targeted layeredcontainment and community mitigation measures to includepossible quarantine when directed.

5.1.4.2.5.5.4.the geographicas applicable.

Prepare to screen DOD dependents from outside ofPI-containment area engaged in early return to US,

5.1.4.2.5.5.5. Screen personnel leaving affected region, asapplicable. Develop and implement isolation and quarantinestrategy options for screened personnel.

5.1.4.2.5.5.6. Enhance/expand ongoing public healthsurveillance and communications/reporting routines, to includemonitoring of suspected human-to-human transmission cases.

5.1.4.2.5.5.7. Develop, plan, and test processes to deliveressential goods to personnel assigned to home care or quarantine.

5.1.4.2.5.5.8. Begin inventory of essential supplies to includemedical, food, water and infection control material.

5.1.4.2.5.5.9. Issue public information notices to continue andexpand public education.

5.1.4.2.5.5.10. Develop and establish volunteer networks.Include planning for training, security access, andcommunications with volunteers.

1-20 Enclosure (1)

MCO 6220.1

NOV 0 6 2009

5.1.4.2.5.5.11. Develop and provide mandatory country specificForce Health Protection (FHP) briefs and evaluate need to issuePPE and anti-virals to forces deploying to high risk locationscurrently in Phase 3 or Phase 4.

5.1.4.2.5.5.12.forces returningappropriate.

Conduct redeployment medical screening of allfrom Phase 3 or Phase 4 afflicted areas as

5.1.4.2.5.5.13. Establish installation coordination and crisisresponse structures. Ensure coordination with state, tribal,and local partners.

5.1.4.2.5.5.14. Continue issuing public information notices andconduct public education on plans and individual/familypreparedness and response.

5.1.4.2.5.5.15. Plan for alternate service delivery strategiesand activities for children and youth for periods when socialdistancing measures are enacted (e.g., on-line, telephone, ordrive thru book or movie check-out, PPE and handwashing/sanitizing capabilities at movie theaters, arcades,shopping facilities, etc.).

5.1.4.2.5.5.16. Register requirements through medical supplychain/TLAMMs for projected vaccines, antivirals, antibiotics,supplies and equipment.

5.1.4.2.5.5.17. Exercise and coordinate with TLAMMs to validateprocedures for receipt, transport, storage/management, securityand distribution of PPE, anti-virals, antibiotics and vaccines.

5.1.4.2.5.5.18. Verify/report changes in the number ofpersonnel in each DOD antiviral/vaccine prioritized tier groupto higher headquarters in order to establish requirements foranti-virals/vaccines.

5.1.4.2.5.5.19. Train appropriate personnel on the use of ofJPTA and JMeWs, as applicable.

5.1.4.2.5.5.20. Develop/promulgate guidance to protectinstallation mortuary affairs personnel.

5.1.4.2.6. Phase 3 - Interdict Phase.Phase 3.




1-21 Enclosure (1)

MCO 6220.1

NOV 0 6 2009



IncludeComponent

5.1.4.2.6.1.4. Installation Commander's Intent. Includeinstallation commander's intent for Phase 3.




5.1.4.2.6.5. Key Tasks. Identify key installation tasks forPhase 3. Consider identifying an OPR for each task andreference section of the installation plan that outlines thedetails for task accomplishment. Based on HHQ guidance, thefollowing tasks will be included as a minimum (in addition toapplicable key tasks from earlier phases). Supplement asrequired based on AOR plans and installation commander guidance.

5.1.4.2.6.5.1. Provide comprehensive exposure surveillance forall forces deploying in support of operations or conductingconsequence management at home installations. Exposuresurveillance will be employed to conduct retrospective analysisin order to improve the FHP of future operations,prepare/protect potentially unimpacted areas, and supportfollow-up medical care to previously deployed forces.

5.1.4.2.6.5.2. Conduct an initial occupational andenvironmental health assessment. The initial assessment shouldidentify additional Occupation/Environmental Health and Safety(OEHS) requirements, if required.

5.1.4.2.6.5.3. Be prepared to modify installation responsebased on declaration of outbreak severity lAW the pandemicseverity index (PSI).

1-22 Enclosure (1)

MCO 6220.1

NOV 0 6 2009

5.1.4.2.6.5.4. Conduct screening of installation personnel, toinclude transiting forces. Direct isolation and/or quarantineof personnel, as required.

5.1.4.2.6.5.5. Implement appropriate installation targetedlayered containment measures.

5.1.4.2.6.5.6. Consider implementation of COOP based ongeographic threat.

5.1.4.2.6.5.7. Stand-up the installation Emergency OperationsCenter to enhance installation situational awareness and monitorPI preparations.'

5.1.4.2.6.5.8. Implement installation specific self-reportingprocedures.

5.1.4.2.6.5.9. Implement medical screening for all forcesreturning from countries suspected of human-to-humantransmission, to include obtaining contact history andconducting febrile screening.

5.1.4.2.6.5.10. Finalize and review installation guidance/SOPsfor implementation of social distancing measures, isolation andquarantine.

5.1.4.2.6.5.11. Identify and train the personnel required tostaff a MTF 24-hour hotline.

5.1.4.2.6.5.12. Complete inventories and mobilization ofmedical supplies, food, water and infection control supplies (tosupport in-hospital care, alternate care, isolation andquarantine facilities).

5.1.4.2.6.5.13. BPT to implement procedures for receipt,transport storage/management, security and distribution of PPE,vaccines (when available), antivirals, antibiotics, supplies andequipment.

5.1.4.2.6.5.14. Increase liaison between installation and localPublic Health (PH), law enforcement, hospital response, senior.military leaders (GCC, Service, Installation Commanders) andlocal civilian political leaders.

5.1.4.2.6.5.15. Integrate information available to identifypersonnel & families that require support for home care.

5.1.4.2.6.5.16. Review and BPT to implement social distancingmeasures in coordination with local authorities (e.g., closinginstallation theaterS, bowling alleys & other non-essential

1-23 Enclosure (1)

MCO 6220.1

NOV 0 6 2009

services, providing drive thru prescription/medical materieloptions, library and school closures, etc.).

5.1.4.2.6.5.17. Provide education material to base populace onpublic health measures related to both seasonal and pandemicinfluenza.

5.1.4.2.6.5.18. Prepare for GCC AOR-wide infection controlthrough education and notifications regarding measures affectingpublic transportation, air travel, and public gatherings.

5.1.4.2.6.5.19. BPT to issue personnel advisories and implementsocial distancing and nsheltering" concepts. This may includerestricting personnel from attending public gatherings such asreligious services, funerals, weddings, closing installationtheaters, bowling alleys & other non-essential services, andimplementing alternate work/school schedules. Continue publicinformation and education campaigns regarding value of selfimposed social distancing.

5.1.4.2.6.5.20. Validate final list of essential personnel;prepare and disseminate related notification documents.

5.1.4.2.6.5.21. Exercise notification of contact lists,including established unit/organization volunteer networks.

5.1.4.2.6.5.22. BPT implement new installation accessprocedures by use of DOD identification card scanners to limithuman-to human contact.

5.1.4.2.6.5.23. BPT activate select volunteer network chains tosupport deliveries of essential goods.

5.1.4.2.6.5.24. BPT issue PPE lAW CDC and HHQ guidance.

5.1.4.2.6.5.25. BPT implement daily MEDSITREPS/reporting upchain of command.

5.1.4.2.6.5.26. BPT implement use of JPTA and JMeWS.

5.1.4.2.7. Phase 4 - Stabilize Phase. Include a description ofPhase 4.




1-24 Enclosure (1)


MCO 6220.1

NOV () 6 2009

IncludeComponent



5.1.4.2.7.3. Phase Objective and Desired Effects.information from HHQ plans, as required. Outlineobjectives and desired effects for Phase 4.

Includeinstallation


5.1.4.2.7.5. Key Tasks. Identify key installation tasks forPhase 4. Consider identifying an aPR for each task andreference section of the installation plan that outlines thedetails for task accomplishment. Based on HHQ guidance, thefollowing tasks will be included as a minimum (in addition toapplicable key tasks from earlier phases). Supplement asrequired based on AOR plans and installation commander guidance.

5.1.4.2.7.5.1. For Pandemic Severity Index 2 or 3:

5.1.4.2.7.5.1.1. Declare installation public health emergency.

5.1.4.2.7.5.1.2. Initiate active surveillance for cases.

5.1.4.2.7.5.1.3. Continue to increase and expand publicinformation and education campaigns.

5.1.4.2.7.5.1.4. Prepare and notify of impending cancellation/suspension of non- essential events and services, or alternateavailability/access to essential goods and services.

5.1.4.2.7.5.1.5. Send out notifications to continue informingall concerned, including the public, regarding preparations andintent to implement increased social distancing measures.

5.1.4.2.7.5.1 .. Activate, as needed, operation of volunteernetworks to support operations.

1-25 Enclosure (1)

5.1.4.2.7.5.1.7.civilians livingreduce chance of

Mca 6220.1

NOV 0 6 2009

Implement travel restrictions and recommendon post voluntarily follow restrictions, toacquiring or spreading PI.

5.1.4.2.7.5.1.8. Direct social distancing on all forms of masstransit (limit seating to every other seat and wearing of PPE,lAW CDC and HHQ guidance) .

5.1.4.2.7.5.1.9. Limit military flights to/from regionsdesignated safe. Conduct preflight screening for febrilerespiratory illness including temperature and signs and symptomsof illness. Screen arriving and departing passengers. Requireinfection control during air travel.

5.1.4.2.7.5.1.10. Restrict installation personnel from usingCommercial Air Travel unless necessary to meet missionrequirements.

5.1.4.2.7.5.1.11. Limit private bus, ferry and other boattravel.

5.1.4.2.7.5.1.12. Direct social distancing for taxi use andminimize travel within cities, between cities/regions.

5.1.4.2.7.5.1.13. Implement Infection Control Measures.

5.1.4.2.7.5.1.14. Distribute masks, gloves, providetraining/fit testing lAW CDC and HHQ guidance.

5.1.4.2.7.5.1.15. Identify "clean" care facilities/locations.

5.1.4.2.7.5.1.16. Quarantine asymptomatic exposed individualsand BPT isolate and treat sick individuals.

5.1.4.2.7.5.1.17. Enforce general infection control measuresduring public transportation, air travel, and at publicgatherings and provide Individual hand washing & stations placedat public facilities. Utilize personal antimicrobial handsanitizers when soap and hot water hand washing facilities arenot accessible/available.

5.1.4.2.7.5.1.18. Conduct screening for personnel with symptomsat the entrance into key installation facilities.

5.1.4.2.7.5.1.19. Establish screening checkpoints atinstallation entry points.

5.1.4.2.7.5.1.20. Establish screening checkpoints at key areassuch as commissaries, dining facilities and essential public

1-26 Enclosure (1)

MCO 6220.1

NOV 0 6 2009

gatherings and random points at non essential areas such asshoppettes and exchanges.

5.1.4.2.7.5.1.21. Implement new installation access proceduresby use of DOD identification card scanners to limit human-tohuman contact.

5.1.4.2.7.5.1.22. Cancel all public gatherings on installationsto include but not limited to religious services, holidaycelebrations, sporting events, movies, and weddings.

5.1.4.2.7.5.1.23. BPT close public facilities (i.e. schools,day care centers, non essential gov/military activities). BPTimplement installation COOP plans. Implement alternate,key/essential work schedules and quarantine, as necessary.

5.1.4.2.7.5.1.24. BPT implement social distancing measures incommissaries and exchanges by limiting size of groups in thesefacilities.

5.1.4.2.7.5.1.25. Continue distribution of masks, gloves,thermometers etc. In accordance with CDC and HHQ guidance.Continue training/fit testing.

5.1.4.2.7.5.1.26. Continue operation of quarantine andisolation facilities and support home care requirements.

5.1.4.2.7.5.1.27. Maintain continuous wear of PPE by firstresponders and clinic/hospital personnel, lAW CDC and HHQguidance.

5.1.4.2.7.5.2. For Pandemic Severity Index 4 or 5:

5.1.4.2.7.5.2.1. Declare installation publ'ic health emergency.

5.1.4.2.7.5.2.2. Operate Emergency Operations Centercontinuously. Increase staffing to Crisis level manning.

5.1.4.2.7.5.2.3. Cancel/suspend all non essential events andservices.

5.1.4.2.7.5.2.4. Implement alternate strategies to provideessential goods and services (e.g., delivery, drive through,scheduled pick-up of pre-ordered goods, etc.) to ensure basiclife support of homebound personnel/families, isolation andquarantine facilities, alternate care locations, clinics andMTFs. Essential goods and services include food, water, basicmedical supplies (PPE, first aid supplies), prescriptiondrugs/pharmaceuticals (e.g., insulin, chemotherapy drugs,medical gases), and may include specialized public information

1-27 Enclosure (1)

MCO 6220.1

NOV 0 6 2009

notices for personnel with language, accessibility, or otherimpairments.

5.1.4.2.7.5.2.5.network.

Implement full activation of unit volunteer

5.1.4.2.7.5.2.6. Restrict Active Duty personnel from usingpublic transportation unless it's essential to meet missionrequirements.

5.1.4.2.7.5.2.7. Cancel non-essential regional private bus,ferry and other boat travel.

5.1.4.2.7.5.2.8.

5.1.4.2.7.5.2.9.thermometers etc.testing complete.

Limit Car Travel to Mission essential travel.

Complete distribution of masks, gloves,lAW CDC and HHQ guidance. Ensure training/fit

5.1.4.2.7.5.2.10. Provide daily public information/statusupdates using a variety of media and giving consideration tonon-English speaking groups and special needs population(elderly or immobile, blind, deaf and hard of hearing, etc.).

5.1.4.2.7.5.2.11. Deliver essential goods to isolation andquarantine locations, clinics and MTFs. These goods may includefood, water, basic medical supplies (ie, PPE, first aid supplies)

5.1.4.2.7.5.2.12.and HHQ guidance.

Distribute replacement stocks of PPE lAW CDCConduct training/fit testing as required.

5.1.4.2.7.5.2.13. Continue quarantine and isolation procedures.Ensure Enforcement on quarantine and isolation personnelassigned to these categories. BPT adjust guidelines forcommunity, work space or facility.

5.1.4.2.7.5.2.14. Monitor individuals in Transmission zone(s)Options include phone calls, home visits, via web/e-mail andvideo where possible.

5.1.4.2.8. Phase 5 - Recovery Phase.Phase 5.






1-28 Enclosure (1)


MCO 6220.1

NOV 0 6 2009

IncludeComponent


5.1.4.2.8.2. Timing. Describe when this phase will occur andhow the installation will determine the need to be in this phase.Include guidance on what drives a change from Phase 5 to aprevious phase (0 to 4) .

5.1.4.2.8.3. Phase Objective and Desired Effects.information from HHQ plans, as required. Outlineobjectives and desired effects for Phase 5.

Includeinstallation


5.1.4.2.8.5. Key Tasks. Identify key installation tasks forPhase 5. Consider identifying an aPR for each task andreference section of the.installation plan that outlines thedetails for task accomplishment. Based on HHQ guidance, thefollowing tasks will be included as a minimum (in addition toapplicable key tasks from earlier phases). Supplement asrequired based on AOR plans and installation commander guidance.

5.1.4.2.8.5.1. Expect gradual return to normal operation assituation dictates (1st wave of outbreak has passed) .

5.1.4.2.8.5.2. Evaluate effectiveness of FHP measures for usein future waves/pandemics

5.1.4.2.8.5.3. Assess feasibility of easing/reversing phasesback to normal FHP status/measures.

5.1.4.2.8.5.4. Ensure all personnel complete post-deploymentFHP requirements.

5.1.4.2.8.5.5. When feasible rescind public health emergencydeclaration.

5.1.4.2.8.5.6. Continue to monitor and assess for follow onwaves.

5.1.4.2.8.5.7. Stress the importance of good hygiene andinfection control to installation through education programs.

5.1.4.2.8.5.8. BPT to re-implement FHP measures as required.

1-29 Enclosure (1)

MCO 6220.1

NOV 0 6 2009

5.1.4.2.8.5.9. Document lessons learned and adjust installationlevel plans appropriately in anticipation of next wave ofpandemic.

5.1.4.2.8.5.10. Establish and publicize bereavement supportgroups, conduct public memorials, acknowledging installationlosses to pandemic.

5.1.4.2.8.5.11. Conduct recovery and reconstitution operations.

5.1.5. Roles and Responsibilities. The roles andresponsibilities contained in this format template are not allinclusive. However, the included information has beenspecifically directed by HHQ PI guidance and policy. Therefore,the following information MUST be included.

5.1.5.1. Installation Commander

5.1.5.1.1. Ensure the PI Annex to the installation plan issynchronized with CONPLAN 3551 and includes AOR-specificrequirements as directed by the GCC.

5.1.5,.1.2. As directed by the GCC, be prepared to provideHealth Service Support (HSS) to indigenous civilians on anemergency basis, or resources permitting, when community/hostnation medical infrastructure is insufficient to support itspopulation and no other alternatives are available to relievepain and suffering.

5.1.5.1.3. Develop guidance for allocating scarce installationmedical resources during mass casualty events.

5.1.5.1.4. BPT provide installation medical assets to supportPI contingency operations as directed by the GCC.

5.1.5.1.5. Ensure appropriate installation personnel meet preand post-deployment force health protection measures.

5.1.5.1.6. Ensure installation PI planning, training, andexercise activities are conducted in conjunction with state,tribal, and local partners to the maximum extent possible.

5.1.5.1.7. BPT implement targeted layered containment andcommunity mitigation measures to include possible quarantine.

5.1.5.1.8. Ensure installation PI planning and responseprocedures are supported by sufficient command and controlcapabilities.

1-30 Enclosure (1)

MCO 6220.1NOV 0 6 2009

5.1.5.1.9. Where operationally feasible, establish policies foradopting flexible worksites (e.g., telecommuting) and flexiblework hours (e.g., staggered shifts) in the event of a pandemic.

5.1.5.1.10. Identify facilities, other than the hospital and/orclinic, where mass vaccination, antiviral administration, andpatient care can be accomplished.

5.1.5.1.11. Ensure installation plan accounts for mental healthand chaplain support for emergency workers.

5.1.5.1.12. Ensure installation mission essential functions areadequately addressed in the PI plan and that the specificsoutlined in the DOD Implementation Plan for PI, Annex Darecovered.

5.1.5.1.13. Establish orders of succession for key leadershippositions. Ensure personnel identify to fill key positions areadequately trained to fill the position.

5.1.5.2. Medical Group Commander

5.1.5.2.1. Establish a clear medical command and controlarchitecture for use in a PI environment.

5.1.5.2.2. Develop installation plans for the identification,purchase, storage, management, and distribution of medicalsupplies for sustainment during the installation PI response.

5.1.5.2.3. BPT treat DOD government and contractor civilianswho are deployed with u.s. forces and working in the AOR.

5.1.5.2.4. BPT treat NGO and PVO personnel under an establishedreciprocal or cost reimbursement agreement basis.

5.1.5.2.5. BPT treat infectious noncombatant patients in theevent they cannot be moved or transferred to civilian or hostnation medical facilities.

5.1.5.2.6. BPT initiate immunization of the key population oncea licensed vaccine is available.

5.1.5.2.7. Coordinate the use of other DOD, community and/orhost nation, medical treatment facility assets commensurate withthe phase of the operation.

5.1.5.2.8. Track and report any adverse events followingvaccine and/or antiviral administration in accordance withexisting policies and guidelines. Ensure GCC/SG is included inthe reporting chain.

1-31 Enclosure (1)

MCO 6220.1

NOV 0 6 2009

5.1.5.2.9. Ensure installation MTF performs daily influenzalike illness surveillance and trend analysis and reporting lAWDOD policy.

5.1.5.2.10. Ensure appropriately trained installation publichealth or preventive medicine professionals monitor theElectronic Surveillance System for the Early Notificat·ion ofCommunity-based Epidemics (ESSENCE).

5.1.5.2.11. Ensure installation has ready access to a 10-daysupply of approved antivirals and other essential medicalsupplies to support the key population.

5.1.5.2.12. Ensure adequate stockage and sourcing of PPE formedical staff and other coming into contact with PI patients.

5.1.5.2.13. Ensure MTF performs periodic inventory review andupdate of supplies that will be in high demand during aninfluenza pandemic.

5.1.5.2.14. Ensure the MTF has proper administrative measuresin place for the detection of PI, prevention of its spread, andmanagement of its impact on the facility and staff.

5.1.5.2.15. Ensure MTF has criteria and methods for measuringcompliance with PI response measures (e.g., infection controlpractices, case reporting, patient placement, healthcare workerillness surveillance) .

5.1.5.2.16. Ensure MTF has procedures for the receipt, storage,and distribution of assets received from Federal stockpiles.

5.1.5.2.17. Ensure the needs of special populations areaddressed in installation PI planning.

5.1.5.2.18. BPT provide mass immunization and care forpotentially large numbers of patients.

5.1.5.2.19. BPT screen, isolate, and recommend quarantinestrategy options for personnel transiting and/or departing theinstallation.

5.1.5.2.20. Ensure MTF PI preparedness stocks are maintained inaccordance with the FDA's Shelf Life Extension Program (SLEP).

5.1.5.3. Public Health Emergency Officer (PHEO)

5.1.5.3.1. During plan development and in all phases, provideinstallation commander with estimates on the health and

1-32 Enclosure (1)

MCO 6220.1

NOV 0 6 2009

environment threats associated with PI, and recommendedcountermeasures and training for the key population.

5.1.5.3.2. Coordinate appropriate veterinary service supportfor PI operations.

5.1.5.3.3. Ensure installation-level and facility-level publichealth education programs are established consistent with themakeup of the key population.

5.1.5.3.4. Incorporate planning suggestions for state, tribal,and local partners (including health departments and healthcarefacilities) into installation PI planning.

5.1.5.3.5. Coordinate installation FHP measures and resourcerequirements with Service and GCC PI planners.

5.1.5.3.6. Coordinate the use of other DOD, community and/orhost nation, medical treatment facility assets commensurate withthe phase of the operation.

5.1.5.3.7. Ensure Occupational and Environmental HealthSurveillance (OEHS) assessments are conducted as required.

5.1.5.3.8. During installation PI exercises and training,evaluate the installation's FHP measures, PPE requirements,targeted layered containment strategies, and communitymitigation strategies for completeness and synchronization withHHQ guidance and policy.

5.1.5.4. Mission Support Group Commander

5.1.5.4.1. Develop installation plans for the identification,purchase, storage, management, and distribution of non-medicalsupplies for sustainment during the installation PI response.

5.1.5.4.2. Ensure installation PI plan addresses adequateavailability of essential supplies, services, and contracts.

5.1.5.5. Judge Advocate.

5.1.5.6. Public Affairs

5.1.5.6.1. Ensure clear, effective and coordinated riskcommunication before, during, and after a pandemic.

5.1.6. Coordinating Instructions

5.1.6.1. Personnel suspected of having PI will be masked andisolated as soon as recognized.

1-33 Enclosure (1)

MCO 6220.1

NOV 0 6 2009

5.1.6.2. Personnel suspected of having PI exposure will bemasked and quarantined as soon as recognized.

5.1.6.3. Personnel known to have PI will not requireddecontamination.

5.1.7. Administration and Logistics. Identify how keyinstallation organizations are to be supported and what supportthey must provide for themselves or to others in a PIenvironment.

5.1.8. Command and Control (C2). Identify any commandrelationships both internal and external to the installationthat are unique to the installation response in a PI environment.

5.1.8.1.authorityauthority

Delegation of Authority. Establish delegations ofto ensure all installation personnel know who hasto make key decisions in a COOP situation.

5.1.8.1.1. Outline which installation positions must be atleast three deep to account for the expected high rates ofillness and absenteeism. Identify personnel, by position ratherthan name, to backfill these positions.

5.1.8.2. Orders of Succession. Establish an order ofsuccession for key installation leadership positions. Identifythe orders of succession by position or title, rather than name,and ensure they are at least three deep per key position.

5.1.9. Tabs. The installation PI Annex will contain Tabs thatgenerally align with the Annexes in the DoD Global PI CONPLANand supporting COCOM PI CONPLANs. Where appropriate, PI Tabsmay reference information from the base Installation BiologicalPreparedness Plan. Installations may include additional Tabs asdesired, or as directed by HHQ plans. At a minimum, thefollowing Tabs will be included:

5.1.9.1. Tab B - Intelligence. At a minimum, this Tab willaddress the following information:

5.1.9.1.1. To Be Determined based on CONPLAN 3551.

5.1.9.2. Tab C - Operations. At a minimum, this Tab willaddress the following information:

5.1.9.2.1. Identify and prioritize installation essentialmissions and functions that must be maintained in a pandemicenvironment. Determine if any essential mission can beredistributed or transferred to other locations/installations.

1-34 Enclosure (1)

MCO 6220.1

NOV 0 6 2009

5.1.9.2.2. Outline the installation processes to maintainessential functions, services, and COOP in a PI environment fora sustained period of six to eight weeks.

5.1.9.2.3. Identify alternate operating locations for criticalinstallation missions.

5.1.9.2.4. Address the impact of absenteeism and socialdistancing on COOP and the potential impact on the keypopulation's resiliency given the possible scarcity of criticalresources (e.g., antivirals, immunizations, food, water, etc.)

5.1.9.2.5. Identify potential 2nd and 3rd order effects of a PIoutbreak on the installation's ability to sustain operations,maintain installation support requirements, and provide forcehealth protection to the key population. Outline theinstallation's plan to mitigate these effects.

5.1.9.3. Tab D - Logistics. At a minimum, this Tab willaddress the following information:

5.1.9.3.1. Identify critical supplies, goods or services thatrequire priority delivery from industry/suppliers to ensure COOPand sustainment of key population. Outline the installation'splan, coordinated with HHQ and DLA, to obtain these supplies ina PI environment.

5.1.9.3.2. Consider the effect of a pandemic on essentialcontract and support services to the installation. Outlinemitigation strategies to ensure continued support in a pandemicenvironment. Ensure installation PI plan addresses adequateavailability of essential supplies, services, and contracts. lAWrequirements as outlined in the DOD Implementation Plan for PI,Annex D.

5.1.9.3.3. Outline the methodology and materials theinstallation will use to equip the key population for protectionagainst the new strain of virus.

5.1.9.3.4. Outline the installation plan to re-deploy, asrequired, and reconstitute the installation between PI waves.

5.1.9.4. Tab E - Personnel. At a minimum, this Tab willaddress the following information:

5.1.9.4.1. Outline installation human capital plans for apandemic environment. Consider:

5.1.9.4.1.1. Compensation for nonessential and essentialemployees '.

1-35 Enclosure (1)

MCO 6220.1

NOV 0 62009

5.1.9.4.1.2. Normal and Mandatory sick leave.

5.1.9.4.1.3. Family medical leave.

5.1.9.4.1.4. Installation telework policy.

5.1.9.4.1.5. Procedures for processing grievances.

5.1.9.4.2. Outline the installation plan for cross-trainingpersonnel to facilitate continuation of essential missions andfunctions in a PI environment.

5.1.9.4.3.system for

Outline the installation personnel accountabilitya pandemic environment.

5.1.9.5. Tab F - Public Affairs. At a minimum, this Tab willaddress the following information:

5.1.9.5.1. Outline how the installation will communicate withthe key population during a pandemic.

5.1.9.5.2.its state,

Outline how the installation will communicate withtribal, and local partners during a pandemic.

5.1.9.5.3. Outline procedures that ensure installation publicaffairs themes and messages are consistent with DOD and HHQpolicy and guidance.

5.1.9.6. Tab J - Home Preparedness Planning. At a minimum,this Tab will address the following information:


5.1.9.7. Tab K - Command, Control, Communications, and ComputerSystems. At a minimum, this Tab will address the followinginformation:

5.1.9.7.1. Identify measures to ensure effective communicationsat the tactical and operational levels in support of DoDpersonnel and civil authorities.

5.1.9.7.2. Outline the installation plan to ensure thefunctionality of critical communications systems in a pandemicenvironment. Consider connectivity to HHQ, internalorganizations, and external partners.

5.1.9.7.3. Identify installation communications capabilities tosupport telework in a pandemic environment.

1-36 Enclosure (1)

MCO 6220.1

NOV 0 6 2009

5.1.9.7.4. Outline the installation plan to identify, protect,and ensure availability of vital records and databases, that is,electronic and hardcopy documents, references, records, andinformation systems needed to support essential functions duringa COOP situation.

5.1.9.8. Tab M - Restriction of Movement. At a minimum, thisTab will address the following information:

5.1.9.8.1. Installation social distancing plan. Address, at aminimum:

5.1.9.8.1.1. The general installation population.

5.1.9.8.1.2. Social distancing in mission essential operations.

5.1.9.8.1.3. Procedures to notify key population of socialdistancing implementation.

5.1.9.8.2. Quarantine. Address, at a minimum:

5.1.9.8.2.1. Quarantine locations and facilities. Addressgroup quarantine, home quarantine, and work quarantine.

5.1.9.8.2.2. Requirements for quarantine support (e.g.,security, food, PPE, etc)

5.1.9.8.2.3. Procedures for subjecting individuals toquarantine, monitoring them during quarantine, and removing themfrom quarantine.

5.1.9.8.3. Isolation. Address, at a minimum:

5.1.9.8.3.1. Isolation locations and facilit~es. Address thedifferent isolation options for those not requiringhospitalization, including on-base isolation and home isolation.

5.1.9.8.3.2. Requirements for isolation support (e.g., security,food, PPE, etc)

5.1.9.8.3.3. Procedures for subjecting individuals to isolation,monitoring them during isolation, and removing them fromisolation.

5.1.9.9. Tab Q - Health Services. At a minimum, this Tab willaddress the following information:

5.1.9.9.1. Outline detailed installation FHP measures, by phase,lAW guidance outlined in CONPLAN 3551, Annex Q. Supplement, as

1-37 Enclosure (1)

MCO 6220.1

NOV 0 6 2009

required, based on AOR-specific and installation commanderguidance.

5.1.9.9.2. Outline how the installation will conduct PI medicalsurveillance in support of installation activities, facilities,and key population.

5.1.9.9.3. Outline how the installation will protect the keypopulation during an Influenza Pandemic. Especially considerthose critical to mission essential functions.

5.1.9.9.4. Outline procedures to ensure FHP support to anyCOCOM or Joint HQ on the installation is prioritizedcommensurate with Service HQ to ensure COOP at all levels.

5.1.9.9.5. Outline specific force health protection measuresand community mitigation measures that the installation willtake, by phase, to mitigate and contain the effects of a PI.Plan and coordinate FHP implementation with HHQ, other militaryinstallations in close proximity, and state, tribal, and localpartners.

5.1.9.9.6. Outline procedures for the management of staff whobecome ill in the workplace. Ensure procedures are lAWrequirements as outlined in the DoD Implementation Plan for PI,Annex D.

5.1.9.10. Tab R - Reports. At a minimum, this Tab will addressthe following information:


5.1.9.10.2. Address the installation procedures for collectingand reporting costs incurred during all PI phases.

5.1.9.11. Tab S - Education, Training, and Exercises. At aminimum, this Tab will address the following information:

5.1.9.11.1. Address the requirement for the installation toexercise its PI preparedness biennially, at a minimum.

5.1.9.11.2. Address the requirement for the installation toexercise with other DOD components and state, tribal, and localpartners to the maximum extent possible.

5.1.9.11.3. Outline the methodology and materials theinstallation will use to train the key population on protectivemeasures against the new strain of virus.

1-38 Enclosure (1)

MCO 6220.1

NOV 0 6 2009

5.1.9.12. Tab T - HHQ, State, Tribal, and Local PartnerCoordinat i o'::n"'.=--A~t-a'::'::m"'7i-'-n-:i"'m:"'u::'m=,=t-'h-'J.~·s="'T"'a"'b::'!-w-7i '=1"'1::...-'a"-'::d-':d:"r"'e:"'s-s"--"'::t7h"'e='=f0 11owinginformation:

5.1.9.12.1.prepared toby HHQ.

Include the statement that the installation will beprovide assistance to civil authorities as directed

5.1.9.12.2. Outline the installation procedures to ensure theinstallation IPBB is shared with other military installations inthe AOR, to include sister Service installations.

5.1.9.12.3. Outline installation methodology to coordinate withstate, tribal, and local organizations to promote efforts toassure continuity of installation critical assets in a PIenvironment.

5.1.9.12.4. Outline installation plan to support localgovernments and utilities to ensure uninterrupted flow ofessential services to the installation.

5.1.9.13. Tab X - Execution Checklists. At a minimum, this Tabwill address the following information:


5.1.9.14. Tab Y - Strategic Communication. At a minimum, thisTab will address the following information:

5.1.9.14.1. Outline procedures that ensure installationstrategic communications efforts are consistent with DOD and HHQpolicy and guidance.

5.1.9.15. Tab Z - Distribution.

5.2. Smallpox. TBD by Service.

5.3. SARS. TBD by Service:

6. Disease Containment Execution Checklists. Includechecklists developed for quick and effective installationresponse to biological events.

7. MOAs!MAAs. Include memoranda of agreement and mutual aidagreements developed to provide reciprocal assistance to, andreceive reciprocal assistance from, local authorities andorganizations.

1-39 Enclosure (1)

Mca 6220.1

NOV 0 6 2009

B. Geographically-Separated Unit (GSU) Support. Identifyunique requirements associated with the support of installationGSU(s) in the preparation for and response to a biological event.

9. Essential Elements of Friendly Information. Identifyapplicable EEFIs, relating to the preparation for and responseto a biological event that may expose sensitive installationvulnerabilities, intelligence, capabilities, plans, and/orprocedures.

10. Maps and Charts. Include applicable products for use inpreparing for and responding to a biological event.

1-40 Enclosure (1)

MCO 6220.1

NOV 0 6 2009

Operational Reporting

1. Purpose. This enclosure sets forth the reporting proceduresand formatting required to support the execution of CONPLAN3551-09. It describes the OPREP-3, monthly, weekly and dailyreporting requirements as they pertain to the various phases ofCONPLAN 3551-09.

2. Types of Reports

a. OPREP-3. This report will be used for any significantPI event that warrants immediate notification to the CMC.

(1) OPREP-3 Thresholds

(a) Initial confirmed novel influenza case within acommand (e.g., installation) or military treatment facility(MTF) .

(b) Initial confirmed cluster (>25 cases) suggestiveof novel PI.

(c) Significant mission impact (actual or probable)resulting from PI outbreak.

(d) PI causing or potentially causing an adverseimpact to potential DSCA forces allocated or to anticipated DSCAmissions.

(e) Other pandemic related incidents of significantinterest as determines by the reporting organization.

(2) OPREP-3 Sample Format

UNCLAS (Classify as required)MSGID/OPREP-3/REPORTING UNIT/001A//REF/A/TEL/REPORTING UNIT/DTG//AMPN/REF A IS INITIAL MSG REPORT TO CMC//FLAGWORD/PINNACLE FOR PI EVENT/-//TIMELOC/DTG/GEOGRAPHIC LOCATION//GENTEXT/INCIDENT IDENTIFICATION AND DETAILS OF THE PI EVENT.MEDICAL ASSESSMENT, OPERATIONAL ASSESSMENT AND COORDINATINGACTIONS SHALL BE ADDRESSED IN THIS PARAGRAPH.//RMKS/AMPLIFYING REPORT TO FOLLOW//DECL/DERI:REPORTING UNIT/DTG//

2-1 Enclosure (2)

MCO 6220.1NOV 0 6 2009

b. Situation Reports (SITREPs). The SITREP is the primaryreport submitted by the Marine Corps to the NMCC and the NORADUSNORTHCOM Command Center. This report includes basicinformation about the PI surveillance network, the PI situation,current and future related activities, and logistical andpersonnel status and requirements.

(1) Monthly. The purpose of this report is to providesituational awareness on PI matters· during Phases 0 and 1. Thisreport will capture exercises, resource requirements, readinessstatus and any other information that is deemed significant bythe reporting command. Required information and recommendedformat:

CLASSIFICATION (UNCLAS/FOUO) or other classification as requiredMSGID/GENADMIN/ORIGINATING ORGANIZATION/CURRENT DATE//SUBJ/MONTHLY H1N1 SITREP//REF/A/DOC/CMC WASHINGTON DC/OBJUNE2007//REF/B/USNORTHCOM CONPLAN 3551-09//REF/C/SECDEF EXORD/281200ZAUG09//REF/D/DOC/SECDEF MOD 1 TO REF C/010000Z0CT09//REF/E/DOC/HQMC COOP PLAN, ANNEX E/17 SEP 09//NARR/REF A IS MCO 3504.2, OPERATIONS EVENT/INCIDENT REPORT(OPREP-3), THAT DIRECTS UNITS TO SUBMIT SIR REPORTS TO HQMC(ATTN: MARINE CORPS OPERATIONS CENTER) REGARDING THE DIAGNOSIS

OF ANY DISEASE OR THE EXTENSIVE OUTBREAK OF ANY CONDITION AMONGPERSONNEL THAT MAY POTENTIALLY DEGRADE THE OPERATIONALREADINESS OF A UNIT OR INSTALLATION. REF B IS USNORTHCOMCONPLAN 3551-09 CONCEPT PLAN TO SYNCHRONIZE DOD PANDEMICINFLUENZA PLANNING. REF C IS SECDEF APPROVED EXORD THAT DIRECTSDOD EXECUTION OF USNORTHCOM CONPLAN 3551-09 AND SUPPORTINGPANDEMIC INFLUENZA PLANS IN RESPONSE TO THE INFLUENZA A (H1N1)OUTBREAK. REF D IS SECDEF-APPROVED MODIFICATION TO DOD SUPPORT TOINFLUENZA (H1N1) EXORD THAT DIRECTS DOD EXECUTION OF USNORTHCOMCONPLAN 3551-09 AND SUPPORTING PANDEMIC INFLUENZA OPERATIONALPLANS IN RESPONSE TO THE INFLUENZA OUTBREAK. REF E IS ANNEX E TOTHE HQMC COOP PLAN.//POC/I.A.MARINE1/RANK/POC/-/TEL: DSN XXX-XXXX/TEL: (XXX)XXX-XXXXXXX//POC/I.A.MARINE2/RANK/POC/-/TEL: DSN XXX-XXXX/TEL: (XXX) XXXXXXX//GENTEXT/REMARKS/1. SITUATION.

A. INTERAGENCY(IA)/HOST NATION (HN) .(1) DEGRADATION IN IA CAPABILITIES.(2) DEGRADATION IN HN CAPABILITIES IN A PANDEMIC

INFLUENZA (PI) ENVIRONMENT.2. OPERATIONS.

2-2 Enclosure (2)

MCO 6220.1

NOV 0 6 2009

A. OPERATIONS IMPACT OF PION:(1) TRAINING.(2) MISSION ASSURANCE.(3) STRATEGIC COMMUNICATIONS.(4) INFORMATION OPERATIONS.(5) PUBLIC AFFAIRS.

3. LOGISTICS.A. ASSESSMENT OF LOGISTICS POSTURE IN SUPPORT OF PI

PLANNING.B. PHARMACEUTICAL COUNTER-MEASURES.C. MEDICAL COUNTER-MEASURES.D. PERSONAL PROTECTIVE EQUIPMENT (PPE).E. BUDGET CONSTRAINTS.F. ADDITIONAL LOGISTICS CONSTRAINTS/IMPACTS.

4. IMPACT OF PION MEDICAL OPERATIONS.A. BIO-SURVEILLANCE.B. FACILITIES CAPACITY.C. STATUS OF QUARANTINE/ISOLATION FACILITIES.D. SHORTFALLS.

5. PLANNING.A. AOR PI PLANNIING OPERATIONS.B. PI EXERCISES.C. COORDINATION WITH IA/HN.

6. COMMANDERS MISSION ASSURANCE ASSESSMENT.7. ADDITIONAL INFORMATION (AS REQUIRED).8. POCo9. RANK, NAME, ORGANIZATION, CONTACT NUMBER.

(2) Weekly. The purpose of this report is to providedetailed situational awareness on specific PI incidents duringPhase 2. This report will capture resource requirements,potential shortfalls, force health protection measures,readiness status and any information that is deemed significantby the reporting command. This report will contain acommander's estimate with respect to current and projectedmission assurance risk assessments. Required information andrecommended format:

CLASSIFICATION (UNCLAS/FOUO) or other classification as requiredMSGID/GENADMIN/ORIGINATING ORGANIZATION/CURRENT DATE//SUBJ/WEEKLY H1Nl SITREP//REF/A/DOC/CMC WASHINGTON DC/08JUNE2007//REF/B/USNORTHCOM CONPLAN 3551-09//REF/C/SECDEF EXORD/281200ZAUG09//REF/D/DOC/SECDEF MOD 1 TO REF C/010000Z0CT09//REF/E/DOC/HQMC COOP PLAN, ANNEX E/17 SEP 09//NARR/REF A IS MCO 3504.2, OPERATIONS EVENT/INCIDENT REPORT(OPREP-3), THAT DIRECTS UNITS TO SUBMIT SIR REPORTS TO HQMC

2-3 Enclosure (2)

MCO 6220.1NOV 0 6 2009

(ATTN: MARINE CORPS OPERATIONS CENTER) REGARDING THE DIAGNOSISOF ANY DISEASE OR THE EXTENSIVE OUTBREAK OF ANY CONDITION AMONGPERSONNEL THAT MAY POTENTIALLY DEGRADE THE OPERATIONALREADINESS OF A UNIT OR INSTALLATION. REF B IS USNORTHCOMCONPLAN 3551-09 CONCEPT PLAN TO SYNCHRONIZE DOD PANDEMICINFLUENZA PLANNING. REF C IS SECDEF APPROVED EXORD THAT DIRECTSDOD EXECUTION OF USNORTHCOM CONPLAN 3551-09 AND SUPPORTINGPANDEMIC INFLUENZA PLANS IN RESPONSE TO THE INFLUENZA A (HINl)OUTBREAK. REF D IS SECDEF-APPROVED MODIFICATION TO DOD SUPPORT TOINFLUENZA (HINl) EXORD THAT DIRECTS DOD EXECUTION OF USNORTHCOMCONPLAN 3551-09 AND SUPPORTING PANDEMIC INFLUENZA OPERATIONALPLANS IN RESPONSE TO THE INFLUENZA OUTBREAK. REF E IS ANNEX E TOTHE HQMC COOP PLAN.//POC/I.A.MARINEI/RANK/POC/-/TEL: DSN XXX-XXXX/TEL: (XXX)XXX-XXXXXXX//POC/I.A.MARINE2/RANK/POC/-/TEL: DSN XXX-XXXX/TEL: (XXX) XXXXXXX//GENTEXT/REMARKS//1. SITUATION. lAW ESTABLISHED INFORMATION REQUIREMENTS PROVIDEUPDATE TO EXISTING SECDEF DECISION SUPPORT TEMPLATE (DST)OUTLINED CCIR/PIR/FFIR/EEFI.2. IMPACT OF PION:

A. IMPACT ON MARINE FORCES (COMMANDERS ASSESSMENT) .B. IMPACT ON C2 STRUCTURE/ORGANIZATION (COMMANDERS

ASSESSEMENT) .3. OPERATIONS. OPERATIONS OVERVIEW AND THE IMPACT OF PIONOPERATIONAL CAPABILITY ..

A. ASSESSMENT NEXT 7 DAYS.B. LAND OPERATIONS.C. MARITIME OPERATIONS.D. TRAINING.E. AEROSPACE OPERATIONS.F. INFORMATION OPERATIONS.G. STRATEGIC COMMUNICATIONS.H. PUBLIC AFFAIRS.

4. lAW ANNEX B OF CONPLAN 3551, PROVIDE A STATUS OF THE PISURVEILLANCE NETWORK.5. THREAT OUTLOOK AND ASSESSMENT, INTSUM AND DISUM REPORTING6. EMERGING THREATS WITHIN THE JOA WHICH MAY AFFECT THEREGIONAL BALANCE OF POWER.7. SUMMARY OF SUSPECT INCIDENTS WITHIN JOA ASSOCIATED WITHTHREAT FORCES AND THE IMPACT OF PION THEIR ABILITY TO CONDUCTOPERATIONS.8. CHANGES TO CCIR.9. LOGISTICS.

A. IDENTIFICATION OF EMERGING FORCEREQUIREMENTS/UNITS/ASSETSAS VALIDATED AND SOURCED BY FORCE PROVIDER.

2-4 Enclosure (2)

MCO 6220.1

NOV 0 6 2009

B. IMPACT OF PION POINT OF EMBARKATION (POE)/POINT OFDEBARKATION (POD) AND IDENTIFIED JOINT, RECEPTION, STAGING,ONWARD MOVEMENT, AND INTEGRATION (JRSOI) LOCATION AND THE PIIMPACT ON THESE LOCATIONS.

C. MOVEMENT AND FORCE TRACKING TIMELINE (IMPACT ON MOVEMENTTABLES, FORCE ROTATIONS) .

D. ASSET/CARGO/EQUIPMENT TABLE, (ACTUAL MOVEMENT/FORCETRACKING TIMELINES) .

E. COMMAND EXPECTATIONS FOR ADDITIONAL FORCE/ASSET SOURCING.F. FACILITIES (CRITICAL INFRASTRUCTURE/BASE SUPPORT

INSTALLATIONS/OPERATIONAL STAGING AREAS) .G. LOGISTICS SHORTFALLS ATTRIBUTED TO PI ENVIRONMENT.H. STATUS OF PERSONAL PROTECTIVE EQUIPMENT.I. STATUS OF QUARANTINE/ISOLATION FACILITIES.

10. MEDICAL.A. FORCE HEALTH PROTECTION.B. STATUS OF MEDICAL FACILITIES (INCLUDE BIO

SURVEILLANCE/TREATMENT CAPACITY) .C. SHORTFALLS.D. ASSESSMENT NEXT 7 DAYS.

11. COMMUNICATIONS,A. OVERVIEW OF IMPACT OF PION COMMUNICATIONS.B. COMMUNICATION SHORTFALLS.

12. PERSONNEL.A. TOTAL TROOP STRENGTH.B. OPERATIONAL READINESS/COMBAT EFFECTIVENESS.C. CASUALTY DATA.

(1) DEATHS.(2) HOSPITALIZED.(3) TREATED FOR H1N1.(4) PERSONNEL SHORTFALLS.


(3) Daily. The purpose of this report is to providespecific situational awareness on PI events during Phases 3, 4and 5. This report will contain a commander's estimate withrespect to current and projected mission assurance riskassessments, ability to conduct assigned missions/forceprojection and implementation of force health protectionmeasures as they affect the key population within the AOR andhost nation support. Required information and recommendedformat:

2-5 Enclosure (2)

MCO 6220.1

NOV 0 6 2009

CLASSIFICATION (UNCLAS/FOUO) or other classification as requiredMSGID/GENADMIN/ORIGINATING ORGANIZATION/CURRENT DATE//SUBJ/DAILY H1N1 SITREP//REF/A/DOC/CMC WASHINGTON DC/08JUNE2007//REF/B/USNORTHCOM CONPLAN 3551-09//REF/C/SECDEF EXORD/281200ZAUG09//REF/D/DOC/SECDEF MOD 1 TO REF C/010000Z0CT09//REF/E/DOC/HQMC COOP PLAN, ANNEX E/17 SEP 09//NARR/REF A IS MCO 3504.2, OPERATIONS EVENT/INCIDENT REPORT(OPREP-3), THAT DIRECTS UNITS TO SUBMIT SIR REPORTS TO HQMC(ATTN: MARINE CORPS OPERATIONS CENTER) REGARDING THE DIAGNOSIS

OF ANY DISEASE OR THE EXTENSIVE OUTBREAK OF ANY CONDITION AMONGPERSONNEL THAT MAY POTENTIALLY DEGRADE THE OPERATIONALREADINESS OF A UNIT OR INSTALLATION. REF B IS USNORTHCOMCONPLAN 3551-09 CONCEPT PLAN TO SYNCHRONIZE DOD PANDEMICINFLUENZA PLANNING. REF C IS SECDEF APPROVED EXORD THAT DIRECTSDOD EXECUTION OF USNORTHCOM CONPLAN 3551-09 AND SUPPORTINGPANDEMIC INFLUENZA PLANS IN RESPONSE TO THE INFLUENZA A (H1N1)OUTBREAK. REF D IS SECDEF-APPROVED MODIFICATION TO DOD SUPPORT TOINFLUENZA (H1N1) EXORD THAT DIRECTS DOD EXECUTION OF USNORTHCOMCONPLAN 3551-09 AND SUPPORTING PANDEMIC INFLUENZA OPERATIONALPLANS IN RESPONSE TO THE INFLUENZA OUTBREAK. REF E IS ANNEX E TOTHE HQMC COOP PLAN.//POC/I.A.MARINE1/RANK/POC/-/TEL: DSN XXX-XXXX/TEL: (XXX)XXX-XXXXXXX//POC/I.A.MARINE2/RANK/POC/-/TEL: DSN XXX-XXXX/TEL: (XXX) XXXXXXX//GENTEXT/REMARKS//1. SITUATION. lAW ESTABLISHED INFORMATION REQUIREMENTS PROVIDEUPDATE TO EXISTING SECDEF DECISION SUPPORT TEMPLATE (DST)OUTLINED CCIR/PIR/FFIR/EEFI.2. IMPACT OF PION.

A. IMPACT ON MARINE FORCES (COMMANDERS ASSESSMENT) .B. IMPACT ON C2 STRUCTURE/ORGANIZATION (COMMANDERS

ASSESSEMENT) .3. OPERATIONS. OPERATIONS OVERVIEW AND THE IMPACT OF PIONOPERATIONAL CAPABILITY.

A. ASSESSMENT NEXT 7 DAYS.B. LAND OPERATIONS.C. MARITIME OPERATIONS.D. TRAINING.E. AEROSPACE OPERATIONS.F. INFORMATION OPERATIONS.G. STRATEGIC COMMUNICATIONS.H. PUBLIC AFFAIRS.

4. lAW ANNEX B OF CONPLAN 3551, PROVIDE A STATUS OF THE PISURVEILLANCE NETWORK.5. THREAT OUTLOOK AND ASSESSMENT, INTSUM AND DISUM REPORTING

2-6 Enclosure (2)

MCO 6220.1

NOV 0 62009

6. EMERGING THREATS WITHIN THE JOA WHICH MAY AFFECT THEREGIONAL BALANCE OF POWER.7. SUMMARY OF SUSPECT INCIDENTS WITHIN JOA ASSOCIATED WITHTHREAT FORCES AND THE IMPACT OF PION THEIR ABILITY TO CONDUCTOPERATIONS.8. CHANGES TO CCIR.9. LOGISTICS.

A. IDENTIFICATION OF EMERGING FORCEREQUIREMENTS/UNITS/ASSETSAS VALIDATED AND SOURCED BY FORCE PROVIDER.

B. IMPACT OF PION POINT OF EMBARKATION (POE)/POINT OFDEBARKATION (POD) AND IDENTIFIED JOINT, RECEPTION, STAGING,ONWARD MOVEMENT, AND INTEGRATION (JRSOI) LOCATION AND THE PIIMPACT ON THESE LOCATIONS.

C. MOVEMENT AND FORCE TRACKING TIMELINE (IMPACT ON MOVEMENTTABLES, FORCE ROTATIONS) .

D. ASSET/CARGO/EQUIPMENT TABLE, (ACTUAL MOVEMENT/FORCETRACKING TIMELINES) .

E. COMMAND EXPECTATIONS FOR ADDITIONAL FORCE/ASSET SOURCING.F. FACILITIES (CRITICAL INFRASTRUCTURE/BASE SUPPORT

INSTALLATIONS/OPERATIONAL STAGING AREAS) .G. LOGISTICS SHORTFALLS ATTRIBUTED TO PI ENVIRONMENT.H. STATUS OF PERSONAL PROTECTIVE EQUIPMENT.I. STATUS OF QUARANTINE/ISOLATION FACILITIES.

10. MEDICAL.A. FORCE HEALTH PROTECTION.B. STATUS OF MEDICAL FACILITIES (INCLUDE BIO

SURVEILLANCE/TREATMENT CAPACITY) .C. SHORTFALLS.D. ASSESSMENT NEXT 7 DAYS.

11. COMMUNICATIONS.A. OVERVIEW OF IMPACT OF PION COMMUNICATIONS.B. COMMUNICATION SHORTFALLS.

12. PERSONNEL.A. TOTAL TROOP STRENGTH.B. OPERATIONAL READINESS/COMBAT EFFECTIVENESS.C. CASUALTY DATA.

(1) DEATHS.(2) HOSPITALIZED.(3) TREATED FOR HIN1.(4) PERSONNEL SHORTFALLS.


3. Requirement. MARFORCOM/MARFORPAC/MARFORRES/MCCDC/MCIEAST/MCI WEST/M&RA/HQBN, HQMC will provide a monthly situation

2-7 Enclosure (2)

MCO 6220.1NOV 0 6 2009

report to HQMC (ATTN:MARINE CORPS OPERATIONS CENTER) by 1200 ESTon the last day of the month beginning on 31 OCT 09 for Phase 0& Phase 1. If Phase 2 is implemented, weekly situation reportswill be submitted each Friday by 1200 EST. If phase 3, 4, or 5are implemented, daily situation reports will be submitted eachday by 1200 est.

4. Classification: All pandemic influenza reportingclassifications will be kept at for official use only levelwhenever possible. however, upgraded classification may benecessary based on situation and circumstances. Classificationdetermination will be made by the reporting unit. Allclassified reports will be marked accordingly with overallclassification and appropriate portion markings.

2-8 Enclosure (2)

Mea 6220.1

NOV 0 6 2009

Preparedness and Response

Pandemic Influenza

Enclosure (3)3-1

Duties and ResponsibilitiesPublic Health Emergency Officer

(PHEO)

Meo 6220.1NOV 0 6 2009

Public Health Emergency Officer (PHEO)

• The PHEO is the frontline responder on a militaryinstallation in a Public Health Emergency (PHE) , whether ofnatural, technologic, or terrorist cause. PHEOs are responsiblefor providing commanders with guidance and recommendations onpreparing for, responding to, and recovering from a PHE. Theadvice provided by PHEOs must be consistent with currentmedical, scientific, and public health knowledge, and mustconsider the population at risk, command critical missions, andprocesses and procedures of military and national responseplans.

• A PHEO shall be a senior health professions military officeror DOD civilian employee affiliated with the command, or thecommander of a higher level or associated command and should bethe command surgeon, local equivalent, hospital commander, orsenior leader with experience and training in functionsessential to effective PHE management.

• PHEOs should have a Master of Public Health, 2 yearsexperience in public health, preventative medicine, orenvironmental health, and significant operational experience.However, other officers with a strong public health backgroundwho can meet PHEO competencies with additional training canserve as PHEOs.

• PHEO major areas of responsibility:

• Situational Awareness of Public Health Threat

Not Started In Progress Completed

0 0 0

Not Started In progress Completed

0 0 0


o 0 0

• Ensure relevant surveillance andinformation systems are monitored.

• Establish installation-level rapidnotification of suspected orconfirmed cases of quarantinablediseases to the PHEO.

• Establish processes for sharinginformation on suspected or confirmedcases with local, tribal, state,federal or host nation public healthauthorities.

3-2 Enclosure (3)


o o o

MCO 6220.1NOV 0 6 2009

• Ensure PHEO accessibility 24/7:


o 0 0


o 0 0


o 0 0


o 0 0


o 0 0


o 0 0


o 0 0


o 0 0


o 0 0

• Develop phone triage protocol toprocess reports.

• Enlist a cadre of respondersavailable within 30 minutes ofreceiving report/call.

• Ensure Medical Health Services(MRS) and Laboratory Response Network(LRN) procedures and protocols are incompliance.

• Ensure all reportable suspectedand confirmed cases are reportedfollowing current policy.

• Ensure that active and passivesystems monitor inpatient andoutpatient data sources to detectcases and clusters of public healthsignificance in,all coveredpopulations.

• Maintain contact with Service andDOD sources of expert epidemiologicsupport.

• Oversee hospital surveillance ofquarantinable diseases, including:

• Quarantine of groups of exposedpeople.

• Containment measures that apply tospecific sites.

3-3 Enclosure (3)

• Declaration of a PHE


0 0 0

Not Started. In Progress Completed

0 0 0


0 0 0


0 0 0Not Started In Progress Completed







0 0 0

Mca 6220.1

NOV 0 6 2009

• Ensure decision algorithms fordeclaration of a PHE are developed,trained, and executed.

• Ensure that PHE declarationresults in appropriate notificationprocedures.

• Advise appropriate strategy forcontainment (individual andcommunity-based) :

• Short-term, voluntary home curfew.

• Suspension or restriction of groupassembly.

• Cancellation of public events.

• Closure of public places.

• Restriction of travel or shelterin-place.

• "Cordon Sanitaire."

• Ensure a process to handlequarantine exemptions.

• Establish procedures for medicalevaluation and isolation of those whoexhibit signs of illness.

3-4 Enclosure (3)

Mca 6220.1NOV 0 6 2009


0 0 0


0 0 0


o 0 0


o 0 0

• Develop protocols for monitoringand enforcing quarantine procedures.

• Address psychological healthsupport needs.

• Ensure protection of persons,including medical examination,testing, vaccination, and treatment.

• Establish guidelines fortermination of a PRE.

• Provide Expertise and Consultation to the Commander


o 0 0


o 0 0


o 0 0


o 0 0

• Advise installation and othercommanders on medical/public healthaspects of a public disease emergencyand disease containment strategies.

• Educate commanders on specificquarantinable and other diseases ofconcern.

• Advise on public health anddisease outbreak emergency responsepolicies, plans, procedures, andguidelines in support of command andcontrol capabilities to properlyrespond to disasters, public healthemergencies, and disease outbreaks.

• Advise Medical Treatment Facility(MTF) commanders on preparedness,prevention, response, exercise, andtraining activities.

3-5 Enclosure (3)


o 0 0


o 0 0


000Not Started In Progress Completed

o 0 0

MCO 6220.1

NOV 0 6 2009

• Institute emergency responseprograms for public health anddisease outbreaks on militaryinstallations to include active andReserve component installations,Reserve Centers, armories, asappropriate in CONUS.

• Recommend a PHE be declared (andappropriately implement vaccination,quarantine, and social distancingwhen necessary) .

• Maintain essential services andmission capability.

• Advise on public health measurefor mass care functions.

• Epidemiologic Outbreak Investigation

Not Started In Progress Completed • Identify contacts and conduct

0 0 0contact training.

Not Started In Progress Completed • Remain current on all aspects of

0 0 0procedures for quarantinable andother diseases of interest.


o 0 0


o 0 0

• Establish a coordination processand procedure for outbreakinvestigations with military, State,and local health officials, security,and investigative agencies asappropriate.

• Conduct and supportepidemiological investigations, andcoordinate investigations withcivilian authorities.

3-6 Enclosure (3)


0 0 0




0 0 0


o 0 0


o 0 0

Mca 6220.1NOV 0 6 2009

• Establish containment measures forindividuals, including:

• Patient Isolation.

• Management of Contacts.

• Participate in PHE exercises anddrills and incorporate lessonslearned into plans.

• Plan for provision of care in nonhospital settings.

• Ensure that public healthsurveillance for infectious diseasesand injuries - including events thatmight indicate terrorist activity is timely and complete, and reportingof suspected terrorist events isintegrated with evolving,comprehensive networks of thenational public health surveillancesystem.

• Guidance on Diagnosis, Treatment, and Prophylaxis ofThose Infected or Potentially Exposed


o 0 0


o 0 0

• Maintain currency on Service, MHS,and other policy guidance (DHHS, FDA)regarding disease diagnosis,treatment, and prophylaxis.

• Develop strategies for "just-intime" (JIT) training of non-criticalstaff and others who are involved indiagnosis, treatment, and medicalcare for exposed and potentiallyexposed.

3-7 Enclosure (3)


0 0 0



0 0 0


0 0 0


0 0 0


0 0 0


o 0 0


o 0 0

MCO 6220.1NOV 0 6 2009

• Ensure appropriate infectioncontrol practices to prevent diseasespread.

• Identify and isolate all potentialpatients.

• Consider implementationshielding, cancellation of publicevents, and "snow days."

• Improvise prioritization ofservices in the event of reducedstaffing.

• Establish parameters andcapabilities to execute a "communitytriage" program .

• Ensure the needs of specialpopulations are addressed through theprovisions of appropriate informationand assistance, to include children,disabled, and institutionalized.

• Reference Joint Commission on theAccreditation of RealthcareOrganizations (JCAHO) alteredstandards of care that may need to beaddressed, such as staff ratio in adeclared PRE.

• Ensure development of massvaccination and mass chemoprophylaxisdistribution plans or annexes.

• Support Development of Plans and Exercises for EmergencyHealth Powers


o 0 0• Ensure medical facilities haveprocedures to detect, prevent spread,and manage impact of quarantinablediseases that build on existingoperational and National preparednessplans.

3-8 Enclosure (3)


o 0 0


o 0 0Not Started In Progress Completed


o 0 0


o 0 0


o 0 0


o 0 0


o 0 0


o 0 0


o 0 0

MCO 6220.1NOV 0 6 2009

• Coordinate with local publichealth, community, health carefacilities at the local, State,regional, and country/Federal levelas response partners for a PRE.

• Identify potential isolation andquarantine facilities.

• Plans for "clinics" and"hotlines."

• Ensure MTFs have PI staffingcontingency plans.

• Ensure installations participatein planning, training, and exerciseactivities with other agencies.

• Encourage COCOM components toparticipate in similar operationswith the host nation (HN) asrequested.

• Develop operational objectives forPRE response.

• Prepare for on-site assistancefrom DOD and others, including:technical and emergency responsepersonnel.

• Prepare for on-site assistancefrom DOD and others, including:

• Technical and Emergency Responsepersonnel.

3-9 Enclosure (3)



0 0 0


0 0 0


0 0 0



0 0 0

Mca 6220.1

NOV 0 6 2009

• Centers for Disease Control andPrevention.

• Strategic National Stockpile(SNS) personnel.

• National Disaster Medical System(NDMS) teams.

• Emergency Medical Response (EMR)teams.

• ather specialized response teams.

• Plan for emergency credentialing.

• Logistics/Acquisition of Medical Countermeasures andPersonal Protective Equipment (PPE)


O' 0 0


o 0 0

• Conduct a capacity assessmentdefining the resources, including theidentification of health care andquarantine surge capacity resourceshortfalls, requirements for specificdiseases, and installationpopulation.

• Establish plans and systems forproviding mass distribution ofmedications and other appropriatesupplies to care for potentiallylarge numbers of patients andmaintain quarantine population.

3-10 Enclosure (3)


o 0 0


0 0 0


0 0 0


0 0 0


0 0 0

Mca 6220.1

NOV 0 6 2009

• Ensure appropriate surge-capacitycapability to sustain health caredelivery and health medical supportin quarantine situations.

• Distribute vaccines and anti-viralmedications following appropriateplans and guidance.

• Identify principle materialrequirements for PI, includevaccines, anti-viral/anti-bacterialdrugs, ventilators, and PPE.

• Coordinate purchases of drugs andvaccine through the Defense SupplyCenter Philadelphia (DSCP).

• Maintain procedures for thereceipt, storage, and distribution ofassets received from Federalstockpiles.

• Conduct Risk Communication


o 0 0


o 0 0


o 0 0

• Pre-draft messages for PHEsituation scenarios which shouldinclude such information as diseaseprogression, movement restrictionrationale, availability, and locationof support services.

• Pre-plan venues, methods,locations, times, and communicatorsof information related to the PHE.

• Ensure public information andeducation on disease of concern iscommunicated clearly, early, andrepeatedly.

3-11 Enclosure (3)


0 0 0


0 0 0


0 0 0


0 0 0




0 0 0

Meo 6220.1

NOV 0 6 2009

• Notify and communicate with thepopulation during the PHE.

• Identify language-specificmaterials for educating patients,family, and the community.

• Establish "community triage"communications capabilities,including hotlines.

• In .coordination with theappropriate PAO, release the:

• Declaration of a PHE and itstermination.

• Steps individuals should take toprotect themselves ..

• Actions taken to control ormitigate the emergency.

• Coordination with the State, local, HN and Allied ForceHealth and other Officials


o 0 0• Establish working relationshipswith PHE management agencies,emergency medical services (EMS),medical, health, behavior careproviders, fire, law enforcements,other Federal, State, local responseorganizations, local emergencyplanning committees, humanitarian andvolunteer organizations, academicinstitutions, and other pertinentagencies and organizations.

3-12 Enclosure (3)


o 0 0


o 0 0


o 0 0


o 0 0


o 0 0


0 0 0


0 0 0

MCO 6220.1

NOV 0 62009

• Maintain familiarity with Stateand HNs in disease reporting,quarantine, and other diseasecontainment strategies and how theyapply to installation population andactivities.

• Coordinate planning and executionof medical and public health aspectsof disease containment strategieswith local officials.

• Ensure individuals subject toRestriction of Movement (ROM) areprovided written notice of the reasonfor ROM as soon as feasible, as wellas the plan of examination, testing,and/or treatment.

• Develop a system so that all nonmilitary personnel subject to ROM whocontest the reason have theopportunity to present informationsupporting exemption or release tothe commander within 8 hours ofreceipt.

• Participate in local, Statewide,and regional PHE plans, exercises,and drills.

• Partner with law enforcementregarding enforcement, quarantineprocess, and procedures.

• Provide education to firstresponders and others in the use ofPPE.

3-13 Enclosure (3)

Mea 6220.1

NOV 0 6 2009

Pandemic Influenza


Medical Treatment Facility(MTF)

4-1 Enclosure (4)

MTF Pandemic Influenza Planning Checklist

MCO 6220.1

NOV 0 6 2009

• Experts at the World Health Organization (WHO) and elsewherebelieve that the world is now closer to another pandemicinfluenza (PI) than at any time since 1968.

• Planning for PI is critical for ensuring a sustainablehealthcare response. This checklist was developed to help MTFsassess and improve their preparedness for responding to PI.Because of differences among MTFs (e.g., characteristics of thepatient population, size of the MTF/community, scope ofservices), each MTF will need to adapt this checklist to meetits unique needs and circumstances. This checklist should beused as one of several tools for evaluating current plans or indeveloping a comprehensive PI plan. Additional information canbe found at www.flu.gov.

• An effective plan will incorporate information from state,regional, tribal and local health departments, emergencymanagement agencies/authorities, MTF associations and suppliersof resources. In addition, MTFs should ensure that their PIplans comply with applicable state and federal regulations andwith standards set by accreditation organizations, such as theJoint commission on Accreditation of Healthcare Organizations(JCAHO). Comprehensive pandemic influenza planning can also helpfacilities plan for other emergency situations.

• Structure for planning and decision making


o 0 0


o 0 0

• PI has been incorporated intodisaster planning and exercises forthe MTF.

• A multidisciplinary planningcommittee has been identified tospecifically address PI preparednessplanning and preparedness testing.

4-2 Enclosure (4)

Mca 6220.1NOV 0 6 2009



o 0 0

• Primary and backup responsibilityhas been assigned for coordinatingpreparedness planning. (Insert names,titles and contact information)

• Primary:

• (Name)

• (Title)

• (Contact info)

• Backup:

• (Name)

• (Title)

• (Contact info)

Not Started In Progress Completed • Members of the planning committee

0 0 0 include (as applicable to eachsetting) the following: (Checkcategories below that apply anddevelop a list of committee memberswith the name, title, and contactinformation for each personnelcategory checked below, and attach tothis checklist. )

Not Started In Progress Completed • MTF Administration.

0 0 0

Not Started In Progress Completed • Legal counsel/risk management.

0 0 0

4-3 Enclosure (4)


MCO 6220.1

NOV 0 6 2009


o o o• Infection control/epidemiology.

Not Started In Progress Completed • Disaster Coordinator.

o o oNot Started In Progress Completed

o 0 0


o 0 0

• Public Relations Coordinator,Public Information Officer.

• Medical staff (e.g., internalmedicine, pediatrics, MTFist,infectious disease) .


o o o• Nursing administration.


o 0 0

• Human Resources (e.g., personnel,including Equal EmploymentOpportunities) .




o

o

o

o

o

o

o

o

o

•

•

•

Facility personnel representative.

Occupational Health.

Physical Therapy.

Not Started In Progress Completed • Intensive care.


o

o

o

o

o

o• Emergency Department.

4-4 Enclosure (4)

Mca 6220.1NOV 0 6 2009


Not Started In Progress Completed • Respiratory Therapy.

0 0 0

Not Started In Progress Completed • Diagnostic Imaging (Radiology) .

0 0 0

Not Started In Progress Completed • Discharge Planning.

0 0 0

Not Started In Progress Completed • Staff development.

0 0 0Not Started In Progress Completed • Engineering and maintenance.

0 0 0Not Started In Progress Completed • Environmental services.

0 0 0Not Started In Progress Completed • Central (sterile) services.

0 0 0Not Started In progress Completed • Security.

0 0 0Not Started In Progress Completed • Dietary (food) services.

0 0 0Not Started In Progress Completed • Pharmacy services.

0 0 0Not Started In Progress Completed • Information technology.

0 0 0

4-5 Enclosure (4)


Mca 6220.1

NOV 0 6 2009


0 0 0


0 0 0


0 0 0


o 0 0


o 0 0

• Purchasing agent/materialsmanagement.

• Laboratory services.

• Expert consultants (e.g.,ethicist, mental/behavioralprofessionals) .

• Other member(s) as appropriate(e.g., volunteer services, communityrepresentative, clergy, localcoroner, medical examiner,morticians) .

• Points of contact for informationon PI planning resources have beenidentified within local, state andtribal health departments and thestate hospital association (insertnames, titles, and contactinformation. )

• Local health department:

• (Name)

• (Title)

• (Contact info)

• State health department:

• (Name)

• (Title)

• (Contact info)

4-6 Enclosure (4)


Mca 6220.1

NOV 0 6 2009


o 0 0


o 0 0

• Points of contact for informationon PI planning resources have beenidentified within local, state andtribal health departments and thestate hospital association (insertnames, titles, and contactinformation. )

• State MTF association:

• (Name)

• (Title)

• (Contact info)

• Tribal health association:

• (Name)

• (Title)

• (Contact info)

• Local, regional or state emergencypreparedness groups, includingbioterrorism/communicable diseasecoordinators points of contact, havebeen identified. (Insert name, titleand contact information for each)

• City:

• (Name)

• (Title)

• (Contact info)

4-7 Enclosure (4)

Mca 6220.1

NOV 0 6 2009



o 0 0


o 0 0

• Local, regional or state emergencypreparedness groups, includingbioterrorism/communicable diseasecoordinators points of contact, havebeen identified. (Insert name, titleand contact information for each)

• County:

• (Name)

• (Title)

• (Contact info)

• Other regional (and/or tribal)

• (Name)

• (Title)

• (Contact info)

• Local or regional PI planninggroups have been contacted forinformation on coordinating thefacility's plan with other PI plans.

• Development of a written PI plan

Not Started In progre~a Completed

o 0 0

• Copies of relevant sections of theHHS Pandemic Influenza Plan(available atwww.hhs.gov/pandemicflu/plan/) andpolicy documents that may beforthcoming (available atwww.flu.gov) have been obtained andreviewed for incorporation into thefacility's plan.

4-8 Enclosure (4)

MCO 6220.1

NOV 0 6 2009


Not Started In Progress Completed • Copies of relevant sections of

0 0 0other available plans (i.e., state,tribal, regional, or local) have beenobtained and reviewed forincorporation into the facility'splan.

Not Started In Progress Completed • HQMC.

0 0 0Not Started In Progress Completed • MARFOR.

0 0 0Not Started In Progress Completed • Installation.

0 0 0Not Started In Progress Completed • State.

0 0 0Not Started In Progress Completed • Regional.

0 0 0Not Started In Progress Completed • Local.

0 0 0

Not Started In Progress Completed • Tribal.

0 0 0Not Started In Progress Completed • A copy of the facility plan and

0 0 0other relevant materials areavailable in Administration andInfection Control. (List otherlocations where information isavailable, including facilityintranet sites and attach to thischecklist. )

4-9 Enclosure (4)

MCO 6220.1

NOV 0 6 2009



o 0 0


o 0 0


o 0 0


o 0 0

• The plan includes strategies forcollaborating with local and regionalplanning and response groups and MTFsand other healthcare facilities inorder to coordinate response effortsat the community level (e.g.,staffing, material and otherresources, triage algorithms, etc.).

• The plan identifies the person(s)authorized to implement the plan andthe organizational structure thatwill be used, including thedelegation of authority to carry outthe plan 24/7.

• The plan stratifies implementationof specific actions on the basis ofthe WHO Pandemic Phases, USGovernment Pandemic Stages, DODPandemic Phases (USNORTHCOM CONLAN3551-07) and the pandemic severityindex level worldwide, in the UnitedStates and at the local level. (Seesection IV and Appendix 3 of the"Community Strategy for PandemicInfluenza Mitigation" atwww.flu.gov/plan/community/commitigation.html. )

• Responsibilities of key personneland departments within the facilityrelated to executing the plan havebeen described.

4-10 Enclosure (4)

Mea 6220.1

NOV 0 6 2009



o 0 0• Personnel who will serve as backup (e.g., B team) for key personnelroles have been identified.

Not Started In Progress Completed • A tabletop simulation exercise or

0 0 0other exercises have been developedto test the plan.

• Date performed

• Date performed

Not Started In Progress Completed • A full scale drill/exercise has

0 0 0been developed to test the plan.

• Date performed

Not Started In progress Completed • The plan is updated regularly and

0 0 0includes current contact informationand lessons learned from exercisesand drills.

Not Started In Progress Completed • The facility plan includes the

0 0 0elements listed in #3 below.

• Elements of a PI plan


o 0 0• A plan is in place forsurveillance and detection of PI infacility patients and staff.

4-11 Enclosure (4)

MTF d ' £1 l' h k1' MCa 6220.1Pan emJ.c In uenza P annJ.ng C ec J.st NOV 0 6 2009


o 0 0


o 0 0

• A method for performing andreporting syndromic surveillance forpersons with influenza-like illnesshas been tested and evaluated duringthe regular influenza season inpreparation for using the system forPI surveillance. MTF sites forsyndromic surveillance should includethe emergency department, MTFclinics, and occupational health.Surveillance reports are sent to MTFepidemiology/infection controlpersonnel and to the local healthauthority. (The frequency ofreporting should be determined by thelocal health authority and reflectthe pandemic severity level, as wellas any applicable federal or staterecommendations.)

• Responsibility has been assignedfor monitoring public healthadvisories (federal and state) andfor updating the pandemic responsecoordinator and members of the PIplanning committee when PI has beenreported in the United States and isnearing the geographic area .

• Primary:

• (Name)

• (Title)

• (Contact info)

• Backup:

• (Name)

• (Title)

• (Contact info)

4-12 Enclosure (4)

Mea 6220.1

MTF Pandemic Influenza Planning Checklist NOV 0 6 2009


o 0 0


o 0 0


o 0 0

• A written protocol has beendeveloped for monitoring andreporting seasonal influenza-likeillness among MTF sized patients,volunteers, and staff (e.g., weeklyor daily number of patients and staffwith influenza-like illness). (Havinga system for tracking illness trendsduring seasonal influenza will ensurethat the MTF can detect stressorsthat may affect operating capacity,including staffing and supply needs,during a pandemic.) Information onthe clinical signs and diagnosis ofinfluenza is available atwww.cdc.gov/flul .

• A protocol has been developed forthe evaluation and diagnosis of MTFsized patients and/or staff withsymptoms of PI. Information on theclinical signs and diagnosis ofinfluenza is available atwww.cdc.gov/flu.

• A protocol has been developed forthe management of persons withpossible PI who are seen in theemergency department, MTF clinics, orare transferred from another facilityor referred for MTF prioritization byan admitting physician. The protocolincludes criteria for detecting apossible case, the diagnostic work-upto be performed, infection controlmeasures to be implemented, medicaltreatment, and directions fornotifying infection control.

4-13 Enclosure (4)

Mca 6220.1



o 0 0


o 0 0


o 0 0


o 0 0

• Protocols include triggers fordifferent levels of action that arebased on the Pandemic Severity Index(See www.flu.gov or www.cdc.gov/flu.)

• A system is in place to monitorfor and internally review healthcareassociated transmission of seasonalinfluenza among patients and staff inthe facility. Information used fromthis monitoring system is used toimplement prevention interventions(e.g., isolation, cohorting). (Thissystem will be necessary forassessing PI transmission.)

• A facility communication plan hasbeen developed and is coordinatedwith the local health authority. Formore information, seewww.hhs.gov/pandemicflu/plan.

• Key public health points of contactfor communication during PI have beenidentified.

• Local Health Department:

• (Name)

• (Title)

• (Contact info)

• State Health Department:

• (Name)

• (Title)

• (Contact info)

4-14 Enclosure (4)

Mca 6220.1



o 0 0


o 0 0

• Key public health points of contactfor communication during PI have beenidentified.

• Regional Health Department:

• (Name)

• (Title)

• (Contact info)

• Tribal Health Department:

• (Name)

• (Title)

• (Contact info)

• Responsibility has been assignedfor communications with public healthauthorities (i.e., case reporting,status updates) during a pandemic.

• Primary:

• (Name)

• (Title)

• (Contact info)

• Backup:

• (Name)

• (Title)

• (Contact info)

4-15 Enclosure (4)

MTF Pandemic Influenza Planning ChecklistMCO 6220.1NOV 0 6 2009


o 0 0


o 0 0


o 0 0


0 0 0


0 0 0

• Responsibility has been assignedfor communicating. with the public.

• Clinical spokesperson:

• (Name)

• (Title)

• (Contact info)

• Public Relations spokesperson:

• (Name)

• (Title)

• (Contact info)

• Methods of communicating with thepublic (e.g., public serviceannouncements (PSAs), messagemapping) and the subjects that willbe addressed have been discussed.

• Plans and responsibilities forcommunicating with MTF staff,volunteers, and private medical staffhave been developed. Anticipateemployee fear/anxiety and plancommunications accordingly.

• Plans and responsibilities forcommunication with patients and theirfamily members have been developed.

• The types of communication needs(e.g., staff and community updates)and methods of communication (e.g.,intranet, PSAs, and newspaperreports) have been identified and areappropriate for individuals withvisual, hearing, or otherdisabilities, or limited Englishproficiency.

4-16 Enclosure (4)

Mca 6220.1

MTF Pandemic Influenza Planning ChecklistNDV 062009


o 0 0


o 0 0

• Responsibility has been assignedfor internal communications withstaff regarding the status and impactof PI in the MTF.

• Primary:

• (Name)

• (Title)

• (Contact info)

• Backup:

• (Name)

• (Title)

• (Contact info)

• A list has been created of otherhealthcare entities, including theirpoints of contact, within the region(e.g., other MTFs, long-term care andresidential facilities, local MTF'semergency medical services, clinics,relevant community organizations[including those involved withdisaster preparedness]) with which itwill be necessary to maintaincommunication in real-time and beable to report information in atimely and accurate manner during apandemic (Insert location of the listof contacts and attach a copy to thepandemic plan:)

• Location of list:

•

4-17 Enclosure (4)

MTF Pandemic Influenza Planning

Mca 6220.1

ChecklistNOV 0 6 2009


o 0 0


o 0 0


o 0 0

• The facility has been representedin discussions with other MTFsregarding local plans for interfacility communication during apandemic.

• A plan is in place to provideeducation and training for personneland information for patients andvisitors to ensure that theimplications of and basic preventionand control measures for PI areunderstood. (For more information andresources see www.cdc.gov/flu) .

• A person has been designated withresponsibility for coordinatingeducation and training on PI (e.g.,identifies and facilitates access toavailable programs, maintains arecord of personnel attendance) .(Insert name, title and contactinformation. )

• Primary:

• (Name)

• (Title)

• (Contact info)

• Backup:

• (Name)

• (Title)

• (Contact info)

4-18 Enclosure (4)

Mca 6220.1

MTF Pandemic Influenza Planning ChecklistNOV 0 6 2009


o 0 0


o 0 0


o 0 0

• Current and potential opportunitiesfor long-distance (e.g., Web-based)and local (e.g., health departmentor MTF-sponsored) influenza trainingprograms have been identified. (Seewww.cdc.gov/flu) .

• Language, format (i.e., preparedfor individuals with visual, hearingor other disabilities) and readinglevel appropriate materials forclinical and non-clinical personnelhave been identified to supplementand support education and trainingprograms (e.g., materials availablethrough state and federal publichealth agencies and throughprofessional organizations), and aplan is in place for obtaining thesematerials.

• Education and training for MTFpersonnel includes information ondifferences in pandemic influenzainfection prevention and controlmeasures if necessary and areprovided in languages and format(i.e., prepared for individuals withvisual, hearing or otherdisabilities) appropriate for MTFpersonnel. Regular education andtraining should include, but not belimited to: training in Standard andDroplet Precautions; use ofrespiratory protection; socialdistancing and respiratoryhygiene/cough etiquette.

4-19 Enclosure (4)

Mea 6220.1

MTF Pandemic Influenza Planning ChecklistNOV a6 2009


o 0 0


o 0 0


o 0 0


o 0 0


o 0 0

• Education and training includesinformation on the MTFs PI plan,including relevant personnelpolicies, and operational changesthat will occur once the plan isimplemented.

• A plan has been established forexpediting the identification of,credentialing and training of nonfacility staff brought in from otherlocations within the region toprovide patient care when the MTFreaches a staffing crisis.

• Informational materials (e.g.,brochures, posters) on PI andrelevant MTF policies (e.g.,visitation) have been developed oridentified for patients and theirfamilies. These materials arelanguage format (i.e., prepared forindividuals with visual, hearing orother disabilities) and reading-levelappropriate and a plan is in place todisseminate these materials to MTFpatients and visitors.

• A plan has been developed fortriage (e.g., initial patientevaluation) and admission of patientsduring a pandemic that includes thefollowing:

• A designated location, separatefrom other clinical triage andevaluation areas, (utilizing theprinciples of social distancing) forthe triage of patients with possiblePI.

4-20 Enclosure (4)

Mca 6220.1

MTF Pandemic Influenza Planning Checklist!'J0V 0 6 2009


o 0 0


o 0 0


o 0 0


0 0 0


0 0 0


0 0 0


0 0 0

• Assigned responsibility tospecifically-trained healthcarepersonnel overseeing the triageprocess.

• Use of signage to direct andinstruct patients with possible PIonthe triage process that is language,format· (i. e., prepared forindividuals with visual, hearing orother disabilities) and reading-levelappropriate.

• A telephone triage system forprioritizing patients who require amedical evaluation (i.e., thosepatients whose severity of symptomsor risk for complications necessitatebeing seen by a physician) .

• Criteria for prioritizing admissionof patients to those in most criticalneed.

• Coordination with local emergencymedical services and 9-1-1 servicesfor transport of suspected flupatients.

• A method to specifically trackadmissions and discharges of patientswith PI.

• A plan has been developed toaddress the needs of specific patientpopulations that may bedisproportionately affected during apandemic or that may need servicesnormally not provided by the MTF(e.g., pediatric and adult MTFs mayneed to extend services to otherpopulations)

4-21 Enclosure (4)

MCO 6220.1

MTF Pandemic Influenza Planning Checklis~OV 0 6 200~

Not Started In progress Completed • Populations to consider:

o o oNot Started In Progress Completed • Children and their families.

o o oNot Started In Progress Completed • Frail elderly and their caretakers.

o o oNot Started In Progress Completed • Young adults.



o 0 0


• Patients with chronic diseases(e.g., diabetes, hemodialysis).

• Physically or mentally challenged /individuals with disabilities.

• Pregnant women.


o 0 0

• Immunocompromised children andadults.

Not Started In Progress Completed • Others. (specify)

o o oNot Started In Progress Completed • Issues to consider:

o o oNot Started In Progress Completed • Clinical expertise available.



• Need for specialized equipment,medical devices, and medications.

• Transportation.

o o o4-22 Enclosure (4)

Mca 6220.1

MTF Pandemic Influenza Planning ChecklistNOV 062009






0 0 0


0 0 0


0 0 0


o 0 0

Not_Started In Progress Completed

o 0 0

• Mental health concerns.

• Need for social services.

• Translation services/medicalinterpreters.

• Cultural issues affectingbehavioral response.

• A plan has been developed forfacility access during a pandemicthat includes the following:

• Criteria and protocols formodifying admission criteria on thebasis of current bed capacity.

• Criteria and protocols for closingthe facility to new admissions andreferrals to other facilities.

• Criteria and protocols for limitingor restricting visitors to the MTF,including specific plans forcommunicating with patients' familiesabout MTF rules for visiting familymembers.

• A contingency plan has beendeveloped in the event of MTFquarantine in conjunction with localjurisdictions to ensure quarantine isenforced and necessary supplies,equipment, and basic necessities canbe delivered and maintained.

4-23 Enclosure (4)

MTF Pandemic Influenza Planning

Mea 6220.1

NOV 0 6 2009Checklist

• MTF security personnel input intoprocedures for enforcing facilityaccess controls.

• Plans for facilitatingidentification (e.g., special badges)of non-facility healthcare personneland volunteers by security staff andfacilitating their access to thefacility when deployed.


0 0 0


0 0 0


0 0 0

• A plan has beenfacility securitythat includes the

developed forduring a pandemicfollowing:


o 0 0


o 0 0


o 0 0


o 0 0

• The identity of key and essentialpersonnel who would have access tothe facility during a pandemic.

• Recruitment and training ofadditional security personnel (e.g.,local police, national guard) that iscoordinated by the local healthauthority.

• Plans for establishing acontrolled, orderly, flow of patientswithin the facility.

• An infection control plan thatincludes the following is in placefor managing MTF patients withpandemic influenza: (For the mostrecent information on pandemicinfluenza infection controlrecommendations for staff in ahealthcare setting, seewww.pandemicflu.gov/plan/healthcare/maskguidancehc.html.)

4-24 Enclosure (4)

Mea 6220.1

MTF Pandemic Influenza Planning ChecklistNOV

0 6 2009


o 0 0


o 0 0


o 0 0

• An infection control policy thatrequires healthcare personnel to useat a minimum Standard Precautions(www.cdc.gov/ncidod/dhgp/gl_isolation_standard.html) and DropletPrecautions (i.e., mask for closecontact)(www.cdc.gov/ncidod/dhgp/gl isolation_droplet.html) with symptomaticpatients.

• A communication plan is developedto inform all MTF staff and employeesabout appropriate need for and use ofinfection control measures, socialdistancing practices, and personalprotective equipment.

• Use of respiratory protection(i.e., N-95 or higher-ratedrespirator as feasible) by personnelwho are performing aerosol-generatingprocedures (e.g., bronchosocopy,endotrachael intubation, opensuctioning of the respiratory tract)Use of N-95 respirators for otherdirect care activities involvingpatients with confirmed or suspectedpandemic influenza is also prudent.If supplies of N-95 or higher-ratedrespirators are not available,surgical masks can provide benefitsagainst large droplet exposures.(Additional guidance available atwww.pandemicflu.gov/plan/healthcare/maskguidancehc.html.)

4-25 Enclosure (4)

MCO 6220.1

MTF Pandemic Influenza Planning ChecklistJ0V 062009


o 0 0


o 0 0


o 0 0

• A strategy for implementingRespiratory Hygiene/Cough Etiquettethroughout the MTF. (For information,seewww.cdc.gov/flu/professionals/infectioncontrol/resphygiene.htm.)

• A plan for cohorting patients withknown or suspected PI in designatedunits or areas of the facility.

• Responsibility has been assignedfor regularly monitoring www.flu.govfor updates/revisions of infectioncontrol recommendations andimplementing recommended changes.Once a PI virus is detected and itstransmission characteristics areknown, HHS/CDC will provide updatedguidance on any need to modifyinfection control recommendations.Any changes to currentrecommendations will be published onwww.flu.gov.

• Primary:

• (Name)

• (Title)

• (Contact info)

• Backup:

• (Name)

• (Title)

• (Contact info)

4-26 Enclosure (4)

Mea 6220.1

MTF Pandemic Influenza Planning ChecklisttJ0V 0 6 2009


o 0 0


o 0 0


o 0 0


o 0 0


o 0 0


o 0 0

• A plan for monitoring adherence toinfection control procedures and formonitoring the effectiveness of theinfection control plan.

• The facility's human resource andpayment policies should be reviewedto identify and eliminate languagethat may encourage staff to work whenill or even when they are symptomaticwith influenza-like illness andespecially when they are within theperiod of communicability. An

occupational health plan foraddressing staff absences and otherrelated occupational issues has beendeveloped that includes thefollowing:

• A liberal/non-punitive sick leavepolicy that addresses the needs ofill and symptomatic personnel andfacility staffing needs duringvarious levels of a pandemic healthcrisis. The policy considers thefollowing:

• The handling of personnel whodevelop symptoms while at work.

• Allowing and encouraging ill peopleto stay home until no longerinfectious.

• When personnel may return to workafter having PI.

4-27 Enclosure (4)

Mea 6220.1



o 0 0


o 0 0


o 0 0


o 0 0


o 0 0


o 0 0

• Personnel who need to care forfamily members who become ill oraffected by closed care centers.

• Personnel who must stay home tocare for children if schools andchildcare centers close.

• A plan to educate staff andvolunteers to self-assess and reportsymptoms of pandemic influenza beforereporting for duty; consider a phonetriage system similar to that usedfor patients.

• A list of mental/behavioral health,community and faith-based resourcesthat will be available to providecounseling to personnel during apandemic.

• A system to track annual influenzavaccination of personnel. (Having asystem in place to track annualvaccination will facilitatedocumentation and tracking of PIvaccine in personnel.)

• A plan for managing personnel whoat the time of a pandemic are atincreased risk for influenzacomplications 7 (e.g., pregnantwomen, immunocompromised workers,employees 65 yrs of age and over). Aplan might include, for example,placing them on administrative leave,altering their work location, orother appropriate alternative.

4-28 Enclosure (4)

Mca 6220.1

MTF Pandemic Influenza Planning Checklisl!0V 0 6 2009


o 0 0


o 0 0


o 0 0

Not Started In Progress Complet~d

o 0 0


o 0 0


o 0 0

• A vaccine and antiviral use planhas been developed. (For usefulinformation on this subject seewww.hhs.gov/pandemicflu/plan) .

• CDC and state health departmentwebsites have been identified forobtaining the most currentrecommendations and guidance for theuse, availability, access, anddistribution of vaccines andantiviral medications during apandemic.

• Local and/or state healthdepartments and the MTF have agreedupon the MTFs role, if any, in alarge scale program to distributevaccine and antivirals to the generalpopulation.

• A list has been developed of keyhealthcare and other personnel whoare essential for maintaining MTFoperations during PI who would be thefirst priority for influenzavaccination.

• A plan is in place for expeditingadministration of influenza vaccineto patients as recommended by thestate health department.

• A plan is in place for expeditingprovision of antiviralprophylaxis/treatment to patients asrecommended by the state healthdepartment.

4-29 Enclosure (4)

Mea 6220.1

MTF Pandemic Influenza Planning ChecklistNOV 0 62009


o 0 0


o 0 0


o 0 0


o 0 0


o 0 0


o 0 0


o 0 0


• A plan is in place for expeditingadministration of influenza vaccineto staff as recommended by the statehealth department.

• A plan is in place for expeditingprovision of antiviralprophylaxis/treatment to staff asrecommended by the state healthdepartment.

• The vaccine/antiviral planconsiders the following:

• How decisions on allocation oflimited vaccine or antivirals will bemade.

• How persons who receive antiviralprophylaxis/treatment will befollowed for adverse events.

• Security issues have beenidentified and addressed in theinfluenza vaccine and antivirals useplans.

• Issues related to surge capacityduring a pandemic have been addressedand discussed with the local and/orState health department and other PIplanning partners.

• Healthcare services.

o o o

4-30 Enclosure (4)

MTF Pandemic Influenza PlanningMca 6220.1

ChecklistNOV 0 6 2009


o 0 0


o 0 0


o 0 0


o 0 0


o 0 0



0 0 0

• Plans include strategies formaintaining the MTFs core missionsand continuing to care for patientswith chronic diseases (e.g.,hemodialysis and infusion services),women giving birth, emergencyservices, and other types of requiredcare unrelated to influenza.

• Criteria have been developed fordetermining when to cancel electiveadmissions and surgeries.

• Plans for shifting healthcareservices away from the hospital,e.g., to home care or pre-designatedalternative care facilities, havebeen discussed with local,state,tribal, or regional planningcontacts.

• Ethical issues concerning howdecisions will be made in the eventhealthcare services must beprioritized and allocated (e.g.,decisions based on probability ofsurvival) have been discussed.

• A procedure has been developed forcommunicating changes in hospitalstatus to health authorities and thepublic.

• Staffing.

• A contingency staffing plan hasbeen developed that identifies theminimum staffing needs andprioritizes critical and nonessential services on the basis ofessential facility operations.

4-31 Enclosure (4)

MCO 6220.1



o 0 0


o 0 0


o 0 0


o 0 0


o 0 0

• The contingency staffing planconsiders how health professionsstudents assigned to the facilitywill be utilized.

• A plan has been developed forutilizing non-facility volunteerstaff, such as those who may be madeavailable through a State EmergencySystem for Advanced Registration ofVolunteer Health Professionals (ESARVHP) to provide patient care when thehospital reaches a staffing crisis.

• The contingency staffing planincludes a strategy for training ofnon-facility volunteers (e.g.,retired clinicians, trainees) andincludes a procedure for rapidcredentialing/privileging (consistentwith the JCAHO disaster privilegingstandard MS.4.110) and badging foreasy identification by security andaccess to the facility when deployed.

• The contingency staffing planincludes a strategy for crosstraining and reassignment ofpersonnel to support criticalservices.

• The contingency staffing planconsiders alternative strategies forscheduling work shifts in order toenable personnel to work longer hourswithout becoming overtired.

4-32 Enclosure (4)

Mca 6220.1



o 0 0


o 0 0


o 0 0

• Responsibility has been assignedfor conducting a daily assessment ofstaffing status and needs during PI.

• Primary:

• (Name)

• (Title)

• (Contact info)

• Backup:

• (Name)

• (Title)

• (Contact info)

• Define criteria for declaring a"staffing crisis" that would enablethe use of emergency staffingalternatives.

• Strategies have been developed forsupporting personnel whose familyand/or personal responsibilities orother barri~rs prevent them fromcoming to work (e.g., strategies thattake into account the principles ofsocial distancing when schools areclosed, care of elders,transportation, reasonableaccommodation or state governmentalmandate) .

4-33 Enclosure (4)

MCO 6220.1



o 0 0


0 0 0


0 0 0


o 0 0


o 0 0

• The staffing plan includesstrategies for collaborating withlocal and regional planning andresponse groups to address widespreadhealthcare staffing shortages duringa crisis, including the developmentof memorandums of advanced agreement(MAAs) and memorandums ofunderstanding (MOUs) with regionaland tribal healthcare partners.

• Consumable and durable medicalequipment and supplies:

• Estimates have been made of thequantities of essential patient carematerials and equipment (e.g.,intravenous pumps and ventilators,pharmaceuticals, diagnostic testingmaterials) and personal protectiveequipment (e.g., masks, respirators,gowns, gloves, and hand hygieneproducts), that would be neededduring an eight-week pandemic withsubsequent eight-week pandemic waves.

• Estimates have been shared withlocal, regional, and tribal planninggroups to better plan stockpilingagreements.

• A strategy has been developed forhow priorities would be made in theevent there is a need to allocatelimited patient equipment (e.g.,ventilators), pharmaceuticals (e.g.,antiviral and antibacterial therapy),and other resources.

4-34 Enclosure (4)

Mea 6220.1



o 0 0


o 0 0


o 0 0


o 0 0


• A plan has been developed toaddress related shortages of supplies(e.g., intravenous fluids, personalprotective equipment), includingstrategies for using normal andalternative channels for procuringneeded resources.

• A list of alternative vendors formedical devices, pharmaceuticals, andcontracted services (e.g., laundry,housekeeping, food services) has beendeveloped.

• A plan has been developed formaintaining critical laboratorytesting capability in-house andpriorities for tests that requireshipping; back-up plans are in placefor testing services that will remainin-house.

• A process is in place to track andreport to public health and otherresponse partners, in real-time,information regarding the status ofthe hospital and resources availablethat would identify burden on thesystem.

• Bed capacity.


o 0 0

• Surge capacity plans includestrategies to help increase hospitalbed capacity.

4-35, Enclosure (4)

Mea 6220.1

MTF P d . I £1 l' Ch k1 . NOV 0 6 2009an em1C n uenza P ann1ng ec 1St

Not Started -In Progress

o oCompleted

o• Signed agreements have beenestablished with area hospitals andlong-term-care facilities to acceptor receive appropriate non-influenzapatients who need continued inpatientcare to optimize utilization of acutecare resources for seriously illpatients.


o 0 0


o 0 0


o 0 0


• Facility space has been identifiedthat could be adapted for use asexpanded inpatient beds and thisinformation has been provided tolocal, regional, and tribal planningcontacts.

• Plans are in place to increasephysical bed capacity (staffed beds),including the equipment, personneland pharmaceuticals needed to treat apatient with influenza (e.g.,ventilators, oxygen, antivirals).

• Logistical support has beendiscussed with local, state, tribaland regional planning contacts todetermine the MTFs role in the setup, staffing, and provision ofsupplies and in the operation of predesignated alternate care facilities.

• Postmortem care:


o 0 0

• A contingency plan has beendeveloped for managing an increasedneed for post mortem care anddisposition of deceased patients.

4-36 Enclosure (4)

Mea 6220.1

MTF Pandemic Influenza Planning ChecklisJ~OV 0 6 2009


o 0 0


o 0 0


o 0 0


o 0 0


o 0 0

• An area in the facility that couldbe used as a temporary morgue hasbeen identified.

• Logistical support for themanagement of the deceased has beendiscussed with local, state, tribal,or regional planning contacts andlocal coroners/medical examiners.

• Local morticians have been involvedin planning discussions.

• Mortality estimates have been usedto anticipate and supply needed bodybags and shroud packs.

• Plans for expanding morgue capacityhave been discussed with local,State, tribal and regional planningcontacts.

4-37 Enclosure (4)

Mea 6220.1

NOV 0 6 2009

Pandemic Influenza


Continuity of Operations(COOP)

P,;lOOl!l{Jl1 ie IillEmergeIllG}'

_ Res ponse P lall1l. ---~ ".'

5-1 Enclosure (5)

Mca 6220.1

NOV 0 6 2009coOP Pandemic Influenza Planning Checklist

• Strategic Objective 1. Throughout pandemic influenza (PI),and in support of HQMC Mission Essential Functions (MEFS), allagencies / personnel must be prepared to perform their highlevel activities and services, including the initial threat oroncoming first wave, through an actual pandemic health crisisand, if necessary, to help reconstitute governmental functions.To accomplish this objective, the following elements andcriteria should be evaluated:

• Validation of your organizational high level activities.

• Identification of positions, skills and personnel neededto continue essential services and functions.

• Documentation of your organizational Delegations ofAuthority and Lines of Succession.

• Identification of who needs access to Classifiedsystems.

• Development and test of a Telework plan.

• Development and test of a social distancing plan.

• Personnel accountability.

• Strategic Objective 2. People accomplish the mission ofMarine Corps agencies, and a potential PI outbreak that couldpotentially affect up to 40% of the workforce, could compromisethe ability of the agencies to accomplish their mission.Agencies must plan to deal with the potential human capitalimplications. Marine Corps personnel, contractor support, andor their family members, may be infected, exposed orincapacitated. There may also be a need to limit potentialexposure. Planning for mission continuity includes the abilityof an agency to provide for the well being and care for allpersonnel prior to, during and following PI.

5-2 Enclosure (5)

COOP Pandemic Influenza Planning Checklist

Meo 6220.1

NOV 0 6 2009

• High-level activities that enable continuation of vitalservices and responsibilities must be identified. Personnelmust be identified and notified of their status as missionessential. To plan for an expected absenteeism rate of up to40%, pre-establishment of Delegations of Authority and Orders ofSuccession are vital. Assessment should include:

• High-Level Activities


o 0 0


o 0 0


o 0 0

Not Started. In Progress Completed

o 0 0

• Does the agency's plan includedefinitions and identification ofessential services and functionsneeded to sustain agency mission andoperations?

• Does the agency's plan includedetermination of which, if any,essential services and functions, ornon-essential operational supportfunctions can be suspendedtemporarily and for what durationbefore adversely impacting agencymission (e.g. up to 40 percentabsenteeism for two (2) weeks duringthe peak of a pandemic, and lowerlevels of absenteeism for a few weekson either side of the peak) .

• Has the agency planned to sustainessential services and functionsduring a pandemic influenza outbreak,under the following scenarios:

• Workforce reductions (up to 40percent absenteeism for two weeksduring the peak of a pandemic, andlower levels of absenteeism for a fewweeks on either side of the peak)?

5-3 Enclosure (5)

MCO 6220.1NOV 0 6 2009

COOP Pandemic Influenza Planning Checklist


o 0 0


o 0 0


o 0 0


o 0 0


o 0 0


o 0 0

• Has the agency developed a broadbased implementation of socialdistancing policies?

• Has the agency identifiedpositions, skills and personnelneeded to continue essential servicesand functions? (For pandemicpurposes, essential personnel mayinclude a larger percentage of theagency workforce than identified inCOOP planning.)

• Has the agency developed a plan toensure and consider appropriate levelof staffing to continue essentialfunctions?

• As appropriate, has the agencyinitiated pre-solicited, signed andstanding agreements with contractorsand other third parties to ensurefulfillment of mission essentialrequirements, including contingenciesfor backup should primary suppliersor contractors be unable to providerequired personnel, services orsupplies?

• Has the agency identified andtrained back-up personnel (2-3 deep)to continue essential services andfunctions, including backup personnelin different geographic locations, asappropriate?

• Has the agency established a .rosterof personnel and back-up personnel,by position, needed to continueessential services and functions?

5-4 Enclosure (5)

MCO 6220.1COOP Pandemic Influenza Planning Checklist NOV 0 6 2009

• Delegations of Authority


o 0 0


o 0 0

• Lines of Succession


o 0 0


o 0 0

• Were delegations of authority atleast three deep and communicated topersonnel?

• Has the agency establisheddelegations of authority to take intoaccount the expected rate ofabsenteeism?

• Were lines of succession at leastthree deep and communicated topersonnel?

• Has the agency established linesof succession to take into accountthe expected rate of absenteeism?

• HQMC's traditional COOP relocation facilities willpotentially provide minimal relief during PI. The global natureof PI will render our ability to relocate personnel thataccomplish critical functions away from the disruption moot.Agencies will identify which functions can be performed fromplaces other than the traditional office (most likely anemployee's home), and identify the requirements required toenable those functions to be accomplished.

Comments:

5-5 Enclosure (5)

Mca 6220.1

NOV 0 6 2009COOP Pandemic Influenza Planning Checklist

• Primary and Alternate Operating Facilities / Worksites


o 0 0


o 0 0

Comments:

• Has the agency developed andimplemented a plan to identifyadequate alternate worksites (e.g.,home or other adequate alternateworksites that maintain socialdistancing measures), as appropriate,to assure capability to maintainessential services for up to severalmonths during a pandemic.

• Has the agency identified whichessential services and functions canbe continued from designatedoperating facilities or alternativeoperating facilities (e.g., home orother adequate alternate worksites)and those that need to be performedat a designated department or agencyoperating facility? (A designatedoperating facility is an existingagency facility that may remain openduring a pandemic with appropriatesocial distancing for staff thatcannot perform their functionsremotely and are needed to supportthe continuation of essentialservices and functions.)

5-6 Enclosure (5)

Meo 6220.1

COOP Pandemic Influenza Planning Checklist NOV 0 6 2009

• Once agencies identify which activities may be performed athome, capabilities must be provided to support communicationsrequirements.

• Telework and Information Technology Capabilities


o 0 0


o 0 0


o 0 0


o 0 0

• Has the agency developed a plan toensure Telework cap~bility andalternative workplace access forappropriate staff, includingpersonnel supporting essentialservices and functions?

• Has the agency reviewed andrevised for all operations, Teleworkpolicies and procedures,incorporating latest OPM guidance, asappropriate, including security,infrastructure, user communications,and operations and maintenance?

• Has the agency assessed andprioritized current Teleworkcapability (number of employees thatcan be Telework enabled) to supportessential functions and otheroperations in terms of equipment andtelecommunications (i.e., laptops,pre-loaded software, broadband, faxmachines, conference call capability,printers, network/remote accesscapability, help desk support, etc.)?

• Has the agency identified anagency Telework coordinator anddisseminated contact informationagency-wide?

5-7 Enclosure (5)

Mca 6220.1



o 0 0


o 0 0


o 0 0


o 0 0


o 0 0

Comments:

• Has the agency determined whichemployees are eligible to Teleworkand offered Telework arrangements toall eligible personnel?

• Has the agency arranged to providetechnology support sufficient to meet.Telework needs during a pandemic?

• Has the agency ensured itstelecommunications infrastructure iscapable of handling Teleworkarrangements and securing sensitiveinformation?

• Has the agency developed andimplemented Telework agreements, andfiled such agreements with theTelework coordinator?

• Has the agency assessed allTelework policies, guidelines, andrequirements for compliance withFederal equal employment opportunitylaws that prohibit discrimination onthe basis of disability, age, orpregnancy, among others?

5-8 Enclosure (5)

MCO 6220.1

COOP Pandemic Influenza Planning Checklist NOV 0 62009


o 0 0

Comments:

• Has the agency identified theequipment and capabilities requiredby personnel. For instance personneldesignated as mission essential mayneed full access to NMCI (email,shared drives, applications etc) andwill require an NMCI laptop, BURASaccess, CAC readers and an Internetconnection. Mission essentialpersonnel may require access toOutlook Web Access (OWA) andrestricted DOD websites (PKI enabled)and will require CAC readers, apersonally owned computer, and anInternet connection. Non-essentialpersonnel mayor may not have arequirement for network access. Nonessential personnel for whom it hasbeen determined access to online Navyservices is required will require CACreaders, a personally owned computer,and an Internet connection. Thosenon-essential personnel that do notrequire access to online NMCIservices shall be instructed toremain in contact with organizationalpersonnel via phone.

5-9 Enclosure (5)

MCO 6220.1

. COOP Pandemic Influenza Planning Checklist NOV 0 6 2009


o 0 0


o 0 0


o 0 0

• Has the agency pre-stagednecessary equipment to enabletelework, including CAC readers andNMCI approved CAC software?

• Has the agency completed OutlookWeb Access (OWA) forms, OWA UserResponsibilities and AcknowledgementForms, and OWA training?

• Does the agency test teleworkcapabilities once each month?

• Although PI will not directly affect the physicalinfrastructure of an agency, PI will ultimately threaten alloperations by its impact on an agencies' human resources. Thehealth threat to personnel is the primary threat to maintainingessential missions and services during a pandemic.

• Education of the workforce regarding health, safety, humanresource issues, personnel responsibilities and actions prior toa pandemic health crisis is critical. Every media availableshould be utilized to pre-position information and keep theworkforce up-to-date on plans and help them understand theirrights and responsibilities.

• Human Resources


o 0 0• Were civilian employees able toidentify the types of leave availableto them in the event they or theirfamily members are infected, exposedor incapacitated, requiring theemployee to stay away from theregular work site?

5-10 Enclosure (5)

MCO 6220.1



o 0 0


o 0 0


o 0 0


o 0 0


o 0 0

• Did essential civilian employeeshave Telework agreements?

• Were non essential civilianemployees aware of "safe haven" orTelework capabilities during apandemic health crisis?

• Did civilian employees know how tocommunicate with their supervisors,and supervisors to employees, tocheck the status, well being andavailability of employees for work?

• Were civilian employees aware ofpotential benefits issues andassistance available to them duringsuch an event?

• Were employees aware of wherethey should seek medical treatmentand information?

• Communication to the Workforce


o 0 0


o 0 0

• Is leadership aware of how theywill be notified that a pandemichealth crisis has occurred or isexpected to occur and to put PI COOPplans in action?

• How will social distancingtechniques be put in place andcommunicated to the workforce?

5-11 Enclosure (5)

Mea 6220.1

COOP Pandemic Influenza Planning Checklist NOV 0 62009

• Protect and Safeguard Personnel


o 0 0


o 0 0


o 0 0


o 0 0


o 0 0

• Were plans in place to mitigatefurther infection control to preventthe spread of the virus, e.g., hasinformation been communicatedregarding methods to prevent thespread of germs?

• Does leadership have a plan toidentify other staff members that mayhave potentially been in contact withstaff member(s) who became ill?

• Are supplies available orpersonnel aware of methods todecontaminate/clean areas the staffmember may have infected that may beused by others?

• Is management aware of steps totake to remove a potentially infectedcivilian employee from the worksiteand to ensure the employee is welland not-contagious before returningto the worksite?

• Has consideration been given tothe potential for utilizinginstallation medical treatmentfacilities or Employee AssistancePrograms to provide trained healthcare provider assistance indiagnosing and verifying potentialinfluenza in a civilian employee atthe worksite who appears ill?

5-12 Enclosure (5)

Mea 6220.1



o 0 0


o 0 0


o 0 0


o 0 0

• Are sufficient and availableinfection control supplies (e.g.,handsanitizers, enviro~mental

cleaning supplies and educationalmaterials) available?

• Have contracts been evaluated todetermine if modification will berequired for housekeeping to cleanfacilities and equipment?

• Is the Human Resources staff ableto provide adequate, proper advice onhow to handle civilian employees whobecome ill in the workplace?

• Does leadership know how torespond to questions on availabilityof vaccines for civilian employees?Does he or she know where to findthose answers?

• Some work must be accomplished at the regular work site.Additionally, some personnel may become ill or be exposed priorto official notification of the onset of a pandemic healthcrisis. Leadership should be prepared to socially distancepersonnel at the regular work site in either event.

• Social Distancing


o 0 0


o 0 0

• For work that had to be done inthe office, were alternative plansmade for accomplishing that work?

• Was consideration given to spacingpersonnel sufficiently apart topromote and support socialdistancing?

5-13 Enclosure (5)

Mea 6220.1



o 0 0• If personnel are sociallydistanced at the worksite can theyaccess their files on a shared driveor otherwise have access to theirwork files if not located at theirregular desk or site?

Not Started In Progress Completed • Was consideration given to shift

0 0 0work to preclude all personnel beingat the regular worksite at the sametime?


o 0 0

Comments:

• Was consideration given toadjusting parking or making otherarrangements for essential personnelto commute to work using personalrather than public transportation?

5-14 Enclosure (5)

Mea 6220.1

NOV 0 6 2009

@. OtTips Pandemic Influenzator

Prcpari ng forPandem'le E' Ju


Preparing the Workplace

6-1 Enclosure (6)

Mea 6220.1

NOV 0 6 2009PREPARING THE WORKPLACE

• A pandemic is a global disease outbreak. Pandemic Influenza(PI) occurs when a new influenza virus emerges for which thereis little or no immunity in the human population, begins tocause serious illness and then spreads easily person-to-personworldwide. Worldwide PI could have a major effect on the globaleconomy, including travel, trade, tourism, food, consumption andeventually, investment and financial markets. Planning for PIis essential to minimize impact. As with any catastrophe,having a contingency plan is essential.

e In the event of PI, leadership will playa key role inprotecting personnel's health and safety. Agencies will likelyexperience personnel absences. Proper planning will protectpersonnel and lessen the impact of PI within the agency. Asstated in the President's National Strategy for PandemicInfluenza, all ·stakeholders must plan and be prepared.

e This PI planning guidance / checklist was developed basedupon traditional infection control and industrial hygienepractices. This guidance is intended for planning purposes andis not specific to a particular viral strain. Additionalguidance may be needed as an actual pandemic unfolds and more isknown about the characteristics of the virulence of the virus,disease transmissibility, clinical manifestation, drugsusceptibility, and risks to different age groups andsubpopulations. This planning guidance should be used to helpidentify risk levels in workplace settings and appropriatecontrol measures that include good hygiene, cough etiquette,social distancing, the use of personal protective equipment, andstaying home from work when ill. Up-to-date information andguidance is available through theewww.flu.gov website.

Enclosure (6)

PREPARING THE WORKPLACE

Mea 6220.1

NOV 0 6 2009

• How a Severe Pandemic Influenza Could Affect the Workplace

• Unlike natural disasters or terrorist events, PI will bewidespread, affecting multiple areas of the United States andother countries at the same time. A pandemic will also be anextended event, with multiple waves of outbreaks in the samegeographic area; each outbreak could last from 6 to 8 weeks.Waves of outbreaks may occur over a year or more. Your workplacewill likely experience:

• Absenteeism - A pandemic could affect as many as 40percent of the workforce during periods of peak influenzaillness. Personnel could be absent because they are sick,must care for sick family members or for children ifschools or day care centers are closed, are afraid to cometo work, or the employer might not be notified that theemployee has died.

• Who Should Plan for a Pandemic

• To reduce the impact of PIon your operations and personnel,it is important to begin continuity planning for a pandemic now.Lack of continuity planning can result in a cascade of failuresas employers attempt to address challenges of a pandemic withinsufficient resources and personnel who might not be adequatelytrained in the jobs they will be asked to perform. Properplanning will allow agencies to better protect their personnel.

@101Tipsfor

Prcparin<r forPandemic Flu

.\ I If' UUOlL I'"LcuJ,,~ nt)(j 1'llIfll'ICr ..

0"

Richard Brenner

- - .II mulli ClJJDl tiD III

Prep "fig forPandemt FIll

6-3

~---~----: ,oun CUll' '0

--~=;.::=:::~- ...:.-..-

-~-

Enclosure (6)


• How Influenza Can Spread Between People

Mea 6220.1

NOV 0 6 200g

• Influenza is thought to be primarily spread through largedroplets (droplet transmission) that directly contact the nose,mouth or eyes. These droplets are produced when infected peoplecough, sneeze or talk, sending the relatively large infectiousdroplets and very small sprays (aerosols) into the nearby airand into contact with other people. Large droplets can onlytravel a limited range; therefore, people should limit closecontact (within 6 feet) with others when possible. To a lesserdegree, human influenza is spread by touching objectscontaminated with influenza viruses and then transferring theinfected material from the hands to the nose, mouth or eyes.Influenza may also be spread by very small infectious particles(aerosols) traveling in the air .. The contribution of each routeof exposure to influenza transmission is uncertain at this timeand may vary based upon the characteristics of the influenzastrain.

6-4 Enclosure (6)


• How Agencies Can Protect Their Personnel

Mca 6220.1

NOV 0 6 2009

• For most agencies, protecting their personnel will depend onemphasizing proper hygiene (disinfecting hands and surfaces) andpracticing social distancing. Social distancing means reducingthe frequency, proximity, and duration of contact between peopleto reduce the chances of spreading pandemic influenza fromperson-to-person. Agencies should implement good hygiene andinfection control practices.

• The types of measures that may be used to protect yourself,and your personnel (listed from most effective to leasteffective) are: engineering controls, administrative controls,work practices, and personal protective equipment (PPE).

• There are advantages and disadvantages to each type ofcontrol measure when considering the ease of implementation,effectiveness, and cost. For example, hygiene and socialdistancing can be implemented relatively easily and with littleexpense, but this control method requires personnel to modifyand maintain their behavior, which may be difficult to sustain.

• Work Practice Controls


o 0 0

• Providing resources and a workenvironment that promotes personalhygiene. For example, providetissues, no-touch trash cans, handsoap, hand sanitizer, disinfectantsand disposable towels for personnelto clean their work surfaces.

6-5 Enclosure (6)


Mca 6220.1

NOV 0 Ii 2009


o 0 0


o 0 0


o 0 0

• Administrative Controls


o 0 0


o 0 0


o 0 0

• Encouraging personnel to obtain aseasonal influenza vaccine (thishelps to prevent illness fromseasonal influenza strains that maycontinue to circulate) .

• Providing personnel with up-to-dateeducation and training on influenzarisk factors, protective behaviors,and instruction on proper behaviors(for example, cough etiquette andcare of personal protectiveequipment) .

• Developing policies to minimizecontacts between personnel.

• Developing policies that encourageill personnel to stay at home withoutfear of any reprisals.

• The discontinuation of unessentialtravel to locations with high illnesstransmission rates.

• Consider practices to minimizeface-to-face contact betweenpersonnel such as e-mail, websitesand teleconferences.

6-6 Enclosure (6)


Mca 6220.1

NOV 0 62009


o 0 0


o 0 0

• Engineering Controls


o 0 0

• Where possible, encourage flexiblework arrangements such astelecommuting or flexible work hoursto reduce the number of youremployees who must be at work at onetime or in one specific location.

• Developing emergency communicationsplans. Maintain a forum for answeringpersonnel concerns. Develop Internetbased communications if feasible.

• Installing physical barriers, suchas clear plastic sneeze guards.

• Personal Protective Equipment

Not Started In Progress Completed • Selected based on the hazard to

0 0 0personnel.

Not Started In Progress Completed • Properly fitted and some must be

0 0 0periodically refitted (e.g. ,respirators) .

Not Started In Progress Completed • Conscientiously and properly worn.

0 0 0

6-7 Enclosure (6)


Mea 6220.1

NOV 0 6 2009

Not Started In Progress Completed • Regularly maintained and replaced,

0 0 0 as necessary.

Not Started In Progress Completed • Properly removed and disposed of to

0 0 0avoid contamination of self, othersor the environment.

• Steps to Reduce the Risk of Exposure to PI in theWorkplace

• The best strategy to reduce the risk of becoming infectedwith influenza during a pandemic is to avoid crowded settingsand other situations that increase the risk of exposure tosomeone who may be infected. If it is absolutely necessary to bein a crowded setting, the time spent in a crowd should be asshort as possible. Some basic hygiene and social distancingprecautions that can be implemented in every workplace includethe following:

• Encourage sick personnel to stay athome.

• Encourage personnel to wash theirhands frequently with soap and wateror with hand sanitizer if there is nosoap or water available. Also,encourage personnel to avoid touchingtheir noses, mouths, and eyes.


0 0 0


0 0 0

6-8 Enclosure (6)


Mea 6220.1

NOV 0 6 2009


o 0 0


o 0 0


o 0 0


o 0 0

• Encourage your personnel to covertheir coughs and sneezes with atissue, or to cough and sneeze intotheir upper sleeves if tissues arenot available. Everyone should washtheir hands or use a hand sanitizerafter they cough, sneeze or blowtheir noses.

• Personnel should avoid closecontact with their coworkers(maintain a separation of at least 6feet". They should avoid shakinghands and always wash their handsafter contact with others. Even ifpersonnel wear gloves, they shouldwash their hands upon removal of thegloves in case their hand(s) becamecontaminated during the removalprocess.

• Provide personnel with tissues andtrash receptacles, and with a placeto wash or disinfect their hands.

• Keep work surfaces, telephones,computer equipment and otherfrequently touched surfaces andoffice equipment clean. Be sure thatany cleaner used is safe and will notharm your personnel or your officeequipment.

6-9 Enclosure (6)


Mea 6220.1

I\!OV 0 6 2009


o 0 0


o 0 0


o 0 0

• Discourage personnel from usingother personnel's phones, desks,offices or other work tools andequipment.

• Minimize situations where groups ofpeople are crowded together, such asin a meeting. Use e-mail, phones andtext messages to communicate witheach other. When meetings arenecessary, avoid close contact bykeeping a separation of at least 6feet, where possible, and assure thatthere is proper ventilation in themeeting room.

• Reducing or eliminating unnecessarysocial interactions can be veryeffective in controlling the spreadof infectious diseases. Reconsiderall situations that permit or requirepersonnel and visitors (includingfamily members) to enter theworkplace. Workplaces which permitfamily visitors on site shouldconsider restricting/eliminating thatoption during PI. Work sites with onsite day care should consider inadvance whether these facilities willremain open or will be closed, andthe impact of such decisions onpersonnel.

6-10 Enclosure (6)


Mca 6220.1

NOV 0 6 2009

Not Stprted In Progress Completed

o 0 0

Comments:

• Promote healthy lifestyles,including good nutrition, exercise,and smoking cessation. A person'soverall health impacts their body'simmune system and can affect theirability to fight off, or recoverfrom, an infectious disease.

6-11 Enclosure (6)

.. ,

Mea 6220.1

NOV 0 6 2009

Pandemic Influenza


Individual and Family

7-1 Enclosure (7)

Individual and Family Planning Checklist

Mea 6220.1

NOV 0 62009

• You can prepare for PI now. You should know both themagnitude of what can happen during a pandemic outbreak and whatactions you can take to help lessen the impact of PIon you andyour family. This checklist will help you gather the informationand resources you may need in case of a flu pandemic.

• Plan for PI


o 0 0


o 0 0


o 0 0


o 0 0


o 0 0

• Store a two week supply of waterand food. During a pandemic, if youcannot get to a store, or if storesare out of supplies, it will beimportant for you to have extrasupplies on hand. This can be usefulin other types of emergencies, suchas power outages and disasters.

• Periodically check your regularprescription drugs to ensure acontinuous supply in your home.

• Have any nonprescription drugs andother health supplies on hand,including pain relievers, stomachremedies, cough and cold medicines,fluids with electrolytes, andvitamins.

• Talk with family members and lovedones about how they would be caredfor if they got sick, or what will beneeded to care for them in your home.

• volunteer with local groups toprepare and assist with emergencyresponse.

7-2 Enclosure (7)


Mea 6220.1

NOV 0 62009


o 0 0



o 0 0


o 0 0


o 0 0


o 0 0



o 0 0


• Get involved in your community asit works to prepare for PI.

• To limit the spread of germs andprevent infection:

• Teach your children to wash handsfrequently with soap and water, andmodel the correct behavior.

• Teach your children to covercoughs and sneezes with tissues, andbe sure to model that behavior.

• Teach your children to stay awayfrom others as much as possible ifthey are sick. Stay home from workand school if sick.

• Items to have on hand for anextended stay at home:

• Examples of food and nonperishables:

• Ready-to-eat canned meats, fish,fruits, vegetables, beans, and soups.

• Protein or fruit bars.

o o oNot Started In Progress Completed • Dry cereal or granola.

o o o

7-3 Enclosure (7)


Mca 6220.1

NOV 0 6 2009


o o o• Peanut butter or nuts.

Not Started In Progress Completed • Dried fruit.


o

o

o

o

o

o• Crackers.

Not Started In Progress Completed • Canned juices.

o o oNot Started In Progress Completed • Bottled water.


o 0 0• Canned or jarred baby food andformula.

Not Started In Progress Completed • Pet food.


o

o

o

o

o

o• Other non-perishable items.


o 0 0


o 0 0


o 0 0

• Examples of medical, health, andemergency supplies:

• Prescribed medical supplies suchas glucose and blood-pressuremonitoring equipment.

• Soap and water, or alcohol-based(60-95%) hand wash.

7-4 Enclosure (7)


Mca 6220.1

NOV 0 62009.

Not Started In Progress Completed • Medicines for fever, such as

0 0 0 acetaminophen or ibuprofen.

Not Started In Progress Completed • Thermometer.

0 0 0Not Started In Progress Completed • Anti-diarrheal medication.

0 0 0

Not Started In progress completed • Vitamins.

0 0 0

Not Started In Progress Completed • Fluids with electrolytes.

0 0 0Not Started In Progress Completed • Cleansing agent/soap.

0 0 0

Not Started In Progress Completed • Flashlight.

0 0 0Not Started In progress Completed • Batteries.

0 0 0

Not Started In Progress Completed • Portable radio.

0 0 0

Not Started In Progress Completed • Manual can opener.

0 0 0Not Started In Progress Completed • Garbage bags.

0 0 0Not Started In Progress Completed • Tissues, toilet paper, disposable

0 0 0diapers.

7-5 Enclosure (7)


• Family Emergency Health Information Sheet

Mca 6220.1

NOV 0 6 2009

• It is important to think about health issues that couldarise if an influenza pandemic occurs, and how they couldaffect you and your loved ones. For example, if a massvaccination clinic is set up in your community, you mayneed to provide as much information as you can about yourmedical history when you go, especially if you have aserious health condition or allergy.

• Create a family emergency health plan using thisinformation. Fill in information for each family member inthe space provided. Like much of the planning for apandemic, this can also help prepare for other emergencies.

• Family Member Information

Family Member Blood Type Allergies Past / Current CurrentMedical Conditions Medications

/ Dosages

7-6 Enclosure (7)


Mca 6220.1

NOV 0 6 ZOOll

• Interim Guidance: Taking Care of a Sick Person in Your Home

• H1N1 flu virus infection (formerly known as swine flu)can cause a wide range of symptoms, including fever, cough,sore throat, body aches, headache, chills and fatigue. Somepeople have reported diarrhea and vomiting associated withH1N1 flu. Like seasonal flu, H1N1 flu in humans can vary inseverity from mild to severe. Severe disease withpneumonia, respiratory failure and even death is possiblewith H1N1 flu infection. Certain groups might be morelikely to develop a severe illness from H1N1 flu infection,such as pregnant women and persons with chronic medicalconditions. Sometimes bacterial infections may occur at thesame time as or after infection with influenza viruses andlead to pneumonias, ear infections, or sinus infections.

• The following information can help you provide safercare at home for sick persons during a flu outbreak or flupandemic.

• How the Flu Spreads

• The main way that influenza viruses are thought tospread is from person to person in respiratory droplets ofcoughs and sneezes. This can happen when droplets from acough or sneeze of an infected person are propelled throughthe air and deposited on the mouth or nose of peoplenearby. Influenza viruses may also be spread when a persontouches respiratory droplets on another person or an objectand then touches their own mouth or nose (or someone else'smouth or nose) before washing their hands.

• People with H1N1 flu who are cared for at home should:


o 0 0

• Check with their health careprovider about any special care theymight need if they are pregnant orhave a health condition such asdiabetes, heart disease, asthma, oremphysema.

7-7 Enclosure (7)


Mca 6220.1

NOV 0 6 2009


o 0 0


o 0 0


• Check with their health careprovider about whether they shouldtake antiviral medications.

• Stay home for 7 days after yoursymptoms begin or until you have beensymptom-free for 24 hours, whicheveris longer, except to seek medicalcare or for other necessities.

• Get plenty of rest.


o 0 0


o 0 0


o 0 0


o 0 0

• Drink clear fluids (such as water,broth, sports drinks, electrolytebeverages for infants) to keep frombeing dehydrated.

• Cover coughs and sneezes. Cleanhands with soap and water or analcohol-based hand rub often andespecially after using tissues andafter coughing or sneezing intohands.

• Wear a facemask - if available andtolerable - when sharing commonspaces with other household membersto help prevent spreading the virusto others. This is especiallyimportant if other household membersare at high risk for complicationsfrom influenza.

• Avoid close contact with othersdo not go to work or school whileill.

7-8 Enclosure (7)


Mca 6220.1

NOV 0 62009


o 0 0


o 0 0


o 0 0


o 0 0



o 0 0


o 0 0


o 0 0

Comments:

• Be watchful for emergency warningsigns that might indicate you need toseek medical attention.

• Get medical care right away if thesick person at home:

• Has difficulty breathing or chestpain.

• Has purple or blue discolorationof the lips.

• Is vomiting and unable to keepliquids down.

• Has signs of dehydration such asdizziness when standing, absence ofurination, or in infants, a lack oftears when they cry.

• Has seizures (for example,.uncontrolled convulsions) .

• Is less responsive than normal orbecomes confused.

7-9 Enclosure (7)


• Medications to Help Lessen Symptoms of the Flu

MCO 6220.1

NOV 0 6 Z009

• Check with your healthcare provider or pharmacist forcorrect, safe use of medications.

• Antiviral medications can sometimes help lesseninfluenza symptoms, but require a prescription. Most peopledo not need these antiviral drugs to fully recover from theflu. However, persons at higher risk for severe flucomplications, or those with severe flu illness who requirehospitalization, might.benefit from antiviral medications.Antiviral medications are available for persons 1 year ofage and older. Ask your health care provider whether youneed antiviral medication.

• Influenza infections can lead to or occur with bacterialinfections. Therefore, some people will also need to takeantibiotics. More severe or prolonged illness or illnessthat seems to get better, but then gets worse again may bean indication that a person has a bacterial infection.Check with your health care provider if you have concerns.

• Warning! Do not give aspirin (acetylsalicylic acid) tochildren or teenagers who have the flu; this can cause arare but serious illness called Reye's syndrome. For moreinformation about Reye's syndrome, visit the NationalInstitute of Health website.

• Check ingredient labels on over-the-counter coldand flu medications to see if they contain aspirin.

• Children 5 years of age and older and teenagerswith the flu can take medicines without aspirin, suchas acetaminophen (Tylenol®) and ibuprofen (Advil®,Motrin®, Nuprin®), to relieve symptoms.

• Children younger than 4 years of age should NOT begiven over-the-counter cold medications without firstspeaking with a health care provider.

7-10 Enclosure (7)


• Medications to Help Lessen Symptoms of the Flu

MCO 6220.1NOV 0 6 2009

• The safest care for flu symptoms in childrenyounger than 2 years of age is using a cool-misthumidifier and a suction bulb to help clear awaymucus.

• Fevers and aches can be treated with acetaminophen(Tylenol®) or ibuprofen (Advil®, Motrin®, Nuprin®) ornonsteroidal anti-inflammatory drugs (NSAIDS).Examples of these kinds of medications include:

Generic Name Brand Name (s)

Acetaminophen Tylenol®

Ibuprofen Advil®, Motrin®, Nuprin®

Naproxen Aleve

• Over-the-counter cold and flu medications usedaccording to the package instructions may help lessensome symptoms such as cough and congestion.Importantly, these medications will not lessen howinfectious a person is.

• Check the ingredients on the package label to seeif the medication already contains acetaminophen oribuprofen before taking additional doses of thesemedications-don't double dose! Patients with kidneydisease or stomach problems should check with theirhealth care provider before taking any NSAIDS.

• Steps to Lessen the Spread of Flu in the Home

• When providing care to a household member who is sickwith influenza, the most important ways to protect yourselfand others who are not sick are to:

7-11 Enclosure (7)


Mca 6220.1

NOV 0 6 2009


o 0 0


o 0 0


o 0 0


o 0 0


o 0 0

• Keep the sick person away fromother people as much as possible,especially. others who are at highrisk for complications from PI.

• Remind the sick person to covertheir coughs, and clean their handswith soap and water or an alcoholbased hand rub often, especiallyafter coughing and/or sneezing.

• Have everyone in the householdclean their hands often, using soapand water or an alcohol-based handrub. Children may need reminders orhelp keeping their hands clean.

• Ask your health care provider ifhousehold contacts of the sickperson-particularly those contactswho may be pregnant or have chronichealth conditions-should takeantiviral medications such asoseltamivir (Tamiflu®) or zanamivir(Relenza®) to prevent the flu.

• If you are in a high risk groupfor complications from influenza, youshould attempt to avoid close contact(within 6 feet) with household

members who are sick with influenza.If close contact with a sickindividual is unavoidable, considerwearing a facemask or respirator, ifavailable and tolerable. Infantsshould not be cared for by sickfamily members.

7-12 Enclosure (7)


• Placement of the Sick Person

Mca 6220.1

NOV 0 6 2009


o 0 0

Not Started In Progress Complet~d

o 0 0


o 0 0


o 0 0


o 0 0

• Keep the sick person in a roomseparate from the common areas of thehouse. (For example, a spare bedroomwith its own bathroom, if that'spossible.) Keep the sickroom doorclosed.

• Unless necessary for medical careor other necessities, people who aresick with an influenza-like-illnessshould stay home and minimize contactwith others, including avoidingtravel, for 7 days after theirsymptoms begin or until they havebeen symptom-free for 24 hours,whichever is longer. Children,especially younger children, mightpotentially be contagious for longerperiods.

• If persons with the flu need toleave the home (for example, formedical care), they should wear afacemask, if available and tolerable,and cover their nose and mouth whencoughing or sneezing.

• Have the sick person wear afacemask - if available and tolerable- if they need to be in a common areaof the house near other persons.

• If possible, sick persons shoulduse a separate bathroom. Thisbathroom should be cleaned daily withhousehold disinfectant

7-13 Enclosure (7)


• Protect other persons in the home

Mea 6220.1

NOV 0 62009


o 0 0


o 0 0


o 0 0


o 0 0


o 0 0


o 0 0

• The sick person should not havevisitors other than caregivers. Aphone call is safer than a visit.

• If possible, have only one adultin the home take care of the sickperson. People at increased risk ofsevere illness from flu should not bethe designated caretaker, ifpossible.

• If you are in a high risk groupfor complications from influenza, youshould attempt to avoid close contact(within 6 feet) with householdmembers who are sick with influenza.If close contact with a sickindividual is unavoidable, considerwearing a facemask or respirator, ifavailable and tolerable.

• Avoid having pregnant women carefor the sick person. (Pregnant womenare at increased risk of influenzarelated complications and immunitycan be suppressed during pregnancy) .

• Avoid having sick family memberscare for infants and other groups athigh risk for complications ofinfluenza.

• All persons in the householdshould clean their hands with soapand water or an alcohol-based handrub frequently, including after everycontact with the sick person or theperson's room or bathroom.

7-14 Enclosure (7)


Mca 6220.1

NOV 0 62009


o 0 0

Not Started In Progress completed

o 0 0

Not Started In Progress completed

o 0 0

• If you are the Caregiver


o 0 0


o 0 0


o 0 0

• Use paper towels for drying handsafter hand washing or dedicate clothtowels to each person in thehousehold. For example, havedifferent colored towels for eachperson.

• If possible, consideration shouldbe given to maintaining goodventilation in shared household areas(e.g., keeping windows open inrestrooms, kitchen, bathroom, etc.).

• Antiviral medications can be usedto prevent the flu, so check withyour health care provider to see ifsome persons in the home should useantiviral medications.

• Avoid being face-to-face with thesick person.

• When holding small children whoare sick, place their chin on yourshoulder so that they will not coughin your face.

• Clean your hands with soap andwater or use an alcohol-based handrub after you touch the sick personor handle used tissues, or laundry.

7-15 Enclosure (7)


Mea 6220.1

NOV 0 6 2009


a a a


a a a


a a a


a a a

• Talk to your health care providerabout taking antiviral medication toprevent the caregiver from gettingthe flu.

• If you are at high risk ofinfluenza associated complications,you should not be the designatedcaretaker, if possible.

• If you are in a high risk groupfor complications from influenza, youshould attempt to avoid close contact(within 6 feet) with householdmembers who are sick with influenza.Designate a person who is not at highrisk of flu associated complicationsas the primary caretaker of householdmembers who are sick with influenza,if at all possible. If close contactwith a sick individual isunavoidable, consider wearing afacemask or respirator, if availableand tolerable.

• Monitor yourself and householdmembers for flu symptoms and contacta telephone hotline or health careprovider if symptoms occur.

• Using Facemasks or Respirators


a a a• Avoid close contact (less thanabout 6 feet away) with the sickperson as much as possible.

7-16 Enclosure (7)

Mea 6220.1NOV 0 6 2009



o 0 0


o 0 0


o 0 0


o 0 0


o 0 0

• If you must have close contactwith the sick person (for example,hold a sick infant), spend the leastamount of time possible in closecontact and try to wear a facemask(for example, surgical mask) or N95disposable respirator.

• An N95 respirator that fits snuglyon your face can filter out smallparticles that can be inhaled aroundthe edges of a facemask, but comparedwith a facemask it is harder tobreathe through an N95 mask for longperiods of time. More information onfacemasks and respirators can befound at www.flu.gov.

• Facemasks and respirators may bepurchased at a pharmacy, buildingsupply or hardware store.

• Wear an N95 respirator if you helpa sick person with respiratorytreatments using a nebulizer orinhaler, as directed by their doctor.Respiratory treatments should beperformed in a separate room awayfrom common areas of the house whenat all possible.

• Used facemasks and N95 respiratorsshould be taken off and placedimmediately in the regular trash sothey don't touch anything else.

7-17 Enclosure (7)


Mca 6220.1

NOV 0 62009


o 0 0


o 0 0

• Avoid re-using disposablefacemasks and N95 respirators, ifpossible. If a reusable fabricfacemask is used, it should belaundered with normal laundrydetergent and tumble-dried in a hotdryer.

• After you take off a facemask orN95 respirator, clean your hands withsoap and water or an alcohol-basedhand sanitizer.

• Household Cleaning, Laundry, and Waste Disposal


o 0 0


o 0 0


o 0 0

• Throwaway tissues and otherdisposable items used by the sickperson in the trash. wash your handsafter touching used tissues andsimilar waste.

• Keep surfaces (especially bedsidetables, surfaces in the bathroom, andtoys for children) clean by wipingthem down with a householddisinfectant according to directionson the product label.

• Linens, eating utensils, anddishes belonging to those who aresick do not need to be cleanedseparately, but importantly theseitems should not be shared withoutwashing thoroughly first.

7-18 Enclosure (7)


Mca 6220.1

NOV 0 6 2009


o 0 0


o 0 0


o 0 0

Comments:

• Wash linens (such as bed sheetsand towels) by using householdlaundry soap and tumble dry on a hotsetting. Avoid "hugging" laundryprior to washing it to preventcontaminating yourself. Clean yourhands with soap and water or alcoholbased hand rub right after handlingdirty laundry.

• Eating utensils should be washedeither in a dishwasher or by handwith water and soap.

• Linens, eating utensils, anddishes belonging to those who aresick do not need to be cleanedseparately, but importantly theseitems should not be shared withoutwashing thoroughly first.

7-19 Enclosure (7)

Wear YourPersonal Protective

EquipmentMea 6220.1

NOV 0 6 2009

Pandemic Influenza


Personnel Protective Equipment

(PPE)

8-1 Enclosure (8)

Personal Protective Equipment

Mca 6220.1

NOV 0 6 2009

• It is recommended that sufficient and accessible infectioncontrol supplies and, if needed, PPE to control the spread ofdisease are provided for your staff and personnel. (Where theleadership has evaluated the work site and determined that PPEis required to be worn, it is the leadership's responsibility toassure that PPE is provided at that site).

• There are various levels of control that can be used toprotect personnel including, engineering controls, workpractices, administrative controls, and PPE. Some examples ofthese controls include: barriers/sneeze guards, promotingpersonal hygiene measures, minimizing face-to-face contact, andgloves/respirators. A combination of these controls is likelyto be used by most agencies. Signage in common areas around theworkplace encouraging and explaining how to use these controlsmay increase awareness and good hygiene behavior.

• Classifying Personnel Exposure to Pandemic Influenza

• Personnel risks of occupational exposure to influenza duringa pandemic may vary from very high to high, medium, or lower(caution) risk. The level of risk depends in part on whether ornot jobs require close proximity to people potentially infectedwith the pandemic influenza virus, or whether they are requiredto have either repeated or extended contact with known orsuspected sources of pandemic influenza virus such as coworkers,the general public, outpatients, school children or other suchindividuals or groups.

• To help leadership determine appropriate work practices andprecautions, the workplaces and work operations have beendivided into four risk zones, according to the likelihood ofpersonnel's' occupational exposure to pandemic influenza. Weshow these zones in the shape of a pyramid to represent how therisk will likely be distributed. The vast majority of Americanworkplaces are likely to be in the medium exposure risk or lowerexposure risk (caution) groups.

8-2 Enclosure (8)


Medium

Mea 6220.1

NOV 0 6 2009

• Very high exposure risk occupations are those with highpotential exposure to high concentrations of known orsuspected sources of pandemic influenza during specificmedical or laboratory procedures.

• High exposure risk occupations are those with highpotential for exposure to known or suspected sources ofpandemic influenza virus.

• Medium exposure risk occupations include jobs thatrequire frequent, close contact (within 6 feet) exposuresto other people such as coworkers, the general public,outpatients, school children, or other such individuals orgroups.

• Lower exposure risk (caution) occupations are those thatdo not require contact with people known to be infectedwith the pandemic virus, nor frequent close contact (within6 feet) with the public. Even at lower risk levels,however, leadership should be cautious and developpreparedness plans to minimize personnel infections.

• Leadership of critical infrastructure and key resourcepersonnel (such as law enforcement, emergency response, orpublic utility employees) may consider upgrading protectivemeasures for these personnel beyond what would be suggested bytheir exposure risk due to the necessity of such services forthe functioning of society as well as the potential difficultiesin replacing them during a pandemic (for example, due toextensive training or licensing requirements)

8-3 Enclosure (8)


PPE Item Cost and Planned Rates of Usage

Mea 6220.1

NOV 0 6 2009

Items Unit Unit Amount CostCost Required per per

Person Personfor 30days

Tissues 100/box $0.90 1 per week.

$3.60

Hand Sanitizer 8 oz. $3.00 1 per week $12.00

Disinfectant 35/box $3.00 1 per week $12.00Wipes

Protective each $1.55 1 per day $46.50Gowns

Disposable each $1.50 1 per day $45.00Coveralls

Goggles each $4.00 1 per person $4.00

Face Shields each $3.00 1 per person $3.00

Gloves 500/box $25.00 25 per day $37.50

Surgical Masks 300/box $60.00 1 per day $6.00

N-95 Masks 200/box $200.00 1 per day $30.00

SAR/PAPR each $600.00 1 per person $600.00

8-4 Enclosure (8)


Mea 6220.1

NOV 0 6 2009

Ensemble Identification and Accompanying PPE

Ensemble 1: Hand sanitizer, tissues, disinfectant wipes

Ensemble 2: Surgical mask, hand sanitizer, tissues,disinfectant wipes

Ensemble 3: N-95, Gloves, hand sanitizer, tissues,disinfectant wipes

Ensemble 4: N-95, gloves, goggles, face shield, protectivegowns / coveralls, hand sanitizer, tissues, disinfectant wipes

Ensemble 5: SAR / PAPR, N-95, gloves, goggles, face shield,protective gowns / coveralls, hand sanitizer, tissues,disinfectant wipes

Ensemble Costs

Ensemble Cost per person/30 days

1 $27.60

2 $33.60

3 $95.10

4 $148.60

5 $748.60

8-5 Enclosure (8)


Level of Risk and Associated Ensemble

Mea 6220.1

NOV 0 6 Z009

."1fil~1m·~aie personnel perfeming aerosol:~ra€ing preeeau~s on p~ patients. Ensem61e (5)

_. .. '. . .

Very High • Laboratory personnel collecting or handling

E'ltposure specimens from PI patients. EnseiDble (4)Risk .-

• HedicalExaminers perferming autopsies.Eil.6':"'l.'le (4)

• Health Care personnel exposed to PI Patients.High Ensemble (3)

Exposure • First Responders (EMT, Fire, MP). Ensemble (3)Risk

• Security guards. Ensemble (2 )

• Response forces with high-frequency contact withthe general public. Ensemble (2 )

• Personnel working in high-density workMedium environments (e.g. , COC, EOC, JOC) . Ensemble (2)

ExposureRisk • Personnel providing care to ill family members.

Ensemble (2 )

• Outpatients seeking treatment at the MTF.

Ensemble (2 )

Low • Personnel with minimal contact with the generalExposure public or co-workers. Eil.semble (1)

Risk ~ Ensemble• General population. (1)

.,

8-6 Enclosure (8)

MCO 6220.1

NOV 0 6 2009

Pandemic Influenza Handbook For Commanders and ManagersCivilian Human Capital Information

Introduction

This handbook provides human capital information to assistcommanders and management officials in preparation for apandemic influenza outbreak. It further serves as a tool formanagement officials by outlining civilian human resourcesflexibilities available to assist in planning for the continuityof operations and maintaining essential functions during a·pandemic outbreak.

Each year in the United States, approximately 5 to 20% of thepopulation contracts influenza resulting in approximately 36,000deaths. A pandemic influenza may result in up to a 40%absenteeism rate that may last six to twelve weeks within aregion where an outbreak is occurring.

Commanders have the responsibility for mission accomplishmentand the well-being of the workforce - both of which could beseriously impacted by a local outbreak of the influenza virus.While it is inevitable that members of the workforce will becomeinfected, there are a number of human resources flexibilitiesthat can assist commands in maintaining continuity of essentialoperations.

Although highlights of civilian human resources programs andflexibilities are provided in this handbook, more detailedinformation is available at the Office of Personnel ManagementPandemic Influenza information website:http://www.opm.gov.pandemic/index.asp

Commands should monitor official announcements related to apandemic influenza health crisis from Federal, State, and/orlocal health officials. Appropriate actions should be taken toprevent the spread of disease in response to guidance frompublic health officials.

Preparing for a Pandemic

It is impossible to know in advance whether a particularinfluenza virus will lead to a human pandemic. Influenza ishighly contagious and can spread rapidly. After employeesbecome ill, there will be little time to establish a plan ofaction and without preparation, commands will be forced to reactto situations rather than act according to plan. A pandemic

9-1 Enclosure (9)

MCO 6220.1

NOV 06 200Q

influenza outbreak can compromise the ability of a command toaccomplish its mission. Commanders should consider thefollowing in preparing for a possible pandemic situation:

• Involve the following personnel during the planning stages:Human Resources, Emergency Management, Information Technology,Security, Safety, Legal, Finance, union officials, medicalprofessionals, and first line supervisors.

• Establish an emergency plan of action. At a minimum, theplan should address procedures to be taken by personnel and thesteps necessary to continue essential operations during apandemic influenza outbreak.

• Test the plan of action to determine its effectiveness andmake any modifications needed.

• Communicate plan of action to the workforce.

Preventive Measures

According to the Centers for Disease Control and Prevention(CDC), influenza is believed to be spread mainly person-toperson through coughing or sneezing of infected people.Preventive measures include':

• Keeping workplaces clean.

• Reminding employees to cover up coughs and sneezes withtissues or upper sleeves and wash hands frequently.

• Avoid touching eyes, nose or mouth.

Workplace posters reminding employees of preventive measures areavailable at the DOD Disaster Preparedness and Response website:http://www.cpms.osd.mil/disasters/.

Social Distancing

Another option for preventing the spread of the influenza virusamong the workforce is the use of social distancing. Socialdistancing is the public health practice of encouraging peopleto keep their physical distance from each other during diseaseoutbreaks in order to stop or slow the spread of infection.Such efforts may become necessary, especially where there havenot been sufficient immunizations within the workforce.

9-2 Enclosure (9)

MCO 6220.1

NOV 0 Ii 2009

In a work environment, social distancing can take the form of:

• Expanding the distance between desks.

• Closing the cafeteria and other gathering locations, tothe extent possible.

• Canceling conferences and well-attended meetings.

• Conducting meetings via the telephone or videoteleconference instead of face-to-face.

• Moving an employee with flu-like symptoms to work apartfrom the remainder of the workforce.

• Authorizing employees to work at alternative locations(See Telework section) .

• Establishing work shifts so there are fewer employees inthe work environment at a given time. (See Work Schedulesection. Establishment of mandatory shifts solely for socialdistancing should be considered as a last resort based on thepossible disruption caused to the employees' personal lives.)

The key to any social distancing effort is to have employeesremain at least 6 feet apart and to avoid handling objectspreviously handled by other employees.

Personnel Accountability

Contact procedures should be in place to achieve 100% personnelaccountability during emergencies. Organizations and employeesmust be made aware of pre-established report in procedures,phone numbers, and e-mail addresses.

• Commanders should ensure plans and procedures are in placefor full accountability of all employees.

• Ensure mechanisms are in place to inform personnel as tothe current operating status of commands/activities.

• Call-in information and procedures should be distributedto all employees prior to the need.

• Ensure employees notify supervisors in a timely mannerwhen emergency and/or personal contact information has beenchanged.

9-3 Enclosure (9)

Mca 6220.1

NOV 0 6 2009

• Conduct call-in exercises to ensure systems and proceduresprovide expected results.

Telework

Emergency Preparations

Telework is an excellent tool in addressing continued missionaccomplishment during a period of pandemic influenza. Teleworkagreements are particularly important for those employeesconsidered essential for mission accomplishment. TeleworkAgreements should communicate expectations for regular, ad hocand emergency telework.

• Sufficient equipment and technical support must beavailable to provide access and assistance to remote users. ITsystems must have the capability to handle increased remoteconnectivity during a pandemic situation.

• IT and information security must be in place and enforcedat the same level whether employees telework or perform dutiesat the traditional worksite.

• Telework should be utilized/tested on a routine basis toensure organizations have the capability to function from remotelocations.

• In an emergency situation, employees may be asked totelework without a prior telework agreement in place.

• Telework may be approved for the length of time theemployee has work to perform at a location other than thetraditional worksite.

Telework and Family Care

Employees may need to provide care to sick family members,and/or childcare for children who have been sent home due to thepandemic.

• If the child or sick family member will require minimalcare, the employee may telework, if approved, during the time heor she is not providing care to the child or sick family member.The employee must request leave for the remainder of the time.

• If the employee will be providing constant care to a childor a sick family member, telework is not appropriate.

9-4 Enclosure (9)

Mca 6220.1

NOV 0 6 2G09

• Employees may also request adjustments to their workschedules in order to perform telework during the time they arenot responsible for family care.

Commands should be flexible when determining whether or not anemployee can accomplish duties from home while caring for achild or sick family member during a pandemic situation.

Medical Considerations

• Commands must protect employee privacy and refrain fromdisclosing the identity of infected employees.

• Directing employees for medical evaluation - Medicalevaluations may only be required when the position occupied bythe employee contains properly developed medical standards orphysical requirements, or it is part of an established medicalevaluation program. Managers should contact their HumanResources and legal office if they have questions about medicalexaminations.

• Commands may contact the on-site or local employee healthservices for resource information regarding transmission ofinfluenza, or any communicable disease, and the precautions thatshould be taken to reduce the illness' spread in the workplace.

Leave

• Normal leave provisions apply.

• Sick (and annual) leave may be used for personal medicalcare, family medical care, bereavement, and exposure to acommunicable disease.

• Employees exhibiting signs of illness should be remindedof their leave options for seeking medical attention, such asrequesting sick or annual leave.

• Sick leave may be granted only when supported byadministratively acceptable evidence as determined by managementofficials. (Generally, a management official may consider anemployee's self-certification as to the reason of absenceas administratively acceptable evidence, regardless of durationof the absence.) A management official may also require amedical certificate or other administratively acceptableevidence for an absence in excess of 3 workdays, orfor a lesser period when management determines it is necessary.

9-5 Enclosure (9)

Mca 6220.1

NOV 0 6 2009

• Sick leave may be appropriate if health authorities(Federal, State, or local) or a health care provider determinesthat an exposed employee may jeopardize the health of others.

• Sick leave should not be granted to employees for thepurpose of caring for a healthy child sent home due to schoolclosures. (Annual leave, other paid time off, or leave withoutpay should be used for this purpose.

Insufficient Leave Balance

Commands may use the following options for employees withinsufficient leave balances during a pandemic, where appropriate:

• Telework.

• Advanced leave.

• Leave donations through the Voluntary Leave TransferProgram;

• Leave Without Pay.

• Excused absence (see Administrative Leave section) .

Administrative Leave (Excused Absence)

If a government-wide policy on excused absence is developed inresponse to a pandemic situation, commands will be notified assoon as possible. Until such time, administrative leave isusually used as the last resort and should only be used forperiods of short duration.

• Administrative leave is a paid, non-duty status that doesnot require the employee's consent or request.

• Employees temporarily prevented from working (e.g.,because of installation/workplace closure) may be grantedadministrative leave if arrangements cannot be made for theemployee to telework or work from an alternative duty station.

• Under special circumstances, employees who pose apotential health risk may be placed on administrative leave andordered to stay away from the workplace, to protect employeesand prevent the spread of disease. Prior to grantingadministrative leave, commands should seek advice from the HumanResource office.

9-6 Enclosure (9)

Mea 6220.1

NOV 0 6 2009

Family and Medical Leave Act (FMLA)

• Employees may invoke entitlement to unpaid leave under.FMLA.

• Employees may take up to 12 weeks of leave without payduring a 12-month period for a serious health condition thatprevents the employee from performing his or her duties or tocare for a spouse, son, daughter, or parent with a serioushealth condition.

• Employees may substitute their accrued annual and/or sickleave for unpaid leave in accordance with current laws andregulations.

Enforced Leave

• Enforced leave occurs when management officialsinvoluntarily place an employee in a non-duty status, i.e.,annual leave, sick leave, or leave without pay. Managementofficials should NOT place an employee on enforced leavewithout first consulting with their Human Resources and legaloffice because such action may constitute an adverse action(constructive suspension) and result in a grievance or an actionappealable to the Merit Systems Protection Board.

Management-Employee Relations

Safeguarding the Workforce When an Employee Exhibits Symptoms ofIllness

• Express general concern and remind the employee of his orher leave options for seeking medical attention, such asrequesting sick leave, annual leave, advanced leave, or leavewithout pay.

• Use telework if appropriate (See Telework section) .

• If other options are not available, place the employee onadministrative leave (See Administrative Leave section) .

Directing an Employee to Leave the Workplace

• If the employee is physically unable to perform work, orposes a health risk to himself/herself or others.

9-7 Enclosure (9)

MCO 6220.1NOV 0 6 2009

• Based on objective evidence (statement from medicalprofessional, employee living in a quarantined area, employeeadmits illness, etc.) only, not suspicion.

• Consider the employee's ability to safely depart theworkplace.

• Consult with Human Resources and legal office ifconsidering this action.

Dealing With an Employee Reluctant to Return to the Workplace

• Direct the employee to report to work or provideadministratively acceptable medical evidence that continuedabsence is necessary.

• An employee who fails to report to work or provideadministratively acceptable documentation may be charged withabsence without leave (AWOL).

• AWOL may result in disciplinary action against theemployee.

Work Schedules

Commands may consider work schedule flexibilities to ensurecontinuity of operations and promote the "social distancing" ofemployees:

• Activities have the discretion to change an employee'swork schedule.

• Work schedule changes must be consistent with law,regulations, and any applicable collective bargaining agreement.

• Alternate work schedules, such as compressed workschedules and flexible work schedules, may be considered.

• Shift work is a mitigation strategy for reducing thespread of germs.

• Activities may require employees to perform overtime work.Overtime pay and premium pay rules still apply during a pandemic.

Pay and Benefits

Certain pay provisions are or may become available during apandemic emergency. These should aid commands in managingworkload and providing assistance to employees. Current

9-8 Enclosure (9)

MCO 6220.1

NOV 0 6 2009employee benefits will remain in effect throughout the course ofany outbreak. In adjusting the schedules of employees topromote social distancing and to provide flexibilities during apandemic, commands should consider the implications of suchadjustments on Overtime Pay, Night Pay, Sunday Pay, and anyapplicable Holiday Premium Pay.

Annual Premium Pay Cap

• If it is determined that an emergency or mission criticalwork condition exists under 5 C.F.R. §550.106, employees may bepaid under an annual premium pay limitation instead of abiweekly limitation.

• Provides a financial benefit for employees whose premiumpay would otherwise cause them to exceed the biweekly limit.

Evacuation Pay

• An agency may order one or more employees to evacuate fromtheir worksite during a pandemic health crisis to a safe havenlocation.

• During an authorized evacuation, employees may be requiredto work from designated safe havens. A safe haven is adesignated area to which an employee will be evacuated, such ashome or an alternate location.

• Evacuation pay is used to ensure employees continue to bepaid when standard time and attendance procedures cannot befollowed.

• Based on regular rate of pay.

Hazardous Duty Pay {HDP)/Environmental Differential Pay (EDP)

• HDP and EDP are additional payments for job-relatedexposure to hazards, physical hardships, or working conditionsof an unusually severe nature which cannot be eliminated orsignificantly reduced by preventive measures (e.g., safetyequipment, protective clothing).

• There is no authority to pay HDP or EDP to employees forthe potential exposure to pandemic influenza.

9-9 Enclosure (9)

MCO 6220.1

NOV 0 62009

Benefits

Benefits for Federal employees and eligible family membersremain unchanged during a pandemic influenza. The following OPMWebsite has a wealth of information about employee and familysupport benefits and policies.http://www.opm.gov/employment_and_benefits/employeesupport2.asp

Hiring Flexibilities

To ensure the continuity of operations of Marine Corp's criticaland essential functions, commands may utilize a variety ofstaffing flexibilities to fill emergency or special staffingneeds by considering excepted appointments; reemployingannuitants; direct hire authority; contractor personnel;competitive service appointments of 120 days or less; and theReemployment Priority List (RPL).

Additional information regarding staffing flexibilities isavailable on OPM's website athttp://www.opm.gov/pandemic/index.asp.

Labor Relations

With almost any action taken by management to address a pandemicinfluenza outbreak, there may be associated labor relationsobligations. If possible, these obligations should be addressedwell before the need arises to take emergency measures.

Planning

Activities should begin now to address what steps may be neededin the event a pandemic influenza outbreak impacts operations.In formulating your plan, it is strongly recommended that unionrepresentatives serve on any planning committee. Plans mayaddress such items as telework and associated technology issues,social distancing, union/employee notification, etc.

Regardless of union involvement on the planning committee, anyfinal plan will have to be shared with the union, and in mostcases, labor relations obligations must be metprior to implementation. (Fulfilling your labor relationsobligations may in most cases be delayed if an actual emergencyexists and immediate implementation of a plan is required forthe necessary functioning of the activity.)

9-10 Enclosure (9)

MCO 6220.1NOV 0 B 2009'

Important First Step

One of the first steps to be taken is to review your collectivebargaining agreement to determine:

• What authorities have already been negotiated;

• What provisions need to be added; and

• Which provisions may serve to hinder the timelyimplementation of your plan.

Where additional provisions are needed or where compliance withthe contract may hinder implementation of an effective pandemicplan, management should immediately address those matters withthe union and seek to make the necessary additions or changes.Where contract provisions need to be modified, the parties can,if appropriate, agree that such changes occur only in thepresence of a pandemic-related emergency.

Emergency Actions

Where a plan of action has not been fully formulated, or wherenegotiations have not been completed and a pandemic outbreakoccurs requiring immediate action necessary to address theemergency:

• Management, in most cases, may take unilateral steps toaddress the emergency prior to fulfilling its labor relationsobligations; but

• Unions should be provided as much advance notice aspossible and bargaining should commence as soon as practicablewith any subsequent agreement receiving retroactive effect tothe extent possible.

Important Note - Management's decision to unilaterally implementchanges to working conditions based on an ~emergency" situationis reviewable in a third party forum via a grievance or unfairlabor practice. In other words, while management may determinethat an emergency exists, such determination is subject to thirdparty review.

Activities are encouraged to work with their servicing CPACs inaddressing the labor relations obligations associated with anypandemic influenza initiative.

9-11 Enclosure (9)

Mea 6220.1

NOV 0 6 2009

Nonappropriated Fund (NAF) Workforce

NAF operates under different personnel policies and regulationsthan appropriated fund employees. For example, NAF employees arenot subject to the statutory biweekly limitation on premium pay.

9-12 Enclosure (9)

Date post:	01-Mar-2018
Category:	Documents
Upload:	buidien
View:	241 times
Download:	1 times

HEADQUARTERS UNITED STATES MARINE CORPS … 6220.1.pdf · headquarters united states marine corps...

Documents