Isolation & Quarantine
Response

Core Elements of Planning


PRIMARY RESPONSE FOCUS AREAS FOR PUBLIC HEALTH
The core of our operations plan consists of three primary response focus areas. As you build your plan, you may consider including additional response focus areas based on your expert skills.

Surveillance and Epidemiology. This focus area will be managed and conducted by our existing communicable disease experts. Their work will be supported by other epidemiologists pulled from other programs areas who have been trained to support communicable disease staff in their outbreak investigation work. The primary difference between day-to-day operation and activation is the number of epidemiologists assigned.

Legal Response Team. It is important to understand and document the processes for establishing involuntary detention for isolation and quarantine. Staff on the Legal Team would assist with preparation of factual declarations and track due dates.

Case and Contact Monitoring. We have expertise in tracking and following the line of case contact investigations, but did not have a structure to support it beyond about ten or twenty people. An Isolation and Quarantine Response Center (IQRC) was developed to put this expertise into practice on a much larger scale.

Social and Human Support for Individuals and Families in Isolation or Quarantine. Supporting individuals and families who have been told to stay put through an isolation or quarantine order was a focus area we needed community partnership assistance. Early on in our planning efforts, we reached out to the social services provider communities to help us with this aspect of the isolation and quarantine response.

INVOLVING THE RIGHT PARTNERS
A broad roster of individuals and agencies would be required as responders in the event of I & Q implementation. In addition to coordinating the implementation of I & Q with traditional "response partners" (e.g., fire, law enforcement, EMS, emergency management, hospitals), you will need strong ties to social service community partners who can assist in supporting medically fragile populations.

PLANNING CONSIDERATIONS FOR BUILDING THE OPERATIONS MODEL
Assumptions for Structuring Internal Operations

• Isolation and quarantine is a subset of communicable disease surveillance activities.


• For a surge situation, it is possible to package isolation and quarantine monitoring as a subset of the work as long as reporting pathways to Communicable Disease-Surveillance are strong and quality assurance strategies exist.


• Cultural competency must be embedded in the work (e.g., interpreter services are always available as needed).


• All policies and procedures to assure the care of protected health information (PHI) apply. HIPAA applies unless waived by the Federal government.


• Even if not "fully mobilized," apply principles of Incident Command System to assist in the allocation of resources (e.g. staff, electronic equipment, field staff services).

Guidance for Developing Internal Operations

• Review and examine any policies, Standard Operating Procedures (SOP) , and current plans in place that relate to the area in which you are planning the internal structure.


• Review and examine your laws as they apply to isolation and quarantine.


• Examine the connections already in place for the daily work of communicable disease, clinical practice, community based Public Health infrastructure, and health provider communities.


• Examine the organization emergency planning structure and determine how to connect this plan into overall planning.


• Think about evaluation measures as you proceed in planning.


• Identify the systems and processes needed to document assurance activities with respect to the legal requirements of isolation or quarantine. For example, addressing needs while in isolation or quarantine.

Using an Isolation and Quarantine Response Center (IQRC) Organizational Chart



Download PDF of chart

• Nomenclature at Lead level and above is prescribed by National Incident Management System (NIMS). Nomenclature below Lead level needs to be descriptive and not duplicate any title in the structure above.


• At the present stage of development in this chart Leads report to Leads.


• Reporting is always vertical, moving upward. It is important that procedures and Job Cards articulate that staff in a job function can complete the work as outlined in job aids, keeping their lead apprized of issues and reporting any problems they are not able to solve.

Developing Job Cards

Job Cards need to prescribe the duties of the job and reference other job aids such as procedures, prepared FAQs, department policy/procedures, for example, HIPAA regulations.

Illustrating an Example Site Plan

An IQRC Site Arrangement Sample has been included to illustrate an Isolation and Quarantine Resource Center site. Set-up will be specific to your site and resources. Keep in mind the number of phones and holding capacity of equipment.

Response Coordination
Key elements of case/contact response coordination are identification, assessment, monitoring and support. We developed a variety of Tools & Samples that can be used for operational planning. Key tools for response coordination include:

• I&Q Bridge of Day-to-Day to Emergency Operations. This diagram illustrates the required activities once it is determined that an individual needs to be in isolation or quarantine, and the point at which daily monitoring can follow. Performing these activities may be fluid depending upon: the disease, role of health care providers/hospital discharge planners, work levels within CD-Epi, etc. The roles of Intake-Discharge Lead and Intake-Discharge Coordinator were developed to accommodate the fluidity of these activities. They also serve as key to managing the "caseload" within the IQRC. In addition these roles, which will probably entail multiple coordination and follow-up phone calls, frees the Monitoring Lead (and Monitors) to pursue the volume of check-in work which will exist in the IQRC.


• Daily Monitoring Algorithm. After considering possible problems and interactions that could arise in the monitoring process, we found it necessary to simplify. This algorithm represents the fundamental work involved in a daily monitoring call.


• Daily Brokering Plan Sample Form. This tool is a key communication tool between several parties. It is used to document confirmation of how requests will be sent to the broker from the IQRC. It is meant to document any plan alterations and promote some regular communication between the point persons.


• Daily Liaison Contact Sheet Sample. The IQRC will need to have active liaison relationships with many Public Health resources as illustrated on the IQRC Organizational Chart. The purpose of the contact sheet is to identify the people in those positions and with their contact numbers.