Urban City is a metropolis with a large commuter workforce with major hubs where large numbers of commuters congregate while waiting for connections. Recently, Urban City has been experiencing an early influenza season, with more than usual numbers of people becoming ill with colds and flu.

One weekday, the Universal Adversary terrorist group disburses aerosol anthrax among the commuters using a concealed improvised spraying device. The commuters do not notice the fine aerosol hanging in the air around them.

Twelve hours post-release, patients within and outside of Urban City present to emergency departments with influenza-like-illness complaints and symptoms. Many are seen and discharged, while a few are serious enough to require admission. Eighteen hours post-release, with large numbers of patients overwhelming emergency departments and clinics, and multiple fatalities, a diagnosis of respiratory anthrax is made in several hospitals in the area. Local public health departments determine that the cases shared common commute locations and issue a case definition and alert to healthcare providers. Law enforcement and CDC are notified.

* HICS recommendations	Medworxx ERS Solutions
Does your hospital have a procedure for notifying appropriate internal experts, including infectious diseases, infection control and hospital epidemiology?	Maintain a real-time contact directory of all internal and external personnel and volunteers. Use ERS notification tools to send information and updates to groups of users. Post mandatory Alerts through the system and run reports to make sure they are read.
Does your hospital have a process to ensure staff personal protection and communicate appropriate infection precaution instructions staffing a timely manner?	Store all policies and procedures in a central document repository and distribute as needed. Guides, posters and other presentation media can also be stored in the repository. Train staff with online courses and track compliance.
Does your hospital have a process to inventory appropriate medications, including antibiotics?	Manage all resources including Persons, Equipment, Supplies, Facilities and Aircraft. Resource Management includes typing, inventories, deployment and tracking.
Does your hospital identify essential personnel (i.e., medical, nursing, environmental services, facilities, nutrition and food services, administrative, respiratory therapy, radiology technicians, medical records, information technology and laboratory, etc.) that would be priority for receiving prophylaxis and PPE to protect those staff most at risk and to ensure the continuation of essential services?	Build and Manage Skills Inventories for all Persons in the system (Internal, External and Volunteers) before an incident. Determine essential skills and run reports on the skills inventory to prioritize prophylaxis distribution.
Does your hospital have a means of notifying external partners, e.g., public health, law enforcement, emergency management agency?	Integrate with automated notification engines. Export the contact directory from ERS and get a report of who was notified and when they can respond. It makes no difference if the contacts are internal staff or external agencies.

* HICS recommendations	Medworxx ERS Solutions
Does your hospital have a procedure established to provide ongoing situational briefings to staff and patients, including description of incident and safety issues?	Keep everyone informed with ERS' internal content management system. Share status, situation awareness, briefings, incident details and FAQs with the hospital or community as this information is produced.
Does your hospital have a procedure to regularly update the facility status and communicate critical issues/needs to the local EOC?	Configure External Responder Portal to share information in real-time with partners and agencies not on ERS. For each portal, you decide what information to share and external responders see data as you update it via a secure web portal.
Does your hospital have a procedure to track and report to HCC and local authorities the ED/clinic and inpatient census and symptoms.	Integrate directly with existing ADT system for patient census and status. If integration is not desired, track patients and beds directly in ERS.
Does your hospital have a plan to adjust staff schedules to meet the needs of the response including: Reassigning staff who have recovered from flu to care for flu patients? Reassigning staff at high risk for complications of flu (e.g., pregnant women, immunocompromised persons) to low risk duties (e.g., no flu patient care or administrative duties only)?	Track 'flu status' of all staff through the person module with extensible attributes. Run reports to identify high-risk staff and those already recovered from flu and adjust scheduling accordingly.
Does your hospital have inventory procedures for: Current hospital supplies of medications, equipment and supplies? Receiving medications, equipment and supplies from outside resources (i.e., federal, state or local stockpiles, vendors, other facilities) and returning those medications or supplies upon termination of the event?	Manage resources from typing and inventories through deployment and recovery. Include external supplies in your inventory under unique categories to enhance tracking and returns.