Part of the Plan: Use of Incident Command System (ICS) and Emergency Operation Center (EOC) Structures During the 2009 H1N1 Influenza Vaccination Response

Background: Per the Federal Emergency Management Agency’s National Incident Management System guidelines, the use of incident command systems (ICSs) and emergency operation centers (EOCs) to manage public health emergencies has become more common. In an effort to understand how ICSs and EOCs are used to respond to a vaccine-related emergency, we conducted a survey of Immunization Program Managers (IPMs) regarding their use of ICSs and EOCs during the 2009 H1N1 influenza vaccination response. 

Objectives: Examine how immunization programs used ICSs and EOCs and other preparedness activities during the H1N1 vaccination response, focusing on improving the response to future vaccine-related emergencies.

Methods: The survey was administered via email to 64 state/city/territorial IPMs in June 2010. Data were analyzed using SAS, version 9.2 (Cary, NC).

Results: Eighty-four percent (54/64) of IPMs responded to the survey.  Thirty four percent of IPMs indicated participation in or coordination of preparedness events within two years before the pandemic.  Fifty-six percent found their existing pandemic plan helpful as it provided both an established framework and forged collaborations among entities involved in the response. Of the 44% that found the plan unhelpful to implementing H1N1 vaccines, the primary reasons cited were the inappropriateness of the plan for the specifics of this pandemic and being outdated or inadequate.  Seventy-six percent indicated their health department used ICS and 49% opened an EOC to manage the vaccine campaign. Forty-three percent used both.  ICS commanders were Public Health Preparedness Coordinators (33%), State Public Health Officers (40%) and 23% by various others (i.e. IPMs, State Medical Officers, etc.). ICS was activated for an average of 28 weeks (range: 12-50) during the response.

Conclusions: ICS and EOCs were widely used by health departments during the H1N1 influenza vaccine response.   Flexibility and collaborations were key elements in making use of pre-existing pandemic response plans.