Open Access Open Access  Restricted Access Subscription or Fee Access

An influenza pandemic exercise in a major urban setting, Part I: Hospital health systems lessons learned and implications for future planning

Wendy H. Lyons, RN, MSL, Frederick M. Burkle Jr, MD, MPH, DTM, FAAP, FACEP, Deborah L. Roepke, MPA, James E. Bertz, MD, DDS, FACS


A 2007 pandemic exercise in Maricopa County, Arizona, the 5th largest urban population in the United States, revealed major vulnerabilities in planning, response, resource utilization, and the decision-making process, which would be common to any large urban setting where multiple independent organizations exist and have not yet coordinated or shared their plans. Communication challenges are both prevalent and magnified in large urban settings. There must be tough, broad-based decision making by healthcare leadership with guidance and processes at every level to assure compliance to the primary goals of pandemic flu plans necessary to control the transmission rate of the disease. A unifying decision-making element such as a Health-related Emergency Operations Center is critical for the coordination, which serves all urban health systems. Education and training in pre-event protocols for triage management is crucial at every level where resources will be scant. This is especially true in admissions to intensive care units and priorities for ventilator use.


pandemic planning, urban disaster planning, disaster exercises, hospital system pandemic planning, health emergency operations centers, pandemic triage, emergency preparedness, NIMS Compliance, Hospital Incident Command Centers, Medical Coordination Cente

Full Text:



Corburn J: Confronting the challenges in reconnecting urban planning and public health. Am J Public Health. 2004; 94(4): 541-546.

Kochtitzky CS, Frumkin H, Rodriquez R, et al.: Urban planning and public health at CDC. MMWR Morb Mortal Wkly Rep. 2006; 55 (Suppl 2): 34-38.

Maldin B, Lam C, Franco C, et al.: Regional approaches to hospital preparedness. Biosecur Bioterror. 2007; 5(1): 43-53.

Light PC: The Katrina effect on American preparedness. New York University Center for Catastrophe, Preparedness, and Response (Report), 2006. Available at Accessed November 11, 2008.

Gray BH, Hebert K: After Katrina: Hospitals in hurricane Katrina. Available at Accessed November 11, 2008.

MathEcology, LLC: MathEcology Version DoDIM 1.0 (customized for public health data calculated). Phoenix,AZ: MathEcology,LLC, 2007.

Christian MD, Hawryluck L, Wax RS, et al.: Development of a triage protocol for critical care during an influenza pandemic. CMAJ. 2006; 175(11): 1377-1381.

Burkle FM Jr, Hsu EB, Loehr M, et al.: Definition and functions of health unified command and emergency operations centers for large-scale bioevent disasters within the existing ICS. Disaster Med Public Health Prep. 2007; 1(2): 135-141.

Bielajs I, Burkle FM Jr, Archer FL, et al.: Development of prehospital, population-based, triage-management protocols for pandemics. Prehosp Disaster Med. 2008; 23(5): 420-431.

Burkle FM Jr: Population-based triage-management in response to surge-capacity requirements during a large-scale bioevent disaster. Acad Emerg Med. 2006; 13(11): 1118-1129.

World Health Organization: Epidemic and pandemic alert and response. Avian influenza-situation in Pakistan-update 2. Available at Accessed January 11, 2009.



  • There are currently no refbacks.