After action report

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  Surveillance and Epidemiology
  
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  Command, Control, and Communications
  
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  Risk Communication
  
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  Resource Coordination
  

The exercise consisted of three sections:

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  Unfolding Situation--Decisions and Responses; A new influenza A subtype has been spreading from person to person in countries in Southeast Asia and initially materializes in the United States in Florida. Participants are required to discuss the steps they would take to prepare for the disease before it spreads to their jurisdiction.
  

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  Later Developments--Decisions and Responses; he disease spreads to Nebraska. Participants are required to discuss everything from how they would initially detect the disease’s presence in their community, to how they would mitigate the disease’s effect on their community, to how they would manage, distribute, and administer a vaccine for the disease.
  

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  Debriefing and Self-Evaluation; Participants reflect on the exercise experience and discuss strengths and areas for improvement. Participants are then asked to identify the three most important gaps that they identified and to outline concrete, short-term plans for beginning to address these gaps.
  

Participants were encouraged to develop short - and long-term plans for all of the gaps identified.

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  The participants of all agencies involved demonstrated an excellent ability to recognize the difficulties of dealing with a pandemic flu emergency.
  
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  The participants demonstrated a positive attitude and ability to recognize and react to shortfalls in planning as they were uncovered.
  
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  Each state understood its own reporting system and had an excellent understanding when to include state Heath and Human Services System.
  
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  Local Health Departments were comfortable with surveillance communication across state lines, on the local level, and stated they would be conducting emails and phone calls with cross border partners as situations developed.
  

In addition, several successes of this exercise should be recognized, among them:

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  This was the first major exercise of this nature that included Colorado, Kansas, Nebraska, and Wyoming.
  
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  It was a major, and positive, undertaking to gather this many partners on a video conference to deal with pandemic flu emergency issues.
  

Through the exercise, several opportunities for improvement in the ability to respond to a pandemic flu incident were identified:

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  It was unclear how states would communicate with one another on the state level and who would be the lead in sharing information.
  
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  There was no clear command structure in place across state lines. The exercise was designed to be played without a declared emergency, or EMAC assistance. Without this declared emergency at the state level, it would be very difficult to coordinate the activities of the four player-states. Each state should determine what would realistically take place in this scenario at their respective state and national levels to determine what support would be available.
  
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  It was clear that, while informal communication between the states was excellent, there is a lack of formal agreements on how health districts should deal with pandemic flu issues across their states borders. It is recommended that each state should revisit the scenario, to explore the possibility of working with local, state and federal agencies in an emergency.