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Pre-Deployment Processes: COVID-19 Considerations

Pre-Deployment Processes: COVID-19 Considerations
Updated Mar. 1, 2021
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Pre-deployment processes, including the pre-deployment briefing, Just-in-time (JIT) training and equipping the team, are discussed in more detail in the RRT General Guidance, Section 4.3 3. Given the concerns for COVID-19 transmission, additional pre-deployment processes may include addressing concerns associated with COVID-19 responders through counseling and the provision of sensitization materials for family members and the community 11, 12. Additionally, a medical pre-deployment screening may be instituted to ensure RRT members do not have underlying medical conditions that might put them at higher risk for severe illness from COVID-19 9. Additionally, if not instituted as part of an RRT readiness process in the Non-Emergency Phase, if the RRT member will require a respirator, they should have an initial fit test for the appropriate model/style/size respirator as dictated by local, national and/or international guidance 13 .

Pre-Deployment Briefing

The purpose of the pre-deployment briefing is to provide situational awareness including the latest information on the COVID-19 outbreak and response to deploying RRT members so that they can be effective and safe in the field. Considering COVID-19 transmission, this can be done remotely but often occurs in person due to the need to equip the RRT around the same time as well as confirming the RRT members can properly don and doff personal protective equipment (PPE) 14 . The following information can be considered for inclusion in a COVID-19 pre-deployment briefing:

  • General information about the status of the outbreak:
  • Latest COVID-19 surveillance data and/or situation reports. This may include local/country specific reports as well as:
  • Previous response efforts prior to the RRT deployment including any RRT debriefings from previous teams returning from the field or reports from local public health authorities
  • Standardized tools and equipment to use in the field (3 Equipping the team), such as:
    • COVID-19 case investigation forms (WHOpdf iconexternal icon, CDC pdf icon[202 KB, 2 pages])
    • Analytic software (e.g. Microsoft Excel©, Epi Info, Go.Dataexternal icon, etc.)
    • COVID-19 laboratory sample collection methods Table 2
    • COVID-19 media materials for the community and healthcare facilities (e.g. pamphlets, posters, etc.) Table 2
    • Local, national, and international guidelines
    • Reporting mechanisms identifying the leadership structure and communication responsibilities at all levels. For example, daily RRT reporting by the team leader to the emergency coordination unit (i.e., a public health emergency management program using an Incident Management System or country-equivalent system)
    • Objectives that are clear and well-defined and lead to concrete activities in the field (Table 3)
    • Indicators or metrics for measuring response effectiveness (Table 3)
    • Update on current safety and security situation, including emergency evacuation plans as well as the following for COVID-19:
      • Practicing proper hand hygiene and wearing of PPE as directed can be included as an activity for all RRT members 14, 15
      • RRT member self-monitoring protocol including how to monitor for signs and symptoms, frequency of checking (e.g. daily fever checks), how this should be documented and guidance on who to report to if they become ill (e.g. medical clinic, RRT leadership, etc.) 16
    • It is Important to highlight resilience information including appropriate protective strategies (e.g. peer support systems and healthy sleeping habits) and available resources to support the mental and behavioral health of the RRT team members while in the field 17, 18, 19

Just-in-time Training

JIT training provides technical information, such as biological and epidemiologic characteristics of the COVID-19 transmission as well as role-specific pertinent information for COVID-19. Considering COVID-19 transmission, JIT training can be provided as e-learning modules, quick webinars, or as reference materials to be reviewed remotely or en route to the field if time does not allow for a more formal training. If the pre-deployment is occurring in-person, JIT training can be provided simultaneously.

CDC is assisting the WHO’s Health Emergencies Programme on the creation of online, open-access COVID-19 RRT specific training materialsexternal icon that can be adapted to a country’s COVID-19 response context. Once finalized, these trainings will include COVID-19 technical modules on IPC, active case finding and contact tracing, RRT composition and roles, occupational safety and health, data management, environmental cleaning, laboratory sample management, and risk communications and community engagement 20, 21 .

There are several other global initiatives for compiling and developing COVID-19 training materials for RRTs. Although the external trainings are not officially endorsed by CDC, they are included here to illustrate the breadth of resources available to be adapted for a COVID-19 RRT JIT training. Some examples include (in alphabetical order):

Maintaining an up-to-date resource database for JIT trainings can save time and effort in deploying a COVID-19 RRT. Table 2 highlights some open-access JIT trainings relevant to a COVID-19 RRT sorted by role. The external trainings are not officially endorsed by CDC but are provided to illustrate examples of materials that may be useful prior to deployment or while in transit. As trainings may become obsolete over time, updated guidance may supersede the trainings presented below.

Table 2

Role

Resource/Training

Role

Epidemiology

Resource/Training

Role

Laboratory

Resource/Training

Role

Infection Prevention Control

Resource/Training

Role

Case Management

Resource/Training

Role

Social Mobilization/Risk Communication

Resource/Training

alert icon

JIT training is one component of a larger RRT training paradigm as mapped out in the RRT General Guidance, Section 3 3 . If RRT training did not exist prior to COVID-19 transmission, JIT training should be used as the RRT onboarding training for new RRT members in the RRT Emergency Phase.

Equipping the Team

Equipping the team for COVID-19 should focus on the technical/scientific supplies, as well as the operational and the safety (e.g. PPE) supplies. Below is a sample equipment list for COVID-19 RRT members deploying to the field. This list should be adapted to the local/national guidance as well as to the context of the COVID-19 response in the country. Extra check boxes have been added to encourage adaptation. The different categories generally align with specific roles on the team, but some overlap is expected. When adapting the list, consider what materials may be available for procurement in the field versus what needs to be procured from headquarters and carried by the RRT to the field. Please see sample equipment

Sample equipment checklist for deploying COVID-19 RRT members

Team Overall

check square light icon List of key contacts (local officials, external partners, national stakeholders, etc.)

check square light icon Most recent situation report (ensure it is regularly received)

check square light icon Money to finance team activities

check square light icon Map (if available) and list of healthcare facilities, by type

check square light icon Mobile phone with sufficient credit to stay in contact with team members and emergency coordination unit

Epidemiology

check square light icon National guidelines for COVID-19 response (WHO/CDC guidelines where national guidelines are not available)

check square light icon National data to reference/comparison with local data (if national COVID-19 RRT)

check square light icon Computer with data analysis software (MS Excel©, EpiInfo, etc.)

check square light icon Copies of COVID-19 RRT surveillance/epidemiology training materials (printed and electronic copies)

check square light icon Standardized line list templates with key variables (printed and electronic copies)

check square light icon Hospital patient registers with key variables

check square light icon Case definitions (printed and electronic copies)

check square light icon Case investigation forms (printed and electronic copies)

check square light icon Notebook and writing utensils

check square light icon Camera, to take photos of hand-written line lists or other documents for later analysis

check square light icon GPS for healthcare facility coordinates

Laboratory

check square light icon National guidelines for laboratory protocols and testing (if don’t exist, include WHO protocols)

check square light icon Sample collection job aids

check square light icon Laboratory training materials (printed and electronic copies)

check square light icon Laboratory request form

check square light icon Gloves

check square light icon N95 masks

check square light icon Gowns

check square light icon Face shields

check square light icon Head covers/shoe covers if collecting samples

check square light icon Specimen collection supplies (swabs, sterile transport tubes, sterile saline, sputum collection cup – may vary depending on type of test administered)

check square light icon Transport media

check square light icon Cold packs/cooler (per assay requirements)

check square light icon Specimen collection bags

check square light icon Laboratory coats (disposable if appropriate)

check square light icon Permanent markers

check square light icon Laboratory tape/labels

check square light icon Packaging and shipping materials

Infection Prevention and Control

check square light icon Surgical masks and respirators (e.g. N95 mask)

check square light icon Face shields or goggles

check square light icon Gloves

check square light icon Gowns

check square light icon Other PPE per national guidelines

check square light icon Alcohol-based hand rub (if available)

check square light icon Soap

check square light icon Handwashing stations with covers and spigots

check square light icon Healthcare facility evaluation checklist

check square light icon Social mobilization/information education and communication materials

check square light icon Cleaning and disinfection supplies (e.g. bucket, cloths, 0.1% sodium hypochlorite or other disinfectant, 0.5% chlorine for large spills)

Case Management – Patient Care

check square light icon Medications for disease treatment (per local and/or national guidelines)

check square light icon Medical supplies for patient treatment (e.g. needles, intravenous tubing, oxygen tubing, oxygen tanks, etc.)

check square light icon Supplies to assess patient status (e.g. pulse oximeter, blood pressure cuff, etc.)

Case Management – Health Facility

check square light icon National guidelines for COVID-19 clinical care, healthcare facilities, etc.

check square light icon RRT case management training materials (printed and electronic copies)

check square light icon Clinical care posters/media for healthcare facility staff

check square light icon Case investigation forms (printed and electronic copies)

Social Mobilization/Risk Communication- Household/ Community

check square light icon Brochures, factsheets, posters specific to COVID-19

check square light icon Health education/health promotion materials for distribution

check square light icon Information on access to nearest healthcare facility and pharmacies

check square light icon Megaphone

check square light icon Photo and video equipment (per local guidance and attitudes toward photography and filming) including lenses, batteries, chargers, memory cards, and storage for media

check square light icon Awareness of recent/historical events impacting a community’s willingness and ability to engage in preventative behaviors

check square light icon Risk communication materials developed for previous outbreaks to be used as reference

Social Mobilization/Risk Communication – Health Facility

check square light icon National guidelines for outbreak response

check square light icon Patient management posters for COVID-19

check square light icon Educational posters and/or pamphlets for patients, caregivers, and contacts (if appropriate)

check square light icon Awareness of recent/historical events impacting health facility staff and patients (e.g. shortages of PPE in the area)