Developing and Implementing an Approach to “All Hazards Emergency Response” Jim Price,...
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Transcript of Developing and Implementing an Approach to “All Hazards Emergency Response” Jim Price,...
Developing and Implementing an Approach to “All Hazards Emergency Response”
Jim Price, Tacoma-Pierce County Health Department
Session Objectives
• Know the difference between a plan and a procedure
• Understand how to organize a set of Emergency Plan and Implementing Procedures (EPIPs)
• Know the steps to develop an EPIP
• Understand the need for a process for administrative review and approval
A. 100%
B. 50-99%
C. 25-49%
D. <25%
Poll Question 1
In my opinion, the percent of staff in my health department who understand the difference between a plan and an implementing procedure is:
“Plan”
• Document containing policies and response requirements
• Not a list of steps/job actions
• Includes all hazards: Biologic Natural disaster Technologic
What is an EPIP?
An EPIP is the collection of job task sheets and associated information organized by Emergency Response Organization Sections or Branches.
How policies and requirements are to be implemented
Includes:• Emergency response• Program maintenance
Emergency Plan Implementing Procedures
VS.
Plan vs. EPIP – Example
•Establish an EP program = policy•Elements of the EP program = requirements
•How to accomplish requirements = EPIP:
Who receives initial callHow call triagedHow event level
determinedWho/what/how is
information communicatedHow ERO accomplishes their tasks
Emergency Plan Implementing Procedures
Normal Ops(SOP)
Emergency Ops(EPIP)
(EPIP)
Standard Operating Procedure
A. Yes
B. No
Poll Question 2
Do you now feel that you could describe the difference between a plan and a procedure?
Developing EPIPs
•What are the established requirements and policies to be covered?
•What ERO positions are to be included?•What are the logical steps (task analysis) to
complete the identified task(s)?•How can the EPIP be organized for ease of use?
Review:
Checklist:•Is the EPIP consistent with other EPIPs?
•Can the EPIP be understood by the user?
EPIP 1:
Writing EPIPs
•Biologic
•Natural disaster
•Technological
At TPCHD, divided incident types into categories: Recognition of
emergency conditions
OperationsSection Chief
Triage UnitLead
Field FacilitiesBranch Director
POD / BDS Group Supervisor (1)
POD / BDS Group Supervisor (2)
POD / BDS Group Supervisor (3)
POD / BDS Group Supervisor (5)
POD / BDS Group Supervisor (6)
Containment Group Supervisor
Enforcement Unit Lead
[ Monitoring ]
Phone MonitoringUnit Lead
Field MonitoringUnit Lead
Alternate Triage & Treatment Center Branch Lead
POD / BDS Group Supervisor (4)
Triage Group Supervisor (1)
Triage Group Supervisor (2)
Triage Group Supervisor (1)
Triage Group Supervisor (2)
Operations Section Chief
Mission:Activates, coordinates, and provides overall command and control of identified operations support staff. This staff include the Triage Unit, and the Field Facility Branch.
EPIP Template
•Position title
•Mission
•Location•Chain of
command•Job task
sheets
Located:TPCHD Emergency Operations Facility (EOF)
EPIP Example
A. Having systems in place to recognize incident
B. Driving the response by determining the severity of the incident
C. Realizing that PH emergencies can emerge slowly
D. Early notification that PH emergencies can emerge slowly
Poll Question 3
In my opinion, the following is most important in recognizing an emergency condition:
Evaluate the need for SNS.The County Executive or designee should havemade an emergency proclamation prior to theSNS request going forward to the State EOC.
If an SNS request is anticipated,complete a request letter and forwardto the Policy Liaison in the EOC.
Direct the OperationsSection Chief toactivate the necessarynumber of PODs.
Start Here
Evaluate the need to implement containmentmeasures. If containment measures may beneeded, go to EPIP 4h for additionalinformation.
Obtain approval from the TPCHDHealth Officer to implementvoluntary containment measures.
Coordinate steps to obtain aninvoluntary containment order withthe Operations Section Chief and theTPCHD Health Officer or delegate,and legal council.
If not already accomplished, request the EOCOperations Liaison to activate the Hospital Bio-Plan.
Continued on next page
Direct the Operations Section Chief toactivate the Investigation Branch and initiatesurveillance activities.
Direct Finance/Admin.Section Chief todistribute the drug cacheto ERO staff through thesign-in/sign-out process.
Request the EOF Liaison to contact the DOH Duty Officer and request PugetSound Air Quality to pull the bio-watch sample and determine if any PierceCounty biological sentinel systems have detected positive indications for abiological agent.
Incident Manager, EPIP 4
Organizing the EPIPs
EPIP 1: Recognition of Emergency Conditions
EPIP 2: Notification and Communication
EPIP 3: Emergency Operations Facility
EPIP 4: Biological Incident
EPIP 5: Natural Disaster
EPIP 6: Technological Incident
EPIP 7: Maintaining Emergency Preparedness
Incident Recognition: HealthIncident Flow Sheet
EPIP 1
Emergency Plan Policies Requirements InfrastructureMaintaining Emergency
Preparedness EPIP 7
RespiratoryProtection
EPIP 7a
TrainingEPIP 7c
Facilities &Equipment EPIP
7b
Standard OperatingProcedures
Drills & ExercisesEPIP 7d
Procedure Dev./Maint
EPIP 7e
Program QualityImprovement
EPIP 7f
Notification/CommunicationEPIP 2
Biologic AgentResponse
EPIP 4
Small PoxEPIP 4d
RecoveryEPIP 3h
POD OperationsEPIP 4e
ContainmentOperations
EPIP 4f
Pandemic FluEPIP 4b
AnthraxEPIP 4c
Natural DisasterResponse
EPIP 5
EarthquakeEPIP 5a
FloodEPIP 5b
LaharEPIP 5c
TechnologicalIncident Response
EPIP 6
RadiologicalMaterials Response
EPIP 6a
Chemical ReleaseEPIP 6b
Operation of the EOFEPIP 3
Finance/AdminSectionEPIP 3a
PHIO SupportUnits
EPIP 3b
Operations SectionEPIP 3c
Planning SectionEPIP 3d
Logistics SectionEPIP 3e
Alternate Triageand Treat Center
EPIP 3f
Continuity ofOperations
EPIP 3g
Response to aBDS Alarm
EPIP 4a
Poll Question 5
My PH jurisdiction has a formal system for categorizing the severity of an incident.
A. Yes
B. No
EPIP 1: Recognizing Emergency Conditions
• Public health emergencies begin slowly.• System in place to recognize incident.• Tie response to severity of incident.• Recognition and notification are vital.
Poll Question 6
My PH jurisdiction has a system for identifying action levels based on the severity of an incident.
A. Yes
B. No
Recognizing Emergency Conditions (cont.)
Identify levels of response for the LHJ:• Off-normal• Low • Medium• High
TPCHD Emergency Action Levels
Response:
• Notify other program on-call staff and Public Health Information Officer (PHIO).
• Enter data into incident tracking.
Off-normal incidents involve no program resource reallocation, but may have media or significant public concerns. Inquiries are defined as off-normal incidents.
Low level incidents require a resource reallocation by a single department program to appropriately respond to the incident.
Response: • Notify other program on-call staff, PHIO, and
Emergency Operations Facility (EOF) manager.
• Enter data into incident tracking.
• Potential for limited activation of the EOF.
TPCHD Emergency Action Levels (cont.)
TPCHD Emergency Action Levels (cont.)
Medium level incidents require resource reallocation by more than one program within the Health Department to appropriately respond to the incident.
Response:• Activate the EOF.
• Notify Pierce County Department of Emergency Management.
• Notify Washington Department of Health.
TPCHD Emergency Action Levels (cont.)
Response: • Activate the EOF.• Notify Pierce County Department of
Emergency Management.• Notify Washington Department of Health.• Request activation of the county EOC.
High level events impact TPCHD as well as other outside agencies.
Data Source Minimum Suspicion levelFood & Community Safety ----- Suspicious incident or significant increase in foodborne illness or pool, spa, or school
related complaintsEnvironmental Health ----- Reports of unexplained symptoms, suspected illness, or contamination associated with
environmental agents----- Reports of water system tampering/contamination.
Communicable Disease Control ----- Suspicious or unusual clustering of incidents or cases of disease.Syndromic Surveillance ----- Statistically significant increase in a syndromeDeath Surveillance ----- Unexplained death or cluster of suspicious deathsLaw Enforcement ----- Credible third party concerning terrorists threatSensors ----- Positive indications on JSIPP, BDS, or BiowatchDisaster ----- Significant imminent or actual incident requiring TPCHD responseOther ----- Significant media or public concern calls may be receivedZoonotic Disease Surveillance ----- Suspicion of a link between animal and human diseaseProgram Resources ----- May require Program resource realignment to appropriately respond
Urgent situation or likely togenerate media or publicconcern
Convene/notifyrepresentatives from CD,EH, F&CS, & PHIO
Is Incident potentiallyclassified at low,medium or high?
Report at dailybriefing
Determine statusof incident
Increased # reportabledisease or othercomplaints overexpected norm, withepidemiologic links
Suspicious unexplaineddeath
Suspicious or unusualclustering of events
# of cases of importantsyndromes seen at ERsor by EMS significantlyhigher than expected.
Detection of highpathogen avianinfluenza in U.S.
Evidence of intentionalwater systemcontamination.
Reallocation ofProgram resources torespond to the incident.
Outbreak or incident likely tooverwhelm resources of a program orgenerate a high level of publicconcern
Increased # of reportable diseases orother complaints > expected norm,with high potential for secondaryspread
Greater or more than 2 cases ofsimilar unexplained critical illness ordeath with infectious hallmarks &epidemiologic links
Rare death with possibleenvironmental or food-related cause.
Extremely suspicious or unusualclustering of incidents
Likely case of human to humantransmission of avian influenza inmajor U.S. transportation hub.
Illness associated with water systemtampering.
Reallocation of multiple Program’sresources to respond to the incident.
Outbreaks or eventlikely to overwhelmthe resources ofTPCHD
Disease or event withpotential for extremepublic health impactor public panic
ImplementEPIP #2
yes
yes
HEALTH INCIDENT FLOW SHEET
STATUS DETERMINATION & RESPONSE Date Initiated __________
Identify & notifyIncident Manager
Notify EOFManager
Note: This will link to EPIP #2, HealthIncident Status: Low, Medium or Higher
Use next page to document steps.
nono
No actionrequired.Considerentering
into IncidentTracking
Enter into Incident Tracking
HIGHMEDIUMNormal LOW
OffNormal
Requires additionalProgrammatic
attendtion beyondwhat is considerednormal, i.e., non-
compliant TBpatient, Pandemic
Alert, Phase 3
Notify Program Lead or appropriate PublicHealth Manager, report at the daily briefing. Ifevent occurs after the daily meeting send out
an email to the HD Surveillance List.
EPIP 2: Notification and Communication
• Concept of Operations
• Declaring an Emergency
Incident is off-normal
Incident is low level
Incident is medium level
Incident is high level
EPIP 2: Notification and Communication
Attachments:
1. TPCHD Emergency Response Organization Activation List
2. EOF Support Unit List
3. TPCHD Emergency Response Facilities Telephone List
4. Outside Agency Contact List
5. TPCHD Safety Monitor Contact List
6. Local Health Jurisdiction Contact List
EPIP 2: Notification and Communication (cont.)
Attachments (cont.)
7. TPCHD Situation Report
8. TPCHD GIS Unit
9. TPCHD Language Unit
10. Media Outlet Contact Lists
11. Public Information Officer Contact List
12. TPCHD Essential Services Functions Contact List
13. Pierce County High School Contact List
EPIP 3: EOF Command Staff
• EOC Policy Liaison
• EOF Incident Manager
• EOF Manager
• Safety Officer
• Liaison Officer
• Public Health Information Officer (PHIO)
EPIP 3: EOF General Staff/Activities
3a: Finance/Admin Section
3b: PHIO Support Units
3c: Operations Section
3d: Planning Section
3e: Logistics Section
3f: Continuity of Operations
3g: Alternate Triage and Treatment Sites
3h: Recovery
Event Based EPIPs
• EPIPs 4, 5, and 6 categories of incident types:
Biologic
Natural disaster
Technologic
• Provide information on general tasks for each category.
• Actions for specific types of incidents are included in the next level of EPIP.
EPIP 4: Biologic
4a: Response to a BDS Alarm
4b: Small Pox
4c: Pandemic Influenza
4d: Anthrax
4e: Operating Points of Dispensing
4f: Containment Operations
EPIP 5: Natural Disasters
5a: Earthquake
5b: Flood
5c: Lahar
EPIP 6: Technologic
6a: Radiological
6b: Chemical
EPIP 7
Provide information on how the Public Health Emergency Preparedness and Response Program is being administered.
• Procedure development• Training• Drills and exercises
• Facilities and equipment• Respiratory protection• Quality improvement
Notification is received into LHJCall is triaged and appropriate Program Identified.
Step 2: If incident meets minimum suspicion level, otherProgram Representatives notified and conference isheld to determine level of emergency condition.
Step 1: Program Representative reviews HealthIncident Flow Sheet (EPIP 1)
Step 3: Additional ERO staff/facilities are activated, andoutside agencies notified.
Step 4: EPIP 3 reviewed to determine general actionsto be taken regardless of type of incident.
Step 5: Appropriate incident specific EPIP (4, 5, or 6)reviewed to determine any additional actions to be takenfor that specific incident.
Step 6: Appropriate incident type specific EPIP (# a, b,c, d, etc.) reviewed to determine any additional actionsto be taken for that specific type of incident.
Questions?
Comments?