ESF8: Medical Surge Planning and Coordination

Emergency medical surge planning in your County and the value of

integrating medical and non-medical volunteers into your plan

AGENCY LOGO

Emergency Support Function #8- Health and Medical (ESF8)

ESF8 is a system of health and medical agencies that are coordinated in an emergency based on a common set of established plans, tools and resources in order to meet specific outcomes that affect the health and medical care of those involved in the incident (casualties and responders.)

ESF8 as a System

• NIMS/ICS principles apply to incident response but not always to EOC management

• Existing system of relationships become extended beyond agency/jurisdictional boundaries– Examples: Infection Control, Patient triage and

tracking, Surge staffing for Alternate Care Facility• ESF8 System Models

– Basic: agency-agency– Intermediate: multi-agency, limited number of

ESFs– Complex: multi-agency, multi-jurisdictional, full

EOC response

ESF8 as Outcomes• Effective Patient Tracking• Effective coordination in response

(resolves differences among agencies)• Efficient utilization of resources• Efficient and rapid response and request

for support• Common operational model (local, state,

federal)• Ensures agency response is competent

based on agency/discipline standards• Strategic guidance and direction

Daily Organizational Objectives

Time

DepartmentalOperations Center

EmergencyOperations Center

Daily Organizational Objectives

DepartmentalOperations Center

Complexity Analysis

ICS Level Change

Authority Change

Emergency Response

Where did ESF originate?

• National Response Framework- assigned federal agencies to “Emergency Support Functions”:– Guidance: “Governments at all levels should use the

NIMS resource management principles described below to enhance response capabilities.”

– State Emergency Operations Plan (SEOP)– County Emergency Operations Plan (Contains ESF

annexes)– Post 9-11 mandate to remove the “silos” that limit

communication between organizations.

• “Seat” in the EOC/MACG?– Ops vs. non-ops. Where will you fit in?

National Response Framework (NRF)

• Framework Document (Base Plan)• Support Annexes• Incident Annexes • Emergency Support Function (ESF) Annexes

– Outline agency responsibilities for coordination, planning, support, resources, program implementation, and services during emergencies

ESF #11 - Agriculture and Natural ResourcesESF #12 - EnergyESF #13 - Public Safety and SecurityESF #14 - Long-Term Recovery/MitigationESF #15 - External Affairs

ESF #1 - TransportationESF #2 - CommunicationsESF #3 - Public Works, EngineeringESF #4 - FirefightingESF #5 - Emergency ManagementESF #6 - Mass Care, HousingESF #7 - Resource SupportESF #8 - Public Health, Medical, MortuaryESF #9 - Urban Search and Rescue ESF #10 - Oil and Hazardous Materials

Colorado Emergency Support Functions

1. Transportation 6. Mass Care, Housing &

Human Services

11. Agriculture & Natural

Resources

2. Communications 7. Resource Support 12. Energy

3. Public Works & Engineering

8. Public Health & Medical

8a . Mental Health

13. Public Safety & Security

4. Fire Fighting

4a. Wildfire Suppressions

9. Search & Rescue 14. Long Term Community Recovery & Mitigation

5. Emergency Management 10. Oil & Haz Mat Response

15. External Affairs

ESF #8: Public Health, Medical, Mortuary

• CDPHE can provide local jurisdictions the following types of support:– Health Surveillance – Biological Hazards Consultation – Pharmaceutical Supplies and Distribution – Assessment of Health/Medical Needs – Health/Medical Equipment and Supplies – Medical Care Personnel – Mortuary Services – Food and Drug Safety – Potable Water/Wastewater – Solid Waste Disposal – Radiological and Chemical Hazards Consultation – Vector Control – Environmental Impact Assistance – Public Health Information

ESF 8: Public Health and Medical

Functional Role Organization Participant

Public Health Authority Local Public Health Department

Hospitals Trauma Centers

Critical Access Hospitals

Veteran’s Hospitals

Private Physicians Medical Society

Independent Physicians Association

Primary Care Offices

Emergency Medical Services (EMS)

Fire Department, EMS Services

EMS Coordinator

Mental Health Department of Human Services

Mass Fatalities Management Coroner

Level 1Local, State, Federal

Response

Federal Declaration

Department of Justice

Health & Human

Services

Environmental Protection

Agency

Federal Emergency

Management Agency

Department of Energy

Department of Defense

Interior

Transportation

General Services American

Red Cross

Other Federal Agencies

TransportationCOVOAD

volunteers

Human Services

MilitaryAffairs

Governors’ Office

Governor

Local Affairs

Public Health &

Environment

Others

Level 2State, Local Response

State Declaration

Personnel and Admin

Public Safety

Higher Education

Div of Emergency

Mgmt

Dept of Agricultur

e

Natural Resources

Local Affairs

Regulatory

CountyCommissioners

City Council

ResponseTeams

Level 3Regional Response

Others

Police Dept

Fire Dept

City Council

PublicWorks

CitizensGroups

EMS Hospitals

Level 4Local Response

Local HD

Other

Disaster Event

Emergency Manager

ActivationMust ESF8 be activated by

emergency management?

Medical Surge ESF8 Activation Thresholds

Hospital needs additional resources

Patient surge exceeds hospital

Consider activating Mesa County Hospital

Coordination Center

Consider activating Mesa County Multi-

agency Coordination Group

Medical Resources exceed availability in county

Patient surge exceeds county

Consider Declaration of Emergency

ESF8 Planning Committee Mission Statement:

• “The County Emergency Support Function 8 Planning Committee (ESF8 Committee) is a multi-disciplinary, coordinating group representing ESF8 agencies and organizations. The Committee addresses critical healthcare needs in our Community. The ESF8 Committee develops strategies and solutions which synchronize the use of diverse healthcare resources during emergencies or disasters affecting County.

ESF 8 On the Ground

County Health Department

Medical Supply Caches/Warehouse

Communications Center

Hospital Coordination System or Hospital Designee

Emergency Medical Services

County Healthcare Coordination System

(HCS)/ESF8 Medical Reserve Corps

State PH Liaison

Regional Liaisons

CDEM/RETAC/Public Health

Hospital #1

Hospital #2

Hospital #3

TIER III

TIER ITIER IITIER IV

VA Hospital

County Emergency Operations Center (EOC)

EMS Agencies

Primary Care & Medical Offices

Human & Environmental Health

Basic Response Example: Agency to Agency

• Hospital-EMS

• Public Health- Hospital ICP

Intermediate Response Example: Multi-Agency, Multi-Jurisdiction,

Limited Number of ESFs

• Alamosa, CO, Salmonella (ESFs 3, 5, 8, and 15)

• Limited geographic area flooding/natural disaster.

• Chemical hazmat spill response with casualties.

• H1N1? Intermediate or severe? Where were we at?

Complex Response Example: Multi-Agency, Full EOC Response

• Catastrophic natural event (Snowstorm, outbreak, flooding)

• Pitkin County, CO- Dirty bomb/mass casualty

• Train derailment (i.e. Silverton-Durango, Amtrak)