Situation Manual Template - Web viewIdentify at least one gap in your agency’s existing...

Pandemic Influenza TabletopSituation Manual

January 8, 2014Lutheran Medical CenterFacilitator: Kelly Keenan

EXERCISE OVERVIEW

Exercise Name Foothills Healthcare Coalition Pandemic Influenza Tabletop

Exercise Dates January 8, 2014

ScopeThis exercise is a Tabletop Exercise that is planned for 4 hours at Lutheran Medical Center.

Mission Area(s) Protection, Response, Recovery

PHEP and HPP Capabilities

Community/ Healthcare System Preparedness, Emergency Operations Coordination, Public Health Surveillance and Epidemiological Investigation, Emergency Operations Coordination, Preparedness Information Sharing

Objectives

Describe your agency’s roles in the response. Identify at least one gap in your agency’s existing Emergency

Operations Plan. Articulate the process to contact appropriate partnering agencies

during business hours, as well as after hours, for response to a pandemic influenza outbreak.

Threat or Hazard Pandemic Influenza

Sponsor Jefferson County Public Health and Foothills Healthcare Coalition

Participating Organizations Please see Appendix B.

Point of Contact

Kelly Keenan, MPHJCPH Emergency Response Planner & FHCC [email protected] 303-271-8391

Kim Vowell, CSPSt. Anthony Hospital Safety Manager & FHCC [email protected] •720-321-0134

5/5/2023 Foothills Healthcare Coalition 2

GENERAL INFORMATION

TABLETOP EXERCISE

This exercise is a tabletop exercise. In a tabletop exercise, people come together to review and discuss a hypothetical emergency situation. It is designed to allow participants to talk through plans and problems. It is NOT designed to measure anyone’s performance, but designed to evaluate processes. This exercise will serve as a springboard for further planning and more comprehensive exercises.

EXERCISE OBJECTIVES AND CORE CAPABILITIES

The exercise objectives in Table 1 describe the expected outcomes for the exercise. The objectives are linked to core capabilities, which are distinct critical elements necessary to achieve the specific mission area(s). The objectives and aligned core capabilities are guided by elected and appointed officials and selected by the exercise planning team.

Table 1. Exercise Objectives and Associated Core Capabilities

Exercise Objective PHEP and HPP Capabilities

Describe your individual and your agency’s roles in the response

Community/ Healthcare System Preparedness, Emergency Operations Coordination, Public Health Surveillance and Epidemiological Investigation

Identify at least one gap in your agency’s existing Emergency Operations Plan

Emergency Operations Coordination

Know how to contact the appropriate partnering agencies during business hours as well as after hours

Preparedness, Information Sharing

EXERCISE STRUCTURE

This exercise will be a facilitated exercise. Players will participate in the following 5 modules:

Module 1: Detection Module 2: Communication Module 3: Outbreak / Investigation Module 4: Crisis Module 5: Long Term Effects (Recovery)

Each module begins with an update that summarizes key events occurring within that time period. After the updates, participants review the situation and engage in functional group discussions of appropriate protection and response issues. For this exercise, the functional groups are as follows:


Public health Hospitals EMS Long term care and home health agencies Community Associates, include emergency management, corners and behavioral health

After these functional group discussions, participants will engage in a moderated large group discussion, in which a spokesperson from each group will present a synopsis of the group’s actions, based on the scenario.

PARTICIPANT ROLES AND RESPONSIBILITIES

The term participant encompasses many groups of people, not just those playing in the exercise. Groups of participants involved in the exercise, and their respective roles and responsibilities, are as follows:

Players. Players are personnel who have an active role in discussing or performing their regular roles and responsibilities during the exercise. Players discuss or initiate actions in response to the simulated emergency.

Evaluators & Note Takers. Evaluators and Note Takers do not directly participate in the exercise. However, they may support the development of player responses to the situation during the discussion by asking relevant questions or providing subject matter expertise. They are assigned to observe and document certain objectives during the exercise. Their primary role is to document player discussions, including how and if those discussions conform to plans, polices, and procedures.Facilitators. Facilitators provide situation updates and moderate discussions. They also provide additional information or resolve questions as required. Key exercise planning team members also may assist with facilitation as subject matter experts (SMEs) during the exercise.

EXERCISE GUIDELINES

This exercise will be held in an open, low-stress, no-fault environment. Varying viewpoints, even disagreements, are expected.

Respond to the scenario as if it was real, using your knowledge of current plans and capabilities (i.e., you may use only existing assets) and insights derived from your training.

Decisions are not precedent setting and may not reflect your organization’s final position on a given issue. This exercise is an opportunity to discuss and present multiple options and possible solutions.

Issue identification is not as valuable as suggestions and recommended actions that could improve response and recovery efforts. Problem-solving efforts should be the focus.


EXERCISE GROUD RULES

Please respect the following ground rules.

Respond as if the scenario is real.

Don’t “play” the scenario or get stuck in the weeds.

Play the role of your department, agency or community throughout the exercise.

Operate within current resource constraints and realities.

This is a no fault environment, no answers are wrong.

Be respectful of everyone.

Respect everyone’s time, no side bar conversations.

Participate and actively engage in the discussion.

EXERCISE ASSUMPTIONS AND ARTIFICIALITIES

In any exercise, assumptions and artificialities may be necessary to complete play in the time allotted and/or account for logistical limitations. Exercise participants should accept that assumptions and artificialities are inherent in any exercise, and should not allow these considerations to negatively impact their participation. During this exercise, the following apply:

The exercise is conducted in a no-fault learning environment wherein capabilities, plans, systems, and processes will be evaluated.

The exercise scenario is plausible, and events occur as they are presented.

All players receive information at the same time.

EXERCISE EVALUATION

Evaluation of the exercise is based on the exercise objectives and aligned PHEP and HPP capabilities, capability targets, and critical tasks. Evaluation will be based on the notes taken by the Evaluators and Note Takers. Additionally, players will be asked to complete participant feedback forms. These documents, coupled with facilitator observations and notes, will be used to evaluate the exercise and complete the After-Action Report (AAR).

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MODULE 1: DETECTION

Day 1

A 47-year-old man from Golden, Colorado arrives at the emergency department (ED) at Foothills Hospital with fever, chills, malaise, cough, and shortness of breath. He is a prominent wildlife photographer who returned two days ago with his wife from an assignment in Hong Kong. Last night, despite feeling feverish and tired, he attended an awards banquet with 200 of his colleagues the night before.

At Foothills Hospital he is evaluated in the Emergency Department. A chest x-ray reveals pneumonia. He is subsequently intubated and placed on a ventilator due to severe respiratory distress. Just as he is moved to the Intensive Care Unit (ICU), his wife begins to complain of similar symptoms and is admitted as a patient at Foothills Hospital.

His wife’s respiratory status severely deteriorates and she is urgently transferred to the ICU. The photographer suffers a cardiac arrest and cannot be revived. He passes away. Meanwhile, his wife struggles to stay alive.

The Infection Preventionist (IP) is concerned based on rapid onset of illness in both patients. The IP orders an infectious disease (ID) consult. The ID specialist interviews the couple’s family and learns the husband was assigned to Hong Kong to photograph migratory birds. The ID specialist orders specimen collection and a battery of tests.

KEY ISSUES

A patient has presented to the local emergency department with unusual symptoms and pneumonia after returning from overseas travel. After suffering cardiac arrest, he passes away.

His wife begins struggling with similar symptoms and is on life support.

ID specialists within the hospital are concerned and begin an investigation.


MODULE 2: COMMUNICATION

Day 3

Lead article in Morbidity and Mortality Weekly Report (MMWR) describes a recent cluster of human avian influenza A (H5N1) cases in Eastern Europe. New human cases of avian influenza A (H5N1) continue to be reported by World Health Organization (WHO) in South East Asia. The report says that human-to-human transmission has occurred, but remains limited to household contacts and health care staff caring for confirmed cases. The WHO increases the Global Pandemic Alert Level to the “alert phase”.

Four more patients arrive at Foothills Hospital with severe influenza-like illness. One of the new patients mentions they had recently traveled from Hong Kong.

Day 5

Colorado Department of Public Health and Environment (CDPHE) reference lab reports that original sample from the index case is positive for Avian Influenza A Type H5. That specimen is sent to CDC for confirmatory testing.

After receiving the lab results, CDPHE notifies Jefferson County Public Health and Foothills Hospital of these results. CDPHE and local public health departments notify healthcare providers in the state are notified of the diagnosis using the Health Alert Network (HAN). Additionally, the HAN explains that all suspect cases are to be reported into CEDRS using a newly developed diagnosis called “H5N1”, or reported directly to local public health.

Epidemiological contact tracing begins to identify contacts of the suspected cases, starting with banquet attendees and flight passengers.

The story becomes breaking news. Headlines include: Possible avian flu case in Golden, CO; this is believed to be the first case of avian flu diagnosed in a US citizen!; Suspected case was on a recent international flight!; Suspected case attended a large public gathering shortly after returning!; We are all at risk of bird flu exposure!;

The public stars to panic. Government officials and local hospitals receive calls from media outlets around the country. Jefferson County Public Health and several area hospitals receive calls from panicked citizens. CO-HELP is activated to address public concerns. Jefferson County Public Health releases information to the public about proper hygiene during influenza outbreaks.

KEY ISSUES

New human cases of avian influenza A (H5N1) continue to be reported by the WHO and a recent cluster of human cases in Eastern Europe was reported in a large publication.


Human to human transmission has occurred, but remains limited.

CDPHE State Lab has confirmed the index case’s sample was positive for avian influenza type H5, and this sample has been sent to CDC for confirmatory testing.

Healthcare providers in the state are notified of the incident using the Health Alert Network. The media is reporting this information, which is causing public panic.


MODULE 3: OUTBREAK AND INVESTIGATION

Day 9

CDOHE receives confirmation of positive H5N1 influenza from CDC. At the request of CDPHE, CDC deploys Epidemic Intelligence Service (EIS) officers to Colorado to help with case investigations. Suspected cases and their contacts are monitored by the health department, many are placed under quarantine orders.

In addition to the index case, two more patients who had contact with the index case have died (suspected H5N1). Healthcare agencies begin to see increasing numbers of staff calling in sick or not reporting to work. The school district notices a marked decrease in attendance of students so they begin to push messaging to parents that sick students should stay home.

Day 12

Foothills Hospital admits several more patients with suspected avian influenza, including two of their own healthcare workers. They begin to see an increase in employee absenteeism. Other hospitals in Colorado are seeing patients with similar symptoms and reporting those cases to CDPHE using CEDRS. Hospitals across Colorado are nearing or are at capacity according to EMSystems HavBed reports.

Worldwide there are reports of sporadic cases of severe influenza in East Asia, Eastern Europe and, most recently, in Africa. Mortality of patients with avian flu in Asia has exceeded 50%. WHO states that it is still at the Alert Phase and requests nations continue to analyze the risk for their population and act accordingly.

KEY ISSUES

CDPHE and CDC confirm cases of H5N1 avian influenza in Colorado; 8 confirmed 43 suspected cases.

The illness is spreading and hospitals are becoming overwhelmed by patients seeking treatment.

Hospitals are running short on critical supplies and also notice a significant impact on staffing due to the illness.

Local health departments are using a large number of staff to conduct case investigations and manage quarantine.

WHO states that it is still at the Alert Phase and requests nations continue to analyze the risk for their population and act accordingly.


MODULE 4: CRISIS

Day 16

Regional hospitals report shortage of ventilators, ED beds and ICU beds. Hospitals are triaging patients, admitting only the most severe cases.

Public health officials determine most effective control measures. Pharmaceutical and community containment strategies are evaluated.

Day 23

Two Jefferson County pharmacies have experienced burglaries, presumably by persons looking for antivirals. Law enforcement is unable to respond immediately because of unprecedented absenteeism among officers.

Local healthcare facilities report an increase in employees calling in sick; many are unwilling to come to work. Absenteeism is on the rise in essential services such as waste collection, utility services, and public safety. Many businesses encourage workers to telecommute. The State of Colorado declares a statewide public health emergency.

KEY ISSUES

Increased absenteeism is making everyday duties difficult, with critical infrastructure affected.

Many businesses are being forced to adjust work hours, workload, and responsibility due to increased sick calls.

Citizens are concerned and acting irrationally, breaking into local pharmacies seeking antivirals and other medications.

The State of Colorado declares a statewide public health emergency.


MODULE 5: LONG-TERM EFFECTS (RECOVERY)

Day 31

CDC further classifies outbreak as a novel strain of avian influenza H5N1 with genetic components of human influenza. Evidence supports person-to-person transmission. There have been almost 1,000 suspected cases statewide. 75 have died, including numerous healthcare workers and first responders.

Some mortuaries refuse to accept bodies of people who died of influenza. Funeral homes overwhelmed. There are long delays in providing funerals and burial services.

In the U.S., public health officials struggle to control the spread of influenza H5N1. Public health systems and hospitals remain overwhelmed and severely lacking in supplies and staffing.

Local businesses are suffering from lack of workers and customers. Poultry consumption is down because consumers are afraid of getting sick from eating chicken.

Public health officials predict that the pandemic will continue for several more months and result in over 85,000 deaths nationwide. Estimated nationwide economic impact will exceed $100 billion.

KEY ISSUES

WHO states they have moved into the Pandemic Phase (global spread of a new subtype of influenza).

Mortuaries are now overwhelmed by the staggering number of deaths. Some are confused about transmission of illness so they refuse to accept bodies who died from influenza or related complications.

US public health officials struggle to control the spread of illness.

Local businesses are suffering due to loss of revenue and staff illness and death.

The poultry industry has been negatively affected due to the “avian” influenza and sales of chicken have decreased dramatically.

Economic impacts are seen far and wide, with estimates of over $100 billion in negative impact.


APPENDIX A: EXERCISE SCHEDULE

Time ActivityJanuary 8, 2014

12:00-12:30 Lunch, welcome and opening remarks

12:30-12:50 Module 1: Detection

12:50-1:30 Module 2: Communication

1:30-1:45 Break

1:45-2:15 Module 3: Outbreak & Investigation

2:15-2:45 Module 4: Crisis

2:45-3:00 Break

3:00-3:30 Module 5: Long-term Effects (Recovery)

3:30-4:00 Hot Wash


APPENDIX B: QUESTIONS BY FUNCTIONAL GROUP

Public Health Functional Group

MODULE 1Public Health Questions

The hospital may have questions about what type of infection control measures should be in place for the ill couple. What resources would you use to answer this question?

Is this situation serious enough that you would be concerned? If not, when would you become concerned?

Looking ahead, what are the primary responsibilities of the public health department in this type of situation?

Large Group Questions

At this time, would your agency be aware of the situation? If so, how did you find out about it?

Would your agency want to know that something unusual is happening this early in the incident?

Which agencies should be alerted of the situation at this time?

If you were alerted, what steps would your agency take?

In this situation, is there evidence that something unusual is happening?

What actions should be taken at this time?


Who would your agency coordinate with at this point in the incident? How would you share information with your community associates?

Would your local Department Operations Center be activated at this point in the incident? Would you implement Incident Command structure within your agency?

How will you address public concern? What are your messaging strategies?

If the CDC and CDPHE did not provide guidance about the disease, how would your agency find accurate information?



The notification about the incident will initially be sent out using the Health Alert Network. Does your agency receive these alerts? Who at our agency receives them? What do they do with the information, and who do they share it with? What happens if the Health Alert comes out at night or on the weekend?

What information about the incident would you share with your staff, especially considering the media attention the issue is receiving? Would your agency consider releasing information directly to the media?

How would your agency identify suspected cases? What would you do if you had a suspected case at your facility?

What infection control measures would your agency implement? How would you make those decisions?


How would you work alongside a CDC’s Epidemic Intelligence Service (EIS) officers? What concerns would you have?

How will you assist in the resource order and prioritization process for locally requested supplies that are limited in quantity?


What are you likely to be more worried about at this time – staff shortages or equipment shortages? Why? What would you do to mitigate these concerns?

What are your biggest concerns at this time? What are you doing to mitigate these concerns? If you can’t mitigate these concerns, what will you do?


How would you prioritize staff to assist with the epidemiological investigation, especially with increasing absenteeism? Which programs would your agency need to keep functioning, and which programs could be stopped so that staff can help with the incident?

If there was prophylaxis available, how will your agency staff the RTP and PODs? Be sure to consider the already high staff demands of the epidemiological investigation and high absenteeism rates.

How will your agency assist during a mass fatality incident?



What infrastructure is critical to your agencies operations (e.g. power, water, sewage)? How would your agency handle a failure of this infrastructure?

How would your agency handle a crisis of absent employees?

How would civil unrest impact your agency?

At what point would staff and/or equipment shortages become debilitating for your agency’s operations? What would happen then?

MODULE 5Large Group Questions

How would you deal with a possible collapse of basic infrastructure? Is this written into your Emergency Operations Plans? Do your Emergency Operations Plans address a point of failure, where you can no longer operate at all?

What can be done to mitigate the detrimental effects on businesses? What agency would be responsible?

Because influenza comes in waves, how does your agency plan to get ready for the next wave?

How will you encourage workers to return to work after they have recovered from the flu?

How would your agency address workers grief and stress?


Long Term Care and Home Health Functional Group

MODULE 1Long Term Care and Home Health Questions

What types of infection control and disease prevention actions do you take on a regular basis to protect your patient population from infectious diseases?

If the index case was in your facility, either as a guest or as a patient, how would you respond?









How would your facility identify a suspected cases?

Does your agency’s medical history questionnaire include a travel history question? Would there be the benefit to including that information?

How would you manage a suspected case? How would you prevent an outbreak from occurring within your facility?

What additional information would you request at this time? Who would you contact?








How would your facility handle a decrease in staff? How would that impact your daily operations and facility capacity?

How would your facility control an outbreak if it occurred within your facility?

How will your facility maintain situational awareness?


What are you likely to be worried about at this time – staff shortages or equipment shortages? Why? What would you do to mitigate these concerns?



What, if any, components of your organization’s emergency management plan would you activate at this time? How would that impact your normal operations?

What staffing changes would be considered to ensure adequate coverage considering the decreased staffing?

Under what circumstances could your agency help with hospital triage and basic patient care? Would your agency consider taking that risk during an incident?






Hospital Functional Group

MODULE 1Hospital Questions

1. Is this an abnormal situation?

2. At what point would you contact your local public health department?

3. How would all of your staff find out about this incident? At what point would it be important for them to be aware of the incident? How would this information be communicated?

4. In addition to sending specimens to the CDPHE lab, would you notify anyone else of a possible outbreak incident?


1. At this time, would your agency be aware of the situation? If so, how did you find out about it?

2. Would your agency want to know that something unusual is happening this early in the incident?

3. Which agencies should be alerted of the situation at this time?

4. If you were alerted, what steps would your agency take?

5. In this situation, is there evidence that something unusual is happening?

6. What actions should be taken at this time?


1. How would your hospital identify suspected cases? Does your agency’s medical history questionnaire include a travel history question? What would be the benefit to including that information?

2. How would you manage a suspected case? How would you prevent an outbreak from occurring within your hospital?

3. What infection control measures need to be taken? If there wasn’t any information available about the novel disease, how would you select infection control measures? Would your current PPE supplies impact this decision?



1. The notification about the incident will initially be sent out using the Health Alert Network. Does your agency receive these alerts? Who at our agency receives them? What do they do with the information, and who do they share it with? What happens if the Health Alert comes out at night or on the weekend?

2. What information about the incident would you share with your staff, especially considering the media attention the issue is receiving? Would your agency consider releasing information directly to the media?

3. How would your agency identify suspected cases? What would you do if you had a suspected case at your facility?

4. What infection control measures would your agency implement? How would you make those decisions?


How would your facility handle a decrease in staff and an increase in patients?

What types of supplies would you likely be running low on during an emergency such as this?

How would you request needed supplies? What would you do if they were not available?

Do you have MOUs or MOAs in place with your supply vendors to get additional supplies if needed during an incident? Do you believe these agreements would be fulfilled in this type of incident?





How would you manage an influx of fatalities within your facility?

How would you manage day to day operations and disaster operations with a decreased staff due to illness or absenteeism?


How would your agency protect the health and safety of its employees?













EMS Functional Group

MODULE 1EMS Questions

Who in your agency is responsible for reporting notifiable diseases?

What kind of PPE do you have available on a regular basis that would help control the spread of infectious disease? Would you have any additional needs?









How would you identify a suspected case? How would you manage a suspected case?

What impact would transporting a suspected case have on your agency?








How would you handle increased operations with a decreased number of staff? Would you try to triage response calls? If so, how?

What type of additional needs would your agency have at this point in the incident?

How would risk communication regarding the influenza outbreak be shared among your staff?

Questions




What type of decontamination procedures would be followed during this type of an incident?

The hospitals are overwhelmed and understaffed. How will this impact your operations?







Community Functional Group

MODULE 1Behavioral Health Questions

Looking ahead, what support may be provided to ED staff and their families if the incident gets worst? What steps would you need to take in order to provide such support?

Corner Questions An individual has died of an unknown infectious disease. Would your agency be

involved? Would the mortuary be aware of the cause of death, and the potential need for infection control measures?

Emergency Management Questions

Looking ahead, what are the primary responsibilities of emergency management in this type of situation?









How could public panic be prevented or reduced?

Corner Questions As the facility rate increases, how would that impact your involvement in the incident?


At this point, would the EOC be activated? If so, would it be a full activation or select ESFs? What ESFs would be notified?


Since this is a health related incident, and most health departments and hospitals are not on WebEOC, how would you maintain and share situational awareness information with partners?







What organizational capacity do you have to help manage community distress and the “worried well?”

Corner Questions What would your involvement in fatality management be at this time? When would you

implement your mass fatality plan?


Many agencies are struggling with staffing shortages. How can you help?






Many agencies employees are working overtime, in stressful conditions and away from their families. As behavioral health professionals, what do you find most concerning about this situation?

Corner Questions How would your agency handle a decrease in staff? How would that impact your daily

operations? How would that impact your ability to implement your mass fatality plan?

What other agencies do you depend on to support the mass facility plan?


How would you handle decreased staff for your local EOC? Do you have back up staff trained and ready to assist in an emergency? What would you do if there weren’t enough people to staff the EOC?












APPENDIX C: EXERCISE PARTICIPANTS

Name Organization Functional GroupSuzi Albo Colorado Lutheran Home Long TermAngel Anderson Jefferson County Public Health Public HealthSteve Aseltine West Metro Fire/Rescue EMSBrenda Barrett Mt Evans Home Health & Hospice Long TermChristine Billings Jefferson County Public Health EvaluatorSusan Black Colorado Lutheran Home Long TermMitchell Brown Jefferson County Public Health Public HealthMargaret Bryan Jefferson County Public Health EvaluatorKodi Bryant Jefferson County Public Health Public HealthRon Celentano Jefferson County Office of Emergency Management CommunityAlan Colon US Dept of Justice CommunityBrandon Daruna Gilpin Ambulance Authority EMSDiana Delgado Eaton Senior Communities Long TermJody Erwin Jefferson County Department of Health and Environment Public HealthMargaret Farrar Exempla Colorado Lutheran Home Long TermMark Fellers Gilpin Ambulance CommunityDeborah French Colorado Hospital Association ObserverAlice Huges Lutheran Medical Center HospitalBetsy Isherwood Katz Lutheran Medical Center HospitalDr. Mark Johnson Jefferson County Public Health Public HealthNicolena Johnson Clear Creek EMS EMSKelly Keenan Jefferson County Public Health FacilitatorDan Kipp Bear Creek Center Long TermAna Marin Cachu Jefferson County Public Health EvaluatorKonalyn Melon Bear Creek SWF Long TermDave Mitchell Arvada Fire Protection District EMSGlenn Most Exempla West Pines HospitalSandra Newell Colorado Lutheran Home Long TermMegan Nies CDPHE Public HealthBarb O'Kane Colorado School of Mines CommunityTom Olbrich Jefferson Center for Mental Health CommunityMichael Piper Arvada Fire Protection District EMSRichard Prestidge Colorado Hospital Association HospitalDan Pruett Jefferson County Coroner's Office CommunityJohn Putt Alpine Rescue Team EMSAmanda Reiff Jefferson County Public Health Public HealthDebbie Roberge Coulter Student Health Center CommunityGwyn Rodman-Rice Jefferson County Department of Health and Environment Public HealthScott Rogers West Metro Fire Rescue EMS


Kristen Roth Jefferson Center for Mental Health CommunityKevin Schmidt West Metro Fire Rescue Evaluatorsarah schoeder Eaton Senior Communities Long TermGinny Schwartzer SCL Health HospitalLee Sholtz St. Anthony Central Hospital HospitalLauren Smith Exempla Colorado Lutheran Home Long TermPamela Stephens Jefferson County Public Health Public HealthCharles Storch Lutheran Medical Center HospitalRan Tao Jefferson County Public Health EvaluatorWendy Trogdon Clear Creek County Public HealthNicholas VanEpps Gilpin Ambulance & Gilpin County EMSKimberly Vowell St. Anthony Hospital HospitalThomas Weldon Jefferson County Coroner's Office CommunityJessa Woodward Jefferson County Public Health Public HealthJanelle Worthington Jefferson County Public Health Evaluator


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