Cascade City-County Health Department. Emergency Response Plan

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2 CCHD Annex A Risk Communication Annex B Volunteer Plan Annex C Functional Needs Annex D Specimen Transport Plan Annex E Contact Protocol Annex F Continuity of Operations Annex G Mass Care Annex H and H Communicable Disease Surveillance and Epi-Response Annex I Secondary Transmission Annex J Isolation and Quarantine Annex K Pandemic Influenza Annex L Emergency Medical Countermeasures (EMC) Annex M CHEMPACK and EMC Cache Procedures Annex N Hazmat or Unknown Biological Annex O Foodborne/Waterborne Outbreak Annex P Mass Fatality Annex Q Truck Wreck Protocol Annex R Biohazard Detection System (BDS) Response Attachment Contact Information Attachment MCA Title 50, ARM Chapter 37 Attachment Responder Registry Attachment Community Resource List Attachment ERP Distribution List Attachment Organization and Functional Responsibility Attachment Activation

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4 RECORD OF CHANGES Annex or Change Date Attachment Annex K PHAB Standards and Measures cited; mass care and mass fatality references added Attachment 7 Created Annex H Appendix D created Annexes E, H, H-1 Contact information updated Attachment 1 Updated

5 RECORD OF DISTRIBUTION Annex or Attachment Shared With Date Annex L LEPC Annex D Cascade Co. DES, Great Falls Emergency Management, GFFR Annex M Cascade Co. DES, Great Falls Emergency Management, GFFR, LEPC, Great Falls Emergency Services , Annex A Cascade Co. DES, Great Falls Emergency Management

6 CASCADE CITY-COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN PRIMARY AGENCY: SUPPORT AGENCIES: Cascade County Disaster and Emergency Services City of Great Falls Emergency Management Local Emergency Planning Committee INTRODUCTION Purpose The (ERP) is meant to complement the Cascade County Emergency Operations Plan (EOP) by providing guidance for mobilizing and managing public health services during emergencies and disasters. It will be implemented by Health Department staff through coordination with the County s Disaster and Emergency Services (DES) Coordinator and the operation of the City/County Emergency Operations Center (EOC). When indicated, CCHD will assist local DES Officials in implementing the Cascade County EOP. This ERP will be used within the scope of the Cascade County EOP. Authority Authority for public health emergency planning and response can be found in Montana Code Annotated (MCA) Title 50 and Administrative Rules of Montana (ARM) Chapter 37. A table of contents for MCA Title 50 and ARM Chapter 37 is located in Attachment 2 of this (ERP). Administration Local public health officials, including the Health Officer and the Board of Health, are responsible for following and upholding all directives in MCA Title 50 and ARM Chapter 37. Specific roles and responsibilities of the Health Officer and Board of Health are outlined within the Annexes of this. Confidentiality As a Covered Entity, CCHD is bound by the privacy rules outlined by the Health Insurance Portability and Accountability Act (HIPAA). In emergency situations, covered entities may share patient information in the following ways: 4

7 Treatment patient information may be shared to provide treatment. Treatment includes: o Sharing information with other providers (including hospitals and clinics) o Referring patients for treatment o Coordinating patient care with others Notification patient information may be shared to identify, locate, and notify family members, guardians, or anyone else responsible for the individual s location, general condition, or death. o Individuals should give verbal permission, when possible; however, if the patient is incapacitated or not available, providers may share information for these purposes if, in their professional judgment, doing so is in the patient s best interest. o When a provider is sharing information with disaster relief organizations that are authorized by law or charter to assist in disaster relief efforts, it is unnecessary to obtain a patient s permission to share information if doing so would interfere with the organization s ability to respond. Imminent Danger patient information may be shared as necessary to prevent or lessen a serious and imminent threat to the health and safety of a person or the public consistent with applicable law and the provider s standards of ethical conduct. Facility Directory facilities maintaining a directory of patients/clients can tell people who call or ask about individuals whether the individual is at the facility, their location in the facility, and general condition. If the President declares an emergency or disaster and the Secretary of HHS declares a public health emergency, the Secretary may waive sanctions and penalties against a covered hospital that does not comply with certain provisions of the Privacy Rule. The Privacy Rule remains in effect. The waivers are limited and apply only for limited periods of time. The following provisions may be waived: The requirements to obtain a patient s agreement to speak with family members or friends involved in the patient s care (45 CFR (b)) The requirement to honor a request to opt out of the facility directory (45 CFR (a)) The requirement to distribute a notice of privacy practices (45 CFR ) The patient s right to request privacy restrictions (45 CFR (a)) 5

8 The patient s right to request confidential communications (45 CFR (b)) 1 SCOPE CCHD is responsible for protecting the health of residents in Cascade County during any disaster or emergency. In Cascade County a public health disaster or emergency situation could occur at any time and have the potential to disrupt the community, cause damage, and threaten public health. Potential Hazards The Cascade County Pre-Disaster Mitigation Plan acknowledges that communicable disease/pandemic hazards are highly likely and can be catastrophic in magnitude in comparison to other hazards. It is assumed that CCHD will be a lead authority in these situations, and components of communicable disease/pandemic mitigation and response are addressed in this ERP. The Cascade County Pre-Disaster Mitigation Plan prioritizes the list of possible hazards in Cascade County. 1. Wildfire 2. Structure fire 3. Severe summer weather 4. Hazardous materials incidents 5. Transportation accidents 6. Severe winter weather 7. Flooding/levee failure 8. Dam failure 9. Landslides/mudslides 10. Earthquakes This ERP addresses the public health response, should one be necessary, related to the above events. Depending upon the nature, severity, and length of the incident, public health concerns can include disease outbreaks, sanitation, food and water contamination and air quality issues. In any disaster or emergency event, CCHD will make every effort possible to provide support, monitoring, and information to responders and the public. Mental Health Services/Support Any public health emergency has the potential to negatively impact mental health. According to the Cascade County Emergency Operations Plan Annex G (2011), local mental health agencies will be responsible for ensure[ing] that appropriate mental health services are available for disaster victims, survivors, bystanders, responders 1 U.S. Department of Health and Human Services, Health Information Privacy, accessed June 25,

9 and their families, and other community care-givers during response and recovery. In the event of public health emergencies in which CCHD assumes the lead response role, local mental health agencies shall coordinate with the established Public Information Officer to arrange for dissemination of information regarding available mental health services. Assumptions For CCHD emergency response involvement, the following assumptions are implied: A. Incidents may occur without warning and at a time when offices are closed. B. Not all emergencies or disasters will require activation of this plan. This plan is based on a worst-case incident, but is able to adapt to the severity of the current incident/event. C. While this plan is based on full activation of resources, each response will be conducted at the lowest possible activation level to effectively and efficiently handle the situation. D. The initial response to a public health emergency will likely resemble the routine response to an everyday occurrence. E. Response to all incidents will be in compliance with the National Response Framework (NRF) and the National Incident Management System (NIMS) as mandated by Homeland Security Presidential Directive (HSPD) #5. It is anticipated that CCHD s response will be conducted at the lowest possible activation level to effectively and efficiently handle the situation using the Incident Command System. F. During a disaster or emergency, CCHD may request activation of the local Emergency Operations Center (EOC) or may be asked to participate at the request of the IC or EOC Manager. The EOC functions as a communication center for emergency response activities within Cascade County, as well as, a point of contact for elected officials and media sources. A CCHD representative will be present or available to the EOC depending on the need or circumstance. G. In the event of a public health emergency or disaster, CCHD will assume the lead role in working with the county s DES Emergency Coordinator, other EOC participants and local health professionals, including those at the state and federal levels. H. CCHD planning, training and exercise activities should be integrated with emergency management and first responders as much as possible. CCHD officials are familiar with other local emergency operations plans and procedures in order to avoid duplication or gaps in service. 7

10 I. State and Federal assistance is available to supplement county resources during declared disaster and emergency events. J. Disasters may occur across county lines that would require collaboration in coordinating a multi-jurisdictional response. CONCEPT OF OPERATIONS Emergency Response Team During a public health emergency, the CCHD Emergency Response Team will direct CCHD response operations, but the Health Officer will maintain ultimate authority. The Emergency Response Team is made up of the Health Officer, Prevention Services Division Manager, Environmental Health Division Manager, Preparedness & Communications Officer, Emergency Planner, and other CCHD personnel as deemed necessary by the Health Officer. Line of Succession In the event that the Health Officer is not available, another CCHD official will assume Emergency Response Team duties for public health emergencies. The line of succession to the Health Officer is as follows: 1. Prevention Services Division Manager 2. Environmental Health Division Manager 3. Family Health Services Division Manager For further information on lines of succession, refer to Annex F: Continuity of Operations Plan (COOP). Emergency Notification CCHD has a dedicated emergency telephone number in the event that Health Department phone lines become overloaded during an emergency. CCHD emergency responders can be reached 24/7 through Mathews Answering Service at the following phone number: This number will be distributed to the local DES Coordinator, physicians, clinics, the local hospital, City and County officials, and will be included in the Cascade County Emergency Operations Plan. National Incident Management System/Incident Command System CCHD has adopted the National Incident Management System (NIMS) for emergency preparation and response. To ensure compliance with NIMS requirements, all CCHD staff receive training on NIMS and the Incident Command System (ICS). Additionally, all emergency response training and exercise activities practice NIMS and ICS. 8

11 CCHD will utilize the ICS structure through the local EOC and the IC to coordinate response efforts with the State Emergency Operations Center (SEOC). The following is a summary of basic points from the Cascade County Emergency Operations Plan, 2011 that provides a brief overview of the county operated ICS: The Incident Command System will be used by all responding agencies. The first responder to an incident becomes the Incident Commander. The Incident Commander will adapt the management structure of the ICS to reflect the need and complexity of the incident. This may include, but is not limited to activating the EOC, establishing unified command and requesting mutual aid support from neighboring jurisdictions. The initial on-scene Incident Commander may be relieved by an official who has the experience and legal authority to do so. The 911 Dispatch Center will be notified of this change in command so that it may be properly documented. Although direction and control in most emergency response situations will be exercised by the on-scene Incident Commander, emergencies of wide scope may require that direction and control be assumed by a Unified Command. Logistics CCHD will utilize agency-owned and local resources first during emergency response. If a disaster or emergency cannot be resolved with local resources, the Health Officer or DES Emergency Coordinator may activate mutual aid agreements for state and federal assistance when the emergency exceeds local resource capabilities. Montana Code Annotated 2014, Title 10, Chapter 3, Part 9 outlines the responsibilities of each political jurisdiction within the state of Montana to support other jurisdictions with resources when requested and if available during times of emergency. As a County entity, CCHD is subject to and can request assistance through this Code. If further aid and/or assistance is required, the Incident Commander will request the DES Coordinator to begin the process of an emergency or disaster declaration to State officials in order to obtain additional resources. Any local requests for resources should go through local DES unless otherwise directed. The assistance needed will be requested by executing mutual aid agreements with other governmental units, American Red Cross, Salvation Army, CERT, other volunteer groups, and the Montana DES. If additional resources beyond State capabilities are required, the Montana DES will coordinate requests to the proper federal agencies, including FEMA, for a declaration of a disaster or emergency in order to obtain supplemental federal funding and technical assistance. Finance, Compensation, and Liability 9

12 All financial considerations will be the responsibility of CCHD s Accountant, with oversight from the Health Officer or designee. A limited-balance response fund is available to help offset extra costs associated with public health emergency response activities. Per MCA , the Governor may authorize the incurring of liabilities and expenses to be paid as other claims against the state from the general fund, in the amount necessary, upon activation of the incident response portion of the state disaster and emergency plan. Money may not be used to reimburse a local government for incidental response costs incurred by that local government. Once a county spends the equivalent of 2 mills for authorized expenses, at least once per year, the county commissioners can request state assistance by contacting DES. Documentation of those being covered for compensation, meal reimbursement, and incidentals must be maintained. Per MCA , the governing body of the jurisdiction shall estimate expenditures and levy an emergency millage to cover expenditures. The millage levied shall not exceed 2 mills on the municipality s taxable valuation. Per MCA , a person responding to a request for assistance is entitled to all applicable benefits, including workers compensation, normally available from their home jurisdiction. Per MCA , a person responding to a request for assistance who is under the operational control of the requesting member is considered to be an employee of the requesting jurisdiction for liability purposes. Liability protection is provided to organizations when a Public Readiness Emergency Preparedness (PREP) Act declaration is issued. A PREP Act declaration provides immunity from liability (except for willful misconduct) for claims of loss caused, arising out of, relating to, or resulting from the manufacture, distribution, or dispensing of emergency medical countermeasures. A PREP Act is specifically for the purpose of providing immunity from liability and is different from, and not dependent on, other emergency declarations. The PREP Act can be found at ACTIONS: INITIAL ACTIONS Devise Plan of Action Once notification of an emergency has been received, the Emergency Response Team will confer and devise a plan of action. Emergency Response Team duties include: Communicate with DES Emergency Coordinator 10

13 Communicate with DPHHS Officials Communicate with local LEPC Determine if ICS should be activated Contact necessary organizations or health care providers Contact first responders as necessary Inform and instruct CCHD management regarding CCHD response Organize CCHD resources and personnel Organize local resources to implement plan of action Monitor and evaluate CCHD response effort Assist county EOC depending on need and circumstance Create health information for release by PIO Contact CCHD volunteers Provide appropriate training to volunteers Activate Appropriate Annex(es) The Emergency Response Team will determine whether it is necessary to activate any annex(es). This determination will be based upon the emergency type and CCHD s ability to respond within everyday operations. If additional personnel and/or resources above and beyond normal operations are required, activating an annex, or annexes, may be necessary. See CCHD Attachment 7 for a flow chart outlining CCHD s ERP activation process. Notify Appropriate CCHD Personnel In the event that CCHD personnel need to be contacted during a public health emergency, the Emergency Response Team will notify those individuals using a CCHD personnel call-down list. The list is available from the following CCHD personnel: Health Officer Prevention Services Division Manager Environmental Health Division Manager Family Health Services Division Manager Accountant Preparedness & Communications Officer Emergency Planner Administrative Assistant to the Health Officer Privacy Officer and Accreditation Coordinator Additionally, all CCHD management staff are equipped with division call down lists to contact any of their staff after hours. All CCHD staff have had some level of training in the Incident Command System and, as such, are aware they may assume roles not within the scope of everyday operations. The Emergency Response Team will make every attempt to assign staff 11

14 to emergency operations positions closely related to their job duties. Just in Time Training will be provided for all staff members, especially those filling roles that differ from everyday operations. Convene Emergency Response Team Upon receiving emergency notification, the CCHD Emergency Response Team will meet at the Health Department located at th St S., Great Falls. In the event that the above location becomes inaccessible, the CCHD Emergency Response Team will meet at rd St NW, Great Falls. If that location is also inaccessible, the CCHD Emergency Response Team will determine an appropriate alternate location and meet there. Alternate meeting locations may include the local Emergency Operations Center, 12 1 st Ave S, and the Cascade County Commissioner s chambers, Room 111 Courthouse Annex. Activate Public Health EOC Should a public health event require the guidance and assistance of other community partners, but not require a community-wide response, the Health Officer will activate the Public Health EOC. See Annex H: Communicable Disease Surveillance. Provide EOC Representative In the event that the Cascade County EOC is activated during a time when CCHD participation is required, the Health Officer or a designee will act as the CCHD representative. In the event that the Health Officer is not available, the highestranking CCHD official will assume those duties (see B for CCHD line of succession). The location of the EOC is to be determined based on the emergency, but may include the local Emergency Operations Center, 12 1 st Ave South or the CCHD th St South. ACTIONS: POST-EVENT ACTIONS Develop After-Action Report Any event that leads to activation of an ERP annex requires an After-Action Report (AAR). The AAR will include successes and areas for improvement, including a plan of action for making improvements. The Preparedness & Communications Officer will be responsible for completing the AAR. Input from other staff involved in the event may be necessary. The Health Officer will approve the AAR. ADDITIONAL RESPONSIBILITIES Primary Agency Provide public health assistance and interventions to affected areas and individuals. 12

15 These efforts may include: o Communicable disease surveillance o Providing guidance for the control of communicable disease including isolation and quarantine measures and the disposal of bodies infected with a communicable disease o Providing emergency medical countermeasures including prophylaxis, antivirals and pharmaceuticals o Investigating suspected food borne and water borne illness outbreaks o Coordinating with other agencies to provide guidance on health hazards and protective measures during a biological emergency Training staff CCHD is committed to training its staff about emergency preparedness and the public health response. All appropriate Department staff will have the necessary training to perform essential tasks that could be required in an emergency. CCHD will take full advantage of the training resources available from County, State, and Federal emergency management agencies and DPHHS. All CCHD staff are required to complete basic Incident Command System training courses through FEMA s Emergency Management Institute. These courses include IS 100.b Introduction to Incident Command System and IS 700.a National Incident Management System (NIMS), An Introduction. Selected staff members, including Leadership, Public Health Emergency Preparedness staff, Public Health Nurses and others designated will undergo additional ICS training including, but not limited to, IS 200 ICS for Single Resources and Initial Action Incidents and ICS 300 Intermediate ICS for Expanding Incidents. Annually, CCHD staff will be trained on role of the Department in an emergency event during their initial employment orientation. This will include information about the critical role that public health plays, the response authority and responsibility of the Department, information about other key response agencies used in emergency response, an introduction to the Health Department s chain of command, and an introduction to this. This training will be documented on Department Continuing Education records maintained by their immediate manager or supervisor. Additionally, records of training attendees will be kept by Public Health Emergency Preparedness staff. Conduct drills and exercises In coordination with other agencies and counties, CCHD will facilitate and/or participate, to the extent possible, in countywide and statewide emergency response exercises. CCHD expects to participate in or conduct at least two drills or exercises annually. Plan Development and Maintenance 13

16 The CCHD Preparedness & Communications Officer is responsible for the development and maintenance of this plan. The plan will be reviewed and updated annually, or as needed. REFERENCES 1. Cascade County Emergency Operations Plan: Draft; Aug Emergency Operations Plan Template for Local Health Departments; Colorado DPHE, Aug Baltimore County Emergency Operations Plan; Feb Guidelines, Standards & Resources for Preparing Local Public Health s; Technical Assistance and Training Center, University of Montana, Jan Public Health Emergency Preparedness & Response, Centers for Disease Control and Prevention, National Pharmaceutical Stockpile, Centers for Disease Control and Prevention, Protocol for Mass Prophylaxis, Indiana State Department of Health, July Emergency Support Function #8 Public Health and Medical Services Annex, July Montana Department of Public Health and Human Services, Emergency Operations Plan, December Dawson County (MT), Emergency Medical Countermeasures Plan, January

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