PUBLIC HEALTH and MEDICAL SERVICES PRIMARY AGENCY: SUPPORT AGENCIES: Ross County Health District Ross County Emergency Management Agency Ross County Sheriff s Office Chillicothe City Police Department Ross County EMS South Central Regional Public Health NON-GOVERNMENT SUPPORT AGENCIES: First Capital Red Cross Adena Regional Medical Center Family Healthcare I. INTRODUCTION A. Purpose This plan is meant to outline and to guide emergency response actions and activities of the Ross County Health District, Ross County s only public health agency. We are charged with protecting and promoting public health in Chillicothe and Ross County, through a variety of services and programs, both mandated and those that are not mandated by the Ohio Revised Code. This plan identifies the roles and responsibilities of the health district, as well as those of our partners. B. Scope This plan serves as the Base Plan that will guide initial response activities. Additionally, a number of annexes and appendices exist, which address specific potential emergencies and disasters, and serve to supplement the base plan as well as guide the response for those specific events. These plans together are intended to serve as an all hazards plan. However, events could arise that are not covered in this plan and require independent thought or alternative adaption. It should be noted that, while some authority in the area of healthcare response is given to public health agencies in the Ohio Revised Code, the Ross County Health District has neither the manpower nor the expertise to provide healthcare in an event. We do not employ physicians, nor are our public health nurses familiar with emergency healthcare treatment of the clinical type. C. Policies 1. NIMS Adoption and Compliance Statement Plans, exercises, & trainings are developed and structured to be consistent with local, regional, state, & federal regulations, standards, and policies and to comply with the National Response Framework (NRF), National Incident Management System (NIMS) HSPD-5, and National Infrastructure Protection Plan (NIPP) contributing to the National Preparedness Goal - HSPD-8. 2. ESF-8 Integration into County Emergency Operations Plan SCO RPH ERP 1
The Ross County Health District Emergency Response Plan has been integrated into the Ross County All-Hazards Emergency Operations Plan (EOP). That plan is the single legal document that describes responsibilities of agencies and individuals for carrying out specific actions in or in preparation for an emergency or disaster in Ross County. The RCHD ERP functions, as a part of the Ross County EOP, to provide specific information for the preparedness, response, mitigation, and recovery responsibilities of the Ross County Health District for public healthrelated disaster situations in Ross County. 3. ESF-8 Agencies and Resources Coordination The Ross County Health District is the Lead agency for ESF-8 activities at the local-level, South Central Ohio Public Health at the regional-level, and the Ohio Department of Health at the state-level. Local Public Health Resources have been identified in advance of an emergency/disaster. Local ESF-8 resource requests will be coordinated with the local EMA. State-level ESF-8 resources can be activated upon request from the local Emergency Management Agency (EMA) when local resources have been exhausted. D. Phases of Emergency Management for Public Health 1. Mitigation Mitigation activities are those designed to either prevent the occurrence of an emergency or longterm activities to minimize the potentially adverse effects of an emergency. 2. Preparedness Preparedness activities, programs, and systems are those that exist prior to an emergency and are used to support and enhance response to an emergency or disaster. Planning, training, and exercising are among the activities conducted in this phase. 3. Response Response is activities and programs designed to address the immediate and short-term effects of the onset of an emergency or disaster. It helps to reduce the casualties and damage and to speed recovery. Response activities include direction and control, emergency information and warning, mass dispensing, and other similar operations. 4. Recovery Recovery is the phase that involves restoring systems to normal. Short- term recovery actions are taken to assess the damage and return vital life support systems to minimum operating standards; long term recovery actions may continue for months or maybe even for years. II. SITUATION AND ASSUMPTIONS A. Situations 1. County Description: Ross County is located in South Central Ohio, bounded by Pickaway County on the north; Hocking, Vinton, and Jackson counties on the east; Pike County to the south; and Highland and Fayette counties to the east. Ross county encompasses an area of 687 square miles and has a population of 78,249 (2010 US Census). Chillicothe (pop. 21,99) is the only city. 2. Ross County s main highways include: US 35 (east/west); US 23 (north/south); and US 50 (southeast/southwest). Two main railroads run north/south through the county, and the county owns an airport with 5,400 ft. of paved runway. SCO RPH ERP 2
3. The county s largest employers include: Adena Health System; Glatfelter Paper Company; Kenworth Truck Company; Veterans Affairs Medical Center; Horizon Telcom; and city and county government. 4. The county has a number of potential natural vulnerabilities that could affect public health, including: flooding, tornadoes, wind storms, and winter storms (ice and snow). Man-made disasters are also possible and include: terrorist attacks, damn breaks, chemical spills/releases, and radiation events (a uranium enrichment plant is located in Pike County, approx. 22 miles south of Ross County). Also, epidemics, pandemics, and other disease outbreaks are possible and pose the most likely large scale threat to public health. Ross County is exposed to many hazards, all of which have the potential to disrupt the community, cause damage, and impact the public health. Possible hazards for Ross County include, but are not limited to, floods, tornados/severe wind storms, severe winter storms, earthquakes, landslides/subsidence, wild fires, power outages, human infectious disease, HAZMAT spills, power outages, civil disturbances, and terrorism. Ross County is a rural county, with many pockets of geographically isolated residents who may be difficult to reach. Ross County is exposed to many hazards, all of which have the potential to disrupt the community, cause damage and result in casualties. Possible hazards of this type for Ross County include, but are not limited to, floods, wind storms, tornadoes, severe winter storms, extreme heat and drought, power outages, wildfire, earthquake, human infectious disease, HAZMAT spills, nuclear plant accident, civil disturbance, and terrorism. As a rural county with just one hospital, Ross County has limited resources for both care and for emergency preparedness and responses. B. Assumptions 1. The events that would apply the most stress to local public health are those in which the Ross County Health district would serve as the lead response agency. These include large scale disease outbreaks (influenza, etc.); and a food-borne outbreak of significant size. The health district and public health will play a much smaller role in most events, and our responsibilities in those are outlined in the County EOP. 2. Resources needed for a significant public health response are limited within the county: these include both manpower and material. However, the health district has a good working relationship with the county EMA, local hospital, and other partners. Additionally, MOUs and MOAs for mutual aide exist with other local health district/departments in our region. 3. Our response responsibilities and activities are outlined in the County EOP and in the annexes that accompany this plan. Disasters: 1. May occur at any time with little or no warning. 2. Require significant information-sharing at the unclassified and classified levels across multiple jurisdictions and between public and private sectors. 3. Involve single or multiple geographic areas. 4. May have significant county and state impact and/or require significant county and state information sharing, resource coordination, and/or assistance. 5. Can span the spectrum of incident management to include prevention, protection, response, and recovery. 6. Involve multiple, highly varied hazards or threats. SCO RPH ERP 3
7. May result in numerous casualties; fatalities; displaced people; property loss; disruption of normal life support systems, essential public services, and basic infrastructure; and significant damage to the environment. 8. Impact critical infrastructure across sectors. 9. May overwhelm capabilities of County and State Governments, and private sector infrastructure owners and operators. 10. Attract an influx of spontaneous volunteers and supplies. 11. May require short-notice asset coordination and response. 12. May require prolonged, sustained incident management activities. III. CONCEPT OF OPERATIONS The goal of the Ross County Health District is to work to prevent events or disasters that might threaten the health of persons in Ross County (or public health). This is done through planning, training, and public education activities. However, not all events can be controlled or avoided. Mitigation: Any action taken to eliminate or reduce the risk of a hazard or event on the public health of Ross County residents. These actions may include public education materials; training for staff and for businesses/service providers; strengthening relationships with partners and stakeholders. Preparedness: Any activity performed in advance of an emergency or event, which may improve response to the event. This can include training for employees; agency exercises and those that also include partners; hazard and risk analysis; planning and the purchasing of material or supplies that will improve response efficiency. Response: Actions taken immediately before, during, or directly after an event, which may protect health or save lives. These can include, but are not limited to, publicly announced warnings, mass vaccination clinics or points of distribution (PODs), isolation and quarantine orders, and the assessment for safety of food and water supplies. Recovery: Short term activities taken to promote the return to normalcy and an environment that is safe and conducive to good public health. This may include but is not limited to overseeing that conditions are not conducive to the gathering of disease carrying vectors, such as mosquitoes, rats, or fleas, safety of food and water supplies, and the distribution of vaccines needed during recovery efforts, such as the tetanus vaccine. A. Emergency Response Plan (ERP) Activation Authority The Ross County Health District ERP may only be activated under the authorization of the Health Commissioner or Deputy Health Commissioner, or by the person identified as backup personnel in the event that neither of the above persons are available to lead the response. The Emergency Response Plan may be activated, as deemed necessary by the Health Commissioner/Deputy, or identified backups, during a bioterrorism event, disaster, or public health emergency that is impacting, or has the potential to impact the health of the residents of Ross County. The legal authorities of the Ross County Health District, Board of Health, and Health Commissioner are stated in the Ohio Revised Code, in a variety of sections from 3700-3798. Additionally, authorities are also given as responsibilities outlined in the Ross County Emergency Operations Plan, implied by the signatures that exist there. SCO RPH ERP 4
B. Typical Sequence of Emergency Activities / Typical Course of Actions 1. Identify the threat 2. tification 3. Assessment 4. Identify public health Resources 5. Creation of public health objectives 6. Identify response roles 7. Implement/execute the response to address the objectives 8. Monitor/assess the response 9. Demobilization 10. Recovery Operations 11. After Action Review 12. Review and Revise Plans C. Resource Requests Identify the threat Analyze the threat Determine incident objectives Identify public health resources Request resources Formulate Incident Command structure Assign responsibilities Respond Monitor progress Report critical information Assess situation Demobilize Recovery operation After Action review Review and revise plans In the event that the health district becomes overwhelmed or runs out of material resources, the Health Commissioner or Incident Commander will contact the Ross County Emergency Management Agency at the Emergency Operations Center to request resources. The EMA will then contact the Ohio Emergency Management Agency with this request. The Ohio Emergency Management Agency will then contact the appropriate agency, i.e., the Ohio Department of Health at the ESF-8 desk at the Ohio Emergency Operations Center, to make the official request. In addition to making the formal request, it is appropriate for the Ross County Health District to contact the Ohio Department of Health or the ESF-8 desk at the Ohio Emergency Operations Center for a consultation. IV. ASSIGNMENT OF RESPONSIBILITIES A. RCHD Emergency Functions/Responsibilities: 1. Assessment of county health and medical needs. Assistance in assessing potable water and waste water/solid waste disposal issues and coordination to provide potable water and wastewater/solid water disposal equipment. 2. Public Health Surveillance SCO RPH ERP 5
Surveillance and investigations to determine disease patterns and potential disease outbreaks and implement prevention strategies. 3. Monitoring of the availability and utilization of health systems assets. Supply, restock, and prioritize health-related equipment and supplies. 4. Provision of public health and medical related services, supplies, and personnel. Provide logistical support for public health personnel in the field. Provide pharmaceuticals, medical equipment, and supplies as available (includes the coordination and tracking of medical resources and equipment). Provide consultation for the decontamination of people, buildings, and the environment, when applicable. Provide mass dispensing clinics for the prophylaxis of the entire county population, if necessary. 5. Identification of areas where public health problems could occur. Public Health assessments of conditions at the site of the emergency to determine health needs and priorities. 6. Provision of medical related information releases and public health recommendations and related releases to the public. 7. Research and consultation on potential health hazards, medical problems, and appropriate levels of PPE, when applicable. 8. Assume all duties as outlined in Annex H of the Ross County EOP 9. Environmental sampling and analysis/collecting specimens for lab testing. Coordination with ODH on specimen submission of possibly hazardous or contaminated substances throughout an emergency. Testing of products for public consumption. 10. Veterinary support. 11. Assistance and support for mass casualty and mass fatality incidents. Assist with Triage Operations. Assist in the identification of mass burial sites. Assist in the handling of infectious/contaminated bodies. 12. Coordination with other local, regional, state, and federal partners. Assess and make recommendations concerning the public health needs of emergency responders. If appropriate, staff the ESF-8 desk/represent public health at the County EOC. B. Support Agency Roles and Responsibilities: Agency Regional Public Health Agencies Ohio Department of Health Public Health Emergency Roles/Responsibilities Provide reciprocal emergency management aid and assistance in case of any hazard too great to be dealt with unassisted. Provide subject matter experts for consultation and guidance on emergency situations, provide laboratories for testing of samples, and provide available equipment/pharmaceuticals to local Memorandum of Understanding/Agreements Established Yes SCO RPH ERP 6
Ross County EMA Red Cross Ross County Sheriff s Office Ross County Local School Districts Ross County EMS Healthcare Clinics Pharmacies Mental Health Ross County Coroner Ohio Environmental Protection Agency health districts for emergency response activities. Resources acquisition and coordination Provide volunteer assistance or possibly food/refreshments for response personnel, if possible Provide security for health district response activities, equipment, pharmaceuticals Provide school facilities for the use of POD (Point of Dispensing) operations Have staff on standby at POD sites for transport to medical facilities. Provide assistance to nursing staff for triage operations and possibly provision of vaccines or medications. Provide medical staff for response activities, if possible. Provide pharmaceutical handling assistance for POD operations, if possible Help coordinate mental health activities outlined in County EOP. Lead response to mass fatality event, with assistance from RCHD. Provide information/assistance to the health department on the clean-up or decontamination of environments that pose risk to public health. Signed POD Site Security Worksheet Yes Yes Yes Yes V. TRAINING AND EXERCISE A Multi-Year Training and Exercise Plan (MT&EP) has been developed and is updated annually to provide a timeline of training and exercising activities to take place throughout each PHEP Grant Fiscal Year cycle. The MT&EP incorporates NIMS training requirements and Homeland Security Exercise and Evaluation Program (HSEEP) guidelines. A. Training The Public Health Emergency Preparedness (PHEP) Coordinator is responsible for RCHD staff emergency response training and training SCO RPH ERP 7
documentation. The PHEP Coordinator ensures all new and current staff complete and maintain the appropriate level of NIMS and other emergency preparedness training for their identified emergency response roles. Review of the health district s ERP is part of the orientation training for new core emergency response staff including the Health Commissioner, Director of Nursing, Director of Environmental Health, and the PHEP Coordinator. Core emergency response staff must, additionally, review the emergency plans on an annual basis. B. Exercising The health district conducts and participates in exercises, both locally and regionally, to test and validate plans, checklists, and response procedures and to evaluate the training and skills of response personnel. Corrective actions identified through the after action/corrective reporting process are addressed in future plan revisions and training & exercise programs. VI. PLAN DEVELOPMENT AND MAINTENANCE A. Development The RCHD ERP design and content is coordinated with other public health jurisdictional plans within Homeland Security Regions 7 & 8, the South Central Ohio Public Health Region, and Southeast Ohio Hospital All-Hazards Plan, and the Ohio Department of Health ESF-8 Plan. The RCHD ERP is to be kept current through an ongoing revision system. The PHEP Coordinator, in collaboration with the core emergency response staff and the Ross County Board of Health, are responsible for ensuring that all necessary revisions to the plans are made and distributed to the necessary plan holders. Plan revisions may also be coordinated with the input from support agencies identified within this plan. Plan holders are prohibited from making changes, revisions, or additions to individual copies of the plan. Revisions are to be made on one master copy maintained by the PHEP Coordinator and distributed to the proper plan holders. Plan Holders include: Ross County Health District Core Emergency Response Staff (Health Commissioner, Director of Nursing, Director of Environmental Health, Emergency Response Coordinator). Ross County EMA Ross County Sheriff s Office SCO RPH ERP 8
B. Maintenance The RCHD ERP and accompanying Annexes, Appendices, and Implementing Instructions will be reviewed and updated on an annual basis for content changes based on information gathered from exercises, trainings, and Federal/State guidelines. Updates to notifications and contact lists will be made as changes occur. The RCHD ERP and accompanying Annexes, Appendices, and Implementing Instructions will be reviewed and updated on an annual basis for content changes based on information gathered from exercises, trainings, and Federal/State guidelines. Necessary updates to implementing instructions will be made as changes occur. C. Availability of Emergency Response Plans to the Public Copies of the RCHD ERP and its accompanying Annexes, Appendices, and Implementing Instructions may be requested by the public. Requests for copies of the plans must be made to the PHEP Coordinator. Plan content will be released in accordance with Ohio Sunshine Laws and Ross County Health District Records Release Policy. Exempt plans or plan content will be reviewed by the PHEP Coordinator and Administrator before release. Any Emergency Response Plan information provided to the public must be approved by the Health Commissioner. VII. AUTHORITY & REFERENCES A. Authority Ohio Revised Code, Section 3707 B. References Ohio State Emergency Support Function-8 & associated TABS & Appendices Bureau of Public Health Preparedness Planning Unit, All Hazard Emergency Response Plan Framework and Planning Guidance Authority Ohio Revised Code, Section 3707 Ross County Board of Health Resolution 09-2003 Reference Ross County Emergency Support Function-8 Ohio Emergency Support Function-8 Bureau of Public Health Preparedness Planning Unit, All Hazard Emergency Response Plan Framework and Planning Guidance SCO RPH ERP 9
VIII. PROMULGATION DOCUMENT/SIGNATURE PAGE The Ross County Health District s Triad (Health Commissioner, Director of Nursing, Director of Environmental Health) are responsible for ensuring that this plan is written, approved by the Ross county Board of Health, and that it is reviewed each year in accordance with requirements from ODH. The Public Health Emergency Preparedness Coordinator (who also serves as the Emergency Response Coordinator) is tasked with maintaining this and all RCHD response plans, as well as the distribution of them to partners. The Regional Public Health Coordinator, Regional Hospital Coordinator, and Regional Epidemiologists, along with the Regional Public Health Steering & Planning will develop any additional standard operating procedures and mutual-aid agreements in an effort to make sure plans are similar throughout the region. Dr. Timothy Angel, Health Commissioner Date Kathy Wakefield, DON Date Ben Avery, Director of Environmental Health Date SCO RPH ERP 10