cross disciplinary collaboration discussion

Cross Disciplinary Collaboration Discussion

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ESF 8 Planning Standards & Annex

Updated 10-11-2012

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• The local ESF 8 – Health & Medical annex to the CEOP provides information related to health & medical activities conducted in response to any incident.

• This annex describes actions by county health & medical partners in support of incident response.

• ESF 8 standards should be address in the ESF 8 Annex & can be found at http://www.kansastag.gov/KDEM.asp?PageID=187

ESF 8 Planning Standards

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http://www.kansastag.gov/KDEM.asp?PageID=187

• A template has been made available online via the KDHE-BCHS Preparedness website

http://www.kdheks.gov/cphp/operating_guides.htm• The template contains the same language that is in

the Super System (pervious known as Bold) which is available to emergency managers.

• The template follows the same format as the ESF 8 Planning Standard Document

Is there a County Emergency Operation Plan ESF 8 Annex template? YES

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http://www.kdheks.gov/cphp/operating_guides.htm

• Many disciplines and organizations play a role or roles in many if not all sections/capabilities

• The process of planning with those partners together & engaged in a dialogue of– what assistance is needed,– who can provide assistance & when, – and how to help assure a coordination of all these

efforts between one another

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Explanation of Roles

• On-going communication/planning should be maintained

• What help can be sought– by mutual aid– contracted– regional partners

• How does that assistance help promote either agency and/or overall community response and recovery actions?

• How does the health & medical sector coordinate itself with emergency management for requesting state assistance or provision of common operating picture information between county partners and the state.

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Explanation of Roles

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Preparedness Capability

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Explanation of Roles – Preparedness Stool

The template includes the following sections:O. Identification of ESF 8 MembersI. Purpose & Scope (short & to the point)II. Concept of Operations (bulk of plan)III.Responsibilities (listed out by agency)IV.Financial Management (short & to the point)V. References & Authorities (only needs county info)VI.Attachments (Add contacts, maps, other plans, &

any forms as you see fit)

What is in the ESF 8 Annex?

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• When using the ESF 8 Annex Template, it is important to note that all text can be changed to fit the local jurisdiction. This is a template & is not customized for each jurisdiction in Kansas.

• The template should be completed at the county level but may reference access to regional resources/mutual aid across the plan. It is not the expectation that each county can solely sustain all of these capabilities/activities.

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Is the template flexible? YES

COMPLETING THE ANNEX How? Who receives the final version?

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Important notice about Super System• If a local county is not using the KDEM Super System to

develop the ESF 8 Annex, then this template needs to be filled out & submitted to the local emergency manager. The template should not be submitted to KDHE.

• If a local county is using the KDEM Super System, then the designee to fill out the information within the Super System needs to get into contact with the local emergency manager to coordinate these efforts.

Super System & Emergency Management

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• It is highly recommended that the entire health & medical sector coordinates through the local ESF 8 Coordinator to ensure that correct & appropriate information is included in the plan.

What if our county is using a contactor to complete the county EOP through homeland security & emergency management?

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1. Schedule a meeting with emergency management & ESF 8 partners

2. Provide ESF 8 Annex template & standards to community partners

3. As a group, go through each of the six sections one by one

– Add, delete & modify– Focus on concept of operations &

responsibilities– Use a projector to make changes as a

team.

4. Send the draft version to the partners

5. Schedule a 2nd meeting if needed6. Work with emergency manager to

store the completed version (Super System or providing to KDEM).

Example: Concept of Operations

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ESF 8 PLANNING TEAM“Identify the Team”

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Identify agencies within the following areas:• Coordinating Agency• Primary Agencies • Support Agencies• State Agencies• Federal Agencies

ESF 8 Planning Team

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Example- Johnson County

Example- Franklin County

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Example- Butler County

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Example- State

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Example- Feds

SECTION 1- PURPOSE & SCOPE“Start Here”

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Section 1- Purpose & Scope

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Section 1- Purpose & Scope

Example- Cowley County

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Use template OR Use template OR develop your own develop your own

languagelanguage

SECTION 2- CONCEPT OF OPERATIONSBY SUBJECT AREA

“The Meat of the Annex”

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SECTION 2- CONCEPT OF OPERATIONS

Operational Overview

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Example- Cowley County

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• The Cowley County Emergency Operations Center (EOC) will serve as the central location for interagency coordination and executive decision-making, including all activities associated with ESF #8.

• The Cowley County Health Officer/Medical Officer or designee leads all local public health and medical response to public health emergencies and incidents covered by ESF #8.

• The Public Health Officer/Medical Officer or designee through the Office of the City-Cowley County Health Department (CCHD), coordinates local ESF #8 preparedness, response, and recovery actions. These actions do not alter or impede the existing authorities of any department or agency supporting ESF #8

Briefly describe Briefly describe what ESF 8 and what ESF 8 and

County EOC County EOC ResponseResponse

Identify ESF 8 Identify ESF 8 Coordinating Coordinating

agencyagency

Great best Great best practice to add practice to add

thisthis

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Example: Sherman County How do you How do you coordinate with coordinate with

emergency emergency management?management?• The Sherman County Public Health Department

is the primary agency for providing ESF #8 technical assistance, resources and support during response activities.

• Close coordination is maintained with local, state and federal officials to determine potential needs for support and the most expeditious means of acquiring that support. Various incident management systems will be used for collecting, processing, and disseminating information.

• The County Emergency Operations Center (EOC) will serve as the central location for interagency coordination and executive decision-making, including all activities associated with ESF #8.

“The Biological Incident Appendix (BIA) to this annex establishes how public health response activities will be coordinated to meet the needs generated by disasters in Johnson County. As described in the BIA, the Johnson County Health Department is responsible for:

– the investigation of disease reports, establishing control measures, and notifying appropriate authorities to ensure preventative measures are carried out,

– providing accurate information to the public and other authorities regarding public health,– maintaining records & cumulative data related to immunizations and communicable disease,– ensuring appropriate vaccine supply, source of drug and antidotes, and supply in

collaboration with hospitals/pharmacies, KDHE and the Center for Disease Control and Prevention (CDC),

– coordination of distribution and administration of these drugs, and– epidemiological monitoring and investigation,– maintaining an inventory of supplies and equipment that may be needed in the event of a

public health emergency or incident.– the activation and management of Strategic National Stockpile assets, and mass prophylaxis

and vaccination procedures.”31

Example: Johnson County Briefly describe any Briefly describe any local decon local decon capabilities capabilities


Continuity of Operations

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• Continuity of operations establishes policies and guidance to ensure the essential business functions of the healthcare system in the community are continued in the event that a manmade, natural or technological emergency disrupts or threatens to disrupt normal business operations. The community hospital and county health department have established a Continuity of Operations Plan (COOP). The county health department COOP is managed through an electronic application to ensure access to plan during an emergency.

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Example: KDHE Template Include a simple Include a simple statement about the statement about the

pre-established COOP pre-established COOP plans already in place.plans already in place.


Medical Surge

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• “EMSystem is the region’s primary method of communicating hospital status and capabilities and coordinating patient routing during a multi-casualty incident (MCI). EMSystem, a web-based program providing real-time information on hospital emergency department status, patient capacity, and the availability of staffed beds and specialized treatment capabilities, is used in the metropolitan area to link all acute-care hospitals and most EMS agencies.”

• “The Hospital Emergency Administrative Radio (HEAR) system is available to link hospitals and many area EMS agencies in the metropolitan area on a single channel radio system. The HEAR system serves as a backup to the EMSystem in the event of a mass casualty incident.”

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Example: Johnson County Include a simple Include a simple statement about statement about

EMSystem & Other EMSystem & Other communication systemscommunication systems

• “Decontamination of victims and fatalities will be addressed by Med-Act’s Hazardous Materials Medical Support Team and the Fire Branch function. Medical Branch EMS personnel will not be directly involved in this aspect of scene operations.”

• “Victims will be tracked by: 1) Serialized Triage Tag number, 2) Transport Sector status boards, and 3) a database maintained by the Medical Communications Sector (MEDCOM), within the Medical Branch. The regional electronic patient tracking system may also be used in MCI events, as described in the Regional MCI Plan.”

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Example: Johnson County Briefly describe any Briefly describe any local decon local decon capabilities capabilities

Briefly describe Briefly describe patient tracking patient tracking process and/or process and/or

systemsystem

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There are two hospitals in Cowley County: South Central Regional Medical Center in Arkansas City and William Newton Hospital in Winfield who are responsible for tracking their own hospital status and capacity. Both hospitals have a role as an NDMS Receiving Hospital. Both hospitals have a memorandum of agreement with the South Central Kansas Regional Hospital Preparedness Group (SCKRHPG) to provide and receive resources.

Example- Cowley CountyKeep it simple- Keep it simple-

Describe the Describe the hospitals’ role in hospitals’ role in

medical surgemedical surge

• Additional transportation to health & medical facilities, coordinate with ESF 1 – Transportation– Mention MOUs, if applicable

• Alternate Care Sites (ACS) – may provide additional treatment area(s)– Mention ACS plan, if applicable

• Regional relationships offer potential access to mutual aid resources– Mention MOUs, if applicable

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Section 2- Concept of Operations Medical Surge


Epidemiology and Surveillance

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Example- template Take the 3 requirements & Take the 3 requirements & make 3 bullets in the planmake 3 bullets in the plan


Fatalities management

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• “The Johnson County Coroner, who also functions as medical examiner, is ultimately responsible for the overall coordination of activities related to mass fatality incidents; however, there are many other organizations that are involved in the resolution of such events”

• “The Johnson County Coroner’s Office will be notified of any mass fatality incident through the Johnson County Emergency Communications Center. Initial information to be relayed to the Coroner’s Office includes:– Type of incident (aircraft crash, explosion, building collapse, etc.)– Location of the incident– Time of Occurrence– Status of the recovery of the survivors, if any (not yet begun, ongoing,

completed)– The approximate number of dead– Known hazards to responders– If known, the location of the command post, identity of the Incident

Commander and contact information”42

Example: Johnson County Think about Think about coroner coroner

responsibilitiesresponsibilities

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Example- Cowley County Think about Think about coroner coroner


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Example- Cowley County cont. Outline Outline resources to the resources to the

best of your best of your knowledgeknowledge

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Example- Cowley County cont.It’s OKAY to not It’s OKAY to not have locally but have locally but have access to!have access to!


Pre- hospital care

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• “Victims will be triaged on scene as directed by the Medical Officer or Triage Officer. When conducting initial triage at a Mass Casualty Incident (MCI), the START (Simple Triage And Rapid Treatment) system will be utilized. Patients should be divided into five categories, Immediate (Red), Delayed (Yellow), Minor (Green), Morgue (Black) and Involved (White).”

• “JC Med-Act will activate their Emergency Medical Services Operations Center (EMSOC) to monitor, coordinate, and support EMS response activities as needed.”

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Example: Johnson CountyStraightforwardStraightforward

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Example: Harvey CountySIMPLESIMPLE

• Victims will be triaged on scene as directed by the Harvey County EMS. International Triage Codes will be used. Severity of injury classifications are as follows:

• Casualty information will be routed through the Incident Commander, and through Harvey County EMS. Harvey County EMS and the Harvey County Health Department will coordinate with ESF #15 – External Communications on disseminating casualty information gathered from city/departmental EOCs. Information and statistics will be compiled from radio logs, facsimiles, databases and direct communications with EMS staff

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Victims will be triaged on scene as directed by the Medical Sector of Incident Command. International Triage Codes will be used.

Severity of injury classifications are as follows: •Seriously injured victims will be categorized: “Type Red” •Moderately injured victims will be categorized: “Type Yellow” •Minor injuries will be categorized: “Type Green” •Dead or mortally wounded are: “Type Black

Victims will be tracked by using the following: •Serialized Triage •Tag number •Transport

Example- Sherman County EasyEasy


Medical Countermeasure Dispensing

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Points of Dispensing (POD) LocationsWyandotte County operates multiple Points of Dispensing (PODs) to serve the needs of the population. Points of Dispensing (PODs) are designated dispensing locations for persons who are currently healthy but may have been "exposed" and need prophylactic medication. You will be notified through news outlets if you need to receive medications. In the event a POD site is not available, alternate locations have been established. PODs are sometimes identified as Neighborhood Distribution Centers.

What to Expect from Points of Dispensing (PODs)The Point of Dispensing (POD) is the primary tool used by the local health department to get appropriate medicines and information into the public sector by the quickest and most efficient manner. To this end, it is requested that only one person that is 18 or older, and typically the head of the household, come through the POD and receive medicines and instructions for all members of their household. Individuals that are ill and/or showing symptoms of "exposure" should go to their local hospital for treatment.

What to Expect from Hospitals / ClinicsPOD sites are designed for people "exposed" but without illness; otherwise hospitals are the route of treatment.

What to Expect from the Police DepartmentLocal law enforcement will provide protection to the POD site. Security will be strictly enforced and the local police and/or county sheriff will be on-site in significant numbers. Peace officers will assist with the smooth flow of clients throughout the POD.

What to Expect from Emergency Medical Services (EMS)Emergency Medical Services (EMS) across the Kansas City and North East Region will provide transport support to the POD sites. Symptomatic patients capable of self-transport to the hospital will do so, otherwise, EMS services will be provided.

What to Expect from the Fire DepartmentThe Fire Department may be dispatched to emergency medical calls in support of local EMS and may be involved at POD sites.

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Example: Wyandotte County Explain mass Explain mass dispensingdispensing

http://www.kscri.org/

What to Expect from Hospitals / ClinicsPOD sites are designed for people "exposed" but without illness; otherwise hospitals are the route of treatment.

What to Expect from the Police DepartmentLocal law enforcement will provide protection to the POD site. Security will be strictly enforced and the local police and/or county sheriff will be on-site in significant numbers. Peace officers will assist with the smooth flow of clients throughout the POD.

What to Expect from Emergency Medical Services (EMS)Emergency Medical Services (EMS) across the Kansas City and North East Region will provide transport support to the POD sites. Symptomatic patients capable of self-transport to the hospital will do so, otherwise, EMS services will be provided.

What to Expect from the Fire DepartmentThe Fire Department may be dispatched to emergency medical calls in support of local EMS and may be involved at POD sites.

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Example: Wyandotte County Explain partners Explain partners roles in mass roles in mass

dispensingdispensinghttp://www.kscri.org/


Medical Material Distribution

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Example: Template Stick to the pointStick to the point


Non-Pharmaceutical Interventions

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• K.S.A 65-119a - Provides the duties and powers of local health officers.“Any county or joint board of health or local health officer having knowledge of

any infectious or contagious disease, or of a death from such disease, within their jurisdiction, shall immediately exercise and maintain a supervision over such case or cases during their continuance, seeing that all such cases are properly cared for and that the provisions of this act as to isolation, restriction of communication, quarantine and disinfection are duly enforced. The county or joint board of health or local health officer shall communicate without delay all information as to existing conditions to the Secretary of Health and Environment. The local health officer shall confer personally, if practicable, otherwise by letter, with the person in attendance upon the case, as to its future management and control.” Further, provides the authority to prohibit or restrict public gatherings “The county or joint board of health or local health officer is herby empowered and authorized to prohibit public gatherings when necessary for the control of any and all infectious or contagious disease.”

Example: Harvey County

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Include isolation Include isolation & quarantine & quarantine authorities? authorities?

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• The Kansas Isolation and Quarantine statute K.S.A. 65-129 provides the template for control efforts in the case of large-scale outbreaks of naturally occurring diseases, like pandemic influenza, SARS or artificially introduced biological agents in connection with bioterrorism. The [JURISDICTION] Board of Health may also issue advisories or recommendations for the closure of public buildings, events and activities. In partnership with local school districts, schools may also be dismissed to aid in disease containment measures.

• When necessary, ESF 8 will coordinate with ESF 13 –Public Safety to ensure the safety of public and community members related to isolation and quarantine.

• The hospital maintains an appropriate HVAC system which is an essential tool for the control of infection. The hospital has a negative pressure room and procedures to keep contaminants and pathogens from reaching surrounding areas within the hospital. These procedures are outlined in internal hospital policies and will be actives as outlined in these policies to prevent cross-contaminations from room to room.

Example: Template

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Many of the prior county ESF 8 plans did not include specific items to address the new 5

standards for non-pharmaceutical interventions.

Please check your plan.

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Responder Health and Safety

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• Appropriate and efficient rest/work cycles must be established and monitored. The rehabilitation of rescuers will follow established guidelines. Injured rescuers will be evaluated.

• Sanitation and hygiene is a priority. Inspections are important to ensure that rescuers food and water supplies remain free of contamination.

• Health Department employees and EMS personnel may be asked to perform duties under dangerous circumstances and consideration must always be given to employee safety. Further, since EMS and local Health Department employee activities may directly affect the level of morbidity and mortality of disease, all employees will be provided education at their orientation and annually thereafter, regarding appropriate precautions to limit likelihood of exposure to potentially toxic and/or infectious agents.

• Staff’s exposure to toxic agents or infection will be limited as much as possible.

Example: Harvey County

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How will you How will you protect protect

responders? responders?

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• “The Johnson County Mental Health Center and other Johnson County emergency service providers have established and staff the Johnson County Critical Incident Stress Management (CISM) Team. The team provides specialized assistance to on-scene emergency responders, dispatch personnel, Emergency Operations Center (EOC) personnel, and other community care-givers, and their families.”

Example: Johnson County

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Who will provide Who will provide crisis counseling? crisis counseling?

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Volunteer Management

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• JCHD will not be utilizing spontaneous volunteers during a biological incident; all unaffiliated volunteers will be directed to the VOAD/COAD. – Unaffiliated/Spontaneous Volunteer: Any Individual

acting in support of County operations of their own accord with no official ties to a department, agency or government (Spontaneous/ convergent volunteer).

– Volunteer: Any Individual acting in support of County operations by the request and direction of their agency (Red Cross, Salvation Army, Medical Reserve Corp, etc.)


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What is your What is your local-level local-level process?process?

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Volunteer agencies and community organizations may have staff available to assist …

• CERTs (traffic and crowd control, and other duties as assigned by EMAs, such as photographing license plates to help identify potential victims)

• Citizen Corps – Retired LE Officers (recovery)• Amateur Radio Operators (communications)• Medical Reserve Corps (identification, recovery and

other medical functions)• Medical Students – Paramedics, EMTs, Doctors,

Nurses, Science Students, etc. (medical functions)…

Example: Mid-America Regional Council

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What are your What are your local resources?local resources?

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• “ESF 8 has access to the Kansas System for the Early Registration of Volunteers (K-SERV) system, which can be utilized as a volunteer database at the local and state levels. In addition, various health and medical entities have an internal volunteer database. Each facility should utilize internal policies and procedures for verifying and credentialing. In the event that volunteers are needed to provide assistance during an incident response, K-SERV offers an opportunity for volunteer request and receipt through a standard operating procedure.”

Example: KDHE

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What do you What do you have access to at have access to at the state-level?the state-level?

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Environmental Health

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Example: Mid-America Regional Council

Keep it broadKeep it broad• Local Health Departments will also

work to ensure the safety of food and water supplies and when required by the event, will coordinate with local EMAs and the state to request state and federal assistance to provide resources, expertise and adequate support for environmental issues and to help ensure worker health and safety.


Behavioral Health

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• Behavioral (Mental Health)The Cowley County Mental Health and Counseling Center is responsible for coordinating behavioral health provisions for all individuals affected by a disaster, both in the response and recovery phases, including:

– Current Caseload: The Cowley County Mental Health and Counseling Center as well as various private therapists care for people already at risk due to their history, present condition, or other factors.

– Survivors: The Cowley County Mental Health and Counseling Center will coordinate the behavioral health needs of those who have been injured, had family members killed or injured, or suffered extensive property losses. In addition, non-governmental agencies, such as The American Red Cross and other agencies and organizations that normally work with special population members can assist in providing care for those who, while not directly affected by the disaster, may become more severely traumatized, such as the elderly, the disabled and non-English speaking.

– Emergency Workers: The Cowley County Mental Health Department provides specialized assistance to on-scene emergency responders, dispatch personnel, emergency operations center personnel, and other community caregivers, as well as any of their families.

• Behavioral Health Staffing– All agencies and organization with responsibilities for behavioral health will coordinate their activities with the

Cowley County Emergency Operations Center (EOC) through a liaison with the Cowley County Mental Health and Counseling Center.

– During the recovery phase, the Cowley County Mental Health and Counseling Center will continue to provide services or will assist in referring individuals to other agencies, depending on the needs and circumstances of the individual.

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Example: Cowley County Best practice for Best practice for behavioral healthbehavioral health

• “The Mental Health Center belongs to a state-wide network of credentialed mental health providers. Additionally, the Mental Health Center is part of the Regional Homeland Security Mental Health Response System led by the Greater Kansas City Chapter of the American Red Cross. These resources, along with other local affiliated agencies, would be utilized to respond to a community disaster."

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Resources are Resources are identifiedidentified

SECTION 2- CONCEPT OF OPERATIONSACTIONS SECTION

“What are the action steps”

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Example: Johnson County Actions are very Actions are very detaileddetailed

Each phase requires Each phase requires specific skills & specific skills & knowledge to knowledge to

accomplish the tasks accomplish the tasks & requires & requires

cooperation & cooperation & collaborationcollaboration

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Example: Butler County Actions listed out Actions listed out correctly in order correctly in order

and are kept and are kept simplesimple

SECTION 3 RESPONSIBILITIES“Who is going to do which action steps?”

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Johnson County Public Health

Preparedness

Ensure each of the preparedness responsibilities identified for the County ESF-8 Team (listed above) are accomplished

Maintain an inventory of agency resources Provide current emergency contact information to Johnson County Emergency

Management and Homeland Security

Response

Provide public health support in emergency/disasters, in accordance with departmental operations guides & protocols, existing MOUs & agreements, and the ESF-8 Public Health and Medical Services Annex.

Ensure each of the response responsibilities identified for the County ESF-8 Team (listed above) are accomplished regardless of the activation/staffing level of the County EOC

Arrange for appropriate staffing of the County ESF-8 Team in the EOC throughout activations

Coordinate the ESF-8 Team activities in the County EOC

Recovery

Coordinate the ESF-8 support of recovery activities Coordinate the restoration of ESF-8 resources and/or capabilities as needed Ensure ESF-8 Team Members and/or their agencies provide appropriate records of

costs incurred Conduct an ESF-8 after action review

Mitigation Identify and implement mitigation activities to prevent or lessen the impact of future incidents

Johnson County Med-Act

Preparedness




Response

Provide medical support in emergency/disasters, in accordance with departmental operations guides & protocols, existing MOUs & agreements, and the ESF-8 Public Health and Medical Services Annex.

Ensure each of the response responsibilities identified for the County ESF-8 Team (listed above) are accomplished regardless of the activation/staffing level of the County EOC

Arrange for appropriate staffing of the County ESF-8 Team in the EOC throughout activations

Coordinate the ESF-8 Team activities in the County EOC

Recovery

Coordinate the ESF-8 support of recovery activities Coordinate the restoration of ESF-8 resources and/or capabilities as needed Ensure ESF-8 Team Members and/or their agencies provide appropriate records of

costs incurred Conduct an ESF-8 after action review

Mitigation Identify and implement mitigation activities to prevent or lessen the impact of future incidents

Johnson County Mental Health

Preparedness




Response Provide mental health support in emergency/disasters, in accordance with departmental operations guides & protocols, existing MOUs & agreements, and the ESF-

Example: Johnson County Easy to Easy to understandunderstand

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Example: Franklin County To the pointTo the point

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Example: Franklin County Even identified Even identified coroner’s coroner’s


SECTION 4 FINANCIAL MANAGEMENT“Money management”

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Section 4: Financial Management

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Example: Sherman CountyWhy is financial Why is financial

management management important?important?• Each ESF agency is responsible for

establishing administrative controls necessary to manage the expenditure of funds and to provide reasonable accountability and justification for federal reimbursement in accordance with the established guidelines.

• The first source of funds for expenditures by agencies in response to an emergency, imminent disaster, or recovery from a catastrophic incident, is to be from funds County Emergency Funds.

SECTION 5: REFERENCE & AUTHORITIES“Items of Importance”

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Section 5: Reference & Authorities

SECTION 6: ATTACHMENTS“Other info you may need”

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Section 6: Attachments

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Example: Sherman CountyIncludes agreements Includes agreements

and reasoning for and reasoning for having agreements having agreements

Attachments Includes :• List of services/contracts• Sample forms and logs• Agreements and Understandings

All agreements and understandings entered into for the purchase, lease, or otherwise use of equipment and services, will be in accordance with the provision of laws and procedures.

The Proclamation of a State Disaster issued by the Governor may suspend selected rules and regulations that affect support operations. The primary agency will determine the specific impact of the situation and inform the ESF group members.

Kansas defined Tier 1-4 Coordination

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cross disciplinary collaboration discussion

Documents

annex template

local esf

local county

health medical annex

identification of esf

template flexible

county partners

county health medical