emergency operations plan - nor-cal emsnorcalems.org/lemsa-hpp/docs/20130301_nor-cal_ems_eop.pdfmar...

2013

Emergency

Operations

Plan

March 1, 2013 [NOR-CAL EMS EOP ]

NOR-CAL EMS 1

RESPONSE ACTIONS

� Assess the situation

� Contact/Respond to the MHOAC or designee

� If appropriate contact the RDMHS

� Address requests for assistance and information

� Identify/assist with resource needs for the medical-health response

� Collect and analyze data through surveillance systems

� Obtain ICS forms for proper documentation of the incident

� Document all response actions


NOR-CAL EMS 2

Handling Information

The title of this document is the Nor-Cal Emergency Operations Plan.

1. This plan will be maintained and updated by Northern California Emergency Medical

Services (Nor-Cal EMS) staff. This plan will be reviewed and updated as necessary each

year by April 1st. Review and revisions to the plan should include corrective actions listed

in exercise and real event after action reports (AARs), legislative updates, updates of

relevant operational procedures, a review of practical applications, and updates of

informational materials to all staff at all sites. Updates to telephone, fax, and email lists,

personnel rosters, resource lists and physical changes that effect the implementation of

this plan will also be conducted.

2. Points of Contact:

Dan Spiess

CEO

Nor-Cal EMS

457 Knollcrest Drive, Suite 120

Redding, CA 96002

Office: 530-229-3979

[email protected]

Patti Lima

Project Coordinator

Nor-Cal EMS

457 Knollcrest Drive, Suite 120

Redding, CA 96002

Office: 530-229-3979

[email protected]


NOR-CAL EMS 3

Plan Revisions

DATE ACTION PAGES INVOLVED


NOR-CAL EMS 4


NOR-CAL EMS 5

Table of Contents

Immediate Response Action................................................................................................1

Handling Information..........................................................................................................2

Plan Revisions.......................................................................................................................3

Section 1

• .........................................................................................................................Introdu

ction............................................................................................................................6

• .........................................................................................................................Overvi

ew of NorCal EMS.....................................................................................................6

• .........................................................................................................................Missio

n..................................................................................................................................7

• .........................................................................................................................Purpos

e..................................................................................................................................7

• .........................................................................................................................Scope

....................................................................................................................................7

• .........................................................................................................................Assum

ptions..........................................................................................................................7

• .........................................................................................................................Plan

Overview....................................................................................................................8

• .........................................................................................................................Hazard

s and Vulnerabilities ..................................................................................................9

• .........................................................................................................................Critical

Functions and Priorities .............................................................................................9

Section 2

• .........................................................................................................................Prepar

edness Overview ........................................................................................................10


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Section 3

• .........................................................................................................................Medica

l and Health Coordination..........................................................................................11

• .........................................................................................................................MHO

AC Program and LEMSA Roles................................................................................12

• .........................................................................................................................17

Required MHOAC Program Functions, Responsibilities and LEMSA roles: ..........13

• .........................................................................................................................RDM

HC\S Program............................................................................................................14

• .........................................................................................................................CDPH

and LEMSA ...............................................................................................................15

Section 4

• .........................................................................................................................Inciden

t Level 1 .....................................................................................................................15

• .........................................................................................................................Inciden

t Level 2 .....................................................................................................................15

• .........................................................................................................................Inciden

t Level 3 .....................................................................................................................16

• .........................................................................................................................Emerg

ency system activation ...............................................................................................16

• Authority to Activate the Medical-Health Plan/System...............................................16

• Immediate Notifications...............................................................................................16

• .........................................................................................................................Medica

l Health Branch Director Responsibilities .................................................................17

Section 5

• .........................................................................................................................Inform

ation Sharing....................................................................................................18

• .........................................................................................................................Inform

ation Flow........................................................................................................22


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• .........................................................................................................................County

Notification and Situation Reporting.............................................................25

Section 6

• .........................................................................................................................Medica

l-Health Resource Requests / County Role....................................................26

APPENDIX A: Contacts and Resource Directory ............................................................30

APPENDIX B: Forms............................................................................................................33

APPENDIX C: Acronyms.....................................................................................................39

APPENDIX D: GLOSSARY................................................. ...............................................39


NOR-CAL EMS 8

SECTION 1 INTRODUCTION

This plan was developed to establish methods and procedures to guide Northern California

Emergency Medical Services (Nor-Cal EMS) as a LEMSA in the response to a disaster or an

immediate threat to the public’s health or to the healthcare delivery system.

This plan follows the guidelines and practices of the National Incident Management System

(NIMS) and California’s Standardized Emergency Management System (SEMS).

This plan was developed to work functionally within the Nor-Cal EMS six-county region.

OVERVIEW OF NOR-CAL EMS

Nor-Cal EMS provides services under contract to the 6 counties of Glenn, Lassen, Modoc,

Plumas, Sierra and Trinity. These counties encompass in excess of 16,000 square miles with a

resident population of approximately 112,000.

The agency’s primary responsibility is to serve as the Local Emergency Medical Services

Agency (LEMSA) for its contract counties. Nor-Cal EMS monitors and regulates emergency

care on behalf of its contract counties. LEMSA responsibilities are defined in Division 2.5 of the

California Health and Safety Code. Components of the EMS system are defined in Section

1797.103 of the Health and Safety Code and include the following:

The authority shall develop planning and implementation guidelines for emergency medical

services systems which address the following components:

(a) Manpower and training.

(b) Communications.

(c) Transportation.

(d) Assessment of hospitals and critical care centers.

(e) System organization and management.

(f) Data collection and evaluation.

(g) Public information and education.

(h) Disaster response

In addition to providing policies and protocols that address disaster medical response, Nor-Cal

EMS plays a role in the coordination among public and private entities involved in the Public

Health and Medical System when unusual events and emergencies occur.


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PURPOSE

The purpose of this plan is to provide guidance for the LEMSA’S role in assisting in coordinated

response among health and medical agencies to incidents that affect the health of residents and/or

critically impact the healthcare delivery system.

SCOPE

This plan serves as guidance as to how Nor-Cal EMS will assist in the integration and

coordination during a response. This plan provides direction in the notification and participation

of Nor-Cal EMS as the LEMSA.

ASSUMPTIONS

• Each County in the Nor-Cal EMS region will respond to all health emergencies and

disasters requiring a coordinated medical and health response.

• Essential County services will be maintained as long as conditions permit.

• The County will provide prompt and effective response and recovery operations in the

event of an emergency or disaster.

• The LEMSA and Counties will activate their respective EOPs

• The LEMSA will be available to assist as requested in the County Department Operations

Center (DOC) when opened for health emergencies.

• Each element of the emergency management organization is responsible for assuring the

preparation and maintenance of appropriate and current emergency operating procedures,

resource lists and checklists. The checklists detail how assigned responsibilities are

performed to support SEMS implementation and to ensure a successful response during a

major disaster.


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PLAN OVERVIEW

The Nor-Cal EMS EOP provides direction for the operations associated with the LEMSA’s

response to a disaster and identifies coordination with local, county, regional, state, and federal

agencies.

Plan:

• Describes policies and protocols for providing emergency support.

• Describes the incident management activities necessary for a successful LESMA

emergency response.

Training:

• Provides standard guidelines for minimum emergency preparedness training requirements

for LESMA staff.

Preparedness:

• Describes activities aimed at achieving agency readiness

Plan Appendices will include more specific information such as Job Action Sheets, ICS forms,

etc.

Plan Annexes will include supplementary plans that are detailed and specific to particular

hazards or events including:

o CHEMPACK Plan

o Regional MCI Plan

o Nor-Cal EMS FTS Plan

o California Public Health & Medical Emergency Operations Manual


NOR-CAL EMS 11

HAZARDS & VULNERABILITIES

The six-county region is vulnerable to a number of natural disasters including but not

limited to:

� Floods

� Wild fires

� Severe Storms

� Extreme Heat

� Earthquake

� Snow & Ice Events

� Landslides

� Dam Failure

� Disease Outbreak/Epidemic/Pandemic

The six-county region is also vulnerable to man-made disasters including but not limited

to:

� Bio-Terrorist Event

� Chemical Spill/Release

� Radiological Exposure/Release

� Civil Disturbance

� Terrorist Event

� War

� Aviation Disaster

� Utility Disruptions (power, water, sewage)

� Interruption of major routes of transportation including freeways, highways and both

passenger and freight railways.

CRITICAL FUNCTIONS AND PRIORITIES

Priorities during an emergency are:

1. Life-threatening situations

2. Injury to persons

3. Safety of property

4. Preservation of the Public Health Record


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SECTION 2: PREPAREDNESS PHASE

PREPAREDNESS OVERVIEW

Nor-Cal EMS will place emphasis on:

1. Emergency planning

2. Training

The preparedness phase involves those activities taken in advance of an emergency. These

activities develop operational capabilities, readiness and effective response to a disaster situation.

Actions might include mitigation activities, emergency/disaster planning, training and exercises,

and public education.


NOR-CAL EMS 13

SECTION 3: HEALTH & MEDICAL COORDINATION

The primary goal of this manual is to strengthen coordination between Public Health and EMS

when unusual events and emergencies occur. This is particularly important when large scale

emergencies exceed the response capacity of the Operational Area and require coordination with

additional partners beyond “routine business.” California’s Public Health and Medical System

relies upon specific coordination programs that support public health and medical activities while

integrating into the existing emergency management structure. These coordination programs,

include the Medical Health Operational Area Coordination (MHOAC) Program and Regional

Disaster Medical and Health Coordination (RDMHC) Program. The operational processes

described in this manual support California’s Standardized Emergency Management System

(SEMS) and the National Incident Management System (NIMS). The table below identifies the

five SEMS levels and the corresponding functional entities within the Public Health and Medical

System:

SEMS LEVEL ENTITY WITH PUBLIC HEALTH AND MEDICAL ROLE

State State agencies with a public health and medical role, including but not limited to:

• California Department of Public Health (CDPH), including Duty Officer Program

and/or Joint Emergency Operations Center (JEOC) if activated.

• Emergency Medical Services Authority (EMSA), including Duty Officer Program

and/or JEOC if activated.

• California Department of Health Care Services (DHCS).

• California Emergency Management Agency (OES) Executive Duty Officer and/or

State Operations Center (SOC) if activated.

• California State Warning Center (CSWC) operated by OES.

Region • Regional Disaster Medical and Health Coordination (RDMHC) Program.

• OES Regional Duty Officer or Regional Emergency Operations Center (REOC) if

activated.

Operational Area • Medical Health Operational Area Coordination (MHOAC) Program.

• Operational Area Emergency Operations Center (EOC) if activated.

Local

(City/County/

Special District)

• Local Health Department (LHD).

• Local Environmental Health Department (EHD).

• Local Emergency Medical Services Agency (LEMSA).

• Local Emergency Management Agencies.

• Department/Agency Departmental Operations Centers (DOCs).

• Local Government EOCs.

Field • Numerous organizations/entities including but not limited to hospitals, EMS

providers, community clinics, skilled nursing facilities, laboratories, public water

systems and dispatch centers.


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SEMS provides the fundamental structure for emergency response in California, incorporating

the use of the Incident Command System, Operational Area concept, multi-agency coordination,

and California Disaster and Civil Defense Master Mutual Aid Agreement. The State Emergency

Plan (SEP), in accordance with the California Emergency Services Act, outlines the activities of

all California jurisdictions within a statewide emergency management system.

Within the Public Health and Medical System, coordinating functions exist at the level of the

Operational Area, Mutual Aid Region, and State.

• Within the Operational Area, the MHOAC Program coordinates the functions identified

in Health and Safety Code §1797.153

• Within the Mutual Aid Region, the RDMHC/S Program coordinates the functions

identified in Health and Safety Code §1797.152

• At the State level, State agencies coordinate their activities to support emergency

response. CDPH functions as the lead State agency for public health and EMSA functions

as the lead State agency for medical, including emergency medical services. During

emergency activations, CDPH & EMSA join to form a Joint Emergency Operations

Center (JEOC).

MHOAC PROGRAM / LEMSA ROLES

The MHOAC Program is housed in Public Health in each of the six counties. It is comprised of

the Public Health Emergency Preparedness Programs and Hospital Preparedness Program staff.

MHOAC Program Responsibilities

Summary of Basic Responsibilities:

� Medical Health Branch Director in the OA EOC (when activated)

� Coordination of the medical and health response (to include medical, public health,

environmental health, & behavioral health)

� Coordinates the provision of all medical-health resources within the OA

� Works collaboratively with the Regional Disaster Medical Health Specialist/Coordinator

(RDMHS/C)

� Makes medial health resource requests to the RDMHS/C

� Processes requests for medical health mutual aid from the RDMHS/C

� Submits Situation Status Reports (SITREPs)to RDMHS/C and CDPH/EMSA or JEOC (if

activated)


NOR-CAL EMS 15

17 Required MHOAC Program Functions, Responsibilities and

Nor-Cal EMS LEMSA roles:

RESPONSIBILITY* AGENCY RESPONSIBLE

LHD / MHOAC - Primary 1) Assessment of immediate medical needs

NCEMS - Support*

LHD / MHOAC - Primary 2) Coordination of disaster medical and health resources

NCEMS - Support*

LHD / MHOAC - Primary 3) Coordination of patient distribution and medical evaluation

NCEMS - Support*

LHD / MHOAC - Primary 4) Coordination with inpatient and emergency care providers

NCEMS - Support*

5) Coordination of out-of-hospital medical care providers LHD / MHOAC - Primary

NCEMS - Support*

6) Coordination and integration with fire agency personnel, resources, and

emergency fire pre-hospital medical services.

OES

LHD / MHOAC - Primary 7) Coordination of providers of non-fire based pre-hospital emergency

medical services. NCEMS - Support*

LHD / MHOAC - Primary 8) Coordination of the establishment of temporary field treatment sites

NCEMS - Support*

9) Health surveillance and epidemiological analyses of community health

status

LHD / MHOAC

10) Assurance of food safety LHD / MHOAC

11) Management of exposure to hazardous agents LHD / MHOAC

12) Provision or coordination of mental health services LHD / MHOAC

13) Provision of medical and health public information protective action

recommendations

LHD / MHOAC

14) Provision or coordination of vector control services LHD / MHOAC

15) Assurance of drinking water safety LHD / MHOAC

16) Assurance of the safe management of liquid, solid, and hazardous

wastes.

LHD / MHOAC

17) Investigation and control of communicable disease LHD / MHOAC

*At the request of the MHOAC or RDMHS, Nor-Cal EMS will participate in these activities in a

supporting role at the DOC/EOC or remotely


NOR-CAL EMS 16

RDMHC/S PROGRAM

The Regional Disaster Medical Health Coordinator (RDMHC) coordinates disaster information

and medical and health mutual aid and assistance within the Mutual Aid Region or in support of

other affected Mutual Aid Region(s). The Regional Disaster Medical and Health Specialist

(RDMHS) is a component of the RDMHC Program who directly supports regional preparedness,

response, mitigation and recovery activities.

Similar to the MHOAC Program, effective coordination within the Mutual Aid Region may

require the involvement of various organizations and State agencies (e.g., CDPH and EMSA).

The support of activated Medical and Health Branches at Regional Emergency Operations

Centers (REOCs) is coordinated by RDMHC Programs, CDPH and EMSA.

The Nor-Cal EMS region includes six of the thirteen counties in Mutual Aid Region III.

CDPH & EMSA

CDPH functions as the lead State agency for public health and EMSA functions as the lead State

agency for medical, including emergency medical services. In addition to conducting program

activities in accordance with statutory and regulatory authorities, CDPH and EMSA conduct

operations to support California’s public health and medical response during emergencies.

CDPH and EMSA operate Duty Officer Programs on a 24 hour-per-day, 365 day-per-year basis.

The CDPH and EMSA Duty Officer Programs receive notifications from internal and external

sources regarding emerging public health, environmental health, and medical events and notify

appropriate State level programs and local partners to increase awareness when a threat is

approaching or imminent. When unusual events occur that require additional coordination and

communication, the CDPH and/or EMSA Duty Officer Programs notify management, internal

programs, local partners, and other State agencies in accordance with established policies and

procedures. When incidents require further coordination, CDPH, EMSA and the DHCS activate

the JEOC to coordinate information and resources in support of California’s public health and

medical response.


NOR-CAL EMS 17

SECTION 4: INCIDENT LEVELS

The Public Health and Medical Incident Level is based on the need for health and/or medical

resources to effectively manage the incident. There are three levels (Level 1, 2 or 3) based on

the need for resources:

Level 1 Public Health and Medical Incident

• Can be adequately mitigated using available health and/or medical resources from within

the affected Operational Area OR

• By accessing resources from other Operational Areas through existing agreements

(including day-to-day agreements, memoranda of understanding, or other emergency

assistance agreements).

• May require emergency system activation, including activation of DOCs or EOCs within

the Operational Area (See DOC Activation Levels)

During Level 1 Incidents, a variety of response partners may be involved depending on the

nature of the incident, including LEMSA, LHD, EHD and other Public Health and Medical

System participants. The MHOAC Program should be notified of Level 1 Public Health and

Medical Incidents, including the need for accessing resources through existing agreements, and

assist in accordance with local policies and procedures. Health and medical resource requests

within the Operational Area should be coordinated according to local policies and procedures


• Requires health and/or medical resources from other Operational Areas within the Mutual

Aid Region beyond those available through existing agreements AND

• May include the need for distribution of patients to other Operational Areas.

• Resource requests should be coordinated by the MHOAC Program of the affected

Operational Area (See Resource Management)

• Typically requires regional assistance and, therefore, assistance from the RDMHC

Program

A Level 2 Public Health and Medical Incident will typically require assistance from the RDMHC

Program within the Mutual Aid Region and may require emergency system activation, including

activation of DOCs or EOCs within the Operational Area and Mutual Aid Region.


NOR-CAL EMS 18


• The need for health and/or medical resources exceeds the response capabilities of the

affected Operational Area and associated Mutual Aid Region.

o This determination is made from an assessment of health and medical resources

relative to current and expected demands.

• As with Level 2 Public Health and Medical Incidents, requests for health and medical

resources are coordinated by the MHOAC Program within the affected Operational

Area(s), working in conjunction with the RDMHC Program(s) (See Resource

Management)

• Activation of DOCs/EOCs within the Operational Area, Mutual Aid Region, and State

will occur during a level 3 event

• State and/or federal government response agencies may begin mobilizing and pre-

positioning resources while awaiting local requests

A Level 3 Public Health and Medical Incident will lead to activation of DOCs/EOCs within the

Operational Area, Mutual Aid Region, and State.

Emergency system activation occurs when Department Operations Centers (DOCs) and/or

Emergency Operation Centers (EOCs) are activated within the Operational Area to coordinate a

response to an unusual event or disaster.

• Health impacts are a primary/major result of the incident, OR

• Regionally coordinated action is required to address public health threats, OR

• Routine activities, organizational relationships, and resources of the health department

are NOT sufficient OR other medical entities are NOT sufficient for response to an actual

or potential incident or event.

Authority to Activate the Medical-Health Plan/System

� MHOAC or designee

� Health Officer or designee

� Public Health Director

� Health Services Agency Director or Deputy Director

� PH Program Manager

� MHOAC Program/EP Program Coordinator

Immediate Notifications

� County office of Emergency Services/Sheriff’s Office

� County Public Health � California Department of Public Health 24/hour duty-officer: (916) 328-6305 or

[email protected]

� EMSA Duty Officer: (916) 553-3470 or [email protected]

� RDMHS: 530-722-6615 or 530-204-7049

� If Bioterrorism event: Federal Bureau of Investigation: (916) 481-9110


NOR-CAL EMS 19

Upon an activation of the County/Operational Area EOC, medical and health coordination will

be handled at the EOC Medical-Health Branch. The Health DOC may stay operational if it is

needed to support Public Health response activities.

Medical Health Branch Director Responsibilities

• Communication & coordination with all medical and health sites within the OA

• Assess community medical status and needs

• Complete medical-health resource requests (see Resource Management)

• Communication & coordination with the RDMHS, CDPH, & EMSA (JEOC if activated)

• Communication & coordination with the County Health Officer on matters that involve

medical policy or legal decisions such as isolation, quarantine, crisis standards of care,

allocation of scarce medical resources, etc.

• Complete Medical-Health Situation Reports (SITREPs)


NOR-CAL EMS 20

SECTION 5:

COMMUNICATION & INFORMATION SHARING

COMMUNICATION MODES Nor-Cal EMS will utilize several modes of communication during an incident. Multiple modes

of communication will provide redundancy.

Modes include:

• Phone (landline & cell)

• Conference Call

• Fax

• Email

• Web-based communications, e.g. EMResource

• CAHAN (State web-based alerting & notification system)

• Handheld radios

• Written message via runner

• In-person

INFORMATION SHARING Sharing information with horizontal and vertical response partners supports situational awareness

and decision-making at all levels of emergency management. Timely communication of incident

information, including impact to the Public Health and Medical System, current and anticipated

resource needs, and the capacity to respond are essential to developing a common operating

picture. Three conditions are identified, along with triggers for transitioning from one operating

condition to the next:

• Day-to-Day Activities;

• Unusual Events; and

• Emergency System Activation.

County Health DOC performs the following functions:

� Manage the emergency or disaster under the ICS guidelines

� Coordinate all County & HPP emergency activities, resources and requests to and from

other agencies

� Coordinate communication and resources for medical-health community

� Development and implement the Incident Action Plan, to coordinate resources and

actions with the local Operational Area EOC (if open)

� Evaluate the Incident Action Plan frequently and modify as needed

� Maintain emergency communication with the local County EOC (if open), and/or County

OES throughout the emergency


NOR-CAL EMS 21

Nor-Cal EMS (LEMSA)

Given the specifics of a disaster or emergency Nor-Cal EMS is responsible for the following

activities:

� Notify Public Health/MHOAC Program of any status changes

� Notify Public Health/MHOAC Program of any resource needs/requests

� Local and State agencies in accordance with statutory and regulatory requirements and local

policies and procedures Notify Public Health/MHOAC Program of any resource

needs/requests

� Monitor the capacity of HCFs to receive patients and communicate operational status to EMS

providers

� Ensure that hospital bed availability assessments (HAvBED) are completed when requested

by CDPH/EMSA

� Provide situational information to the MHOAC Program in accordance with local policies

and procedures

� Coordinate with EMS providers, MHOAC Program, and others regarding pre-hospital triage,

patient care, and medical transportation of injured or contaminated patients in accordance

with local policies and procedures

� Coordinate the establishment of patient staging areas or Field Treatment Sites (FTS) to care

for patients awaiting transportation to medical facilities

� Coordinate the movement and distribution of patients by EMS providers, including

evacuation of patients and re-population of HCFs

RDMHC/S Program

The RDMHS is responsible for conducting the following activities:

� Establish incident-specific communication with the MHOAC Program in the affected

Operational Area

� Verify situational information with the MHOAC Program

� Notify the CDPH and/or EMSA Duty Officer Program (or JEOC if activated)

� Notify emergency management agencies in accordance with policies and procedures, including

the OES Regional Duty Officer (or REOC if activated)

� Notify the MHOAC Program(s) in unaffected Operational Areas within the Mutual Aid Region to

inform and provide advance warning if requests for assistance are anticipated

� If the State has requested a Medical and Health Situation Report, notify the impacted MHOAC

Program immediately of request

� Monitor the situation to identify immediate or impending response needs and take appropriate

action

� In consultation with CDPH and EMSA, prepare to support the Medical and Health

Branch of the REOC if activation is anticipated


NOR-CAL EMS 22

CDPH and/or EMSA Duty Officer Program (or JEOC if activated):

The State is responsible for conducting the following activities:

� Share information with State agencies, including OES, in accordance with policies and

procedures

Day-to-Day Activities Information routinely flows between Public Health and Medical System participants, including but not

limited to local health departments (LHDs), local environmental health departments (EHDs),local

emergency medical services agencies (LEMSAs), health care facilities and State and federal agencies in

accordance with statutory and regulatory requirements. When an operational problem occurs in the

course of ordinary day-to-day activities, relevant information should be reported to the appropriate

local and State agencies in accordance with statutory and regulatory requirements and local policies and

procedures.

Unusual Events

Beyond ordinary day-to-day activities, unusual events may occur that do not rise to the level of

an emergency but warrant enhanced situational awareness and notification of partners. See

Figure 2 at the end of this chapter. An unusual event may be self-limiting or a precursor to

emergency system activation. As described in the previous chapter, an unusual event is defined

as an incident that significantly impacts or threatens public health, environmental health or

medical services. It is important to note that the determination of “significant impact or threat” is

applied within the context of a reference baseline for the affected jurisdiction. An incident may

significantly disrupt essential Public Health and Medical System services in one county while a

similar occurrence in another county may have minimal impact on Public Health and Medical

System services. The triggers that prompt transition from routine, day-to-day information flow

to enhanced information sharing associated with unusual events include:

• The incident significantly impacts or is anticipated to impact public health or safety;

• The incident disrupts or is anticipated to disrupt the Public Health and Medical System;

• Resources are needed or anticipated to be needed beyond the capabilities of the Operational

Area, including those resources available through existing agreements (day-to-day agreements,

memoranda of understanding, or other emergency assistance agreements);

• The incident produces media attention or is politically sensitive;

• The incident leads to a Regional or State request for information; and/or

• Whenever increased information flow from the Operational Area to the State will assist in the

management or mitigation of the incident’s impact.


NOR-CAL EMS 23

Emergency System Activation

Emergency system activation occurs when an incident leads to activation of Department

Operations Centers (DOCs) and/or Emergency Operation Centers (EOCs). See Figure 3 at the

end of this chapter. Emergency system activation should trigger an enhanced level of information

sharing to support the needs of the incident. Particularly during a large-scale disaster that triggers

the activation of multiple DOCs and EOCs, the need for accurate and reliable information grows

significantly. Situational reporting provides the foundation for support and coordination and

facilitates resource acquisition. A Medical and Health Situation Report should be completed and

submitted in accordance with the guidance provided in this manual when an unusual event or

emergency system activation occurs. Further information is provided below


NOR-CAL EMS 24

Information Flow during Day to Day Activities


NOR-CAL EMS 25

Information Flow during Unusual Events


NOR-CAL EMS 26

Information Flow during Emergency System Activation


NOR-CAL EMS 27

COUNTY NOTIFICATION AND SITUATION REPORTING

When an unusual event or emergency system activation occurs, providing incident information

to response partners is critical. Prompt notification of response partners is likely to reduce

incoming requests for information from multiple sources and allow response partners to

anticipate the need for additional resources to support the affected jurisdiction.

Immediate notification of the incident to key partners is critical in response as well as

determining a communication plan for the incident. Additional notifications may be sent to

inform partners of new information or changes in situation status. Other relevant activities should

be undertaken as soon as possible, e.g., establishing communication with affected entities and

response agencies, verifying reported information, etc.

Medical-Health Situation Reports

The occurrence of an unusual event or emergency system activation should always trigger

completion of a Health and Medical Situation Report by County Public Health that is shared with

relevant partners representing the Public Health and Medical System, including the MHOAC

Program, RDMHS Program, CDPH and/or EMSA Duty Officer Programs (or JEOC if

activated). The Health and Medical Situation Report is also shared with partner agencies, e.g.,

local, regional and State emergency management, at all SEMS levels so that relevant health and

medical information can be incorporated into more comprehensive situation reports.

Public Health’s MHOAC Program is responsible for capturing the current operating picture of

the operational area and reporting it through the Health & Medical Situation Report to the

RDMHS, CDPH, and EMS (JEOC if activated). Public Health/MHOAC will request current

status information from all major healthcare facilities in order to properly complete the

operational area report.

At the local level, SITREPs will be used to determine each HCF’s level of impact from the event

& their capability to continue providing medical care to the community

Medical-Health SITREPs provide an overall snapshot of the medical & health community.


NOR-CAL EMS 28

�

SECTION 6: RESOURCE MANAGEMENT

MEDICAL-HEALTH RESOURCE REQUESTS / COUNTY ROLE

During emergency system activation, entities involved in the Public Health and Medical System

may require additional resources for response operations. Additional resources may be medical

and health resources, e.g., medical equipment and supplies, medical transportation, or health care

personnel but may also be non-medical and health related resources, e.g., power generators,

potable water, etc.

Requests for any medical and health resources that cannot be obtained locally or through existing

agreements should follow standardized resource ordering procedures in accordance with SEMS

and the Resource Management procedures. The general flow of medical and health resource

requests and assistance is shown in the CA Public Health & Medical Emergency Operations

Manual.

The MHOAC Program (PH) is the resource ordering point for resources related to the

medical and health system response at the local level, in accordance with local and state policies

and procedures.

Personnel Authorized to Request Medical-Health Resource

• MHOAC or designee

• PH IC

• PH Director

• County HSA Director

• MHOAC Program/EP Program staff (under the direction of their supervisor)

• OA EOC Logistics Section, Medical-Health Branch, or EOC Manager

Prior to requesting resources, the MHOAC Program should confirm the following with the

requesting Public Health and Medical entity:

• Is the resource need immediate and significant (or anticipated to be so)?

• Has the supply of the requested resource been exhausted, or is exhaustion imminent?

• Is the resource or an acceptable alternative available from:

o The internal, corporate supply chain?

o Other commercial vendors?

o Through existing agreements?

• Have any relevant payment/reimbursement issues been addressed?

A Medical and Health Situation Report should precede or accompany resource requests unless

extraordinary circumstances prevail.


NOR-CAL EMS 29

All resource requests should be entered into the Response Information Management System

(RIMS) at the Operational Area level. Request GC SO/OES access to RIMS.

All resource requests should include the following information (minimum data elements):

Resource Request Process by Jurisdictional Level

If additional resources are needed to mitigate the effects of an emergency, the following

activities should occur:

Healthcare Facilities & Other Field Level Medical-Health Entities

� If medical and health resources are needed that cannot be obtained through existing

agreements, request resources through the MHOAC Program

o Include required logistical support (“wrap around services”) such as food, lodging

and fuel as part of the resource request.

� Complete HCF Medical-Health Resource Request Form and submit request to PH

DOC/MHOAC

o HCF Med-Health Resource Request Form & directions in Appendix F

MHOAC Program

� Attempt to fill resource requests within the Operational Area or by utilizing existing

agreements

o day-to-day agreements, memoranda of understanding, or other emergency

assistance agreements

o Note: If an Operational Area has existing agreements with neighboring

Operational Areas and urgently requires resources, it may request and obtain

those resources as needed to meet the demands of the situation

� If requested resources cannot be met within the Operational Area or through existing

agreements

o A Medical and Health Resource Request is prepared

o Includes the minimum information including the need for logistical support

(“wrap around services”) such as food, lodging, and fuel.

o Submit the resource request to the:

� RDMHS Program, which will begin to coordinate the resource acquisition

process; and

� County SO/OES (or Operational Area EOC if activated).

� Receipt of request is confirmed

� Entry into RIMS is confirmed

� A Med-Health SITREP is provided to the RDMHS Program, County SO/OES Area (or

Operational Area EOC if activated), and CDPH and EMSA Duty Officers (or JEOC if

activated) to support the requested resources

� The requestor is notified of the outcome of the request and delivery details if the request

is filled


NOR-CAL EMS 30

LEMSA

� Assist the requesting MHOAC and/or RDMHS Program in refining the resource request

and/or identifying alternative resources

� Provide Local and State agencies in accordance with statutory and regulatory requirements

and local policies and procedures Notify Public Health/MHOAC Program of any resource

needs/requests

RDMHC/S Program

The RDMHS is responsible for conducting the following activities:

� Assist the requesting MHOAC Program in refining the resource request and/or

identifying alternative resources

� Immediately begin the process of filling the request by coordinating with unaffected

Operational Areas within the Mutual Aid Region

� Coordinate with the OES Regional Duty Officer (or REOC if activated) to ensure proper

tracking and fulfillment of the resource request

� Notify the CDPH and/or EMSA Duty Officers (or JEOC if activated) that a resource

request is being processed.

� Notify the requesting MHOAC Program, CDPH and/or EMSA Duty Officers (or JEOC if

activated), and OES Regional Duty Officer (or REOC if activated) of the outcome of the

request and delivery details if the request is filled within the Mutual Aid Region.

Regional Emergency Operations Center/State Operations Center (if activated)

The REOC is responsible for conducting the following activities:

� If the request cannot be filled within the Mutual Aid Region, the OES Regional Duty

Officer (or REOC if activated) coordinates with the other RDMHC/S Programs within

the OES Administrative Region to fill the resource request

� If the resource request cannot be filled within the OES Administrative Region, the

request is forwarded to the OES Executive Duty Officer (or SOC if activated) to seek

resource availability in unaffected OES Administrative Regions or from State agencies

� he SOC coordinates with State agencies, other states or the Federal government to fill the

request if necessary and notifies the REOC and RDMHC/S Program of the outcome

Joint Emergency Operations Center (if activated)

The JEOC is responsible for conducting the following activities:

� Monitor Medical and Health Resource Requests

� Coordinate with State agencies to identify and mobilize medical and health resources

� Provide CDPH and EMSA-maintained resources in accordance with policies and

procedures

After-Action Reports


NOR-CAL EMS 31

Following any activation of the PH DOC, Nor-Cal EMS will complete a HSEEP compliant

AAR/CAP within 90 days of the close of the incident period and submit to its State Authority,

CDPH-EPO, and any other relevant partners including health care partners involved in the

response, GCSO OES, RDMHS, EMSA, etc.

The Standardized Emergency Management System (SEMS) regulations require any city, city and

county, or county declaring a local emergency for which the Governor proclaims a State of

Emergency, to complete and transmit an After-Action Report to the State (Cal-EMA, CDPH for

health events) within 90 days of the close of the incident period. The After-Action Report will

be HSEEP compliant and provide, at a minimum, the following:

� Overview of the incident

� Response actions taken

� Application of SEMS

� Corrective Actions

� Necessary modifications to plans and procedures

� Training needs

� Recovery activities to date

The After-Action Report and Corrective Action Plan will serve as a source for documenting the

GCPH and/or GC OA emergency response activities, and actions. The report will identify areas

of concern and provide information for addressing modifications of procedures and plans. It will

also be utilized to develop a work plan for implementing modifications to the EOP and local

government policy.

AAR/CAP Directions

Utilize the HSEEP AAR/CAP template available on the HSEEP website:

https://hseep.dhs.gov

� Public Health Emergency Preparedness Program staff are trained in HSEEP and should

assist in the completion of all PH AAR/CAP.


NOR-CAL EMS 32

APPENDIX A:

Directory of Contacts

• CDPH Duty Officer: o CDPH Duty Officer: [email protected]

• EMSA Duty Officer: o EMSA Duty Officer: [email protected]

REGIONAL Public Health CONTACTS Organization Who to Contact Contact Number (530)

RDMHS Todd Frandsen 722-6615/204-7049

Butte Mark Lundberg 538-7581/370-0766

Colusa Christine Steinhoff 458-0380/458-0200

Lassen Joanna Zimmermann 251-8183/257-6121

Modoc Kelly Crosby 233-6311/640-8622

Plumas Tina Venable 283-3646/249-3679

Shasta Dave Maron 225-5593/225-3767

Sierra LeTina Vanetti 993-6737/289-3700

Siskiyou Lynn Corliss 841-2130/841-2900

Sutter Lou Ann Cummings 822-7215/822-7307

Tehama Linda Rose 527-6824/529-7900

Trinity Carol Huang 623-8218/227-2113

Yuba Joseph Cassady 749-6781/682-8648

LEMSA Contacts Organization Who to Contact Contact Number

Nor-Cal EMS Dan Spiess 530-229-3979

Nor-Cal EMS Dr. Eric Rudnick 530-229-3979

STATE Contacts Organization Who to Contact Contact Number

Cal-EMA Deborah Russell 227-4016/248-9026

EMSA Duty Officer 916-553-3470

CDPH-EPO Duty Officer 916-328-3605

FEDERAL Contacts

Organization Who to Contact Contact Number

FBI

SA Sheldon Fung (WMD)

SA Rob Borne Special Agent

(WMD)

Brian Alvarez (EOD/Bomb)

1-916-481-9110 (24 Hour)

916-977-2462/416-9118

[email protected]

916-977-2222/416-1742

[email protected]

CDC Emergency Hotline 1-770-488-7100


NOR-CAL EMS 33

Medical-Health Resource Directory * For more information on any of these resources, contact NOR CAL EMS at 530-229-3979.

CAHAN

• Web-based alerting and notification system

• Send alerts at varying levels of importance to partners registered on the system

• Currently, many healthcare facilities in NorCal EMS Region are on CAHAN

HAVBED (EMResource):

• Obtain password from Public Health

• Provides current status of all hospitals in region III

o ED status, bed status/census by unit including specialty units (NICU, ICU, etc.)

Local:

• Public Health’s Emergency Preparedness Cache

o ACS supplies, medical shelter supplies, 10 bed mobile hospital (tent hospital),

mobile clinic, communications equipment, PPE, generators, etc.

o Contact Public Health DOC for complete resource list

• Hospital/Facility Emergency Preparedness Cache

o PPE, PAPRs, decontamination equipment, generators, medical supplies, HCF

surge/expansion supplies, etc.

o Contact Public Health DOC for complete resource list

• Disaster Healthcare Volunteers (DHV)

o Healthcare volunteers, includes medical professionals

o Contact Public Health DOC

Regional:

• CHEMPACK (nerve agent antidote)

• DTPA (radiological treatment)

State:

• Disaster Healthcare Volunteers (DHV)

o Contact EMSA to request volunteers from outside the County

o Currently more than 15,000 registered volunteers statewide (4/11)

• Cal-Mats

o CA Medical Assistance Teams


NOR-CAL EMS 34

o Deployable teams that support specialized medical response needs

o Contact EMSA for more information

o Request through RDMHS

• Ambulance Strike Teams

o Regionally positioned ambulance strike teams

o Contact RDMHS or LEMSA for additional information


• Mobile Field Hospitals

o 200 bed, complete mobile field hospitals

o 3 maintained by EMSA

o Contact PH EMSA for more details


• Mission Support Team Mission Support Teams (MSTs)

o MSTs provide logistical support to deployed mobile medical assets maintained by

EMSA, (e.g., California Medical Assistance Teams or mobile field hospitals)

o Provide coordination between the requesting local jurisdiction and the deployed

asset(s).

• Disaster Medical Support Unit (DMSU)

o DMSU provides enhanced communication ability and supplies to support field

deployment, including medical supplies and provisions for AST personnel.

Federal:

• Strategic National Stockpile-Medical Countermeasures

o The SNS is a collection of large quantities of medical material, equipment, and

pharmaceuticals for distribution to states when needed in response to a disaster or

emergency.

o 12 hr Push Pack

� Large pack of varied medical materiel

� Very large, for extremely large response

o Managed Inventory

� PPE, various medical materiel, specialized vaccines & pharmaceuticals

such as for response to BT event

o Contact PH DOC for complete SNS Plan


NOR-CAL EMS 35

APPENDIX B: FORMS


NOR-CAL EMS 36

INCIDENT BRIEFING (ICS 201)

1. Incident Name:

2. Incident Number:

3. Date/Time Initiated: Date: Time:

9. Current Organization (fill in additional organization as appropriate):

6. Prepared by: Name: Position/Title: Signature:

ICS 201, Page 3 Date/Time:

Incident Commander(s)

Operations Section Chief Planning Section Chief Logistics Section Chief Finance/Administration

Section Chief

Safety Officer

Public Information Officer

Liaison Officer


NOR-CAL EMS 37

INCIDENT BRIEFING (ICS 201)

1. Incident Name:

2. Incident Number:

3. Date/Time Initiated:

Date: Time:

10. Resource Summary:

Resource

Resource

Identifier

Date/Time

Ordered ETA Arr

ived

Notes (location/assignment/status)

�

�

�

�

�

�

�

�

�

�

�

�

�

�

�



NOR-CAL EMS 38

1. Incident Name:

2. Incident Number:

3. Date/Time Initiated: Date: Time:

10. Resource Summary:

ICS 201, Page 4 Date/Time:

Incident Action Plan

• Use this form as the base document for your IAP

• Consider adding additional ICS forms, as needed, to complete your IAP o ICS Forms 203-208 may be added to the IAP o Attach ICS 201 for additional information for Briefings

ICS 202

Incident Objectives

Purpose: The Incident Objectives (ICS 202) describes the basic incident strategy, incident objectives, command

emphasis/priorities, and safety considerations for use during the next operational period.

Preparation: The ICS 202 is completed by the Planning Section following each Command and General Staff

meeting conducted to prepare the Incident Action Plan (IAP). In case of a Unified Command, one Incident

Commander (IC) may approve the ICS 202. If additional IC signatures are used, attach a blank page.

Distribution: The ICS 202 may be reproduced with the IAP and may be part of the IAP and given to all

supervisory personnel at the Section, Branch, Division/Group, and Unit levels. All completed original forms must

be given to the Documentation Unit.

Notes:

The ICS 202 is part of the IAP and can be used as the opening or cover page.

If additional pages are needed, use a blank ICS 202 and repaginate as needed.

Block

Number Block Title Instructions

1 Incident Name Enter the name assigned to the incident. If needed, an incident number can be

added.

2 Operational Period

Date and Time From

Date and Time To

Enter the start date (month/day/year) and time (using the 24-hour clock) and

end date and time for the operational period to which the form applies.


NOR-CAL EMS 39

Block


3 Objective(s) Enter clear, concise statements of the objectives for managing the response.

Ideally, these objectives will be listed in priority order. These objectives are

for the incident response for this operational period as well as for the duration

of the incident. Include alternative and/or specific tactical objectives as

applicable.

Objectives should follow the SMART model or a similar approach:

Specific – Is the wording precise and unambiguous?

Measurable – How will achievements be measured?

Action-oriented – Is an action verb used to describe expected

accomplishments?

Realistic – Is the outcome achievable with given available resources?

Time-sensitive – What is the timeframe?

Operational Period Command

Emphasis

Enter command emphasis for the operational period, which may include

tactical priorities or a general weather forecast for the operational period. It

may be a sequence of events or order of events to address. This is not a

narrative on the objectives, but a discussion about where to place emphasis if

there are needs to prioritize based on the Incident Commander’s or Unified

Command’s direction. Examples: Be aware of falling debris, secondary

explosions, etc.

4

General Situational Awareness General situational awareness may include a weather forecast, incident

conditions, and/or a general safety message. If a safety message is included

here, it should be reviewed by the Safety Officer to ensure it is in alignment

with the Safety Message/Plan (ICS 208).

Site Safety Plan Required?

Yes � No �

Safety Officer should check whether or not a site safety plan is required for

this incident. 5

Approved Site Safety Plan(s)

Located At

Enter the location of the approved Site Safety Plan(s).

6 Incident Action Plan (the items

checked below are included in this

Incident Action Plan):

� ICS 203

� ICS 204

� ICS 205

� ICS 205A

� ICS 206

� ICS 207

� ICS 208

� Map/Chart

� Weather Forecast/ Tides/Currents

Other Attachments:

Check appropriate forms and list other relevant documents that are included

in the IAP.

� ICS 203 – Organization Assignment List

� ICS 204 – Assignment List

� ICS 205 – Incident Radio Communications Plan

� ICS 205A – Communications List

� ICS 206 – Medical Plan

� ICS 207 – Incident Organization Chart

� ICS 208 – Safety Message/Plan

7 Prepared by

Name

Position/Title

Signature

Enter the name, ICS position, and signature of the person preparing the form.

Enter date (month/day/year) and time prepared (24-hour clock).


NOR-CAL EMS 40

Block


8 Approved by Incident

Commander

Name

Signature

Date/Time

In the case of a Unified Command, one IC may approve the ICS 202. If

additional IC signatures are used, attach a blank page.


NOR-CAL EMS 41

1. Incident Name: 2. Operational Period: Date From: Date To:

Time From: Time To:

3. Objective(s):

4. Operational Period Command Emphasis:

General Situational Awareness

5. Site Safety Plan Required? Yes � No �

Approved Site Safety Plan(s) Located at:

6. Incident Action Plan (the items checked below are included in this Incident Action Plan):

� ICS 203 � ICS 207 Other Attachments:

� ICS 204 � ICS 208 �

� ICS 205 � Map/Chart �

� ICS 205A � Weather Forcast/Tides/Currents �

� ICS 206 �



NOR-CAL EMS 42

1. Incident Name: 2. Operational Period: Date From: Date To:

Time From: Time To:

8. Approved by Incident Commander: Name: Signature:

ICS 202 IAP Page _____ Date/Time:

APPENDIX C: Acronyms

ACS: Alternate Care Site

CAHAN: CA Health Alert Network

CDPH: CA Dept. of Public Health

DHV: Disaster Healthcare Volunteers

DOC: Department Operations Center (PH DOC)

EMSA: Emergency Medical Services Authority

EOC: Emergency Operations Center

FTS: Field Treatment Site

HCF: Health Care Facility

JEOC: CDPH-EMSA Joint Emergency Operations Center

LEMSA: Local Emergency Medical Services Authority (Nor-Cal EMS)

LTCF: Long Term Care Facility

MCI: Mass or Multi Casualty Incident

MHOAC: Medical Health Operational Area Coordinator

OES: Office of Emergency Services

POC: Point of Contact

PODS: Point of Dispensing Sites

RDMHS: Regional Disaster Medical Health Specialist

RIMS: Resource Inventory Management System

SITREP: Situation Report

SNS: Strategic National Stockpile, AKA Medical Countermeasures


NOR-CAL EMS 43

APPENDIX D: GLOSSARY

Acronym Term

ARES Amateur Radio Emergency Services (Ham Radios)

CAHAN CA Health Alert Network

OES

California Emergency Management Agency: Lead agency for

coordinating emergency activities related to fire and rescue,

management, search and rescue, law enforcement, and public

information.

CD Communicable Disease

CDPH

California Department of Public Health: A State agency that works

closely with health care professionals, county governments and

health plans to provide a health care safety net for California’s low-

income residents and persons with disabilities.

CERC Crisis Emergency Risk Communication (Plan)

DHS U.S. Department of Homeland Security

DHV Disaster Health Volunteers

DOC

Department Operations Center: An emergency operations center

(EOC) specifically set up by a single department or agency such as

Public Health.

DSW Disaster Service Worker

EM Emergency Management

EMS Emergency Medical Services: Refers to the providers of pre-hospital

911 response and medical treatment.

EMSA

Emergency Medical Services Authority: Responsible for prompt

delivery of disaster medical resources to local governments in

support of their disaster medical response.

EOC

Emergency Operations Center: The physical location at which the

coordination of information and resources to support incident

management (on-scene operations) activities takes place.

EOM

California Public Health and Medical (EF8) Emergency Operations

Manual, EOM. Provides guidance to local health departments

(LHDs) on responding to disasters that require resources outside the

response capability of the Operational Area (OA).

EOP Emergency Operations Plan

FOUO For Official Use Only

FTS Field Treatment Site (See FTS Plan)

HAvBED Hospital Available Beds for Emergencies and Disasters

HCC

Hospital Command Center: Site within the hospital or health care

facility where overall emergency response and support activities are

coordinated.

HO Health Officer

HPP Hospital Preparedness Program

HSEEP Homeland Security Exercise and Evaluation Program


NOR-CAL EMS 44

Acronym Term

IAP Incident Action Plan: An oral or written plan containing general

objectives reflecting the overall strategy for managing an incident.

ICS

Incident Command System. A standardized on-scene emergency

management specifically designed to provide for the adoption of an

integrated organizational structure that reflects the complexity and

demands of single or multiple incidents, without being hindered by

jurisdictional boundaries.

ITAM Initial Threat Assessment Meeting

JEOC Joint Emergency Operations Center (CDPH/EMSA EOC)

JERP Joint Epidemiological Response Plan (10 County N-E CA Regional

Epi Project)

JIC Joint Information Center

JIS

Joint Information System; integrates incident information and public

affairs into a cohesive organization designed to provide consistent,

coordinated, accurate, accessible, timely, and complete information

during crisis or incident operations.

LEMSA

Local Emergency Medical Services Agency. The agency,

department, or office having primary responsibility for

administration of emergency medical services in a county.

LHD

Local health department. The agency, department, or office having

primary responsibility for administration of public health services in

a county.

LTCF Long Term Care Facility

MCI Mass Casualty Incident. An incident resulting in a large number of

persons with injuries or deaths.

MH Mental Health

MHOAC/P Medical Health Operational Area Coordinator/Program. A

functional designation within the Operational Area normally

fulfilled by the county health officer and local EMS agency

administrator (or designee), responsible for the development of a

medical and health disaster plan and coordination of situational

information and mutual aid during emergencies.

NIMS

National Incident Management System. Provides a systematic,

proactive approach guiding government agencies at all levels, the

private sector, and non-government organizations to work

seamlessly to prevent, protect against, respond to, recover from and

mitigate the effects of incidents, regardless of cause, size, location,

or complexity, in order to reduce the loss of life or property and

harm to the environment.

NVIH North Valley Indian Health

OA

Operational Area. An intermediate level of the State’s emergency

organization, consisting of a county and all other political

subdivisions within the geographical boundaries of the county.

OA EOC Operational Area Emergency Operations Center (County EOC)

OES Office of Emergency Services


NOR-CAL EMS 45

Acronym Term

PH Public Health

PHEP Public Health Emergency Preparedness program

PHICS Public Health Incident Command System

PIO Public Information Officer

POC Point of contact

RDMHC/S Regional Disaster Medical Health Coordinator or Specialist.

Regional contact for local PH & medical coordination.

REOC

Regional Emergency Operations Center. Provide centralized

coordination of resources among Operational Areas (OAs) within

their respective regions, and between the OA and the State

government level.

RIMS Response Information Management System

SEMS

Standardized Emergency Management System. A system required

by California Government Code for managing response to multi-

agency and multi-jurisdictional emergencies in California.

SITREP Situation Report

SNS Strategic National Stockpile (AKA Medical Countermeasures

Program)

SO Sheriff’s Office

SOC State Operations Center (State EOC)

TTX Tabletop Exercise

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