ADHS NPI Playbook June13 - Arizona Department of Health … · 2018-04-27 · ADHS Non-Pharmaceutical Interventions Playbook 3 preparedness, response, and recovery activities carried

Non-PharmaceuticalInterventionsBureauofEpidemiologyandDiseaseControlOfficeofInfectiousDiseaseServices

January2016

ADHSNon-PharmaceuticalInterventionsPlaybook i

TableofContentsIntroduction...................................................................................................................................................1

Purpose..........................................................................................................................................................1

Assumptions...................................................................................................................................................2

ConceptofOperations...................................................................................................................................2

TypesofNon-PharmaceuticalInterventions..............................................................................................3

UseofNPIsbyHazardTypes......................................................................................................................4

ProcedureforIsolation&Quarantine........................................................................................................7

PublicHealthRiskCommunication................................................................................................................8

Triggers/SeverityIndex................................................................................................................................11

LegalAuthorities..........................................................................................................................................12

FederalLaw..............................................................................................................................................12

ArizonaRevisedStatutes(A.R.S.).............................................................................................................12

Roles&Responsibilities...............................................................................................................................17

CountyHealthDepartments....................................................................................................................17

ArizonaDepartmentofHealthServices(ADHS).......................................................................................18

CentersforDiseaseControlandPrevention(CDC)..................................................................................18

OtherOrganizations.................................................................................................................................19

NPIPlaybookMaintenance..........................................................................................................................20

Appendices...................................................................................................................................................21

Definitions................................................................................................................................................21

NPIDecisionMatrix..................................................................................................................................22

ADHSOfficeofInfectiousDiseaseServicesOrganizationChart...............................................................23

EducationalMaterials...............................................................................................................................24

MessagingTemplates...............................................................................................................................26

Resources.................................................................................................................................................29

ADHSNon-PharmaceuticalInterventionsPlaybook 1

IntroductionPublichealthemergencies,suchasmonsoonfloodingandcommunicablediseaseoutbreaks,areunpredictableintermsoftiming,onset,andseverity.Implementationofbothpharmaceuticalandnon-pharmaceuticalinterventions(NPIs)iscriticalinreducingmorbidityandmortalitycausedbytheseevents.Inadisease-relatedemergency,anovelvirusmaybeinvolved,decreasingthelikelihoodthatawell-matchedstrainvaccineisavailable.Inaddition,currentlyavailablemedicationsmaybeineffectiveagainstanovelpathogen.Asaresult,NPIsbecomecriticalinpreventingfurtherdiseasespread.NPIsareactionsseparatefromtheutilizationofmedicaltherapies(suchasvaccination,chemoprophylaxis,antibioticsandantivirals),whichpeopleandcommunitiescantaketohelppreventorlimitthespreadofillnesses.AlthoughNPIsareusuallyrelatedtodiseasemitigation,theseinterventionsmayalsobeimplementedtoprotectthepublicfrominjuryandexposureduringanaturaldisaster,biological,chemical,orradiologicalincident.

TheStateofArizonaispreparedtoimplementthelayereduseofNPIsasoutlinedinthisplan;however,thedecisiontoimplementvariousNPIsandcommunitymitigationstrategiesbeginsatthelocallevel.EachArizonacountyhealthdepartmentisresponsibleforpreparingandmaintainingacounty-specificNPIplan.

Decisionsaboutwhatinterventionsshouldbeusedduringanemergencyeventshouldbebasedontheobservedseverityoftheevent,itsimpactonspecificsubpopulations,theexpectedbenefitoftheinterventions,thefeasibilityofsuccess,thedirectandindirectcosts,andtheconsequencesoncriticalinfrastructure,healthcaredelivery,andsociety.Themostcontroversialelements(e.g.,prolongeddismissalofstudentsfromschoolsandclosureofchildcareprograms)arenotlikelyneededinlesssevereemergencies,butcouldsavelivesduringsevereevents.

TheNon-PharmaceuticalInterventionsPlaybookdefinesArizonaDepartmentofHealthServices’expectedrolesandresponsibilitiesforimplementingandsustainingNPIsinthecommunityinresponsetoanemergencyeventaffectingpublichealth.Thisplanisbasedonpublichealthpracticeandexperience,lessonslearned,andsupportedbystateandfederallaw.

PurposeThepurposeoftheNon-PharmaceuticalInterventionsPlaybookistoprovideguidancetotheArizonaDepartmentofHealthServices(ADHS),localhealthjurisdictions,andsupportingagenciesregardingidentification,implementation,andde-escalationofnon-pharmaceuticalinterventionsinresponsetoanemergencyeventinArizona.Theplandescribesthecircumstancesandeventsinwhichresponseactionsandmeasuresmaybenecessary,leadershipprotocols,supportinglegalauthorities,andemergencyriskcommunicationmechanisms.

Specifically,thepurposeofthisplanisto:• Establishthedecision-makingcriteriausedbytheADHSDirectorordesigneetodeterminewhencertainnon-pharmaceuticalinterventionsarenecessary.

• Definetheauthorities,rolesandresponsibilitiesofADHS,localhealthjurisdictions,andsupportingagenciesintheeventofapublichealthemergencyrequiringimplementationofNPIs.

• Describetheprocessforimplementingisolationandquarantine,bothvoluntaryandinvoluntary.

• Describetheprocessforimplementinginterventionsimpactingvulnerablepopulations(e.g.,


infectioninpersonswithdisabilities,personswithspecialmedicalneeds,homelesspersons,andtheelderly).

• DelineatecommunicationandcoordinationmechanismstooccuramongADHS,local,stateandtribalentitiesduringanemergencyeventaccordingtothecommunicationproceduresintheADHSCrisis&EmergencyRiskCommunication(CERC)Plan.

• AssistADHSandresponsepartnersinlimitingthespreadofinfectiousdiseasesandreducingillnessanddeath.

TheNon-PharmaceuticalInterventionsPlaybookwillbecoordinatedwithotherADHSpublichealthemergencypreparednessplansandactivities,aswellaswithplansoflocal,stateandfederalpartners.

AssumptionsThisplanassumesthefollowing:• Non-pharmaceuticalinterventionplanningandimplementationeffortsmustincorporateandaddresstheuniqueneedsandcircumstancesofvulnerablepopulationsincludingthehomeless,limitedEnglishspeakingpopulations,personswithspecialmedicalneeds,etc.

• Interventionsmaybenecessarywithintribalnations;ADHSwillcoordinatewithcountyhealthdepartments,IndianHealthServices,andtribalauthoritiesinthecaseofapublichealthemergency,toformulateresponsestrategiesthatrespectjurisdictionalauthority.

• Allpoliciesandprocedurestoassurethecareofprotectedhealthinformationshallapply.PoliciesandproceduresrecognizethatADHSmaymakenecessarydisclosurestoprotectpublichealthwhenitisactingasthepublichealthauthority.

• Largescaleinterventionswillrequiretheparticipationofmanypublichealthresourcesaswellascoordinationwithmultiplecommunity,healthcare,andfirstresponderagencies.

• ADHSmayutilizeisolationandquarantineasoneofseveraltoolstoreducethespreadofcommunicablediseasesandwillfocusongainingvoluntarycompliancefromillorexposedpersonsandimplementingtheleastrestrictivemeanspossibletoreducethespreadofillness.

• Aneffectivepublichealthcommunicationsprogramisessentialtoachievingvoluntarycompliancewithalldiseasecontrolstrategies.

• Isolationandquarantinemayrequiretheinvoluntarydetentionofindividualswhomayposeathreattothepublic’shealthanddonotcooperatewithrequestsfromtheADHSDirector,MedicalDirector,ordesignee.

• Non-pharmaceuticalinterventionsraisesocial,legal,financial,andlogisticalchallengesthatshouldbeanticipatedandaddressed.Social,financial,andpsychologicalneedsofinfectedorexposedpersonsandtheircontactsmustbemetinordertosuccessfullyimplementinterventions.

• Socialmediaoutletsmayplayanimportantroleinthedisseminationofinformationtothepublic.

• Dependingonthecrisisorevent,theADHSHealthEmergencyOperationsCenter(HEOC)maybeactivatedandwouldbetheleadentityonallNPIdecisionsandexecutionofthose.

ConceptofOperationsTheNPIPlaybookconceptofoperationsaddressestheNPIstrategicapproachpublichealthagenciesmayconsiderfortheiroverallpre-eventplanning.ThisplaybookprovidesaframeworkortemplateforthemanagementofNPIs,promotingaunifiedapproachtoallmitigation,


preparedness,response,andrecoveryactivitiescarriedoutinthestateofArizona.Implementationofinterventionsmayneedtobeimplementedrapidly,canbecomplicatedandresourceintensive,andcanbedifficultforaffectedpersonstoendure.NPIscanincludemeasuresthataffectindividuals(e.g.handhygiene)andmeasuresthataffectgroupsorwholecommunities(e.g.cancellationofmassgatherings).Forthemajorityofemergencyincidents,individual-basedinterventionsarerecommendedandeasiertoimplement.However,duringsevereevents,community-wideinterventionsneedtobeconsideredandmaybeimplementedtoprotectpublichealth.Commonlyusedinterventionsincludeisolation,quarantine,socialdistancing,restrictionsonmovement,externaldecontamination,hygiene,andprecautionaryprotectivebehaviors.SomeNPIssuchasisolationandquarantinecanbeconsideredindividualaswellasimplementedcommunity-wide.Isolationisdefinedasseparatingandrestrictingthemovementofillpeoplewithacontagiousdiseasetopreventtransmissiontoothers.Quarantineisdefinedasseparatingandrestrictingthemovementofwellpeoplewhowereexposedtoacontagiousdiseasetopreventtransmissiontoothers.Quarantinetypicallylastsaslongastheincubationperiodoftheinfectiousagent.SocialDistancingisdefinedasreducinginteractionsandincreasingthedistancebetweenpeopleinsettingswhereindividualscomeintoclosecontactwithoneanother.TypesofNon-PharmaceuticalInterventions–IndividualNPIscaninclude:• Stayinghomewhenyouaresick.• Stayinghomeifyouhavebeenexposedtoafamilyorhouseholdmemberwhoissick.• Coveringcoughsandsneezeswithatissue.• Washinghandsorusinghandsanitizer.• Coveringyournoseandmouthwithamaskorclothifyouaresickandaroundpeopleoratamassgatheringinacommunitywhereothersaresick.

• Wearinglongsleeveshirtsandpantstopreventmosquitobites.• Externaldecontaminationsuchasremovingclothingorwashinghairafterradiologicalevent.

CommunityNPIscaninclude:• Patientcohorting(e.g.illpatientsawayfromwellpatientsinlong-termcarefacility)• Shelteringinplace(canbeduetobiological,chemicalorradiologicalevent)• Haltingpublictransportation• Restrictingtravel(e.g.air,train,car,walking)• Evacuation/relocation• Facilityclosures(e.g.schools,childcarecenters,theatres)• Massgatheringcancellations(e.g.concerts,festivals,conferences)

EnvironmentalNPIscaninclude:• Routinesurfacecleaning• Wastemanagement• Creationofphysicalbarriers(e.g.sandbags)• Debrisclearing• Creationoffirebreaks• Roadclearance


UseofNPIsbyHazardTypes–Thefollowingscenariosareprovidedasexamples,NPIrecommendationsmayvary,dependingontheseverityoftheevent.Notethatthefirstrespondersinanincident/emergencyeventareusuallycomprisedoflocalhealthemergencyservices,supplementedbystateandvolunteerorganizations;intheseinstances,thefocusandlegalresponsibilityofthemedicalandhealthcoordinationeffortisatthelocaljurisdictionallevel(LocalHealthOfficer)andafterthoseresourceshavebeenexhausted,upwardtotheArizonaStateHealthDepartmentforfurthercoordination,legalguidanceandsupport.BiologicalorInfectiousDiseaseOutbreakIfthepublichealthemergencyiscategorizedasbiological,alocalhealthdepartmentorentitymustfirstdetermineifitwasintentional(human-caused)oranaturallyoccurringepidemic.Interventionsthatmaybeconsideredforbiologicalorinfectiousdiseaseoutbreaksinclude:• Isolation&Quarantine• Restrictionsonmovement(e.g.cohorting,shelterinplace)• Traveladvisories/warnings• Haltingpublictransportation• Evacuation/relocation(includingpatientrelocation)• School&childcareclosures• Massgatheringpostponement/cancellation• Recommendationstoavoidcrowdedplaces• Externaldecontamination• Environmentaldecontamination

BioterrorismIncidentAbioterrorismeventisdefinedasterrorisminvolvingtheintentionalreleaseordisseminationofbiologicalagentstocauseillnessordeathinpeople.Theseagentsarebacteria,viruses,ortoxins,andmaybeinanaturallyoccurringorahuman-modifiedform.Biologicalagentscanbespreadthroughtheair,water,orinfood.Terroriststendtousebiologicalagentsbecausetheyareextremelydifficulttodetectanddonotcauseillnessforseveralhourstoseveraldays.Duetothisdelayindetection,diseasespreadoccursrapidlyandnon-pharmaceuticalinterventionsneedtobeimplementedtorestrictfurtherspread.

MeaslesMeaslesvirusishighlycontagiousandcanbetransmittedbydirectcontactwithinfectiousdropletsorbyairbornespreadwhenaninfectedpersonbreathes,coughs,orsneezes.Measlesviruscanalsoremaininfectiousintheairforuptotwohoursafteraninfectedpersonleavesanarea.In2000,measleswasdeclaredeliminatedfromtheUnitedStates;however,measlescasesandoutbreaksstilloccureveryyearintheUnitedStatesduetomeaslesstillbeingcommonlytransmittedinmanypartsoftheworld.In2014,theU.S.experienced23measlesoutbreaks,includingonelargeoutbreakof383cases,occurringprimarilyamongunvaccinatedAmishcommunitiesinOhio.In2015,theU.S.experiencedalarge,multi-statemeaslesoutbreaklinkedtoanamusementparkinCalifornia.


Duetotheunavailabilityofaspecifictreatmentformeasles,non-pharmaceuticalinterventionsplayamajorroleinreducingdiseasespread.EbolaVirusDisease(EVD)Ebolaisarareanddeadlydiseaseandistransmittedthroughdirectcontact(throughbrokenskinormucousmembranesintheeyes,nose,ormouth)with:- bloodorbodyfluidsofapersonwhoissickwithorhasdiedfromEbola,- objects(likeneedlesandsyringes)thathavebeencontaminatedwithbodyfluidsfromapersonwhoissickwithorhasdiedfromEbola,and

- infectedfruitbatsorprimatesSinceMarch2014,WestAfricahasexperiencedthelargestoutbreakofEbolainhistory,withmultiplecountriesaffected,andapproximately28,600cases.DuetoexperimentalvaccinesandtreatmentsforEbolabeingunderdevelopment,butnotfullytestedforsafetyoreffectiveness,non-pharmaceuticalinterventionsarecrucialinreducingspread.NaturalDisastersNaturaldisasterssuchasflood,tornados,fires,earthquakes,andhurricanesaffectthousandsofpeopleeveryyear.Communitiesshouldconductthreatassessmentstomaintainawarenessofthemostcommonnaturaldisasterthreatsintheirregionandbebetterpreparedtoprotecttheircitizensforthoseimpendinghazards.Interventionsthatmaybeconsideredfornaturaldisastersinclude:• Restrictionsonmovement(e.g.cohorting,shelterinplace)• Traveladvisories/warnings• Haltingpublictransportation• Evacuation/relocation(includingpatientrelocation)• School&childcareclosures• Massgatheringpostponement/cancellation• Creationofphysicalbarriers(e.g.sandbags)• Debrisclearing• Roadclearance• Cooling/heatingcenters• Creationoffirebreaks

HeatWaveHeatcankillbypushingthehumanbodybeyonditslimits.Mostheatdisordersoccurbecausethevictimhasbeenoverexposedtoheatorhasover-exercisedforhisorherageandphysicalcondition.Olderadults,youngchildrenandthosewhoaresickoroverweightaremorelikelytosuccumbtoextremeheat.Between2000and2012,1535deathsfromexposuretoexcessivenaturalheatoccurredinArizona;inPhoenix,Arizona,normaldailymaximumtemperaturesreach>100°FinearlyJuneandcanremainatthatleveluntilmid-SeptemberorOctober.Byrecognizingaheatwaveinitsearlystages,localagenciescantakeactionsthatwillenablethepublictopreventaheatrelated


illnessordeath.(re:ADHSHeatPlan,dtd2014).Heat-relatedillnessesarelargelypreventable;timelyandpropermessagingaboutpracticingheatsafetymeasuresiskeytoprotectingthosemostvulnerabletoextremeheatconditions.SevereMonsoon/FloodingFloodsareamongthemostfrequentandcostlynaturaldisasters.Conditionsthatcausefloodsincludeheavyorsteadyrainforseveralhoursordaysthatsaturatetheground.Flashfloodsoccursuddenlyduetorapidlyrisingwateralongastreamorlow-lyingarea.Eachyear,avarietyofstorm-relateddangersaffectArizona,particularlyfromlatespringintoearlyautumn,althoughlightningstrikes,highwinds,andflashfloodingcanoccurduringanyseasoninArizona.June15ththroughSeptember30thhasbeendefinedas“MonsoonSeason”;thisisaperiodofongoingextremeheatwhichisfollowedbyaninfluxofmoistureleadingtodailyroundsofthunderstormsthatcanstrikesuddenlyandwithviolentforce.September2014broughtrecord-breakingrainstoArizonathataffectedcommunitiesinthecentralvalleyallthewaytoTucson;schoolsclosed,highwayswerefloodedandlitteredwithabandonedvehicles(requiringmultiplewaterrescues),approximately200homeswerefloodedandthestormledtotwofatalities.TheheavyrainswerecharacterizedinanArizonaRepublicheadlineasa“slow-movingdisaster”.Flashfloodsaretheprimarythunderstorm-relatedkillerandmostflashflooddeathsoccurinvehicles.Priorityshouldbeplacedonthoseactionsandmessagingthatprovidethehighestlikelihoodforlife-savinginterventions.Considerthatfloodingcanoccurslowly(rainfallformanydays);canberapid(developingwithinhoursordays);orcanbeconsidered“flashfloods”thatoccurveryquicklywithlittleornowarning.Allinterventionsshouldbeconsideredandplannedforinthecaseofeachofthesetypesoffloods.WildfiresAwildfireorwildlandfireisdefinedasanuncontrolledfireinanareaofcombustiblevegetationthatoccursinacountrysidearea.Dependingonthetypeofvegetationthatisburned,awildfirecanalsobeclassifiedasabrushfire,forestfire,desertfire,grassfire,hillfire,oravegetationfire.Awildfirediffersfromotherfiresbyitsextensivesize,thespeedatwhichitcanspreadoutfromitsoriginalsource,itspotentialtochangedirectionunexpectedly,anditsabilitytojumpgapssuchasroads,riversandfirebreaks.Arizonahasexperiencednumerouswildlandfiresovertheyears,fromthe2002Rodeo-ChediskiFirethatburnedover460,000acrestothelargestinhistoryWallowFirein2011thatsweptthrough530,000acres.ThemostrecentYarnellHillFirein2013burnedover8,400acresandkilled19CityofPrescottfirefighters,membersoftheGraniteMountainhotshots.Since2002,wildfireshaveburnedover4millionacresinArizona.Winds,prolongeddroughtandhightemperatureshavecombinedtomakeArizonaforestsanddesertareasextremelydryeveryyear;that,coupledwithincreasedhumanactivityandlightningstrikes,predictably,everyyearcanbeabusyfireyearinourstate.ThestateofArizonaisnostrangertowildfires.Withahot,dryclimate,wildfiresarepossibleyear-roundacrossthestate.AlthoughthemostimportantissueiskeepingtheArizonacitizenssafeandoutofharm’sway,otherpublichealthimpactsincludeair,waterquality,andwaste


disposalpost-wildfireevents.Well-plannedcommunicationsplanswithmessagingdevelopedinadvancearekeytokeepingresidentsinformedbothbeforeandafterwildfireevents.ProcedureforIsolation&Quarantine–WhenastateofemergencyisdeclaredwheretheArizonaDepartmentofHealthServices(theDepartment)iscoordinatingallmatterspertainingtothepublichealthemergencyresponseofthestate,theDepartmenthastheauthoritytoisolateandquarantinepersonswhenthereisanimminentinfectiousdiseasethreat(ArizonaRevisedStatutes[A.R.S.]§36-787).TherearethreesourcesofauthorityanddirectionforIsolationandQuarantineinArizona:

A.R.S.§36-624Givescountiestheauthoritytoconductisolationandquarantinemeasures.MustbeconsistentwiththedueprocessrequirementsthatarespecifiedunderA.R.S.§36-788and36-789.A.R.S.§36-787through36-789Providesthegovernor–inconsultationwiththeDepartment,theDepartment,andthelocalhealthauthority–withisolationandquarantineauthorityduringastateofemergencyorstateofwaremergency.ArizonaAdministrativeCode(A.A.C.)R9-6-303Theserulesgivethelocalhealthagencyaprocessfromwhichtoissueisolationand/orquarantineordersthatarecongruentwithA.R.S.§36-624,A.R.S.§36-788andA.R.S.§36-789.Additionally,therulesrequirespecificcontrolmeasuresforcertaindiseases(e.g.,A.A.C.R9-6-390-viralhemorrhagicfever).

FormoredetailsontheArizonaRevisedStatuteslisted,seetheLegalAuthoritiessection.IftheDepartmentorlocalhealthauthorityfindsitnecessarytoisolateorquarantineapersonorgroupofpersonsforadiseaseotherthantuberculosis,itmustadheretotheprocessdescribedbelow.DuringaGovernor-declaredstateofwarorstateofemergency,theArizonaDepartmentofHealthServicesorcountyhealthdepartmentmustfollowtheprocessbelowwhenisolatingorquarantiningapersonorgroupofpersons:


PublicHealthRiskCommunicationDuringaresponseorevent,itisimportanttoestablishclearandconsistentlinesofcommunication.Effectivepublichealthriskcommunicationisnecessarytoinformthepublicnotonlyofthespecificinterventionsbeingimplemented(e.g.whichschools/businesses/eventsareclosed)buttherationalebehindthesemeasures.Wheneveracrisisoccurs,communicatorsmustbereadytoprovideinformationtohelppeoplemakethebestpossibledecisionsfortheirhealthandwell-being.Notethatthismayneedtobedoneinarapidtimeframeandwithoutknowingalldetailsaboutthecrisis.

StateofDeclaredEmergencyorStateofDeclaredWarEmergency

DepartmentDirectivetoIndividualorGroup

PetitionforaCourtOrderisfiledwithSwornAffidavit

Notificationtoperson(s)identifiedinPetition

CourtHearing

CourtOrder

TheGovernormustfirstsignanemergencydeclaration.

Ifadelaywouldposeathreattopublichealth,theDepartmentmayissueadirectivetoanindividualorgroupandspecifytheisolationorquarantinerequirementsthatmustbefollowed.

Within10daysafterissuingthedirective,theDepartmentmustpetitionthecourtforacourtordertocontinueisolationorquarantine.

Individualorgroupmustbenotifiedwithin24hoursafterfilingpetition.

Ahearingmustbeheldonthepetitionwithin5daysafterthepetitionisfiled.Itmaybecontinuedfor10daysunderextraordinarycircumstances.

Thecourtorderiseffectiveforupto30days.Ifneeded,theDepartmentmaymovetoextendtheorderforanadditional30days.


ADHShaspublishedaCrisis&EmergencyRiskCommunicationPlan(CERC)thatidentifiescommunicationprotocolsandprocedurestobefollowedintheeventofacrisisoremergencywithpublichealthconsequences.Theultimategoalistoprovideaframeworkforcommunicatingwiththepublic,media,ADHSstaff,governmentagenciesandallotherstakeholdersduringacrisisoremergency.Dependingonthescopeoftheevent,ADHSwillworkwithintheJointInformationSystem(JIS)forminorincidentsorwithintheactivationofaJointInformationCenter(JIC)foramajorresponse.Throughongoingexercises,trainings,real-worldresponsesandhabitualinter-agencyrelationships,Arizonaispreparedtoeffectivelyandefficientlyrespondtoawidevarietyofemergencysituations.OncetheADHScommunicationprocessandproceduresareputinplace,itwillbeimportanttoconsiderwhatthepublicexpectationswillbefromapublichealthperspective.Thefollowingareafewcommunicationgoalstoconsiderforapublicaudience:

• Providewantedfacts;• Empowerthemasdecisionmakers;• Involvethemasparticipants,notspectators;• Providewatchguardoverresourceallocation;• Recoverorpreservewell-beingandnormalcy.

Communicationfailuresthatmayhamperoperationsandrecoveryefforts:

• Mixedmessagesfrommultipleexperts;• Informationreleasedlate;• Paternalisticattitudes;• Notcounteringrumorsandmythsinreal-time;• Publicpowerstrugglesandconfusion.

TheJIS/JICstaffwillidentifywaystoexpediteinformationtothepublicwhileworkingtocoordinatemediafunctionswithstakeholdersstatewide.Duringtheevent,communicationtothepublicmayincludemediareleases,websitecontent,talkingpointsforspokespersons,interviews,socialmedia,publicserviceannouncements,andadvertising.“JustincaseArizona”isastatewideemergencyanddisasterpreparednesscampaignsponsoredbytheArizonaDepartmentofHealthServices(http://www.justincasearizona.com/).Itsimplifiesthepreparednessmessagebybreakingallemergenciesdownintooneoftwotypes;thoseforwhichyouneedtobe“preparedtostay”(orshelterinplace),andthoseforwhichyouneedtobe“preparedtogo”(orevacuate)whenthetimecomes.Awealthofinformation,includingchecklistsandfamilyplans,isalsoavailablethroughtheArizonaEmergencyInformationNetwork(AzEIN)(https://ein.az.gov/).AzEINhelpsArizonansfindinformationaboutlocalemergenciesandhealthandhumanservicesandistheofficialsourceoftimelyinformationduringnaturalorman-madeemergenciessuchaspandemicinfluenza,wildfires,floods,utilityoutages,andevacuations.Inanticipationofincreasedtelephonecallsandotherinquiriesfromthegeneralpublic,apublichealthinformationlinecurrentlyexistsandcanbecoordinated,scriptedandactivatedbytheArizonaDepartmentofHealthServices.Thebi-lingual,24/7menu-driveninformationlinecanbeaccessedthroughoutArizona(MetropolitanPhoenix602-364-4500andstatewide800-314-9243).Inaddition,acallcentermaybeactivatedattheprivatesector,local,orstatelevel.Inthis


case,ADHSstaffwillworkwithaffectedlocalhealthdepartments,emergencymanagement,andhealthcaresystempartnerstodevelopcallcentermessagingandmaterials.MoredetailedcallcenterinformationcanbeobtainedviatheCERC.Inapandemicevent,ADHShastheleadinpublicinformationfunctions.SincenumerousagencieswillpotentiallyworkinsupportoftheADHSpublicinformationfunction,aJointInformationCenter(JIC)maybeestablishedasrequiredbythenatureandscaleoftheevent.TheJICwillperformthefollowing:

• ProvideguidanceandproceduresfordisseminatingEmergencyPublicInformation(EPI)insupportofthestate’sresponseandrecoverytoanemergency/disaster.

• Providefortheeffectivecollection,monitoring,managementanddisseminationofaccurate,usefulandtimelyinformationtomediaoutletsduringemergencies/disasters.

• Disseminateemergencyinstructionsandprotectiveactionstothepublic.• Maintainprocedurestodisseminatepublicinformationandinstructionsforobtainingdisasterassistance.

• Provideprocedurestodevelopanddisseminatepublicinformationregardinggovernmentalresponseandrecoveryoperations.

• CoordinateEPItoavoidpanic,fearandconfusionresultingfromrumorsandhearsay.• Providelong-termpubliceducationeffortsrelatedtohazardawareness,familyprotectionplanningandemergencyself-help.

Additionally,localpublicserviceannouncementscanbeusedtopromotethefollowinginformation:

• Educatethepublictorecognizethesignsandsymptomsofcommunicablediseases.• Encouragethepublictovoluntarilyself-isolateorself-quarantineandforhowlong.• Notifybusinessesthatillindividualsshouldnotgotowork.• Informthepublicofhotlinephonenumbersandwebsitesforeventupdates.• Informthepublicofwheretoobtaineducationalmaterials.• Announcethecancellationoflargepublicgatherings(concerts,sportingevents,etc.)

ADHSNon-PharmaceuticalInterventionsPlaybook11

Triggers/SeverityIndex

PotentialInterventionOptions ExtremeHeat Fire Severe

Monsoon/Flooding BiologicalAgent Radiation

ú PrecautionaryBehaviors

ú Traveladvisories/warnings

ú Establishmentofcoolingcenters

Riskforextremeheatatexpectedlevelsforsummer;Severityindexcategory1-2

Containedfireinareaswhereeventsareoccurring;noevacuationneeded

Precipitationatexpectedlevelsduringmonsoonseason;floodwatchissued

Agentwithknownmeansofspread,orlowmorbidity/mortality

Radiologicalincidentoccurred;noreleaseorreleasecontained

ú CancellationsofMassGatherings

ú Closures(school,daycare,etc.)

ú Physicalbarriers(e.g.sandbags)

Severityindexcategories3-4maybeapplicable;cancellationofeventsneededtoensurepublicsafety

Uncontainedfireinareaswhereeventsareoccurring;cancellationofeventsneededtoensurepublicsafety

Severefloodinginareaswhereeventsareoccurring;cancellationofeventsneededtoensurepublicsafety

Agentwithknownmeansofspreadinareaswhereeventsareoccurring;cancellationofeventsneededtoensurepublicsafety

Radiologicalincidentoccurredwhereeventsareoccurring;cancellationofeventsneededtoensurepublicsafety

ú Isolationú Quarantineú Evacuation/relocation

ú Decontamination(external,environmental,etc.)

Severityindexcategory5;poweroutageduringmonsoonseason

Large,complexincidentinvolvingmulti-agencyresponse;uncontainedfireinresidentialareas;evacuationneeded

Floodwarningissued;severefloodinginresidentialareas;evacuationordered

Agentwithunknownmeansofspread,orhighmorbidity/mortality

Radiologicalincidentaffectingresidentialareas;exposuretodangerouslevelsofradiation;decontaminationand/ortreatmentneeded


LegalAuthorities

FederalLaw–ThefederalgovernmentderivesitsauthorityforisolationandquarantinefromtheCommerceClauseoftheU.S.Constitution.Undersection361ofthePublicHealthServiceAct(42UnitedStatesCode[U.S.C.]§264),theU.S.SecretaryofHealthandHumanServicesisauthorizedtotakemeasurestopreventtheentryandspreadofcommunicablediseasesfromforeigncountriesintotheUnitedStatesandbetweenstates.FederalisolationandquarantineareauthorizedbyExecutiveOrderofthePresident.ThePresidentcanrevisethislistbyExecutiveOrder.TheauthorityforcarryingoutthesefunctionsonadailybasishasbeendelegatedtotheCentersforDiseaseControlandPrevention(CDC).Federalisolationandquarantineareauthorizedforthesecommunicablediseases:• Cholera • Yellowfever• Diphtheria • Viralhemorrhagicfevers• Infectioustuberculosis • Severeacuterespiratorysyndromes• Plague • Fluthatcancauseapandemic• Smallpox

UnderTitle42CodeofFederalRegulations(CFR)parts70and71,CDCisauthorizedtodetain,medicallyexamine,andreleasepersonsarrivingintotheUnitedStatesandtravelingbetweenstatesthataresuspectedofcarryingthesecommunicablediseases.

ArizonaRevisedStatutes(A.R.S.)–Title3:AgricultureTitle36:PublicHealthandSafety

Statute Description3-1205-Controlofanimaldiseases

Whenadvisedoftheoccurrenceofadiseaseofanimalsorpoultrywhichconstitutesathreattothelivestockorpoultryindustries,thedirectormayissuelawfulordersandadoptruleshedeemsnecessary.Thestateveterinarianmayenteranyplacewhereasuspectedanimalorpoultrymaybeandtakecustodyoftheanimalorpoultryforthepurposeofdeterminingthepresenceofacontagious,infectiousorcommunicabledisease.Thedirectormaydirectthestateveterinarianandagencyemployeesto:1. Establishquarantinesanddefinetheirboundaries.2. Destroyanimalsorpoultrywhennecessarytopreventthespreadofanyinfectious,

contagiousorcommunicabledisease.3. Appointappraisersforthepurposeofindemnifyingownersofanimalsorpoultry

destroyed.4. Controlthemovementofanimalsorpoultry,animalorpoultryproductsandagricultural

productswhichmaybedirectlyrelatedtodisseminationofdiseasesaffectingthelivestockorpoultryindustries.

Anypersonwhoviolatesanylawfulorderorruleissuedpursuanttotheprovisionsabove,orbreaksanyquarantineestablishedbythestateveterinarianforthepreventionandcontrolofdiseaseamonglivestockorpoultry,isguiltyofaclass2misdemeanor.

36-136-Powers Thedirectormayenter,examineandsurveyanysourceandmeansofwatersupply,sewage


anddutiesofdirector(Publicworks/WaterSupply)

disposalplant,seweragesystem,prison,publicorprivateplaceofdetention,asylum,hospital,school,publicbuilding,privateinstitution,factory,workshop,tenement,publicwashroom,publicrestroom,publictoiletandtoiletfacility,publiceatingroomandrestaurant,dairy,milkplantorfoodmanufacturingorprocessingplant,andanypremisesinwhichthedirectorhasreasontobelievethereexistsaviolationofanyhealthlaworruleofthestatethatthedirectorhasthedutytoadminister.

36-621-Reportofcontagiousdiseases

Apersonwholearnsthatacontagious,epidemicorinfectiousdiseaseexistsshallimmediatelyreportittothehealthdepartment.

36-623-Reportbyphysicianofdeathfromcontagiousdisease

Physiciansshallreportthedeathofpatientsdyingfromcontagious,infectiousorepidemicdiseasestothelocalhealthdepartmentwithinitsjurisdiction.Thereportshallbemadewithin24hoursafterdeath,andshallincludethespecificnameandcharacterofthedisease.

36-624-Quarantineandsanitarymeasurestopreventcontagion

Whenacountyhealthdepartmentisapprisedthatinfectiousorcontagiousdiseaseexistswithinitsjurisdiction,itshallimmediatelymakeaninvestigation.Iftheinvestigationdisclosesthatthediseasedoesexist,thecountyhealthdepartmentmayadoptquarantineandsanitarymeasuresconsistentwithdepartmentrulesandsections36-788and36-789topreventthespreadofthedisease.ThecountyhealthdepartmentshallimmediatelynotifyADHSoftheexistenceandnatureofthediseaseandmeasurestakenconcerningit.

36-630-Violation;classification

Guiltyofaclass3misdemeanorunlessanotherclassificationisspecificallyprescribedinthisarticle:

- Apersonwhoknowinglysecreteshimselforothersknowntohaveacontagiousorinfectiousdisease

- Amemberofaboardofhealthoranofficerofalocalhealthdepartmentwhowithcriminalnegligencefailsorrefusestoperformaduty

- Apersonwhoviolatesaprovisionofthisarticleorarule,regulation,order,instructionormeasureadoptedandgiventherequiredpublicitybyaboardofhealth

36-631-Violation;classification

Guiltyofaclass2misdemeanor:- Apersonwhoknowinglyexposeshimselforanotherafflictedwithacontagiousorinfectiousdiseaseinapublicplaceorthoroughfare,exceptinthenecessaryremovalofsuchpersoninamannerleastdangeroustothepublichealth.

36-787-Publichealthauthorityduringstateofemergencyorstateofwaremergency

Duringastateofemergencyorstateofwaremergencydeclaredbythegovernorinwhichthereisanoccurrenceorimminentthreatofanillnessorhealthconditioncausedbybioterrorism,anepidemicorpandemicdiseaseorahighlyfatalinfectiousagentorbiologicaltoxinandthatposesasubstantialriskofasignificantnumberofhumanfatalitiesorincidentsofpermanentorlong-termdisability,thedepartmentshallcoordinateallmatterspertainingtothepublichealthemergencyresponseofthestate.Thedepartmenthasprimaryjurisdiction,responsibilityandauthorityfor:1. Planningandexecutingpublichealthemergencyassessment,mitigation,preparedness

responseandrecoveryforthisstate.2. Coordinatingpublichealthemergencyresponseamongstate,localandtribalauthorities.3. Collaboratingwithrelevantfederalgovernmentauthorities,electedofficialsofother

states,privateorganizationsandprivatesectorcompanies.4. Coordinatingrecoveryoperationsandmitigationinitiativessubsequenttopublichealth

emergencies.5. Organizingpublicinformationactivitiesregardingstatepublichealthemergency

responseoperations.6. Establishing,inconjunctionwithapplicableprofessionallicensingboards,aprocessfor

temporarywaiveroftheprofessionallicensurerequirementsnecessaryfortheimplementationofanymeasuresrequiredtoadequatelyaddressthestateofemergencyorstateofwaremergency.

7. Grantingtemporarywaiversofhealthcareinstitutionlicensurerequirementsnecessaryforimplementationofanymeasuresrequiredtoadequatelyaddressthestateof


emergencyorstateofwaremergency.Inadditiontotheauthorityprovidedabove,duringastateofemergencyorstateofwaremergency,thegovernor,inconsultationwiththedirectorofthedepartmentofhealthservices,mayissueordersthat:1. Mandatemedicalexaminationsforexposedpersons.2. Rationmedicineandvaccines.3. Providefortransportationofmedicalsupportpersonnelandillandexposedpersons.4. Provideforprocurementofmedicinesandvaccines.

Inadditiontotheauthorityprovidedabove,duringastateofemergencyorstateofwaremergencyinwhichthereisanoccurrenceortheimminentthreatofsmallpox,plague,viralhemorrhagicfeversorahighlycontagiousandhighlyfataldiseasewithtransmissioncharacteristicssimilartosmallpox,thegovernor,inconsultationwiththedirectorofthedepartmentofhealthservices,mayissueordersthat:1. Mandatetreatmentorvaccinationofpersonswhoarediagnosedwithillnessresulting

fromexposureorwhoarereasonablybelievedtohavebeenexposedorwhomayreasonablybeexpectedtobeexposed.

2. Isolateandquarantinepersons.LawenforcementofficialsofthisstateandtheNationalGuardshallenforceordersissuedbythegovernorunderthissection.Diseasessubjecttothissectiondonotincludeacquiredimmunedeficiencysyndromeorotherinfectioncausedbythehumanimmunodeficiencyvirus.Ifduringastateofemergencyorstateofwaremergencythepublichealthisnotendangerednothinginthistitleshallauthorizethedepartmentoranyofitsofficersorrepresentativestoimposeonanypersonagainsttheperson'swillanymodeoftreatment,providedthatsanitaryorpreventivemeasuresandquarantinelawsarecompliedwithbytheperson.Nothinginthistitleshallauthorizethedepartmentoranyofitsofficersorrepresentativestoimposeonanypersoncontrarytohisreligiousconceptsanymodeoftreatment,providedthatsanitaryorpreventivemeasuresandquarantinelawsarecompliedwithbytheperson.Atthegovernor'sdirection,thedepartmentmayusereasonableeffortstoassistthepersonsandinstitutionsaffectedbythestateofemergencyorstateofwaremergencydeclaredpursuanttothissectioninseekingreimbursementofcostsincurredasaresultofprovidingservicesrelatedtotheimplementationofisolationandquarantineunderthisarticletotheextenttheseservicesarenototherwisesubjecttoreimbursement.

36-788-Isolationandquarantineduringastateofemergencyorstateofwaremergency

Duringastateofemergencyorstateofwaremergencyasdeclaredpursuanttosection36-787,thedepartmentorlocalhealthauthoritymustinitiateaninvestigationifthatagencyhasreasonablecausetobelievethatahighlycontagiousandfataldiseaseexistswithinitsjurisdiction.Subjecttotheprovisionsofthisarticle,personswhohavecontractedthediseaseorwhohavebeenexposedtothediseasemaybesubjecttoisolationandquarantineifthedirectordeterminesthatquarantineistheleastrestrictivemeansbywhichthepubliccanbeprotectedfromtransmissionofthedisease,duetothenatureofthediseaseandavailablepreventivemeasures,orrefusalbyanindividualtoacceptlessrestrictivemeasurestopreventdiseasetransmission.Diseasesforwhichisolationandquarantinemaybeordereddonotincludeacquiredimmunedeficiencysyndromeorotherinfectioncausedbythehumanimmunodeficiencyvirus.Thedepartmentorlocalhealthauthoritymay,duringthestateofemergencyorstateofwaremergencydeclaredbythegovernor,dothefollowing:


1. Establishandmaintainplacesofisolationandquarantine,whichmayincludetheresidenceofthepersonquarantined.

2. Requireisolationorquarantineofanypersonbytheleastrestrictivemeansnecessarytoprotectthepublichealth.Thedepartmentorlocalhealthauthorityshalluseallreasonablemeanstopreventthetransmissionofdiseaseamongtheisolatedorquarantinedpersons.

Thedepartment,acountyhealthdepartmentorapublichealthservicesdistrictshallensure,totheextentpossible,thatthepremisesinwhichapersonisisolatedorquarantinedismaintainedinasafeandhygienicmannerandisdesignedtominimizethelikelihoodoffurthertransmissionofdiseaseorotherharmtoapersonsubjecttoisolationorquarantine.Adequatefood,clothing,medicationandothernecessities,competentmedicalcareandmeansofcommunicatingwiththoseinandoutsidethesesettingsshallbemadeavailable.Apersonsubjecttoisolationorquarantineshallcomplywiththedepartment'sorlocalhealthauthority'srulesandorders,shallnotgobeyondtheisolationorquarantinepremisesandshallnotcomeincontactwithanypersonnotsubjecttoisolationorquarantineotherthanaphysicianorotherhealthcareprovider,departmentorlocalhealthauthorityorpersonauthorizedtoenteranisolationorquarantinepremisesbythedepartmentorlocalhealthauthority.Otherthanapersonauthorizedbythedepartmentorlocalhealthauthority,apersonshallnotenteranisolationorquarantinepremises.If,byreasonofanunauthorizedentryintoanisolationorquarantinepremises,thepersonposesadangertopublichealth,thedepartment,orlocalhealthauthoritymayplacethepersoninisolationorquarantinepursuanttothissectionorsection36-789.Thedepartmentorlocalhealthauthoritymustterminateisolationorquarantineofapersonifitdeterminesthattheisolationorquarantineisnolongernecessarytoprotectthepublichealth.

36-789-Dueprocessforisolationandquarantineduringastateofemergencyorstateofwaremergency

A. Thedepartmentorlocalhealthauthoritymayisolateorquarantineapersonorgroupofpersonsthroughawrittendirectivewithoutfirstobtainingawrittenorderfromthecourtifanydelayintheisolationorquarantineofthepersonwouldposeanimmediateandseriousthreattothepublichealth.Thedirectiveshall:1. Specifytheidentityofthepersonorpersonssubjecttoisolationorquarantine,thepremisessubjecttoisolationorquarantine,thedateandtimeatwhichisolationorquarantinecommences,thesuspectedhighlycontagiousandfataldisease,ifknown,andthatastateofemergencyhasbeendeclaredbythegovernor.

2. Begiventothepersonorpersonstobeisolatedorquarantined.Ifthedirectiveappliestogroupsofpersonsanditisimpracticaltoprovideindividualcopies,itmaybepostedinaconspicuousplaceintheisolationorquarantinepremises.

B. Withintendaysafterissuingthewrittendirective,orwhenanydelayintheisolationor

quarantineofapersonorgroupofpersonswillnotposeanimmediateandseriousthreattothepublichealth,thedepartmentorlocalhealthauthorityshallfileapetitionforacourtorderauthorizingtheinitialorcontinuedisolationorquarantineofapersonorgroupofpersons.Thepetitionshallspecifythefollowing:1. Theidentityofthepersonorgroupofpersonssubjecttoisolationorquarantine.2. Thepremisessubjecttoisolationorquarantine.3. Thedateandtimeatwhichisolationorquarantinecommences.4. Thesuspectedcontagiousdisease,ifknown.5. Astatementofcompliancewiththeconditionsandprinciplesforisolationand


quarantine.6. Astatementofthebasisonwhichisolationorquarantineisjustifiedpursuanttothisarticle.

C. Thepetitionmustbeaccompaniedbytheswornaffidavitofthedepartmentorlocalhealth

authorityattestingtothefactsassertedinthepetition,togetherwithanyfurtherinformationthatmayberelevantandmaterialtothecourt'sconsideration.

D. Noticetoapersonorgroupofpersonsidentifiedinapetitionfiledpursuanttosubsection

Bofthissectionmustbecompletedwithintwenty-fourhoursafterfilingthepetitionandinaccordancewiththerulesofcivilprocedure.

E. Ahearingmustbeheldonapetitionfiledpursuanttothissectionwithinfivedaysafter

filingofthepetition.Inextraordinarycircumstancesandforgoodcauseshown,thedepartmentorlocalhealthauthoritymayapplytocontinuethehearingdateonapetitionfornotmorethantendays.Ifthecourtgrantsacontinuanceitmustgivedueregardtotherightsoftheaffectedpersons,theprotectionofthepublic'shealth,theseverityoftheemergencyandtheavailabilityofnecessarywitnessesandevidence.

F. Thecourtshallgrantthepetitionif,byapreponderanceoftheevidence,isolationor

quarantineisshowntobereasonablynecessarytoprotectthepublichealth.G. Acourtorderauthorizingisolationorquarantinemaydosoforaperiodnottoexceed

thirtydays.Theordermust:1. Identifytheisolatedorquarantinedpersonorgroupofpersonsbynameorsharedorsimilarcharacteristicsorcircumstances.

2. Specifyfactualfindingswarrantingisolationorquarantinepursuanttothisarticle,includinganyconditionsnecessarytoensurethatisolationorquarantineiscarriedoutwithinthestatedpurposesandrestrictionsofthisarticle.

3. Beservedonanaffectedpersonorgroupofpersonsinaccordancewiththerulesofcivilprocedure.

H. Beforeanisolationorquarantineorderexpires,thedepartmentorlocalhealthauthority

maymovetocontinuetheisolationorquarantineforanadditionalperiodnottoexceedthirtydays.Thecourtshallgrantthemotionif,byapreponderanceoftheevidence,isolationorquarantineisshowntobereasonablynecessarytoprotectthepublichealth.

I. Apersonorgroupofpersonsisolatedorquarantinedpursuanttothissectionmayapplyto

thecourtforanordertoshowcausewhythepersonorgroupofpersonsshouldnotbereleased.Thecourtmustruleontheapplicationtoshowcausewithinforty-eighthoursafteritisfiled.Ifthecourtgrantstheapplication,thecourtmustscheduleahearingontheordertoshowcausewithintwenty-fourhoursafteritissuestheordertoshowcause.Theissuanceofanordertoshowcausedoesnotstayorenjoinanisolationorquarantineorder.

J. Apersonisolatedorquarantinedpursuanttothissectionmayrequestacourthearing

regardingtheperson'streatmentandtheconditionsofthequarantineorisolation.K. OnreceivingarequestforahearingpursuanttosubsectionJofthissection,thecourtmust

setadateforahearing.Thehearingmusttakeplacewithintendaysafterthecourtreceivestherequest.Therequestforahearingdoesnotaltertheorderofisolationorquarantine.Ifthecourtfindsthattheisolationorquarantineofthepersonorgroupofpersonsdoesnotcomplywiththerequirementsofthissectionorsection36-788,thecourt


mayprovideremediesappropriatetothecircumstancesofthestateofemergency,therightsoftheindividualandinkeepingwiththeprovisionsofthisarticle.

L. Arecordoftheproceedingspursuanttothissectionshallbemadeandretained.If,

becauseofastateofemergencyorstateofwaremergencydeclaredpursuanttosection36-787,partiescannotpersonallyappearbeforethecourt,theproceedingsmaybeconductedbytheauthorizedrepresentativesofthepartiesandheldbyanymeansthatallowsallpartiestofullyparticipate.

M. Thecourtshallappointcounselatstateexpensetorepresentapersonorgroupofpersons

whoissubjecttoisolationorquarantinepursuanttothisarticleandwhoisnototherwiserepresentedbycounsel.Representationbyappointedcounselcontinuesthroughoutthedurationoftheisolationorquarantineofthepersonorgroupofpersons.Thedepartmentorlocalhealthauthoritymustprovideadequatemeansofcommunicationbetweentheisolatedorquarantinedpersonsandtheircounsel.

N. Inanyproceedingsbroughtpursuanttothissection,topromotethefairandefficient

operationofjusticeandhavinggivendueregardtotherightsoftheaffectedpersons,theprotectionofthepublic'shealth,theseverityoftheemergencyandtheavailabilityofnecessarywitnessesandevidence,thecourtmayordertheconsolidationofindividualclaimsintogroupsofclaimsif:1. Thenumberofpersonsinvolvedortobeaffectedissolargeastorenderindividualparticipationimpractical.

2. Therearequestionsoflaworfactcommontotheindividualclaimsorrightstobedetermined.

3. Thegroupclaimsorrightstobedeterminedaretypicaloftheaffectedperson'sclaimsorrights.

4. Theentiregroupwillbeadequatelyrepresentedintheconsolidation.36-910-Seizure(Food)

Allowsthehealthdepartmenttodetainorembargoanyfoodthat“issuspectedofbeingadulteratedormisbrandedwithinthemeaningofthisarticleastobedangerousorfraudulent.”

Roles&Responsibilities

CountyHealthDepartments–• Leadagencyinepidemiologicalinvestigationsandmanagementofcommunicableoutbreakswithincountyjurisdiction.

• Assesspublichealththreat,potentialconsequences,anddeterminewhetherisolationandquarantinearenecessaryfortheincident.

• Seekcooperationandcomplianceofinfectedorexposedpersonsforisolationandquarantinerequests.Ifnecessary,mayneedtoimmediatelyrequestacourtordertodetaininfectedorexposedpersonsandplacetheminisolationorquarantine.

• AnalyzeinformationgatheredduringtheinvestigationonanongoingbasisincollaborationwithADHStoevaluatetheeffectivenessoftheintervention.Itiscriticalindeterminingtheneedforbroaderapplicationofquarantineandthetimingofwithdrawalofcontainmentmeasures.

• Identifyfacilitieswithinjurisdictionalboundariesthatmayqualifyasisolationandquarantinedetentioncentersforbothvoluntaryandcompulsorycontacts.

• Coordinatewithlocallawenforcementagenciesto:


ú Tracethewhereaboutsofpersonswhohaveviolatedrestrictions,ifneeded.ú Provideescortforpersonsrequiringtransportationforpurposesofinvoluntaryisolationofquarantine,ifneeded.

ú Executearrestwarrantsrelatedtoisolationandquarantinecases.ú Providesecurityforrestrictedfacilitiesorhomes.

NOTE:TransportationofinfectiouspersonswillbemanagedbylocalEmergencyMedicalServiceprovidersthroughcoordinationwiththecountyhealthdepartment.

• Coordinatewithlocalcommunity-basedorganizationstoaddressbasicneedsoftheindividual(s)placedinisolationandquarantine,including,butnotlimitedto:food,clothing,shelter,medicalcare,communicationwithfamilymembers,legalcounsel,accesstomentalhealthandotherpsychologicalsupport.

• CoordinatewithArizonaDepartmentofEconomicSecurity(ADES)andlocalsourcestoprovidetemporaryfinancialassistanceforpersonsisolatedorquarantined,ifneeded.

ArizonaDepartmentofHealthServices(ADHS)–• Providetechnicalassistanceandguidancetocountyhealthdepartmentsregardingnon-pharmaceuticalinterventionsandpreparednessactivitiesincludingplanning,legaldocumentation,isolationandquarantineimplementation,andrelease.

• PrepareandsubmittimelyrequestsforGovernor’sDeclarationofStateofEmergency,asrequired.

• Ifneeded,activateADHSEmergencyOperationsCenterand/orJointInformationCenterforcoordinatingallpublicinformationrelease,mediarequests,andresponseactivities.

• CoordinatewithcountyhealthdepartmentandIndianHealthServicesoninterventionsaffectingtribalnationsanditsmemberswithincountyjurisdictionalborders.

• Actasaliaisonwithothercounty,stateandfederalagencies,includingCentersforDiseaseControlandPrevention,ifneeded.

NOTE:CountyhealthdepartmentswillcoordinatewithStateEmergencyMedicalServicesiflocalEMSorcountyhealthrequiresassistancewithtransportationofinfectiouspersons.

CentersforDiseaseControlandPrevention(CDC)–• Providetechnicalassistanceandguidanceonallhealthmattersrelatingtoisolationand/orquarantine.

• AssumeleadershipinallcaseswhereinfectedpersonsenterArizonaviainterstateorinternationaltransportationmeansunderfederalauthoritieslistedabove.SeeLegalAuthorities.

• Assumecontrolandauthorizeactionintheeventthatmeasurestakenbylocalandstatehealthauthoritiesareinsufficienttopreventthespreadtootherstates.

Arizona-MexicoBorderCoordinationDuringapublichealthemergency,includinganinfectiousdiseaseoutbreak,theArizona-Sonoraborderregionmaybehighlyaffected.ArizonaandSonorasharea370mile(595km)borderthatincludesfiveinternationalportsofentry(POE)alongtheinternationalU.S.-Mexicoborder.ThePOEsaresituatedinfourArizonabordercounties,theTohonoO’odhamNation,andtwoSonoranjurisdictionsthatencompasssixbordermunicipalities.Onadailybasis,tensofthousandsofresidentsoftheborderregioncrosstheborderbothnorthandsouthbound.


ToincreasetheefficacyofcoordinatedactivitiesbetweentheArizonaDepartmentofHealthServices(ADHS)andtheSecretaríadeSaludPúblicadeSonora(SSP)duringallpublichealthemergenciesaffectingArizonaandSonora,theArizona-SonoraRegionalPandemicandEmergencyResponsePlanwasdeveloped.TheADHSOfficeofBorderHealth(OBH)servesastheprimaryconduitforpublichealthcommunicationandcoordinationbetweenADHSandtheSSP.IntheeventofapublichealthemergencyaffectingtheArizona-Sonoraborderregion,orbothstates,theSSPwillcoordinatewiththeADHSthroughtheOBH,orotherappointedpersonnelatthestatelevel,tomaintainbinationalcommunicationandcollaborationbetweenbothstate-levelpublichealthagencies.Cross-bordercoordinationbetweenADHSandtheSSPpertainsto,butisnotlimitedto,thefollowingareas:communication,publicinformation(media),sharingofpublichealthinformationincludingepidemiology,infectiousdiseasesurveillance&laboratorysurveillancedata,andisolationandquarantine.TheSSPandADHSwillcollaborateandexchangepublichealthinformationtoemploypreventivemeasurestoattempttominimizethenumberofaffectedpeopleduringaninfectiousdiseaseoutbreakorpublichealthemergency.TheOBHservesastheprimaryconduitforbinationalcommunicationandcoordinationforcross-borderpublichealthactivitiesandincidentsofpublichealthconcern.Intheeventofapublichealthemergency,theOBHstaffwillmaintaincommunicationwiththeSecretariatofHealth(SSP)inHermosillo,Sonora.Initialcontactwillbeestablishedviaatelephonecall.AcalldownlistismaintainedandroutinelyupdatedbytheOBHandSSP.Allpertinentinformation,dataandinfectiousdiseasecaseinformation,andlaboratorytestingprotocolsandresultswillbesharedviatheSecureIntegratedResponseElectronicNotification(SIREN)system:Email,CurrentResponseportal,ortheBorderHealthportal.IfSIRENisunavailable,telephonesandfaxmachineswillbeusedtoshareinformation.TheOBHOfficeChiefandBorderSurveillanceEpidemiologist(s)areresponsibleformaintainingcommunicationwiththeSonoraSecretariatofHealth.IfOBHpersonnelarenotavailabletoinitiateandmaintaincommunicationwiththeSSP,anidentifiedbackupteamofSpanish-speakingADHSpersonnelwillbeestablished.TheOBHwillestablishroutineconferencecallsbetweentheADHSandtheSSP,andmayincluderepresentationfromtheGovernors’OfficesofArizonaandSonora,andanyotherlocal,stateandfederalagencyasdeemednecessary.ParticipantsontheteleconferencecallwillbedeterminedbyADHSandSSPand/orGovernor’sofficeofeachrespectivestate.TheSSPpersonnelatthelocal-levelbordermunicipalitieswillfirstestablishcommunicationwiththeSonorastate-levelandotherSonoraborderregionhealthentitiesintheeventofasuspectorprobablecaseofaninfectiousdiseaseoutbreak.State-levelpersonnelfromtheSSPwillthenbegincommunicationwiththeADHSviatheOBHOfficeChief,ordesignee.OtherOrganizations–Inmanypublichealthemergencies,otherstate,federal,andlocalagenciesmayneedtobeinvolved.Theseagenciesmayincludelawenforcement,fireandotherfirstresponders,correctionalfacilities,agriculture,education,andotherorganizations.


U.S.CustomsandBorderProtectionForArizonacountiesborderingwithMexico(Yuma,Pima,SantaCruzandCochise),partnershipsbetweenlocalhealthdepartmentsandrespectiveBorderPatrolofficesareextremelyimportant.Currently,allfourcountieshaveworkingrelationshipswiththeU.S.CustomsandBorderProtectionofficestoensureopen,habituallinesofcommunicationnowandgoingforward.Specificpartnershipshaveincludedcollaborationoninfectiousdiseaseplans,jointplanningonworkshopsandtable-topexercisesthathaveassistedinoutliningagencyrolesandresponsibilities.Countyhealthdepartmentsareproactiveinensuringallcriticalcontactinformationisavailableandsharedwithborderpatrol,whentheneedtocommunicatearises.Countiesalsoprovideborderpatrolincidentmanagementteamswithnotesandupdatesregardingseasonalandemergingdiseases(Zikaisthemostrecentexample).ArizonaDepartmentofCorrectionsArizonaDepartmentofCorrections(ADOC)hascontractedwithCorizonCorrectionalHealthcaretoprovidefullservicemedical,mentalhealthanddentalcaretotheinmateshousedatthefollowingprisoncomplexes:ArizonaStatePrisonComplex(ASPC)-Lewis,Phoenix,Perryville,Winslow,Douglas,Safford,Florence,Eyman,Tucson,andYuma.Dependingonthedisease/condition,theyfollowtheestablishedreportablediseaseguidelinessetforthbyADHSandisolation/treatmentguidelinessetforthbyCDC.InmatesarescreenedforcommunicablediseasesuponintaketotheAlhambraReceptionUnitinPhoenixwheremostnewintakesarereceivedfortheirintakescreening.Oncethescreeningisconductedandtheyare"cleared"fortransporttoafacilityappropriatetomeettheircustodyclassificationandmedicalneedstheyreceiveanotherscreeningbyanursetoassuretheyarefreefromcommunicablediseases,andmajorhealthneedsareidentified.Nurselineisconducteddailytoofferinmatestheopportunitytoreportanysymptomsofconcern;providerlinesareconductedroutinelyaswell.Ifacommunicablediseaseisnotedatanyoftheseencountersinmatesareimmediatelyisolatedaspertheestablishedprotocolforthedisease/condition.Theyarethenassessedbyaphysiciantodetermineanappropriatetreatmentplan.Ifthecondition/diseasemeetsreportableguidelinesasestablishedbyADHS,areportablediseaseformiscompletedbytheFacilityHealthAdministratororDirectorofNursingandissubmittedtoADHS.Incasesofoutbreaks,theRegionalDirectorofNursingandRegionalMedicalDirectoraretobenotifiedbytheFHAandDONtohelpcoordinateserviceswiththeDOCandADHS.

NPIPlaybookMaintenance

TheNPIPlaybookandallsupportingdocumentswillbereviewedonanannualbasisorasneeded;theADHSOfficeofInfectiousDiseaseServices(OIDS)istheleadentity.Revisionswillreflectchangesinstatutes,rules,regulations,implementationprocedures,improvedcapabilities,andcorrectionofgapsidentifiedinexercisesandactualincidentsorresponses.PleasesubmitanycommentsorsuggestededitstoADHSOIDS,PublicHealthEmergencyPreparednessEpidemiology(PHEPE)Program.


Appendices

Definitions–Isolation Separatingandrestrictingthemovementofillpeoplewithacontagious

diseasetopreventtransmissiontoothers.Quarantine Separatingandrestrictingthemovementofwellpeoplewhowere

exposedtoacontagiousdiseasetopreventtransmissiontoothers.Quarantinetypicallylastsaslongastheincubationperiodoftheinfectiousagent.

SocialDistancing Reducinginteractionsandincreasingthedistancebetweenpeopleinsettingswhereindividualscomeintoclosecontactwithoneanother.

JointInformationSystem(JIS)

AnIncidentCommandSystem(ICS)concept,theJISprovidesthemechanismtoorganize,integrate,andcoordinateinformationtoensuretimely,accurate,accessibleandconsistentmessagingacrossmultiplejurisdictionsand/ordisciplineswithnongovernmentalorganizationsandtheprivatesector.MinorincidentsoreventswouldnormallycallfortheactivationoftheJIS.InaccordancewiththeArizonaStateEmergencyResponse&RecoveryPlan(SERRP),theArizonaDivisionofEmergencyManagement(ADEM)willactivatetheJIStosupportgeneral(non-publichealthspecific)emergencyresponseactivitiesinthestate.InthiscaseADHSwillsupportADEMJISbyprovidingpublicinformationtoassistwiththedevelopment,coordination,anddisseminationofpublichealthmessaging.

JointInformationCenter(JIC)

AnIncidentCommandSystem(ICS)concept,theJICisestablishedtocoordinateallincident-relatedpublicinformationactivities.Itisthecentralpointofcontactforallnewsmediaresponsetoanevent.Publicinformationofficialsfromallparticipatingagenciesshouldco-locateattheJIC.Majorresponsesmaycallforactivationofaphysical(facility)JIC.

EmergencyOperationsCenter(EOC)

AspartoftheIncidentCommandSystem(ICS),theEmergencyOperationsCenter(EOC)supportstheon-sceneIncidentCommandTeamwithinformationandcoordinationofresources.TheEOCisacentralizedfacilitythathasinformationmanagementandcommunicationsystems,andsupportstheincident/responsewithplanning,operations,logisticsandfinance.ADHSactivatesits’HealthEmergencyOperationsCenter(HEOC)whichisresponsibleforcoordinatinghealth-specificprogramresponseactivities,implementinghealthpolicydirectives,determiningthemissionandprioritiesoftheresponse,engaginginlong-rangeplanning,coordinatingwithexternalpartnersandagencies,andprovidingdirectionandauthoritytoact.

IncidentCommandSystem(ICS)

Thecombinationoffacilities,equipment,personnel,procedures,andcommunicationsoperatingwithinacommonorganizationalstructure,designedtoaidinthemanagementofresourcesforemergencyincidents.Itmaybeusedforallemergencies,andhasbeensuccessfullyemployedbymultipleresponsedisciplines.ICSisusedatalllevelsofgovernment(local,State,Tribal,andFederal)toorganizefieldleveloperations.


NPIDecisionMatrix–


ADHSOfficeofInfectiousDiseaseServicesOrganizationChart–


EducationalMaterials–



MessagingTemplates–Influenza(FirstFluCase)HealthAlertNetworkTemplate

DearHealthCareProvider:

TheArizonaDepartmentofHealthServiceshasconfirmedthefirstinfluenzacaseinArizonaforthe20xx-20xxinfluenzaseason.

Westronglyrecommendvaccinatingyourpatientsandstaffagainstinfluenzathroughoutthefluseason.Alleligibleindividualsaged6monthsoroldershouldbevaccinated.

Pleaseremindyourpatientsthebestwaytopreventfluandotherrespiratorydiseases,include:

• Getvaccinatedagainsttheflu• Washhandsoften• Avoidtouchingyourfacewithunwashedhands• Coveryourcoughandsneezes• Cleananddisinfectsurfacesfrequently• Avoidclosecontactwithsickpeople• Stayathomeifyouaresick

Forquestionsregardingthe2015-2016fluvaccine,callyourlocalhealthagencyortheArizonaImmunizationProgramOfficeat(602)364-3630.Influenzavaccinerecommendationsareavailableatcdc.gov/vaccines/hcp/acip-recs/index.html.Formoreinformation,visitazdhs.gov/fluorcdc.gov/flu.EnterovirusD68AssociatedwithSevereRespiratoryIllnessinChildren

InlateAugust,theCentersforDiseaseControlandPrevention(CDC)wasnotifiedbytwostatesofanincreaseinchildrenhospitalizedwithsevererespiratoryillness.EnterovirusD68(EV-D68)wasidentifiedinmanyofthesepatients.Therearenowseveralotherstatesreportingincreasesinadmissionsforsevererespiratoryillness.ItispossiblethatthesearealsoassociatedwithEV-D68.EV-D68appearstospreadviaclosecontact(e.g.,saliva,sputum,feces)withinfectedindividuals.Currently,thereisnovaccinetopreventEV-D68andnospecificantiviraltreatmentrecommended.However,patientscanhelpprotectthemselvesandothersfromrespiratoryillnessesby:• avoidingclosecontactwithpeoplewhoaresick;• avoidingtouchingeyes,nose,andmouthwithunwashedhands;• washinghandsoftenwithsoapandwater,especiallyafterchangingdiapers;• cleaning/disinfectingfrequentlytouchedsurfaces,suchastoysanddoorknobs,especiallyifsomeoneissick;

• ensuringvaccinations,includingtheinfluenzavaccine,areuptodate.CliniciansshouldbeawareofEV-D68asoneofmanycausesofviralrespiratorydiseaseandshouldreportclustersofunexplainedrespiratoryillnesstotheirlocalpublichealthagency.PleaserefertothisMMWRformoredetailedinformation:www._______________


NoticetoOutdoorSpecialEvents(RadiologicalHazard)

Staytunedtolocalradio.Specificinstructionswillbegivenbyauthorities.Localinstructionsalwaystakeprecedencetoanythingwritteninthispressrelease.Evacuateifyouareadvisedtodoso.Keepcarwindowsandventsclosed;usere-circulatedair.Whenyouhavereachedshelter,remainindoorsand:•Closedoorsandwindows•Turnofftheairconditioner,ventilationfans,furnaceandotherairintakes•Gotoaroomwithasfewwindowsaspossibleorabasement•Ifyoumustgooutdoors,coveryournoseandmouthwithahandkerchief

Ifyouhavejustbeenoutdoors,takeathoroughshowerand:•Changeyourclothesandshoes•Puttheitemsyouwerewearinginaplasticbag•Sealthebagandstoreitoutoftheway•Clothescanlaterbewashedasyounormallywouldinthewashingmachine.Anycontaminationwouldremaininthewaterandnotcontaminatethewashingmachine.

Putfoodincoveredcontainersorintherefrigerator.Foodnotpreviouslyincoveredcontainersshouldbewashedfirst.Washingshouldbedoneinaplaceotherthaninthekitchentopreventcontaminationoffoodsanddishes.Donotsellorconsumeanyfoodstuffsuntiltheyhavebeentestedforcontamination.Youmightbetoldtowashyouroutdoorequipmentwithsoapandwater.Cleaningdoesnotdestroyradioactivity.However,cleaningisusefulinmovingradioactivematerialstoaplacewheretheireffectswouldbelessharmful.Youshouldwearprotectiveclothingduringcleaningactivities.ExtremeHeatHealthAlertNetworkTemplate

NationalWeatherServicehasdeclaredanExcessiveHeatWarningbeginningatxxA.M.today,month,day,20xxuntil8P.M.tonightforxxxCounties.Daytimehighsareexpectedtobeinthe110to113degreerange.Residentsareadvisedtostaycool,stayhydrated,andstayinformed.Inareaswithanexcessiveheatwarning,itisrecommendedforschoolstokeepstudentsindoorsforphysicalactivityandrecess.Ifstudentsaregoingoutdoorsforrecess,itisrecommendedthatschoolsprovidewater(8gulpsevery15minutes),provideshade,encouragestudentstowearhats,sunscreenandlightcoloredclothingandprovidefrequentbreaks;ifstudentsshowsignsandsymptomsofheatillnessorwanttogoinside,itisadvisedtogetthemtoacoolenvironmentimmediately,suchasinsidetheschoolbuilding;additionally,itisveryimportantthatstudentsbehydratedbefore,duringandafterbeingoutsideforphysicalactivityand/orrecess.Extremelyhighorunusuallyhottemperaturescanaffectyourhealth.Onaverage,675deathsfromextremeheateventsoccureachyearintheUnitedStates.Mostvulnerableareadultsage65andolder,thosewhoworkorexerciseoutdoors,infantsandchildren,thehomelessorpoor,andpeoplewithachronicmedicalconditionorpeopleoncertainmedications.Takethenecessaryprecautionstopreventserioushealtheffectssuchasheatexhaustionorheatstroke.


Staycool• Stayinair-conditionedbuildings• ContacttheArizonaDepartmentofHealthServicesat602-364-3118orlocateanair-conditionedrefugestationinyourarea

• Donotrelyonafanasyourprimarycoolingdevice• Limitoutdooractivity,especiallymiddaywhenitisthehottestpartoftheday,andavoiddirectsunlight

• Wearloose,lightweight,light-coloredclothing• Takecoolshowersorbathstoloweryourbodytemperature• Checkonat-riskfriends,familyandneighborsatleasttwiceaday

Stayhydrated• Drinkmorethanusualanddon’twaituntilyou’rethirstytodrink• Drinkfromtwotofourcupsofwatereveryhourwhileworkingorexercisingoutside• Avoidalcoholorliquidscontaininghighamountsofsugar• Makesureyourfamily,friendsandneighborsaredrinkingenoughwater

Stayinformed• Checkyourlocalnewsforextremeheatwarningsandsafetytips• Visitthexxx.countywebsitetofindlocalinformationandtipsforpreventingheatsickness• Signupforfreeweatheralertstoyourphoneore-mail• Keepyourfriends,familyandneighborsawareofweatherandheatsafetyinformation

Additionally,theArizonaDepartmentofHealthServicesencouragesallresidentstolearnthesignsandfirstaidresponseforheat-relatedillness.Warningsignsandsymptomsvarybutmayinclude:HeatExhaustion–Symptoms• Heavysweating• Weakness• Skincold,pale,andclammy• Weakpulse• Faintingandvomiting

WhatYouShouldDo• Movetoacoolerlocation.• Liedownandloosenyourclothing.• Applycool,wetclothstoasmuchofyourbodyaspossible.• Sipwater.• Ifyouhavevomitedanditcontinues,seekmedicalattentionimmediately.

HeatStroke–Symptoms• Highbodytemperature(above103°F)• Hot,red,dryormoistskin• Rapidandstrongpulse• Possibleunconsciousness

WhatYouShouldDo• Call911immediately—thisisamedicalemergency.• Movethepersontoacoolerenvironment.• Reducetheperson'sbodytemperaturewithcoolclothsorevenabath.• DoNOTgivefluids.


EmergencycoolingcentersandhydrationstationswillbeopenthroughoutMaricopaCounty.Eachcenterwillprovidecoolairandwaterfreetothepublic.

Formoreinformationonextremeheat,call602-364-3118orvisit:ADHSHeatSafety

ADHSExtremeWeather&PublicHealth

Wantdailyhealthupdates?FollowtheArizonaDepartmentofHealthServicesonFacebookandTwitter

Sanitation&HygieneinaFlood

Itiscriticalforyoutoremembertopracticebasichygieneduringtheemergencyperiod.Alwayswashyourhandswithsoapandwaterthathasbeenboiledordisinfected:•Beforepreparingoreatingfood;•Aftertoiletuse;•Afterparticipatinginfloodcleanupactivities;and•Afterhandlingarticlescontaminatedwithfloodwaterorsewage.

Whencleanwaterisnotavailable,youcanusealcohol-basedproductsmadeforwashinghands.Floodwatersmaycontainfecalmaterialfromoverflowingsewagesystems,andagriculturalandindustrialbyproducts.Althoughskincontactwithfloodwaterdoesnot,byitself,poseaserioushealthrisk,thereissomeriskofdiseasefromeatingordrinkinganythingcontaminatedwithfloodwater.Ifyouhaveanyopencutsorsoresthatwillbeexposedtofloodwater,keepthemascleanaspossiblebywashingwellwithsoaptocontrolinfection.Ifawounddevelopsredness,swelling,ordrainage,seekimmediatemedicalattention.Inaddition,parentsneedtohelpchildrenavoidwaterborneillness.Donotallowchildrentoplayinfloodwaterareas,washchildren'shandsfrequently(alwaysbeforemeals),anddonotallowchildrentoplaywithflood-watercontaminatedtoysthathavenotbeendisinfected.Youcandisinfecttoysusingasolutionofonecupofbleachin5gallonsofwater.Formoreinformationabouthealthandsafetyduringaflood,pleasevisittheArizonaDepartmentofHealthServices’Websiteatwww.azdhs.govorcalltheStatePublicHealthInformationlineat(602)364-4500orstatewidetoll-freeat(800)314-9243.Resources–AdditionalNPIResources:CDCNonpharmaceuticalInterventions(NPIs)

NationalAssociationofCountyandCityHealthOfficers(NACCHO):Capability11:Non-PharmaceuticalInterventions

TRACIE–HealthcareEmergencyPreparednessInformationGateway:TopicCollection:NPI/TechnicalResources

Documents

ADHS NPI Playbook June13 - Arizona Department of Health … · 2018-04-27 · ADHS Non-Pharmaceutical Interventions Playbook 3 preparedness, response, and recovery activities carried