Developing and Implementing an Approach to “All Hazards Emergency Response”

Jim Price, Tacoma-Pierce County Health Department

Session Objectives

• Know the difference between a plan and a procedure

• Understand how to organize a set of Emergency Plan and Implementing Procedures (EPIPs)

• Know the steps to develop an EPIP

• Understand the need for a process for administrative review and approval

A. 100%

B. 50-99%

C. 25-49%

D. <25%

Poll Question 1

In my opinion, the percent of staff in my health department who understand the difference between a plan and an implementing procedure is:

“Plan”

• Document containing policies and response requirements

• Not a list of steps/job actions

• Includes all hazards: Biologic Natural disaster Technologic

What is an EPIP?

An EPIP is the collection of job task sheets and associated information organized by Emergency Response Organization Sections or Branches.

How policies and requirements are to be implemented

Includes:• Emergency response• Program maintenance

Emergency Plan Implementing Procedures

VS.

Plan vs. EPIP – Example

•Establish an EP program = policy•Elements of the EP program = requirements

•How to accomplish requirements = EPIP:

Who receives initial callHow call triagedHow event level

determinedWho/what/how is

information communicatedHow ERO accomplishes their tasks

Emergency Plan Implementing Procedures

Normal Ops(SOP)

Emergency Ops(EPIP)

(EPIP)

Standard Operating Procedure

A. Yes

B. No

Poll Question 2

Do you now feel that you could describe the difference between a plan and a procedure?

Developing EPIPs

•What are the established requirements and policies to be covered?

•What ERO positions are to be included?•What are the logical steps (task analysis) to

complete the identified task(s)?•How can the EPIP be organized for ease of use?

Review:

Checklist:•Is the EPIP consistent with other EPIPs?

•Can the EPIP be understood by the user?

EPIP 1:

Writing EPIPs

•Biologic

•Natural disaster

•Technological

At TPCHD, divided incident types into categories: Recognition of

emergency conditions

 

OperationsSection Chief

Triage UnitLead

Field FacilitiesBranch Director

POD / BDS Group Supervisor (1)

POD / BDS Group Supervisor (2)

POD / BDS Group Supervisor (3)

POD / BDS Group Supervisor (5)

POD / BDS Group Supervisor (6)

Containment Group Supervisor

Enforcement Unit Lead

[ Monitoring ]

Phone MonitoringUnit Lead

Field MonitoringUnit Lead

Alternate Triage & Treatment Center Branch Lead

POD / BDS Group Supervisor (4)

Triage Group Supervisor (1)

Triage Group Supervisor (2)

Triage Group Supervisor (1)

Triage Group Supervisor (2)

Operations Section Chief

Mission:Activates, coordinates, and provides overall command and control of identified operations support staff. This staff include the Triage Unit, and the Field Facility Branch.

EPIP Template

•Position title

•Mission

•Location•Chain of

command•Job task

sheets

Located:TPCHD Emergency Operations Facility (EOF)

EPIP Example

A. Having systems in place to recognize incident

B. Driving the response by determining the severity of the incident

C. Realizing that PH emergencies can emerge slowly

D. Early notification that PH emergencies can emerge slowly

Poll Question 3

In my opinion, the following is most important in recognizing an emergency condition:

Evaluate the need for SNS.The County Executive or designee should havemade an emergency proclamation prior to theSNS request going forward to the State EOC.

If an SNS request is anticipated,complete a request letter and forwardto the Policy Liaison in the EOC.

Direct the OperationsSection Chief toactivate the necessarynumber of PODs.

Start Here

Evaluate the need to implement containmentmeasures. If containment measures may beneeded, go to EPIP 4h for additionalinformation.

Obtain approval from the TPCHDHealth Officer to implementvoluntary containment measures.

Coordinate steps to obtain aninvoluntary containment order withthe Operations Section Chief and theTPCHD Health Officer or delegate,and legal council.

If not already accomplished, request the EOCOperations Liaison to activate the Hospital Bio-Plan.

Continued on next page

Direct the Operations Section Chief toactivate the Investigation Branch and initiatesurveillance activities.

Direct Finance/Admin.Section Chief todistribute the drug cacheto ERO staff through thesign-in/sign-out process.

Request the EOF Liaison to contact the DOH Duty Officer and request PugetSound Air Quality to pull the bio-watch sample and determine if any PierceCounty biological sentinel systems have detected positive indications for abiological agent.

Incident Manager, EPIP 4

Organizing the EPIPs

EPIP 1: Recognition of Emergency Conditions

EPIP 2: Notification and Communication

EPIP 3: Emergency Operations Facility

EPIP 4: Biological Incident

EPIP 5: Natural Disaster

EPIP 6: Technological Incident

EPIP 7: Maintaining Emergency Preparedness

Incident Recognition: HealthIncident Flow Sheet

EPIP 1

Emergency Plan Policies Requirements InfrastructureMaintaining Emergency

Preparedness EPIP 7

RespiratoryProtection

EPIP 7a

TrainingEPIP 7c

Facilities &Equipment EPIP

7b

Standard OperatingProcedures

Drills & ExercisesEPIP 7d

Procedure Dev./Maint

EPIP 7e

Program QualityImprovement

EPIP 7f

Notification/CommunicationEPIP 2

Biologic AgentResponse

EPIP 4

Small PoxEPIP 4d

RecoveryEPIP 3h

POD OperationsEPIP 4e

ContainmentOperations

EPIP 4f

Pandemic FluEPIP 4b

AnthraxEPIP 4c

Natural DisasterResponse

EPIP 5

EarthquakeEPIP 5a

FloodEPIP 5b

LaharEPIP 5c

TechnologicalIncident Response

EPIP 6

RadiologicalMaterials Response

EPIP 6a

Chemical ReleaseEPIP 6b

Operation of the EOFEPIP 3

Finance/AdminSectionEPIP 3a

PHIO SupportUnits

EPIP 3b

Operations SectionEPIP 3c

Planning SectionEPIP 3d

Logistics SectionEPIP 3e

Alternate Triageand Treat Center

EPIP 3f

Continuity ofOperations

EPIP 3g

Response to aBDS Alarm

EPIP 4a

Poll Question 5

My PH jurisdiction has a formal system for categorizing the severity of an incident.

A. Yes

B. No

EPIP 1: Recognizing Emergency Conditions

• Public health emergencies begin slowly.• System in place to recognize incident.• Tie response to severity of incident.• Recognition and notification are vital.

Poll Question 6

My PH jurisdiction has a system for identifying action levels based on the severity of an incident.

A. Yes

B. No

Recognizing Emergency Conditions (cont.)

Identify levels of response for the LHJ:• Off-normal• Low • Medium• High

TPCHD Emergency Action Levels

Response:

• Notify other program on-call staff and Public Health Information Officer (PHIO).

• Enter data into incident tracking.

Off-normal incidents involve no program resource reallocation, but may have media or significant public concerns. Inquiries are defined as off-normal incidents.

Low level incidents require a resource reallocation by a single department program to appropriately respond to the incident.

Response: • Notify other program on-call staff, PHIO, and

Emergency Operations Facility (EOF) manager.

• Enter data into incident tracking.

• Potential for limited activation of the EOF.

TPCHD Emergency Action Levels (cont.)

TPCHD Emergency Action Levels (cont.)

Medium level incidents require resource reallocation by more than one program within the Health Department to appropriately respond to the incident.

Response:• Activate the EOF.

• Notify Pierce County Department of Emergency Management.

• Notify Washington Department of Health.

TPCHD Emergency Action Levels (cont.)

Response: • Activate the EOF.• Notify Pierce County Department of

Emergency Management.• Notify Washington Department of Health.• Request activation of the county EOC.

High level events impact TPCHD as well as other outside agencies.

Data Source Minimum Suspicion levelFood & Community Safety ----- Suspicious incident or significant increase in foodborne illness or pool, spa, or school

related complaintsEnvironmental Health ----- Reports of unexplained symptoms, suspected illness, or contamination associated with

environmental agents----- Reports of water system tampering/contamination.

Communicable Disease Control ----- Suspicious or unusual clustering of incidents or cases of disease.Syndromic Surveillance ----- Statistically significant increase in a syndromeDeath Surveillance ----- Unexplained death or cluster of suspicious deathsLaw Enforcement ----- Credible third party concerning terrorists threatSensors ----- Positive indications on JSIPP, BDS, or BiowatchDisaster ----- Significant imminent or actual incident requiring TPCHD responseOther ----- Significant media or public concern calls may be receivedZoonotic Disease Surveillance ----- Suspicion of a link between animal and human diseaseProgram Resources ----- May require Program resource realignment to appropriately respond

Urgent situation or likely togenerate media or publicconcern

Convene/notifyrepresentatives from CD,EH, F&CS, & PHIO

Is Incident potentiallyclassified at low,medium or high?

Report at dailybriefing

Determine statusof incident

Increased # reportabledisease or othercomplaints overexpected norm, withepidemiologic links

Suspicious unexplaineddeath

Suspicious or unusualclustering of events

# of cases of importantsyndromes seen at ERsor by EMS significantlyhigher than expected.

Detection of highpathogen avianinfluenza in U.S.

Evidence of intentionalwater systemcontamination.

Reallocation ofProgram resources torespond to the incident.

Outbreak or incident likely tooverwhelm resources of a program orgenerate a high level of publicconcern

Increased # of reportable diseases orother complaints > expected norm,with high potential for secondaryspread

Greater or more than 2 cases ofsimilar unexplained critical illness ordeath with infectious hallmarks &epidemiologic links

Rare death with possibleenvironmental or food-related cause.

Extremely suspicious or unusualclustering of incidents

Likely case of human to humantransmission of avian influenza inmajor U.S. transportation hub.

Illness associated with water systemtampering.

Reallocation of multiple Program’sresources to respond to the incident.

Outbreaks or eventlikely to overwhelmthe resources ofTPCHD

Disease or event withpotential for extremepublic health impactor public panic

ImplementEPIP #2

yes

yes

HEALTH INCIDENT FLOW SHEET

STATUS DETERMINATION & RESPONSE Date Initiated __________

Identify & notifyIncident Manager

Notify EOFManager

Note: This will link to EPIP #2, HealthIncident Status: Low, Medium or Higher

Use next page to document steps.

nono

No actionrequired.Considerentering

into IncidentTracking

Enter into Incident Tracking

HIGHMEDIUMNormal LOW

OffNormal

Requires additionalProgrammatic

attendtion beyondwhat is considerednormal, i.e., non-

compliant TBpatient, Pandemic

Alert, Phase 3

Notify Program Lead or appropriate PublicHealth Manager, report at the daily briefing. Ifevent occurs after the daily meeting send out

an email to the HD Surveillance List.

EPIP 2: Notification and Communication

• Concept of Operations

• Declaring an Emergency

Incident is off-normal

Incident is low level

Incident is medium level

Incident is high level

EPIP 2: Notification and Communication

Attachments:

1. TPCHD Emergency Response Organization Activation List

2. EOF Support Unit List

3. TPCHD Emergency Response Facilities Telephone List

4. Outside Agency Contact List

5. TPCHD Safety Monitor Contact List

6. Local Health Jurisdiction Contact List

EPIP 2: Notification and Communication (cont.)

Attachments (cont.)

7. TPCHD Situation Report

8. TPCHD GIS Unit

9. TPCHD Language Unit

10. Media Outlet Contact Lists

11. Public Information Officer Contact List

12. TPCHD Essential Services Functions Contact List

13. Pierce County High School Contact List

EPIP 3: EOF Command Staff

• EOC Policy Liaison

• EOF Incident Manager

• EOF Manager

• Safety Officer

• Liaison Officer

• Public Health Information Officer (PHIO)

EPIP 3: EOF General Staff/Activities

3a: Finance/Admin Section

3b: PHIO Support Units

3c: Operations Section

3d: Planning Section

3e: Logistics Section

3f: Continuity of Operations

3g: Alternate Triage and Treatment Sites

3h: Recovery

Event Based EPIPs

• EPIPs 4, 5, and 6 categories of incident types:

Biologic

Natural disaster

Technologic

• Provide information on general tasks for each category.

• Actions for specific types of incidents are included in the next level of EPIP.

EPIP 4: Biologic

4a: Response to a BDS Alarm

4b: Small Pox

4c: Pandemic Influenza

4d: Anthrax

4e: Operating Points of Dispensing

4f: Containment Operations

EPIP 5: Natural Disasters

5a: Earthquake

5b: Flood

5c: Lahar

EPIP 6: Technologic

6a: Radiological

6b: Chemical

EPIP 7

Provide information on how the Public Health Emergency Preparedness and Response Program is being administered.

• Procedure development• Training• Drills and exercises

• Facilities and equipment• Respiratory protection• Quality improvement

Notification is received into LHJCall is triaged and appropriate Program Identified.

Step 2: If incident meets minimum suspicion level, otherProgram Representatives notified and conference isheld to determine level of emergency condition.

Step 1: Program Representative reviews HealthIncident Flow Sheet (EPIP 1)

Step 3: Additional ERO staff/facilities are activated, andoutside agencies notified.

Step 4: EPIP 3 reviewed to determine general actionsto be taken regardless of type of incident.

Step 5: Appropriate incident specific EPIP (4, 5, or 6)reviewed to determine any additional actions to be takenfor that specific incident.

Step 6: Appropriate incident type specific EPIP (# a, b,c, d, etc.) reviewed to determine any additional actionsto be taken for that specific type of incident.

Questions?

Comments?