Emergency Response Plan 2016 - meigs-health.com · Assistance and support for mass casualty and mass fatality incidents. Coordination with other local, regional, state, and federal

MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN

2016 Direction & Control Annex 1

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Meigs County General Health District

www.meigs-health.com

740.992.6626

Emergency Response Plan

2016 Aimee Imbrosciano, Health Commissioner

Courtney Midkiff, Administrator

Frank Gorscak, Emergency Response Coordinator

http://www.meigs-health.com/



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Date

Reviewed

Changes

Made* Signature/Title

02/18/2014 Yes Frank Gorscak



Y or N

ANNEX 1:

DIRECTION AND CONTROL



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* Summary of Changes can be found at the end of this annex.



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This page was intentionally left blank.



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TABLE OF CONTENTS

PURPOSE ......................................................................................................................... 14

SITUATIONS AND ASSUMPTIONS ........................................................................................... 14

CONCEPT OF OPERATIONS ................................................................................................. 14

Initial Notification & Communications ......................................................................... 14

Incident Assessment ............................................................................................................ 14 Diagram1: Initial Notification & Communications ....................................................... 16

Sequence of Events........................................................................................................ 16

Diagram 2: ICS for HCHD .............................................................................................. 17

ORGANIZATION & ASSIGNMENT OF RESPONSIBILITIES .............................................................. 17

Meigs County Health Department ............................................................................... 17

Supporting Agencies ...................................................................................................... 18

Scene Operations ........................................................................................................... 19

Department Operations Center ................................................................................... 19

MEIGS County Emergency Operations Center ............................................................ 20

Regional Coordination Center (RCC) ......................................................................... 20

IMPLEMENTING INSTRUCTIONS ............................................................................................. 20

AUTHORITIES AND REFERENCE .............................................................................................. 20

SUMMARY OF CHANGES .................................................................................................... 21



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PURPOSE

The purpose of this annex is to provide support to Command authorities during a

public health emergency response, meanwhile collaborating and communicating

between partnering agencies. This annex should provide support to Minimize

confusion that can occur as a result of unified command.

SITUATION AND ASSUMPTIONS

Situations:

A public health incident that has occurred that requires human and/or

material resources that are beyond the day-to day levels.

The public health incident is likely to continue for greater than 24 hours.

Assumption(s):

Local Command and Control will consist of the pre-established Command

structure and coordination through the local EOC.

The Meigs County communities will to be affected by a large-scale disease

outbreak such as pandemic influenza and therefore must be prepared to

respond regionally for consistent, equitable and affective mitigation.

During a large-scale event, MCHD will experience a shortage of resources

and must coordinate with regional partners for an appropriate response.

Meigs County has EOC capability for local coordination.

Meigs County has plans and procedures to direct emergency operations

within the county.

CONCEPT OF OPERATIONS

Initial Notification & Communications

Initial Notification

The first health department employee that is contacted, or on scene, during a

public health emergency situation will take the role of the Incident Commander.

Incident Assessment

An assessment or “size up” of the situation must be conducted by the Incident

Commander to determine the appropriate course of action. The assessment should

include the “who (including how many affected), what (including the severity),

when, and where” that are involved in the situation and should incorporate other

factors that may increase the complexity of the event. Complexity factors may

include:

Impacts to life, property, and the economy

Community and Responder Safety



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Potentially hazardous materials

Weather and other environmental influences

Likelihood of cascading events

Potential Crime Scene (Including Terrorism)

Political sensitivity, external influences, and media relations

Area involved, jurisdictional boundaries

Availability of resources

Information gathered during the assessment should be documented for accurate

reporting to additional staff and other agencies if further notifications and

communications need to be made.

Health Department Staff that are trained to conduct an Incident Assessment

include the: Health Department Administrator, Public Health Emergency

Response Coordinator, Director of Nursing, Director of Environmental, and

Public Health Supervisor.

The completion of the assessment should help the Incident Commander determine

the Incident Type, which will affect how the Incident Command System (ICS) and

response activities are implemented.



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Diagram1: Initial Notification & Communications

Typical Sequence of Events


MCHD Emergency Response Plan Activated

Annex 1: Direction and Control Activated

Staff Notification

See Implementing Instruction (II): direct & control: Staff Notification & Call-Down.

Transfer of “Command” to the Administrator

Or next available staff member following the chain of command (if necessary)

Health Department Staff that are trained to fill the role of Incident

Commander include the: Health Commissioner, Public Health Emergency

Response Coordinator, Director of Nursing, Director of Environmental, and

Public Health Supervisor.



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Incident Command Post and/or Department Operations Center (DOC) Established

Documentation and a description of the activation, notifications, services

enhanced, services reduced/eliminated, and other pertinent information may be

included on the ICS form 201.

Response Partners’ Notification

The County Commissioners, or their representative, will convene a meeting of

the necessary personnel in order to begin the prophylaxis process for “First

Responders” and essential government. Those personnel may include

representatives from LEMA, Meigs County Job and Family Services, fire, EMS,

law enforcement, Red Cross, hospitals, and others as deemed necessary.

Incident Command Structure

Diagram 2: ICS for MCHD

ORGANIZATION & ASSIGNMENT OF RESPONSIBILITIES

Meigs County Health Department

For a public health incident/emergency, the MCHD would be the lead agency.

Some of the activities that the local health department would be responsible for

include:

Assessment of county health and medical needs.

Surveillance and investigations to determine disease patterns and potential

disease outbreaks and implement prevention strategies.

Monitoring of the availability and utilization of health systems’ assets.

Provide logistical support for public health personnel in the field.



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Provide pharmaceuticals, medical equipment, and supplies as available

(includes the coordination and tracking of medical resources and equipment).

Provide consultation for the decontamination of people, buildings, and the

environment, when applicable.

Provide mass dispensing clinics for the prophylaxis of the entire county

population, if necessary. Identification of areas where public health problems

could occur.

Public Health assessments of conditions at the site of the emergency to

determine health needs and priorities.

Provision of medical related information releases and public health

recommendations and related releases to the public.

Research and consultation on potential health hazards, medical problems,

and appropriate levels of PPE, when applicable.

Coordination of behavioral health assistance.

Environmental sampling and analysis/collecting specimens for lab testing.

Veterinary support.

Assistance and support for mass casualty and mass fatality incidents.

Coordination with other local, regional, state, and federal partners.

Assess and make recommendations concerning the public health needs of

emergency responders.

Supporting Agencies

Agency Responsibilities

MC EMA Director/EOC Notify local authorities when the EOC

opens.

Provide a facility from which local

authorities may coordinate

emergency response activities.

Central point for coordinating the

resources required for a local

response.

Provide situational awareness for the

State, via Ohio EMA

Holzer ER Emergency treatment of severely

affected

Law Enforcement Provide and manage security

operations

Provide and manage traffic flow



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Adjacent Local Health Departments Responsible for infectious disease

surveillance in their county

Provide human and/or materiel

resources when available

Regional Epidemiologist Infectious disease surveillance

Recommendations for treatment,

non-pharmaceutical interventions

Regional Public Health Coordinator Notify the regional response partners

of the activation of the SCO RPH ERP

and the RCC

Act as conduit for communications

between health departments

Act as conduit for communication

between health departments and

Ohio Department of Health

Assist with resource management

Responsible for facilitating

conference calls for incident

leadership

Ohio Department of Health Monitor situation, including any

jurisdictions throughout the state

with/for a similar incident

Available to provide guidance and

recommendations for incident

management

Assist in resource management

Scene Operations

Public health consequences may be associated with a wide variety of emergencies

or disasters that could occur within the county. There may be times when Health

Department scene operations are necessary in response to public health threats

either directly or indirectly resulting from disaster situations. Possible scene

operations for pre-identified disasters that could occur within the county are

detailed in the Meigs County Health Department Public Health Risk Assessment

Hazard Profile .

Department Operations Center

The Meigs County Health Department has a Department Operations Center that

may be activated to conduct ICS and communication operations. The Department



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Operations Center is located in the health department conference room which has

a VoIP Phone system with a conferencing abilities , MARCS radio base station, large-

screen monitor for visuals, MARCS radios, and High Sped Broadband Fiber-Optic

network ports for internet connections.

MEIGS County Emergency Operations Center

The Health Department Incident Commander may request the activation of the

Emergency Operations Center, through the Meigs County Emergency Management

Agency Director, for resources that the health department does not have on hand.

The county EOC is located at Pomeroy Pike, Pomeroy Ohio. Upon activation of the

EOC, MCHD will send a Liaison to the EOC, or establish direct communication, such

as telephone and radio to coordinate information between the Incident

Commander and EOC.

Regional Coordination Center (RCC)

When an incident escalates beyond the capability of the MCHD, the RCC may be

activated. The RCC will make available the means for leadership throughout the

region to communicate and to decide the best way to protect the general public.

See Implementing Instruction (II): direct & control: RCC Activation.

IMPLEMENTING INSTRUCTIONS

II: Direct & Control: Location

CREDENTIALING & BADGING HD EOC, EMA EOC, OR SHERRIFF’S OFFICE

RCC ACTIVATION OPHCS documents local folders SE

SE Collaboration SCO RPH Annexes

Appendices Direct & Control

NIMS RECOMMENDATIONS

AUTHORITIES AND REFERENCES

Title Location

FEMA ICS 300 manual Bookshelf in ERC office

Beyond Initial Response to ICS (Using the

National Incident Management System’s

Incident Command System)

Bookshelf in ERC office

National Incident Management System (2011) Bookshelf in ERC office

Meigs County All Hazards Response Plan (2011) Bookshelf in ERC office



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SUMMARY OF CHANGES 2/18/2014 Footer date change

1/12/2015 Footer date change

1/22/2016 Footer date change, Meigs ema address, communication changes



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Date

Reviewed

Changes

Made* Signature



Y or N

Y or N

Table of Contents

Introduction ............................................................................................................ 25

Situation and Assumptions .................................................................................... 25

Activation and Implementation ........................................................................... 25

Concept of Operations ......................................................................................... 26

Initial Notification 26

Internal Communications 26

Staff Notification Matrix ................................................................................................ 27

External Communications 27

Interoperable Communications 27

Annex 2:

Interoperative

Communications



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Situation Reporting 29

Plan Development and maintenance ................................................................. 30

Training and Exercise ............................................................................................ 30

Implementing Instructions .................................................................................... 30

References ............................................................................................................. 31

Summary of Changes............................................................................................ 31

* Summary of Changes can be found at the end of this document.



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INTRODUCTION

Every public health jurisdiction in the country has a responsibility to develop and

maintain the capability to communicate with its jurisdiction’s response agencies, as

well as with public health agencies in adjacent districts.

The purpose of this Interoperative communications annex is to provide instruction

and guidance for affective communications within the agency and with response

partners in the community before, during, and after an incident.

This plan will address initial notification, staff notification and activation, and external

response partner communications.

The scope of this annex and its related implementing instructions include:

The initial health department notification process;

Communication system use and related protocols; and

Response partner and staff contact directories.

SITUATION AND ASSUMPTIONS

Situation

An incident requiring public health action has occurred.

Assumptions

1. Enhanced Interoperative communications is needed to respond to the

incident and to keep staff and response partners informed and safe.

2. Staff has been trained on each form of communications.

3. Staff will respond to meet the community’s needs should an incident

occur.

4. Adjacent jurisdictions may be responding to the same/similar incident.

5. Compliance with National Incident Management System (NIMS) will occur

throughout the response efforts.

6. ODH and CDC may be involved at any response level.

ACTIVATION AND IMPLEMENTATION

Typical Sequence of Activities:

The Meigs County Health Department (MCHD) Emergency Response Plan should

be activated prior to the activation of this Annex.

The activation and implementation of the Interoperative Communications Plan

should be considered during any incident that requires communications beyond

the “normal business” communications.

The activation and implementation of this annex, and related implementing

instructions, is determined by the Administrator, Health Commissioner, or other

designee.



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The determination of communication systems to be used, frequency of

communications, and the projected time needed for enhanced

communications should be made.

The health commissioner, or his designee, will notify the Board of Health and the

County Commissioners of the activation and brief them on the situation if the

incident is projected to extend beyond four (4) hours.

Documentation and a description of the activation, notifications, and need for

change in routine communications may be included on the ICS form 201 and/or

205.



The MCHD will initiate both internal and external notification, alerting, and/or

request for mobilization of staff and partner agencies following the detection of a

public health emergency situation. The primary 24/7 contact number for the Health

District, to receive notifications of public health emergencies, is the main health

department landline number. After-hours calls are directed, via the automated

answering system, to contact the ERC with the information for public health

emergencies (See Implementing Instruction (II): Communications: 24/7 Notification

process).

Internal Communications

An internal notifications contact list has been developed for after-hours emergency

notifications of critical response staff. The list provides an organized pattern of

contacting staff through each director, starting with the Health Commissioner or

acting Incident Commander. The list contains the contact information and backup

contact information for critical response staff. A call log (ICS form Activity Log) is

also included with the contact list for documentation of the message, who was

contacted, and when the message was confirmed.

An additional list of all health department staff, with home/mailing addresses is kept

with the internal notifications list. (See II: Communications: Staff Contact Info & Call-

Down Instructions). Staff notification lists are updated and distributed to the health

department plan initial responders as contact changes occur.

Other internal communications can include Code Red, Meigs County’s reverse

notification system which is programmed to send an emergency message to the

whole county, regions of the county, or to the health department staff or to other

county first responders by landline, cell phone, text messaging or email.



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Staff Notification Matrix

The Ohio Public Health Communication System (OPHCS) may also be used to notify

the core emergency response staff, regional public health preparedness response

coordinator, and regional epidemiologists for emergency situations, if there is a

computer with an internet connection available. See II: Communications: OPHCS).

External Communications

The MCHD maintains four (3) separate external contact lists as part of the MCHD

ERP. The contact lists include:

State and regional health department emergency contact information;

Local government and non-government organizations, and businesses that

would have potential public health resources or response roles in a public

health emergency;

Health Alert Network (HAN) Directory, separating out critical local agencies

with public health roles, has been developed for the early and continual

notification of local public health emergency developments; and

Interoperable Communications

Health Commissioner/Administrator

Incident Commander

Director of

Nursing

PH Nurses

WIC Staff

Lice Aids

Director of Environmental Health

Registered Sanitarians

Plumbing Inspector

Director of Preparedness, & Administration

Clerical Staff

Preparedness Staff



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The Meigs Health Department has access to multiple communication systems for

county, regional, and statewide communication activities.

Health Meigs Department communication systems include:

Land Line

Mobile Phone/Cell Phone

Fax

Email

Ohio Public Health Communication System (OPHCS)

Multi-Agency Radio Communication System (MARCS)

Meigs County Radio System

Voice over IP Phones

TeamSpeak (Voice Over IP)

Meigs County Code Red

In addition to the above communication systems, HAM radio operators may be

requested through the Emergency Management Agency (EMA) Director as a

communications resource external to the Health Department.

The Ohio Department of Health and Regional Coordination Center should be

notified to what alternate communications systems we are using and how to

contact us using them if the primary systems (landline, email) fail. (See II:

Communications: MARCS and II: Communications: OPHCS)

Essential Elements of Information and Situation Reporting

Essential Elements of Information (EEI) are made up of information gathered from a

variety of input sources that come from a number of event-related systems, which

help construct a timely picture and contribute to the development of Situational

Awareness. EEI may lead to certain actions being taken, or include information that

may have cascading effects. Typically they will be the “who, what, when, where,

and why” of the emergency response.

EEI may be needed by first responders and emergency responders; emergency

operations centers; stakeholders and partners; and the public.

An incident, depending on size and scope, can affect:

People: This can be the general public, vulnerable populations, and

special needs populations. It can include non-English speakers,

homeless or transitory persons, and tourists or out-of-towners. EEIs can

affect decisions made in an emergency response or disease outbreak.

Systems: This is hospitals and other healthcare systems, infrastructure,

transportation, and communications. The incident may have an

impact on these systems and lead to an inability to provide certain

services.



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Service Providers: These are people who staff and provide services in

the various systems. An incident or disaster may impact the ability of

the service providers to serve affected populations.

While the emergence of a new and deadly disease in our community – or an

outbreak – may not cause the initial infrastructure and property damage that a

flood, tornado, or earthquake might, an outbreak, or even a single case, may have

serious impacts in other ways. People are affected, possibly infected, and almost

certainly afraid for their life. They also will fear for their loved ones. Hospitals and

healthcare systems may become stressed or overwhelmed. People who provide

services may react out of fear, and fail to carry out their function of maintaining

systems, thus negatively impacting the public and the ability of responders to

manage the situation.

A disease outbreak or the presence of a disease like Ebola Hemorrhagic Viral

Disease – regardless of the number of human infections – will almost certainly have a

short term effects (an initial strain on the healthcare system in managing the

situation and even dealing with the worried-well; rushes on food, water, and

medical supplies); and a long term effect (maintaining law and order in the

community, the continued ability to provide services, stress on the stress on the

healthcare system).

While they are similar, they may also differ and require the gathering of different

types of information. In the short term, in addition to healthcare situations, EEIs

should include a close monitoring of social media for rumors or incorrect information

that may prove harmful; and watch for signs of “rushes” on food, water, and even

health products. In the long run EEI should monitor potential barriers to the provisions

of services and service provider’s ability and willingness to provide critical services.

EEI should help to guide the actions of decision makers to ensure that the response

addresses the fear a community will feel during a disease outbreak or the presence

of a feared disease such as Ebola Hemorrhagic Viral Disease. The EEI may also help

address possible shortages of supplies and/or personal protective equipment

needed by service providers.

Situation Reporting

The Health Meigs Department will provide situation reports to the Regional

Coordination Center (RCC) and/or the Ohio Department of Health’s (ODH)

Department Operations Center during any public health emergency that requires

the use of situation reports. A generic standard report has been developed due to

the high variability of emergency situations, see: Implementing Instruction:

communications: Situational Awareness. The Health Department will work with the

RCC and ODH on the exact type of information needed by those entities and will

adapt the situation report according to the guidelines/requirements of the RCC and

the ODH.

When an incident requires the mass dispensing of medical countermeasures, health

departments may submit a weekly situation report of the medical countermeasure



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movement and availability to ODH through the Ohio Public Health Analysis Network

(OPHAN). This is a requirement if the medical countermeasure is obtained through

State or Federal assets.

The Ohio Department of Health has a Situational Portal through which local health

departments can “read only” situational activities occurring at that state agency.

Access to that portal is limited to health departments only. Access information to

the situational portal can be found in implementing instruction (II): communications:

Situational Awareness.

Any Incident Action Plans and After Action/Corrective Action Plans will be submitted

to the Regional Coordination Center and the Ohio Department of Health as

requested or required.

PLAN DEVELOPMENT AND MAINTENANCE

Implementing Instructions

See the “Plan Development and Maintenance” section of the Meigs County Public

Health Emergency Response Plan - Base Plan.

Authorities and Reference

See the “Plan Development and Maintenance” section of the Meigs County Public

Health Emergency Response Plan - Base Plan.

TRAINING AND EXERCISE

The health department will ensure training for Interoperative Communications.

Components of Interoperative communications will be exercised monthly.

Interoperative communications training, exercise, and evaluation plan is contained

in the Multi-Year Training and Exercise Plan.


II: Communications: Location

24/7 Notification Process ERC office; MeigsPrime server

Technical Assistance for Communications x

OPHCS Protocols ERC Office

MARCS Usage & Matrix ERC Office

OPHAN ERC Office, GMIS

HAN & Emergency Contacts MeigsPrime Server

Communications Matrix Meigs ERP

Landlines & Mobile Phones x

Incident Notification & Staff Call -Up Meigs Call-Down List



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Internet Communications X

County Radio System MARCS, Code Red

Situation Awareness MARCS, Landline, Cell phone

REFERENCES

Title Location

Directions for uploading OPHAN forms

OPHCS Administrative and Collaborative

License User Manuals ERC Office

VOIP (The Ohio Department of Health

Telephone User Guide for Cisco 7940 (VOIP)

Phones. September 27, 2005.

Debatable is if ODH VoIP is usable.

Office of Information Technology “Using

your MARCS Digital Radios” Instruction Book

2007

ERC Office

SUMMARY OF CHANGES

NOVEMBER 10, 2014 Punctuation, footer date change

July 10, 2015 added Essential Elements of Information (EEI) and other pertinent info



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Date

Reviewed

Changes


03/18/2014 Y or N Frank Gorscak ERC


Y or N

Y or N

TABLE OF CONTENTS

PUBLIC EDUCATION ................................................................................................... I

Pre-Event ........................................................................................................................ i

Post Event ...................................................................................................................... i

MEDIA/PUBLIC AFFAIRS ............................................................................................. I

Designated Spokesperson .......................................................................................... i

Designated Spokesperson ......................................................................................... ii

Assessment ................................................................................................................... ii

Pre-Scripted Public Advisories .................................................................................... ii

Crisis Communication Team ...................................................................................... ii

Joint Information System ............................................................................................. ii

DISSEMINATION OF PUBLIC INFORMATION ............................................................ III

Special Consideration for Release of Public Information ..................................... iv

DISSEMINATION OF INFORMATION TO RESPONSE PARTNERS ............................... IV

TRAINING AND EXERCISE ......................................................................................... V

ANNEX 3:

EMERGENCY PUBLIC INFORMATION

& WARNING



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PLAN DEVELOPMENT AND REVIEW .......................................................................... V

IMPLEMENTING INSTRUCTIONS ................................................................................ V

EMERGENCY COMMUNICATIONS RESOURCES ...................................................... V

REFERENCES ............................................................................................................. VI

SUMMARY OF CHANGES ........................................................................................VII



2015 Emergency Public Information & Warning Annex 3

ii



2013 Epidemiological Response Annex 4

4.i

I. PUBLIC EDUCATION

A. Pre-Event

The Health Department routinely provides public education on potential

public health threats and preventative measures through brochures, press

releases, meetings/educational events, Facebook, Twitter and the Health

Department website. The Health Department will increase public information

efforts for impending disaster situations with public health implications.

B. Post Event

The Health Department will assist in providing critical public health

information to the media and public during emergency situations or disasters

through media briefings, press releases, information lines, publicly dispersed

fact sheets/flyers, , Facebook, Twitter and the Health Department webpage.

The goals of public information and warning activities, in response to

emergency situations, are to provide accurate, timely, and consistent

information to the public in order to prevent panic and to protect the health

of the residents of Meigs County.

1. Special Populations

The Health Department will make the best effort possible to identify

special/functional populations that are at-risk for certain disaster situations

and target those populations for information releases. Due to the unique

public health implications of schools (K-12) and nursing homes, especially

regarding communicable diseases, they may be specifically targeted for

public information releases or Health Department-organized educational

functions for protective/preventative public health measures.

II. MEDIA/PUBLIC AFFAIRS

The Health Department will work with the media during a public health related

emergency to establish press conference areas, media briefing times, and

controlled on-scene access to the media, if possible. The Health Department PIO

or designee(s) will monitor media outlets (Facebook. Twitter) for rumors or

misinformation as well as determine the effectiveness of media communication

efforts to address in future media briefings or press releases.

A. Designated Spokesperson

1. Primary: Meigs County Health Department Administrator

Secondary: Meigs County Health Department Health

Commissioner

Tertiary: Emergency Response Coordinator

See: “II:EPI&W: Training Roster”

2. The Emergency Response Coordinator, functioning as the Public Information Officer, will coordinate the spokes persons.



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3. All press conferences will be pre-approved by the Health Commissioner/Administrator.

B. Assessment

The intensity and longevity of an emergency, disaster, or crises will affect the

requirements for public information and media relations resources, staff, and

hours of operation. When a situation arises that has the potential to be a

crises, the PIO should begin gathering facts and information about the

situation and alert the Administrator or Director of Nursing to the situation. An

assessment of developing crises should be performed to determine the

severity and prepare communications appropriately. (See II: EPI&W:

Assessment Checklists).

C. Pre-Scripted Public Advisories

A list of pre-scripted public advisories and media releases regarding public

safety and health, to be used in the emergency/disaster are provided for in

the Public Information and Warning Implementing Instructions. The Health

Commissioners approve these public advisories and media releases.

However final authorization from the Health Commissioners or his/her

designated person is required prior to release.

D. Crisis Communication Team

Depending on the nature of the crisis and the number of available staff,

varying roles may be assigned to staff and staff may be assigned more than

one role. The communication team is typically composed of the public

health Triad (Health Commissioner and/or Administrator, Director of

Environmental, Director of Nursing) and the Public Health Emergency

Preparedness Coordinator. The Public Information Officer (PIO) should

already be determined for each agency. The spokesperson for public health

emergencies will be the Health Commissioner or Administrator or the

spokesperson may be selected by other members of the crises

communication team based on the situation and the selected individual’s

level of expertise regarding that situation. A list of team roles and

responsibilities can be found in. (See II: EPI&W: Crisis Communication Team

Roles).

E. Joint Information System

The Joint Information Center (JIC) may be comprised of Public Information

Officers (PIOs) and Spokespersons from all the involved agencies, will

determine:

The Development of appropriate public announcements to address the

emergency with a unified voice.

Media Strategy.

Designation of a JIC spokesperson.



4.iii

Issuance of media releases.

If, when, and where news conferences will be held.

Scheduling of regular media briefings (if needed).

Dissemination of public information via hotline, newspaper, TV, radio,

Internet, and pamphlets via the Unified Command at the EOC.

Establishment of information forums for shelters, schools, churches, etc.

to provide the public with information, education, and guidance as

soon as possible.

1. Local

In the event of a large-scale, multi-jurisdictional emergency, the JIC may

be initiated under the direction of the Emergency Management Agency

Director to coordinate information release among different responsible

agencies. The JIC in Meigs County will open as part of the EOC, if

activated.

Possible JIC locations within the county include the EOC (41859 pomeroy

pike Pomeroy Ohio 45769), the County Courthouse (100 W. 2nd St.

Pomeroy, Ohio 45769), or the Meigs County Health Department (112 E.

Memorial Drive Suite A Pomeroy Ohio 45769). The Meigs County Health

Department will provide a PIO to the EOC or JIC if requested by the EMA.

2. Regional

The Regional Coordination Center (RCC) will aid in the release of public

information during regional emergency so that the counties within the

region have unified messages to report to their local media and

populations. Regional Public Health or the RCC may decide to activate

a Regional JIC with PIO representation from the counties within the South

Central Ohio Region.

For smaller events or for other situations, in which a Regional JIC has not

been established or is not functional, the Meigs County Health

Department can coordinate directly with Athens and Gallia counties as

their media sources are used by Meigs County Residents.

III. DISSEMINATION OF PUBLIC INFORMATION

Meigs County media outlets, such as the Daily Sentinel, MCHD website, MCHD

Facebook and Twitter, are three of the major outlets that reach Meigs County

residents.

MCHD website, Facebook, Twitter, the Daily Sentinel and WYVK K92 FM radio are

some of the primary media outlets the Health Department utilizes for press releases

and PSA’s.

A list of media contacts can be found in Meigs County Health Department Health

Alert Network (HAN) Directory.



4.iv

Special Consideration for Release of Public Information

1. Mass Patient Care

Communications between the health department and the medical

facility (ies) will be established if, and when, it is determined that a

mass patient care facility/area is needed to care for the sick, or

wounded. Communications may be health department to medical

facility, if the Emergency Operations Center (EOC) has not been

opened.

Any mass patient care facility would likely be managed by area

Hospitals. MCHD would assist in providing public information

concerning:

the mass patient care facility;

where to find medical assistance; and

When to go to the hospital, or other medical facility.

See: Appendix 2: Community Containment for additional information.

2. Isolation

The name(s) of an individual(s) placed in isolation will not be released

to the public without permission of the individual, unless there is an

urgent need to identify potential unknown contacts that need to be

treated or receive prophylaxis. The release of this information will be

discussed and determined by the Health Commissioner and the

medical facility at which the individual(s) are admitted. See:

Appendix 2: Community Containment for additional information

3. Quarantine

The name(s) of an individual(s) placed in quarantine will not be

released to the public without permission of the individual, unless there

is an urgent need to identify potential unknown contacts that need to

be treated or receive prophylaxis. The release of this information will

be discussed and determined by the Health Commissioner , Health

Director, Director of Nursing and the Health Board.

The information that may be released would include:

Location/Area of quarantine;

Reason for the quarantine, i.e., the disease; and

Details, such as: the risk to the public, signs and symptoms of the

disease, etc. may be released.

See: Appendix 2: Community Containment for additional

information.

IV. DISSEMINATION OF INFORMATION TO RESPONSE PARTNERS



4.v

The Communication process and coordination between MCHD and our response

partners are detailed in Annex 2: Interoperative Communications.

V. TRAINING AND EXERCISE

Training and exercising of this annex is discussed in the South Central Ohio Multi-

year Training and Exercise Plan.

VI. PLAN DEVELOPMENT AND REVIEW

This annex is reviewed and updated annually.

VII. IMPLEMENTING INSTRUCTIONS

VIII. EMERGENCY COMMUNICATIONS RESOURCES

Message Content Website

CDC: Office of Communication: www.cdc.gov/communication/default.htm

CDC: BT site www.bt.cdc.gov

DHHS: Home www.hhs.gov

DHHS: BT Factsheet www.hhs.gov/news/press/2002pres/20020606

a.html

DHHS: Office of Emergency

Preparedness

ndms.dhhs.gov

DHS: Home www.dhs.gov/dhspublic/

DHS: Emergency Preparedness www.dhs.gov/dhspublic/theme_homeliso

DHS: Public Interest www.ready.gov

D Justice: Office of Domestic

Preparedness

www.op.usdoj.gov/odp

Title Location

II: EPI&W:

Crises Communication Team Roles ERC Office, MeigsPrime Server

Assessment Checklist ERC Office, MeigsPrime Server

PIO Training Roster ERC Office, MeigsPrime Server

Pre-Scripted Public Advisories ERC Office, MeigsPrime Server

http://www.cdc.gov/communication/default.htm

http://www.bt.cdc.gov/

http://www.hhs.gov/

http://www.hhs.gov/news/press/2002pres/20020606a.html

http://www.hhs.gov/news/press/2002pres/20020606a.html

http://ndms.dhhs.gov/

http://www.dhs.gov/dhspublic/

http://www.dhs.gov/dhspublic/theme_homeliso

http://www.ready.gov/

http://www.op.usdoj.gov/odp



4.vi

Message Content Website

FEMA: CONPLAN www.fema.gov/rrr/conplan

FEMA: Response and Recover www.fema.gov/rrr

FEMA: Federal Response Plan www.fema.gov/rrr/frp

American Red Cross: Home: www.redcross.org

Model State Emergency Health

Powers Act

www.publichealthlaw.net/MSEHPA/MSEFIPA

LegActivity050102.pdf

Training Website

CDC: Public Health Training

Network: www.phppo.cdc.gov/phtn/default.asp

CDC: Emergency Risk

Communication www.cdc.gov/cdcynergy/emergency

FEMA: Emergency Management

Institute (EMI)/U.S. Fire

Administration (USFA)

http://training.fema.gov

FEMA: Rapid Response

Information System: www.rris.fema.gov

FBI: Counterterrorism/Weapons

of Mass Destruction Training www.fbi.gov/hq/td/academy/ctwork12.htm

Professional Support Website

Peter Sandman: www.psandman.com/webpubs.htm

Vincent Covello: www.centerforriskcommunication.com/hom

e.htm

IX. REFERENCES

Title Location

Effective Media Communications during

Public Health Emergencies – World Health

Organization Handbook and Field Guide

ERC Office, MeigsPrime Server

Crises and Emergency Risk Communication –

Centers for Disease Control and Prevention

ERC Office, MeigsPrime Server

http://www.fema.gov/rrr/conplan

http://www.fema.gov/rrr

http://www.fema.gov/rrr/frp

http://www.redcross.org/

http://www.publichealthlaw.net/MSEHPA/MSEFIPA%20LegActivity050102.pdf

http://www.publichealthlaw.net/MSEHPA/MSEFIPA%20LegActivity050102.pdf

http://www.phppo.cdc.gov/phtn/default.asp

http://www.cdc.gov/cdcynergy/emergency

http://training.fema.gov/

http://www.rris.fema.gov/

http://www.rris.fema.gov/

http://www.fbi.gov/hq/td/academy/ctwork12.htm

http://www.psandman.com/webpubs.htm

http://www.centerforriskcommunication.com/home.htm

http://www.centerforriskcommunication.com/home.htm



4.vii

Electronic Library of Public Health Emergency

Information

SUMMARY OF CHANGES

3/18/2014 Footer date change

3/25/2015 Footer date change, added additional information lines and media

outlets.



4.viii

Date Reviewed Changes


Y or N

Y or N

Y or N

Y or N

Y or N

Y or N

Y or N

Y or N

Y or N

Y or N

Y or N

Y or N

ANNEX 4: EPIDEMIOLOGY

EPIDEMIOLOGICAL RESPONSE PLAN



4.ix


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4.x

Table of Contents INTRODUCTION AND PURPOSE .............................................................................................. 12

SCOPE ............................................................................................................................. 12

SITUATION AND ASSUMPTIONS ............................................................................................. 13

Situation 13

Assumptions 13

CONCEPT OF OPERATIONS .................................................................................................. 13

Notification and Communication 13

Response Level 1 (Local): 14

Response Level 2 (Regional): 14



INCIDENT COMMAND SYSTEM COMPONENTS OF EPI-TEAM ..................................... 17

Response Actions 18

ORGANIZATION AND ASSIGNMENT OF RESPONSIBILITIES ........................................................... 18

Lead Agency 18

Supporting Agencies 19

State Responsibilities 20

ADMINISTRATION AND LOGISTICS ......................................................................................... 20

Epidemiology & Surveillance Branch 21

Data and Surveillance Group 22

Investigation Group 23

Communications and Public Information 26



4.xi

TACTICAL COMMUNICATION ............................................................................................... 26

De-Mobilization 28

ACTUAL INCIDENT EVALUATION ........................................................................................... 28

PLAN DEVELOPMENT AND MAINTENANCE .............................................................................. 29

Implementing Instructions: 29

Authorities and Reference: 29

Epi-Team Notebooks: 29

TRAINING, EXERCISE, AND EVALUATION ................................................................................ 29

Personnel Training Objectives 30

Training Strategies 30

MEMORANDUMS OF UNDERSTANDING .................................................................................. 30

IMPLEMENTING INSTRUCTIONS .............................................................................................. 30

AUTHORITIES AND REFERENCES ............................................................................................. 32

SUMMARY OF CHANGES ..................................................................................................... 33


Introduction and Purpose

Every public health jurisdiction in the country has a responsibility to develop

and maintain the capability to conduct public health surveillance and

epidemiologic investigation.

The purpose of public health surveillance and epidemiologic investigation is to

establish routine systems and processes and to expand these systems and

processes in response to incidents of public health significance to mount an

effective response to natural and mad-made threats or disease incidents.

This plan will address the conditions, criteria, and situations that may

necessitate coordination of regional epidemiological resources in the South

Central (SC) region for a local or regional response providing uniformity and

guidance for:

Case investigation;

Outbreak Investigation;

Evaluation of the infectious disease surveillance system; and the

Review of disease reports.

Scope

The scope of this standard operating guide includes the South Central Ohio

Public Health Region, its Public Health Emergency Preparedness Program

(PHEP) Epidemiologists, and public health epidemiological surveillance and

response. Though there is no established regional authority and primary

responsibilities of the PHEP Epidemiologists lie with the needs of their own

jurisdiction(s). In any health event requiring an investigation, the PHEP

Epidemiologist will follow the guidelines of their Local Health jurisdiction and/or

ODH.

This annex encompasses Epidemiological Response. Epidemiologic

responsibilities include but are not limited to surveillance, case/outbreak

investigation, data analysis, and prevention and control recommendations.


Situation and Assumptions

Situation

An infectious disease emergency requiring public health action

Assumptions

7. Each LHD should maintain a current list of the human and other

resources needed for interviewing, scribes, data entry, data analysis,

specimen collection, handling and shipping. This list will be referred

to as the local epi-response team.

8. Coordinating regional assistance may not be needed for every

aspect of investigation/control; e.g., prophylaxis and control may

require regional assistance with some diseases while the actual

investigation/interview may be done by LHD. In other cases,

interviewing and specimen collection may require regional

assistance but not prophylaxis and control.

9. The SC LHDs should strive toward a unified epidemiologic response.

The SC epidemiologists will work together on common education,

training, and exercises to ensure a common foundation for

epidemiological investigation.

10. These epidemiologic response guidelines are directed towards

acute communicable disease issues. These guidelines may not be

applicable to non-infectious disease investigations.

11. Response levels will not necessarily correlate to number of illnesses

reported but will be dependent on the disease and the reaction (i.e.

media, public) to the response.

12. Communication between members of the epi-response team will

occur using the most appropriate means available based on the

situation. In most scenarios, telephone and e-mail will suffice with

use of MARCS reserved for communication with members of the

team conducting field work.

13. Compliance with National Incident Management System (NIMS) will

occur throughout the epidemiologic response efforts. Specifically,

the epi-response team will function as a branch under the

Operations Section within the managing jurisdiction’s ICS structure.

14. ODH and CDC may be involved at any response level.

Concept of Operations

Notification and Communication

Notification of the region and implementation of a coordinated regional

epidemiological response will depend on the severity of the incident and

whether it affects more than one jurisdiction and/or county within the SC Ohio


Region. To guide investigation efforts the following four response levels have

been created. Refer to Figure 1 for the ICS structure of the Epi-Team.

Response Level 1 (Local):

If one local health department is affected and the response can be

handled by the local epi-response team; no regional response is

necessary. Follow the guidelines below.

Notification of the PHEP Epidemiologist is required for a report

of a Class A Infectious Disease or one or more cases that

warrant an outbreak investigation even when the response

does not exceed the LHD capabilities.

The Ohio Department of Health will be notified by the LHD or its

designee (such as the PHEP Epidemiologist) in accordance

with the reporting timeframes designated in the Ohio

Administrative Code Chapter 3701-3.

General notification of the incident may be made to the

region as deemed necessary. The decision to notify the region

will be made by the affected jurisdiction’s Health

Commissioner and/or epidemiologist.

ICS will be activated with at least an Incident Commander

and Operations Section.

The potential members of the local Epi-Team are in the Local

Epi-Team Member Contact List.

Response Level 2 (Regional):

If one or more local health departments are affected and the response

needs exceed the capacity of the local epi-response team, additional

assistance is necessary and should follow the guidelines below.








Administrative Code Chapter 3701-3.The affected health

jurisdiction’s epidemiologist will notify the other epidemiologists

in the SC or other regions.


Response will be managed by the local epi-response team

with assistance from the other PHEP (SC or other region’s)

epidemiologists.

Updates out to the region will be made as determined by the

Health Commissioner and the epidemiologists managing the

investigation.

If more than one jurisdiction is involved or additional assistance

is necessary move to Level 3, and activate the RCC.

The ICS structure will expand as needed.


If one or more local health departments are affected and the response

needs exceed the capacity of the local epi-response team and the

PHEP epidemiologists (SC or other region’s), additional assistance is

necessary and should follow the guidelines below.

Notification of the PHEP Epidemiologist is required for a report of a

Class A Infectious Disease or one or more cases that warrant an

outbreak investigation even when the response does not exceed

the LHD capabilities.


designee (such as the PHEP Epidemiologist) in accordance with

the reporting timeframes designated in the Ohio Administrative

Code Chapter 3701-3.

As specified in the SC regional MOU, additional staff to

supplement the response will be requested from the SC region.

Response updates will be made according to the SC regional

communication plan.



If one or more regions in the state or multiple states are affected and the

response needs exceed the capacity of Level 3 response, additional

assistance is necessary and should follow the guidelines below.









Administrative Code Chapter 3701-3.ODH will be consulted for

assistance in recruiting additional staff across the state to aid in

the response.



INCIDENT COMMAND SYSTEM COMPONENTS OF EPI-

TEAM

Figure 1. ICS components of the epidemiologic response plan in South Central Ohio (Epi-Team).

LHD Operations Section

Epidemiology & Surveillance

Branch

Data and Surveillance

Group

Investigation Group

Surveillance

Strike Team

Data Analysis

Strike Team

Case Investigation

Strike Team

Contact Investigation

Strike Team

Laboratory Liaison

Strike Team

Epi-Team


Response Actions

ERP Activation

See the “Concepts of Operations, Emergency Response Plan

Activation Authority” section of the YCHD ERP to determine if

activation of the YCHD ERP is necessary.

Typical Sequence of Activities

The Local Health Department (LHD) ERP has been activated, if

necessary.

This Annex will be activated.

Local and regional resources will be utilized. If it is determined

that the local and regional resources will be insufficient to

provide the projected need of response, State and Federal

assets may be considered.

Command & Control

This Epidemiology and Surveillance Branch, whether applied to

a local or regional response, operates under a local

department ICS structure.

Organization and Assignment of Responsibilities

Lead Agency

The LHD is the Lead Agency for epidemiologic response requiring outbreak

investigation. The purpose of the Epidemiology & Surveillance Branch is to

gather information in order to guide the response and to select strategies to

mitigate morbidity and mortality. In the event more than one LHD is actively

involved in the response, unified command may be established.


Supporting Agencies


Ohio Department of Health

___________________________

Report to Centers for Disease Control and

Prevention and other applicable entities as

needed

Coordinate communication, response, and

resources within the Ohio Department of

Health and other state and federal entities, as

necessary

Statewide surveillance and support to include

assistance with statewide and other

jurisdiction, as necessary

Hospitals and Health Care

Providers

___________________________

Protect/treatment to responders and public

Reporting of infectious disease to include

gathering necessary information

Emergency Medical Services

____________________________

Protect/treatment, medical transport to

responders and public

Emergency Management

Agency (EMA)

____________________________

Coordinate County EOC Operations, to include

Coordination of resources

Notification of and collaboration with other

County EMAs

Law Enforcement/Sheriff

___________________________

Upon request & availability, if warranted:

Security;

Traffic control; &

Area control.

Law Enforcement/State Patrol

____________________________

Upon request & availability, if warranted:

Criminal investigation, if necessary;

Provide security

Public Works

___________________________

Access, if needed


Advocacy Support Agencies

___________________________

Assist with location of, interview of, education of,

and assessing the needs of individuals with

functional and/or special needs:

Elderly;

Developmental disabilities;

Physical disabilities;

Transportation issues;

Language barriers.

School System/Superintendent

__________________________

Public education and information;

Transportation resources (upon request);

Surveillance and reporting

Elected Officials

__________________________

Responsible for the emergency operations in

their jurisdictions;

Cooperation with the EMA director and

support of EOC operations;

Access City/Township assets to support

operations per EOC requests; and

Participate and support Joint Public

Information Center operations.

State Responsibilities

The Governor of Ohio has the ability to request federal assistance and to waive

or suspend state laws and regulations in the event of an emergency.

Administration and Logistics

The activation and management of an epidemiological response requires

numerous protocols and resources. The protocols and resources have been

pre-identified locally and can be found in the Epi-Team Notebook, including

Job Action sheets detailing the functions of the Epidemiology & Surveillance

Branch and response groups and strike teams to be activated as needed are

outlined below.


Epidemiology & Surveillance Branch

Purpose

The purpose of the Epidemiology & Surveillance Branch is to gather

information in order to guide the response and to select strategies to

mitigate morbidity and mortality.

Objectives

Determine appropriate epidemiology and surveillance

response strategies

Conduct surveillance

Conduct epidemiologic investigations

Identify potential sources of disease and disease transmission

routes

Monitor incidence and prevalence trends to identify new or

unrecognized exposures or risk factors

Describe epidemiologic and clinical features

Report cases to the proper agencies

Methods

Primary strategies for the Epidemiology & Surveillance Branch include:

Surveillance/Data Analysis - Surveillance is the continuous analysis,

interpretation, and dissemination of systematically collected data,

generally using methods distinguished by their practicality, uniformity,

and rapidity rather than by accuracy or completeness. By observing

trends in time, place, and person, changes can be observed or

anticipated, and appropriate action, including investigative or control

measures, can be taken.

Epidemiologic Investigation – Epidemiologic investigation uses epidemiologic

tools, including case investigation, contact investigation, and laboratory

testing, to establish person, place, and time characteristics associated with an

event. Epidemiologic investigations can include cohort and/or case-control

studies. Guidelines for conducting an outbreak investigation are included in

Implementing Instruction-Epi-Outbreak Investigation Protocol.


Implementation

The Epidemiology & Surveillance Branch should be activated for all

responses in which ICS is implemented when a public health event

warrants an epidemiological response beyond routine case

investigation or regular duties.

Data and Surveillance Group

Purpose

To rapidly identify cases and clusters of disease, receive, manage, and

analyze information that will guide the selection of strategies for the

response.

Objectives

Develop, update, and disseminate the case definition

Develop case-finding strategies

Verify the accuracy and completeness of surveillance data

Identify cases for follow-up by the Investigation Group

Determine appropriate data analysis strategies for the response

to:

o Identify sources of disease and disease transmission routes

o Monitor incidence and prevalence of disease trends to

identify new or unrecognized exposures or risk factors

o Describe epidemiologic and clinical features

o Ensure cases are reported to the proper agencies

Methods

Passive Surveillance – Passive surveillance is the collection of data from

existing unsolicited reports of disease. This date may be received from

physicians, hospitals, and laboratories serving South Central Ohio

residents. This data is used to identify cases to determine the magnitude

of the outbreak.

Enhanced Passive Surveillance – Enhanced passive surveillance employs

a mix of active techniques in addition to the passive surveillance

described above. For example, send a health alert that highlights a

specific disease or syndrome to clinical providers in order to stimulate

clinician and/or laboratory reporting.

Active Surveillance - Active surveillance involves actively finding cases

of disease. Examples include calling medical facilities (e.g. laboratories


or emergency departments) or sending field surveillance teams to

hospitals to extract information from hospital records.

Syndromic Surveillance – Syndromic surveillance is the collection and

analysis of non-specific data from multiple data sources to detect a

possible change or trend in the health of a population. Syndromic

surveillance data sources may include data from hospital emergency

departments (i.e. Epi-Center) or other emergency encounters, physician

office visits, over-the-counter pharmaceutical sales (i.e. NRDM), and

school absenteeism records.

Data Analysis – Data analysis is the systemic study of data so that its

meaning, structure, relationships, origins, etc. are understood. Data

analysis uses statistical methods and logical techniques to describe,

summarize, and compare data.

Implementation

The Data and Surveillance Group should be activated when any

component of the Epidemiology & Surveillance Branch has data

analysis or surveillance needs, with strike teams established based on

the specific needs of the investigation. The Data and Surveillance

Group will be activated in tandem with the Investigation Group.

Investigation Group

Purpose

The purpose of the Investigation Group is to carry out case and contact

investigations to collect information on factors that may be associated

with the outbreak.

Objectives

Select appropriate investigation strategies for the response

Conduct case investigations and contact investigations

Collect information about cases, controls, disease characteristics,

clinical characteristics, and possible disease exposures in a

methodologically appropriate and efficient manner

Obtain and prioritize specimens for laboratory testing

Determine if a formal epidemiologic study is needed, and if so,

design and implement study with assistance from the Data and

Surveillance Group


Methods

Case Investigation – Case investigation is used to identify cases of an

infectious disease, evaluate cases for possible exposure factors, assess

case characteristics, provide ODH-approved treatment

recommendations to cases and/or their medical provider, identify

possible contacts to the case, collect and/or manage laboratory

specimens, and/or offer recommendations to help interrupt the

transmission of disease. Case investigation can be important

throughout an event but is particularly important during the initial stages

of an infectious disease emergency response. Investigations may be

conducted over the telephone or in person, depending on the nature

of the outbreak and available resources. Guidelines for case

investigations are included in the Implementing Instruction-Epi – Case

Investigation Protocol.

Epidemiologic Study – An epidemiologic study may be needed in an

outbreak suspected to have originated from one source (“point

source”) in order to identify the specific food item, activity, location,

animal(s), or other exposure that was the source of infection. This

enables targeted public health interventions to remove the source of

disease. In an epidemiologic study, exposures among those who are

sick are compared to exposures among those who are well; thus, many

interviewers may be needed to survey both ill and well persons. A

cohort study and case-control study are examples of epidemiologic

studies. A cohort study may be used if the exposed population is readily

defined. A case-control study may be used when the exposed

population is not easily defined, when multiple exposures need to be

examined, and/or when the disease occurrence is rare. Guidelines for

conducting an outbreak investigation are included in the Implementing

Instruction - Epi – Outbreak Investigation Protocol.

Contact Investigation – Contact investigation is used to identify

contacts to an infectious disease case, evaluate possible contacts for

infection/disease, recommend strategies to treat and/or prevent

infection/disease in the individual contact and/or interrupt the

transmission of disease.

Individual contact investigation may be more effective in controlling the

spread of disease when there are low numbers of cases, when

chemoprophylaxis or vaccination are available and can be promptly

administered to the contact, and/or when no chemoprophylaxis is

available, if quarantine can be promptly implemented.


Individual contact investigation may not be feasible or an effective use

of scarce personnel resources when the prevalence/incidence of

infection is high (e.g. pandemic influenza), when many transmission

routes exist, when the contact tracing process is slower than the

infection process (the incubation period is short, or the basic

reproductive ratio is high or a combination of both), and/or when a

disease has airborne transmission (e.g. smallpox).

Symptom Monitoring – Symptom monitoring involves monitoring either

cases or contacts of a case for new signs and symptoms of disease.

There are two types of monitoring: active and passive. During active

monitoring, a healthcare or public health worker evaluates a case or

contact on a regular basis by phone and/or in person for signs and

symptoms suggestive of disease. During passive monitoring, a case or

contact is asked to perform regular self-assessment and to contact the

health department immediately if specific signs or symptoms develop.

(Patient care recommendations and public health follow-up will be

guided by the ODH Infectious Disease Control Manual). Choosing

active versus passive monitoring will depend on available resources and

the disease.

Survey Development – Questionnaires or survey forms will be needed for

case investigations, contact investigations, epidemiologic studies, and

symptom monitoring. Questionnaires and surveys can be administered

via the telephone, in-person, or through a computer, depending on the

population being targeted (cognitive skills, education level, access to a

telephone or computer, etc.) and available resources.

Implementation

The Investigation Group will be activated when:

Case investigation is required, or

Contact investigation is required, or

An epidemiologic study is needed, or

Symptom monitoring is needed

Specific strike teams will be activated based on what is needed, as

deemed necessary by the Epidemiology & Surveillance Branch Director.

Depending on the situation, other support and functions may be

necessary and provided from other ICS resources. These functions

include:


Communications and Public Information

Tactical Communication o The primary means of communication will be existing phone lines,

internet access and cell phones. MARCs radios or other two way

radio systems may also be used. Alternate types of

communication equipment may need to be used and these

could include HAM radios, and runners;

o Through internet connectivity forms, surveys, and access to enter

data directly into the Ohio Disease Reporting System (ODRS), the

National Outbreak Reporting System (NORS) or other applicable

systems will be maintained. If internet connectivity is not

available or is lost, use paper forms and enter the information

upon restoration of connectivity.

IT and Communications Systems

o IT systems may be utilized to:

Report and manage cases utilizing the Ohio Disease

Reporting System (ODRS);

Prepare Ohio Public Health Communication System

(OPHCS) alerts, public health warnings and advisories, and

other forms of communication:

Communication systems, including telephone lines, fax

machines, copy machines, and computers (tabletop

and/or laptops, printers and internet access) may be used

to maintain communications with appropriate partners,

ODH, and other government/non-government agencies.

The back-up plan if communications equipment, including

radio communications, needs maintenance or becomes

unavailable includes:

o Contacting the EOC and EMA to send IT support;

Contacting any available on site IT personnel; and/or

Contacting the health department’s contractual IT

support company.

o The region’s communications equipment is interoperable.

Radio channels/frequencies will be pre-designated, and

security measures will be taken to ensure efficient

communications among all site personnel.

Detailed information is maintained within Annex 2:

Interoperative Communication of the SCO Regional Public

Health & Hospital Emergency Response Plan.

o See Annex 2: Interoperative Communications of the SCO

Regional Public Health & Hospital Emergency Response Plan


and the Multi-Year Training and Exercise Plan for testing and

exercising of communications systems.

Public Information

o A Public information officer (PIO) will be assigned if the event

warrants and public information will be funneled through this

person to:

Ensure that information released will be closely

coordinated with the local, regional, and state PIO;

Ensure that all staff members provide consistent

information

Public information templates have been developed, as

well as a list of potential resources for agent specific

information and are located in Implementing Instruction:

EPI&W: Communications (PIO) Guidance Document


De-Mobilization

The Incident Commander will work with the local government to determine

when the functions of the Epidemiological Response are complete or near

completion. When this determination has been made, the Incident

Commander will work with the Logistics Section Chief and the Operations

Section Chief to arrange the de-mobilization activities, such as:

Staff reassignment

Equipment/Supplies cleaning, replacement, storage, and return

Documentation of Incident activities

Debriefing of staff and support staff

Actual Incident Evaluation

In addition to the outbreak report, depending on the size and cost of the

response, additional post-event activities may be necessary to ensure that the

event is documented for the public record, to determine the costs of the

event, and to enhance efficiency of operations for future efforts. In this regard,

the evaluation of the epidemiological response should include the following

information:

Expenditures and in-kind costs incurred in the operation

Identified successes and opportunities for improvement

Recommended changes in emergency response plan

Implications for the public health infrastructure

If an After Action Report needs to be to collect of key information that will

improve any future epidemiological response, ODH requires the use of the

Homeland Security Exercise and Evaluation Program’s (HSEEP) template. The

template can be found in “Volume IV Library: Sample Exercise Materials of the

HSEEP Policy and Guidance” on the HSEEP website:

https://hseep.dhs.gov/pages/1001_HSEEP7.aspx

https://hseep.dhs.gov/hseep_Vols/default1.aspx?url=home.aspx

https://hseep.dhs.gov/hseep_Vols/default1.aspx?url=home.aspx

https://hseep.dhs.gov/pages/1001_HSEEP7.aspx


The After Action Report will include, at a minimum:

What occurred, including

o number of cases identified

o start and stop dates/times

o total number of hours of operation

o listing of all personnel involved

o how the process took place

Problems identified throughout the process; and

Suggestions for improvement/improvement plan.

Plan Development and Maintenance

Implementing Instructions:

See the “Plan Development and Maintenance” section of the SCO

Regional Public Health & Hospital Emergency Response Plan Emergency

Response Plan - Base Plan.

Authorities and Reference:

See the “Plan Development and Maintenance” section of the SCO

Regional Public Health & Hospital Emergency Response Plan Emergency

Response Plan - Base Plan.

Epi-Team Notebooks:

Updated annually

Training, Exercise, and Evaluation

The health department will ensure training for Epidemiological Response.

Components of Epidemiological Response will be exercised individually

annually. The Epidemiological Response training, exercise, and evaluation

plan is contained in the Multi-Year Training and Exercise Plan.


Personnel Training Objectives

The team should:

Understand Epidemiological Response, its mission, purpose, and methods

of operation;

Possess the knowledge and skills to perform tasks effectively;

Be cross-trained to work in other functional areas assigned; and

Understand the performance standards and measures for successfully

activating and operating all the functions in the plan.

Training Strategies

Outbreak and investigation training, ODRS training, and training on

other relevant epidemiological response functions is provided to

members of the Local Epi-Team and other key Local Health

Department staff.

A “Just in Time” training approach with the aid of ODH information,

CDC resources and locally developed materials will be utilized to

provide relevant disease information, plan review, and preparation

for other specialized tasks such as conduction interviews.

Cross-training individuals for various epidemiological response roles is

ideal. This will allow individuals to rest without affecting the flow of

the response, as well as allow for flexibility of staffing.

Memorandums of Understanding

Written agreements between the health departments are in place.

After an event, written agreements are critical for federal disaster

reimbursement under the Stafford Act which was enacted to support State

and local governments and their citizens when disasters are overwhelming. The

Federal Emergency Management Agency (FEMA) is tasked with coordinating

the response.

EPI-TEAM NOTEBOOK CONTENTS



JOB ACTION SHEETS

Epidemiology & Surveillance Branch Director

Data and Surveillance Group Supervisor

Surveillance Strike Team Leader

Data Analysis Strike Team Leader

Investigation Group Supervisor

Case Investigation Strike Team Leader

Contact Investigation Strike Team Leader

Laboratory Liaison Team Leader

CASE INVESTIGATION PROTOCOL

ODH HIPAA BULLETIN

OUTBREAK INVESTIGATION PROTOCOL

LOCAL EPI-TEAM MEMBER CONTACT LISTS

REGIONAL EPIDEMIOLOGISTS CONTACT LIST

REQUIRED DOCUMENTATION PROTOCOL IMPLEMENTING

INSTRUCTION

EPIDEMIOLOGY RESPONSE NOTIFICATIONS AND

COMMUNICATIONS

PROCESS FOR POSTING HEALTH ALERTS

Title Location

I: Epidemiological Response

Job action sheets

Case investigation protocol

Epi-Team Notebook

Case investigation protocol Epi-Team Notebook

Outbreak investigation protocol Epi-Team Notebook

Evaluation of the Infectious Disease Surveillance

System Protocol Epi-Team Notebook

Review of Disease Reporting Protocol Epi-Team Notebook

Required documentation protocol implementing

instruction Epi-Team Notebook

Epidemiology Response Notifications and

Communications Epi-Team Notebook

Process for Posting Health Alerts Epi-Team Notebook

II: Emergency Public Information & Warning:

Communications (PIO) Guidance Document


Authorities and References

Reference Location

Ohio Department of Health Infectious Disease Control

Manual

http://www.odh.ohio.gov/healthResources/infectiousD

iseaseManual.aspx

Ohio Administrative Code Chapter3701-3

http://www.odh.ohio.gov/rules/final/f3701-3.aspx


Summary of Changes


Date Reviewed Changes




Y or N

Y or N

Y or N

Y or N

Y or N

Y or N

Y or N

Y or N

Y or N

Y or N

ANNEX 5:

Environmental Health


* Summary of Changes can be found at the end of this document



Framework of this Annex

Introduction ................................................................................................................... 1

General Environmental Health Emergency Response Actions ................................ 1

Immediate Environmental Health Emergency Response Actions ........................... 2

Specific Environmental Health Emergency Response Actions................................. 5

WATER SAFETY AND SUPPLY ............................................................................................ 7

FOOD SAFETY .............................................................................................................. 11

SEWAGE / SEPTIC......................................................................................................... 15

VECTOR CONTROL ....................................................................................................... 18

SOLID WASTE/DEBRIS MANAGEMENT ............................................................................ 22

All-Hazards Environmental Health Emergency Response Actions ................. 27

BIOLOGICAL INCIDENTS: NATURAL OR DELIBERATE .......................................................... 29

Notification of Deliberate Biological Incident ..................................................... 33

CHEMICAL INCIDENTS: ACCIDENTAL OR DELIBERATE ....................................................... 40

RADIOLOGICAL INCIDENT ............................................................................................. 46

WEATHER-RELATED AND OTHER COMMON INCIDENTS .................................................... 50

Worker Safety and Personal Protective Equipment ................................................. 56

ANNEX 5: ENVIRONMENTAL HEALTH




2015 Environmental Health Annex 5

5.1

INTRODUCTION

The purpose of this document is to describe general and specific response

actions that county or city environmental health professionals (i.e., specialists,

sanitarians and or environmentalists) could be responsible for in the event of a

natural disaster, an industrial or transportation related incident, or a deliberate act

of terrorism. In other words, this document attempts to describe potential roles for

local environmental health staff to a public health emergency.

During a natural disaster or other emergency, such as a terrorist attack, the

primary role of the public environmental health system is to provide services

essential for protecting and ensuring the well being of the people in affected

areas, with an emphasis on prevention and control of communicable diseases and

exposures to hazardous materials.

A threat/risk assessment has been created to include the public health-specific

risks for All Hazards identified within the South Central Ohio Public Health

Region/County Jurisdiction. The Risk assessment includes the potential magnitude

and frequency of risks, speed of onset of the risks, and areas of the community or

special populations likely to be impacted by those risks. The assessment also

addresses health department capabilities, Resources, and Operations available to

respond to All Hazards.”

GENERAL ENVIRONMENTAL HEALTH EMERGENCY RESPONSE ACTIONS

The role of environmental health in a public health emergency, such as a

natural or man-made disaster, will vary according to the type (e.g., terrorist-

related, flood, tornado, fire, or prolonged power outage) and severity of the

situation. Environmental health has the primary responsibility for the “health” of

a community following a disaster. This includes basic services such as food

safety, water supply, shelter, sanitation, and waste management that need to

be reestablished.

Depending on the situation, a county might implement their incident command

system (ICS) to respond to both deliberate and natural disasters. Annex 1:

Direction and Control of the Meigs County Health Department Emergency

Response Plan should provide guidance for the use of ICS.

Environmental health activities will likely be in conjunction with, or as a result of a

larger incident. A naturally occurring biological incident would be the exception.

County health departments will be involved in environmental health related

activities in support of the Lead agent for the larger incident, along with many

other local, state, and federal agencies

Public Health Roles



5.2

The traditional role or function of public environmental health staff is regulatory in

nature. The primary day-to-day role is to ensure that licensed facilities, such as:

food and beverage establishments, mobile home parks, recreational camping

areas, school kitchens, and public swimming pools, maintain acceptable

sanitation standards or are closed until those standards identified by State and

County ordinances are met.

A second role is to prevent or minimize the occurrence or spread of disease by

assisting the local county’s EMA, Red Cross, Salvation Army or any other disaster

relief organization, and providing relevant and timely information. This information

could include the following topics: general sanitation, food safety, inspection of

temporary housing, mass feeding centers, drinking water distribution, and waste

disposal. Inspection of temporary shelters (example: Red Cross operated shelters)

prior to opening is also a function the health department performs

A third role is to promote public awareness and provide direction to the public

regarding specific steps or actions that need to be taken to survive, or

minimize their losses due to a catastrophic incident, whether it be natural (e.g.,

a flood or tornado) or man-made (e.g., an industrial accident or act of

terrorism).

An additional role of public environmental health is to provide technical

assistance to the public or community response partners necessary to address

any hazards or threats that are posed by the environment (indoor, outdoor,

natural or man-made).

IMMEDIATE ENVIRONMENTAL HEALTH EMERGENCY RESPONSE ACTIONS

Following a disaster, rapid and effective action is needed to save lives, protect

health and stabilize the situation, to avoid making the emergency worse. Each

county’s environmental health staff should conduct a rapid initial qualitative

assessment to collect information needed to begin an appropriate and timely

response. The purpose of the assessment is to:

Advise HD and other First Responders with a SitRep about

worker/responder safety in the affected area.

Decide whether local capacity (i.e., county resources) is adequate

or external assistance/resources are required;

Identify/recognize potential threats and hazards;

Assess health risks;

Determine priorities and recommend actions;

Develop objectives, determine priorities and intervention strategies;



5.3

Perform intervention strategies, if possible, and identify necessary

resources to address the situation.

First-hand information may be gathered in the field, using the following

techniques:

On-site visual observations of the affected area;

Interviews with key individuals, community leaders, groups of disaster-

affected people, or household members;

Expert measurements and testing and sampling activities (e.g., water quality

testing).

Environmental health staff could participate in the assessment with specialists in

related professions (e.g., engineering, emergency management, community

health promotion) from other departments such as public works, environmental

services, human services or other organizations. All of the findings will be reported

to the County’s Public Health Commissioner as soon as possible.



5.4




5.5

SPECIFIC ENVIRONMENTAL HEALTH EMERGENCY RESPONSE ACTIONS

This section describes specific response actions that local county environmental

health professionals might be responsible for in the event of a natural disaster or

deliberate act of terrorism.

Sections are listed in the order of:

Components of an incident:

o Water Safety and Supply;

o Food safety;

o Sewage / Septic;

o Vector Control; and

o Solid Waste/Hazardous Waste/Debris Management

Sections are organized in the following subsections:

Introduction;

Emergency response objectives; and

Priority activities.



5.6




5.7

I. WATER SAFETY AND SUPPLY

Ensuring safe, potable water in an emergency/disaster situation is a critical

function of public environmental health. Safe drinking water may include bottled,

boiled or treated water, depending on what hazards are present. County

residents should only drink bottled, boiled or treated water until their water supply

is tested and deemed “safe” to consume. Residents accessing public water

systems may receive the “safe” by either their municipality or Environmental

Protection Agency (EPA). Residents with a private water system may request

testing and a declaration of “safe” from the health department or the Ohio

Department of Health. Residents must not use contaminated water to wash dishes

and cooking utensils, brush teeth, wash and prepare food, or make ice. Bottled

water from an unknown source must be boiled or treated before it is used.

Water from sources that are considered to have a significant risk of chemical or

radiological contamination should be avoided until local, state or federal

authorities notify residents that it is safe to use.

Emergency Response Objectives

In a major disaster such as a flood or deliberate terrorist attack, the public water

supply system, which includes treatment plants, storage and pumping facilities,

and distribution networks could be damaged, interrupted or contaminated. If

public water supplies were affected, the following objectives need to be

addressed immediately:

Ensure that an adequate supply of safe, potable water will be available to

the general public;

Disease prevention and surveillance:

o Outbreaks of waterborne diseases such as typhoid, cholera,

dysentery, infectious hepatitis, and others;

Provide Public Information to:

o Regarding water safety and supply;

Consider/assess priority of any interventions needed in regulated food

service establishments.

Priority Activities

There are a number of tasks that county environmental health professionals

could do to prevent or in response to an incident that poses a threat to both

drinking and recreational water safety and supply:

1. Contact water system operators and purveyors to determine if water

service and/or quality have been, or may become affected by the disaster;



5.8

2. Check to ensure that contract labs are able to operate and conduct

appropriate analyses. Assist water system operators and purveyors if

requested;

3. Locate and arrange for the distribution of emergency potable water

supplies;

4. Assist municipal staff, if requested, regarding the delivery of emergency

water supplies via tanker trucks or other means;

5. Provide periodic testing of public swimming pools and provide education to

swimming pool managers and staff;

6. Assist Environmental Protection Agency (EPA) with monitoring recreational

waters, posting warnings for waters with elevated bacteria or chemical

levels, and educating surrounding land users of hazardous “cause and

effect” practices (i.e., direct dumping of sewage/waste, fertilizer use, etc)

7. Public Information:

a. Individual water needs;

b. Rationing;

c. Storage; and

d. Disinfection.

8. Update the County’s website to provide information to the public on water

needs, rationing, storage and disinfection; and

9. Provide advice or assistance in the disinfection and decontamination of

distribution systems, storage tanks and water tanker trucks.

References within this Document

Section II: Food Safety


Title Location

II: Environmental:

Water Safety Practical Guidance Enviro Office

Pre-written Public Education

Title Location

Boil Advisory Guidelines Enviro Office



5.9

Safe Drinking Water & Disinfection of Water Wells Enviro Office

References

Title Location



5.10




5.11

II. FOOD SAFETY

Food safety problems vary in nature, severity and extent, and depend on the

situation during an emergency. A breakdown in vital services, such as an

interruption in water supply or electricity, can severely affect food safety. The main

message to communicate is, “If in doubt, throw it out.”

In the absence of electricity, cold storage may be more difficult, if not

impossible, and foods may be subject to microbial bacterial and fungal

growth, and other forms of spoilage.

Food can be damaged by smoke, chemicals used to extinguish a fire, or by

other chemicals or radiation originating from an accidental or intentional

release. Fires or explosions may result in foodstuffs becoming contaminated with

dangerous chemicals or pathogenic microorganisms, as well as being damaged

by water.

Disaster-affected people eating food from centralized kitchens that are not

properly equipped or poorly run are extremely vulnerable to outbreaks of

foodborne illnesses. A combination of environmental contamination and

improper handling of food increases the public’s risk for cholera, shigellosis,

norovirus and campylobacter.

Canned foods and other shelf-stable products should be stored in a cool, dry

place. They should not be stored above a stove, under a sink, in a damp

garage or basement, or any place exposed too high or low temperature

extremes. High acid foods such as tomatoes and other fruit can be stored up to

18-months. Low acid foods such as meat and vegetables can be kept two to

five years.


In a situation that poses a threat to food safety, the following objectives need

to be addressed immediately:

Contact licensed food service facilities to assess the status of each one;

Assure that mass feeding sites also comply with best practices for safe

and hygienic food preparation and service;

Ensure that licensed food service facilities can provide for handwashing,

ware washing, refrigeration (i.e., generators or dry ice), and safe water,

including dispensing machines that use water (i.e., Ice, soda, coffee);

Public Information regarding food safety topics, such as:

o Salvaging, sorting and proper disposal;

o To help manage donations of food;

o Sanitizing and cleaning kitchen items.



5.12

Priority Activities

There are a number of specific tasks that city and county environmental health

professionals could do in response to an incident that poses a threat to food

safety:

1. Provide technical assistance and consultation to owners/managers of food

facilities regarding general food safety issues;

2. Provide information to owners/managers of food establishments on

salvaging and protecting perishable foods;

3. Provide information to owners/managers of food establishments on sorting

and proper disposal of foods, which may have been contaminated or

adulterated (i.e., packaging compromised, badly dented can);

4. Ensure that contaminated foods are properly collected and disposed of at

sanitary landfills;

5. Provide education and/or complimentary inspections at mass feeding

centers, if established, to ensure safe food handling practices and personal

hygiene for workers and attendees;

6. Provide information to the public addressing protection of perishable foods,

and advice on the sorting and disposal of food that may be contaminated;

and

7. Provide information to the public addressing the handling of foods

contaminated with a chemical or biological agent (i.e., E. coli, salmonella).


Section I: Water Safety and Supply

Section III: Sewage / Septic


Title Location

II: Environmental:

Food Safety & Food-Bourne Illness Practical

Guidance Enviro Office




5.13

Title Location

Food Safety During Power Outages Enviro Office

What to Do In An Emergency! (For food service operations & retail food establishments)

Enviro Office

How to Wash Your Hands Enviro Office

Hand Washing Fact Sheet Enviro Office

Foodborne Disease Fact Sheet Enviro Office

Foodborne Disease Questions & Answers Enviro Office

Hepatitis A Fact Sheet Enviro Office

Hepatitis A Questions & Answers Enviro Office

References

Title Location

“Food Safety Guidance in

Emergency Situations”. Food &

Agriculture Organization of the

United Nations. (2005).

Ftp://ftp.fao.org/es/esn/food/emergency.pdf



5.14




5.15

III. SEWAGE / SEPTIC

Sewage systems are a network of pipes that carry wastes away from a population

to sewage treatment facilities. Septic systems are a smaller, private system used to

handle waste usually in a rural setting. A sewer system may lose electrical power,

become flooded, or damaged in a disaster. Additionally, a waste/wastewater

treatment facility may be taken out of service, loss of water pressure/supply can

interrupt waste removal processes, and mass congregations of people may

overwhelm existing amenities. In such cases, waste-containing fecal matter may

be released into the environment.

Effective sanitation is essential to provide a healthy and acceptable environment

for people to live in after a disaster strikes. The first priority in preventing the spread

of fecal contamination is to isolate and contain feces. The links between

sanitation, water supply, and health are directly affected by hygiene behavior. It

is important to bear this in mind when considering technical options, so that

facilities provided in emergencies are acceptable to the users and can be used

and maintained hygienically.

Human feces may contain a range of disease causing organisms including viruses,

bacteria, and eggs or larvae of parasites. On the other hand, urine is relatively

harmless. Microorganisms contained in human feces may enter a human body

through contaminated food, water, eating and cooking utensils, and by contact

with contaminated objects. Oral-fecal transmission of enteric microorganisms may

especially be a major cause of illness in disasters and emergencies. Such

infections can contribute to stress, fluid loss and undernourishment, making people

more susceptible to the impacts of other health hazards.


In the event that inadequate sanitation poses a health threat to the general

public, the following objectives need to be addressed immediately:

Disease Prevention and Surveillance:

o Prevent human exposure to, and the spread of disease-causing

microorganisms;

o Prevent contamination of water supplies; and

o Prevent degradation of surface and groundwater quality.

Priority Activities

There are a number of tasks that county environmental health professionals could

perform in response to an incident that poses threats related to inadequate

sanitation services.



5.16

1) Coordinate provision of emergency waste disposal facilities for affected

neighborhoods and local government facilities, and work with municipal

staff;

2) Secure commercial chemical toilets and hand washing stations, and arrange

for servicing;

3) Provide Public Information:

a) Alternate human waste disposal methods if commercial toilets are not

available;

b) Recommendations regarding personal hygiene; and

c) Water conservation education in support of a shelter, or facility that

may need to be used for a prolonged period of time.

4) Supervise the construction of alternate, human waste disposal units such as a

latrine.



Implementing Instruction

Title Location

II: Environmental:

Pre-written Pubic Education

Title Location

Sanitation Emergency Guidance

References Title Location



5.17



5.18

IV. VECTOR CONTROL

Disasters frequently create conditions that result in population increases in insects

(e.g., mosquitoes and flies) and rodents or increased contact between humans

and vector/nuisance species. In such situations, the chances of disease

transmission increase sharply. For example, floods and heavy rains will create new

mosquito breeding sites in disaster rubble and/or standing water. If sewage

systems are disrupted and riverbanks are disturbed, rodents will leave these areas

and head for other sources of food and harborage. After a disaster, there will be a

considerable amount of solid waste including food waste that can serve as a food

supply for rodents and insects like houseflies.

In addition to disease hazards posed by insects and rodents, they can contribute

to psychological stress by being a major nuisance in a disaster situation.

Vector control measures needed in a disaster situation are dependent on the

following six primary factors:

The type of disaster (e.g., a flood) influences the type and extent of

environmental changes, which can cause increases in vector problems.

The geographical extent of the disaster (disaster: widespread vs local).

Climatic and geographical factors that may intensify or mitigate the effects

of the disaster.

The impact or loss of services such as garbage collection, sewage

treatment and animal control.

The extent of damaged or lost housing resulting in increased exposure to

vectors.

The existing vector species and prevalence of vector-borne diseases in the

geographic area and at that time of year.


In the event that a disaster situation occurs in which vectors pose a threat to the

public’s health and well being, the following objectives need to be addressed

immediately:

Provide Public Information regarding common vector related topics:

o Transmitted diseases;

o Insect repellent use and safety; and

o Pesticide use and safety.

Coordinate emergency corrective measures against vectors that cause

public health problems.

Priority Activities



5.19

There are a number of specific tasks that county environmental health

professionals could do to minimize health hazards and nuisance conditions posed

by vectors (e.g., mosquitoes, flies, ticks and rodents) associated with a disaster

situation.

1. Assess conditions in the disaster area (e.g., standing water, uncollected

and exposed solid waste containing food waste and a damaged or

flooded sewer system) that may promote vector populations.

2. Work with private and public refuse haulers and municipal staffs to reinstate

regular refuse collection or arrange for special pickups.

3. Provide Vector Control by contacting Gallia or Athens Health Departments

for use of their licensed services.

4. Provide Public Information:

a. Addressing how to avoid mosquito and tick bites;

b. Insect repellent safety and use; and

c. Pesticide safety and use.


None


Title Location

II: Environmental

Vector Control Practical Guidance Enviro Office


Title Location

Fight the Bite (mosquito) ODH website



5.20

References

Title Location

“Updated Information regarding Insect

Repellents”. ODH. (2012)

http://www.cdc.gov/ncidod/dvbi

d/westnile/RepellentUpdates.htm



5.21




5.22

V. SOLID WASTE/DEBRIS MANAGEMENT

In the event of a natural disaster or a deliberate act of terrorism, the infrastructure

that routinely deals with the storage, collection and disposal of solid waste (i.e.,

non-hazardous residential, commercial and industrial waste) may be interrupted

anywhere from a few days to several months. Failure of the collection system in a

populated community for two to three weeks could lead to many public health-

related problems.

There are two basic categories of disaster impacts regarding solid waste

management:

The disruption of the solid waste storage, collection, and disposal system

that affects the ability for ongoing generation of solid waste to be

managed properly.

The management of large quantities of debris, including separating

materials requiring different types of management methods, and then

ensuring proper management of each material type.

Description of Waste

Type of Waste Description of Waste

General Solid

Waste

Food, packaging, clothing, appliances, furniture, machinery,

electronic equipment, garbage, plastic, paper, bottles, cans, loose

carpet, paper products, scrap tires, street dirt, dead animals. Items

in this category that have been contaminated with hazardous waste

would be disposed of as a “hazardous waste”.

Agricultural &

Vegetative

Waste

Vegetative or woody waste, tree limbs, brush, shrubs (does not

include buildings, dead animals, or vehicles). Items in this category

that have been contaminated with hazardous waste would be

disposed of as a “hazardous waste”.

Construction &

Demolition

Debris (CDD)

Brick, stone, mortar, asphalt, lumber, wallboard, glass, roofing, metal,

piping, fixtures, electrical wiring, heating equipment, insulation,

carpeting attached to structures, railroad ties, utility poles, mobile

homes. Items in this category that have been contaminated with

hazardous waste would be disposed of as a “hazardous waste”.

Clean Hard Fill

(a subset of

CDD)

CDD which consists only of reinforced or non-reinforced concrete,

asphalt concrete, brick, block, tile, and stone which can be reused

as construction or fill material. Items in this category that have been

contaminated with hazardous waste would be disposed of as a

“hazardous waste”.

Medical/ Needles and medical related glass, syringes, blood containing or



5.23

Type of Waste Description of Waste

Infectious

Waste

saturated items including tubing, clothing, bandages, etc. Items in

this category that have been contaminated with hazardous waste

would be disposed of as a “hazardous waste”.

Hazardous

Waste/

Household

Hazardous

Wastes

Flammable materials (fuels, gasoline, kerosene, propane tanks,

oxygen bottles), explosives, batteries, household chemicals

(cleaners, solvent, mercury, paint), industrial and agricultural

chemicals, cleaners, solvents, fertilizers, etc.

Radiological

Wastes Nuclear medicine materials and associated patient wastes, certain

monitoring equipment.


Disaster situations often result in large volumes of waste or building debris that

can overburden the waste management infrastructure and present the

following potential public health concerns: insect and rodent harborage;

diseases caused by environmental agents (e.g., mold); and chemical

contamination. Building debris could be contaminated with asbestos,

radioactive particles, lead, mercury, and human remains. In this situation, the

following objectives need to be addressed:

Advise responders and workers of Hazards in dealing with disaster

debris/waste.

Coordinate solid waste and debris management functions with the Ohio EPA,

Local Emergency Management Agency, Regional Solid Waste District, solid

waste haulers and waste disposal facilities.

Determine the extent of disruption of solid waste management system

Provide Public Information, guidance and oversight

Ensure proper storage, collection, and disposal of solid waste

Priority Activities

There are a number of specific tasks that county environmental health

professionals could do in response to an incident that disrupts the “normal”

solid waste management system, as well as assist in the community’s return to

“normal” following an incident.

1. Check with appropriate contacts (e.g., State EPA, Regional Solid Waste

District, solid waste haulers, and disposal facilities) to determine extent of solid

waste management system disruption, including both disruptions to facilities

and equipment, and to transportation routes. Determine timeline for

reestablishment of disrupted services.



5.24

2. Check with waste haulers, disposal facilities, and other contractors to assess

their capacity to manage increase volumes of solid waste or debris.

3. Work with contacts to determine if temporary solid waste disposal sites or

“staging areas” need to be established to store and sort debris resulting from

a disaster (see Implementing Instruction: Environmental Health: Waste

Management Practical Guidance).



5.25

4. Public Information:

a. Work with appropriate contacts to publicize the availability of

emergency disposal and or transfer sites.

b. Regarding changes in the solid waste management system resulting

from the disaster and the required waste collection activities from

businesses and homeowners.

c. Discouraging disposal of household hazardous materials in sewers,

drains, or soil.

5. Work with other governmental agencies to:

a. Determine different types of waste within the debris, including the

extent of possible contamination of the solid waste (e.g., by hazardous

materials, hazardous wastes, bio-hazardous waste, or radioactive

waste).

6. Assist the EPA, as needed, to provide increased regulatory oversight as

needed for licensed facilities, and determine if regulatory waivers are

necessary.

7. Assist the EPA, as needed, to provide regulatory oversight and technical

assistance as needed for material segregation and material handling, waste

evaluation/ classification, proper management of specific waste types, and

reporting.

8. Serve as a liaison between disaster site cleanup operations, waste haulers,

and disposal facilities.

References within this document

None


Title Location

II: Environmental:

Waste Management Practical

Guidance

Household Hazardous Waste

Hazardous Waste

Medical Hazardous

Infectious

Debride Staging Areas

Enviro Office



5.26


Title Location

Emergency Sanitation Enviro Office

References

Title Location

Ohio Mercury Outreach & Training Manual Enviro Office

Reference-Environmental-

MercurySpillResponseMatrix

Enviro Office

Reference-Environmental-

MercurySpillSchoolsResidence

Enviro Office



5.27

ALL-HAZARDS ENVIRONMENTAL HEALTH EMERGENCY RESPONSE ACTIONS

This section describes specific response actions that local county environmental

health professionals would be responsible for in the event of an incident specific

disaster, natural or deliberate act of terrorism.

Sections are listed in the order of:

Incident Type:

o Biological Incident;

o Chemical Incident;

o Radiological Incident; and

o Weather-Related incidents.

Sections are organized in the following subsections:

Introduction;

Emergency response objectives; and

Priority activities.



5.28




5.29

VI. BIOLOGICAL INCIDENTS: NATURAL OR DELIBERATE

Natural Biological Incident

Foodborne diseases, intoxications or infections are terms applied to illnesses

acquired by consumption of contaminated food or water. Foodborne disease

outbreaks are recognized by the occurrence of gastrointestinal illness within a

variable time period (minutes to days) after consumption of shared or similar food

or water sources among individuals. Specifically, the occurrence of the potential

for foodborne illness must be considered when two or more individuals have any,

and/or all of the following:

Have symptoms of diarrhea and/or vomiting

Have similar incubation periods

Have a shared food and/or water source

Have symptoms of flushing, burning of mouth and throat, parasthesia of lips,

mouth or face.

Most commonly the exposure was within 72 hours before onset of symptoms. For

some organisms the time may be longer such as Campylobacter and hepatitis A.

Persons with vomiting and/or diarrheal symptoms may spread the causative

agent from person to person. This may occur in the following settings: food

establishments, childcare settings, schools, camps, board and lodging facilities,

private parties, caterers or at water activity facilities. The time period may be

variable because the illness may occur for some time before it reaches a “critical

mass” to be identified or a person is diagnosed with a pathogenic organism.

Actions to prevent further transmission and control strategies may include:

Restrictions for individuals with diarrhea and/or vomiting,

Following proper hand washing and cleaning/disinfecting procedures,

Identification of the causative agent (laboratory confirmed or

epidemiological data),

Avoidance of contaminated food or water,

Destruction of contaminated food, and

Closure of facility pending action.

A protocol outlining the conditions, criteria, and situations that may necessitate

the coordination of regional epidemiological resources in the South Central (SCO)

region for a local or regional response has been established in the SCO Regional

Public Health and Hospital Emergency Response Plan: Annex 4: Epidemiological

Response.

DELIBERATE BIOLOGICAL INCIDENT



5.30

A threatened/deliberate human biologic incident is an event where an intention is

expressed or warning made that an infectious agent will be used (or has been

used) to cause harm to people. For example, this may occur when a person

receives a letter labeled as containing a possible bioterrorism agent (e.g. the

bacteria which causes anthrax or plague) or a telephone caller threatens to use

such an agent as a weapon.

The guidelines presented are applicable for a threatened incident. Potential

terrorists utilizing biologic agents may not always threaten or notify that an event

has taken place. Recognition then, in some instances, will take place by

hospitals/ER/physicians who report increased numbers of ill persons to public

health authorities. Indicators of a covert incident are:

Unusual dead or dying animals – sick or dying animals, people or fish

Unusual casualties – unusual illness for region/area, definite pattern inconsistent

with natural disease

Unusual liquid, spray or vapor – spraying and/or suspicious devices or

packages

With most biological weapon exposures, onset of disease is gradual and non-

specific. Initially, fever, malaise, and fatigue may be present sometimes in

association with a nonproductive cough and mild chest discomfort.

A. Biological Agent Properties

Unique Biological Agent Characteristics

o Are odorless, colorless, tasteless, and most will not penetrate skin (with the

exception of T-2 mycotoxins).

o Have an incubation time before symptoms develop.

o Will not vaporize to become an inhalational hazard unlike chemical agents.

o Require very small amounts (less than a teaspoon) to be effective.

Category A (examples: anthrax, plague, tularemia, smallpox, botulism)

o Highest priority agents

o Result in high mortality rates and have the potential for major public

health impact

o Might cause public panic and social disruption

o Require special action for public health preparedness

Category B (ex: glanders, brucellosis, food & water safety threats, ricin)

o Second highest priority agents

o Are moderately easy to disseminate

o Result in moderate morbidity and mortality rates



5.31

o Require specific enhancements of CDC’s diagnostic capacity and

enhanced disease surveillance

Category C (ex: niphan virus, hantavirus)

o Third highest priority agents that include emerging pathogens that could

be engineered for mass dissemination in the future because of:

Availability

Ease of production and dissemination

Potential for high morbidity and mortality rates and major health

impact

B. Agent Forms

Biological Agents can be in liquid or dry (powdered) forms. Dry agents are

typically more concentrated, more easily disseminated, and are more stable

(require less temperature control for storage) but are also more difficult and

dangerous to produce. Both liquid and dry agents can be weaponized, though

dry agents are more likely to be weaponized due to their superior properties as a

weapon. Weaponized powders would have particles that are mostly 1-5 microns

in size, free flowing, and electrostatically neutral (will not “cling” to other objects).

Weaponized powders would appear as very fine powders that could become

airborne by even the slightest of disturbances (including the breeze produced by

a person as they walk by the powder).

C. Dissemination

Since most biological agents cannot penetrate intact skin, the most common

routes of exposure are inhalation, ingestion, or (less so) injection. For inhalation,

most biological weapons (except for certain dry weaponized agents) must be

aerosolized through the use of a dissemination device. For effective dissemination

via aerosolization, sophisticated dissemination devices and certain

meteorological conditions are required. Aerosolizing devices must be able to

create weapon particles that are small enough to be able to reach the deep

parts of the lungs (alveoli) but large enough to stick without being exhaled. The

ideal biological weapon particle size is 1-5 microns. Weapon particles larger than

15 to 18 microns will quickly fall out of the air following aerosolization.

If a device is released outdoors, meteorological conditions must ideally be at

night with low to no wind and a temperature inversion. Sunlight can kill certain

biological agents, winds above 20 mph will dissipate biological agents, and

temperature inversions (which are also more common at night or in low sunlight

conditions) keep biological agents low to the ground where they will be most

effective. Humidity may also play a role in the effectiveness of the agent

depending on the agent type (dry vs. liquid).

Due to the complexity required for aerosolized attacks, terrorists would be more

likely to use ingestion as the route of exposure by contaminating food supplies



5.32

and/or drinking water supplies (although drinking water sources would likely

render agents ineffective through dilution).


By Federal law, the Federal Bureau of Investigation (FBI) will be the lead law

enforcement agency handling the criminal investigation in conjunction with the

local law enforcement.

Health Department officials, both state and local and the Ohio Department of

Agriculture should be considered major resources in determining whether a

biologic threat actually exists; in coordinating epidemiology and surveillance; in

performing laboratory testing; and in coordinating follow-up.


The universal response objectives to a deliberate or natural biological incident

includes the utilization of the LIVE Principles:

Limit Exposure

Isolation of Contamination (which requires knowing who and what is

contaminated, and controlling additional contamination that results from

life-saving measures)

Verify the threat (by highlighting early transport of sample to laboratory)

Eliminate contamination (by selecting soap and water decontamination

instead of chemical decontamination)



5.33

Priority Activities



5.34

Notification of Deliberate Biological Incident



5.35

State Surveillance Data Communications

ODH ODAg

Agency Responsibility Comment

Local &

State EMA

Information Management Parties that receive

notification other than

through the EMA should

insure that the EMA has

been notified.

LHD ODH Initial Notification:

Communicable Disease Reporting

(Class A) - Non-Business Hours."

614.722.7221

Follow-up & Notifications:

Potentially exposed individuals

follow-up & lab results

Notify Urgent Cares, Physicians’

offices, etc

Use: Communicable

Disease Reporting

(Class A) - Non-Business

Hours protocol

Poison

Center

Perform research on materials data

for personnel protection &

emergency medical information

Provided information to the LHDs,

hospitals, & incident commander, if

requested.

Secured phone lines will

be used between the

hospitals, Poison

Center, and Health

Department.

Use a caller ID

verification code.

National Domestic Preparedness Weapons of Mass Destruction

Hotline/Helpline, contact is made as necessary. EMERGENCY number is 1-800-

424-8802.

Communicate

1. Maintain frequent communication (conference calls, emails, faxes) with all

involved agencies.

2. Give input to epidemiologists regarding patron and food service worker

interviews.

3. Provide menus from the facility or event to epidemiologists.

4. Provide patron names and/or reservation lists to epidemiologists.



5.36

5. Provide liaison with facility.

6. Use authority to close/reopen facility as needed.

Investigate

See Annex 4: Epidemiological Response Plan of the SCO Regional Public Health

and Hospital Emergency Response Plan

Resources within this Document



Title Location

II: Environmental:

CBRNE Guidance & Decontamination Enviro Office

Food Safety & Foodborne Illness Practical

Guidance

Enviro Office

Water Safety Practical Guidance Enviro Office

II: EPI:

Infectious Disease Outbreak (Class A1 After Hours

Reporting)

References

Title Location

"Threatened Bioterrorism Incident: Information Sheet

for Potentially Exposed Persons," Centers for Disease

Control and Prevention, 1999.

http://www.dhs.wisconsin.

gov/publications/P4/P421

06.pdf

"Medical Management of Biological Casualties -

Handbook," Second Edition; U. S. Army Medical

Research Institute of Infectious Diseases; (2011)

http://www.usamriid.army

.mil/education/bluebook

pdf/USAMRIID%20BlueBoo

k%207th%20Edition%20-

%20Sep%202011.pdf

Keim M, Kaufmann A; "The Anthrax Hoax

Phenomenon: Principles for Emergency Response to

Bioterrorism," Annals of Emergency Medicine, 34:2

177-182, August 1999.

http://www.annemergme

d.com/article/S0196-

0644(99)70227-1/fulltext



5.37

Title Location

Inglesby, TV and et. al; "Anthrax as a Biological

Weapon: Medical and Public Health

Management," JAMA. 281:18; 1735-1745, 1999.

http://www.med.navy.mil

/sites/nhrota/Patients/Doc

uments/Anthrax%20as%20

a%20Biological%20Weapo

n.pdf

English J, Cundiff M, Malone J, Pfeiffer J, Bell M,

Stelle L, Miller J; "Bioterrorism Readiness Plan: A

Template for Healthcare Facilities," April 13, 1999.

http://emergency.cdc.go

v/bioterrorism/pdf/13apr9

9APIC-

CDCBioterrorism.pdf

"Bioterrorism Alleging Use of Anthrax and Interim

Guidelines for Management -United States, 1998;"

MMWR. 48(04); 69-74,1999.

http://www.cdc.gov/mm

wr/PDF/wk/mm4804.pdf

WMD Threats: Sample Guidelines Reissue.” National

Domestic Preparedness Office: Special Bulletin.

(January 2000)

Environmental Reference

Folder

Emergency Response to Domestic Biological

Incidents: Participant Manual V2.2. National

Center for Biomedical Research and Training.

Louisiana State University. 2005.

Preparedness Library

CDC: Public Health Emergency Preparedness and

Response http://www.bt.cdc.gov/

Meigs County All Hazards Mitigation Plan, Annex A,

Community Profile

Emergency Management

Agency Office, Meigs

County

Meigs County Health Department Emergency

Response Plan: Annex 4: Epidemiological

Response Plan

ERC Office

APIC Bioterrorism Task Force & CDC Hospital

Infections Program Bioterrorism Working Group -

"Bioterrorism Readiness Plan: A Template for

Healthcare Facilities."

http://www.apic.org.

Homeland Security (2006). “WMD Response

Guidebook”, version 3.3 Preparedness Library

http://www.apic.org/



5.38

Title Location

Alibek, K and et al (2005). Jane’s Chem-Bio

Handbook, 3rd edition. Preparedness Library

Meigs County Health Department Public Health Risk

Assessment Hazard Profile ER Office

“Chemical/Biological/Radiological Incident

Handbook”. Chemical, Biological and Radiological

(CBRN) Subcommittee.

(October 1998)

http://www.au.af.mil/au/

awc/awcgate/cbr_hdbk/

cbr_hdbk.htm

“Anthrax: How to Recognize and Handle a

Suspicious Package or Envelope”. CDC. (2004)

http://emergency.cdc.go

v/agent/anthrax/mail/pdf

/suspiciouspackages.pdf

“Guidance on Initial Response to a Suspicious

Letter/Container With a Potential Biological Threat”

FBI, HHS, CDC, DHS. (2004)

http://www.bt.cdc.gov/pl

anning/pdf/suspicious-

package-biothreat.pdf



5.39




5.40

VII. CHEMICAL INCIDENTS: ACCIDENTAL OR DELIBERATE

Chemical releases that endanger the safety and health of the general public can

be caused by either an accidental industrial release, or the deliberate release of

industrial chemicals and or chemical warfare agents. Industrial chemicals such as

acids, alkalines, ammonia, chlorine, hydrogen cyanide, pesticides, and herbicides

are widely used and available throughout the country. Industrial chemicals have

been used by terrorists as improvised explosives, incendiaries and poisons in

several incidents.

Scientists often categorize hazardous chemicals by the type of chemical or by the

effects a chemical would have on people exposed to it. The categories/types

used by the Centers for Disease Control and Prevention are as follows:

Bio toxins—poisons that come from plants or animals

Blister agents/vesicants—chemicals that severely blister the eyes, respiratory

tract, and skin on contact

Blood agents—poisons that affect the body by being absorbed into the blood

Caustics (acids)—chemicals that burn or corrode people’s skin, eyes, and

mucus membranes (lining of the nose, mouth, throat, and lungs) on contact

Choking/lung/pulmonary agents—chemicals that cause severe irritation or

swelling of the respiratory tract (lining of the nose and throat, lungs)

Incapacitating agents—drugs that make people unable to think clearly or that

cause an altered state of consciousness (possibly unconsciousness)

Long-acting anticoagulants—poisons that prevent blood from clotting

properly, which can lead to uncontrolled bleeding

Metals—agents that consist of metallic poisons

Nerve agents—highly poisonous chemicals that work by preventing the

nervous system from working properly

Organic solvents—agents that damage the tissues of living things by dissolving

fats and oils

Riot control agents/tear gas—highly irritating agents normally used by law

enforcement for crowd control or by individuals for protection (for example,

mace)

Toxic alcohols—poisonous alcohols that can damage the heart, kidneys, and

nervous system

Vomiting agents—chemicals that cause nausea and vomiting

Accidental Chemical Incident

This is usually the result of Toxic Industrial Chemicals/Materials, aka Hazardous

Material (HazMat) involved in a transportation accident, equipment failure at the

manufacturer, equipment failure at the “end user” facility, and/or human error.

http://www.bt.cdc.gov/agent/agentlistchem-category.asp#biotoxins

http://www.bt.cdc.gov/agent/vesicants/

http://www.bt.cdc.gov/agent/agentlistchem-category.asp#blood

http://www.bt.cdc.gov/agent/agentlistchem-category.asp#acids

http://www.bt.cdc.gov/agent/agentlistchem-category.asp#choking

http://www.bt.cdc.gov/agent/agentlistchem-category.asp#incapacitating

http://www.bt.cdc.gov/agent/agentlistchem-category.asp#anticoagulant

http://www.bt.cdc.gov/agent/agentlistchem-category.asp#metals

http://www.bt.cdc.gov/agent/agentlistchem-category.asp#nerve

http://www.bt.cdc.gov/agent/agentlistchem-category.asp#organicsolvents

http://www.bt.cdc.gov/agent/agentlistchem-category.asp#riotcontrol

http://www.bt.cdc.gov/agent/agentlistchem-category.asp#toxicalcohols

http://www.bt.cdc.gov/agent/agentlistchem-category.asp#vomiting



5.41

The chemical(s) is readily identified and the quantity of the “spill” or release will be

known.

Deliberate Chemical Incident

A deliberate chemical incident is the intentional use of toxic chemicals to inflict mass casualties

and mayhem on an unsuspecting population. The use of chemical agents by

individuals/groups is to threaten, injure, or kill people. Such incidents elicit

immediate response from police, fire, and EMS personnel, who may be the

intended target.

Potential differences of a deliberate chemical incident/attack compared with a

"routine" hazardous materials incident include the following:

Intent to cause mass casualties

Great toxicity of substance(s)

Greater risk to first responders

Overwhelming number of victims

Mass hysteria, panic

A. Chemical Agents Properties

Unique Chemical Agent Characteristics

o Often have detectable properties, like an unexplained odor, color/residue,

and/or taste

o Can produce symptoms (irritated eyes, burning skin, cough, etc) almost

immediately and can penetrate skin.

o Can be very reactive in the environment, meaning they can change their

form when exposed to water and/or air. Causing an explosion, vaporize

and become an inhalation hazard.

o Need to be in large quantities to be used as a weapon.

High Hazard Threat Ranking (example: ammonia & sulfuric acid)

o High toxicity

o Easily vaporized

o Usually widely produced, stored, and/or transported

Medium Hazard Threat Ranking (example: carbon monoxide & methyl

isocyanate)

o May have a few “high hazard” characteristics

Low Hazard Threat Ranking (example: bromine and nitric oxide)

o Not likely a hazard



5.42

See: National Institute of Justice (2000). “Guide for the Selection of Chemical

Agent and Toxic Industrial Material Detection Equipment for Emergency First

Responders, Volume I”, for list of chemicals.

B. Agent Forms

Chemical agents can present as gases, dust, mist, liquids or solids that have toxic

effects on people, animals and/or plants. Exposure can result from inhalation,

ingestion or contact with a person's skin or mucous membranes. Of all exposure

routes, ingestion is the easiest to control, provided that the contaminated sources

are known or at least suspected. Simple hygienic measures and control of

supplies of food and drinking-water can significantly reduce the risk of exposure

C. Deliberate Chemical Dissemination

Most often, deliberate release of chemical agents are disseminated in liquid form,

although they are often referred to as gases (such as mustard gas). During their

release they rapidly change form and become a combination of liquid droplet

and/or vapor.


In the event that the public’s health is threatened by the accidental or

deliberate release of a chemical agent, the following objectives need to be


Work with appropriate emergency responders and governmental

agencies to ensure the safety of the general public;

Assess whether food safety and water supply sources have been impacted

by the incident;

Public Information:

o Provide timely information regarding the chemical incident; and

o Explain contamination and how to decontaminate.

Priority Activities

There are a number of tasks that county environmental health professionals

could do in response to a chemical incident that poses a threat to public

health. With the exception of public information, public health will be assisting

the Environmental Protection Agency (EPA) with these activities.

1. Provide Public Information regarding:

a. Health and safety hazards posed by the release of a chemical;

b. Clean up or decontamination issues.

2. Assist with assessment of the incident impact on air quality, food and

water resources in the area near the release.

3. Establish a hotline to receive calls from the general public.



5.43

4. Contact licensed food service establishments in the affected area to

assess the status of each one.

5. Conduct environmental sampling (e.g., water soil and vegetation)





Title Location

II: Environmental:

CBRN Guidance & Decontamination ER Office

References

Title Location

Annex 3: Public Information & Warning ER Office

Annex 4: Epidemiological Plan ER Office

Medical Management of Chemical Casualties

Handbook

http://www.brooksidepres

s.org/Products/Operation

alMedicine/DATA/operati

onalmed/Manuals/RedHa

ndbook/001TitlePage.htm

CDC – NIOSH: NTIS Publication No. PB-94-195047:

Documentation for Immediately Dangerous to Life or

Health Concentrations (IDLH): NIOSH Chemical

Listing & Documentation of Revised IDLH Values (as

of 3/1/95)

http://www.cdc.gov/nios

h/idlh/intridl4.html

Ohio Mercury Outreach & Training Manual Enviro office

Homeland Security (2006). “WMD Response

Guidebook”, version 3.3 ER Office



5.44

Title Location

CDC: Emergency Preparedness and Response:

Chemical Emergencies

www.bt.cdc.gov/chemic

al

CDC: Emergency Preparedness and Response:

Chemical Emergencies Overview

www.bt.cdc.gov/chemic

al/overview.asp

Belson, MG and et al (2005). “ Case Definitions for

Chemical Poisoning”. MMWR 54(RR01); 1-24.

www.cdc.gov/mmwr/pre

view/mmwrhtml/rr5401a1.

htm

Alibek, K and et al (2005). Jane’s Chem-Bio

Handbook, 3rd edition.

2008 Emergency Response Guidebook (revised

02/2009)

National Institute of Justice (2000). “Guide for the

Selection of Chemical Agent and Toxic Industrial

Material Detection Equipment for Emergency First

Responders, Volume I”



5.45




5.46

VIII. RADIOLOGICAL INCIDENT

Radiological emergencies, events of ionizing radiation contamination, can

range in severity. Possible scenarios for radiation exposure in the south central

region might include:

Report of “found” radioactive material;

Vehicular accident involving the transport of radiological or nuclear

material;

Fixed facility accident involving a Radiological Dispersal Device (RDD);

Attack from radiological dispersion devices (termed dirty bombs); or

Silent source of radiation placed discreetly in a public place.

Environmental Health Professionals are mostly likely untrained to deal with the

majority of radiological issues. Training must be provided and adapted to the

radiological environments that sanitarians could encounter during a disaster.

Training information should include understanding the potential terrorist threat,

knowing indicators of nuclear or radiological device use, understanding

notification requirements, knowing response plans and procedures, individual

protective measures and measures to safeguard others, and general

decontamination procedures.


In case of radiological emergencies, the following objectives need to be


Cooperate with federal government; establish an organized and

integrated capability for a timely, coordinated response to a radiological

emergency;

Specify authorities and their responsibilities of county public health

department in such emergencies;

Locate and treat victims potentially exposed elevated levels of

radiation;

Provide Public Information regarding:

o Response activities in radiological emergency; and

o Ensure availability of immediate medical treatment to those

requiring it.

Assist in environmental monitoring and in personal monitoring.

Priority Activities

There are four primary activities that the Public Health Professionals could do

when responding to a radiological/nuclear emergency.



5.47

1. Public Information & Warning:

a. Notify the major public service facilities within the affected area of the

occurrence of the radiological emergency;

b. Provide information regarding the general response procedures;

c. Set up service hotline, answer public inquires regarding radiological

emergency preparedness and response. Provide technical guidelines

in food, water, shelter, air quality, and sewage disposal issues during

emergency.

2. Mass Screening and Dispensing (or assist with) of agents that may decrease

the severity of radiological/nuclear effects to those exposed (example:

iodine tabs, Prussian blue);

3. Assist with environmental monitoring:

a. Collaborate with other emergency response organizations (e.g. Ohio

EPA), collect water, soil and air samples in the cold or warm zone when

necessary;

b. Sample collection - Conduct environmental sampling (e.g. water, soil

and air) in the cold zone.

4. Assist with personal monitoring:

a. Assist with and conduct personal monitoring at a designated

reception center; and

b. Conduct epidemiological surveillance and monitor individuals for

long-term health effects after being exposed to radiological

contaminated water, vegetable, soil, and air.





Title Location

II: Environmental:

CBRN Guidance & Decontamination

References

Title Location



5.48

Title Location

Medical Management of Radiological

Casualties Handbook

http://www.usuhs.mil/afrri/outreach/pdf

/2edmmrchandbook.pdf

Homeland Security (2006). “WMD

Response Guidebook”, version 3.3



5.49




5.50

IX. WEATHER-RELATED AND OTHER COMMON INCIDENTS

Hazard Public Health Risk Probable Operations

Major

Floods/

Flash

Floods/

Dam

Failure

- Disease associated with

consumption of water or

food contaminated by

flood water.

- Vector-bourne disease

associated with flood

water.

- Mold growth

- Sewer backups or

sewage system/field

damage

- Private water system

damage/ contamination

- Tetanus risk

- Secondary HAZMAT

spills/Environmental

Contamination

Public information releases

- Alerting people not to drink water or eat

food that has come into contact with

flood waters

- Vector & water-borne disease issues

- Location of potable water, shelters, etc

- Information for water sampling,

disinfection of private water systems, &

boiling water

- Information on cleanup procedures/

decontamination of households or

businesses

Water testing/ sampling for suspected

flood damage to well systems

Septic systems damage assessment

- Assist homeowners

Surveillance

- Increased disease

- Negative health trends

Inspections

- Shelters

- Retail food establishments

- Mobile home parks/ campgrounds

- Pools/beaches



5.51


- Schools

Prophylaxis for tetanus/other possible

flood-associated communicable diseases

Assist solid waste district with debris

management

Assist EMA identifying public health risks

during damage assessment

Tornados/

Severe

Wind

Storms



food contaminated by

prolonged power outages

- Vector-bourne disease

associated with solid

waste/debris collection


- Alerting people not to drink water or eat

food that has come into contact with

flood waters

- Vector & water-bourne disease issues

- Available medical care/information

related to the incident

- Location of shelters, potable water

Surveillance

- Increased disease


Inspections

- Shelters


- Mobile home parks/ campgrounds

- Pools/beaches



5.52


- Schools

Assist solid waste district with debris

management

Assist EMA identifying public health risks

during damage assessment

Severe

Winter

Storms



food as a result of

prolonged power outages

- Increase of heart attacks

associated with labor

intensive activities such as

snow shoveling

- Increase injuries related

to icy walkways & roads

- Hypothermia

Surveillance


Inspections

- Shelters


- Higher risk populations for heart attacks

to avoid strenuous activities

- Location of shelters, warming stations

- Food safety after power outage

- Hazards of alternative heat sources

(carbon monoxide poisoning)

- Safe ice/snow removal from roof, gutters,

etc.

Power

Outages



food as a result of loss of

refrigeration

- Water safety concerns

Surveillance

- Increased disease


Inspections



5.53


as water purification

systems shut down

- Well water availability as

a result of power loss to

pump

- Loss of waste

water/septic

- CO poisoning from

improperly installed

generators or improper

use of heating devices

indoors

- Electrical home medical

equipment needs

- Hypothermia in winter

months

- Shelters



- Food safety after prolonged power

outage

- Information for boiling water, if needed

- Dangers of improperly using generators &

heating devices

- Location of shelters, potable water,

shelters for specific needs (warming

station, medical equipment support, etc)

References within this document

Section I: Water Safety & Supply


Section III: Sewage / Septic

Section V: Solid Waste/Hazardous Waste/Debris Management


Title Location

II: Environmental:



5.54

Title Location

Water Safety Practical Guidance

Food Safety & Food-bourne Illness Practical Guidance

Vector Control Practical Guidance

Waste Management Practical Guidance

Safety Guidance

Mass Shelter Site Inspection Forms


Title Location

Water Safety Develop

Food Safety Develop

Electric and Gas Utilities Develop

Clean Up and Mold Develop

General Safety Precautions Develop

Inspecting the Damage Develop

Safety During Clean Up Develop

Carbon Monoxide Poisoning Develop

What To Do In An Emergency: for food service

operations and retail food establishments

References

Title Location

“Recovery After the Flood”. ODH. (1997)

http://www.odh.ohio.gov/~/media/OD

H/ASSETS/Files/php/disaster%20prepare

dness/floodmanual.ashx



5.55

Annex 3: Emergency Public Information and Warning


2015 Resource Management Annex 6

56

WORKER SAFETY AND PERSONAL PROTECTIVE EQUIPMENT

Disaster sites pose many potential health and safety concerns. The hazards and

exposures reflect many factors such as: the unstable nature of the site, the types of

hazardous substances present, temperature extremes, and the type of work being

performed at the site. An accurate assessment of all hazards may not be possible

because they may not be immediately obvious or identifiable. Response and

recovery personnel may make decisions and decide on protective measures based

on limited information. In addition to the hazards of direct exposure, workers are

also subject to dangers posed by the unstable physical environment, the stress of

working in protective clothing and the emotional trauma of the situation.

PPE Definition: Specialized clothing or equipment worn by employees for

protection against health and safety hazards. Personal protective

equipment is designed to protect many parts of the body, i.e., eyes,

head, face, hands, feet, and ears.

For the purposes of this plan, PPE is defined as any type of protective

clothing or equipment (steel-toed boots, leather gloves, hard hats, etc.) to

be used in an emergency response and not exclusively the medical PPE

that is typically thought of in a public health response.

Respirator Use: In the event that respirators are identified as a

recommended or required type of PPE to be used in a response, the

health department should follow OSHA regulations in developing a

respiratory protection program. A respiratory program should include:

o A written respiratory protection program with required worksite-

specific procedures and elements for required respirator use.

o A medical evaluation to determine the worker’s ability to use a

respirator.

o A Fit testing for the employee with the same make, model, style,

and size of respirator that will be used.

o Effective training to employees who are required to use respirators.


In the event that a disaster situation poses a threat to the health and safety of

environmental health professionals who are participating in response and recovery

efforts, the following objectives need to be addressed immediately:

Compile a list of all known site hazards that could be encountered during

disaster response and recovery activities;

Collect, assess and review potential health effects associated with each known

site hazard;

Help select appropriate personal protective equipment (PPE) to be used by

response and recovery personnel during site activities;



57

Ensure that response and recovery personnel have received adequate PPE

training, fit testing; and

Ensure that response and recovery personnel have received health and

safety training related to conditions in the disaster area.

Priority Activities

There are a number of important responsibilities that county environmental health

professionals must complete to ensure they are properly protected during a disaster

situation.

1. Collaborate with other governmental/private sector organizations to

collect information about existing and potential hazards in the disaster

area.

2. Conduct a qualitative assessment of potential hazards posed in the disaster

area.

3. Review guidelines for selecting PPE to use in all phases of response and

recovery activities

4. Select appropriate personal protective equipment to use in all phases

of response and recovery activities.

5. Maintain current information on responders’ health and potential injuries to

assess risk and implement new safety measures if warranted.

6. Provide initial and recurring health and safety training for all personnel

involved in disaster response and recovery activities.

7. Inspect all personal protective equipment for signs of deterioration

and replace if necessary.

8. Establish effective mechanisms for implementing safety decisions

affecting all response personnel in the disaster area.

References

Title Location

National Ag Safety Database publication

titled “Safe Foods After a Disaster” 8/1996

Review – include if appropriate as

Implementing Instruction.

May be included as “Reference”

U.S. Department of Agriculture publication

titled “Food Safety and Security-What

Consumers Need to Know” 9/29/ 03




FEMA publication titled Food and Water in an

Emergency 2/11/03





58

Title Location


Environmental Health in Emergencies and

Disasters A Practical Guide 2002




Fact Sheet: Hazardous Waste, Department of

Environmental Protection – Pennsylvania

Wastes: Citizens Hazardous Waste Permit

Guide, U.S. EPA




Biological PPE



59

Date

Changes

Made* Signature

3/18/2014 yes Frank Gorscak

3/1/2015 yes Frank Gorscak

TABLE OF CONTENTS

PURPOSE .................................................................................................................... I

SITUATIONS AND ASSUMPTIONS ............................................................................... I

CONCEPT OF OPERATIONS ...................................................................................... I

Activation and Implementation ................................................................................. i

Typical Sequence of Activities....................................................................................... i

Direction and Control .................................................................................................. i

Direction and Control ..................................................................................................... ii Pre-Event ........................................................................................................................... ii Internal Resource Requesting ....................................................................................... iii External Resource Requesting, Initial and Subsequent .......................................... iv Regional Resources ........................................................................................................ v State and Federal Resources ........................................................................................ v Resource Tracking ........................................................................................................... v

MUTUAL AID AGREEMENTS ...................................................................................... V

MEMORANDUM OF UNDERSTANDINGS ................................................................. VI

Annex 6:

Resource Management



60

IMPLEMENTING INSTRUCTIONS ............................................................................... VI

REFERENCES ............................................................................................................. VI

SUMMARY OF CHANGES ........................................................................................VII

* Summary of Changes is located at the end of this document.



61



2015 Annex 7: COOP/Recovery Plan

i

INTRODUCTION

The ability of public health to conduct operations and perform essential

services during emergencies may be affected by a lack of available

resources. A variety of mechanisms may be employed to provide assistance

during emergencies. These mechanisms fall into two broad categories: 1) Pre-

Event planning (mutual aid/memorandums of agreements); and 2) Event

generated requests, through the Meigs emergency management agency, to

the Ohio Emergency Management Agency.

PURPOSE

This instruction describes:

The process of establishing agreements for emergency response

assistance prior to an incident occurring; and

The use of a standardized resource requesting process when the

response ability of health department or Meigs County is exceeded.

SITUATIONS AND ASSUMPTIONS

An incident has occurred that has the potential to expend

resources (human and materiel) beyond the normal expected

usage.

The incident will likely affect the public’s health.


Activation and Implementation

Typical Sequence of Activities

The Meigs County Health Department Emergency Response Plan and/or

the Meigs County Emergency Response Plan should be activated prior to

the activation of this Annex.

The activation and implementation of the Resource Management Plan

should be considered during any incident that affects the health of a

significant portion of the county’s population.

The activation and implementation of Annex 6: Resource Management

Plan of the MCHD Emergency Response Plan is determined by Health

Commissioner, or his designee.

Documentation and a description of the activities and actions taken

related to the response management by MCHD may be included on the

ICS form 201; a resource management spread sheet; and/or an ICS

Activity Log.

Direction and Control



ii

The Fiscal/Logistic Chief is responsible for the tracking and documenting

requests for and use of resources. The Fiscal Officer OR Public Health

Emergency Preparedness Coordinator is usually assigned to that Incident

Command System position. Sections: “Internal Resource Requesting”, “External

Resource Requesting”, and “Resource Tracking” explains the process for

requesting materials/supplies and personnel

The diagram below illustrates where the Logistics/Fiscal Chief position is

located in the Incident Command system.

Meigs County Health Department Responsibilities

Meigs County Health Department is responsible for:

Monitoring the material/supply and personnel needs of the health

department during an incident;

Requesting additional resources when it is determined that current

materiel and/or personnel will not be sufficient to manage the incident;

and

Tracking the movement, expenditure, transfer, return, and disposal of

materiel and personnel while in possession of the health department.

Pre-Event

The health department maintains a local public health and medical resources

list that identifies public health resources in advance of a disaster that could

expedite the mobilization and delivery of available resources.

Health Alert Network (HAN) Resource List

Special Medical Needs Resource List

EMA Resources Directory

Memorandum of Understanding OR Mutual Aid Agreement

Incident Commander

Operations Chief Planning Chief Security Chief Logistic/Fiscal

Chief

Public Information

Officer Safety Officer



iii

A Memorandum of understanding or Mutual Aid Agreement (MOU) is a

document describing a bilateral or multilateral agreement between two or

more parties. It expresses a convergence of will between the parties,

indicating an intended common line of action. It is often used in cases where

parties either do not imply a legal commitment or in situations where the

parties cannot create a legally enforceable agreement. It is a more formal

alternative to a gentlemen's agreement. MOUs are not legally binding but

they carry a degree of seriousness and mutual respect, stronger than a

gentlemen’s agreement. Examples of uses of a MOU include, but not limited

to:

Immediate use of a facility/building for dispensing medications;

Use of personnel to supplement staffing; and

Have priority for delivery of goods or services, such as: oxygen, printing

documents, etc.

After an event, these written agreements are critical for federal disaster


and local governments and their citizens when disasters are overwhelming.

Internal Resource Requesting

The health department has equipment and staffing resources that are readily

available for response to emergency situations. Documentation must be kept

for any health department resources used for an emergency situation.

Resource documentation may include, but is not limited to:

1. Exact type of resource requested;

2. Number of the resource requested (ie 3000 face masks);

3. Name of the person/agency that placed the order (may require a

signature);

4. Destination of the resource; and

5. Signature of Incident Commander approving release of the

resource.

A resource request for any material/supply or personnel should be made

following the chain of command within the Incident Command Structure.

Requests will be made and approved through immediate supervisors, moving

vertically up the chain of command until it reaches the respective section

chief (Operations, Planning, Security, etc.). Once the section chief receives

and approves the resource request, the request will move horizontally on the

ICS to the Logistics/Fiscal Chief. The Logistics/Fiscal Chief will then fill the

request internally or request the resource through the external resource

requesting process.

Section Chief

(Operations/Planning/

Security/etc.)

Logistics/Fiscal Chief

http://en.wikipedia.org/wiki/Document

http://en.wikipedia.org/wiki/Bilateralism

http://en.wikipedia.org/wiki/Multilateral

http://en.wikipedia.org/wiki/Gentlemen%27s_agreement



iv

External Resource Requesting, Initial and Subsequent

When resources needed during/for an incident that are not available within

the health department and its usual supply system, OR when health

department resources are predicted to be insufficient the health department

may look to external sources to meet the resource need. Public health

resource requests, for resources that are external to the Meigs County Health

Department, must be coordinated through the Emergency Management

Agency (EMA)/Emergency Operations Center (EOC) during emergency

situations. Resource requests by the health department may include, but are

not limited to:

1. Exact resource type;

2. Where it needs to be shipped;

3. Incident Commander’s signature.

The request can be verbally made via a communications system such as:

landline, cell phone, or Voice-over Internet Phone and should be followed by

a “hard copy” of the request via fax or paper. Requests for resources

documented on ………

Subsequent requests for the same external resource materials would follow the

same process as the initial request.

The health department will be responsible for any external resources supplied

to the health department for emergency response.

The flowchart below illustrates the external resource requesting process.

Supervisor Supervisor

Request Request Request



v

Regional Resources

Requests for regional resources will be directed through the Meigs County EMA

to the “holder” of the resource and the OEMA. As a courtesy and to help

provide a common operating picture for the south central region, the Regional

Public Health Preparedness Coordinator should be made aware of the

request.

State and Federal Resources

Requests for State or Federal resources will be directed to the State EMA,

through the Meigs County EMA, and then to the Ohio Department of Health

and CDC, as necessary. State/Federal medical materiel requests, including

SNS requests, may require specific requisition forms to be signed by the Health

Commissioner or designee. As a courtesy and to help provide a common

operating picture for the south central region, the Regional Public Health

Preparedness Coordinator should be made aware of the request.

Resource Tracking

All resources received and/or moved will be tracked to their final end point;

expended, returned, or disposed of. Unless a particular resource management

system is required to be used by the Ohio Department of Health (ODH) or Ohio

Emergency Management Agency (OEMA) (i.e., Impact SIIS, HDIS), MCHD will

use an excel spreadsheet to manage the movement of resources.

After an event, the tracking documents will be critical for federal disaster


and local governments and their citizens when disasters are overwhelming.

MUTUAL AID AGREEMENTS

Health Department

Logistics/Fiscal

Chief

County

Emergency

Management

Agency

Local & Regional

Resources

Ohio

Emergency

Management

Agency

Federal

Emergency

Management

Agent



vi

Agency Services Date

10 LHDs in South Central Public

Health region

Personnel support X 3 days 2010

21 LHDs in entire Southeast Public

Health region

Personnel Support X 3 days 2010

MEMORANDUM OF UNDERSTANDINGS

Agency Purpose Date

Senior Citizen Center POD 2010

Meigs EMA General Support and

Cooperation

2014

Red Cross Supplies, Volunteers 2014


Title Location

II: Resource:

Health Alert Network Resource List

Special Medical Needs Resource List

Resource Testing

II: Dispensing :

SNS Request Movement Return Disposal

REFERENCES

Title Location



vii

Title Location

SCO Public Health Resource/Phone Book

EMA Resources Directory PHEP bookshelf

Reference-Resource-MOU Writing Guide HMG

OPHCS documents local

folders SE SE

Collaboration RPH_SCO

ERP Templates Resource

Reference-Resource-MOU Writing Guide Fed


folders SE SE



Reference-Resource-Mutual Aid Agreement

Sample


folders SE SE



SUMMARY OF CHANGES

3/18/2014: Spelling and punctuation changes. fg

3/19/2015: date change fg



viii

Annex 7:

Continuity of Operations (COOP) &

Recovery Plan

Date

Reviewed

Changes

Made* Signature

04/17/2014 Y Frank Gorscak

4/21/2015 Y Frank Gorscak

Y or N Y or N



ix

* Summary of Changes is located at the end of this document.



x




xi

Annex 7: Continuity of Operations (COOP) & Recovery

Table of Contents

INTRODUCTION ................................................................................................... 14

PURPOSE, OBJECTIVES AND ASSUMPTIONS .............................................................. 14

CONCEPT OF OPERATIONS ................................................................................... 17

Direction and Control ..................................................................................... 17

Activation and Implementation ................................................................... 17

Responsibilities .................................................................................................. 17

Sites of Assembly ............................................................................................. 19

Essential Services ............................................................................................. 20

Essential Personnel .......................................................................................... 21

Vital Records .................................................................................................... 22

Fiscal ................................................................................................................. 23

Communications ............................................................................................. 23

Employee Notification ....................................................................................... 23 Communications ................................................................................................ 23 Internal Communications ................................................................................. 24 External Communications ................................................................................ 24 Problem Management ..................................................................................... 24 Information Technology .................................................................................... 24

Security ............................................................................................................. 25

HUMAN RESOURCE MANAGEMENT ........................................................................ 25

Staffing Issues ................................................................................................... 25

Administrative Support During Recovery Efforts ......................................... 26

Finance Issues .................................................................................................. 27

RECONSTITUTION ................................................................................................. 28

RECOVERY STRATEGIES......................................................................................... 28

General Health Department Recovery Strategies ..................................... 28

Recovery Management ................................................................................ 29

COMMUNITY RECOVERY MANAGEMENT RESPONSIBILITIES ......................................... 29

IMPLEMENTING INSTRUCTIONS/REFERENCES ............................................................. 31

SUMMARY OF CHANGES ...................................................................................... 32



xii



xiii




14

Introduction

It is the responsibility of government to assist the public and private sector during an incident, as well

as assisting in its recovery. Recovery from an incident is part of a continuum of emergency

management functions.

The Health Department utilizes partnerships with business, community leadership, cultural and faith-

based groups, emergency management, healthcare, social services, housing and sheltering, media,

mental/behavioral health, Area Agency on Aging, education and childcare settings in developing a

community Recovery Plan related to the continuation, restoration and recovery of public health,

medical, and/or mental/behavioral health systems and services.

Continuity of Operations: Processes and procedures an organization has put in place to ensure that

mission-critical business functions can continue during and after a disaster. In other words, how an

agency intends to continue operating during an incident.

Recovery: Addresses the process after the incident has occurred. Short-term recovery involves the

restoration of critical services to support life, health, and safety of the population. Long-term

recovery is the community's effort to regain normal functions like commerce and employment. In

most cases, recovery begins during the response phase of the event when damage is identified and

assessed.

The health and welfare of the Meigs County Public is dependent on this agency’s ability, to ensure

that we can execute our essential missions, in the event of a threat to its normal continuity of

operations. The Meigs County Health Department (MCHD) performs essential functions and services

that may be adversely impacted in the event of a natural or man-made disaster. In such events, this

agency plans to continue/recover operations and maintain essential functions and services.

Purpose, Objectives and Assumptions

Purpose:

The purpose of this plan is to define the continued essential operations capabilities and recovery

process developed to restore and maintain the Meigs County Health Departments critical business

Continuity of Operations



15

functions. The plan will detail the procedures for responding to an emergency situation that affects

the Health Department’s ability to provide services to the residents of Meigs County.

The Plan involves data management, communications and operations center movement and setup

in response to an event requiring operations to be continued outside normal operation.

It will include recovery functions for restoring the MCHD to 100% of its total operational capacity. This

plan functions as part of the Meigs County Emergency Management Agency (EMA) All-Hazards

Recovery Plan.

Scope

This plan is limited to the health department’s perceived responsibilities and expectation of services

and activities that will be essential during an incident. It briefly identifies the responsibilities of other

response partners, as they relate to health department activities.

Focusing on the restoration of the infrastructure and critical services to support life, health, and safety

of the population, this plan also identifies the responsibilities of the Meigs County Health Department

in the recovery of the county from disasters that have impacted the public’s health within the

county.

Objectives of the Plan

Maintain essential services

Facilitate timely recovery of business functions

Minimize loss of life

Minimize or prevent loss of data

Minimize the critical decisions to be made in a time of crisis

Situation and Assumptions

Situation

The Health Department has conducted a Public Health Hazard Analysis and Risk Assessment that is

based off of the Meigs County Emergency Management Agency’s Hazard Analysis and Risk

Assessments. The Public Health Risk Assessment includes information on the impacts potential hazards

within the county may have on department operations.

Hazard Potential Impact on Meigs County Health Department

Operations

Floods Could interfere with staff’s ability to get to work. Could

interfere with travel of sanitarian and nursing staff

through the county.

Winter Storms Could interfere with staff’s ability to get to work. Could

interfere with travel of sanitarian and nursing staff

through the county. Could potentially disrupt

communications (phones, internet). Winter storms

could be cause for the health department to shut



16

Hazard Potential Impact on Meigs County Health Department

Operations

down temporarily.

Tornados and High Winds Could damage or destroy health department facilities

and equipment. Could disrupt communications

(phones, internet).

HAZMAT Incidents-

Transportation

Could contaminate health department facilities,

incapacitate staff.

Civil Disturbance, Riots,

Terrorism

Due to safety concerns for staff, could completely stop

health department’s capability to conduct services for

duration of riot. Could damage or destroy health

department facilities and equipment. Could disrupt

communications (phones, internet).

Power Outages Health Department has a generator; power outages

should not affect health department operations as

long as generator is functioning properly.

Earthquakes Could damage or destroy health department facilities

and equipment. Could disrupt communications

(phones, internet) and utilities.

EH Virus (like Ebola) Could incapacitate a large percentage of staff.

Pandemic Flu Could incapacitate a large percentage of staff.

Assumptions

The specific type of emergency and scale of that emergency can greatly affect how and what

business resumption efforts will take place. The ultimate goal of this plan is to provide guidance to

maintain operations for worst-case scenarios, but the plan should provide capabilities to offer as

many services as possible given a wide range of possible emergency situations. The current

information gathered on health department operations, personnel, resource requirements, and vital

records that provide the basis for this plan may not reflect the absolute minimum capabilities that the

health department can operate on. Further training and exercising of the plan will be required to

determine what limits the health department has based on various emergency scenarios with varying

levels of severity. Closure of the health department could occur due to lack of staff or because

certain events could present an unacceptable level of risk to employees or other individuals.

This section identifies the assumptions made by the Meigs County Health Department Continuity of

Operations and Recovery Plan.

1. An emergency or disaster has occurred

2. The type of disaster (fire, civil unrest, natural disaster, terrorist attack, chemical spill, biological

event) and the impact of a disaster will vary significantly.



17

3. Resources are available.

4. Trained personnel exist to establish authority and to implement plans and procedures.

5. Circumstances of an emergency or disaster may affect the health department's ability to

participate in local recovery efforts. Possible consequences of emergencies include prohibited

access to facilities/equipment, disrupted power, ruptured gas lines, power outage, water

damage, smoke damage, chemical damage, structural damage, communications loss, etc

6. An Alternate site will be available to the Health Department at the time of need.


Direction and Control

The ultimate responsibility and authority of implementing quarantine or any other form of community

containment during a public health emergency is that of the Board of Health, the Health

Commissioner and the State’s public health authority.

Activation and Implementation

Typical Sequence of Activities:

The Meigs County Health Department Emergency Response Plan should be activated prior to the

activation of this Annex.

The activation and implementation of the Recovery Plan should be considered during any

incident that affects a wide spread area or when the physical structure of the health department

is affected, including power outage, communications loss, etc. for a prolonged period of time.

The activation and implementation of this Annex is determined by Health Commissioner, or his

designee, and may be considered during any incident that affects operations for longer than 24

hours.

The determination of services to be increased and/or decreased should be made.

The Health Commissioner/Administrator, or designee, will notify the Board of Health and the

County Commissioners of the activation and brief them on the details of the incident, expected

increase and/or decrease of “normal” services and estimated timeline for return to normal

services.

The Health Commissioner/Administrator, or designee, will discuss/notify other pertinent response

partners of the recovery activities to be taken, and ask for their assistance via the Meigs County

EOC, if needed, and to educate the public.

Documentation and a description of the activation, notifications, changes in services, recovery

strategies implemented, and other pertinent information may be included on the ICS form 201.

A Public Service Announcement should be made to inform the public of changes in services and

any health recommendations.

Responsibilities

In its initial phases, recovery for large disasters in Meigs County is coordinated by the staff of the

Emergency Operations Center (EOC) and focusing on providing essential services, such as



18

mass care, emergency medical services, debris removal, and utilities restoration. As short-term

recovery transitions to long-term recovery, the EOC will transition to a more re-vitalizing, restore

to normal focus.

Health Department

Damage assessment

Reassemble work units

Life, safety and health protective measures for impacted citizens

Assist other agencies in securing food, water, clothing, shelter, fuels and transportation

Provide essential health department services (See details below, page 8)

Record keeping for potential reimbursement

Recovery of vital records (birth/death certificates. bank statements, licenses, contracts,

accounting documents, payroll records, etc.)

Access to funds for recovery

Assistance from state/federal agencies may require completion of documents or coordination

of assistance with Local, State and Federal Agencies

Debris Clearance

Repair or replacement of damaged & hazardous facilities

Other Response Agencies

All agencies in Hocking County Government have duties directly associated with the recovery

of the community following a disaster. Additionally, all governmental agencies have the

responsibility to return to normal business capabilities as soon as possible following an event.

All Meigs County agencies (including the Health Department) shall:

Develop a Recovery Plan and Procedures

Train personnel in its implementation

Test procedures/provisions

Begin record keeping of disaster expenses

Assess damages

Assess capabilities to conduct normal business

Assess needs to return to normal business

Establish Communication with the Meigs County EOC

Re-establish interrupted utility service

Conduct short term repairs needed to support normal operations

Begin recovery of Vital and Important Records needed to conduct normal business



19

Begin reconstruction and long term repairs with available funds

Re-establish normal services

Provide organization, supervision and coordination of emergency health and

environmental health services

Provide assistance in the coordination of Emergency Medical Services and Mental Health

Services.

Establish health and medical priorities and controls for emergency services including

distribution of auxiliary health and medical supplies, distribution of equipment and

assignment of health and medical personnel.

Provide emergency public information utilizing the Joint Information Center

Provide first aid care and treatment of minor injuries and emergency health care within the

range allowed by available resources and staff skills.

Implementation of mass immunization programs, as the need requires.

Coordinate countywide surveillance of potential problems related to public water supplies;

sewage disposal system failures; solid waste accumulation and disposal; food storage;

preparation and serving areas (i.e. shelters, food kitchens, etc.) disease carrying animals and

insects.

Sites of Assembly

Primary Site

Upon receiving notifications of an emergency, Health Department Personnel will assemble at:

Meigs County Health Department

112 E. Memorial Dr. suite A

Pomeroy Ohio 45769

If the main Health Department location becomes inaccessible, an alternate assembly place will be

selected from the below table and will be dependent on any damage these sites may have

sustained. Implementing instruction (II): COOP/Recovery: Temporary Site Considerations and II:

COOP/Recovery: Notification of Relocation may be utilized for this process.

Other Sites Considered or with a MOU



20

Locations for Assembly

Local Churches

Meigs EMA EOC

Meigs Senior Citizens Center

Pomeroy City Municipal Building

Don Porter vacant GM Dealership

Under special circumstances, some staff may be able to

operate from home.

Essential Services

During emergency situations, the health department’s operational capacity for administrative

functions or public services may be limited. It is important to pre-determine what services are

absolutely essential to maintain core public health services.

Essential Services

Animal Bite Complaints – rabies risk

Immunizations – only those necessary and related to the incident per

order of the medical director.

Disease Surveillance and Investigation - Prioritization and intensity of

disease investigation is a judgment call based on several factors:

Categorization on Ohio's Reportable Infectious Diseases List (Class

A, Class B, etc.)

Communicability of the disease

Virulence of the disease

Rarity of the disease

Current events and/or outbreaks

Sensitive occupations/settings

See Annex 4: Epidemiological Response Plan for additional prioritization

Public Health Service Announcements – related to the incident

Birth and Death Certificate Registration and Issuance

Devolution of Services

The size and extent of the incident, as well as the available staff, will determine the need for and rate

of service devolution. The health and well-being of the community as a whole should be the focus of

services provided. The Health Commissioner, acting as the designated representative of the Board of



21

Health, will determine what services will be limited, or expanded as well as when to limit or expand

them.

Reconstitution of Services

As the immediate incident resolves and the community begins to recover, the health department will

move to a more “recovery phase” focus and eventually return to “normal” operations.

“Reconstitution” may be over a few days to a few months.

Essential Personnel

Essential (Core) Staff and Chain of Succession include:

All staff members are considered essential. Core Staff and their back-ups are listed in the table

below.

Core Staff Back-up for Core Staff

Health Commissioner Medical Director or Administrator or DON

Environmental Health Director (EHD) Registered Sanitarians

Director of Nursing (DON) Public Health Nurses

Public Health Preparedness Coordinator Regional Public Health Preparedness Coordinator

Regional Epidemiologist Other Epidemiologist in SCO or SEO region

Registrar Deputy Registrar or pre-designated Clerical staff

Fiscal Agent Pre-designated Clerical Staff

Core staff is aware of their positions and how they will be managed in the event of a disaster.

Strategies for minimizing the possibility that staff become ill: e.g., working from home even in early

stages of a pandemic, or other social distancing measures, are being considered. If working from

home, staff will need to address any computer connection/technological issues. However, vital

statistic functions would have to be performed onsite or at a site designated by ODH Bureau of Vital

Statistics. Other public health services also require onsite availability for the public.

Essential Skills required to sustain services:

– Current Ohio RN license and updated nursing duties.

– Vital Statistics skills and office skills (organizational skills and ability to access vital information

(plans) and operate equipment).

– Current Ohio Registered Sanitarian license or “Sanitarian-In-Training” applicant with the

Ohio Board of Sanitarians.

Back-ups for staff include:

Meigs County Medical Reserve Corps would be utilized to back up public health nurses. Meigs

County Citizens Corps may also be utilized to back up non-medical functions. See Appendix 8:

Volunteer Management Plan. Additional backup personnel for core staff could be requested from



22

other health department jurisdictions through use of Regional MOUs. Back-ups will receive just in time

training on the skills needed to fulfill their job duties.

Essential systems & supplies include:

- Computer systems and backup systems;

- Refrigeration units for vaccines;

- IT systems (including computers and email);

- MARCS/ two-way radios; and

- Telephones (including fax).

Emergency supply requests that cannot be requisitioned through usual sources will be obtained via

requests to the Meigs County EMA office.

Critical staff numbers and skills required to maintain essential services:

50% absentee rate would severely impact essential services. It is likely that business functions

would stop if more than 50% of staff were absent. The decision to close the health department

when absentee rates threaten safe business continuity would be made by the Health

Commissioner.

To accommodate a decreased work force, the following actions have been completed and will

continue to occur when new staff is acquired.

– Clerical staff have crossed trained and are able to complete all clerical tasks in all divisions;

– Nursing staff have crossed trained in all the services offered by the nursing division; and

– Environmental health staff have cross trained within their division and have at least two (2)

back-ups per service offered.

Steps to minimize risk to staff include:

- Regular training updates;

- Proper emergency equipment;

- Standard emergency procedures;

- Proper PPE;

- Vaccinations or antivirals when available; and

- Critical Incident Stress Management (CISM).

Vital Records

A vital records table was created to identify what records are essential for health department

operations, whether they exist in electronic or hardcopy format, how or if they are backed up, and

how the information would be restored in a continuity of operations situation.

Vital Record Title Format Back-up How would they be re-stored?

Birth certificates Paper ODH Server



23

Vital Record Title Format Back-up How would they be re-stored?

Death certificates Paper ODH Server

well paper HDIS

septic paper HDIS

WIC records Paper /

electronic

WIC Server Request access from state WIC

Immunization

records

Paper /

electronic

Impact

Medical records Paper /

electronic

HDIS Request additional program

software from ODH

All vital records on the server should be backed up on a daily basis and all vital records on individual

staff computers should be backed up at least on a weekly basis or dependent on when new

information is added to the records. Reasonable efforts should be made to convert hardcopy-only

documents into an electronic format that can be backed up. Backup devices include external hard

drives, tape drives, USB jump drives, floppy disk or CD writeable drives, and backups to the server. All

backup devices are stored in a safe place off site or kept in a fireproof safe on site.

Fiscal

The fiscal agent is responsible for backing up critical records.

Critical Records Current Location Other Locations

Payroll & accounting systems Health Department Courthouse

Insurance Policies Health Department Courthouse

Bank Account Records Health Department Courthouse

Back-up device for Server Health Department Courthouse

Communications

Employee Notification

Employees will be contacted directly in the event of an emergency situation through the Emergency

Call List. Employees will be given instructions on where and when to report for work and to receive

status on the situation.

Communications

Cell phones, county radios, and MARCS radio systems could be utilized until landlines could be

reestablished. MARCS radio equipment assistance could be provided through a communications

company located within the region, or utilizing regional MOUs. Other MARCS technical assistance



24

could be requested through the State Health Department or the Ohio DAS MARCS Help Desk.

Contact information for MARCS radio technical assistance is listed in the Health Alert Network (HAN)

Directory.

Landline assistance would be provided through local phone company service and/ or local

contracted phone Service Company. Contact information for landline phone technical assistance is

listed in the Health Alert Network (HAN) Directory.

Voice-over Internet Phones are available for person-to-person conversations between local health

departments throughout the state. It can also be used to support small conference calls (Nine (9)

calls, or less) without assistance from ODH. For any technical phone issues, or conference calls

greater than nine(9) callers, ODH would be contacted.

A high-speed internet connection would need to be established. The state health department IT staff

would be contacted to determine the feasibility of establishing or reestablishing a T1 line for either the

primary or alternate site. If the T1 line is not a viable option, then cable internet or DSL options would

be considered.

Internal Communications

Communications to the board of health on the status of the health department recovery will be

handled by the Incident Commander or Health Commissioner.

External Communications - Media

External communications are addressed in the Crisis Communication Plan. Any and all press inquiries

must be directed to Public Information Officer identified in the crisis communication plan. UNDER NO

CIRCUMSTANCES ARE HEALTH DEPARTMENT EMPLOYEES OR VOLUNTEERS TO PROVIDE INFORMATION TO

ANY MEDIA REPRESENTATIVE. Recovery Status updates will be communicated at pre-announced

intervals.

External Communications – Local Partners

Employees who are designated to communicate with our local partners or stakeholders will be

provided with a statement or list of statements regarding the recovery effort. These statements will

come through our Public Information Officer. It is important that EVERYONE tell the same story.

Updates will be provided at regular intervals as recovery efforts are ongoing.

Problem Management

If a problem is encountered that cannot be resolved by health department personnel, that will result

in a delay in the recovery of any critical functions, a special meeting of the board of health, health

commissioner and team leaders will be held to determine a course of action to resolve the issue.

Information Technology (IT)

Having a computer network with a server is necessary to run essential health department software

applications. MCHD would contact our primary contact for assistance in reestablishing, at least, a

basic computer network for health department operations. Contact information for IT support is listed

in the Health Alert Network (HAN) Directory.

State health department IT staff may also be contacted for assistance with configuring the local

network. The health department server is backed up daily and stored at an off-site location. Backup



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sources would have to be utilized to reestablish any lost information. Any specialized software will

have to be downloaded, obtained through regional MOU’s, or requested from the Ohio Department

of Health or respective vendors of that software.

Security

The security of staff, vital statistics records (birth and death certificates), client medical records, and

medical countermeasures (vaccine, antivirals, etc) are provided for in the health department’s

current location. The security measures include:

All doors, other than the main entrance/exit are locked at all times. The doors allow those inside

to exit, but require a key to enter.

Doors between public and non-public spaces can be locked to limit passage of unauthorized

individuals.

Rooms with vital statistics documents and medical records are locked.

Rooms storing vaccine and/or antivirals can be locked.

Vaccine storage refrigerators are monitored constantly for loss of appropriate temperature.

When selecting an alternate assembly/working site, security will be an important consideration. The

situation at that time will determine how “secure” the location will need to be. If the alternate

assembly site is used because the current location has been damaged as a result of a weather

incident, then security will include locked spaces for vital/confidential records & locked outer doors.

If the alternate assembly site is damaged (unusable) as a result of criminal actions, then exterior

alarms and/or surveillance cameras, locked vaccine/medical countermeasures, separate and

lockable space separating public and non-public areas, etc may be more appropriate.

Human Resource Management

Staffing Issues

Staffing will be provided by Meigs County Health Department Personnel.

Management of the Meigs County Health Department ERP will be undertaken by the core

leadership staff.

Injury to Employee

If an employee is injured on the job as a result of a declared emergency or during the recovery

process, the first step is to seek medical attention for the injured employee as quickly as possible.

Every employee should be made familiar with the emergency numbers in the local area for

contacting police, fire or ambulance services. From most locations we can dial 911 or dial 740-992-

6618

Once medical attention has been provided for the injured employee, it is important to notify

management as soon as reasonably possible so that appropriate family notifications and paperwork

can be completed. Initial information to be provided is as follows:

Employee Name

Location at time of injury



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Nature of injury (if known)

Time injury occurred

Brief description of circumstances under which injury occurred

Employee Fatalities

In the event that an emergency situation results in the death of one or more employees, it is

imperative that the information be communicated to management as quickly as is reasonably

possible. This is to ensure that communication can be made to family members as quickly and

compassionately as possible under the circumstances. A phone call to the Board of Health members

should be made as soon as possible. Initial information to be provided is as follows:

Employee Name

Location at time of death

Time death occurred

Brief description of circumstances under which death occurred

Where deceased has been taken (if known)

Temporary Staff/Volunteers

If the support of additional staff during the recovery effort is required, contact the Meigs County EOC.

Every effort will be made to provide any additional help needed to support the recovery effort.

Family Issues

The health department realizes that to respond to the community’s needs in a disaster situation, the

health department must recognize the hardships placed on the families of its personnel. To be able

to perform their best at a time when it is needed most, employees need to have a level of comfort

that their family members are safe and the employee’s absence during the recovery effort will not

place undue hardship on them.

The level of support to personnel will clearly be defined by the nature of the disaster itself. In the case

of a natural disaster where the employee’s family may be at risk, it may allow for time to relocate

family members or allow the family to accompany the employee to the recovery site until further

arrangements can be made.

Family issues should be brought to the attention of the supervisor as soon as feasible.

Administrative Support During Recovery Efforts

During the recovery effort administrative volunteers will be deployed to support the recovery efforts

as available or required. The primary team will be located at the main health department site.

Additional volunteers may be sent to off-site locations to provide support such as answering phones,

locating supplies, etc.



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The primary responsibilities of the administrative staff are as follows:

1. Answering phones

2. Making pages/text messages as requested to communicate to staff

3. Making travel arrangements for staff

4. Providing food at site locations

5. Distributing pre-approved information as requested

6. Making copies

7. Keeping track of the locations of employees

8. Setting up conferences with local partners

Food and Travel

It is the department’s Incident Commander (Likely the Health Commissioner or his representative)

and Logistics/Fiscal Chief’s responsibility to determine their staff’s food and transportation needs

during an emergency situation and to communicate them to supervisors. Consolidating the requests

for these services during an emergency will help ensure the quickest possible response while

eliminating redundancy.

The Logistics/Fiscal Chief is responsible for ordering food for the sites and facilitating transportation,

particularly where normal methods of transportation are unavailable.

Identify the number of meals needed, the times needed and the locations in which they are to

be delivered as well as any special dietary requirements.

Any required travel arrangements throughout the COOP and recovery efforts will be made by

individual personnel and approved by their supervisor.

Finance Issues

The Fiscal Officer and Health Commissioner will handle all finance issues during a declared disaster.

This is to include travel, meals, equipment or any other type of expense related to the recovery effort.

It is imperative that all expenses can be tracked for reimbursement purposes.

Equipment Purchases

Requests for items like general office supplies should be requested through the Supervisors and then

given to Fiscal Officer. Requests will be completed as quickly as possible through existing vendor

relationships or if necessary through other vendors. The Board of Health must approve all equipment

purchases over $500.00.

Existing vendor relationships should be used wherever feasible to facilitate billing and payment for

services.



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Expenses

The normal procedures for submitting expense will continue during the recovery effort. All disaster

related expenses should be referred to the supervisor and then given to Fiscal Officer. Every effort will

be made to reimburse the employee for out-of-pocket expenses as expeditiously as possible.

Reconstitution

The process of restoring normal operations in either primary or alternate facilities following a large-

scale disaster would require a comprehensive approach among various state and local government

and private agencies. Core health department staff operating under the incident command system

would be required to provide an orderly and systematic approach to determine what services will be

offered, order the necessary equipment to run those operations, and assign staff to specific functions.

Communications and information technology pose the biggest challenge and are the most

important step in reestablishing the infrastructure necessary for health department operations.

In the event of a pandemic, special infection control measures must be taken to prevent the spread

of disease among staff and from visitors. Strategies to minimize illness among staff and visitors

include:

Restrict workplace entry of people with influenza symptoms

Practice good personal hygiene and workplace cleaning habits

Increase social distancing (enable telecommuting, avoid face-to-face contact)

Manage staff who become ill at work

Manage staff who travel overseas

Provide hand washing sanitizers for work areas

Provide PPE for staff when they have to work in close quarters with each other or with the

public

See Appendix 6: Pandemic Response Plan for more details on infection control measures for

widespread disease.

Recovery Strategies

The recovery effort for Meigs County government in large disasters will be coordinated from the

Emergency Operations Center (EOC). The Office of Emergency Management (EMA) manager will be

the Applicant Agent for Meigs County Government to apply for and coordinate receipt of state and

federal recovery funds.

General Health Department Recovery Strategies

Business functions will be recovered in priority sequence.

Communications concerning the recovery status will be coordinated through the EOC so that

those executing the recovery will not be interrupted repeatedly for status.



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Acquisition of equipment and supplies needed for the recovery effort will be coordinated

through the EOC. Purchases will be handled in-house

Coordination of travel arrangements, food and accommodations for individuals supporting the

recovery effort.

Personnel from other agencies may be called in to support the recovery efforts.

Recovery Management

The objectives and the functions are to:

1. Make a preliminary assessment of the damage.

2. Notify Health Commissioner and Board of Health on current status, impact to health

department and plan of action.

3. Work with EOC if disaster is declared.

4. Initiate the plan during the emergency situation.

5. Organize and control the Internal Command Centers as a central point of control of the

recovery efforts.

6. Organize and provide support to the recovery effort.

7. Retrieve offsite records and recovery information from offsite storage.

8. Report to the alternate site identified in their procedures.

9. Execute the business recovery procedures.

10. Communicate the status of the recovery to the EOC as needed.

11. Establish shifts for recovery team members to support the recovery effort 24/7.

12. Establish liaison with alternate site personnel if needed.

13. Support efforts to return to normal operations.

14. Reestablish support operations affected by the disaster.

15. Identify replacement equipment/software needed for recovery effort and to return to normal

operations.

Community Recovery Management Responsibilities

Emergency Medical/Healthcare Services

The health department may assist, in any way possible, with the recovery of local emergency

medical and healthcare services to full functionality. The health department may be able to assist

with replenishing depleted medical materials and other medical resources. The health department

may also provide first aide care and treatment to minor injuries and emergency healthcare (e.g. at

risk infants, emergent nutrition needs, etc.) within the range allowed by available resources and staff.

Mortuary Services



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The health department may assist the county coroner and funeral homes with implementing

procedures for the handling of bodies and burials following mass fatality events within the county.

See Appendix 5: Fatality Management for additional details

Mental Health Services

The health department may arrange for Critical Incident Stress Debriefing (CISD) and other

counseling services for victims and recovery workers OR for public health staff and other community

representatives. The health department has a written MOU with the Tri County Mental Health and a

verbal agreement with the local Red Cross to provide mental health services during emergencies

within the county. In the event that local mental health services are overwhelmed, the Health

Department Incident Commander or Liaison to the EMA/EOC will contact the Regional Coordination

Center or Regional Public Health Preparedness Coordinator to request mental health services from

the Regional Critical Incident Stress Management (CISM) team. The health department may also be

able to obtain mental health professionals through the Medical Reserve Corps. See Appendix 4:

Mental Health for First Responders for additional details.

Damage Assessment

The MCHD may coordinate with the local EMA, the Red Cross, and the OEPA in assessing the

damage of private septic systems, water well systems, and manufactured home parks within the

county. If public water and/or sewer systems are affected within the county, MCHD may assist with

assessing damage upon request from the municipality.

Decontamination of Affected Structures and Land

The MCHD may oversee decontamination to ensure inhabitability of homes and buildings. The

MCHD may provide direct guidance for the biological decontamination of buildings. For chemical

or radiological decontamination, the MCHD may coordinate with local HAZMAT groups and the Ohio

Environmental Protection Agency to ensure the structures are safe for people to inhabit.

Monitor Public Health Concerns

The MCHD may be responsible for the coordination of countywide surveillance of potential problems

related to private water supplies, private sewage disposal system failures, solid waste accumulation

and disposal, as well as: monitoring food storage, preparation and serving areas for shelters, food

kitchens, etc. and vector control. The MCHD may assist with surveillance of public water and sewage

disposal systems upon request from the municipality. Surveillance for disease outbreaks that may be

directly or indirectly related to the incident will also be conducted by the health department and the

regional epidemiologist.

Reconstruction

During the recovery phase of an emergency situation, the health department must use available

funds to begin the process of repairing any structural damage to the health department and

replacing any damaged equipment required for the health department to operate at full capacity.

Notifications to the Public

Public notifications are made as described in the MCHD ERP’s incident specific annexes, Annex 3:

Public Information and Warning in the MCHD ERP, and related implementing instructions.



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Document and Critique Incident Recovery

Documentation and critiquing is essential to capture what actions were taken and resources were

used/expended (including finances), evaluate what can be done to improve operational readiness,

highlight strengths and initiatives, and identify training and equipment shortfalls. This documentation

becomes the legal record for the incident.

ICS forms attached to the Meigs County Health Department Emergency Response Plan may be used

for financial and resource tracking for emergency situations.


Title Location

II: COOP Recovery:

Relocation Notification ERC Office

Temporary Location Site Considerations ERC Office

Generator User Manual ERC Office

Basic Recovery Steps ERC Office

RCC Personnel Management ERC Office

References

Title Location

Meigs County Health Department Personnel

Policies & Procedures

MCHD Server

Meigs County Emergency Response Plan Meigs County Emergency

Operations Plan on PHER

Coordinator’s bookshelf

Meigs County All Hazards Recovery Plan Meigs County Emergency



South Central Ohio Regional Public Health

Emergency Response Plan, Annex 7: COOP

& Recovery Plan

Meigs County Emergency





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Summary of Changes

1. Pg. 17 casualty to fatality FG 4/17/2014

2. Pg. 18 and 19- added document locations

3. 4/17/2015-cahnged footer date



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END OF DOCUMENT

Documents

Emergency Response Plan 2016 - meigs-health.com · Assistance and support for mass casualty and mass fatality incidents. Coordination with other local, regional, state, and federal