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MARITIME COMMUNICABLE

DISEASE EMERGENCY

RESPONSE PLAN

Guidelines for Response to Public

Health Emergencies

(Revised 2/28/2020: 6:30 p.m.)

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Definitions

Active Screening: Measures designed to detect ill persons and their contacts that are more thorough than usual screening procedures, and may include the use of health declaration forms, personal interviews, and public health assessment of suspected ill persons.

Cohort: Arriving travelers on a single vessel kept together for the purpose of processing while travelers from that vessel undergo public health primary screening or public health secondary screening; this typically occurs near the location of public health primary screening and before travelers pass through routine immigration, customs and agriculture processing.

Communicable Disease: A disease that is transmitted through direct contact with an infected individual or indirectly through a vector.

Conditional Release: Release of a traveler from public health restriction, such as quarantine and/or isolation under 42 C.F.R. Part 71, provided that the traveler agrees to certain conditions. Conditional release can be accomplished through an order that is enforceable to the same extent as an order for quarantine or isolation.

Contact: a person who has been in such association with an infected person or animal or contaminated environment as to have had opportunity to acquire that infection.

Contact tracing: Identification, location, and diagnosis of persons who may have come into contact with an infected source.

Isolation: The temporary holding of ill or potentially exposed travelers and/or crew at a Port of Entry or aboard a vessel while the threat to public health is being determined by the Director of CDC or while transportation to a medical or quarantine facility is being arranged, or the Quarantine facility is being established.

Entry Screening: The utilization of public health measures to detect ill international travelers and their contacts upon arrival at a U.S. port of entry.

Exit Screening: The utilization of public health measures to detect ill international travelers and their contacts before they depart from a U.S. point of embarkation to isolate the presence of active illness or recent exposure which may be associated with the development of future illness.

Infectious Disease: Any illness that is caused by a pathogenic microorganism (for example, virus, bacteria, fungi, or parasite). The terms infectious disease and communicable disease often are incorrectly used interchangeably.

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Abbreviations

MDPD Miami-Dade County Police Department

MDFR Miami-Dade County Fire Rescue

CBP Customs and Border Protection

CDC Centers for Disease Control and Prevention

CDCMQS Centers for Disease Control and Prevention Miami Quarantine Station

COTP USCG Captain of the Port

DGMQ Division of Global Migration and Quarantine

DOS US Department of State

EOC Emergency Operation Center

FBI Federal Bureau of Investigation

FEMA Federal Emergency Management Agency

FHD-MD Florida Department of Health Miami-Dade County

HHS Department of Health and Human Services

IC Incident Commander

ICE Immigration and Customs Enforcement

ICP Incident Command Post

ICS Incident Command System

IO Incident Officer

LHD Local Health Department

MSIB Maritime Safety Information Bulletin

MOA Memorandum of Agreement

MOU Memorandum of Understanding

NIMS National Incident Management System

PIO Public Information Officer

PLF Passenger Locator Form

PPE Personal Protective Equipment

SHD State Health Department

UC Unified Command

USCG United States Coast Guard

WHO World Health Organization

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1. INTRODUCTION

1.1. Port Miami (POM) is the Cruise Capital of the World as well as one of Florida’s leading

cargo container ports ranking No. 7 in the United States. Because of the sheer volume of traffic flowing through Port Miami, the potential exists for the rapid and widespread dissemination of a communicable disease within the U.S. Therefore, expeditious implementation of public health measures at POM provides an opportunity to prevent the introduction of communicable diseases into the United States.

1.2. This emergency response plan is a guideline that explains in general terms those procedures that POM would implement to address a communicable disease threat event and is subject to modification based on a specific communicable disease threat event. This plan is also not intended to dictate protocols or direct other lead or supporting agencies not under the authority of POM but rather to explain in general terms the assumed responses and protocols based on the lead and/or supporting agencies’ current published regulatory guidelines in order to facilitate the logical flow of the plan.

2. PURPOSE

2.1. To prevent the introduction, transmission, or spread of communicable diseases from foreign countries into the United States.

3. GOVERNING AUTHORITIES

3.1. Federal Quarantine Guidelines

3.1.1. Title 42 United States Code Section 264 (Section 361 of the Public Health Service Act) gives the Secretary of the Department of Health and Human Services (HHS) responsibility for preventing the introduction, transmission, and spread of communicable diseases from foreign countries into the United States and from one state or U.S. possession into another. This statute is implemented through regulations found at 42 CFR Parts 70 and 71. Under its delegated authority, the Centers for Disease Control and Prevention (CDC), through the Division of Global Migration and Quarantine (DGMQ), is empowered to apprehend, isolate, medically examine, or conditionally release passenger(s) and/or crew suspected of carrying a quarantinable disease. By mutual agreement, U.S. Customs and Border Protection (CBP) and the United States Coast Guard (USCG) are required to aid in the enforcement of

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quarantine rules and regulations. Violation of federal quarantine rules and regulations constitutes a criminal misdemeanor, punishable by fine and/or imprisonment.

3.2. Port Miami Quarantine Guidelines

3.2.1. Local authority of the Florida Department of Health – Miami-Dade County (FHD-MD) for quarantine falls under §381.0011(6), Florida Statutes (2004), Duties and Powers of the Department of Health. Human quarantine applies to all passenger(s) and/or crew that engage in the act of segregating, handling, disinfecting, testing, transporting, treating, caring for, and managing fatalities of humans, to eliminate and control exposure of disease-causing agents that pose hazards to the health of all Miami-Dade County visitors and residents. FS 381.0011 describes the "Duties and Powers" of the Department of Health. The FHD-MD will be responsible for guidance on the need for the isolation of symptomatic ill passenger(s) and/or crew and the quarantine of exposed passenger(s) and/or crew (who have not yet become ill). Quarantine is an official order that limits the freedom of movement and actions of passenger(s) and/or crew or animals that is deemed necessary in order to prevent the spread of a notifiable disease or other disease condition. The county health department director or administrator, or the State Health Officer shall determine which passenger(s) and/or crew or animals are subject to quarantine and shall issue appropriate instructions.

3.2.2. Quarantine orders shall be in effect for a time period in accordance with accepted public health practice. (Fla. Admin. Code 64D-3.007(1) (2004)).

3.2.3. Transportation or removal of quarantined passenger(s) and/or crew or animals may be made only with prior approval of the appropriate county health department directors or administrators, or the State Health Officer, or their designated representatives. (Fla. Admin. Code 64D-3.008(1) (2004)).

3.2.4. Transportation or removal of quarantined passenger(s) and/or

crew or animals shall be made in accordance with orders issued by the county health department director or administrator, or the State Health Officer, or their designated representatives. (Fla.

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Admin. Code 64D-3.008(2) (2004))

3.2.5. Quarantine shall be resumed immediately upon arrival of quarantined passenger(s) and/or crew or animals at point of destination for the period of time in accordance with accepted public health practices. (Fla. Admin. Code 64D- 3.008(3) (2004)).

3.3. POM Isolation of Passenger(s) and/or crew and Vaccination Guidelines

3.3.1. Section 381.00315(1)(b)(4), Florida Statutes (2004), provides that the State Health Officer is responsible for:

3.3.2. Ordering an individual to be examined, tested, vaccinated, treated or

quarantined for communicable diseases that have significant morbidity or mortality and present a severe danger to public health. Individuals, who are unable or unwilling to be examined, tested, vaccinated or treated for reasons of health, religion or conscience may be subjected to quarantine. (Fla. Stat. 381.00315(4) (2004)).

3.3.3. If the individual poses a danger to public health, the State Health Officer may subject the individual to quarantine. If there is no practical method to quarantine the individual, the State Health Officer may use any means necessary to vaccinate or treat the individual. (Fla. Stat. 381.00315(4)(b) (2004)).

3.3.4. Any person authorized by the State Health Officer may perform examination, testing, vaccination, or treatment. (Fla. Stat. 381.00315(4)(a) (2004)).

3.3.5. The Legislature has identified three classes of individuals who may refuse vaccination: (1) those who elect to do so for religious reasons (e.g. Christian Scientists), (2) those unable to consent (i.e. developmentally disabled or mentally ill), and (3) those who do not desire vaccination as a matter of conscience. (Fla. Stat. 381.00315(4) (2004)).

3.3.6. The Legislature has created a two-tier system to ultimately ensure and preserve the public health against unvaccinated individuals, even those claiming exemption under statute. (Fla. Stat. 381.00315(4) (2004)).

3.3.7. The State Health Officer may use "any means appropriate" to vaccinate

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or treat any individual. This stem language may be a necessity to obstruct spread of an epidemic. (Fla. Stat. 381.00315(1)(b)(4)(b) (2004)).

3.3.8. The Legislature grants this police power to health officials, instructing

them to act in a prudent manner during a bioterrorism event.

3.3.9. While the Health Department has the expertise to evaluate circumstances necessitating imposition of quarantine, it is unable to enforce quarantine with its present resources. The Health Department would rely upon the cooperation of local, state and federal law enforcement. The Legislature has provided the Health. Department with the authority to work with other agencies. (Fla. Stat. 381.0011(5) (2004)).

4. NOTIFICATION & REPORTING GUIDELINES

4.1. Vessel

4.1.1. Current federal regulations [42 CFR 71.21(a)] require the captain/master of a ship destined for POM to immediately report any death or any ill person among the ship’s passenger(s) and/or crew to the CDC Miami Quarantine Station (CDCMQS) at (305) 526-2910 or the CDC at (800-232-4636).

4.1.2. CDC requires the following basic information about the ill person to make an initial public health assessment: ill person’s name, age, nationality, country of residence, occupation, description of signs and symptoms, travel itinerary (going back three weeks), whether the person had exposure to animals, poultry or other passenger(s) and/or crew with a similar illness (going back three weeks), and suspected diagnosis, if known.

4.1.3. Notifications among responding agencies to a communicable disease

incident on an international vessel should be timely and redundant and a flowchart explaining the response to a vessel arrival with a suspected communicable disease is provided (see Appendix).

4.1.4. Consideration will be given to contacting the designated isolation or treatment facility/hospital, as soon as there is any indication that passenger(s) or crew will require isolation or acute medical care. The facility must be notified once absolute determination is made that an

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ill passenger is to be transported to it.

5. RESPONSE

5.1. Unified Command

5.1.1. In the event a Unified Command is directed and established, this plan will follow protocols and guidelines established within the National Incident Management System (NIMS) and this plan will be used to coordinate response activities.

5.1.2. The Unified Command (see Appendix) of an initial response group (see Appendix ) to a communicable disease emergency at POM may include one or more the following:

5.1.2.1. United States Coast Guard (USCG) 5.1.2.2. Customs and Border Protection (CBP) 5.1.2.3. CDC Miami Quarantine Station (CDCMQS) 5.1.2.4. Florida Health Department – Miami-Dade County (FHD-MD) 5.1.2.5. Port Miami (POM) 5.1.2.6. Miami-Dade County Fire Rescue (MDFR) 5.1.2.7. Miami-Dade County Police Department (MDPD)

5.1.3. Depending on the type and extent of the situation, the Miami-Dade County Office of Emergency Management (MDOEM) and/or the Miami-Dade County Emergency Operations Center (MDEOC) may be activated and one or more Emergency Support Functions (ESF) may be requested to provide additional response support.

5.2. Vessel Mooring and Anchoring Response

5.2.1. The captain/master of the vessel informs the passenger(s) and/or crew that they will have to remain on board until the CDC and MDFR or proxy have arrived and interviewed all necessary parties.

5.2.2. The captain/master of the vessel (with the help of CDC and MDFR

personnel) informs the crew and passengers as to the nature of the situation and the sequence of events.

5.2.3. The arriving vessel may be directed by the USCG Sector Miami to its

originally scheduled berth, or it may be directed to an alternate berth or anchorage.

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5.2.4. When a vessel must be quarantined, alternate anchorages and moorings will be identified by the POM and final selection of a place of vessel quarantine will be made by the USCG Sector Miami and the CDC and potentially other agencies and stakeholders on a case-by-case basis.

5.3. Shore-Side Response

5.3.1. The CDCMQS and MDFR with assistance from CBP, will interview passenger(s) and/or crew regarding symptoms, travel and exposure history. MDFR will conduct a public health assessment via phone CDCMQS until the CDCMQS on-call quarantine public health officer arrives.

5.3.2. Passenger(s) and/or crew who are acutely ill with signs and symptoms,

will be interviewed first utilizing a CDC provided investigation form.

5.3.3. The CDCMQS/FHD-MD will obtain passenger information from all passengers utilizing a Passenger Locator Information Form.

5.3.4. Those passengers who will require epidemiologic follow-up will be

given by CDC Possible Exposure Instructions and the CDC Traveler's Health Alert Notice (if indicated).

5.3.5. The CDC-Division of Global Migration and Quarantine (DGMQ) and the FDH Bureau of Epidemiology, will make a decision about the disposition of all the passenger(s) and/or crew.

5.3.6. Transport by MDFR will be done to the designated isolation or treating

hospital if any patient requires airborne isolation or acute medical care.

5.3.7. The composition of an initial response group to a communicable disease emergency may include one or more the following:

5.3.7.1. CDCMQS 5.3.7.2. CBP 5.3.7.3. USCG Sector Miami 5.3.7.4. MDFR 5.3.7.5. POM Representative 5.3.7.6. Vessel Company Representative 5.3.7.7. MDPD

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5.3.8. The CDCMQS and/or FHD-MD will board the vessel with MDFR to

perform an initial assessment to determine the extent of the health threat. Before boarding, the corresponding public health authority and MDFR will have available appropriate Personal Protective Equipment (PPE).

5.3.9. If a communicable disease emergency is suspected on the vessel, the

CDCMQS and FHD-MD personnel or their designated alternates will lead the illness response investigation, PPE guidance, and advise response activities of response staff.

5.3.10. If a quarantinable disease is suspected, and the isolation of passenger(s) and/or crew is required, the CDCMQS will follow DGMQ protocols and with the ass i s tan ce of the FHD-MD, activate a standing Memorandum of Agreement (MOA) with a designated hospital. The CDCMQS will request transportation by ambulance, ensure transportation personnel are briefed about the situation, and verify infection control procedures are in place.

5.3.11. It is assumed that in the event that quarantine is required for all passengers, a quarantine order will be obtained.

5.4. Quarantine Response

5.4.1. The CDCMQS may undertake one or more of the following in response

to a report of communicable disease among passenger(s) and/or crew on an arriving vessel:

5.4.1.1. Onboard public health assessment 5.4.1.2. Isolation of ill passengers(s) and/or crew 5.4.1.3. Identification and diagnosis of passengers(s) and/or crew who

may have come into contact with an infected passengers(s) and/or crew

5.4.1.4. Distribution of PPE 5.4.1.5. Collection of passenger(s) and/or crew locator information 5.4.1.6. Isolation or quarantine of exposed passengers(s) and/or crew

5.4.2. Conditional release of potentially exposed passengers(s) and/or crew following possible prophylactic interventions

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5.4.3. In the event that quarantine is required to protect the public’s health, whenever possible, onboard facilities should be used to the greatest extent possible. If/when necessary FHD-MD will coordinate for off-site facilities where passenger(s) and/or crew would be transported once initial public health assessment is complete.

5.5. Screening/Isolation

5.5.1. If the capability of the vessel does not have the capacity to serve as a secure health screening platform, POM Operations will secure health screening and additional facilities for passengers when isolation or quarantine is warranted. POM does not have an on-site building to initially screen passengers; only the use of terminals. Rented tents may be utilized to temporarily hold passengers until they can be transported to a suitable off-site facility.

5.5.2. A screening/isolation facility at which the vessel is moored will be considered for use for up to 72 hours. Passengers will be transported by bus to this facility.

5.5.3. For isolation beyond 72 hours, a suitable off-site facility designated by the FHD-MD will be set up to house individuals.

5.5.4. For restriction of movement beyond the number of hours stipulated in

the FHD-MD Human Quarantine Guidelines, a suitable off-site facility designated by the FHD-MD will be set up to house individuals.

5.5.5. Additional information about points of contact, procedures and timelines for seeking local/state, and/or federal orders to restrict movement is included in the FHD-MD Human Quarantine Guidelines.

5.6. Conditional Release

5.6.1. Under certain circumstances, the CDCMQS may conditionally release those passenger(s) and/or crew not deemed close contacts of the index case(s), allowing them to continue their travel. In such situations, the CDCMQS may request the help of local, state and federal agencies in the collection of passenger(s) and/or crew locator information, distribution of health information, possible administration of prophylaxis, and notification and tracking of the released passenger(s) and/or crew.

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5.7. Surge Capacity

5.7.1. In the event of a large scale public health emergency, the CDCMQS will request the help of FHD-MD and MDFR to assist with medical screening and triage, public health screening of ill and exposed passenger(s) and/or crew, distribution of health alert notices, administration of prophylaxis, and collection of personal locator information.

5.7.2. Federal surge capacity resources that will be requested may include CDC deployed staff, United States Public Health Service (USPHS) Commissioned Corps Officers and Health and Human Services (HHS) National Disaster Medical System (NDMS) staff, Regional Emergency Coordinators (REC) and other regional HHS personnel.

5.7.3. CDCMQS has the responsibility for providing training, equipment and overall management of surge personnel. Department of Homeland Security and Department of Public Safety has responsibility for badging of surge staff.

5.8. Media Communications

5.8.1. If Unified Command is established, all responding agencies will provide a Public Information Officer (PIO), or representative for the Joint Information Center (JIC) in accordance with NIMS. The PIOs are to coordinate talking points for press releases through the lead PIO as designated by the Incident Commander. If no Unified Command is established, POM PIO and the Miami-Dade County Office of the Mayor will be the lead.

5.8.2. CDCMQS and the FHD-MD will be responsible for supplying timely and

accurate health information to the lead PIO or the Incident Officer (IO) throughout the response event.

5.9. International Communications

5.9.1. Communication with international public health partners will be coordinated by the CDC.

5.9.2. The U.S. Department of State will be notified whenever any

international person is legally detained or quarantined, to verify the status of the passenger(s) or crewmember(s), and to confirm those

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claiming diplomatic affiliations. If a diplomatic pouch is present on board the vessel its disposition will be determined by the U.S. Department of State in consultation with the Incident Commander (IC).

5.10. Decontamination

5.10.1. Any vessel and/or facility deemed by CDC and other appropriate local/state agencies to need decontamination will be prohibited for use until designated as safe.

6. ORGANIZATIONAL ACTIONS

6.1. Port Miami

6.1.1. Port Operations

6.1.1.1. Coordinate with USCG Sector Miami, CDCMQS, CBP, personnel reference any inbound vessel with reported ill passenger(s) and/or crew on board.

6.1.1.2. Coordinate with USCG, CDC and FHD-MD for recommended

berth assignment and quarantine location.

6.1.1.3. Work with FHD-MD personnel to activate a quarantine

facility, as required.

6.1.1.4. Coordinate with federal, state, and local authorities on media relations and press management.

6.1.1.5. Arrange transportation for individuals who will be quarantined off-site.

6.1.1.6. Provide representative at the Incident Command Post if

Unified Command is established.

6.1.1.7. Coordinate with HHS/CDC and DHS/TSA representatives and vessel operators/agents to provide adequate space to conduct PHPS and PHSS.

6.1.1.8. Provide for traveler cohort staging areas prior to the Federal Inspection Service area, if cohosting is conducted ashore. Comfort measures should be included in the cohort area,

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such as seating (temporary if necessary), access to restrooms, water, etc.

6.1.2. Port Security Operations

6.1.2.1. Secure temporary isolation or quarantine location on Port property if required.

6.1.2.2. In conjunction with USCG, CDC and FHD-MD maintain, update

and exercise the Port of Entry’s (POE's) Communicable Disease Response Plan to properly reflect responder organization, responsibilities and resources.

6.1.3. Public Affairs Office

6.1.3.1. Coordinates with federal, state, and local authorities on media relations and press management.

6.1.3.2. During public health exit screening, post signage and deliver

public service announcements regarding the screening and its potential impact on travelers.

6.2. State and Local Public Health Departments

6.2.1. Provide support (upon CDCMQS request) in the preliminary assessment of ill person(s).

6.2.2. During active screening, conduct public health assessments of travelers at the Public Health Secondary Site (PHSS).

6.2.3. Collaborate with the CDCMQS in providing ongoing public health

assessments of quarantined passenger(s) and/or crew.

6.2.4. Coordinate communication of subject test results back to designated officials at POM.

6.2.5. Provide for mental health interventions for ill passenger(s) and/or crew

and passenger(s) and/or crew who have been exposed and are under quarantine.

6.2.6. Support a temporary detention or quarantine location on POM, if required.

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6.2.7. In the event of traveler’s potential exposure to a person infected with a quarantinable disease or disease or public health importance, coordinate contact tracing and notification with CDCMQS.

6.2.8. Notify Miami-Dade County Medical Examiner or Coroner, as required.

6.2.9. Coordinate with CDCMQS and other federal entities, as required, in issuing quarantine and isolation orders and in managing of quarantine and isolation.

6.2.10. Work with the POM Operations to activate the quarantine facility, as required.

6.2.11. Provide guidance to designated medical treatment facilities and/or the quarantine site medical clinic on the evaluation, diagnosis and clinical management of ill people, including assisting with arrangements for laboratory testing at Miami- Dade County or Florida state public health laboratories or at CDCMQS.

6.2.12. Provide clinical and public health information to Miami-Dade County health care providers and the public.

6.2.13. Provide public health information and recommendations to Miami-Dade County and Florida state authorities.

6.2.14. Coordinate with CDCMQS on public health recommendations and implementation of protective measures, as required and collaborate with the POM PIO or JIC to develop and authorize information for the detained individuals, responders, the media, and the public.

6.3. Miami-Dade County Fire Rescue (MDFR)

6.3.1.1. When requested, assist FHD-MD in conducting a preliminary public health assessment upon arrival to determine if the individual requires medical treatment and whether the person is ill with a quarantinable disease or a disease of public health importance.

6.3.1.2. If a determination to transport a passenger with a suspect

quarantinable disease or disease of public health importance is made by CDC (or Designee), FHD-MD and CDC (or designee)

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shall notify appropriate isolation and/or medical treatment facility.

6.3.1.3. Remove the ill person from the vessel and transport that traveler by ambulance to the designated medical treatment facility after CBP clearance or medical parole.

6.3.1.4. Assist the public health responders and other on-site

healthcare providers and coordinate actions with CDC personnel.

6.4. Miami-Dade County Emergency Management Agencies

6.4.1. Assist and support FHD-MD with supportive measures if quarantine

facilities are activated.

6.4.2. Work with POM, FHD-MD, MDFR, and MDPD to support the planning and preparation activities to operate quarantine facilities.

6.4.3. Seek assistance from the Federal Emergency Management Agency

(FEMA), as required.

6.5. Miami-Dade County Police Department (MDPD)

6.5.1. Provide security for arriving travelers between the vessel and the public health screening areas, in the cohort staging areas, and beyond the isolation and quarantine facilities, as required.

6.5.2. Upon vessel arrival, establish a security perimeter, secure the vessel,

and perform crowd control, as required.

6.5.3. Ensure law enforcement responders have access to appropriate PPE.

6.5.4. Enforce required actions (such as isolation, and quarantine) for ill passenger(s) and/or crew or passenger(s) and/or crew who have been exposed to an illness, as necessary.

6.5.5. Provide escort to ensure the security and enforcement of appropriate isolation and quarantine orders.

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6.5.6. Support a temporary isolation or quarantine location with MDPD oversight.

6.6. Miami-Dade County Medical Treatment Facilities

6.6.1. Receive, isolate, evaluate and treat ill passenger(s) and/or crew, as medically indicated. Maintain infection control measures to limit the spread of quarantinable diseases. This may include isolation of ill passenger(s) and/or crew and use of PPE by staff and visitors, as medically indicated.

6.6.2. Obtain specified diagnostic specimens and ensure that the specimens

are promptly and safely transported to designated laboratories.

6.6.3. Screen exposed passenger(s) and/or crew and evaluate those who develop illness signs or symptoms while in quarantine.

6.6.4. Provide clinical and laboratory diagnostic information to federal, state, and local public health authorities.

6.6.5. Report cases, suspect cases, laboratory confirmation, and/or diagnoses

immediately to appropriate public health authorities.

6.6.6. Coordinate with public health authorities on media relations.

6.6.7. Coordinate with local law enforcement for ill travelers placed under isolation orders or quarantine orders.

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Appendix A – Notifications

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Customs and Border Protection

(305) 536-4758 CDCMQS

USCG COTP Sector Miami

USCG COTP Sector Miami

(305) 535-4302 Commander Jose Perez

CDCMQS CBP

POM Operations

VESSEL

CDC Miami Quarantine Station

(786) 459-3831 Michele Decenteceo

CBP USCG COTP Sector Miami

FHD-MD CDCMQS

Appendix B – General Response Protocol

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CDCMQS Notifies FHD-MD

Ill Person(s) identified onboard Inbound Vessel

Vessel Captain/Master or agent Notifies CDCMQS

Vessel Captain/Master or agent Notifies USCG Sector Miami

USCG Sector Miami Notifies CBP & POM

Consult CDC DGMQ for Isolation

Quarantine Orders

Ill Passenger(s) and/or crew Diagnosed at Hospital, Physician Notifies CDCMQS and FHD-MD

Vessel to be met at POM arrival by CDCMQS, USCG Sector Miami, CBP and MDFR staff

CDCMQS to Assess Threat to Public Health (MDFR and FHD-MD to assess if CDC not on site)

Communicable Disease Suspected?

YES NO

Isolation and/or Quarantine Necessary Onboard Vessel?

Is Stand-Up Facility Required Off Vessel?

YES NO NO YES

Communicable Disease Emergency Response Plan

Implemented

Notification to Local Hospital Emergency Plan Notifications

EMS to Transport to Hospital EMS to Transport Ill person(s) to Hospital

END

POM Notifies MDFR / MDHD

Appendix C – POM Entry Quarantine Response Timeline

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TIME PORT ACTIVITY PHASE

ZERO HOUR

+ 4 HRS

+ 8 HRS

+ 72 HRS

ALERT

ASSESS

RESPONSE

QUARANTINE ACTIVATION

Quarantine of Exposed Persons

Short Term Quarantine Facility Established

Illness identified aboard arriving vessel

Response and medical / public health evaluation

Consultation for quarantine order

Federal Quarantine Order requested

Stand-up Port Quarantine Facility or Detain on board

Appendix D – Incident Command

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Unified Command Incident Commander (TBD)

Command Staff PIO - Safety - Liaison - Law

Operations CDCQSM

USCG Sector Miami CBP

FHD-MD POM MDFR MDPD

Quarantine Treatment

Coordination Security

Mass Casualty Mass Fatality

Admin/Finance FHD-MD

POM MDFR MDPD (EOC)

Planning FHD-MD POM MDFR MDPD (EOC)

Logistics FHD-MD POM MDFR MDPD (EOC)