1. ESF8: Medical Surge Planning and Coordination
Emergency medical surge planning in your County and the value of integrating medical and non-medical volunteers into your plan
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2. Emergency Support Function #8- Health and Medical (ESF8)
ESF8 is a system of health and medical agencies that are coordinated in an emergency based on a common set of established plans, tools and resources in order to meet specific outcomes that affect the health and medical care of those involved in the incident (casualties and responders.)

3. ESF8 as a System
NIMS/ICS principles apply to incident response but not always to EOC management
Existing system of relationships become extended beyond agency/jurisdictional boundaries
Examples: Infection Control, Patient triage and tracking, Surge staffing for Alternate Care Facility
ESF8 System Models
Basic: agency-agency
Intermediate: multi-agency, limited number of ESFs
Complex: multi-agency, multi-jurisdictional, full EOC response

4. ESF8 as Outcomes Effective Patient Tracking
Effective coordination in response (resolves differences among agencies)
Efficient utilization of resources
Efficient and rapid response and request for support
Common operational model (local, state, federal)
Ensures agency response is competent based on agency/discipline standards
Strategic guidance and direction
Do these fit your county?
Are there others?
Can you quickly determine what your priorities would be if you were requested by the EOC? Or requested by other ESF8 agencies?

5. Emergency Response Time Level of Response Complexity Analysis
ICS Level Change
Authority Change
Emergency
Operations Center
Departmental
Operations Center
Departmental
Operations Center
Level of Response
Daily
Organizational Objectives
Daily
Organizational Objectives
Time

6. Where did ESF originate?
National Response Framework- assigned federal agencies to “Emergency Support Functions”:
Guidance: “Governments at all levels should use the NIMS resource management principles described below to enhance response capabilities.”
State Emergency Operations Plan (SEOP)
County Emergency Operations Plan (Contains ESF annexes)
Post 9-11 mandate to remove the “silos” that limit communication between organizations.
“Seat” in the EOC/MACG?
Ops vs. non-ops. Where will you fit in?
Define all Acronyms
“Seat” in EOC is a incident specific= Mass Casualty, ESF8 seat might be EMS…coordinating patient transfers.
THE ESF SEAT is really a liaison role at the county level to engage in coordination and resource support for that particular Emergency Support Function. Sometimes the role will be more operational (i.e. coordinating the delivery of medical resources) and sometimes it will be more non-operational (informing other ESFs and the emergency manager of a particular area of concern or resource capability.)

7. National Response Framework (NRF)
Framework Document (Base Plan)
Support Annexes
Incident Annexes
Emergency Support Function (ESF) Annexes
Outline agency responsibilities for coordination, planning, support, resources, program implementation, and services during emergencies
ESF #11 - Agriculture and Natural Resources
ESF #12 - Energy
ESF #13 - Public Safety and Security
ESF #14 - Long-Term Recovery/Mitigation
ESF #15 - External Affairs
ESF #1 - Transportation
ESF #2 - Communications
ESF #3 - Public Works, Engineering
ESF #4 - Firefighting
ESF #5 - Emergency Management
ESF #6 - Mass Care, Housing
ESF #7 - Resource Support
ESF #8 - Public Health, Medical, Mortuary
ESF #9 - Urban Search and Rescue
ESF #10 - Oil and Hazardous Materials
NOT JUST Physicians… everybody has a role!

8. Colorado Emergency Support Functions
1. Transportation
6. Mass Care, Housing &
Human Services
11. Agriculture & Natural
Resources
2. Communications
7. Resource Support
12. Energy
3. Public Works & Engineering
8. Public Health & Medical
8a . Mental Health
13. Public Safety & Security
4. Fire Fighting
4a. Wildfire Suppressions
9. Search & Rescue
14. Long Term Community Recovery & Mitigation
5. Emergency Management
10. Oil & Haz Mat Response
15. External Affairs

9. ESF #8: Public Health, Medical, Mortuary
CDPHE can provide local jurisdictions the following types of support:
Health Surveillance
Biological Hazards Consultation
Pharmaceutical Supplies and Distribution
Assessment of Health/Medical Needs
Health/Medical Equipment and Supplies
Medical Care Personnel
Mortuary Services
Food and Drug Safety
Potable Water/Wastewater
Solid Waste Disposal
Radiological and Chemical Hazards Consultation
Vector Control
Environmental Impact Assistance
Public Health Information
ESF #8 is responsible for providing public and environmental health, medical and mortuary assistance to local governments in the care and treatment for the ill and injured by mobilizing trained health and medical personnel, medical transport, emergency medical supplies, materials and facilities to the area(s) in need. Other activities include disease and vector control, and the collection, identification and protection of human remains when local resources are depleted. In addition, there is a component of ESF#8 that addresses the provision of mental health care during a disaster.
This slide lists the various services that CDPHE can provide to local jurisdictions during an emergency if needed. Although we are identified as a lead ESF 8 agency, it is important to point out that we are responsible, but we are not necessarily the ones doing the work. For example, for mortuary services we’re a lead in planning for mass fatality, but the coroner or physician in the hospital has the authority for death declaration. Also, Mental Health is part of ESF8 response, but the department of health and human services are the ones responsible for addressing mental health response in Colorado.
As every public health agency is unique, as is every county, your local health department or nursing service may not provide all of the services listed here. For example, Alamosa County Nursing Service doesn’t provide environmental health services in their county. Instead, these services are contracted and provided by CDPHE. As a county, emergency management and public health must work together to determine who the lead agency for ESF#8 is at the local level and what agencies and organizations can provide the various public health, medical and mortuary functions needed during local emergencies and disasters.
ESF 8: Public Health and Medical

10. Organization Participant
Functional Role
Organization Participant
Public Health Authority
Local Public Health Department
Hospitals
Trauma Centers
Critical Access Hospitals
Veteran’s Hospitals
Private Physicians
Medical Society
Independent Physicians Association
Primary Care Offices
Emergency Medical Services (EMS)
Fire Department, EMS Services
EMS Coordinator
Mental Health
Department of Human Services
Mass Fatalities Management
Coroner
Can you think of other ways physicians might collaborate/coordinate?

11. Event Transportation Environmental Protection Agency
Level 1
Local, State, Federal
Response
Federal Declaration
Department of Justice
Health & Human Services
Environmental Protection Agency
Federal Emergency Management Agency
Department of Energy
Department of Defense
Interior
Transportation
General
Services
American
Red Cross
Other Federal
Agencies
Transportation
COVOAD
volunteers
Human
Services
Military
Affairs
Governors’
Office
Governor
Local
Public
Health &
Environment
Others
Level 2
State, Local Response
State Declaration
Personnel and Admin
Safety
Higher Education
Div of Emergency Mgmt
Dept of Agriculture
Natural Resources
Local Affairs
Regulatory
County
Commissioners
City Council
Response
Teams
Level 3
Regional Response
Others
Police
Dept
Fire Dept
City
Council
Public
Works
Citizens
Groups
EMS
Hospitals
Level 4
Local Response
Local HD
Other
Disaster
Event
Emergency
Manager
Disasters/incidents escalate and involve all aspects of incident command at the varying response levels. Each organization/agency has a designated role. ESFs form the backbone of organizing the response/support.

12. Must ESF8 be activated by emergency management?
Activation
Must ESF8 be activated by emergency management?
No. ESFs are able, through their own planning and collaboration processes to function and coordinate prior to formal activation through the Emergency manager and the EOC.

13. Medical Surge ESF8 Activation Thresholds
Patient surge exceeds county
Medical Resources exceed availability in county
Patient surge exceeds hospital
Medical Surge
Hospital needs additional resources
Consider activating Mesa County Hospital Coordination Center
Consider activating Mesa County Multi-agency Coordination Group
Consider Declaration of Emergency

14. ESF8 Planning Committee Mission Statement:
“The County Emergency Support Function 8 Planning Committee (ESF8 Committee) is a multi-disciplinary, coordinating group representing ESF8 agencies and organizations. The Committee addresses critical healthcare needs in our Community. The ESF8 Committee develops strategies and solutions which synchronize the use of diverse healthcare resources during emergencies or disasters affecting County.

15. ESF 8 On the Ground County Health Department
Medical Supply Caches/Warehouse
Communications Center
Hospital Coordination System or Hospital Designee
Emergency Medical Services
County Healthcare Coordination System (HCS)/ESF8
Medical Reserve Corps
State PH Liaison
Regional Liaisons
CDEM/RETAC/Public Health
Hospital #1
Hospital #2
Hospital #3
TIER III
TIER I
TIER II
TIER IV
VA Hospital
County Emergency Operations Center (EOC)
EMS Agencies
Primary Care & Medical Offices
Human & Environmental Health

16. Basic Response Example: Agency to Agency
Hospital-EMS
Public Health- Hospital ICP
Small school bus starts on fire…smoke inhalation…no casualties- only worried well to transport.
Nursing home/hospital/clinic norovirus outbreak.
How would this evolve into a larger effort with more staff/agencies/facilities
Other examples?

17. Intermediate Response Example: Multi-Agency, Multi-Jurisdiction, Limited Number of ESFs
Alamosa, CO, Salmonella (ESFs 3, 5, 8, and 15)
Limited geographic area flooding/natural disaster.
Chemical hazmat spill response with casualties.
H1N1? Intermediate or severe? Where were we at?
Alamosa- let the participants decide what the org chart MIGHT HAVE LOOKED LIKE in their county.
Pick the disaster of you choice and support it’s reasonableness.
ESF8 partners should be planning around “LIKELY SCENARIOS” . The goal of this committee (ESF8) is to identify those initially in the planning.

18. Complex Response Example: Multi-Agency, Full EOC Response
Catastrophic natural event (Snowstorm, outbreak, flooding)
Pitkin County, CO- Dirty bomb/mass casualty
Train derailment (i.e. Silverton-Durango, Amtrak)
Dr. Tice/Cameron, help with support for Haiti.