1. A Tale of Many towns - cross- discipline health and medical preparedness Sean M. O’Brien, Coordinator Barnstable County Regional Emergency Planning Committee Terence Hayes, Director Dennis Health Department October 2015

2. Building Our Foundation The Formation of the Barnstable County Regional Emergency Planning Committee

3. First, A Little Geography Cape Cod is peninsula in Southeast MA. Barnstable County encompasses Cape Cod We have fifteen communities in the County Martha's Vineyard is Dukes County Nantucket is Nantucket County

4. A Little More Geography We are “Geographically Connected” Year round population of 218,000 Summer population 800K+ Surrounded by water on all sides Limited ingress and egress.

5. Cape Cod Towns Provincetown Truro Wellfleet Eastham Orleans Brewster Chatham Harwich Dennis Yarmouth Barnstable Mashpee Sandwich Falmouth Bourne

6. Next, A little History The Barnstable County Department of Health and Environment (BCDH&E)was established by act of Massachusetts Legislature in 1926. BCDH&E provides support to the 15 communities in Barnstable County.

7. October 12, 2001, Our Start in EP September 11 th Public Health/HAZMAT Event Anthrax at press outlets/The U.S. Capital Over 100 HAZMAT Calls in SE MA

8. What is an LEPC? Local Emergency Planning Committee Regional Emergency Planning Committee (REPC) 1986 Superfund Amendments and Reauthorization Act (SARA Title III) Emergency Protection and Community Right to Know Act (EPCRA) An LEPC is a group of first responders et al in a community to plan, train and prepare for hazardous materials emergencies in that community.

9. Emergency Planning and Community Right to Know Act. Our vehicle for regionalizing emergency preparedness efforts for Cape Cod First established to address EPCRA compliance for the communities that participate. The structure outlined a multi-disciplined and multi- jurisdictional format. We knew we could use this as a foundation for and “All Hazard” approach to emergency preparedness efforts for our region. As a region we prepare to be on our own for emergencies for 48-72 hours before support arrives.

10. Membership 15 communities on Cape Cod and Nantucket SARA Title III mandates we have the following 13 disciplines o Public Health o Environmental o Police, Law Enforcement o Fire o Emergency Medical Services o Health Care/Hospital o Local Political o Emergency Management o Community Groups o Broadcast/Print Media o HAZMAT Facility Operators o Disaster Relief Agencies o Transportation Agencies We added o Regional Communication Centers

11. The Players on Cape Cod 15 Health Departments and Boards of Health 15 Police Departments 20 Fire Departments with EMS services 1 Regional EMS support agency. 1 Regional Planning Agency 2 Hospitals 5 Community Health Centers 1 Power Company 1 Sheriff’s Department (Communication) 15 Departments of Public Works 1 Regional Transportation Agency 1 Chapter American Red Cross 2 Medical Reserve Corps (Until 2008) Etc.…

12. SARA Title III Structure helped bring the groups together. BCDH&E was chosen for this task because we were not a public safety agency. “Neutral” We built the committee on existing associations and by working with a progressive multi-disciplined steering committee. o NEXTEL By regulation, SARA Title III requires a cross disciplined group to do the emergency planning, so it seemed fitting to use the structure to plan for other types of emergencies as well. Each Discipline had a role for the project and Program. “All Hazard “ The REPC has served as a foundation for emergency planning activities on Cape Cod.

13. SARA Title III Structure SARA encourages Multi-disciplined Collaboration. Title III has 4 Major Sections o Emergency Planning o Emergency Notification o Community Right to Know Reporting Requirements o Toxic Chemical Release and Emissions Inventory Reporting

14. What is the BCREPC? The Barnstable County Regional Emergency Planning Committee is a Regional “All Hazard” Multi-disciplined Emergency Planning Organization. We are a Support Function for the Participating Communities and Agencies. 15 Towns in Barnstable County and Nantucket Map from www.capecodfds.com

15. Development of a Regional Hazardous Materials Response Plan A regional Hazardous Materials Response Plan was developed for the 16 Communities. o The response would be from a regional Hazardous Materials Response Team o There is a strong mutual aid plan in place with the fire departments We established a Planning and Readiness Subcommittee to draft the Plan. o “Too Many Cooks Spoil the Broth” o Written by 2 people o Modeled after Military Plan o It was written in a Health Department Job Action Sheets Were developed for the plan. o Will aid jurisdictions with responsibilities

16. “ “All Hazard” Emergency Preparedness A Multi- disciplined “ All Hazard” approach is a must for the four phases of disaster management.

17. Mitigation How do we minimize the effects of an emergency event? o building codes and zoning o vulnerability analyses o public education o Pre-disaster mitigation program

18. Preparedness How do we plan to respond to emergency events? o Emergency Response Plans o Exercises, Drills and Training o Utilization of Warning Systems o Multi-disciplined planning committees

19. Response What are the efforts to minimize the hazards created by a disaster? o Evacuation/Search and Rescue o Emergency Relief Sheltering o MACC/EOCs

20. Recovery How do we bring the community back to a normal state? o Temporary Housing/Sheltering o Grants/Financial Support o Medical Support

21. How We Built the Structure Formation of the Cape and Islands Health Agents Coalition

22. Establishment of a Health Agents Coalition In 2006 we were asked to serve as the fiduciary agent for the a regional Health Agents Coalition. BCDH&E would be coordinating a regional public health emergency preparedness program with 23 communities on Cape Cod, Martha’s Vineyard and Nantucket. Each BCDH&E staff member was assigned communities to serve as a liaison with developing response plans 3 public health nurses were hired to serve as planners and were assigned regions to assist the communities with plan development

23. Public Health Emergency Planning on the Cape and Islands Emergency Planners and Liaisons were tasked with helping each of the 23 communities develop emergency response plans It was determined that individual community plans may be more appropriate than 1 regional plan. o There are differences in how each health department operates o Contracts with visiting nurse associations o Martha’s Vineyard developed a regional plan The plans developed were also used to build and strengthen relationships with the other agencies in the community. Mutual Aid with All of our 23 Communities.

24. Increase Communications Capabilities Our Public Safety Component allowed us to expand into radio communications One of the first tasks of the coalition was to increase communication capabilities. As part of a Homeland Security Grant, each fire and police chief received a new 800 MHz radio. The chief’s had to provide a functioning Radio to the Health Agent

25. State Police Radio System A talk group for the health agents was established on the State Police 800 MHz system. Used Grant $$ to purchase additional radios. Each town has 2 or 3 radios. Conducted weekly drills

26. Hospital Surge In 2006 The HAC Cape Cod Health Care and the REPC began the development of a hospital surge plan for a potential influenza pandemic. This plan was regional.

27. Cape Cod Medical Reserve Corps Dennis Church of the Nazarene established. Great Foundation and successful. Falmouth Hospital established a chapter as well In 2007 the MRC chapters were absorbed by the Cape and Islands Health Agent’s Coalition

28. MRC 2009 H1N1 Influenza Response MRC Volunteers supported the 15 communities on Cape Cod with vaccine clinics. The labor hours of the volunteers were able to offset costs to the communities. MRC Coordinator identified supplies and equipment needed for response. Cape and Islands Coalition returned almost 300K of PHER funding to Commonwealth. Event was a successful test of the local response plans.

29. How the Cape and Islands Health Agents Coalition and BCREPC Supported Local Planning Efforts Terence Hayes, Director Dennis Health Department

30. Cape Cod Medical Reserve Corps Cape & Islands Health Agents Coalition took responsibility for the MRC in 2007. Provide medical and non-medical volunteers for emergencies and on-going public health initiatives.

31. Community Emergency Response Team Trained in basic disaster response skills o fire safety o light search and rescue o team organization o disaster medical operations. CERT members are encouraged to take an active role in emergency preparedness projects

32. Barnstable County Incident Management Team Follows FEMA Incident Command and Incident Management standards Uses ICS standard operating procedures within the framework of the National Incident Management System (NIMS). Either augments ongoing operations through provision of infrastructure support or, when requested, transitions to an incident management function

33. Multi Agency Coordinating Center

34. Regional Shelters

35. Better Prepared

36. 2006 PODS Drill

37. 2009 Drive-thru PODS Drill

38. Less Stressed!

39. Overview of the Barnstable County Regional Sheltering Plan and the Barnstable County MACC Multi-disciplined and Multi-Jurisdictional Emergency Planning Effort

40. Health and Medical Coordinating Coalitions There has been quite a bit of discussion across the Commonwealth of using the Multi Agency Coordination Center (MACC) concept for emergencies. Here is why we use it on Cape Cod

41. The Benchmark Event On December 9, 2005, a tropo- pause fold struck Cape Cod. o Temperature Drop o Power Outages o Shelters Opened o Lack of Cots o Lack of Supplies o Lack of volunteers

42. 2005 Shelter Conditions 31 Shelters across Cape Cod Total 600 cots in the region Red Cross only NGO agency supporting effort

43. Consolidation and Regionalization of Shelter Operations After the December 9, 2005 storm, BCREPC as instructed to… Develop a regional shelter program for the 15 Towns on Cape Cod o Consolidate number of shelters o Expand NGO Participation (More Volunteers) o Expand Shelter Capabilities o Funding Protocols Develop a resource mechanism to centralize resource requests o MACC Concept used o Regional Situational Awareness

44. Regional Sheltering Initiative Locations o Nauset Regional HS, Eastham o Cape Cod Technical HS, Harwich o Dennis Yarmouth Regional HS o Barnstable IS o Falmouth HS o Sandwich HS Veterans School Provincetown. (Satellite) Bournedale School. (Satellite) Each Shelter is supported with a CONNEX Box of Supplies. 5000 cots and sleeping pads across the Cape. Shelters have been opened for many weather events since 2008. A small county budget and grants are used to support the program. Full Service Partner Shelters o MRC, ARC, CERT, DART, ARES

45. Regional Sheltering Case Study: NEMO February 2013 Blizzard 12 Operational Periods 3 Shelters Opened o Sandwich o Nauset o Dennis Yarmouth Shifted Upper Cape Shelter to Falmouth Issues o Volunteers o Facilities and Generators o Feeding o Transportation o Cape Cod Hospital o Nursing Homes/Facility Drop Offs

46. Regional Sheltering Initiative Review Readjustment of the Plan o MOUs with Medical Supply Companies o MOUs with Nursing Agencies Will address Hospital Issues Nursing Homes o MOUs with Additional Volunteer Agencies o All Shelters Now Open o Look at Generators at Shelters o Centralized Kitchen

47. Barnstable County Type 3 Incident Management Team Multi Disciplined teamed formed to support command structure during a major event. Extensive FEMA and MEMA ICS Training and Position Specific Training in ICS Roles. They never take over an incident, Support with ICS On Cape Cod o Supports Planned and Emergency Events o Supports a Multi Agency Coordination Center (MACC )

48. Multi Agency Coordination Center The MACC is operated to assist our region with resource management and support of regional plans (Sheltering) BCREPC Executive Committee determines if shelters open and to make MACC operational. Maintain contact with ESF 8 desk at MEMA for sheltering issues. MACC is staffed by the BCIMT. It most often provides support to the communities with storm response. Ex. NSTAR, Shelter, MEMA

49. Multi Agency Coordination Center The MACC would be used for “All Hazard Response” In certain responses it may be mobile. The community maintains the Incident Commander Role. The MACC provides the region with one voice with regional coordination

50. MACC During January 2015 Blizzard The MACC Concept has been very successful for our region. It is in 24-7 operation and provides constant situational awareness.

51. MACC During February 2015 Blizzard This concept can be used successfully for all types of emergencies.

52. MACC Concerns The MACC is not an Emergency Operations Center, Operations for the emergency are done at the local level. (Except Sheltering) We are not taking over the event. Our MACC is run primarily by volunteers. Personnel issues may arise for long term events. Communities working outside of the MACC structure for resource requests.

53. Projects for Collaboration in an HMCC Determine if a regional approach is warranted for Specific Response Plans Subject Specific Response Plans o Sheltering o Ebola Development of Medical Reserve Corps for your Region

54. Projects for Collaboration in an HMCC Develop a Volunteer Reception Center Plan. o Process Just in Time Volunteers o 3 VRCs Across The Cape Develop an Incident Management Team for Your Area. Initiate a Multi- disciplined Training and Exercise Program

55. The End Any Questions? Terence Hayes Email: o thayes@town.dennis.ma.us Phone o 508-760 6158 Sean M. O’Brien Email: o bcrepc@barnstablecounty.org Phone: (508)-375-6618 Website: o www.bcrepc.org