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 AGENCY LOGO

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.)

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

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?

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

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.)

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!

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

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

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?

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.

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.

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

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.

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

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?

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.

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.