1. ESF8: Medical Surge Planning and Coordination AGENCY LOGO

2. PURPOSE: FOSTER EMERGENCY MEDICAL SURGE PLANNING IN YOUR COUNTY AND INSTILL THE VALUE OF INTEGRATING MEDICAL AND NON-MEDICAL VOLUNTEERS INTO YOUR RESPONSE PLANS A presentation from the Blueprint for the Use of Volunteers in Hospitals and Rural Medical Centers

3. Emergency Support Function (ESF) 8 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)

4. ESF8 as a System NIMS/ICS principles apply to incident response but may not always to processes for Emergency Operations Center (EOC) management Public health and medical relationships may become extended beyond normal functional and jurisdictional boundaries in incidents –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

5. 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

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

7. Where did ESF originate? National Response Framework- assigned federal agencies to “Emergency Support Functions”:National Response Framework- –Guidance: “Governments at all levels should use the NIMS resource management principles described below to enhance response capabilities.” 1 –State Emergency Operations Plan (SEOP) –County Emergency Operations Plan (Contains ESF annexes) –Post 9-11 mandated ESFs to remove the “silos” that limit communication between organizations. ESFs are a “seat” in the EOC/MACG –Some are Operations, vs. some that are non-operations oriented. Where will you fit in? 1 http://www.fema.gov/pdf/emergency/nrf/nrf-core.pdfhttp://www.fema.gov/pdf/emergency/nrf/nrf-core.pdf

8. 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

9. Some examples of County Emergency Support Functions 1. Transportation6. Mass Care, Housing & Human Services 11. Agriculture & Natural Resources 2. Communications7. Resource Support12. Energy 3. Public Works & Engineering 8. Public Health & Medical 8a. Mental Health 13. Public Safety & Security 4. Fire Fighting 4a. Wildfire Suppression 9. Search & Rescue14. Long Term Community Recovery & Mitigation 5. Emergency Management 10. Oil & Hazardous Materials Response 15. External Affairs

10. ESF #8: Public Health, Medical, Mortuary The State Health Department can often 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

11. Functional RoleOrganization Participant Public Health AuthorityLocal Public Health Department HospitalsTrauma Centers Critical Access Hospitals Veteran’s Hospitals Private PhysiciansMedical Society Independent Practice Associations Primary Care Offices Emergency Medical Services (EMS) Fire Department, EMS Services EMS Coordinator Mental HealthBehavioral Health Organizations (BHOs) Mental Health Organizations (MHOs) Mass Fatalities ManagementCoroner ESF8 Functional Roles

12. Level 1 Local, State, Federal Response and Federal Declaration Department of Justice Health & Human Services Environmental Protection Agency Federal Emergency Management Agency Department of Energy Department of Defense Department of the Interior Department of Transportation General Services American Red Cross Other Federal Agencies Transportation COVOAD volunteers Human Services Military Affairs Governors ’ Office Governor Local Affairs Public Health & Environment Others Level 2 State, Local Response State Declaration Personnel and Admin Public 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 Public Health Other Disaster Event Emergency Manager

13. Activation Must ESF8 be activated by emergency management?

14. Medical Surge ESF8 Activation Thresholds Consider declaration of emergency Hospital needs additional resources Patient surge exceeds hospital Consider activating Hospital Coordination Center Consider activating Multi-Agency Coordination Group Medical resources exceed availability in county Patient surge exceeds county

15. ESF8 Planning Committee Mission Statement 1 : “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 our county.” 1 Mesa County ESF8 Planning Committee, Mesa Count y, Colorado

16. ESF8 On the Ground 1 County Health Department Emergency Medical Supply Cache Human & Environmental Health Regional Communications Center Emergency Medical Services County Healthcare Coordination System (HCS)/ESF8 Volunteer Groups State EOC Regional Liaisons (e.g., MMRS) Hospital #2 Hospital #3 Hospital #4 TIER III TIER ITIER IITIER IV Hospital #1 County Emergency Manager/ Operations Center (EOC) EMS Agencies Primary Care & Medical Offices Behavioral Health/Mental Health Hospital Coordination System or Hospital Designee 1 Mesa County ESF8 Planning Committee, Mesa Count y, Colorado

17. Basic Response Example: Agency to Agency Hospital-EMS Public Health- Hospital Infection Prevention Coordinator

18. Intermediate Response Example: Multi-Agency, Multi- Jurisdiction, Limited Number of ESFs City water system salmonella outbreak (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?

19. Complex Response Example: Multi-Agency, Full County EOC Response Catastrophic natural event (Snowstorm, outbreak, flooding) Dirty bomb/mass casualty Train derailment (e.g., Amtrak)

20. Next Steps: Identify common community health assessments and hazard mitigation plans. Host a strategic planning meeting with your public health and medical partners. Work with your emergency manager to create a common training and exercise plan. Host regular meetings to discuss gaps in planning, training and exercising. Identify state and regional resources to support training in the Homeland Security Exercise and Evaluation Program (HSEEP), ICS/NIMS, and Target Capabilities based planning.