1. Developing and Implementing an Approach to “All Hazards Emergency Response” Jim Price, Tacoma-Pierce County Health Department

2. Session Objectives Know the difference between a plan and a procedure Understand how to organize a set of Emergency Plan and Implementing Procedures (EPIPs) Know the steps to develop an EPIP Understand the need for a process for administrative review and approval

3. A.100% B.50-99% C.25-49% D.<25% Poll Question 1 In my opinion, the percent of staff in my health department who understand the difference between a plan and an implementing procedure is:

4. “Plan” Document containing policies and response requirements Not a list of steps/job actions Includes all hazards:  Biologic  Natural disaster  Technologic

5. What is an EPIP? An EPIP is the collection of job task sheets and associated information organized by Emergency Response Organization Sections or Branches. How policies and requirements are to be implemented Includes: Emergency response Program maintenance

6. Emergency Plan Implementing Procedures VS.

7. Plan vs. EPIP – Example Establish an EP program = policy Elements of the EP program = requirements How to accomplish requirements = EPIP:  Who receives initial call  How call triaged  How event level determined  Who/what/how is information communicated  How ERO accomplishes their tasks

8. Emergency Plan Implementing Procedures Normal Ops (SOP) Emergency Ops (EPIP) Standard Operating Procedure

9. A.Yes B.No Poll Question 2 Do you now feel that you could describe the difference between a plan and a procedure?

10. Developing EPIPs What are the established requirements and policies to be covered? What ERO positions are to be included? What are the logical steps (task analysis) to complete the identified task(s)? How can the EPIP be organized for ease of use? Review: Checklist: Is the EPIP consistent with other EPIPs? Can the EPIP be understood by the user?

11. EPIP 1: Writing EPIPs Biologic Natural disaster Technological At TPCHD, divided incident types into categories: Recognition of emergency conditions

12. Operations Section Chief Mission: Activates, coordinates, and provides overall command and control of identified operations support staff. This staff include the Triage Unit, and the Field Facility Branch. EPIP Template Position title Mission Location Chain of command Job task sheets Located: TPCHD Emergency Operations Facility (EOF)

13. EPIP Example

14. A.Having systems in place to recognize incident B.Driving the response by determining the severity of the incident C.Realizing that PH emergencies can emerge slowly D.Early notification that PH emergencies can emerge slowly Poll Question 3 In my opinion, the following is most important in recognizing an emergency condition:

15. Incident Manager, EPIP 4

16. Organizing the EPIPs EPIP 1: Recognition of Emergency Conditions EPIP 2: Notification and Communication EPIP 3: Emergency Operations Facility EPIP 4: Biological Incident EPIP 5: Natural Disaster EPIP 6: Technological Incident EPIP 7: Maintaining Emergency Preparedness

18. Poll Question 5 My PH jurisdiction has a formal system for categorizing the severity of an incident. A.Yes B.No

19. EPIP 1: Recognizing Emergency Conditions Public health emergencies begin slowly. System in place to recognize incident. Tie response to severity of incident. Recognition and notification are vital.

20. Poll Question 6 My PH jurisdiction has a system for identifying action levels based on the severity of an incident. A.Yes B.No

21. Recognizing Emergency Conditions (cont.) Identify levels of response for the LHJ: Off-normal Low Medium High

22. TPCHD Emergency Action Levels Response: Notify other program on-call staff and Public Health Information Officer (PHIO). Enter data into incident tracking. Off-normal incidents involve no program resource reallocation, but may have media or significant public concerns. Inquiries are defined as off-normal incidents.

23. Low level incidents require a resource reallocation by a single department program to appropriately respond to the incident. Response: Notify other program on-call staff, PHIO, and Emergency Operations Facility (EOF) manager. Enter data into incident tracking. Potential for limited activation of the EOF. TPCHD Emergency Action Levels (cont.)

24. Medium level incidents require resource reallocation by more than one program within the Health Department to appropriately respond to the incident. Response: Activate the EOF. Notify Pierce County Department of Emergency Management. Notify Washington Department of Health.

25. TPCHD Emergency Action Levels (cont.) Response: Activate the EOF. Notify Pierce County Department of Emergency Management. Notify Washington Department of Health. Request activation of the county EOC. High level events impact TPCHD as well as other outside agencies.

27. EPIP 2: Notification and Communication Concept of Operations Declaring an Emergency  Incident is off-normal  Incident is low level  Incident is medium level  Incident is high level

28. EPIP 2: Notification and Communication Attachments: 1.TPCHD Emergency Response Organization Activation List 2.EOF Support Unit List 3.TPCHD Emergency Response Facilities Telephone List 4.Outside Agency Contact List 5.TPCHD Safety Monitor Contact List 6.Local Health Jurisdiction Contact List

29. EPIP 2: Notification and Communication (cont.) Attachments (cont.) 7.TPCHD Situation Report 8.TPCHD GIS Unit 9.TPCHD Language Unit 10.Media Outlet Contact Lists 11.Public Information Officer Contact List 12.TPCHD Essential Services Functions Contact List 13.Pierce County High School Contact List

30. EPIP 3: EOF Command Staff EOC Policy Liaison EOF Incident Manager EOF Manager Safety Officer Liaison Officer Public Health Information Officer (PHIO)

31. EPIP 3: EOF General Staff/Activities 3a: Finance/Admin Section 3b: PHIO Support Units 3c: Operations Section 3d: Planning Section 3e: Logistics Section 3f: Continuity of Operations 3g: Alternate Triage and Treatment Sites 3h: Recovery

32. Event Based EPIPs EPIPs 4, 5, and 6 categories of incident types:  Biologic  Natural disaster  Technologic Provide information on general tasks for each category. Actions for specific types of incidents are included in the next level of EPIP.

33. EPIP 4: Biologic 4a: Response to a BDS Alarm 4b: Small Pox 4c: Pandemic Influenza 4d: Anthrax 4e: Operating Points of Dispensing 4f: Containment Operations

34. EPIP 5: Natural Disasters 5a: Earthquake 5b: Flood 5c: Lahar

35. EPIP 6: Technologic 6a: Radiological 6b: Chemical

36. EPIP 7 Provide information on how the Public Health Emergency Preparedness and Response Program is being administered. Procedure development Training Drills and exercises Facilities and equipment Respiratory protection Quality improvement

38. Questions? Comments?