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Public Health Responsibilities During an Emergency

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HCPH coordinating ESF-8 activities at the Hamilton County EMHSA Emergency Operations Center.

HCPH works with Hamilton County EMHSA to prepare for emergencies and to contribute in the planning process.  The following summarizes how public health and medical services will be addressed during a public health emergency, as found in Attachment H – Emergency Support Function #8 within Hamilton County Emergency Management & Homeland Security’s Emergency Operations Plan.

 

Coordinating Entity

Hamilton County Public Health

The Health Collaborative

 

Supporting Entities

Hamilton County Coroner’s Office

Hamilton County Developmental Disabilities Services

Hamilton County Emergency Management & Homeland Security Agency

Hamilton County Mental Health & Recovery Services Board

Hamilton County Sheriff’s Office

American Red Cross

City of Cincinnati Health Department

Great Parks of Hamilton County

Local Hospitals

Public Library of Cincinnati and Hamilton County

Southwest Ohio Critical Incident Stress Management

 

Introduction

Purpose

The purpose of Emergency Support Function (ESF) #8 – Public Health & Medical Services is to establish how public health and medical services activities will be coordinated prior to, during, and after disasters to meet the emergency needs of Hamilton County, OH.  This ESF describes the operational components as well as the roles and responsibilities of the entities necessary to fulfill the duties of ESF #8.

 

Scope

Emergency Support Function #8 – Public Health & Medical Services serves to provide supplemental assistance to local jurisdictions in Hamilton County by identifying and meeting the public health and medical needs of everyone affected by disasters.

 

Activities of ESF #8 include surveillance and assessment of health and medical needs, mass prophylaxis, coordination of medical equipment and supplies, patient tracking and coordination, environmental health and safety, public notification for public health issues, access and functional needs support, mental health services and mass fatality services.

 

Assumptions

Planning requires assumptions based on statistics, history, behavior pattern and likely future trends.  The following assumptions were made as consideration for ESF #8 – Public Health & Medical Services:

 

  • Hazards may affect one or multiple jurisdictions within Hamilton County. Hazards may also extend beyond the borders of Hamilton County and may require a coordinated response and recovery effort between multiple jurisdictions at the local, county, or even state level.

 

  • Local hospitals and the four Local Health Districts (LHDs) in Hamilton County will coordinate the status of communicable disease emergencies and the need for assistance for public health issues.

 

  • Disasters and public health emergencies may overwhelm any or all of the LHDs, the medical community and county emergency resource capabilities. Regional, state or federal resources may need to be requested if they are available.

 

  • Although a primary event may not constitute a public health emergency, secondary events stemming from the initial event may do so.

 

  • Disruption of utility services and facilities, loss of power, and an increase in the number of people requiring sheltering may increase the potential for disease and/or injury.

 

  • Catastrophic events may require the establishment of temporary medical facilities.

 

Concept of Operations

Emergency Support Function (ESF) #8 – Public Health & Medical Services consists of nine broad activities in relation to the Hamilton County Emergency Operations Plan.  These activities are:

 

  1. Surveillance and Assessment of Health and Medical Needs
  2. Mass Prophylaxis
  3. Coordination of Medical Equipment and Supplies
  4. Patient Transportation and Coordination
  5. Environmental Health and Safety
  6. Public Notification for Public Health Issues
  7. Access & Functional Needs Support
  8. Mental Health Services
  9. Mass Fatality Services

 

Surveillance and Assessment of Health and Medical Needs

There are four local health departments located within Hamilton County: Hamilton County Public Health, City of Cincinnati Health Department, City of Norwood Health Department, and the City of Springdale Health Department.  Hamilton County Public Health is responsible for the forty-five (45) jurisdictions within Hamilton County that do not have their own health department.

 

The four local health departments are responsible for monitoring ongoing public health issues within Hamilton County. This is accomplished through the continuous, systematic collection, analysis and interpretation of health-related data from the county and the region. Epidemiologists work with the local health departments and information from regional health care facilities to track potential and current public health threats. Potential public health threats resulting from zoonotic diseases will be coordinated between the Ohio Department of Health and the Ohio Department of Agriculture and shared with local health departments.

 

Medical needs of local healthcare providers are identified and addressed by the Disaster Preparedness Coalition, a multi-disciplinary group of agencies and organizations who collaborate in order to prepare for, respond to, and recover from incidents. The Coalition is a regional working group that meets regularly to share information and coordinate preparedness activities. The Coalition is managed by the Health Collaborative, which administers Coalition meetings and shares information with the Hamilton County EMHSA.

 

When it is determined that the health or medical needs of Hamilton County exceed the ability of local health departments or healthcare providers due to public health incident or other disaster, the Hamilton County EMHSA Director or his/her designee is notified. This notification may lead to the activation of the Hamilton County Emergency Operations Center (EOC) and a change in the Emergency Activation Level for Hamilton County’s EOC.

 

Mass Prophylaxis

Mass prophylaxis is the capability to protect the health of Hamilton County residents through the administration of critical medical countermeasures in response to a public health emergency in order to prevent the development of disease among those who are exposed or are potentially exposed to public health threats.

 

Hamilton County Public Health is responsible for ensuring that appropriate drug prophylaxis and vaccination strategies are implemented in a timely manner upon the onset of an event to prevent the development of disease in exposed individuals. In the event of a large-scale mass prophylaxis event, Hamilton County Public Health may open community-level Point of Dispensing (POD) sites per the Medical Countermeasure Dispensing Plan, an annex to the Hamilton County Public Health Emergency Response Plan – Basic Plan.

 

In the event that a mass prophylaxis event takes place within Hamilton County, the Hamilton County EOC will be activated to support operations. ESF #8 will work with other ESFs within the Hamilton County EOC in support of POD logistics. Potential issues may include, but are not limited to, the transportation of medical countermeasures from the County Drop Site or the Regional Distribution Site to the POD, the transportation of volunteers from a Volunteer Reception Center to a POD, or POD site security.

 

Currently, Hamilton County Public Health has an MOU with Great Parks Hamilton County for Park Rangers to provide security during a mass prophylaxis event to supplement other law enforcement agencies.  An MOU also exists between Hamilton County Public Health and the Public Library of Cincinnati and Hamilton County that states the Public Library will provide five box trucks and personnel to assist in transportation of medical countermeasures.  Hamilton County Public Health has two MOUs with local hospice skilled nursing facilities to provide nurses for psychological first aid and mental health support in the event of an emergency.  A regional mutual aid agreement exists between each of the thirteen local public health departments in the Southwest Ohio Region to provide personnel and resource support in the event of surge during a public health emergency.

 

Coordination of Medical Equipment and Supplies

During a mass prophylaxis event, medical countermeasures may be requested from the Strategic National Stockpile (SNS). Per the Hamilton County Public Health Medical Countermeasure Dispensing Plan, all requests for assets from the SNS must be sent to the Hamilton County EMHSA. Requests for activation of the SNS may come from one of the four local health department health commissioners, or their designees. SNS requests may also come directly from the hospitals.

 

In the event that the Hamilton County EOC has been activated, all SNS requests will be verified by one of the Coordinating Entities of ESF #8 before being sent to the Ohio EMA. This is to ensure that the request is legitimate and cannot be fulfilled from other local or regional assets.

 

If the Ohio EOC is active, the request will be sent from Hamilton County ESF #8 to the State of Ohio ESF #8.  If the Ohio EOC has not been activated, the request will be sent to the Ohio EMA Watch Desk via email and the Ohio EMA Regional Supervisor will be added to the message.  A follow-up phone call will be made to the Ohio EMA Regional Supervisor to ensure the request was received and to ensure the Ohio EMA has context for the request.  If the Hamilton County EOC is not active, the Hamilton County EMHSA will verify with Hamilton County Public Health before submitting an SNS activation request to the Ohio EMA.

 

Other requests for medical equipment and supplies during an incident will be directed from the Logistics Section to ESF #8. ESF #8 Coordinating Entities will work with Supporting Entities and other partners to fulfill the requests appropriately. In the event that a request for medical equipment or supplies cannot be fulfilled by ESF #8, one of the Coordinating Entities will work with the Logistics Section to determine alternative methods for fulfilling the request.

 

Patient Transportation and Coordination

Some disasters will require the transportation of a large number of victims to local healthcare agencies. The increased volume may strain individual hospitals if their surge capacity is exceeded. To that end, patient distribution will be coordinated through the Disaster Network, an 800 MHz radio system managed by the Hamilton County Communications Center. The network may be used for incidents that occur within Hamilton County or incidents that occur outside Hamilton County when patients will be transported to hospitals within our county.

 

Hospitals will enter bed capacity and other patient data into SurgeNet, a web-based software managed by the Health Collaborative. One component of SurgeNet is OHTrac, a State of Ohio tool for patient tracking that aids in family reunification.

 

ESF #8 will work with ESF #4 – Fire & Emergency Medical Services to address any additional patient transportation issues.

 

Environmental Health and Safety

ESF #8 will provide subject matter expertise to address any environmental health and safety issues that may affect first responders or the general public resulting from a disaster. Hamilton County Public Health can coordinate with local, state and federal partners for environmental monitoring, including air, water, and soil monitoring.

 

The City of Cincinnati Health Department coordinates a monitoring and detection team that can be requested through the City of Cincinnati Fire Department or ESF #4 when activated. The Ohio Environmental Protection Agency (EPA) and U.S. EPA can support microbiological, organic and inorganic laboratory analysis of environmental samples.

 

ESF #8 will coordinate with ESF #10 – Hazardous Materials on hazardous materials responses to determine what population protective actions need to be undertaken. Any actions identified for the general public will be immediately shared with ESF #15 – Emergency Public Information for public dissemination.

 

Public Notification for Public Health Issues

Hamilton County Public Health has created a Crisis Communication Plan, an annex to the Hamilton County Public Health Emergency Response Plan – Basic Plan. The Crisis Communication Plan will be activated by Hamilton County Public Health internally and may be handled by Hamilton County Public Health’s Public Information Officer.

 

If the disaster is categorized as a public health emergency, Hamilton County Public Health will assign a staff member to serve as the Public Information Officer in the Hamilton County EOC, which will oversee ESF #15.  Additional details can be found in Annex O – ESF #15.  If the disaster is not a public health emergency but there are public health concerns related to the incident, Hamilton County Public Health may still assign a staff member to serve in the Joint Information Center within the Hamilton County EOC.  This staff member may work remotely from Hamilton County Public Health’s Departmental Operations Center or may be physically present at the Hamilton County EOC.

 

Both Coordinating Entities for ESF #8 should work together and with ESF #15 to ensure a coordinate message is being distributed to the public regarding public health issues. All media inquiries will be directed to the Joint Information Center when it is activated.

 

Access & Functional Needs Support

Hamilton County will make every effort possible to be inclusive in its planning efforts and ensure that all response and recovery actions address the requirements of individuals with access and functional needs. Hamilton County understands that individuals with access and functional needs have the same right to emergency services as other residents.

 

While every effort will be made to plan for those needs, certain considerations may not be identified and addressed during the planning stages. To that end, ESF #8 will be the lead ESF on addressing those needs that are identified during the response and recovery phases of the disaster. ESF #8 includes Hamilton County Developmental Disabilities Services, which will support the other entities within ESF #8 in addressing access and functional needs that arise during the disaster. This includes, but is not limited to, making reasonable modifications to policies, practices and procedures to allow individuals to maintain their independence in general population shelters, assisting in locating durable medical equipment, consumable medical supplies, and personal assistance services.

 

Mental Health Services

Disasters are traumatic experiences for most individuals and as such, Hamilton County residents may respond with increased anxiety, worry, anger, or other forms of emotional distress. In order to support individuals who may require additional assistance in coping with the disaster and the potential uncertainties, ESF #8 will be the lead ESF for coordinating mental health services.

 

Hamilton County Public Health will work with Hamilton County Mental Health and Recovery Services Board (MHRSB) to address mental health needs during a disaster. MHRSB has nearly 50 local behavioral health organizations under contract that provide a full range of community support services that may be called upon during a disaster. In addition, Hamilton County Public Health has a Standard Operating Guide as part of the Public Health Response and Recovery Base Plan specifically for accessing mental/behavioral health resources during a disaster.

 

Mass Fatality Services

Per the Hamilton County Mass Fatality Incident Response Plan, the Hamilton County Coroner’s Office defines a Mass Fatality Incident as an event that results in 25 deaths from a single event. In the event of a Mass Fatality Incident within Hamilton County, the Coroner will retain control and authority over fatality management but will not be the Incident Commander for the larger event. The Coroner’s objective is to recover and identify the victims in a safe and timely fashion and in a dignified and respectful manner.

 

During a Mass Fatality Incident, the Hamilton County Coroner’s Office, as a part of ESF #8, will identify any resource needs related to fatality management and communicate those with the ESF #8 Coordinating Entity. The Coroner’s Office will also work with the American Red Cross and ESF #6 on the establishment of a Family Assistance Center as outlined in the Mass Fatality Plan.

 

Organization and Assignment of Responsibilities

Hamilton County Public Health has the primary responsibility for the public health functions for the majority of jurisdictions within Hamilton County.  As such, Hamilton County Public Health is the designated coordinating entity for public health issues within the Hamilton County EOC.  The Health Collaborative supports emergency preparedness among medical facilities within Hamilton County and the greater region.  As such, the Health Collaborative is the designated coordinating entity for medical services issues within the Hamilton County EOC.  These two organizations have agreed to jointly serve as coordinating entities for this Emergency Support Function (ESF).

 

Coordinating Entities Responsibilities

Hamilton County Public Health will:

  1. Coordinate the activities of Support Entities within ESF #8 to fulfill operational objectives.
  2. Direct, with the Health Collaborative, the activities of the ESF #8 in conjunction with assistance from ESFs at the local, State, or Federal levels as applicable.
  3. Collaborate with other Coordinating Entities to ensure an effective response between ESFs.
  4. Share ESF #8 activity information with appropriate EOC personnel.
  5. Designate sufficient representatives (no less than three) to support/staff 24-hour operations at the Hamilton County EOC. The Hamilton County EMHSA will maintain listings of these personnel, 24-hour contact information, and directions for contacting them in the event of communication outages.
  6. Develop and train all staff responsible for implementing ESF #8 on standard operating procedures.
  7. Conduct and coordinate public health assessments of conditions in the communities affected by the disaster and, where possible, determine where health problems could occur.
  8. Maintain ongoing public health surveillance of affected communities in order to rapidly identify and address public health-related problems.
  9. Conduct and coordinate food service sanitation programs.
  10. Inspect potable and bulk water hauling contractors and temporary water systems.
  11. Provide and coordinate consultation for household sewage disposal, disaster debris disposal, housing sanitation, vector control, and public health nuisances.
  12. Assess and coordinate public health concerns regarding mass fatality efforts in affected communities.
  13. Assist with coordinating the acquisition and distribution of medical supplies and equipment (e.g. Strategic National Stockpile).
  14. Provide and coordinate prophylaxis, including antibiotics, antivirals, vaccines, immunizations, and testing as needed during the disaster. Activities will be coordinated with local fire and/or law enforcement.
  15. Coordinate with ESF #15 – Emergency Public Information for the inclusion of appropriate information for public dissemination including public health and medical advisories.
  16. Coordinate response actions and guide decision making if isolation and/or quarantine of individuals is necessary.
  17. Coordinate with local cemetery owners to determine public health concerns for grave sites/cemeteries that are impacted by the disaster.
  18. Coordinate alternate sources for human waste disposal.

 

The Health Collaborative will:

  1. Direct with Hamilton County Public Health the activities of the ESF #8 in conjunction with assistance from ESFs at the local, State, or Federal levels as applicable.
  2. Collaborate with other Coordinating Entities to ensure an effective response between ESFs.
  3. Designate sufficient representatives (no less than three) to support/staff 24-hour operations at the Hamilton County EOC. The Hamilton County EMHSA will maintain listings of these personnel, 24-hour contact information, and directions for contacting them in the event of communication outages.
  4. Assist in the identification and delivery of medical supplies and services during a disaster.
  5. Coordinate local hospital resources.
  6. Coordinate the assessment of medical needs of the affected communities.
  7. Coordinate with ESF #15 – Emergency Public Information for the inclusion of appropriate information for public dissemination including medical-related information.
  8. Provide research and consultation on emergency medical-related problems as needed.
  9. Assist in making requests for the activation of Alternate Care Centers and Neighborhood Emergency Health Centers.
  10. Assist the hospitals by coordinating the sharing of medical resources to support medical surge.
  11. Cooperate with Hamilton County Public Health for the activation of the Medical Reserve Corps in support of supplementing the internal staffing needs of local hospitals.

 

Supporting Entities Responsibilities

 

Hamilton County Coroner’s Office will:

  1. Coordinate, and within capabilities, supply personnel and materials to support mass fatality response and expanded mortuary services in affected jurisdictions, as outlined in the Hamilton County Mass Fatality Plan.
  2. Identify the remains of disaster-related fatalities.
  3. Process and prepare disaster-related fatalities for disposition.
  4. Assist with the coordination for the disposition of human remains due to the disaster.

 

Hamilton County Developmental Disabilities Services will:

  1. Provide personnel, training and services to assist local organizations in providing for the emergency needs of persons with access or functional needs.

 

Hamilton County Emergency Management & Homeland Security Agency will:

  1. Accept requests from local health departments and hospitals for medical countermeasures from the Strategic National Stockpile and forward them to the Ohio EMA Watch Desk and Regional Supervisor.

 

Hamilton County Mental Health & Recovery Services Board may:

  1. Provide staff, supplies, or facilities to treat victims suffering from disaster-related mental disorders.
  2. Coordinate with its partners and request support in treating victims suffering from disaster-related mental disorders.

 

Hamilton County Sheriff’s Office will:

  1. Provide traffic and crowd control at Point of Distribution locations.
  2. Assist in coordinating security at hospitals and Point of Dispensing locations.
  3. Work with local health departments to enforce isolation and/or quarantine of individuals if established.

 

American Red Cross will:

  1. Activate their Disaster Health Services and Disaster Mental Health Services volunteers in support of Mass Care operations.
  2. Activate their Disaster Medical Assistance Team in response to a Mass Casualty or Mass Fatality Incident.
  3. Support the opening of Family Assistance Centers in accordance with the Hamilton County Mass Fatality Plan.
  4. Support critical incident stress management operations for emergency responders.

 

City of Cincinnati Health Department:

  1. May provide personnel to support/staff 24-hour operations at the Hamilton County EOC. Maintain listings of these personnel, 24-hour contact information, and directions for contacting them in the event of communication outages.
  2. May provide personnel from the City of Cincinnati Health Department ESF #8 to concurrently serve as the Hamilton County ESF #8 Coordinating Entity.
  3. Will conduct and coordinate public health assessments of conditions within the City of Cincinnati if it is affected by the disaster and, where possible, determine where health problems could occur.
  4. Will maintain ongoing public health surveillance within the City of Cincinnati if it is affected in order to rapidly identify and address public health-related problems.
  5. Will conduct and coordinate food service sanitation programs within the City of Cincinnati.
  6. Will inspect potable and bulk water hauling contractors and temporary water systems within the City of Cincinnati.
  7. Will provide and coordinate consultation for household sewage disposal, disaster debris disposal, housing sanitation, vector control, and public health nuisances within the City of Cincinnati.
  8. Will assess and coordinate public health concerns regarding mass fatality efforts within the City of Cincinnati.
  9. Will be available to assist with coordinating the acquisition and distribution of medical supplies and equipment (e.g. Strategic National Stockpile) within the City of Cincinnati.
  10. Will provide and coordinate prophylaxis, including antibiotics, antivirals, vaccines, immunizations, and testing as needed during the disaster within the City of Cincinnati. Activities will be coordinated with local fire and/or law enforcement.
  11. Will coordinate with local cemetery owners within the City of Cincinnati to determine public health concerns for grave sites/cemeteries that are impacted by the disaster.
  12. Will coordinate alternate sources for human waste disposal within the City of Cincinnati.

 

Great Parks of Hamilton County may:

  1. Provide security as medication is transported between Points of Dispensing locations during a mass prophylaxes event.

 

Local Hospitals will:

  1. Maintain ongoing medical surveillance of affected communities to rapidly identify and address emergency medical-related problems in coordination with Hamilton County Public Health.
  2. Notify the Health Collaborative of the status of local health emergencies and the need for assistance.
  3. Active surge plans as needed.

 

Public Library of Cincinnati and Hamilton County will:

  1. Provide five box trucks and personnel to transport medication from the Strategic National Stockpile drop point to Points of Distribution locations during a mass prophylaxes event.

 

Southwest Ohio Critical Incident Stress Management will:

  1. Provide mental health support for emergency responders.