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MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
2016 Direction & Control Annex 1
1.1
Meigs County General Health District
www.meigs-health.com
740.992.6626
Emergency Response Plan
2016 Aimee Imbrosciano, Health Commissioner
Courtney Midkiff, Administrator
Frank Gorscak, Emergency Response Coordinator
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
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Date
Reviewed
Changes
Made* Signature/Title
02/18/2014 Yes Frank Gorscak
01/12/2015 Yes Frank Gorscak
01/22/2016 Yes Frank Gorscak
Y or N
ANNEX 1:
DIRECTION AND CONTROL
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* Summary of Changes can be found at the end of this annex.
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TABLE OF CONTENTS
PURPOSE ......................................................................................................................... 14
SITUATIONS AND ASSUMPTIONS ........................................................................................... 14
CONCEPT OF OPERATIONS ................................................................................................. 14
Initial Notification & Communications ......................................................................... 14
Incident Assessment ............................................................................................................ 14 Diagram1: Initial Notification & Communications ....................................................... 16
Sequence of Events........................................................................................................ 16
Diagram 2: ICS for HCHD .............................................................................................. 17
ORGANIZATION & ASSIGNMENT OF RESPONSIBILITIES .............................................................. 17
Meigs County Health Department ............................................................................... 17
Supporting Agencies ...................................................................................................... 18
Scene Operations ........................................................................................................... 19
Department Operations Center ................................................................................... 19
MEIGS County Emergency Operations Center ............................................................ 20
Regional Coordination Center (RCC) ......................................................................... 20
IMPLEMENTING INSTRUCTIONS ............................................................................................. 20
AUTHORITIES AND REFERENCE .............................................................................................. 20
SUMMARY OF CHANGES .................................................................................................... 21
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PURPOSE
The purpose of this annex is to provide support to Command authorities during a
public health emergency response, meanwhile collaborating and communicating
between partnering agencies. This annex should provide support to Minimize
confusion that can occur as a result of unified command.
SITUATION AND ASSUMPTIONS
Situations:
A public health incident that has occurred that requires human and/or
material resources that are beyond the day-to day levels.
The public health incident is likely to continue for greater than 24 hours.
Assumption(s):
Local Command and Control will consist of the pre-established Command
structure and coordination through the local EOC.
The Meigs County communities will to be affected by a large-scale disease
outbreak such as pandemic influenza and therefore must be prepared to
respond regionally for consistent, equitable and affective mitigation.
During a large-scale event, MCHD will experience a shortage of resources
and must coordinate with regional partners for an appropriate response.
Meigs County has EOC capability for local coordination.
Meigs County has plans and procedures to direct emergency operations
within the county.
CONCEPT OF OPERATIONS
Initial Notification & Communications
Initial Notification
The first health department employee that is contacted, or on scene, during a
public health emergency situation will take the role of the Incident Commander.
Incident Assessment
An assessment or “size up” of the situation must be conducted by the Incident
Commander to determine the appropriate course of action. The assessment should
include the “who (including how many affected), what (including the severity),
when, and where” that are involved in the situation and should incorporate other
factors that may increase the complexity of the event. Complexity factors may
include:
Impacts to life, property, and the economy
Community and Responder Safety
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Potentially hazardous materials
Weather and other environmental influences
Likelihood of cascading events
Potential Crime Scene (Including Terrorism)
Political sensitivity, external influences, and media relations
Area involved, jurisdictional boundaries
Availability of resources
Information gathered during the assessment should be documented for accurate
reporting to additional staff and other agencies if further notifications and
communications need to be made.
Health Department Staff that are trained to conduct an Incident Assessment
include the: Health Department Administrator, Public Health Emergency
Response Coordinator, Director of Nursing, Director of Environmental, and
Public Health Supervisor.
The completion of the assessment should help the Incident Commander determine
the Incident Type, which will affect how the Incident Command System (ICS) and
response activities are implemented.
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Diagram1: Initial Notification & Communications
Typical Sequence of Events
Initial Notification
MCHD Emergency Response Plan Activated
Annex 1: Direction and Control Activated
Staff Notification
See Implementing Instruction (II): direct & control: Staff Notification & Call-Down.
Transfer of “Command” to the Administrator
Or next available staff member following the chain of command (if necessary)
Health Department Staff that are trained to fill the role of Incident
Commander include the: Health Commissioner, Public Health Emergency
Response Coordinator, Director of Nursing, Director of Environmental, and
Public Health Supervisor.
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Incident Command Post and/or Department Operations Center (DOC) Established
Documentation and a description of the activation, notifications, services
enhanced, services reduced/eliminated, and other pertinent information may be
included on the ICS form 201.
Response Partners’ Notification
The County Commissioners, or their representative, will convene a meeting of
the necessary personnel in order to begin the prophylaxis process for “First
Responders” and essential government. Those personnel may include
representatives from LEMA, Meigs County Job and Family Services, fire, EMS,
law enforcement, Red Cross, hospitals, and others as deemed necessary.
Incident Command Structure
Diagram 2: ICS for MCHD
ORGANIZATION & ASSIGNMENT OF RESPONSIBILITIES
Meigs County Health Department
For a public health incident/emergency, the MCHD would be the lead agency.
Some of the activities that the local health department would be responsible for
include:
Assessment of county health and medical needs.
Surveillance and investigations to determine disease patterns and potential
disease outbreaks and implement prevention strategies.
Monitoring of the availability and utilization of health systems’ assets.
Provide logistical support for public health personnel in the field.
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Provide pharmaceuticals, medical equipment, and supplies as available
(includes the coordination and tracking of medical resources and equipment).
Provide consultation for the decontamination of people, buildings, and the
environment, when applicable.
Provide mass dispensing clinics for the prophylaxis of the entire county
population, if necessary. Identification of areas where public health problems
could occur.
Public Health assessments of conditions at the site of the emergency to
determine health needs and priorities.
Provision of medical related information releases and public health
recommendations and related releases to the public.
Research and consultation on potential health hazards, medical problems,
and appropriate levels of PPE, when applicable.
Coordination of behavioral health assistance.
Environmental sampling and analysis/collecting specimens for lab testing.
Veterinary support.
Assistance and support for mass casualty and mass fatality incidents.
Coordination with other local, regional, state, and federal partners.
Assess and make recommendations concerning the public health needs of
emergency responders.
Supporting Agencies
Agency Responsibilities
MC EMA Director/EOC Notify local authorities when the EOC
opens.
Provide a facility from which local
authorities may coordinate
emergency response activities.
Central point for coordinating the
resources required for a local
response.
Provide situational awareness for the
State, via Ohio EMA
Holzer ER Emergency treatment of severely
affected
Law Enforcement Provide and manage security
operations
Provide and manage traffic flow
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Agency Responsibilities
Adjacent Local Health Departments Responsible for infectious disease
surveillance in their county
Provide human and/or materiel
resources when available
Regional Epidemiologist Infectious disease surveillance
Recommendations for treatment,
non-pharmaceutical interventions
Regional Public Health Coordinator Notify the regional response partners
of the activation of the SCO RPH ERP
and the RCC
Act as conduit for communications
between health departments
Act as conduit for communication
between health departments and
Ohio Department of Health
Assist with resource management
Responsible for facilitating
conference calls for incident
leadership
Ohio Department of Health Monitor situation, including any
jurisdictions throughout the state
with/for a similar incident
Available to provide guidance and
recommendations for incident
management
Assist in resource management
Scene Operations
Public health consequences may be associated with a wide variety of emergencies
or disasters that could occur within the county. There may be times when Health
Department scene operations are necessary in response to public health threats
either directly or indirectly resulting from disaster situations. Possible scene
operations for pre-identified disasters that could occur within the county are
detailed in the Meigs County Health Department Public Health Risk Assessment
Hazard Profile .
Department Operations Center
The Meigs County Health Department has a Department Operations Center that
may be activated to conduct ICS and communication operations. The Department
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Operations Center is located in the health department conference room which has
a VoIP Phone system with a conferencing abilities , MARCS radio base station, large-
screen monitor for visuals, MARCS radios, and High Sped Broadband Fiber-Optic
network ports for internet connections.
MEIGS County Emergency Operations Center
The Health Department Incident Commander may request the activation of the
Emergency Operations Center, through the Meigs County Emergency Management
Agency Director, for resources that the health department does not have on hand.
The county EOC is located at Pomeroy Pike, Pomeroy Ohio. Upon activation of the
EOC, MCHD will send a Liaison to the EOC, or establish direct communication, such
as telephone and radio to coordinate information between the Incident
Commander and EOC.
Regional Coordination Center (RCC)
When an incident escalates beyond the capability of the MCHD, the RCC may be
activated. The RCC will make available the means for leadership throughout the
region to communicate and to decide the best way to protect the general public.
See Implementing Instruction (II): direct & control: RCC Activation.
IMPLEMENTING INSTRUCTIONS
II: Direct & Control: Location
CREDENTIALING & BADGING HD EOC, EMA EOC, OR SHERRIFF’S OFFICE
RCC ACTIVATION OPHCS documents local folders SE
SE Collaboration SCO RPH Annexes
Appendices Direct & Control
NIMS RECOMMENDATIONS
AUTHORITIES AND REFERENCES
Title Location
FEMA ICS 300 manual Bookshelf in ERC office
Beyond Initial Response to ICS (Using the
National Incident Management System’s
Incident Command System)
Bookshelf in ERC office
National Incident Management System (2011) Bookshelf in ERC office
Meigs County All Hazards Response Plan (2011) Bookshelf in ERC office
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SUMMARY OF CHANGES 2/18/2014 Footer date change
1/12/2015 Footer date change
1/22/2016 Footer date change, Meigs ema address, communication changes
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Date
Reviewed
Changes
Made* Signature
11/12/2014 Yes Frank Gorscak
07/10/2015 Yes Frank Gorscak
Y or N
Y or N
Table of Contents
Introduction ............................................................................................................ 25
Situation and Assumptions .................................................................................... 25
Activation and Implementation ........................................................................... 25
Concept of Operations ......................................................................................... 26
Initial Notification 26
Internal Communications 26
Staff Notification Matrix ................................................................................................ 27
External Communications 27
Interoperable Communications 27
Annex 2:
Interoperative
Communications
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Situation Reporting 29
Plan Development and maintenance ................................................................. 30
Training and Exercise ............................................................................................ 30
Implementing Instructions .................................................................................... 30
References ............................................................................................................. 31
Summary of Changes............................................................................................ 31
* Summary of Changes can be found at the end of this document.
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INTRODUCTION
Every public health jurisdiction in the country has a responsibility to develop and
maintain the capability to communicate with its jurisdiction’s response agencies, as
well as with public health agencies in adjacent districts.
The purpose of this Interoperative communications annex is to provide instruction
and guidance for affective communications within the agency and with response
partners in the community before, during, and after an incident.
This plan will address initial notification, staff notification and activation, and external
response partner communications.
The scope of this annex and its related implementing instructions include:
The initial health department notification process;
Communication system use and related protocols; and
Response partner and staff contact directories.
SITUATION AND ASSUMPTIONS
Situation
An incident requiring public health action has occurred.
Assumptions
1. Enhanced Interoperative communications is needed to respond to the
incident and to keep staff and response partners informed and safe.
2. Staff has been trained on each form of communications.
3. Staff will respond to meet the community’s needs should an incident
occur.
4. Adjacent jurisdictions may be responding to the same/similar incident.
5. Compliance with National Incident Management System (NIMS) will occur
throughout the response efforts.
6. ODH and CDC may be involved at any response level.
ACTIVATION AND IMPLEMENTATION
Typical Sequence of Activities:
The Meigs County Health Department (MCHD) Emergency Response Plan should
be activated prior to the activation of this Annex.
The activation and implementation of the Interoperative Communications Plan
should be considered during any incident that requires communications beyond
the “normal business” communications.
The activation and implementation of this annex, and related implementing
instructions, is determined by the Administrator, Health Commissioner, or other
designee.
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The determination of communication systems to be used, frequency of
communications, and the projected time needed for enhanced
communications should be made.
The health commissioner, or his designee, will notify the Board of Health and the
County Commissioners of the activation and brief them on the situation if the
incident is projected to extend beyond four (4) hours.
Documentation and a description of the activation, notifications, and need for
change in routine communications may be included on the ICS form 201 and/or
205.
CONCEPT OF OPERATIONS
Initial Notification
The MCHD will initiate both internal and external notification, alerting, and/or
request for mobilization of staff and partner agencies following the detection of a
public health emergency situation. The primary 24/7 contact number for the Health
District, to receive notifications of public health emergencies, is the main health
department landline number. After-hours calls are directed, via the automated
answering system, to contact the ERC with the information for public health
emergencies (See Implementing Instruction (II): Communications: 24/7 Notification
process).
Internal Communications
An internal notifications contact list has been developed for after-hours emergency
notifications of critical response staff. The list provides an organized pattern of
contacting staff through each director, starting with the Health Commissioner or
acting Incident Commander. The list contains the contact information and backup
contact information for critical response staff. A call log (ICS form Activity Log) is
also included with the contact list for documentation of the message, who was
contacted, and when the message was confirmed.
An additional list of all health department staff, with home/mailing addresses is kept
with the internal notifications list. (See II: Communications: Staff Contact Info & Call-
Down Instructions). Staff notification lists are updated and distributed to the health
department plan initial responders as contact changes occur.
Other internal communications can include Code Red, Meigs County’s reverse
notification system which is programmed to send an emergency message to the
whole county, regions of the county, or to the health department staff or to other
county first responders by landline, cell phone, text messaging or email.
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Staff Notification Matrix
The Ohio Public Health Communication System (OPHCS) may also be used to notify
the core emergency response staff, regional public health preparedness response
coordinator, and regional epidemiologists for emergency situations, if there is a
computer with an internet connection available. See II: Communications: OPHCS).
External Communications
The MCHD maintains four (3) separate external contact lists as part of the MCHD
ERP. The contact lists include:
State and regional health department emergency contact information;
Local government and non-government organizations, and businesses that
would have potential public health resources or response roles in a public
health emergency;
Health Alert Network (HAN) Directory, separating out critical local agencies
with public health roles, has been developed for the early and continual
notification of local public health emergency developments; and
Interoperable Communications
Health Commissioner/Administrator
Incident Commander
Director of
Nursing
PH Nurses
WIC Staff
Lice Aids
Director of Environmental Health
Registered Sanitarians
Plumbing Inspector
Director of Preparedness, & Administration
Clerical Staff
Preparedness Staff
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The Meigs Health Department has access to multiple communication systems for
county, regional, and statewide communication activities.
Health Meigs Department communication systems include:
Land Line
Mobile Phone/Cell Phone
Fax
Ohio Public Health Communication System (OPHCS)
Multi-Agency Radio Communication System (MARCS)
Meigs County Radio System
Voice over IP Phones
TeamSpeak (Voice Over IP)
Meigs County Code Red
In addition to the above communication systems, HAM radio operators may be
requested through the Emergency Management Agency (EMA) Director as a
communications resource external to the Health Department.
The Ohio Department of Health and Regional Coordination Center should be
notified to what alternate communications systems we are using and how to
contact us using them if the primary systems (landline, email) fail. (See II:
Communications: MARCS and II: Communications: OPHCS)
Essential Elements of Information and Situation Reporting
Essential Elements of Information (EEI) are made up of information gathered from a
variety of input sources that come from a number of event-related systems, which
help construct a timely picture and contribute to the development of Situational
Awareness. EEI may lead to certain actions being taken, or include information that
may have cascading effects. Typically they will be the “who, what, when, where,
and why” of the emergency response.
EEI may be needed by first responders and emergency responders; emergency
operations centers; stakeholders and partners; and the public.
An incident, depending on size and scope, can affect:
People: This can be the general public, vulnerable populations, and
special needs populations. It can include non-English speakers,
homeless or transitory persons, and tourists or out-of-towners. EEIs can
affect decisions made in an emergency response or disease outbreak.
Systems: This is hospitals and other healthcare systems, infrastructure,
transportation, and communications. The incident may have an
impact on these systems and lead to an inability to provide certain
services.
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Service Providers: These are people who staff and provide services in
the various systems. An incident or disaster may impact the ability of
the service providers to serve affected populations.
While the emergence of a new and deadly disease in our community – or an
outbreak – may not cause the initial infrastructure and property damage that a
flood, tornado, or earthquake might, an outbreak, or even a single case, may have
serious impacts in other ways. People are affected, possibly infected, and almost
certainly afraid for their life. They also will fear for their loved ones. Hospitals and
healthcare systems may become stressed or overwhelmed. People who provide
services may react out of fear, and fail to carry out their function of maintaining
systems, thus negatively impacting the public and the ability of responders to
manage the situation.
A disease outbreak or the presence of a disease like Ebola Hemorrhagic Viral
Disease – regardless of the number of human infections – will almost certainly have a
short term effects (an initial strain on the healthcare system in managing the
situation and even dealing with the worried-well; rushes on food, water, and
medical supplies); and a long term effect (maintaining law and order in the
community, the continued ability to provide services, stress on the stress on the
healthcare system).
While they are similar, they may also differ and require the gathering of different
types of information. In the short term, in addition to healthcare situations, EEIs
should include a close monitoring of social media for rumors or incorrect information
that may prove harmful; and watch for signs of “rushes” on food, water, and even
health products. In the long run EEI should monitor potential barriers to the provisions
of services and service provider’s ability and willingness to provide critical services.
EEI should help to guide the actions of decision makers to ensure that the response
addresses the fear a community will feel during a disease outbreak or the presence
of a feared disease such as Ebola Hemorrhagic Viral Disease. The EEI may also help
address possible shortages of supplies and/or personal protective equipment
needed by service providers.
Situation Reporting
The Health Meigs Department will provide situation reports to the Regional
Coordination Center (RCC) and/or the Ohio Department of Health’s (ODH)
Department Operations Center during any public health emergency that requires
the use of situation reports. A generic standard report has been developed due to
the high variability of emergency situations, see: Implementing Instruction:
communications: Situational Awareness. The Health Department will work with the
RCC and ODH on the exact type of information needed by those entities and will
adapt the situation report according to the guidelines/requirements of the RCC and
the ODH.
When an incident requires the mass dispensing of medical countermeasures, health
departments may submit a weekly situation report of the medical countermeasure
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movement and availability to ODH through the Ohio Public Health Analysis Network
(OPHAN). This is a requirement if the medical countermeasure is obtained through
State or Federal assets.
The Ohio Department of Health has a Situational Portal through which local health
departments can “read only” situational activities occurring at that state agency.
Access to that portal is limited to health departments only. Access information to
the situational portal can be found in implementing instruction (II): communications:
Situational Awareness.
Any Incident Action Plans and After Action/Corrective Action Plans will be submitted
to the Regional Coordination Center and the Ohio Department of Health as
requested or required.
PLAN DEVELOPMENT AND MAINTENANCE
Implementing Instructions
See the “Plan Development and Maintenance” section of the Meigs County Public
Health Emergency Response Plan - Base Plan.
Authorities and Reference
See the “Plan Development and Maintenance” section of the Meigs County Public
Health Emergency Response Plan - Base Plan.
TRAINING AND EXERCISE
The health department will ensure training for Interoperative Communications.
Components of Interoperative communications will be exercised monthly.
Interoperative communications training, exercise, and evaluation plan is contained
in the Multi-Year Training and Exercise Plan.
IMPLEMENTING INSTRUCTIONS
II: Communications: Location
24/7 Notification Process ERC office; MeigsPrime server
Technical Assistance for Communications x
OPHCS Protocols ERC Office
MARCS Usage & Matrix ERC Office
OPHAN ERC Office, GMIS
HAN & Emergency Contacts MeigsPrime Server
Communications Matrix Meigs ERP
Landlines & Mobile Phones x
Incident Notification & Staff Call -Up Meigs Call-Down List
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Internet Communications X
County Radio System MARCS, Code Red
Situation Awareness MARCS, Landline, Cell phone
REFERENCES
Title Location
Directions for uploading OPHAN forms
OPHCS Administrative and Collaborative
License User Manuals ERC Office
VOIP (The Ohio Department of Health
Telephone User Guide for Cisco 7940 (VOIP)
Phones. September 27, 2005.
Debatable is if ODH VoIP is usable.
Office of Information Technology “Using
your MARCS Digital Radios” Instruction Book
2007
ERC Office
SUMMARY OF CHANGES
NOVEMBER 10, 2014 Punctuation, footer date change
July 10, 2015 added Essential Elements of Information (EEI) and other pertinent info
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Date
Reviewed
Changes
Made* Signature/Title
03/18/2014 Y or N Frank Gorscak ERC
03/25/2015 Y or N Frank Gorscak ERC
Y or N
Y or N
TABLE OF CONTENTS
PUBLIC EDUCATION ................................................................................................... I
Pre-Event ........................................................................................................................ i
Post Event ...................................................................................................................... i
MEDIA/PUBLIC AFFAIRS ............................................................................................. I
Designated Spokesperson .......................................................................................... i
Designated Spokesperson ......................................................................................... ii
Assessment ................................................................................................................... ii
Pre-Scripted Public Advisories .................................................................................... ii
Crisis Communication Team ...................................................................................... ii
Joint Information System ............................................................................................. ii
DISSEMINATION OF PUBLIC INFORMATION ............................................................ III
Special Consideration for Release of Public Information ..................................... iv
DISSEMINATION OF INFORMATION TO RESPONSE PARTNERS ............................... IV
TRAINING AND EXERCISE ......................................................................................... V
ANNEX 3:
EMERGENCY PUBLIC INFORMATION
& WARNING
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PLAN DEVELOPMENT AND REVIEW .......................................................................... V
IMPLEMENTING INSTRUCTIONS ................................................................................ V
EMERGENCY COMMUNICATIONS RESOURCES ...................................................... V
REFERENCES ............................................................................................................. VI
SUMMARY OF CHANGES ........................................................................................VII
* Summary of Changes can be found at the end of this document.
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MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
2013 Epidemiological Response Annex 4
4.i
I. PUBLIC EDUCATION
A. Pre-Event
The Health Department routinely provides public education on potential
public health threats and preventative measures through brochures, press
releases, meetings/educational events, Facebook, Twitter and the Health
Department website. The Health Department will increase public information
efforts for impending disaster situations with public health implications.
B. Post Event
The Health Department will assist in providing critical public health
information to the media and public during emergency situations or disasters
through media briefings, press releases, information lines, publicly dispersed
fact sheets/flyers, , Facebook, Twitter and the Health Department webpage.
The goals of public information and warning activities, in response to
emergency situations, are to provide accurate, timely, and consistent
information to the public in order to prevent panic and to protect the health
of the residents of Meigs County.
1. Special Populations
The Health Department will make the best effort possible to identify
special/functional populations that are at-risk for certain disaster situations
and target those populations for information releases. Due to the unique
public health implications of schools (K-12) and nursing homes, especially
regarding communicable diseases, they may be specifically targeted for
public information releases or Health Department-organized educational
functions for protective/preventative public health measures.
II. MEDIA/PUBLIC AFFAIRS
The Health Department will work with the media during a public health related
emergency to establish press conference areas, media briefing times, and
controlled on-scene access to the media, if possible. The Health Department PIO
or designee(s) will monitor media outlets (Facebook. Twitter) for rumors or
misinformation as well as determine the effectiveness of media communication
efforts to address in future media briefings or press releases.
A. Designated Spokesperson
1. Primary: Meigs County Health Department Administrator
Secondary: Meigs County Health Department Health
Commissioner
Tertiary: Emergency Response Coordinator
See: “II:EPI&W: Training Roster”
2. The Emergency Response Coordinator, functioning as the Public Information Officer, will coordinate the spokes persons.
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3. All press conferences will be pre-approved by the Health Commissioner/Administrator.
B. Assessment
The intensity and longevity of an emergency, disaster, or crises will affect the
requirements for public information and media relations resources, staff, and
hours of operation. When a situation arises that has the potential to be a
crises, the PIO should begin gathering facts and information about the
situation and alert the Administrator or Director of Nursing to the situation. An
assessment of developing crises should be performed to determine the
severity and prepare communications appropriately. (See II: EPI&W:
Assessment Checklists).
C. Pre-Scripted Public Advisories
A list of pre-scripted public advisories and media releases regarding public
safety and health, to be used in the emergency/disaster are provided for in
the Public Information and Warning Implementing Instructions. The Health
Commissioners approve these public advisories and media releases.
However final authorization from the Health Commissioners or his/her
designated person is required prior to release.
D. Crisis Communication Team
Depending on the nature of the crisis and the number of available staff,
varying roles may be assigned to staff and staff may be assigned more than
one role. The communication team is typically composed of the public
health Triad (Health Commissioner and/or Administrator, Director of
Environmental, Director of Nursing) and the Public Health Emergency
Preparedness Coordinator. The Public Information Officer (PIO) should
already be determined for each agency. The spokesperson for public health
emergencies will be the Health Commissioner or Administrator or the
spokesperson may be selected by other members of the crises
communication team based on the situation and the selected individual’s
level of expertise regarding that situation. A list of team roles and
responsibilities can be found in. (See II: EPI&W: Crisis Communication Team
Roles).
E. Joint Information System
The Joint Information Center (JIC) may be comprised of Public Information
Officers (PIOs) and Spokespersons from all the involved agencies, will
determine:
The Development of appropriate public announcements to address the
emergency with a unified voice.
Media Strategy.
Designation of a JIC spokesperson.
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
2013 Epidemiological Response Annex 4
4.iii
Issuance of media releases.
If, when, and where news conferences will be held.
Scheduling of regular media briefings (if needed).
Dissemination of public information via hotline, newspaper, TV, radio,
Internet, and pamphlets via the Unified Command at the EOC.
Establishment of information forums for shelters, schools, churches, etc.
to provide the public with information, education, and guidance as
soon as possible.
1. Local
In the event of a large-scale, multi-jurisdictional emergency, the JIC may
be initiated under the direction of the Emergency Management Agency
Director to coordinate information release among different responsible
agencies. The JIC in Meigs County will open as part of the EOC, if
activated.
Possible JIC locations within the county include the EOC (41859 pomeroy
pike Pomeroy Ohio 45769), the County Courthouse (100 W. 2nd St.
Pomeroy, Ohio 45769), or the Meigs County Health Department (112 E.
Memorial Drive Suite A Pomeroy Ohio 45769). The Meigs County Health
Department will provide a PIO to the EOC or JIC if requested by the EMA.
2. Regional
The Regional Coordination Center (RCC) will aid in the release of public
information during regional emergency so that the counties within the
region have unified messages to report to their local media and
populations. Regional Public Health or the RCC may decide to activate
a Regional JIC with PIO representation from the counties within the South
Central Ohio Region.
For smaller events or for other situations, in which a Regional JIC has not
been established or is not functional, the Meigs County Health
Department can coordinate directly with Athens and Gallia counties as
their media sources are used by Meigs County Residents.
III. DISSEMINATION OF PUBLIC INFORMATION
Meigs County media outlets, such as the Daily Sentinel, MCHD website, MCHD
Facebook and Twitter, are three of the major outlets that reach Meigs County
residents.
MCHD website, Facebook, Twitter, the Daily Sentinel and WYVK K92 FM radio are
some of the primary media outlets the Health Department utilizes for press releases
and PSA’s.
A list of media contacts can be found in Meigs County Health Department Health
Alert Network (HAN) Directory.
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
2013 Epidemiological Response Annex 4
4.iv
Special Consideration for Release of Public Information
1. Mass Patient Care
Communications between the health department and the medical
facility (ies) will be established if, and when, it is determined that a
mass patient care facility/area is needed to care for the sick, or
wounded. Communications may be health department to medical
facility, if the Emergency Operations Center (EOC) has not been
opened.
Any mass patient care facility would likely be managed by area
Hospitals. MCHD would assist in providing public information
concerning:
the mass patient care facility;
where to find medical assistance; and
When to go to the hospital, or other medical facility.
See: Appendix 2: Community Containment for additional information.
2. Isolation
The name(s) of an individual(s) placed in isolation will not be released
to the public without permission of the individual, unless there is an
urgent need to identify potential unknown contacts that need to be
treated or receive prophylaxis. The release of this information will be
discussed and determined by the Health Commissioner and the
medical facility at which the individual(s) are admitted. See:
Appendix 2: Community Containment for additional information
3. Quarantine
The name(s) of an individual(s) placed in quarantine will not be
released to the public without permission of the individual, unless there
is an urgent need to identify potential unknown contacts that need to
be treated or receive prophylaxis. The release of this information will
be discussed and determined by the Health Commissioner , Health
Director, Director of Nursing and the Health Board.
The information that may be released would include:
Location/Area of quarantine;
Reason for the quarantine, i.e., the disease; and
Details, such as: the risk to the public, signs and symptoms of the
disease, etc. may be released.
See: Appendix 2: Community Containment for additional
information.
IV. DISSEMINATION OF INFORMATION TO RESPONSE PARTNERS
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
2013 Epidemiological Response Annex 4
4.v
The Communication process and coordination between MCHD and our response
partners are detailed in Annex 2: Interoperative Communications.
V. TRAINING AND EXERCISE
Training and exercising of this annex is discussed in the South Central Ohio Multi-
year Training and Exercise Plan.
VI. PLAN DEVELOPMENT AND REVIEW
This annex is reviewed and updated annually.
VII. IMPLEMENTING INSTRUCTIONS
VIII. EMERGENCY COMMUNICATIONS RESOURCES
Message Content Website
CDC: Office of Communication: www.cdc.gov/communication/default.htm
CDC: BT site www.bt.cdc.gov
DHHS: Home www.hhs.gov
DHHS: BT Factsheet www.hhs.gov/news/press/2002pres/20020606
a.html
DHHS: Office of Emergency
Preparedness
ndms.dhhs.gov
DHS: Home www.dhs.gov/dhspublic/
DHS: Emergency Preparedness www.dhs.gov/dhspublic/theme_homeliso
DHS: Public Interest www.ready.gov
D Justice: Office of Domestic
Preparedness
www.op.usdoj.gov/odp
Title Location
II: EPI&W:
Crises Communication Team Roles ERC Office, MeigsPrime Server
Assessment Checklist ERC Office, MeigsPrime Server
PIO Training Roster ERC Office, MeigsPrime Server
Pre-Scripted Public Advisories ERC Office, MeigsPrime Server
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
2013 Epidemiological Response Annex 4
4.vi
Message Content Website
FEMA: CONPLAN www.fema.gov/rrr/conplan
FEMA: Response and Recover www.fema.gov/rrr
FEMA: Federal Response Plan www.fema.gov/rrr/frp
American Red Cross: Home: www.redcross.org
Model State Emergency Health
Powers Act
www.publichealthlaw.net/MSEHPA/MSEFIPA
LegActivity050102.pdf
Training Website
CDC: Public Health Training
Network: www.phppo.cdc.gov/phtn/default.asp
CDC: Emergency Risk
Communication www.cdc.gov/cdcynergy/emergency
FEMA: Emergency Management
Institute (EMI)/U.S. Fire
Administration (USFA)
http://training.fema.gov
FEMA: Rapid Response
Information System: www.rris.fema.gov
FBI: Counterterrorism/Weapons
of Mass Destruction Training www.fbi.gov/hq/td/academy/ctwork12.htm
Professional Support Website
Peter Sandman: www.psandman.com/webpubs.htm
Vincent Covello: www.centerforriskcommunication.com/hom
e.htm
IX. REFERENCES
Title Location
Effective Media Communications during
Public Health Emergencies – World Health
Organization Handbook and Field Guide
ERC Office, MeigsPrime Server
Crises and Emergency Risk Communication –
Centers for Disease Control and Prevention
ERC Office, MeigsPrime Server
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
2013 Epidemiological Response Annex 4
4.vii
Electronic Library of Public Health Emergency
Information
SUMMARY OF CHANGES
3/18/2014 Footer date change
3/25/2015 Footer date change, added additional information lines and media
outlets.
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
2013 Epidemiological Response Annex 4
4.viii
Date Reviewed Changes
Made* Signature/Title
Y or N
Y or N
Y or N
Y or N
Y or N
Y or N
Y or N
Y or N
Y or N
Y or N
Y or N
Y or N
ANNEX 4: EPIDEMIOLOGY
EPIDEMIOLOGICAL RESPONSE PLAN
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
2013 Epidemiological Response Annex 4
4.ix
* Summary of Changes can be found at the end of this document.
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MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
2013 Epidemiological Response Annex 4
4.x
Table of Contents INTRODUCTION AND PURPOSE .............................................................................................. 12
SCOPE ............................................................................................................................. 12
SITUATION AND ASSUMPTIONS ............................................................................................. 13
Situation 13
Assumptions 13
CONCEPT OF OPERATIONS .................................................................................................. 13
Notification and Communication 13
Response Level 1 (Local): 14
Response Level 2 (Regional): 14
Response Level 3 (Regional): 15
Response Level 4 (Regional): 15
INCIDENT COMMAND SYSTEM COMPONENTS OF EPI-TEAM ..................................... 17
Response Actions 18
ORGANIZATION AND ASSIGNMENT OF RESPONSIBILITIES ........................................................... 18
Lead Agency 18
Supporting Agencies 19
State Responsibilities 20
ADMINISTRATION AND LOGISTICS ......................................................................................... 20
Epidemiology & Surveillance Branch 21
Data and Surveillance Group 22
Investigation Group 23
Communications and Public Information 26
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
2013 Epidemiological Response Annex 4
4.xi
TACTICAL COMMUNICATION ............................................................................................... 26
De-Mobilization 28
ACTUAL INCIDENT EVALUATION ........................................................................................... 28
PLAN DEVELOPMENT AND MAINTENANCE .............................................................................. 29
Implementing Instructions: 29
Authorities and Reference: 29
Epi-Team Notebooks: 29
TRAINING, EXERCISE, AND EVALUATION ................................................................................ 29
Personnel Training Objectives 30
Training Strategies 30
MEMORANDUMS OF UNDERSTANDING .................................................................................. 30
IMPLEMENTING INSTRUCTIONS .............................................................................................. 30
AUTHORITIES AND REFERENCES ............................................................................................. 32
SUMMARY OF CHANGES ..................................................................................................... 33
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
Introduction and Purpose
Every public health jurisdiction in the country has a responsibility to develop
and maintain the capability to conduct public health surveillance and
epidemiologic investigation.
The purpose of public health surveillance and epidemiologic investigation is to
establish routine systems and processes and to expand these systems and
processes in response to incidents of public health significance to mount an
effective response to natural and mad-made threats or disease incidents.
This plan will address the conditions, criteria, and situations that may
necessitate coordination of regional epidemiological resources in the South
Central (SC) region for a local or regional response providing uniformity and
guidance for:
Case investigation;
Outbreak Investigation;
Evaluation of the infectious disease surveillance system; and the
Review of disease reports.
Scope
The scope of this standard operating guide includes the South Central Ohio
Public Health Region, its Public Health Emergency Preparedness Program
(PHEP) Epidemiologists, and public health epidemiological surveillance and
response. Though there is no established regional authority and primary
responsibilities of the PHEP Epidemiologists lie with the needs of their own
jurisdiction(s). In any health event requiring an investigation, the PHEP
Epidemiologist will follow the guidelines of their Local Health jurisdiction and/or
ODH.
This annex encompasses Epidemiological Response. Epidemiologic
responsibilities include but are not limited to surveillance, case/outbreak
investigation, data analysis, and prevention and control recommendations.
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
Situation and Assumptions
Situation
An infectious disease emergency requiring public health action
Assumptions
7. Each LHD should maintain a current list of the human and other
resources needed for interviewing, scribes, data entry, data analysis,
specimen collection, handling and shipping. This list will be referred
to as the local epi-response team.
8. Coordinating regional assistance may not be needed for every
aspect of investigation/control; e.g., prophylaxis and control may
require regional assistance with some diseases while the actual
investigation/interview may be done by LHD. In other cases,
interviewing and specimen collection may require regional
assistance but not prophylaxis and control.
9. The SC LHDs should strive toward a unified epidemiologic response.
The SC epidemiologists will work together on common education,
training, and exercises to ensure a common foundation for
epidemiological investigation.
10. These epidemiologic response guidelines are directed towards
acute communicable disease issues. These guidelines may not be
applicable to non-infectious disease investigations.
11. Response levels will not necessarily correlate to number of illnesses
reported but will be dependent on the disease and the reaction (i.e.
media, public) to the response.
12. Communication between members of the epi-response team will
occur using the most appropriate means available based on the
situation. In most scenarios, telephone and e-mail will suffice with
use of MARCS reserved for communication with members of the
team conducting field work.
13. Compliance with National Incident Management System (NIMS) will
occur throughout the epidemiologic response efforts. Specifically,
the epi-response team will function as a branch under the
Operations Section within the managing jurisdiction’s ICS structure.
14. ODH and CDC may be involved at any response level.
Concept of Operations
Notification and Communication
Notification of the region and implementation of a coordinated regional
epidemiological response will depend on the severity of the incident and
whether it affects more than one jurisdiction and/or county within the SC Ohio
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
Region. To guide investigation efforts the following four response levels have
been created. Refer to Figure 1 for the ICS structure of the Epi-Team.
Response Level 1 (Local):
If one local health department is affected and the response can be
handled by the local epi-response team; no regional response is
necessary. Follow the guidelines below.
Notification of the PHEP Epidemiologist is required for a report
of a Class A Infectious Disease or one or more cases that
warrant an outbreak investigation even when the response
does not exceed the LHD capabilities.
The Ohio Department of Health will be notified by the LHD or its
designee (such as the PHEP Epidemiologist) in accordance
with the reporting timeframes designated in the Ohio
Administrative Code Chapter 3701-3.
General notification of the incident may be made to the
region as deemed necessary. The decision to notify the region
will be made by the affected jurisdiction’s Health
Commissioner and/or epidemiologist.
ICS will be activated with at least an Incident Commander
and Operations Section.
The potential members of the local Epi-Team are in the Local
Epi-Team Member Contact List.
Response Level 2 (Regional):
If one or more local health departments are affected and the response
needs exceed the capacity of the local epi-response team, additional
assistance is necessary and should follow the guidelines below.
Notification of the PHEP Epidemiologist is required for a report
of a Class A Infectious Disease or one or more cases that
warrant an outbreak investigation even when the response
does not exceed the LHD capabilities.
The Ohio Department of Health will be notified by the LHD or its
designee (such as the PHEP Epidemiologist) in accordance
with the reporting timeframes designated in the Ohio
Administrative Code Chapter 3701-3.The affected health
jurisdiction’s epidemiologist will notify the other epidemiologists
in the SC or other regions.
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
Response will be managed by the local epi-response team
with assistance from the other PHEP (SC or other region’s)
epidemiologists.
Updates out to the region will be made as determined by the
Health Commissioner and the epidemiologists managing the
investigation.
If more than one jurisdiction is involved or additional assistance
is necessary move to Level 3, and activate the RCC.
The ICS structure will expand as needed.
Response Level 3 (Regional):
If one or more local health departments are affected and the response
needs exceed the capacity of the local epi-response team and the
PHEP epidemiologists (SC or other region’s), additional assistance is
necessary and should follow the guidelines below.
Notification of the PHEP Epidemiologist is required for a report of a
Class A Infectious Disease or one or more cases that warrant an
outbreak investigation even when the response does not exceed
the LHD capabilities.
The Ohio Department of Health will be notified by the LHD or its
designee (such as the PHEP Epidemiologist) in accordance with
the reporting timeframes designated in the Ohio Administrative
Code Chapter 3701-3.
As specified in the SC regional MOU, additional staff to
supplement the response will be requested from the SC region.
Response updates will be made according to the SC regional
communication plan.
The ICS structure will expand as needed.
Response Level 4 (Regional):
If one or more regions in the state or multiple states are affected and the
response needs exceed the capacity of Level 3 response, additional
assistance is necessary and should follow the guidelines below.
Notification of the PHEP Epidemiologist is required for a report
of a Class A Infectious Disease or one or more cases that
warrant an outbreak investigation even when the response
does not exceed the LHD capabilities.
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
The Ohio Department of Health will be notified by the LHD or its
designee (such as the PHEP Epidemiologist) in accordance
with the reporting timeframes designated in the Ohio
Administrative Code Chapter 3701-3.ODH will be consulted for
assistance in recruiting additional staff across the state to aid in
the response.
The ICS structure will expand as needed.
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
INCIDENT COMMAND SYSTEM COMPONENTS OF EPI-
TEAM
Figure 1. ICS components of the epidemiologic response plan in South Central Ohio (Epi-Team).
LHD Operations Section
Epidemiology & Surveillance
Branch
Data and Surveillance
Group
Investigation Group
Surveillance
Strike Team
Data Analysis
Strike Team
Case Investigation
Strike Team
Contact Investigation
Strike Team
Laboratory Liaison
Strike Team
Epi-Team
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
Response Actions
ERP Activation
See the “Concepts of Operations, Emergency Response Plan
Activation Authority” section of the YCHD ERP to determine if
activation of the YCHD ERP is necessary.
Typical Sequence of Activities
The Local Health Department (LHD) ERP has been activated, if
necessary.
This Annex will be activated.
Local and regional resources will be utilized. If it is determined
that the local and regional resources will be insufficient to
provide the projected need of response, State and Federal
assets may be considered.
Command & Control
This Epidemiology and Surveillance Branch, whether applied to
a local or regional response, operates under a local
department ICS structure.
Organization and Assignment of Responsibilities
Lead Agency
The LHD is the Lead Agency for epidemiologic response requiring outbreak
investigation. The purpose of the Epidemiology & Surveillance Branch is to
gather information in order to guide the response and to select strategies to
mitigate morbidity and mortality. In the event more than one LHD is actively
involved in the response, unified command may be established.
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
Supporting Agencies
Agency Responsibilities
Ohio Department of Health
___________________________
Report to Centers for Disease Control and
Prevention and other applicable entities as
needed
Coordinate communication, response, and
resources within the Ohio Department of
Health and other state and federal entities, as
necessary
Statewide surveillance and support to include
assistance with statewide and other
jurisdiction, as necessary
Hospitals and Health Care
Providers
___________________________
Protect/treatment to responders and public
Reporting of infectious disease to include
gathering necessary information
Emergency Medical Services
____________________________
Protect/treatment, medical transport to
responders and public
Emergency Management
Agency (EMA)
____________________________
Coordinate County EOC Operations, to include
Coordination of resources
Notification of and collaboration with other
County EMAs
Law Enforcement/Sheriff
___________________________
Upon request & availability, if warranted:
Security;
Traffic control; &
Area control.
Law Enforcement/State Patrol
____________________________
Upon request & availability, if warranted:
Criminal investigation, if necessary;
Provide security
Public Works
___________________________
Access, if needed
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
Advocacy Support Agencies
___________________________
Assist with location of, interview of, education of,
and assessing the needs of individuals with
functional and/or special needs:
Elderly;
Developmental disabilities;
Physical disabilities;
Transportation issues;
Language barriers.
School System/Superintendent
__________________________
Public education and information;
Transportation resources (upon request);
Surveillance and reporting
Elected Officials
__________________________
Responsible for the emergency operations in
their jurisdictions;
Cooperation with the EMA director and
support of EOC operations;
Access City/Township assets to support
operations per EOC requests; and
Participate and support Joint Public
Information Center operations.
State Responsibilities
The Governor of Ohio has the ability to request federal assistance and to waive
or suspend state laws and regulations in the event of an emergency.
Administration and Logistics
The activation and management of an epidemiological response requires
numerous protocols and resources. The protocols and resources have been
pre-identified locally and can be found in the Epi-Team Notebook, including
Job Action sheets detailing the functions of the Epidemiology & Surveillance
Branch and response groups and strike teams to be activated as needed are
outlined below.
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
Epidemiology & Surveillance Branch
Purpose
The purpose of the Epidemiology & Surveillance Branch is to gather
information in order to guide the response and to select strategies to
mitigate morbidity and mortality.
Objectives
Determine appropriate epidemiology and surveillance
response strategies
Conduct surveillance
Conduct epidemiologic investigations
Identify potential sources of disease and disease transmission
routes
Monitor incidence and prevalence trends to identify new or
unrecognized exposures or risk factors
Describe epidemiologic and clinical features
Report cases to the proper agencies
Methods
Primary strategies for the Epidemiology & Surveillance Branch include:
Surveillance/Data Analysis - Surveillance is the continuous analysis,
interpretation, and dissemination of systematically collected data,
generally using methods distinguished by their practicality, uniformity,
and rapidity rather than by accuracy or completeness. By observing
trends in time, place, and person, changes can be observed or
anticipated, and appropriate action, including investigative or control
measures, can be taken.
Epidemiologic Investigation – Epidemiologic investigation uses epidemiologic
tools, including case investigation, contact investigation, and laboratory
testing, to establish person, place, and time characteristics associated with an
event. Epidemiologic investigations can include cohort and/or case-control
studies. Guidelines for conducting an outbreak investigation are included in
Implementing Instruction-Epi-Outbreak Investigation Protocol.
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
Implementation
The Epidemiology & Surveillance Branch should be activated for all
responses in which ICS is implemented when a public health event
warrants an epidemiological response beyond routine case
investigation or regular duties.
Data and Surveillance Group
Purpose
To rapidly identify cases and clusters of disease, receive, manage, and
analyze information that will guide the selection of strategies for the
response.
Objectives
Develop, update, and disseminate the case definition
Develop case-finding strategies
Verify the accuracy and completeness of surveillance data
Identify cases for follow-up by the Investigation Group
Determine appropriate data analysis strategies for the response
to:
o Identify sources of disease and disease transmission routes
o Monitor incidence and prevalence of disease trends to
identify new or unrecognized exposures or risk factors
o Describe epidemiologic and clinical features
o Ensure cases are reported to the proper agencies
Methods
Passive Surveillance – Passive surveillance is the collection of data from
existing unsolicited reports of disease. This date may be received from
physicians, hospitals, and laboratories serving South Central Ohio
residents. This data is used to identify cases to determine the magnitude
of the outbreak.
Enhanced Passive Surveillance – Enhanced passive surveillance employs
a mix of active techniques in addition to the passive surveillance
described above. For example, send a health alert that highlights a
specific disease or syndrome to clinical providers in order to stimulate
clinician and/or laboratory reporting.
Active Surveillance - Active surveillance involves actively finding cases
of disease. Examples include calling medical facilities (e.g. laboratories
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
or emergency departments) or sending field surveillance teams to
hospitals to extract information from hospital records.
Syndromic Surveillance – Syndromic surveillance is the collection and
analysis of non-specific data from multiple data sources to detect a
possible change or trend in the health of a population. Syndromic
surveillance data sources may include data from hospital emergency
departments (i.e. Epi-Center) or other emergency encounters, physician
office visits, over-the-counter pharmaceutical sales (i.e. NRDM), and
school absenteeism records.
Data Analysis – Data analysis is the systemic study of data so that its
meaning, structure, relationships, origins, etc. are understood. Data
analysis uses statistical methods and logical techniques to describe,
summarize, and compare data.
Implementation
The Data and Surveillance Group should be activated when any
component of the Epidemiology & Surveillance Branch has data
analysis or surveillance needs, with strike teams established based on
the specific needs of the investigation. The Data and Surveillance
Group will be activated in tandem with the Investigation Group.
Investigation Group
Purpose
The purpose of the Investigation Group is to carry out case and contact
investigations to collect information on factors that may be associated
with the outbreak.
Objectives
Select appropriate investigation strategies for the response
Conduct case investigations and contact investigations
Collect information about cases, controls, disease characteristics,
clinical characteristics, and possible disease exposures in a
methodologically appropriate and efficient manner
Obtain and prioritize specimens for laboratory testing
Determine if a formal epidemiologic study is needed, and if so,
design and implement study with assistance from the Data and
Surveillance Group
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
Methods
Case Investigation – Case investigation is used to identify cases of an
infectious disease, evaluate cases for possible exposure factors, assess
case characteristics, provide ODH-approved treatment
recommendations to cases and/or their medical provider, identify
possible contacts to the case, collect and/or manage laboratory
specimens, and/or offer recommendations to help interrupt the
transmission of disease. Case investigation can be important
throughout an event but is particularly important during the initial stages
of an infectious disease emergency response. Investigations may be
conducted over the telephone or in person, depending on the nature
of the outbreak and available resources. Guidelines for case
investigations are included in the Implementing Instruction-Epi – Case
Investigation Protocol.
Epidemiologic Study – An epidemiologic study may be needed in an
outbreak suspected to have originated from one source (“point
source”) in order to identify the specific food item, activity, location,
animal(s), or other exposure that was the source of infection. This
enables targeted public health interventions to remove the source of
disease. In an epidemiologic study, exposures among those who are
sick are compared to exposures among those who are well; thus, many
interviewers may be needed to survey both ill and well persons. A
cohort study and case-control study are examples of epidemiologic
studies. A cohort study may be used if the exposed population is readily
defined. A case-control study may be used when the exposed
population is not easily defined, when multiple exposures need to be
examined, and/or when the disease occurrence is rare. Guidelines for
conducting an outbreak investigation are included in the Implementing
Instruction - Epi – Outbreak Investigation Protocol.
Contact Investigation – Contact investigation is used to identify
contacts to an infectious disease case, evaluate possible contacts for
infection/disease, recommend strategies to treat and/or prevent
infection/disease in the individual contact and/or interrupt the
transmission of disease.
Individual contact investigation may be more effective in controlling the
spread of disease when there are low numbers of cases, when
chemoprophylaxis or vaccination are available and can be promptly
administered to the contact, and/or when no chemoprophylaxis is
available, if quarantine can be promptly implemented.
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
Individual contact investigation may not be feasible or an effective use
of scarce personnel resources when the prevalence/incidence of
infection is high (e.g. pandemic influenza), when many transmission
routes exist, when the contact tracing process is slower than the
infection process (the incubation period is short, or the basic
reproductive ratio is high or a combination of both), and/or when a
disease has airborne transmission (e.g. smallpox).
Symptom Monitoring – Symptom monitoring involves monitoring either
cases or contacts of a case for new signs and symptoms of disease.
There are two types of monitoring: active and passive. During active
monitoring, a healthcare or public health worker evaluates a case or
contact on a regular basis by phone and/or in person for signs and
symptoms suggestive of disease. During passive monitoring, a case or
contact is asked to perform regular self-assessment and to contact the
health department immediately if specific signs or symptoms develop.
(Patient care recommendations and public health follow-up will be
guided by the ODH Infectious Disease Control Manual). Choosing
active versus passive monitoring will depend on available resources and
the disease.
Survey Development – Questionnaires or survey forms will be needed for
case investigations, contact investigations, epidemiologic studies, and
symptom monitoring. Questionnaires and surveys can be administered
via the telephone, in-person, or through a computer, depending on the
population being targeted (cognitive skills, education level, access to a
telephone or computer, etc.) and available resources.
Implementation
The Investigation Group will be activated when:
Case investigation is required, or
Contact investigation is required, or
An epidemiologic study is needed, or
Symptom monitoring is needed
Specific strike teams will be activated based on what is needed, as
deemed necessary by the Epidemiology & Surveillance Branch Director.
Depending on the situation, other support and functions may be
necessary and provided from other ICS resources. These functions
include:
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
Communications and Public Information
Tactical Communication o The primary means of communication will be existing phone lines,
internet access and cell phones. MARCs radios or other two way
radio systems may also be used. Alternate types of
communication equipment may need to be used and these
could include HAM radios, and runners;
o Through internet connectivity forms, surveys, and access to enter
data directly into the Ohio Disease Reporting System (ODRS), the
National Outbreak Reporting System (NORS) or other applicable
systems will be maintained. If internet connectivity is not
available or is lost, use paper forms and enter the information
upon restoration of connectivity.
IT and Communications Systems
o IT systems may be utilized to:
Report and manage cases utilizing the Ohio Disease
Reporting System (ODRS);
Prepare Ohio Public Health Communication System
(OPHCS) alerts, public health warnings and advisories, and
other forms of communication:
Communication systems, including telephone lines, fax
machines, copy machines, and computers (tabletop
and/or laptops, printers and internet access) may be used
to maintain communications with appropriate partners,
ODH, and other government/non-government agencies.
The back-up plan if communications equipment, including
radio communications, needs maintenance or becomes
unavailable includes:
o Contacting the EOC and EMA to send IT support;
Contacting any available on site IT personnel; and/or
Contacting the health department’s contractual IT
support company.
o The region’s communications equipment is interoperable.
Radio channels/frequencies will be pre-designated, and
security measures will be taken to ensure efficient
communications among all site personnel.
Detailed information is maintained within Annex 2:
Interoperative Communication of the SCO Regional Public
Health & Hospital Emergency Response Plan.
o See Annex 2: Interoperative Communications of the SCO
Regional Public Health & Hospital Emergency Response Plan
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
and the Multi-Year Training and Exercise Plan for testing and
exercising of communications systems.
Public Information
o A Public information officer (PIO) will be assigned if the event
warrants and public information will be funneled through this
person to:
Ensure that information released will be closely
coordinated with the local, regional, and state PIO;
Ensure that all staff members provide consistent
information
Public information templates have been developed, as
well as a list of potential resources for agent specific
information and are located in Implementing Instruction:
EPI&W: Communications (PIO) Guidance Document
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
De-Mobilization
The Incident Commander will work with the local government to determine
when the functions of the Epidemiological Response are complete or near
completion. When this determination has been made, the Incident
Commander will work with the Logistics Section Chief and the Operations
Section Chief to arrange the de-mobilization activities, such as:
Staff reassignment
Equipment/Supplies cleaning, replacement, storage, and return
Documentation of Incident activities
Debriefing of staff and support staff
Actual Incident Evaluation
In addition to the outbreak report, depending on the size and cost of the
response, additional post-event activities may be necessary to ensure that the
event is documented for the public record, to determine the costs of the
event, and to enhance efficiency of operations for future efforts. In this regard,
the evaluation of the epidemiological response should include the following
information:
Expenditures and in-kind costs incurred in the operation
Identified successes and opportunities for improvement
Recommended changes in emergency response plan
Implications for the public health infrastructure
If an After Action Report needs to be to collect of key information that will
improve any future epidemiological response, ODH requires the use of the
Homeland Security Exercise and Evaluation Program’s (HSEEP) template. The
template can be found in “Volume IV Library: Sample Exercise Materials of the
HSEEP Policy and Guidance” on the HSEEP website:
https://hseep.dhs.gov/pages/1001_HSEEP7.aspx
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
The After Action Report will include, at a minimum:
What occurred, including
o number of cases identified
o start and stop dates/times
o total number of hours of operation
o listing of all personnel involved
o how the process took place
Problems identified throughout the process; and
Suggestions for improvement/improvement plan.
Plan Development and Maintenance
Implementing Instructions:
See the “Plan Development and Maintenance” section of the SCO
Regional Public Health & Hospital Emergency Response Plan Emergency
Response Plan - Base Plan.
Authorities and Reference:
See the “Plan Development and Maintenance” section of the SCO
Regional Public Health & Hospital Emergency Response Plan Emergency
Response Plan - Base Plan.
Epi-Team Notebooks:
Updated annually
Training, Exercise, and Evaluation
The health department will ensure training for Epidemiological Response.
Components of Epidemiological Response will be exercised individually
annually. The Epidemiological Response training, exercise, and evaluation
plan is contained in the Multi-Year Training and Exercise Plan.
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
Personnel Training Objectives
The team should:
Understand Epidemiological Response, its mission, purpose, and methods
of operation;
Possess the knowledge and skills to perform tasks effectively;
Be cross-trained to work in other functional areas assigned; and
Understand the performance standards and measures for successfully
activating and operating all the functions in the plan.
Training Strategies
Outbreak and investigation training, ODRS training, and training on
other relevant epidemiological response functions is provided to
members of the Local Epi-Team and other key Local Health
Department staff.
A “Just in Time” training approach with the aid of ODH information,
CDC resources and locally developed materials will be utilized to
provide relevant disease information, plan review, and preparation
for other specialized tasks such as conduction interviews.
Cross-training individuals for various epidemiological response roles is
ideal. This will allow individuals to rest without affecting the flow of
the response, as well as allow for flexibility of staffing.
Memorandums of Understanding
Written agreements between the health departments are in place.
After an event, written agreements are critical for federal disaster
reimbursement under the Stafford Act which was enacted to support State
and local governments and their citizens when disasters are overwhelming. The
Federal Emergency Management Agency (FEMA) is tasked with coordinating
the response.
EPI-TEAM NOTEBOOK CONTENTS
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
Implementing Instructions
JOB ACTION SHEETS
Epidemiology & Surveillance Branch Director
Data and Surveillance Group Supervisor
Surveillance Strike Team Leader
Data Analysis Strike Team Leader
Investigation Group Supervisor
Case Investigation Strike Team Leader
Contact Investigation Strike Team Leader
Laboratory Liaison Team Leader
CASE INVESTIGATION PROTOCOL
ODH HIPAA BULLETIN
OUTBREAK INVESTIGATION PROTOCOL
LOCAL EPI-TEAM MEMBER CONTACT LISTS
REGIONAL EPIDEMIOLOGISTS CONTACT LIST
REQUIRED DOCUMENTATION PROTOCOL IMPLEMENTING
INSTRUCTION
EPIDEMIOLOGY RESPONSE NOTIFICATIONS AND
COMMUNICATIONS
PROCESS FOR POSTING HEALTH ALERTS
Title Location
I: Epidemiological Response
Job action sheets
Case investigation protocol
Epi-Team Notebook
Case investigation protocol Epi-Team Notebook
Outbreak investigation protocol Epi-Team Notebook
Evaluation of the Infectious Disease Surveillance
System Protocol Epi-Team Notebook
Review of Disease Reporting Protocol Epi-Team Notebook
Required documentation protocol implementing
instruction Epi-Team Notebook
Epidemiology Response Notifications and
Communications Epi-Team Notebook
Process for Posting Health Alerts Epi-Team Notebook
II: Emergency Public Information & Warning:
Communications (PIO) Guidance Document
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
Authorities and References
Reference Location
Ohio Department of Health Infectious Disease Control
Manual
http://www.odh.ohio.gov/healthResources/infectiousD
iseaseManual.aspx
Ohio Administrative Code Chapter3701-3
http://www.odh.ohio.gov/rules/final/f3701-3.aspx
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
Summary of Changes
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
Date Reviewed Changes
Made* Signature/Title
02/20/14 Y or N Frank Gorscak ERC
2/19/2015 Y or N Frank Gorscak ERC
Y or N
Y or N
Y or N
Y or N
Y or N
Y or N
Y or N
Y or N
Y or N
Y or N
ANNEX 5:
Environmental Health
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
* Summary of Changes can be found at the end of this document
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MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
Framework of this Annex
Introduction ................................................................................................................... 1
General Environmental Health Emergency Response Actions ................................ 1
Immediate Environmental Health Emergency Response Actions ........................... 2
Specific Environmental Health Emergency Response Actions................................. 5
WATER SAFETY AND SUPPLY ............................................................................................ 7
FOOD SAFETY .............................................................................................................. 11
SEWAGE / SEPTIC......................................................................................................... 15
VECTOR CONTROL ....................................................................................................... 18
SOLID WASTE/DEBRIS MANAGEMENT ............................................................................ 22
All-Hazards Environmental Health Emergency Response Actions ................. 27
BIOLOGICAL INCIDENTS: NATURAL OR DELIBERATE .......................................................... 29
Notification of Deliberate Biological Incident ..................................................... 33
CHEMICAL INCIDENTS: ACCIDENTAL OR DELIBERATE ....................................................... 40
RADIOLOGICAL INCIDENT ............................................................................................. 46
WEATHER-RELATED AND OTHER COMMON INCIDENTS .................................................... 50
Worker Safety and Personal Protective Equipment ................................................. 56
ANNEX 5: ENVIRONMENTAL HEALTH
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
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2015 Environmental Health Annex 5
5.1
INTRODUCTION
The purpose of this document is to describe general and specific response
actions that county or city environmental health professionals (i.e., specialists,
sanitarians and or environmentalists) could be responsible for in the event of a
natural disaster, an industrial or transportation related incident, or a deliberate act
of terrorism. In other words, this document attempts to describe potential roles for
local environmental health staff to a public health emergency.
During a natural disaster or other emergency, such as a terrorist attack, the
primary role of the public environmental health system is to provide services
essential for protecting and ensuring the well being of the people in affected
areas, with an emphasis on prevention and control of communicable diseases and
exposures to hazardous materials.
A threat/risk assessment has been created to include the public health-specific
risks for All Hazards identified within the South Central Ohio Public Health
Region/County Jurisdiction. The Risk assessment includes the potential magnitude
and frequency of risks, speed of onset of the risks, and areas of the community or
special populations likely to be impacted by those risks. The assessment also
addresses health department capabilities, Resources, and Operations available to
respond to All Hazards.”
GENERAL ENVIRONMENTAL HEALTH EMERGENCY RESPONSE ACTIONS
The role of environmental health in a public health emergency, such as a
natural or man-made disaster, will vary according to the type (e.g., terrorist-
related, flood, tornado, fire, or prolonged power outage) and severity of the
situation. Environmental health has the primary responsibility for the “health” of
a community following a disaster. This includes basic services such as food
safety, water supply, shelter, sanitation, and waste management that need to
be reestablished.
Depending on the situation, a county might implement their incident command
system (ICS) to respond to both deliberate and natural disasters. Annex 1:
Direction and Control of the Meigs County Health Department Emergency
Response Plan should provide guidance for the use of ICS.
Environmental health activities will likely be in conjunction with, or as a result of a
larger incident. A naturally occurring biological incident would be the exception.
County health departments will be involved in environmental health related
activities in support of the Lead agent for the larger incident, along with many
other local, state, and federal agencies
Public Health Roles
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2015 Environmental Health Annex 5
5.2
The traditional role or function of public environmental health staff is regulatory in
nature. The primary day-to-day role is to ensure that licensed facilities, such as:
food and beverage establishments, mobile home parks, recreational camping
areas, school kitchens, and public swimming pools, maintain acceptable
sanitation standards or are closed until those standards identified by State and
County ordinances are met.
A second role is to prevent or minimize the occurrence or spread of disease by
assisting the local county’s EMA, Red Cross, Salvation Army or any other disaster
relief organization, and providing relevant and timely information. This information
could include the following topics: general sanitation, food safety, inspection of
temporary housing, mass feeding centers, drinking water distribution, and waste
disposal. Inspection of temporary shelters (example: Red Cross operated shelters)
prior to opening is also a function the health department performs
A third role is to promote public awareness and provide direction to the public
regarding specific steps or actions that need to be taken to survive, or
minimize their losses due to a catastrophic incident, whether it be natural (e.g.,
a flood or tornado) or man-made (e.g., an industrial accident or act of
terrorism).
An additional role of public environmental health is to provide technical
assistance to the public or community response partners necessary to address
any hazards or threats that are posed by the environment (indoor, outdoor,
natural or man-made).
IMMEDIATE ENVIRONMENTAL HEALTH EMERGENCY RESPONSE ACTIONS
Following a disaster, rapid and effective action is needed to save lives, protect
health and stabilize the situation, to avoid making the emergency worse. Each
county’s environmental health staff should conduct a rapid initial qualitative
assessment to collect information needed to begin an appropriate and timely
response. The purpose of the assessment is to:
Advise HD and other First Responders with a SitRep about
worker/responder safety in the affected area.
Decide whether local capacity (i.e., county resources) is adequate
or external assistance/resources are required;
Identify/recognize potential threats and hazards;
Assess health risks;
Determine priorities and recommend actions;
Develop objectives, determine priorities and intervention strategies;
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
2015 Environmental Health Annex 5
5.3
Perform intervention strategies, if possible, and identify necessary
resources to address the situation.
First-hand information may be gathered in the field, using the following
techniques:
On-site visual observations of the affected area;
Interviews with key individuals, community leaders, groups of disaster-
affected people, or household members;
Expert measurements and testing and sampling activities (e.g., water quality
testing).
Environmental health staff could participate in the assessment with specialists in
related professions (e.g., engineering, emergency management, community
health promotion) from other departments such as public works, environmental
services, human services or other organizations. All of the findings will be reported
to the County’s Public Health Commissioner as soon as possible.
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5.4
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5.5
SPECIFIC ENVIRONMENTAL HEALTH EMERGENCY RESPONSE ACTIONS
This section describes specific response actions that local county environmental
health professionals might be responsible for in the event of a natural disaster or
deliberate act of terrorism.
Sections are listed in the order of:
Components of an incident:
o Water Safety and Supply;
o Food safety;
o Sewage / Septic;
o Vector Control; and
o Solid Waste/Hazardous Waste/Debris Management
Sections are organized in the following subsections:
Introduction;
Emergency response objectives; and
Priority activities.
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5.7
I. WATER SAFETY AND SUPPLY
Ensuring safe, potable water in an emergency/disaster situation is a critical
function of public environmental health. Safe drinking water may include bottled,
boiled or treated water, depending on what hazards are present. County
residents should only drink bottled, boiled or treated water until their water supply
is tested and deemed “safe” to consume. Residents accessing public water
systems may receive the “safe” by either their municipality or Environmental
Protection Agency (EPA). Residents with a private water system may request
testing and a declaration of “safe” from the health department or the Ohio
Department of Health. Residents must not use contaminated water to wash dishes
and cooking utensils, brush teeth, wash and prepare food, or make ice. Bottled
water from an unknown source must be boiled or treated before it is used.
Water from sources that are considered to have a significant risk of chemical or
radiological contamination should be avoided until local, state or federal
authorities notify residents that it is safe to use.
Emergency Response Objectives
In a major disaster such as a flood or deliberate terrorist attack, the public water
supply system, which includes treatment plants, storage and pumping facilities,
and distribution networks could be damaged, interrupted or contaminated. If
public water supplies were affected, the following objectives need to be
addressed immediately:
Ensure that an adequate supply of safe, potable water will be available to
the general public;
Disease prevention and surveillance:
o Outbreaks of waterborne diseases such as typhoid, cholera,
dysentery, infectious hepatitis, and others;
Provide Public Information to:
o Regarding water safety and supply;
Consider/assess priority of any interventions needed in regulated food
service establishments.
Priority Activities
There are a number of tasks that county environmental health professionals
could do to prevent or in response to an incident that poses a threat to both
drinking and recreational water safety and supply:
1. Contact water system operators and purveyors to determine if water
service and/or quality have been, or may become affected by the disaster;
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
2015 Environmental Health Annex 5
5.8
2. Check to ensure that contract labs are able to operate and conduct
appropriate analyses. Assist water system operators and purveyors if
requested;
3. Locate and arrange for the distribution of emergency potable water
supplies;
4. Assist municipal staff, if requested, regarding the delivery of emergency
water supplies via tanker trucks or other means;
5. Provide periodic testing of public swimming pools and provide education to
swimming pool managers and staff;
6. Assist Environmental Protection Agency (EPA) with monitoring recreational
waters, posting warnings for waters with elevated bacteria or chemical
levels, and educating surrounding land users of hazardous “cause and
effect” practices (i.e., direct dumping of sewage/waste, fertilizer use, etc)
7. Public Information:
a. Individual water needs;
b. Rationing;
c. Storage; and
d. Disinfection.
8. Update the County’s website to provide information to the public on water
needs, rationing, storage and disinfection; and
9. Provide advice or assistance in the disinfection and decontamination of
distribution systems, storage tanks and water tanker trucks.
References within this Document
Section II: Food Safety
Implementing Instructions
Title Location
II: Environmental:
Water Safety Practical Guidance Enviro Office
Pre-written Public Education
Title Location
Boil Advisory Guidelines Enviro Office
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
2015 Environmental Health Annex 5
5.9
Safe Drinking Water & Disinfection of Water Wells Enviro Office
References
Title Location
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
2015 Environmental Health Annex 5
5.10
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5.11
II. FOOD SAFETY
Food safety problems vary in nature, severity and extent, and depend on the
situation during an emergency. A breakdown in vital services, such as an
interruption in water supply or electricity, can severely affect food safety. The main
message to communicate is, “If in doubt, throw it out.”
In the absence of electricity, cold storage may be more difficult, if not
impossible, and foods may be subject to microbial bacterial and fungal
growth, and other forms of spoilage.
Food can be damaged by smoke, chemicals used to extinguish a fire, or by
other chemicals or radiation originating from an accidental or intentional
release. Fires or explosions may result in foodstuffs becoming contaminated with
dangerous chemicals or pathogenic microorganisms, as well as being damaged
by water.
Disaster-affected people eating food from centralized kitchens that are not
properly equipped or poorly run are extremely vulnerable to outbreaks of
foodborne illnesses. A combination of environmental contamination and
improper handling of food increases the public’s risk for cholera, shigellosis,
norovirus and campylobacter.
Canned foods and other shelf-stable products should be stored in a cool, dry
place. They should not be stored above a stove, under a sink, in a damp
garage or basement, or any place exposed too high or low temperature
extremes. High acid foods such as tomatoes and other fruit can be stored up to
18-months. Low acid foods such as meat and vegetables can be kept two to
five years.
Emergency Response Objectives
In a situation that poses a threat to food safety, the following objectives need
to be addressed immediately:
Contact licensed food service facilities to assess the status of each one;
Assure that mass feeding sites also comply with best practices for safe
and hygienic food preparation and service;
Ensure that licensed food service facilities can provide for handwashing,
ware washing, refrigeration (i.e., generators or dry ice), and safe water,
including dispensing machines that use water (i.e., Ice, soda, coffee);
Public Information regarding food safety topics, such as:
o Salvaging, sorting and proper disposal;
o To help manage donations of food;
o Sanitizing and cleaning kitchen items.
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
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5.12
Priority Activities
There are a number of specific tasks that city and county environmental health
professionals could do in response to an incident that poses a threat to food
safety:
1. Provide technical assistance and consultation to owners/managers of food
facilities regarding general food safety issues;
2. Provide information to owners/managers of food establishments on
salvaging and protecting perishable foods;
3. Provide information to owners/managers of food establishments on sorting
and proper disposal of foods, which may have been contaminated or
adulterated (i.e., packaging compromised, badly dented can);
4. Ensure that contaminated foods are properly collected and disposed of at
sanitary landfills;
5. Provide education and/or complimentary inspections at mass feeding
centers, if established, to ensure safe food handling practices and personal
hygiene for workers and attendees;
6. Provide information to the public addressing protection of perishable foods,
and advice on the sorting and disposal of food that may be contaminated;
and
7. Provide information to the public addressing the handling of foods
contaminated with a chemical or biological agent (i.e., E. coli, salmonella).
References within this Document
Section I: Water Safety and Supply
Section III: Sewage / Septic
Implementing Instructions
Title Location
II: Environmental:
Food Safety & Food-Bourne Illness Practical
Guidance Enviro Office
Pre-written Public Education
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
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5.13
Title Location
Food Safety During Power Outages Enviro Office
What to Do In An Emergency! (For food service operations & retail food establishments)
Enviro Office
How to Wash Your Hands Enviro Office
Hand Washing Fact Sheet Enviro Office
Foodborne Disease Fact Sheet Enviro Office
Foodborne Disease Questions & Answers Enviro Office
Hepatitis A Fact Sheet Enviro Office
Hepatitis A Questions & Answers Enviro Office
References
Title Location
“Food Safety Guidance in
Emergency Situations”. Food &
Agriculture Organization of the
United Nations. (2005).
Ftp://ftp.fao.org/es/esn/food/emergency.pdf
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
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5.15
III. SEWAGE / SEPTIC
Sewage systems are a network of pipes that carry wastes away from a population
to sewage treatment facilities. Septic systems are a smaller, private system used to
handle waste usually in a rural setting. A sewer system may lose electrical power,
become flooded, or damaged in a disaster. Additionally, a waste/wastewater
treatment facility may be taken out of service, loss of water pressure/supply can
interrupt waste removal processes, and mass congregations of people may
overwhelm existing amenities. In such cases, waste-containing fecal matter may
be released into the environment.
Effective sanitation is essential to provide a healthy and acceptable environment
for people to live in after a disaster strikes. The first priority in preventing the spread
of fecal contamination is to isolate and contain feces. The links between
sanitation, water supply, and health are directly affected by hygiene behavior. It
is important to bear this in mind when considering technical options, so that
facilities provided in emergencies are acceptable to the users and can be used
and maintained hygienically.
Human feces may contain a range of disease causing organisms including viruses,
bacteria, and eggs or larvae of parasites. On the other hand, urine is relatively
harmless. Microorganisms contained in human feces may enter a human body
through contaminated food, water, eating and cooking utensils, and by contact
with contaminated objects. Oral-fecal transmission of enteric microorganisms may
especially be a major cause of illness in disasters and emergencies. Such
infections can contribute to stress, fluid loss and undernourishment, making people
more susceptible to the impacts of other health hazards.
Emergency Response Objectives
In the event that inadequate sanitation poses a health threat to the general
public, the following objectives need to be addressed immediately:
Disease Prevention and Surveillance:
o Prevent human exposure to, and the spread of disease-causing
microorganisms;
o Prevent contamination of water supplies; and
o Prevent degradation of surface and groundwater quality.
Priority Activities
There are a number of tasks that county environmental health professionals could
perform in response to an incident that poses threats related to inadequate
sanitation services.
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
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5.16
1) Coordinate provision of emergency waste disposal facilities for affected
neighborhoods and local government facilities, and work with municipal
staff;
2) Secure commercial chemical toilets and hand washing stations, and arrange
for servicing;
3) Provide Public Information:
a) Alternate human waste disposal methods if commercial toilets are not
available;
b) Recommendations regarding personal hygiene; and
c) Water conservation education in support of a shelter, or facility that
may need to be used for a prolonged period of time.
4) Supervise the construction of alternate, human waste disposal units such as a
latrine.
References within this Document
Section I: Water Safety and Supply
Implementing Instruction
Title Location
II: Environmental:
Pre-written Pubic Education
Title Location
Sanitation Emergency Guidance
References Title Location
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MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
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5.18
IV. VECTOR CONTROL
Disasters frequently create conditions that result in population increases in insects
(e.g., mosquitoes and flies) and rodents or increased contact between humans
and vector/nuisance species. In such situations, the chances of disease
transmission increase sharply. For example, floods and heavy rains will create new
mosquito breeding sites in disaster rubble and/or standing water. If sewage
systems are disrupted and riverbanks are disturbed, rodents will leave these areas
and head for other sources of food and harborage. After a disaster, there will be a
considerable amount of solid waste including food waste that can serve as a food
supply for rodents and insects like houseflies.
In addition to disease hazards posed by insects and rodents, they can contribute
to psychological stress by being a major nuisance in a disaster situation.
Vector control measures needed in a disaster situation are dependent on the
following six primary factors:
The type of disaster (e.g., a flood) influences the type and extent of
environmental changes, which can cause increases in vector problems.
The geographical extent of the disaster (disaster: widespread vs local).
Climatic and geographical factors that may intensify or mitigate the effects
of the disaster.
The impact or loss of services such as garbage collection, sewage
treatment and animal control.
The extent of damaged or lost housing resulting in increased exposure to
vectors.
The existing vector species and prevalence of vector-borne diseases in the
geographic area and at that time of year.
Emergency Response Objectives
In the event that a disaster situation occurs in which vectors pose a threat to the
public’s health and well being, the following objectives need to be addressed
immediately:
Provide Public Information regarding common vector related topics:
o Transmitted diseases;
o Insect repellent use and safety; and
o Pesticide use and safety.
Coordinate emergency corrective measures against vectors that cause
public health problems.
Priority Activities
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There are a number of specific tasks that county environmental health
professionals could do to minimize health hazards and nuisance conditions posed
by vectors (e.g., mosquitoes, flies, ticks and rodents) associated with a disaster
situation.
1. Assess conditions in the disaster area (e.g., standing water, uncollected
and exposed solid waste containing food waste and a damaged or
flooded sewer system) that may promote vector populations.
2. Work with private and public refuse haulers and municipal staffs to reinstate
regular refuse collection or arrange for special pickups.
3. Provide Vector Control by contacting Gallia or Athens Health Departments
for use of their licensed services.
4. Provide Public Information:
a. Addressing how to avoid mosquito and tick bites;
b. Insect repellent safety and use; and
c. Pesticide safety and use.
References within this Document
None
Implementing Instructions
Title Location
II: Environmental
Vector Control Practical Guidance Enviro Office
Pre-written Public Education
Title Location
Fight the Bite (mosquito) ODH website
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References
Title Location
“Updated Information regarding Insect
Repellents”. ODH. (2012)
http://www.cdc.gov/ncidod/dvbi
d/westnile/RepellentUpdates.htm
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V. SOLID WASTE/DEBRIS MANAGEMENT
In the event of a natural disaster or a deliberate act of terrorism, the infrastructure
that routinely deals with the storage, collection and disposal of solid waste (i.e.,
non-hazardous residential, commercial and industrial waste) may be interrupted
anywhere from a few days to several months. Failure of the collection system in a
populated community for two to three weeks could lead to many public health-
related problems.
There are two basic categories of disaster impacts regarding solid waste
management:
The disruption of the solid waste storage, collection, and disposal system
that affects the ability for ongoing generation of solid waste to be
managed properly.
The management of large quantities of debris, including separating
materials requiring different types of management methods, and then
ensuring proper management of each material type.
Description of Waste
Type of Waste Description of Waste
General Solid
Waste
Food, packaging, clothing, appliances, furniture, machinery,
electronic equipment, garbage, plastic, paper, bottles, cans, loose
carpet, paper products, scrap tires, street dirt, dead animals. Items
in this category that have been contaminated with hazardous waste
would be disposed of as a “hazardous waste”.
Agricultural &
Vegetative
Waste
Vegetative or woody waste, tree limbs, brush, shrubs (does not
include buildings, dead animals, or vehicles). Items in this category
that have been contaminated with hazardous waste would be
disposed of as a “hazardous waste”.
Construction &
Demolition
Debris (CDD)
Brick, stone, mortar, asphalt, lumber, wallboard, glass, roofing, metal,
piping, fixtures, electrical wiring, heating equipment, insulation,
carpeting attached to structures, railroad ties, utility poles, mobile
homes. Items in this category that have been contaminated with
hazardous waste would be disposed of as a “hazardous waste”.
Clean Hard Fill
(a subset of
CDD)
CDD which consists only of reinforced or non-reinforced concrete,
asphalt concrete, brick, block, tile, and stone which can be reused
as construction or fill material. Items in this category that have been
contaminated with hazardous waste would be disposed of as a
“hazardous waste”.
Medical/ Needles and medical related glass, syringes, blood containing or
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Type of Waste Description of Waste
Infectious
Waste
saturated items including tubing, clothing, bandages, etc. Items in
this category that have been contaminated with hazardous waste
would be disposed of as a “hazardous waste”.
Hazardous
Waste/
Household
Hazardous
Wastes
Flammable materials (fuels, gasoline, kerosene, propane tanks,
oxygen bottles), explosives, batteries, household chemicals
(cleaners, solvent, mercury, paint), industrial and agricultural
chemicals, cleaners, solvents, fertilizers, etc.
Radiological
Wastes Nuclear medicine materials and associated patient wastes, certain
monitoring equipment.
Emergency Response Objectives
Disaster situations often result in large volumes of waste or building debris that
can overburden the waste management infrastructure and present the
following potential public health concerns: insect and rodent harborage;
diseases caused by environmental agents (e.g., mold); and chemical
contamination. Building debris could be contaminated with asbestos,
radioactive particles, lead, mercury, and human remains. In this situation, the
following objectives need to be addressed:
Advise responders and workers of Hazards in dealing with disaster
debris/waste.
Coordinate solid waste and debris management functions with the Ohio EPA,
Local Emergency Management Agency, Regional Solid Waste District, solid
waste haulers and waste disposal facilities.
Determine the extent of disruption of solid waste management system
Provide Public Information, guidance and oversight
Ensure proper storage, collection, and disposal of solid waste
Priority Activities
There are a number of specific tasks that county environmental health
professionals could do in response to an incident that disrupts the “normal”
solid waste management system, as well as assist in the community’s return to
“normal” following an incident.
1. Check with appropriate contacts (e.g., State EPA, Regional Solid Waste
District, solid waste haulers, and disposal facilities) to determine extent of solid
waste management system disruption, including both disruptions to facilities
and equipment, and to transportation routes. Determine timeline for
reestablishment of disrupted services.
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2. Check with waste haulers, disposal facilities, and other contractors to assess
their capacity to manage increase volumes of solid waste or debris.
3. Work with contacts to determine if temporary solid waste disposal sites or
“staging areas” need to be established to store and sort debris resulting from
a disaster (see Implementing Instruction: Environmental Health: Waste
Management Practical Guidance).
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4. Public Information:
a. Work with appropriate contacts to publicize the availability of
emergency disposal and or transfer sites.
b. Regarding changes in the solid waste management system resulting
from the disaster and the required waste collection activities from
businesses and homeowners.
c. Discouraging disposal of household hazardous materials in sewers,
drains, or soil.
5. Work with other governmental agencies to:
a. Determine different types of waste within the debris, including the
extent of possible contamination of the solid waste (e.g., by hazardous
materials, hazardous wastes, bio-hazardous waste, or radioactive
waste).
6. Assist the EPA, as needed, to provide increased regulatory oversight as
needed for licensed facilities, and determine if regulatory waivers are
necessary.
7. Assist the EPA, as needed, to provide regulatory oversight and technical
assistance as needed for material segregation and material handling, waste
evaluation/ classification, proper management of specific waste types, and
reporting.
8. Serve as a liaison between disaster site cleanup operations, waste haulers,
and disposal facilities.
References within this document
None
Implementing Instructions
Title Location
II: Environmental:
Waste Management Practical
Guidance
Household Hazardous Waste
Hazardous Waste
Medical Hazardous
Infectious
Debride Staging Areas
Enviro Office
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Pre-written Public Education
Title Location
Emergency Sanitation Enviro Office
References
Title Location
Ohio Mercury Outreach & Training Manual Enviro Office
Reference-Environmental-
MercurySpillResponseMatrix
Enviro Office
Reference-Environmental-
MercurySpillSchoolsResidence
Enviro Office
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ALL-HAZARDS ENVIRONMENTAL HEALTH EMERGENCY RESPONSE ACTIONS
This section describes specific response actions that local county environmental
health professionals would be responsible for in the event of an incident specific
disaster, natural or deliberate act of terrorism.
Sections are listed in the order of:
Incident Type:
o Biological Incident;
o Chemical Incident;
o Radiological Incident; and
o Weather-Related incidents.
Sections are organized in the following subsections:
Introduction;
Emergency response objectives; and
Priority activities.
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VI. BIOLOGICAL INCIDENTS: NATURAL OR DELIBERATE
Natural Biological Incident
Foodborne diseases, intoxications or infections are terms applied to illnesses
acquired by consumption of contaminated food or water. Foodborne disease
outbreaks are recognized by the occurrence of gastrointestinal illness within a
variable time period (minutes to days) after consumption of shared or similar food
or water sources among individuals. Specifically, the occurrence of the potential
for foodborne illness must be considered when two or more individuals have any,
and/or all of the following:
Have symptoms of diarrhea and/or vomiting
Have similar incubation periods
Have a shared food and/or water source
Have symptoms of flushing, burning of mouth and throat, parasthesia of lips,
mouth or face.
Most commonly the exposure was within 72 hours before onset of symptoms. For
some organisms the time may be longer such as Campylobacter and hepatitis A.
Persons with vomiting and/or diarrheal symptoms may spread the causative
agent from person to person. This may occur in the following settings: food
establishments, childcare settings, schools, camps, board and lodging facilities,
private parties, caterers or at water activity facilities. The time period may be
variable because the illness may occur for some time before it reaches a “critical
mass” to be identified or a person is diagnosed with a pathogenic organism.
Actions to prevent further transmission and control strategies may include:
Restrictions for individuals with diarrhea and/or vomiting,
Following proper hand washing and cleaning/disinfecting procedures,
Identification of the causative agent (laboratory confirmed or
epidemiological data),
Avoidance of contaminated food or water,
Destruction of contaminated food, and
Closure of facility pending action.
A protocol outlining the conditions, criteria, and situations that may necessitate
the coordination of regional epidemiological resources in the South Central (SCO)
region for a local or regional response has been established in the SCO Regional
Public Health and Hospital Emergency Response Plan: Annex 4: Epidemiological
Response.
DELIBERATE BIOLOGICAL INCIDENT
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A threatened/deliberate human biologic incident is an event where an intention is
expressed or warning made that an infectious agent will be used (or has been
used) to cause harm to people. For example, this may occur when a person
receives a letter labeled as containing a possible bioterrorism agent (e.g. the
bacteria which causes anthrax or plague) or a telephone caller threatens to use
such an agent as a weapon.
The guidelines presented are applicable for a threatened incident. Potential
terrorists utilizing biologic agents may not always threaten or notify that an event
has taken place. Recognition then, in some instances, will take place by
hospitals/ER/physicians who report increased numbers of ill persons to public
health authorities. Indicators of a covert incident are:
Unusual dead or dying animals – sick or dying animals, people or fish
Unusual casualties – unusual illness for region/area, definite pattern inconsistent
with natural disease
Unusual liquid, spray or vapor – spraying and/or suspicious devices or
packages
With most biological weapon exposures, onset of disease is gradual and non-
specific. Initially, fever, malaise, and fatigue may be present sometimes in
association with a nonproductive cough and mild chest discomfort.
A. Biological Agent Properties
Unique Biological Agent Characteristics
o Are odorless, colorless, tasteless, and most will not penetrate skin (with the
exception of T-2 mycotoxins).
o Have an incubation time before symptoms develop.
o Will not vaporize to become an inhalational hazard unlike chemical agents.
o Require very small amounts (less than a teaspoon) to be effective.
Category A (examples: anthrax, plague, tularemia, smallpox, botulism)
o Highest priority agents
o Result in high mortality rates and have the potential for major public
health impact
o Might cause public panic and social disruption
o Require special action for public health preparedness
Category B (ex: glanders, brucellosis, food & water safety threats, ricin)
o Second highest priority agents
o Are moderately easy to disseminate
o Result in moderate morbidity and mortality rates
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o Require specific enhancements of CDC’s diagnostic capacity and
enhanced disease surveillance
Category C (ex: niphan virus, hantavirus)
o Third highest priority agents that include emerging pathogens that could
be engineered for mass dissemination in the future because of:
Availability
Ease of production and dissemination
Potential for high morbidity and mortality rates and major health
impact
B. Agent Forms
Biological Agents can be in liquid or dry (powdered) forms. Dry agents are
typically more concentrated, more easily disseminated, and are more stable
(require less temperature control for storage) but are also more difficult and
dangerous to produce. Both liquid and dry agents can be weaponized, though
dry agents are more likely to be weaponized due to their superior properties as a
weapon. Weaponized powders would have particles that are mostly 1-5 microns
in size, free flowing, and electrostatically neutral (will not “cling” to other objects).
Weaponized powders would appear as very fine powders that could become
airborne by even the slightest of disturbances (including the breeze produced by
a person as they walk by the powder).
C. Dissemination
Since most biological agents cannot penetrate intact skin, the most common
routes of exposure are inhalation, ingestion, or (less so) injection. For inhalation,
most biological weapons (except for certain dry weaponized agents) must be
aerosolized through the use of a dissemination device. For effective dissemination
via aerosolization, sophisticated dissemination devices and certain
meteorological conditions are required. Aerosolizing devices must be able to
create weapon particles that are small enough to be able to reach the deep
parts of the lungs (alveoli) but large enough to stick without being exhaled. The
ideal biological weapon particle size is 1-5 microns. Weapon particles larger than
15 to 18 microns will quickly fall out of the air following aerosolization.
If a device is released outdoors, meteorological conditions must ideally be at
night with low to no wind and a temperature inversion. Sunlight can kill certain
biological agents, winds above 20 mph will dissipate biological agents, and
temperature inversions (which are also more common at night or in low sunlight
conditions) keep biological agents low to the ground where they will be most
effective. Humidity may also play a role in the effectiveness of the agent
depending on the agent type (dry vs. liquid).
Due to the complexity required for aerosolized attacks, terrorists would be more
likely to use ingestion as the route of exposure by contaminating food supplies
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and/or drinking water supplies (although drinking water sources would likely
render agents ineffective through dilution).
Concept of Operations
By Federal law, the Federal Bureau of Investigation (FBI) will be the lead law
enforcement agency handling the criminal investigation in conjunction with the
local law enforcement.
Health Department officials, both state and local and the Ohio Department of
Agriculture should be considered major resources in determining whether a
biologic threat actually exists; in coordinating epidemiology and surveillance; in
performing laboratory testing; and in coordinating follow-up.
Emergency Response Objectives
The universal response objectives to a deliberate or natural biological incident
includes the utilization of the LIVE Principles:
Limit Exposure
Isolation of Contamination (which requires knowing who and what is
contaminated, and controlling additional contamination that results from
life-saving measures)
Verify the threat (by highlighting early transport of sample to laboratory)
Eliminate contamination (by selecting soap and water decontamination
instead of chemical decontamination)
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Priority Activities
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Notification of Deliberate Biological Incident
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State Surveillance Data Communications
ODH ODAg
Agency Responsibility Comment
Local &
State EMA
Information Management Parties that receive
notification other than
through the EMA should
insure that the EMA has
been notified.
LHD ODH Initial Notification:
Communicable Disease Reporting
(Class A) - Non-Business Hours."
614.722.7221
Follow-up & Notifications:
Potentially exposed individuals
follow-up & lab results
Notify Urgent Cares, Physicians’
offices, etc
Use: Communicable
Disease Reporting
(Class A) - Non-Business
Hours protocol
Poison
Center
Perform research on materials data
for personnel protection &
emergency medical information
Provided information to the LHDs,
hospitals, & incident commander, if
requested.
Secured phone lines will
be used between the
hospitals, Poison
Center, and Health
Department.
Use a caller ID
verification code.
National Domestic Preparedness Weapons of Mass Destruction
Hotline/Helpline, contact is made as necessary. EMERGENCY number is 1-800-
424-8802.
Communicate
1. Maintain frequent communication (conference calls, emails, faxes) with all
involved agencies.
2. Give input to epidemiologists regarding patron and food service worker
interviews.
3. Provide menus from the facility or event to epidemiologists.
4. Provide patron names and/or reservation lists to epidemiologists.
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5. Provide liaison with facility.
6. Use authority to close/reopen facility as needed.
Investigate
See Annex 4: Epidemiological Response Plan of the SCO Regional Public Health
and Hospital Emergency Response Plan
Resources within this Document
Section I: Water Safety and Supply
Implementing Instructions
Title Location
II: Environmental:
CBRNE Guidance & Decontamination Enviro Office
Food Safety & Foodborne Illness Practical
Guidance
Enviro Office
Water Safety Practical Guidance Enviro Office
II: EPI:
Infectious Disease Outbreak (Class A1 After Hours
Reporting)
References
Title Location
"Threatened Bioterrorism Incident: Information Sheet
for Potentially Exposed Persons," Centers for Disease
Control and Prevention, 1999.
http://www.dhs.wisconsin.
gov/publications/P4/P421
06.pdf
"Medical Management of Biological Casualties -
Handbook," Second Edition; U. S. Army Medical
Research Institute of Infectious Diseases; (2011)
http://www.usamriid.army
.mil/education/bluebook
pdf/USAMRIID%20BlueBoo
k%207th%20Edition%20-
%20Sep%202011.pdf
Keim M, Kaufmann A; "The Anthrax Hoax
Phenomenon: Principles for Emergency Response to
Bioterrorism," Annals of Emergency Medicine, 34:2
177-182, August 1999.
http://www.annemergme
d.com/article/S0196-
0644(99)70227-1/fulltext
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
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Title Location
Inglesby, TV and et. al; "Anthrax as a Biological
Weapon: Medical and Public Health
Management," JAMA. 281:18; 1735-1745, 1999.
http://www.med.navy.mil
/sites/nhrota/Patients/Doc
uments/Anthrax%20as%20
a%20Biological%20Weapo
n.pdf
English J, Cundiff M, Malone J, Pfeiffer J, Bell M,
Stelle L, Miller J; "Bioterrorism Readiness Plan: A
Template for Healthcare Facilities," April 13, 1999.
http://emergency.cdc.go
v/bioterrorism/pdf/13apr9
9APIC-
CDCBioterrorism.pdf
"Bioterrorism Alleging Use of Anthrax and Interim
Guidelines for Management -United States, 1998;"
MMWR. 48(04); 69-74,1999.
http://www.cdc.gov/mm
wr/PDF/wk/mm4804.pdf
WMD Threats: Sample Guidelines Reissue.” National
Domestic Preparedness Office: Special Bulletin.
(January 2000)
Environmental Reference
Folder
Emergency Response to Domestic Biological
Incidents: Participant Manual V2.2. National
Center for Biomedical Research and Training.
Louisiana State University. 2005.
Preparedness Library
CDC: Public Health Emergency Preparedness and
Response http://www.bt.cdc.gov/
Meigs County All Hazards Mitigation Plan, Annex A,
Community Profile
Emergency Management
Agency Office, Meigs
County
Meigs County Health Department Emergency
Response Plan: Annex 4: Epidemiological
Response Plan
ERC Office
APIC Bioterrorism Task Force & CDC Hospital
Infections Program Bioterrorism Working Group -
"Bioterrorism Readiness Plan: A Template for
Healthcare Facilities."
http://www.apic.org.
Homeland Security (2006). “WMD Response
Guidebook”, version 3.3 Preparedness Library
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
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Title Location
Alibek, K and et al (2005). Jane’s Chem-Bio
Handbook, 3rd edition. Preparedness Library
Meigs County Health Department Public Health Risk
Assessment Hazard Profile ER Office
“Chemical/Biological/Radiological Incident
Handbook”. Chemical, Biological and Radiological
(CBRN) Subcommittee.
(October 1998)
http://www.au.af.mil/au/
awc/awcgate/cbr_hdbk/
cbr_hdbk.htm
“Anthrax: How to Recognize and Handle a
Suspicious Package or Envelope”. CDC. (2004)
http://emergency.cdc.go
v/agent/anthrax/mail/pdf
/suspiciouspackages.pdf
“Guidance on Initial Response to a Suspicious
Letter/Container With a Potential Biological Threat”
FBI, HHS, CDC, DHS. (2004)
http://www.bt.cdc.gov/pl
anning/pdf/suspicious-
package-biothreat.pdf
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VII. CHEMICAL INCIDENTS: ACCIDENTAL OR DELIBERATE
Chemical releases that endanger the safety and health of the general public can
be caused by either an accidental industrial release, or the deliberate release of
industrial chemicals and or chemical warfare agents. Industrial chemicals such as
acids, alkalines, ammonia, chlorine, hydrogen cyanide, pesticides, and herbicides
are widely used and available throughout the country. Industrial chemicals have
been used by terrorists as improvised explosives, incendiaries and poisons in
several incidents.
Scientists often categorize hazardous chemicals by the type of chemical or by the
effects a chemical would have on people exposed to it. The categories/types
used by the Centers for Disease Control and Prevention are as follows:
Bio toxins—poisons that come from plants or animals
Blister agents/vesicants—chemicals that severely blister the eyes, respiratory
tract, and skin on contact
Blood agents—poisons that affect the body by being absorbed into the blood
Caustics (acids)—chemicals that burn or corrode people’s skin, eyes, and
mucus membranes (lining of the nose, mouth, throat, and lungs) on contact
Choking/lung/pulmonary agents—chemicals that cause severe irritation or
swelling of the respiratory tract (lining of the nose and throat, lungs)
Incapacitating agents—drugs that make people unable to think clearly or that
cause an altered state of consciousness (possibly unconsciousness)
Long-acting anticoagulants—poisons that prevent blood from clotting
properly, which can lead to uncontrolled bleeding
Metals—agents that consist of metallic poisons
Nerve agents—highly poisonous chemicals that work by preventing the
nervous system from working properly
Organic solvents—agents that damage the tissues of living things by dissolving
fats and oils
Riot control agents/tear gas—highly irritating agents normally used by law
enforcement for crowd control or by individuals for protection (for example,
mace)
Toxic alcohols—poisonous alcohols that can damage the heart, kidneys, and
nervous system
Vomiting agents—chemicals that cause nausea and vomiting
Accidental Chemical Incident
This is usually the result of Toxic Industrial Chemicals/Materials, aka Hazardous
Material (HazMat) involved in a transportation accident, equipment failure at the
manufacturer, equipment failure at the “end user” facility, and/or human error.
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The chemical(s) is readily identified and the quantity of the “spill” or release will be
known.
Deliberate Chemical Incident
A deliberate chemical incident is the intentional use of toxic chemicals to inflict mass casualties
and mayhem on an unsuspecting population. The use of chemical agents by
individuals/groups is to threaten, injure, or kill people. Such incidents elicit
immediate response from police, fire, and EMS personnel, who may be the
intended target.
Potential differences of a deliberate chemical incident/attack compared with a
"routine" hazardous materials incident include the following:
Intent to cause mass casualties
Great toxicity of substance(s)
Greater risk to first responders
Overwhelming number of victims
Mass hysteria, panic
A. Chemical Agents Properties
Unique Chemical Agent Characteristics
o Often have detectable properties, like an unexplained odor, color/residue,
and/or taste
o Can produce symptoms (irritated eyes, burning skin, cough, etc) almost
immediately and can penetrate skin.
o Can be very reactive in the environment, meaning they can change their
form when exposed to water and/or air. Causing an explosion, vaporize
and become an inhalation hazard.
o Need to be in large quantities to be used as a weapon.
High Hazard Threat Ranking (example: ammonia & sulfuric acid)
o High toxicity
o Easily vaporized
o Usually widely produced, stored, and/or transported
Medium Hazard Threat Ranking (example: carbon monoxide & methyl
isocyanate)
o May have a few “high hazard” characteristics
Low Hazard Threat Ranking (example: bromine and nitric oxide)
o Not likely a hazard
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See: National Institute of Justice (2000). “Guide for the Selection of Chemical
Agent and Toxic Industrial Material Detection Equipment for Emergency First
Responders, Volume I”, for list of chemicals.
B. Agent Forms
Chemical agents can present as gases, dust, mist, liquids or solids that have toxic
effects on people, animals and/or plants. Exposure can result from inhalation,
ingestion or contact with a person's skin or mucous membranes. Of all exposure
routes, ingestion is the easiest to control, provided that the contaminated sources
are known or at least suspected. Simple hygienic measures and control of
supplies of food and drinking-water can significantly reduce the risk of exposure
C. Deliberate Chemical Dissemination
Most often, deliberate release of chemical agents are disseminated in liquid form,
although they are often referred to as gases (such as mustard gas). During their
release they rapidly change form and become a combination of liquid droplet
and/or vapor.
Emergency Response Objectives
In the event that the public’s health is threatened by the accidental or
deliberate release of a chemical agent, the following objectives need to be
addressed immediately:
Work with appropriate emergency responders and governmental
agencies to ensure the safety of the general public;
Assess whether food safety and water supply sources have been impacted
by the incident;
Public Information:
o Provide timely information regarding the chemical incident; and
o Explain contamination and how to decontaminate.
Priority Activities
There are a number of tasks that county environmental health professionals
could do in response to a chemical incident that poses a threat to public
health. With the exception of public information, public health will be assisting
the Environmental Protection Agency (EPA) with these activities.
1. Provide Public Information regarding:
a. Health and safety hazards posed by the release of a chemical;
b. Clean up or decontamination issues.
2. Assist with assessment of the incident impact on air quality, food and
water resources in the area near the release.
3. Establish a hotline to receive calls from the general public.
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4. Contact licensed food service establishments in the affected area to
assess the status of each one.
5. Conduct environmental sampling (e.g., water soil and vegetation)
References within this Document
Section II: Food Safety
Section I: Water Safety and Supply
Implementing Instructions
Title Location
II: Environmental:
CBRN Guidance & Decontamination ER Office
References
Title Location
Annex 3: Public Information & Warning ER Office
Annex 4: Epidemiological Plan ER Office
Medical Management of Chemical Casualties
Handbook
http://www.brooksidepres
s.org/Products/Operation
alMedicine/DATA/operati
onalmed/Manuals/RedHa
ndbook/001TitlePage.htm
CDC – NIOSH: NTIS Publication No. PB-94-195047:
Documentation for Immediately Dangerous to Life or
Health Concentrations (IDLH): NIOSH Chemical
Listing & Documentation of Revised IDLH Values (as
of 3/1/95)
http://www.cdc.gov/nios
h/idlh/intridl4.html
Ohio Mercury Outreach & Training Manual Enviro office
Homeland Security (2006). “WMD Response
Guidebook”, version 3.3 ER Office
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
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Title Location
CDC: Emergency Preparedness and Response:
Chemical Emergencies
www.bt.cdc.gov/chemic
al
CDC: Emergency Preparedness and Response:
Chemical Emergencies Overview
www.bt.cdc.gov/chemic
al/overview.asp
Belson, MG and et al (2005). “ Case Definitions for
Chemical Poisoning”. MMWR 54(RR01); 1-24.
www.cdc.gov/mmwr/pre
view/mmwrhtml/rr5401a1.
htm
Alibek, K and et al (2005). Jane’s Chem-Bio
Handbook, 3rd edition.
2008 Emergency Response Guidebook (revised
02/2009)
National Institute of Justice (2000). “Guide for the
Selection of Chemical Agent and Toxic Industrial
Material Detection Equipment for Emergency First
Responders, Volume I”
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VIII. RADIOLOGICAL INCIDENT
Radiological emergencies, events of ionizing radiation contamination, can
range in severity. Possible scenarios for radiation exposure in the south central
region might include:
Report of “found” radioactive material;
Vehicular accident involving the transport of radiological or nuclear
material;
Fixed facility accident involving a Radiological Dispersal Device (RDD);
Attack from radiological dispersion devices (termed dirty bombs); or
Silent source of radiation placed discreetly in a public place.
Environmental Health Professionals are mostly likely untrained to deal with the
majority of radiological issues. Training must be provided and adapted to the
radiological environments that sanitarians could encounter during a disaster.
Training information should include understanding the potential terrorist threat,
knowing indicators of nuclear or radiological device use, understanding
notification requirements, knowing response plans and procedures, individual
protective measures and measures to safeguard others, and general
decontamination procedures.
Emergency Response Objectives
In case of radiological emergencies, the following objectives need to be
addressed immediately:
Cooperate with federal government; establish an organized and
integrated capability for a timely, coordinated response to a radiological
emergency;
Specify authorities and their responsibilities of county public health
department in such emergencies;
Locate and treat victims potentially exposed elevated levels of
radiation;
Provide Public Information regarding:
o Response activities in radiological emergency; and
o Ensure availability of immediate medical treatment to those
requiring it.
Assist in environmental monitoring and in personal monitoring.
Priority Activities
There are four primary activities that the Public Health Professionals could do
when responding to a radiological/nuclear emergency.
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
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5.47
1. Public Information & Warning:
a. Notify the major public service facilities within the affected area of the
occurrence of the radiological emergency;
b. Provide information regarding the general response procedures;
c. Set up service hotline, answer public inquires regarding radiological
emergency preparedness and response. Provide technical guidelines
in food, water, shelter, air quality, and sewage disposal issues during
emergency.
2. Mass Screening and Dispensing (or assist with) of agents that may decrease
the severity of radiological/nuclear effects to those exposed (example:
iodine tabs, Prussian blue);
3. Assist with environmental monitoring:
a. Collaborate with other emergency response organizations (e.g. Ohio
EPA), collect water, soil and air samples in the cold or warm zone when
necessary;
b. Sample collection - Conduct environmental sampling (e.g. water, soil
and air) in the cold zone.
4. Assist with personal monitoring:
a. Assist with and conduct personal monitoring at a designated
reception center; and
b. Conduct epidemiological surveillance and monitor individuals for
long-term health effects after being exposed to radiological
contaminated water, vegetable, soil, and air.
References within this Document
Section I: Water Safety and Supply
Section II: Food Safety
Implementing Instructions
Title Location
II: Environmental:
CBRN Guidance & Decontamination
References
Title Location
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
2015 Environmental Health Annex 5
5.48
Title Location
Medical Management of Radiological
Casualties Handbook
http://www.usuhs.mil/afrri/outreach/pdf
/2edmmrchandbook.pdf
Homeland Security (2006). “WMD
Response Guidebook”, version 3.3
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IX. WEATHER-RELATED AND OTHER COMMON INCIDENTS
Hazard Public Health Risk Probable Operations
Major
Floods/
Flash
Floods/
Dam
Failure
- Disease associated with
consumption of water or
food contaminated by
flood water.
- Vector-bourne disease
associated with flood
water.
- Mold growth
- Sewer backups or
sewage system/field
damage
- Private water system
damage/ contamination
- Tetanus risk
- Secondary HAZMAT
spills/Environmental
Contamination
Public information releases
- Alerting people not to drink water or eat
food that has come into contact with
flood waters
- Vector & water-borne disease issues
- Location of potable water, shelters, etc
- Information for water sampling,
disinfection of private water systems, &
boiling water
- Information on cleanup procedures/
decontamination of households or
businesses
Water testing/ sampling for suspected
flood damage to well systems
Septic systems damage assessment
- Assist homeowners
Surveillance
- Increased disease
- Negative health trends
Inspections
- Shelters
- Retail food establishments
- Mobile home parks/ campgrounds
- Pools/beaches
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
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Hazard Public Health Risk Probable Operations
- Schools
Prophylaxis for tetanus/other possible
flood-associated communicable diseases
Assist solid waste district with debris
management
Assist EMA identifying public health risks
during damage assessment
Tornados/
Severe
Wind
Storms
- Disease associated with
consumption of water or
food contaminated by
prolonged power outages
- Vector-bourne disease
associated with solid
waste/debris collection
Public information releases
- Alerting people not to drink water or eat
food that has come into contact with
flood waters
- Vector & water-bourne disease issues
- Available medical care/information
related to the incident
- Location of shelters, potable water
Surveillance
- Increased disease
- Negative health trends
Inspections
- Shelters
- Retail food establishments
- Mobile home parks/ campgrounds
- Pools/beaches
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
2015 Environmental Health Annex 5
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Hazard Public Health Risk Probable Operations
- Schools
Assist solid waste district with debris
management
Assist EMA identifying public health risks
during damage assessment
Severe
Winter
Storms
- Disease associated with
consumption of water or
food as a result of
prolonged power outages
- Increase of heart attacks
associated with labor
intensive activities such as
snow shoveling
- Increase injuries related
to icy walkways & roads
- Hypothermia
Surveillance
- Negative health trends
Inspections
- Shelters
Public information releases
- Higher risk populations for heart attacks
to avoid strenuous activities
- Location of shelters, warming stations
- Food safety after power outage
- Hazards of alternative heat sources
(carbon monoxide poisoning)
- Safe ice/snow removal from roof, gutters,
etc.
Power
Outages
- Disease associated with
consumption of water or
food as a result of loss of
refrigeration
- Water safety concerns
Surveillance
- Increased disease
- Negative health trends
Inspections
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
2015 Environmental Health Annex 5
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Hazard Public Health Risk Probable Operations
as water purification
systems shut down
- Well water availability as
a result of power loss to
pump
- Loss of waste
water/septic
- CO poisoning from
improperly installed
generators or improper
use of heating devices
indoors
- Electrical home medical
equipment needs
- Hypothermia in winter
months
- Shelters
- Retail food establishments
Public information releases
- Food safety after prolonged power
outage
- Information for boiling water, if needed
- Dangers of improperly using generators &
heating devices
- Location of shelters, potable water,
shelters for specific needs (warming
station, medical equipment support, etc)
References within this document
Section I: Water Safety & Supply
Section II: Food Safety
Section III: Sewage / Septic
Section V: Solid Waste/Hazardous Waste/Debris Management
Implementing Instructions
Title Location
II: Environmental:
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5.54
Title Location
Water Safety Practical Guidance
Food Safety & Food-bourne Illness Practical Guidance
Vector Control Practical Guidance
Waste Management Practical Guidance
Safety Guidance
Mass Shelter Site Inspection Forms
Pre-written Public Education
Title Location
Water Safety Develop
Food Safety Develop
Electric and Gas Utilities Develop
Clean Up and Mold Develop
General Safety Precautions Develop
Inspecting the Damage Develop
Safety During Clean Up Develop
Carbon Monoxide Poisoning Develop
What To Do In An Emergency: for food service
operations and retail food establishments
References
Title Location
“Recovery After the Flood”. ODH. (1997)
http://www.odh.ohio.gov/~/media/OD
H/ASSETS/Files/php/disaster%20prepare
dness/floodmanual.ashx
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
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Annex 3: Emergency Public Information and Warning
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56
WORKER SAFETY AND PERSONAL PROTECTIVE EQUIPMENT
Disaster sites pose many potential health and safety concerns. The hazards and
exposures reflect many factors such as: the unstable nature of the site, the types of
hazardous substances present, temperature extremes, and the type of work being
performed at the site. An accurate assessment of all hazards may not be possible
because they may not be immediately obvious or identifiable. Response and
recovery personnel may make decisions and decide on protective measures based
on limited information. In addition to the hazards of direct exposure, workers are
also subject to dangers posed by the unstable physical environment, the stress of
working in protective clothing and the emotional trauma of the situation.
PPE Definition: Specialized clothing or equipment worn by employees for
protection against health and safety hazards. Personal protective
equipment is designed to protect many parts of the body, i.e., eyes,
head, face, hands, feet, and ears.
For the purposes of this plan, PPE is defined as any type of protective
clothing or equipment (steel-toed boots, leather gloves, hard hats, etc.) to
be used in an emergency response and not exclusively the medical PPE
that is typically thought of in a public health response.
Respirator Use: In the event that respirators are identified as a
recommended or required type of PPE to be used in a response, the
health department should follow OSHA regulations in developing a
respiratory protection program. A respiratory program should include:
o A written respiratory protection program with required worksite-
specific procedures and elements for required respirator use.
o A medical evaluation to determine the worker’s ability to use a
respirator.
o A Fit testing for the employee with the same make, model, style,
and size of respirator that will be used.
o Effective training to employees who are required to use respirators.
Emergency Response Objectives
In the event that a disaster situation poses a threat to the health and safety of
environmental health professionals who are participating in response and recovery
efforts, the following objectives need to be addressed immediately:
Compile a list of all known site hazards that could be encountered during
disaster response and recovery activities;
Collect, assess and review potential health effects associated with each known
site hazard;
Help select appropriate personal protective equipment (PPE) to be used by
response and recovery personnel during site activities;
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Ensure that response and recovery personnel have received adequate PPE
training, fit testing; and
Ensure that response and recovery personnel have received health and
safety training related to conditions in the disaster area.
Priority Activities
There are a number of important responsibilities that county environmental health
professionals must complete to ensure they are properly protected during a disaster
situation.
1. Collaborate with other governmental/private sector organizations to
collect information about existing and potential hazards in the disaster
area.
2. Conduct a qualitative assessment of potential hazards posed in the disaster
area.
3. Review guidelines for selecting PPE to use in all phases of response and
recovery activities
4. Select appropriate personal protective equipment to use in all phases
of response and recovery activities.
5. Maintain current information on responders’ health and potential injuries to
assess risk and implement new safety measures if warranted.
6. Provide initial and recurring health and safety training for all personnel
involved in disaster response and recovery activities.
7. Inspect all personal protective equipment for signs of deterioration
and replace if necessary.
8. Establish effective mechanisms for implementing safety decisions
affecting all response personnel in the disaster area.
References
Title Location
National Ag Safety Database publication
titled “Safe Foods After a Disaster” 8/1996
Review – include if appropriate as
Implementing Instruction.
May be included as “Reference”
U.S. Department of Agriculture publication
titled “Food Safety and Security-What
Consumers Need to Know” 9/29/ 03
Review – include if appropriate as
Implementing Instruction.
May be included as “Reference”
FEMA publication titled Food and Water in an
Emergency 2/11/03
Review – include if appropriate as
Implementing Instruction.
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Title Location
May be included as “Reference”
Environmental Health in Emergencies and
Disasters A Practical Guide 2002
Review – include if appropriate as
Implementing Instruction.
May be included as “Reference”
Fact Sheet: Hazardous Waste, Department of
Environmental Protection – Pennsylvania
Wastes: Citizens Hazardous Waste Permit
Guide, U.S. EPA
Review – include if appropriate as
Implementing Instruction.
May be included as “Reference”
Biological PPE
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Date
Changes
Made* Signature
3/18/2014 yes Frank Gorscak
3/1/2015 yes Frank Gorscak
TABLE OF CONTENTS
PURPOSE .................................................................................................................... I
SITUATIONS AND ASSUMPTIONS ............................................................................... I
CONCEPT OF OPERATIONS ...................................................................................... I
Activation and Implementation ................................................................................. i
Typical Sequence of Activities....................................................................................... i
Direction and Control .................................................................................................. i
Direction and Control ..................................................................................................... ii Pre-Event ........................................................................................................................... ii Internal Resource Requesting ....................................................................................... iii External Resource Requesting, Initial and Subsequent .......................................... iv Regional Resources ........................................................................................................ v State and Federal Resources ........................................................................................ v Resource Tracking ........................................................................................................... v
MUTUAL AID AGREEMENTS ...................................................................................... V
MEMORANDUM OF UNDERSTANDINGS ................................................................. VI
Annex 6:
Resource Management
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IMPLEMENTING INSTRUCTIONS ............................................................................... VI
REFERENCES ............................................................................................................. VI
SUMMARY OF CHANGES ........................................................................................VII
* Summary of Changes is located at the end of this document.
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i
INTRODUCTION
The ability of public health to conduct operations and perform essential
services during emergencies may be affected by a lack of available
resources. A variety of mechanisms may be employed to provide assistance
during emergencies. These mechanisms fall into two broad categories: 1) Pre-
Event planning (mutual aid/memorandums of agreements); and 2) Event
generated requests, through the Meigs emergency management agency, to
the Ohio Emergency Management Agency.
PURPOSE
This instruction describes:
The process of establishing agreements for emergency response
assistance prior to an incident occurring; and
The use of a standardized resource requesting process when the
response ability of health department or Meigs County is exceeded.
SITUATIONS AND ASSUMPTIONS
An incident has occurred that has the potential to expend
resources (human and materiel) beyond the normal expected
usage.
The incident will likely affect the public’s health.
CONCEPT OF OPERATIONS
Activation and Implementation
Typical Sequence of Activities
The Meigs County Health Department Emergency Response Plan and/or
the Meigs County Emergency Response Plan should be activated prior to
the activation of this Annex.
The activation and implementation of the Resource Management Plan
should be considered during any incident that affects the health of a
significant portion of the county’s population.
The activation and implementation of Annex 6: Resource Management
Plan of the MCHD Emergency Response Plan is determined by Health
Commissioner, or his designee.
Documentation and a description of the activities and actions taken
related to the response management by MCHD may be included on the
ICS form 201; a resource management spread sheet; and/or an ICS
Activity Log.
Direction and Control
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
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The Fiscal/Logistic Chief is responsible for the tracking and documenting
requests for and use of resources. The Fiscal Officer OR Public Health
Emergency Preparedness Coordinator is usually assigned to that Incident
Command System position. Sections: “Internal Resource Requesting”, “External
Resource Requesting”, and “Resource Tracking” explains the process for
requesting materials/supplies and personnel
The diagram below illustrates where the Logistics/Fiscal Chief position is
located in the Incident Command system.
Meigs County Health Department Responsibilities
Meigs County Health Department is responsible for:
Monitoring the material/supply and personnel needs of the health
department during an incident;
Requesting additional resources when it is determined that current
materiel and/or personnel will not be sufficient to manage the incident;
and
Tracking the movement, expenditure, transfer, return, and disposal of
materiel and personnel while in possession of the health department.
Pre-Event
The health department maintains a local public health and medical resources
list that identifies public health resources in advance of a disaster that could
expedite the mobilization and delivery of available resources.
Health Alert Network (HAN) Resource List
Special Medical Needs Resource List
EMA Resources Directory
Memorandum of Understanding OR Mutual Aid Agreement
Incident Commander
Operations Chief Planning Chief Security Chief Logistic/Fiscal
Chief
Public Information
Officer Safety Officer
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A Memorandum of understanding or Mutual Aid Agreement (MOU) is a
document describing a bilateral or multilateral agreement between two or
more parties. It expresses a convergence of will between the parties,
indicating an intended common line of action. It is often used in cases where
parties either do not imply a legal commitment or in situations where the
parties cannot create a legally enforceable agreement. It is a more formal
alternative to a gentlemen's agreement. MOUs are not legally binding but
they carry a degree of seriousness and mutual respect, stronger than a
gentlemen’s agreement. Examples of uses of a MOU include, but not limited
to:
Immediate use of a facility/building for dispensing medications;
Use of personnel to supplement staffing; and
Have priority for delivery of goods or services, such as: oxygen, printing
documents, etc.
After an event, these written agreements are critical for federal disaster
reimbursement under the Stafford Act which was enacted to support State
and local governments and their citizens when disasters are overwhelming.
Internal Resource Requesting
The health department has equipment and staffing resources that are readily
available for response to emergency situations. Documentation must be kept
for any health department resources used for an emergency situation.
Resource documentation may include, but is not limited to:
1. Exact type of resource requested;
2. Number of the resource requested (ie 3000 face masks);
3. Name of the person/agency that placed the order (may require a
signature);
4. Destination of the resource; and
5. Signature of Incident Commander approving release of the
resource.
A resource request for any material/supply or personnel should be made
following the chain of command within the Incident Command Structure.
Requests will be made and approved through immediate supervisors, moving
vertically up the chain of command until it reaches the respective section
chief (Operations, Planning, Security, etc.). Once the section chief receives
and approves the resource request, the request will move horizontally on the
ICS to the Logistics/Fiscal Chief. The Logistics/Fiscal Chief will then fill the
request internally or request the resource through the external resource
requesting process.
Section Chief
(Operations/Planning/
Security/etc.)
Logistics/Fiscal Chief
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
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External Resource Requesting, Initial and Subsequent
When resources needed during/for an incident that are not available within
the health department and its usual supply system, OR when health
department resources are predicted to be insufficient the health department
may look to external sources to meet the resource need. Public health
resource requests, for resources that are external to the Meigs County Health
Department, must be coordinated through the Emergency Management
Agency (EMA)/Emergency Operations Center (EOC) during emergency
situations. Resource requests by the health department may include, but are
not limited to:
1. Exact resource type;
2. Where it needs to be shipped;
3. Incident Commander’s signature.
The request can be verbally made via a communications system such as:
landline, cell phone, or Voice-over Internet Phone and should be followed by
a “hard copy” of the request via fax or paper. Requests for resources
documented on ………
Subsequent requests for the same external resource materials would follow the
same process as the initial request.
The health department will be responsible for any external resources supplied
to the health department for emergency response.
The flowchart below illustrates the external resource requesting process.
Supervisor Supervisor
Request Request Request
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
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Regional Resources
Requests for regional resources will be directed through the Meigs County EMA
to the “holder” of the resource and the OEMA. As a courtesy and to help
provide a common operating picture for the south central region, the Regional
Public Health Preparedness Coordinator should be made aware of the
request.
State and Federal Resources
Requests for State or Federal resources will be directed to the State EMA,
through the Meigs County EMA, and then to the Ohio Department of Health
and CDC, as necessary. State/Federal medical materiel requests, including
SNS requests, may require specific requisition forms to be signed by the Health
Commissioner or designee. As a courtesy and to help provide a common
operating picture for the south central region, the Regional Public Health
Preparedness Coordinator should be made aware of the request.
Resource Tracking
All resources received and/or moved will be tracked to their final end point;
expended, returned, or disposed of. Unless a particular resource management
system is required to be used by the Ohio Department of Health (ODH) or Ohio
Emergency Management Agency (OEMA) (i.e., Impact SIIS, HDIS), MCHD will
use an excel spreadsheet to manage the movement of resources.
After an event, the tracking documents will be critical for federal disaster
reimbursement under the Stafford Act which was enacted to support State
and local governments and their citizens when disasters are overwhelming.
MUTUAL AID AGREEMENTS
Health Department
Logistics/Fiscal
Chief
County
Emergency
Management
Agency
Local & Regional
Resources
Ohio
Emergency
Management
Agency
Federal
Emergency
Management
Agent
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2015 Annex 7: COOP/Recovery Plan
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Agency Services Date
10 LHDs in South Central Public
Health region
Personnel support X 3 days 2010
21 LHDs in entire Southeast Public
Health region
Personnel Support X 3 days 2010
MEMORANDUM OF UNDERSTANDINGS
Agency Purpose Date
Senior Citizen Center POD 2010
Meigs EMA General Support and
Cooperation
2014
Red Cross Supplies, Volunteers 2014
IMPLEMENTING INSTRUCTIONS
Title Location
II: Resource:
Health Alert Network Resource List
Special Medical Needs Resource List
Resource Testing
II: Dispensing :
SNS Request Movement Return Disposal
REFERENCES
Title Location
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
2015 Annex 7: COOP/Recovery Plan
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Title Location
SCO Public Health Resource/Phone Book
EMA Resources Directory PHEP bookshelf
Reference-Resource-MOU Writing Guide HMG
OPHCS documents local
folders SE SE
Collaboration RPH_SCO
ERP Templates Resource
Reference-Resource-MOU Writing Guide Fed
OPHCS documents local
folders SE SE
Collaboration RPH_SCO
ERP Templates Resource
Reference-Resource-Mutual Aid Agreement
Sample
OPHCS documents local
folders SE SE
Collaboration RPH_SCO
ERP Templates Resource
SUMMARY OF CHANGES
3/18/2014: Spelling and punctuation changes. fg
3/19/2015: date change fg
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
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Annex 7:
Continuity of Operations (COOP) &
Recovery Plan
Date
Reviewed
Changes
Made* Signature
04/17/2014 Y Frank Gorscak
4/21/2015 Y Frank Gorscak
Y or N Y or N
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* Summary of Changes is located at the end of this document.
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Annex 7: Continuity of Operations (COOP) & Recovery
Table of Contents
INTRODUCTION ................................................................................................... 14
PURPOSE, OBJECTIVES AND ASSUMPTIONS .............................................................. 14
CONCEPT OF OPERATIONS ................................................................................... 17
Direction and Control ..................................................................................... 17
Activation and Implementation ................................................................... 17
Responsibilities .................................................................................................. 17
Sites of Assembly ............................................................................................. 19
Essential Services ............................................................................................. 20
Essential Personnel .......................................................................................... 21
Vital Records .................................................................................................... 22
Fiscal ................................................................................................................. 23
Communications ............................................................................................. 23
Employee Notification ....................................................................................... 23 Communications ................................................................................................ 23 Internal Communications ................................................................................. 24 External Communications ................................................................................ 24 Problem Management ..................................................................................... 24 Information Technology .................................................................................... 24
Security ............................................................................................................. 25
HUMAN RESOURCE MANAGEMENT ........................................................................ 25
Staffing Issues ................................................................................................... 25
Administrative Support During Recovery Efforts ......................................... 26
Finance Issues .................................................................................................. 27
RECONSTITUTION ................................................................................................. 28
RECOVERY STRATEGIES......................................................................................... 28
General Health Department Recovery Strategies ..................................... 28
Recovery Management ................................................................................ 29
COMMUNITY RECOVERY MANAGEMENT RESPONSIBILITIES ......................................... 29
IMPLEMENTING INSTRUCTIONS/REFERENCES ............................................................. 31
SUMMARY OF CHANGES ...................................................................................... 32
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
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Introduction
It is the responsibility of government to assist the public and private sector during an incident, as well
as assisting in its recovery. Recovery from an incident is part of a continuum of emergency
management functions.
The Health Department utilizes partnerships with business, community leadership, cultural and faith-
based groups, emergency management, healthcare, social services, housing and sheltering, media,
mental/behavioral health, Area Agency on Aging, education and childcare settings in developing a
community Recovery Plan related to the continuation, restoration and recovery of public health,
medical, and/or mental/behavioral health systems and services.
Continuity of Operations: Processes and procedures an organization has put in place to ensure that
mission-critical business functions can continue during and after a disaster. In other words, how an
agency intends to continue operating during an incident.
Recovery: Addresses the process after the incident has occurred. Short-term recovery involves the
restoration of critical services to support life, health, and safety of the population. Long-term
recovery is the community's effort to regain normal functions like commerce and employment. In
most cases, recovery begins during the response phase of the event when damage is identified and
assessed.
The health and welfare of the Meigs County Public is dependent on this agency’s ability, to ensure
that we can execute our essential missions, in the event of a threat to its normal continuity of
operations. The Meigs County Health Department (MCHD) performs essential functions and services
that may be adversely impacted in the event of a natural or man-made disaster. In such events, this
agency plans to continue/recover operations and maintain essential functions and services.
Purpose, Objectives and Assumptions
Purpose:
The purpose of this plan is to define the continued essential operations capabilities and recovery
process developed to restore and maintain the Meigs County Health Departments critical business
Continuity of Operations
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
2015 Annex 7: COOP/Recovery Plan
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functions. The plan will detail the procedures for responding to an emergency situation that affects
the Health Department’s ability to provide services to the residents of Meigs County.
The Plan involves data management, communications and operations center movement and setup
in response to an event requiring operations to be continued outside normal operation.
It will include recovery functions for restoring the MCHD to 100% of its total operational capacity. This
plan functions as part of the Meigs County Emergency Management Agency (EMA) All-Hazards
Recovery Plan.
Scope
This plan is limited to the health department’s perceived responsibilities and expectation of services
and activities that will be essential during an incident. It briefly identifies the responsibilities of other
response partners, as they relate to health department activities.
Focusing on the restoration of the infrastructure and critical services to support life, health, and safety
of the population, this plan also identifies the responsibilities of the Meigs County Health Department
in the recovery of the county from disasters that have impacted the public’s health within the
county.
Objectives of the Plan
Maintain essential services
Facilitate timely recovery of business functions
Minimize loss of life
Minimize or prevent loss of data
Minimize the critical decisions to be made in a time of crisis
Situation and Assumptions
Situation
The Health Department has conducted a Public Health Hazard Analysis and Risk Assessment that is
based off of the Meigs County Emergency Management Agency’s Hazard Analysis and Risk
Assessments. The Public Health Risk Assessment includes information on the impacts potential hazards
within the county may have on department operations.
Hazard Potential Impact on Meigs County Health Department
Operations
Floods Could interfere with staff’s ability to get to work. Could
interfere with travel of sanitarian and nursing staff
through the county.
Winter Storms Could interfere with staff’s ability to get to work. Could
interfere with travel of sanitarian and nursing staff
through the county. Could potentially disrupt
communications (phones, internet). Winter storms
could be cause for the health department to shut
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Hazard Potential Impact on Meigs County Health Department
Operations
down temporarily.
Tornados and High Winds Could damage or destroy health department facilities
and equipment. Could disrupt communications
(phones, internet).
HAZMAT Incidents-
Transportation
Could contaminate health department facilities,
incapacitate staff.
Civil Disturbance, Riots,
Terrorism
Due to safety concerns for staff, could completely stop
health department’s capability to conduct services for
duration of riot. Could damage or destroy health
department facilities and equipment. Could disrupt
communications (phones, internet).
Power Outages Health Department has a generator; power outages
should not affect health department operations as
long as generator is functioning properly.
Earthquakes Could damage or destroy health department facilities
and equipment. Could disrupt communications
(phones, internet) and utilities.
EH Virus (like Ebola) Could incapacitate a large percentage of staff.
Pandemic Flu Could incapacitate a large percentage of staff.
Assumptions
The specific type of emergency and scale of that emergency can greatly affect how and what
business resumption efforts will take place. The ultimate goal of this plan is to provide guidance to
maintain operations for worst-case scenarios, but the plan should provide capabilities to offer as
many services as possible given a wide range of possible emergency situations. The current
information gathered on health department operations, personnel, resource requirements, and vital
records that provide the basis for this plan may not reflect the absolute minimum capabilities that the
health department can operate on. Further training and exercising of the plan will be required to
determine what limits the health department has based on various emergency scenarios with varying
levels of severity. Closure of the health department could occur due to lack of staff or because
certain events could present an unacceptable level of risk to employees or other individuals.
This section identifies the assumptions made by the Meigs County Health Department Continuity of
Operations and Recovery Plan.
1. An emergency or disaster has occurred
2. The type of disaster (fire, civil unrest, natural disaster, terrorist attack, chemical spill, biological
event) and the impact of a disaster will vary significantly.
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3. Resources are available.
4. Trained personnel exist to establish authority and to implement plans and procedures.
5. Circumstances of an emergency or disaster may affect the health department's ability to
participate in local recovery efforts. Possible consequences of emergencies include prohibited
access to facilities/equipment, disrupted power, ruptured gas lines, power outage, water
damage, smoke damage, chemical damage, structural damage, communications loss, etc
6. An Alternate site will be available to the Health Department at the time of need.
Concept of Operations
Direction and Control
The ultimate responsibility and authority of implementing quarantine or any other form of community
containment during a public health emergency is that of the Board of Health, the Health
Commissioner and the State’s public health authority.
Activation and Implementation
Typical Sequence of Activities:
The Meigs County Health Department Emergency Response Plan should be activated prior to the
activation of this Annex.
The activation and implementation of the Recovery Plan should be considered during any
incident that affects a wide spread area or when the physical structure of the health department
is affected, including power outage, communications loss, etc. for a prolonged period of time.
The activation and implementation of this Annex is determined by Health Commissioner, or his
designee, and may be considered during any incident that affects operations for longer than 24
hours.
The determination of services to be increased and/or decreased should be made.
The Health Commissioner/Administrator, or designee, will notify the Board of Health and the
County Commissioners of the activation and brief them on the details of the incident, expected
increase and/or decrease of “normal” services and estimated timeline for return to normal
services.
The Health Commissioner/Administrator, or designee, will discuss/notify other pertinent response
partners of the recovery activities to be taken, and ask for their assistance via the Meigs County
EOC, if needed, and to educate the public.
Documentation and a description of the activation, notifications, changes in services, recovery
strategies implemented, and other pertinent information may be included on the ICS form 201.
A Public Service Announcement should be made to inform the public of changes in services and
any health recommendations.
Responsibilities
In its initial phases, recovery for large disasters in Meigs County is coordinated by the staff of the
Emergency Operations Center (EOC) and focusing on providing essential services, such as
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mass care, emergency medical services, debris removal, and utilities restoration. As short-term
recovery transitions to long-term recovery, the EOC will transition to a more re-vitalizing, restore
to normal focus.
Health Department
Damage assessment
Reassemble work units
Life, safety and health protective measures for impacted citizens
Assist other agencies in securing food, water, clothing, shelter, fuels and transportation
Provide essential health department services (See details below, page 8)
Record keeping for potential reimbursement
Recovery of vital records (birth/death certificates. bank statements, licenses, contracts,
accounting documents, payroll records, etc.)
Access to funds for recovery
Assistance from state/federal agencies may require completion of documents or coordination
of assistance with Local, State and Federal Agencies
Debris Clearance
Repair or replacement of damaged & hazardous facilities
Other Response Agencies
All agencies in Hocking County Government have duties directly associated with the recovery
of the community following a disaster. Additionally, all governmental agencies have the
responsibility to return to normal business capabilities as soon as possible following an event.
All Meigs County agencies (including the Health Department) shall:
Develop a Recovery Plan and Procedures
Train personnel in its implementation
Test procedures/provisions
Begin record keeping of disaster expenses
Assess damages
Assess capabilities to conduct normal business
Assess needs to return to normal business
Establish Communication with the Meigs County EOC
Re-establish interrupted utility service
Conduct short term repairs needed to support normal operations
Begin recovery of Vital and Important Records needed to conduct normal business
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Begin reconstruction and long term repairs with available funds
Re-establish normal services
Provide organization, supervision and coordination of emergency health and
environmental health services
Provide assistance in the coordination of Emergency Medical Services and Mental Health
Services.
Establish health and medical priorities and controls for emergency services including
distribution of auxiliary health and medical supplies, distribution of equipment and
assignment of health and medical personnel.
Provide emergency public information utilizing the Joint Information Center
Provide first aid care and treatment of minor injuries and emergency health care within the
range allowed by available resources and staff skills.
Implementation of mass immunization programs, as the need requires.
Coordinate countywide surveillance of potential problems related to public water supplies;
sewage disposal system failures; solid waste accumulation and disposal; food storage;
preparation and serving areas (i.e. shelters, food kitchens, etc.) disease carrying animals and
insects.
Sites of Assembly
Primary Site
Upon receiving notifications of an emergency, Health Department Personnel will assemble at:
Meigs County Health Department
112 E. Memorial Dr. suite A
Pomeroy Ohio 45769
If the main Health Department location becomes inaccessible, an alternate assembly place will be
selected from the below table and will be dependent on any damage these sites may have
sustained. Implementing instruction (II): COOP/Recovery: Temporary Site Considerations and II:
COOP/Recovery: Notification of Relocation may be utilized for this process.
Other Sites Considered or with a MOU
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Locations for Assembly
Local Churches
Meigs EMA EOC
Meigs Senior Citizens Center
Pomeroy City Municipal Building
Don Porter vacant GM Dealership
Under special circumstances, some staff may be able to
operate from home.
Essential Services
During emergency situations, the health department’s operational capacity for administrative
functions or public services may be limited. It is important to pre-determine what services are
absolutely essential to maintain core public health services.
Essential Services
Animal Bite Complaints – rabies risk
Immunizations – only those necessary and related to the incident per
order of the medical director.
Disease Surveillance and Investigation - Prioritization and intensity of
disease investigation is a judgment call based on several factors:
Categorization on Ohio's Reportable Infectious Diseases List (Class
A, Class B, etc.)
Communicability of the disease
Virulence of the disease
Rarity of the disease
Current events and/or outbreaks
Sensitive occupations/settings
See Annex 4: Epidemiological Response Plan for additional prioritization
Public Health Service Announcements – related to the incident
Birth and Death Certificate Registration and Issuance
Devolution of Services
The size and extent of the incident, as well as the available staff, will determine the need for and rate
of service devolution. The health and well-being of the community as a whole should be the focus of
services provided. The Health Commissioner, acting as the designated representative of the Board of
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Health, will determine what services will be limited, or expanded as well as when to limit or expand
them.
Reconstitution of Services
As the immediate incident resolves and the community begins to recover, the health department will
move to a more “recovery phase” focus and eventually return to “normal” operations.
“Reconstitution” may be over a few days to a few months.
Essential Personnel
Essential (Core) Staff and Chain of Succession include:
All staff members are considered essential. Core Staff and their back-ups are listed in the table
below.
Core Staff Back-up for Core Staff
Health Commissioner Medical Director or Administrator or DON
Environmental Health Director (EHD) Registered Sanitarians
Director of Nursing (DON) Public Health Nurses
Public Health Preparedness Coordinator Regional Public Health Preparedness Coordinator
Regional Epidemiologist Other Epidemiologist in SCO or SEO region
Registrar Deputy Registrar or pre-designated Clerical staff
Fiscal Agent Pre-designated Clerical Staff
Core staff is aware of their positions and how they will be managed in the event of a disaster.
Strategies for minimizing the possibility that staff become ill: e.g., working from home even in early
stages of a pandemic, or other social distancing measures, are being considered. If working from
home, staff will need to address any computer connection/technological issues. However, vital
statistic functions would have to be performed onsite or at a site designated by ODH Bureau of Vital
Statistics. Other public health services also require onsite availability for the public.
Essential Skills required to sustain services:
– Current Ohio RN license and updated nursing duties.
– Vital Statistics skills and office skills (organizational skills and ability to access vital information
(plans) and operate equipment).
– Current Ohio Registered Sanitarian license or “Sanitarian-In-Training” applicant with the
Ohio Board of Sanitarians.
Back-ups for staff include:
Meigs County Medical Reserve Corps would be utilized to back up public health nurses. Meigs
County Citizens Corps may also be utilized to back up non-medical functions. See Appendix 8:
Volunteer Management Plan. Additional backup personnel for core staff could be requested from
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other health department jurisdictions through use of Regional MOUs. Back-ups will receive just in time
training on the skills needed to fulfill their job duties.
Essential systems & supplies include:
- Computer systems and backup systems;
- Refrigeration units for vaccines;
- IT systems (including computers and email);
- MARCS/ two-way radios; and
- Telephones (including fax).
Emergency supply requests that cannot be requisitioned through usual sources will be obtained via
requests to the Meigs County EMA office.
Critical staff numbers and skills required to maintain essential services:
50% absentee rate would severely impact essential services. It is likely that business functions
would stop if more than 50% of staff were absent. The decision to close the health department
when absentee rates threaten safe business continuity would be made by the Health
Commissioner.
To accommodate a decreased work force, the following actions have been completed and will
continue to occur when new staff is acquired.
– Clerical staff have crossed trained and are able to complete all clerical tasks in all divisions;
– Nursing staff have crossed trained in all the services offered by the nursing division; and
– Environmental health staff have cross trained within their division and have at least two (2)
back-ups per service offered.
Steps to minimize risk to staff include:
- Regular training updates;
- Proper emergency equipment;
- Standard emergency procedures;
- Proper PPE;
- Vaccinations or antivirals when available; and
- Critical Incident Stress Management (CISM).
Vital Records
A vital records table was created to identify what records are essential for health department
operations, whether they exist in electronic or hardcopy format, how or if they are backed up, and
how the information would be restored in a continuity of operations situation.
Vital Record Title Format Back-up How would they be re-stored?
Birth certificates Paper ODH Server
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Vital Record Title Format Back-up How would they be re-stored?
Death certificates Paper ODH Server
well paper HDIS
septic paper HDIS
WIC records Paper /
electronic
WIC Server Request access from state WIC
Immunization
records
Paper /
electronic
Impact
Medical records Paper /
electronic
HDIS Request additional program
software from ODH
All vital records on the server should be backed up on a daily basis and all vital records on individual
staff computers should be backed up at least on a weekly basis or dependent on when new
information is added to the records. Reasonable efforts should be made to convert hardcopy-only
documents into an electronic format that can be backed up. Backup devices include external hard
drives, tape drives, USB jump drives, floppy disk or CD writeable drives, and backups to the server. All
backup devices are stored in a safe place off site or kept in a fireproof safe on site.
Fiscal
The fiscal agent is responsible for backing up critical records.
Critical Records Current Location Other Locations
Payroll & accounting systems Health Department Courthouse
Insurance Policies Health Department Courthouse
Bank Account Records Health Department Courthouse
Back-up device for Server Health Department Courthouse
Communications
Employee Notification
Employees will be contacted directly in the event of an emergency situation through the Emergency
Call List. Employees will be given instructions on where and when to report for work and to receive
status on the situation.
Communications
Cell phones, county radios, and MARCS radio systems could be utilized until landlines could be
reestablished. MARCS radio equipment assistance could be provided through a communications
company located within the region, or utilizing regional MOUs. Other MARCS technical assistance
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could be requested through the State Health Department or the Ohio DAS MARCS Help Desk.
Contact information for MARCS radio technical assistance is listed in the Health Alert Network (HAN)
Directory.
Landline assistance would be provided through local phone company service and/ or local
contracted phone Service Company. Contact information for landline phone technical assistance is
listed in the Health Alert Network (HAN) Directory.
Voice-over Internet Phones are available for person-to-person conversations between local health
departments throughout the state. It can also be used to support small conference calls (Nine (9)
calls, or less) without assistance from ODH. For any technical phone issues, or conference calls
greater than nine(9) callers, ODH would be contacted.
A high-speed internet connection would need to be established. The state health department IT staff
would be contacted to determine the feasibility of establishing or reestablishing a T1 line for either the
primary or alternate site. If the T1 line is not a viable option, then cable internet or DSL options would
be considered.
Internal Communications
Communications to the board of health on the status of the health department recovery will be
handled by the Incident Commander or Health Commissioner.
External Communications - Media
External communications are addressed in the Crisis Communication Plan. Any and all press inquiries
must be directed to Public Information Officer identified in the crisis communication plan. UNDER NO
CIRCUMSTANCES ARE HEALTH DEPARTMENT EMPLOYEES OR VOLUNTEERS TO PROVIDE INFORMATION TO
ANY MEDIA REPRESENTATIVE. Recovery Status updates will be communicated at pre-announced
intervals.
External Communications – Local Partners
Employees who are designated to communicate with our local partners or stakeholders will be
provided with a statement or list of statements regarding the recovery effort. These statements will
come through our Public Information Officer. It is important that EVERYONE tell the same story.
Updates will be provided at regular intervals as recovery efforts are ongoing.
Problem Management
If a problem is encountered that cannot be resolved by health department personnel, that will result
in a delay in the recovery of any critical functions, a special meeting of the board of health, health
commissioner and team leaders will be held to determine a course of action to resolve the issue.
Information Technology (IT)
Having a computer network with a server is necessary to run essential health department software
applications. MCHD would contact our primary contact for assistance in reestablishing, at least, a
basic computer network for health department operations. Contact information for IT support is listed
in the Health Alert Network (HAN) Directory.
State health department IT staff may also be contacted for assistance with configuring the local
network. The health department server is backed up daily and stored at an off-site location. Backup
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sources would have to be utilized to reestablish any lost information. Any specialized software will
have to be downloaded, obtained through regional MOU’s, or requested from the Ohio Department
of Health or respective vendors of that software.
Security
The security of staff, vital statistics records (birth and death certificates), client medical records, and
medical countermeasures (vaccine, antivirals, etc) are provided for in the health department’s
current location. The security measures include:
All doors, other than the main entrance/exit are locked at all times. The doors allow those inside
to exit, but require a key to enter.
Doors between public and non-public spaces can be locked to limit passage of unauthorized
individuals.
Rooms with vital statistics documents and medical records are locked.
Rooms storing vaccine and/or antivirals can be locked.
Vaccine storage refrigerators are monitored constantly for loss of appropriate temperature.
When selecting an alternate assembly/working site, security will be an important consideration. The
situation at that time will determine how “secure” the location will need to be. If the alternate
assembly site is used because the current location has been damaged as a result of a weather
incident, then security will include locked spaces for vital/confidential records & locked outer doors.
If the alternate assembly site is damaged (unusable) as a result of criminal actions, then exterior
alarms and/or surveillance cameras, locked vaccine/medical countermeasures, separate and
lockable space separating public and non-public areas, etc may be more appropriate.
Human Resource Management
Staffing Issues
Staffing will be provided by Meigs County Health Department Personnel.
Management of the Meigs County Health Department ERP will be undertaken by the core
leadership staff.
Injury to Employee
If an employee is injured on the job as a result of a declared emergency or during the recovery
process, the first step is to seek medical attention for the injured employee as quickly as possible.
Every employee should be made familiar with the emergency numbers in the local area for
contacting police, fire or ambulance services. From most locations we can dial 911 or dial 740-992-
6618
Once medical attention has been provided for the injured employee, it is important to notify
management as soon as reasonably possible so that appropriate family notifications and paperwork
can be completed. Initial information to be provided is as follows:
Employee Name
Location at time of injury
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Nature of injury (if known)
Time injury occurred
Brief description of circumstances under which injury occurred
Employee Fatalities
In the event that an emergency situation results in the death of one or more employees, it is
imperative that the information be communicated to management as quickly as is reasonably
possible. This is to ensure that communication can be made to family members as quickly and
compassionately as possible under the circumstances. A phone call to the Board of Health members
should be made as soon as possible. Initial information to be provided is as follows:
Employee Name
Location at time of death
Time death occurred
Brief description of circumstances under which death occurred
Where deceased has been taken (if known)
Temporary Staff/Volunteers
If the support of additional staff during the recovery effort is required, contact the Meigs County EOC.
Every effort will be made to provide any additional help needed to support the recovery effort.
Family Issues
The health department realizes that to respond to the community’s needs in a disaster situation, the
health department must recognize the hardships placed on the families of its personnel. To be able
to perform their best at a time when it is needed most, employees need to have a level of comfort
that their family members are safe and the employee’s absence during the recovery effort will not
place undue hardship on them.
The level of support to personnel will clearly be defined by the nature of the disaster itself. In the case
of a natural disaster where the employee’s family may be at risk, it may allow for time to relocate
family members or allow the family to accompany the employee to the recovery site until further
arrangements can be made.
Family issues should be brought to the attention of the supervisor as soon as feasible.
Administrative Support During Recovery Efforts
During the recovery effort administrative volunteers will be deployed to support the recovery efforts
as available or required. The primary team will be located at the main health department site.
Additional volunteers may be sent to off-site locations to provide support such as answering phones,
locating supplies, etc.
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The primary responsibilities of the administrative staff are as follows:
1. Answering phones
2. Making pages/text messages as requested to communicate to staff
3. Making travel arrangements for staff
4. Providing food at site locations
5. Distributing pre-approved information as requested
6. Making copies
7. Keeping track of the locations of employees
8. Setting up conferences with local partners
Food and Travel
It is the department’s Incident Commander (Likely the Health Commissioner or his representative)
and Logistics/Fiscal Chief’s responsibility to determine their staff’s food and transportation needs
during an emergency situation and to communicate them to supervisors. Consolidating the requests
for these services during an emergency will help ensure the quickest possible response while
eliminating redundancy.
The Logistics/Fiscal Chief is responsible for ordering food for the sites and facilitating transportation,
particularly where normal methods of transportation are unavailable.
Identify the number of meals needed, the times needed and the locations in which they are to
be delivered as well as any special dietary requirements.
Any required travel arrangements throughout the COOP and recovery efforts will be made by
individual personnel and approved by their supervisor.
Finance Issues
The Fiscal Officer and Health Commissioner will handle all finance issues during a declared disaster.
This is to include travel, meals, equipment or any other type of expense related to the recovery effort.
It is imperative that all expenses can be tracked for reimbursement purposes.
Equipment Purchases
Requests for items like general office supplies should be requested through the Supervisors and then
given to Fiscal Officer. Requests will be completed as quickly as possible through existing vendor
relationships or if necessary through other vendors. The Board of Health must approve all equipment
purchases over $500.00.
Existing vendor relationships should be used wherever feasible to facilitate billing and payment for
services.
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Expenses
The normal procedures for submitting expense will continue during the recovery effort. All disaster
related expenses should be referred to the supervisor and then given to Fiscal Officer. Every effort will
be made to reimburse the employee for out-of-pocket expenses as expeditiously as possible.
Reconstitution
The process of restoring normal operations in either primary or alternate facilities following a large-
scale disaster would require a comprehensive approach among various state and local government
and private agencies. Core health department staff operating under the incident command system
would be required to provide an orderly and systematic approach to determine what services will be
offered, order the necessary equipment to run those operations, and assign staff to specific functions.
Communications and information technology pose the biggest challenge and are the most
important step in reestablishing the infrastructure necessary for health department operations.
In the event of a pandemic, special infection control measures must be taken to prevent the spread
of disease among staff and from visitors. Strategies to minimize illness among staff and visitors
include:
Restrict workplace entry of people with influenza symptoms
Practice good personal hygiene and workplace cleaning habits
Increase social distancing (enable telecommuting, avoid face-to-face contact)
Manage staff who become ill at work
Manage staff who travel overseas
Provide hand washing sanitizers for work areas
Provide PPE for staff when they have to work in close quarters with each other or with the
public
See Appendix 6: Pandemic Response Plan for more details on infection control measures for
widespread disease.
Recovery Strategies
The recovery effort for Meigs County government in large disasters will be coordinated from the
Emergency Operations Center (EOC). The Office of Emergency Management (EMA) manager will be
the Applicant Agent for Meigs County Government to apply for and coordinate receipt of state and
federal recovery funds.
General Health Department Recovery Strategies
Business functions will be recovered in priority sequence.
Communications concerning the recovery status will be coordinated through the EOC so that
those executing the recovery will not be interrupted repeatedly for status.
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Acquisition of equipment and supplies needed for the recovery effort will be coordinated
through the EOC. Purchases will be handled in-house
Coordination of travel arrangements, food and accommodations for individuals supporting the
recovery effort.
Personnel from other agencies may be called in to support the recovery efforts.
Recovery Management
The objectives and the functions are to:
1. Make a preliminary assessment of the damage.
2. Notify Health Commissioner and Board of Health on current status, impact to health
department and plan of action.
3. Work with EOC if disaster is declared.
4. Initiate the plan during the emergency situation.
5. Organize and control the Internal Command Centers as a central point of control of the
recovery efforts.
6. Organize and provide support to the recovery effort.
7. Retrieve offsite records and recovery information from offsite storage.
8. Report to the alternate site identified in their procedures.
9. Execute the business recovery procedures.
10. Communicate the status of the recovery to the EOC as needed.
11. Establish shifts for recovery team members to support the recovery effort 24/7.
12. Establish liaison with alternate site personnel if needed.
13. Support efforts to return to normal operations.
14. Reestablish support operations affected by the disaster.
15. Identify replacement equipment/software needed for recovery effort and to return to normal
operations.
Community Recovery Management Responsibilities
Emergency Medical/Healthcare Services
The health department may assist, in any way possible, with the recovery of local emergency
medical and healthcare services to full functionality. The health department may be able to assist
with replenishing depleted medical materials and other medical resources. The health department
may also provide first aide care and treatment to minor injuries and emergency healthcare (e.g. at
risk infants, emergent nutrition needs, etc.) within the range allowed by available resources and staff.
Mortuary Services
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The health department may assist the county coroner and funeral homes with implementing
procedures for the handling of bodies and burials following mass fatality events within the county.
See Appendix 5: Fatality Management for additional details
Mental Health Services
The health department may arrange for Critical Incident Stress Debriefing (CISD) and other
counseling services for victims and recovery workers OR for public health staff and other community
representatives. The health department has a written MOU with the Tri County Mental Health and a
verbal agreement with the local Red Cross to provide mental health services during emergencies
within the county. In the event that local mental health services are overwhelmed, the Health
Department Incident Commander or Liaison to the EMA/EOC will contact the Regional Coordination
Center or Regional Public Health Preparedness Coordinator to request mental health services from
the Regional Critical Incident Stress Management (CISM) team. The health department may also be
able to obtain mental health professionals through the Medical Reserve Corps. See Appendix 4:
Mental Health for First Responders for additional details.
Damage Assessment
The MCHD may coordinate with the local EMA, the Red Cross, and the OEPA in assessing the
damage of private septic systems, water well systems, and manufactured home parks within the
county. If public water and/or sewer systems are affected within the county, MCHD may assist with
assessing damage upon request from the municipality.
Decontamination of Affected Structures and Land
The MCHD may oversee decontamination to ensure inhabitability of homes and buildings. The
MCHD may provide direct guidance for the biological decontamination of buildings. For chemical
or radiological decontamination, the MCHD may coordinate with local HAZMAT groups and the Ohio
Environmental Protection Agency to ensure the structures are safe for people to inhabit.
Monitor Public Health Concerns
The MCHD may be responsible for the coordination of countywide surveillance of potential problems
related to private water supplies, private sewage disposal system failures, solid waste accumulation
and disposal, as well as: monitoring food storage, preparation and serving areas for shelters, food
kitchens, etc. and vector control. The MCHD may assist with surveillance of public water and sewage
disposal systems upon request from the municipality. Surveillance for disease outbreaks that may be
directly or indirectly related to the incident will also be conducted by the health department and the
regional epidemiologist.
Reconstruction
During the recovery phase of an emergency situation, the health department must use available
funds to begin the process of repairing any structural damage to the health department and
replacing any damaged equipment required for the health department to operate at full capacity.
Notifications to the Public
Public notifications are made as described in the MCHD ERP’s incident specific annexes, Annex 3:
Public Information and Warning in the MCHD ERP, and related implementing instructions.
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Document and Critique Incident Recovery
Documentation and critiquing is essential to capture what actions were taken and resources were
used/expended (including finances), evaluate what can be done to improve operational readiness,
highlight strengths and initiatives, and identify training and equipment shortfalls. This documentation
becomes the legal record for the incident.
ICS forms attached to the Meigs County Health Department Emergency Response Plan may be used
for financial and resource tracking for emergency situations.
Implementing Instructions
Title Location
II: COOP Recovery:
Relocation Notification ERC Office
Temporary Location Site Considerations ERC Office
Generator User Manual ERC Office
Basic Recovery Steps ERC Office
RCC Personnel Management ERC Office
References
Title Location
Meigs County Health Department Personnel
Policies & Procedures
MCHD Server
Meigs County Emergency Response Plan Meigs County Emergency
Operations Plan on PHER
Coordinator’s bookshelf
Meigs County All Hazards Recovery Plan Meigs County Emergency
Operations Plan on PHER
Coordinator’s bookshelf
South Central Ohio Regional Public Health
Emergency Response Plan, Annex 7: COOP
& Recovery Plan
Meigs County Emergency
Operations Plan on PHER
Coordinator’s bookshelf
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
2015 Annex 7: COOP/Recovery Plan
32
Summary of Changes
1. Pg. 17 casualty to fatality FG 4/17/2014
2. Pg. 18 and 19- added document locations
3. 4/17/2015-cahnged footer date
MEIGS COUNTY HEALTH DEPARTMENT EMERGENCY RESPONSE PLAN
2015 Annex 7: COOP/Recovery Plan
33
END OF DOCUMENT