CALAVERAS COUNTY HEALTHCARE SURGE PLANCALAVERAS COUNTY SURGE PLAN Page 10 of 24 Two or more...

CALAVERAS COUNTY

HEALTHCARE SURGE

PLAN

Revised: August 8, 2014

CALAVERAS COUNTY SURGE PLAN

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TABLE OF CONTENTS

INTRODUCTION ................................................................................................................................................ 4

A. BACKGROUND ........................................................................................................................... 4

B. PURPOSE .................................................................................................................................... 4

C. ASSUMPTIONS ............................................................................................................................ 4

D. DEFINITIONS .............................................................................................................................. 5

E. RESPONSIBLITIES & AUTHORITIES .......................................................................................... 6 1. ALL AGENCIES .......................................................................................................................... 6 2. MEDICAL HEALTH OPERATIONAL AREA COORDINATOR (MHOAC) .............................. 6 3. LOCAL EMS AGENCY............................................................................................................... 7 4. PUBLIC HEALTH OFFICER ...................................................................................................... 8 5. PUBLIC HEALTH DEPARTMENT ............................................................................................ 8 6. HOSPITAL................................................................................................................................... 8

CONCEPTS OF OPERATION ............................................................................................................................ 9

A. MONITORING THE HEALTHCARE SYSTEM .............................................................................. 9

B. DECLARING A HEALTHCARE SURGE EVENT .......................................................................... 9

C. FUNCTIONAL COMPONENTS DURING SURGE ........................................................................ 9 1. MULTI-CASUALTY INCIDENT (MCI) PLAN ............................................................................ 9 2. CONTROL FACILITY OPERATIONS ....................................................................................... 9 3. ALTERNATE CARE SITE (ACS) PLAN .................................................................................... 9 4. MASS PROPHYLAXIS PLAN .................................................................................................... 9 5. FIELD TREATMENT SITE (FTS) PLAN ................................................................................... 9 6. MEDICAL SHELTERING PLAN ................................................................................................ 9 7. CRISIS STANDARD OF CARE ................................................................................................. 9

D. RESPONSE TO HEALTHCARE SURGE ....................................................................................... 9 1. Level I SURGE ............................................................................................................................ 9 2. Level II SURGE ....................................................................................................................... 11 3. Level III SURGE ....................................................................................................................... 14 4. Level IV SURGE ....................................................................................................................... 16

Appendix A: OPERATIONS GLOSSARY ........................................................................................................ 18

Appendix B: AUTHORITIES AND REFERENCES ......................................................................................... 24


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INTRODUCTION

A. BACKGROUND

Medical surge capacity refers to the ability to evaluate and care for a markedly increased volume of patients – challenging or exceeding the normal capacity of a hospital or healthcare system. Individual hospitals plan for and routinely handle surge requirements resulting from seasonal fluctuations in respiratory ailments, environmentally based conditions, and community incidents. In Calaveras County, as throughout most of California, the hospital routinely operates at or near capacity. Moderately-sized incidents are handled in accordance with the Region IV Multi-casualty Incident Plan. Patients are transported to the local hospital, as well as hospitals in neighboring counties and throughout the region to avoid overloading any single hospital. However, very large-scale incidents or widespread disease outbreaks may overwhelm the capacity of all hospitals and other healthcare providers in a region. Responding to such incidents requires the close coordination and cooperation of hospitals, community clinics, governmental agencies, and other healthcare providers.

B. PURPOSE

The purpose of this plan is to provide a framework for the management of a healthcare surge event resulting from an incident that overwhelms the capacity of healthcare providers in Calaveras County and nearby counties in order to meet the overall goal of minimizing mortality and morbidity.

C. ASSUMPTIONS

The Region IV MCI Plan is fully activated and implemented in order to rapidly assess capacities of hospitals throughout the region, and absorb patients from a local incident.

All healthcare services providers and local emergency management agencies utilize the Incident Command System (ICS), the California Standardized Emergency Management System (SEMS), and the National Incident Management System (NIMS).

All medical and health mutual-aid resources are coordinated through the MHOAC and local OES or EOC (if activated).


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D. DEFINITIONS

1. “Control Facility” is the facility designated by the EMS Agency to monitor hospital

capacity and capability and to assume primary responsibility for directing patient destinations by ambulance during a Multiple Casualty Incident or Healthcare Surge Event.

2. “Healthcare Surge Event” means a proclamation by the local health officer or other

appropriate designee, using professional judgment determines, subsequent to a significant event or circumstances, that the healthcare delivery system has been impacted, resulting in an excess in demand over capacity and/or capability in hospitals, community care clinics, public health departments, other primary and secondary care providers, resources, and/or emergency medical services. The local official uses the situation assessment information provided from the healthcare delivery system partners to determine overall local healthcare jurisdiction/operational area medical and health status.

3. “Level I Surge” (Yellow) means that most hospitals within the county are experiencing a surge and are able to manage the situation with the assistance of the Control Facility or waivers for normal patient care services.

4. “Level II Surge” (Orange) means, the hospital in the county requires participation of

additional healthcare assets (e.g. clinics, public health, long term care, etc.) to contain the situation; and regularly scheduled planning sessions or conference calls are necessary in order to strategize, coordinate, collaborate, and communicate among all community healthcare providers, EMS agency, Public Health, Fire, and OES coordinators.

5. “Level III Surge” (Red) means healthcare providers within the county are not capable

of meeting the demand for care, and assistance from outside the Operational Area is required. A local Healthcare Surge Event has been proclaimed. Regional or statewide coordination is necessary in order to meet the medical and health needs of the public.

6. “Level IV Surge” (black) means the healthcare providers within the Operational Area

are not capable of meeting the demand. EMS and hospital standards of care must be recalibrated using pre-approved altered standard of care protocols, and less-acute hospital patients should be triaged from hospitals to appropriate alternate care providers. Statewide or national coordination is necessary.

7. “Medical/Health Operational Area Coordinator (MHOAC)” means the Public Health Officer and local EMS Agency Administrator or designee who is responsible, in the event of a disaster or major incident where mutual aid is requested, for obtaining and coordinating services and allocation of resources within the Operational Area (county) border.


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E. RESPONSIBLITIES & AUTHORITIES

1. ALL AGENCIES

a. Public and private-sector agencies should coordinate planning to minimize the impact of predictable events. Emergency planning is always event-specific because the characteristics of each emergency are different. However, there are general concepts that are applicable in most emergencies. Some of these concepts are articulated in this section.

b. Agencies responsible for operational functions, planning, coordinating, or that are

elements of a critical/high-risk infrastructure should work cooperatively to prevent or mitigate the impact of a natural or man-made disaster.

c. Agencies should verify the availability of equipment and supply caches before an incident. Agencies should always assure that supplies are maintained at desired par-levels.

d. Agencies should establish a Joint Information Center (JIC) before an incident to provide coordinated and focused public education and information messages. These messages should provide the public with credible direction or other actionable information that decreases their reliance on scarce resources.

e. Public and private-sector first responders and first receivers should receive “just in time” training in topics relevant to the incident.

f. All organizations should assure that emergency operations plans, phone numbers, and staff call back trees are current. Update documents as time allows.

g. All organizations should assure that local and state government agency contacts are current.

h. All agencies should verify that they are prepared to provide critical capabilities and functions.

2. MEDICAL HEALTH OPERATIONAL AREA COORDINATOR (MHOAC)

(HSC 1797.153) a. Plan for the provision of medical and health mutual aid within the operational area.

b. Assist the OES coordinator in the coordination of medical and health disaster

resources within the operational area


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c. Act as the 24-hour point of contact for coordination with the RDMHC/S, the State Department of Public Health, and the State EMS Authority.

d. Ensure the development of a medical and health disaster plan for the operational area, including:

1. Assessment of immediate medical needs.

2. Coordination of disaster medical and health resources.

3. Coordination of patient distribution and medical evaluations.

4. Coordination with inpatient and emergency care providers.

5. Coordination of out-of-hospital medical care providers.

6. Coordination and integration with fire agencies personnel, resources, and

emergency fire prehospital medical services.

7. Coordination of providers of non-fire based prehospital emergency medical

services.

8. Coordination of the establishment of temporary field treatment sites.

9. Health surveillance and epidemiological analyses of community health status.

10. Assurance of food safety.

11. Management of exposure to hazardous agents.

12. Provision or coordination of mental health services.

13. Provision of medical and health public information protective action

recommendations.

14. Provision or coordination of vector control services.

15. Assurance of drinking water safety.

16. Assurance of the safe management of liquid, solid, and hazardous wastes.

17. Investigation and control of communicable disease.

3. LOCAL EMS AGENCY

a. Establish policies and procedures approved by the medical director of the local

EMS agency to assure medical control of the EMS system.

b. In collaboration with the Public Health Officer, act as MHOAC.

c. Provide 24/7/365 Duty Officer coverage for the MHOAC Program.


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d. During a significant incident, and prior to a locally declared emergency,

collaborate with the Public Health Officer, Office of Emergency Services, and

other appropriate agencies, to modify the EMS delivery system in order to meet

increased demand on the EMS system.

e. Consider establishing Field Treatment Sites for rapid triage, treatment, and

referral, in cooperation with the OA EOC.

f. Collaborate with the MHOAC to authorize altered triage and response protocols

for the 911 system, including consideration of:

i. Suspension of Pre-Arrival Instructions

ii. Implementation of symptom-specific triage (e.g. Pandemic Outbreak EMD)

iii. Implementation of austere triage protocols

4. PUBLIC HEALTH OFFICER

a. Responsible for the enforcement of public health laws and regulations.

b. May take any preventive measures necessary to protect and preserve the public health.

c. Additional information is included in Appendix 3 – Authorities and References.

5. PUBLIC HEALTH DEPARTMENT

6. HOSPITAL

a. The base hospital shall implement the policies and procedures established by the

local EMS agency and approved by the medical director of the local EMS agency for medical direction of prehospital emergency medical care personnel.

b. Hospitals should work closely with other hospitals within their corporate structure to determine the status of critical hospital services within their regional service area.

c. Hospitals should work with their corporate organization to develop pre-incident inter-

facility staffing reciprocity agreements and post-incident expedited credentialing capacity among their corporate facilities.


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d. All hospitals should implement recurring training in disaster and emergency operations, to include HICS, ICS, SEMS, NIMS, Haz-Mat/Decontamination, and the hospital’s emergency operations plan.

CONCEPTS OF OPERATION

A. MONITORING THE HEALTHCARE SYSTEM

B. DECLARING A HEALTHCARE SURGE EVENT

C. FUNCTIONAL COMPONENTS DURING SURGE

1. MULTI-CASUALTY INCIDENT (MCI) PLAN

2. CONTROL FACILITY OPERATIONS

3. ALTERNATE CARE SITE (ACS) PLAN

4. MASS PROPHYLAXIS PLAN

5. FIELD TREATMENT SITE (FTS) PLAN

6. MEDICAL SHELTERING PLAN

7. CRISIS STANDARD OF CARE

D. RESPONSE TO HEALTHCARE SURGE

Responses to Healthcare System Surge are organized into four distinct levels. The procedures in this Section are generally applicable to most Healthcare System Surge incidents; however, because each incident has its own unique characteristics, hospitals, Local EMS Agency, Control Facility, Dispatch, and EMS personnel are always required to use their best professional judgment to respond to emergency and disaster situations.

1. Level I SURGE: (Yellow)

a. CRITERIA

Criteria for Level I Surge includes:


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Two or more hospitals within the system experiencing a sudden unexpected

increase in the number or severity of patients, and have announced an internal Level I Surge.

b. IMPACTED HOSPITAL(S):

Notify the Control Facility of status change. Update facility status in EMSystem to Advisory (including reason for Level I

Surge) and provide additional updates every two hours, or as requested by Control Facility.

Initiate or continue with internal hospital surge policies.

iii. NON-IMPACTED HOSPITAL(S):

ED charge nurse will receive Level I notification from Control Facility via

EMSystem. ED charge nurse monitors status in their ED.

Investigate/confirm capacity of service(s) in facility.

Update facility status in EMSystem and provide additional updates every two

hours or as requested by Control Facility.

Consider activation of internal hospital surge policies.

iv. MHOAC

Consider establishing ongoing planning sessions/coordination with all potentially impacted agencies/facilities.

Consider site visits of hospitals to verify statuses and Level I activities.

v. CONTROL FACILITY

Assess capacity and capability of other hospitals within county.

Consider assessing capacity and capability of neighboring counties

(Sacramento Regional EMSystem Zones 1-7), when appropriate. Notify MHOAC, hospitals, Local EMS Agency, dispatch providers, and

ambulance providers of Level I Surge in system.


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Coordinate all patient distribution per Patient Distribution Manual of OES Region IV MCI Plan until Surge level indicators have been resolved.

vi. DISPATCH PROVIDERS

Notify supervisors and ambulances providers of Surge Level I activation in

system.

vii. AMBULANCE PROVIDERS

Contact Control Facility for destination decisions.

2. Level II SURGE: (Orange)

i. CRITERIA

Criteria for Level II Surge includes concurrence of two or more EMS or hospital providers that regularly scheduled planning sessions are necessary to mitigate the impact of the surge.

ii IMPACTED HOSPITALS

Take any actions not previously completed for Level I Surge.

Emergency Department to notify appropriate personnel Level II Surge. ED Director and house supervisor respond to ED to assess critical hospital

services and supplies. Attempt to forecast event. Update Facility Status in EMSystem at least every 2 hours or as requested

by the Control Facility.

Consider activating HICS structure.

Consider contacting DHS Licensing and Certification for staffing and bed capacity flexibility.

Augment hospital’s staff, i.e. alternate staffing schedules, consider call-back

staff, and receive staff from corporately-related hospitals. House Supervisor evaluates the need to use outpatient and recovery room to

house admissions House Supervisor approves placement of new admit in hallway of inpatient

department that will admit patient.


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Hospital Administration should consider cancellation of elective procedures.

Participate in community medical/health planning sessions/coordination.

iii OTHER HEALTHCARE PROVIDERS (non-hospital) Consider activating internal emergency response plans.

Consider augmenting staff, i.e. alternate staffing schedules, consider call-

back staff. Participate in community medical/health planning sessions/coordination. Monitor EMSystem and CAHAN as requested by MHOAC.

iv. MHOAC

Take any actions not previously completed for Level I Surge.

Attempt to forecast trend of impaction. Determine capability and capacity for critical hospital services at all hospitals

within the county. Notify County Health Officer and EMS Agency Duty Officer. Notify OES Director. Coordinate community medical/health planning sessions/coordination for as

necessary.

Consider requesting activation of Operational Area EOC. Consider activation of county-specific volunteer program or state ESAR-VHP

program.

Consider requesting activation of JIC. Coordinate Risk Communication messages with Public Health Department,

including: advisory messages to the medical/health community, media updates, etc.

Consider request for declaration of local state of emergency.


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Monitor capabilities and status of ambulance providers. Consider need for alternate medical triage for 911 medical aid requests and

austere care protocols for field EMS personnel. Evaluate the need for additional health/medical resources:

1. Ambulance Strike Teams.

2. Hospital Staff.

3. Equipment/Supplies.

Prioritize Medical Resource Requests.

Prioritize Medical Transportation Requests. Notify RHDMC.

v. CONTROL FACILITY Take any actions not previously completed for Level I Surge.

Determine available capacity for critical hospital services at all hospitals within

the county, Sacramento Regional EMSystem Zones 1-7 and communicate with the Regional Control Facility regarding patient distribution to other Region IV hospitals if needed

Notify hospitals, EMS Agency, dispatch providers, and ambulance providers

of Level II Surge.

If appropriate to situation, direct ambulances to non-impacted destinations, based on service capability.

Standby—consider additional staffing for future operational periods.


Notify EMS Providers of Level II Surge Status. If appropriate to situation, hold or direct non-emergency interfacility transfers

with the objective of developing additional critical hospital service capacity.


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Consider adding additional staff for potentially increased volume of EMS System calls and interfacility transfers.


Contact Control Facility for destination decisions. Upon request of MHOAC, staff and deploy additional ALS, BLS, and Critical

Care Units for potentially increased volume of EMS System calls and interfacility transfers.

If appropriate to situation, hold or direct non-emergency inter-facility transfers

with the objective of developing additional Critical Hospital Service capacity. Add additional staff for increased volume of EMS System calls and inter-

facility transfers.

3. Level III SURGE: (Red)

i. CRITERIA

Criteria for Level III Surge includes: Healthcare Surge Event has been proclaimed by the Public Health Officer or

designee.

ii ALL HOSPITALS Take any actions not completed under Level II Surge.

Hospital Command Center will notify appropriate personnel of Level III Surge.

Participate in community medical/health planning sessions/coordination.

iii. OTHER HEALTHCARE PROVIDERS (non-hospital)

Take any actions not completed under Level II Surge. Participate in community medical/health planning sessions/coordination.

iv. MHOAC

Take any actions not completed under Level II Surge.


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Determine available capacity for critical hospital services at all hospitals within the county.

Coordinate community medical/health planning sessions/coordination for:

1. Attempted forecasting of the duration and impact of the event 2. Coordination of personnel, resource, and supply needs 3. Recruitment of community medical personnel and volunteers 4. Activation of alternate care sites

Evaluate the need for additional health/medical resources:

1. Personnel:

Cal-MAT, DMAT, CMV

2. Equipment/Supplies :

Ambulance Strike Teams

Mobile Field Hospital

Pharmaceutical Caches, Strategic National Stockpile (SNS)

v. CONTROL FACILITY

Determine available bed capacity at all hospitals within the county,

Sacramento Regional EMSystem Zones 1-7, and communicate with other Control Facilities within Region IV regarding patient distribution as needed.

Coordinate additional bed capacity needs with the MHOAC. Consider additional staffing for future operational periods.


Notify EMS Providers of Level III Surge Status. Consider adding additional staff for potentially increased volume of EMS

System calls and interfacility transfers.


Contact Control Facility for destination decisions. If appropriate to situation, hold or direct non-emergency inter-facility transfers

with the objective of developing additional Critical Hospital Service capacity.


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Upon request of MHOAC, staff and deploy additional transport resources for potentially increased volume of EMS System calls and interfacility transfers.

4. Level IV SURGE: (Black)

a. Criteria for Surge Level IV includes:

Altered or Austere Protocols have been adopted by the local coalition of healthcare providers in order to adapt to the increased demand.

1. ALL HOSPITAL(S) Take any actions not taken under Level III.

Hospital Command Center will notify appropriate personnel of Level IV Surge.

Participate in community medical/health planning sessions/coordination for:

1. Implementation of Alternate or Austere Medical Protocols.

iii. OTHER HEALTHCARE PROVIDERS (non-hospital) Take any actions not completed under Level III Surge. Participate in community medical/health planning sessions/coordination for

implementation of Alternate or Austere Medical Protocols.

iv. MHOAC Take any actions not completed under Level III Surge.

Determine available capacity for critical hospital services at all hospitals and

Alternate Care Sites within the county. Participate in community medical/health planning sessions/coordination for:

1. Altered levels of care.

Consider public recruitment of licensed professional volunteers to assist hospitals.

Prioritize requests for medical and health assets.

Notify RHDMC.


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v. CONTROL FACILITY

Notify hospitals, dispatch providers, and ambulance providers of Level IV

Surge in system.

Add additional staff for increased volume of EMS System calls and inter-facility transfers.


Notify EMS Providers of Level IV Surge status. Implement triage and altered response protocols as directed by the MHOAC.

Add additional staff for increased volume of EMS System calls and inter-

facility transfers.

vii. AMBULANCE PROVIDERS Contact Control Facility for destination decisions. Implement triage and altered response protocols as directed by the MHOAC.

Upon request of the EMS Agency, staff and deploy additional ALS, BLS, and

Critical Care Units for increased volume of EMS System calls and inter-facility transfers.

Add additional staff for increased volume of EMS System calls and inter-

facility transfers.


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Appendix A: OPERATIONS GLOSSARY

Finance/Administration: The Section responsible for all incident costs and financial considerations.

Includes the Time Unit, Procurement Unit, Compensation/Claims Unit, and Cost Unit. Base: The location at which primary logistics functions for an incident are coordinated and administered. There is only one base per incident. (Incident name or other designator will be added to the term base.) The Incident Command Post may be collocated with the base. Branch: The organizational level having functional or geographic responsibility for major parts of the Operations or Logistics functions. The Branch level is organizationally between Section and Division/Group in the Operations Section and between Section and Units in the Logistics Section. Branches are identified by functional name (e.g., medical, security). Cache: A pre-determined complement of tools, equipment, and/or supplies stored in a designated location, available for incident use. Camp: A geographical site, within the general incident area separate from the Incident Base, equipped and staffed to provide sleeping, food, water, and sanitary services to incident personnel. Chain of Command: A series of management positions in order of authority. Check-In: The process whereby resources first report to an incident. Check-in locations include:

Incident Command Post (Resources Unit), Incident Base, Camps, Staging Areas, Helibases, Helispots, and Division Supervisors (for direct line assignments). Chief: The ICS title for individuals responsible for functional sections: Operations, Planning, Logistics, and Finance/Administration. Command: The act of directing and/or controlling resources by virtue of explicit legal, agency, or delegated authority. May also refer to the Incident or Team Commander. Command Post: See Incident Command Post. Command Staff: The Command Staff consists of the Public Information Officer, Safety Officer, Liaison Officer, Deputy Incident or Team Commander, and Medical Technical Specialist as needed. They report directly to the Incident or Team Commander. They may have assistants as needed. Communications Unit: An organizational Unit in the Logistics Section responsible for providing communication services at an incident. A Communications Unit may also be a facility (e.g., a trailer or mobile van) used to provide the major part of an Incident Communications Center. Delegation of Authority: A statement provided to the Incident Commander by the agency executive

delegating authority and assigning responsibility. The Delegation of Authority can include objectives, priorities, expectations, constraints, and other considerations or guidelines as needed. Many agencies require written Delegation of Authority to be given to Incident Commanders prior to their assuming command on larger incidents.


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Demobilization Unit: A functional unit within the Planning Section responsible for assuring orderly, safe, and efficient demobilization of incident resources. Departmental Operations Center (DOC): A facility used as an EOC by a distinct discipline or agency. The term DOC is used to distinguish a government-level operations center (see EOC) from a discipline-specific operations center, such as law, fire, EMS, Public Health, etc. DOCs can be used at all SEMS levels above the field response level, depending on the impacts of the emergency. Deputy: A fully qualified individual who, in the absence of a superior, could be delegated the authority to manage a functional operation or perform a specific task. In some cases, a Deputy could act as relief for a superior and therefore must be fully qualified in the position. Deputies can be assigned to the Team Commander, General Staff, and Branch Directors. Director: The ICS title for individuals responsible for supervision of a Branch. Division: Divisions are used to divide an incident into geographical areas of operation. A Division is located within the ICS organization between the Branch and the Task Force/Strike Team. (See Group.) Divisions are identified by alphabetic characters for horizontal applications and, often, by floor numbers when used in buildings. Documentation Unit: A functional unit within the Planning Section responsible for collecting, recording, and safeguarding all documents relevant to the incident. Emergency: Absent a Presidential declared emergency, any incident(s), human-caused or natural, that requires responsive action to protect life or property. Under the Robert T. Stafford Disaster Relief and Emergency Assistance Act, an emergency means any occasion or instance for which, in the determination of the President, Federal assistance is needed to supplement State and local efforts and capabilities to save lives and to protect property and public health and safety, or to lessen or avert the threat of a catastrophe in any part of the United States. Emergency Operations Centers (EOCs): The physical location at which the coordination of information and resources to support domestic incident management activities normally takes place. An EOC may be a temporary facility or may be located in a more central or permanently established facility, perhaps at a higher level of organization within a jurisdiction. EOCs may be organized by major functional disciplines (e.g., fire, law enforcement, and medical services), by jurisdiction (e.g., Federal, State, regional, county, city, tribal), or some combination thereof. Emergency Operations Plan (EOP): The plan that each jurisdiction has and maintains for responding to appropriate hazards. Event: A planned, non-emergency activity. ICS can be used as the management system for a wide range of events (e.g., parades, concerts, or sporting events). Facilities Unit: A functional unit within the Support Branch of the Logistics Section that provides fixed facilities for the incident. These facilities may include the Incident Base, feeding areas, sleeping areas, and sanitary facilities. Federal: Of or pertaining to the Federal Government of the United States of America.


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Function: Function refers to the five major activities in ICS: Command, Operations, Planning, Logistics, and Finance/Administration. The term function is also used when describing the activity involved (e.g., the planning function). A sixth function, Intelligence, may be established, if required, to meet incident management needs. General Staff: A group of incident management personnel organized according to function and reporting to the Incident Commander. The General Staff normally consists of the Operations Section Chief, Planning Section Chief, Logistics Section Chief, and Finance/Administration Section Chief. Ground Support Unit: A functional unit within the Support Branch of the Logistics Section responsible for the fueling, maintaining, and repairing of vehicles and the transportation of personnel and supplies. Group: Groups are established to divide the incident into functional areas of operation. Groups are composed of resources assembled to perform a special function not necessarily within a single geographic division. (See Division.) Groups are located between Branches (when activated) and Resources in the Operations Section. Incident: An occurrence or event, natural or human-caused, that requires an emergency response to protect life or property. Incidents can, for example, include major disasters, emergencies, terrorist attacks, terrorist threats, wildland and urban fires, floods, hazardous materials spills, nuclear accidents, aircraft accidents, earthquakes, hurricanes, tornadoes, tropical storms, war-related disasters, public health and medical emergencies, and other occurrences requiring an emergency response. Incident Action Plan (IAP): An oral or written plan containing general objectives reflecting the overall

strategy for managing an incident. It may include the identification of operational resources and assignments. It may also include attachments that provide direction and important information for management of the incident during one or more operational periods. Incident Base: Location at the incident where the primary Logistics functions are coordinated and administered. (Incident name or other designator will be added to the term Base.) The Incident Command Post may be collocated with the Base. There is only one Base per incident. Incident Commander (IC): The individual responsible for all incident activities, including the development of strategies and tactics and ordering and the release of resources. The IC has overall authority and responsibility for conducting incident operations and is responsible for the management of all incident operations at the incident site. Incident Command Post (ICP): The field location at which the primary tactical-level, on-scene incident command functions are performed. The ICP may be collocated with the incident base or other incident facilities and is normally identified by a green rotating or flashing light. Incident Command System (ICS): A standardized on-scene emergency management construct specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries. ICS is the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources during incidents. It is used for all kinds of emergencies and is applicable to


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small as well as large and complex incidents. ICS is used by various jurisdictions and functional agencies, both public and private, to organize field-level incident management operations. Incident Objectives: Statements of guidance and direction necessary for the selection of appropriate strategies and tactical direction of resources. Incident objectives are based on realistic expectations of what can be accomplished when all allocated resources have been effectively deployed. Incident objectives must be achievable and measurable, yet flexible enough to allow for strategic and tactical alternatives. Intelligence Officer: The Intelligence Officer is responsible for managing internal information, intelligence, and operational security requirements supporting incident management activities. These may include information security and operational security activities, as well as the complex task of ensuring that sensitive information of all types (e.g., classified information, law enforcement sensitive information, proprietary information, or export-controlled information) is handled in a way that not only safeguards the information, but also ensures that it gets to those who need access to it to perform their missions effectively and safely. Liaison Officer: A member of the Command Staff responsible for coordinating with representatives from cooperating and assisting agencies. The Liaison Officer may have assistants. Logistics: Providing resources and other services to support incident management. Logistics Section: The Section responsible for providing facilities, services, and materials for the incident. Mitigation: The activities designed to reduce or eliminate risks to people or property or to lessen the

actual or potential effects or consequences of an incident. Mitigation measures may be implemented prior to, during, or after an incident. Mitigation measures are often informed by lessons learned from prior incidents. Mitigation involves ongoing actions to reduce exposure to, probability of, or potential loss from hazards. Measures may include zoning and building codes, floodplain buyouts, and analysis of hazard- related data to determine where it is safe to build or locate temporary facilities. Mitigation can include efforts to educate governments, businesses, and the public on measures they can take to reduce loss and injury. Mobilization: The process and procedures used by all organizations (Federal, State, and local) for activating, assembling, and transporting all resources that have been requested to respond to or support an incident. Mobilization Center: An off-incident location at which emergency service personnel and equipment are temporarily located pending assignment, release, or reassignment. National Incident Management System (NIMS): A system mandated by HSPD-5 that provides a consistent nationwide approach for Federal, State, local, and tribal governments; the private sector; and nongovernmental organizations to work effectively and efficiently together to prepare for, respond to, and recover from domestic incidents, regardless of cause, size, or complexity. To provide for interoperability and compatibility among Federal, State, local, and tribal capabilities, the NIMS includes a core set of concepts, principles, and terminology. HSPD-5 identifies these as the ICS; multi-agency coordination systems; training; identification and management of resources (including systems for


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classifying types of resources); qualification and certification; and the collection, tracking, and reporting of incident information and incident resources. National Response Framework: A plan mandated by HSPD-5 that integrates Federal domestic prevention, preparedness, response, and recovery plans into one all-discipline, all-hazards plan. Officer: The ICS title for the personnel responsible for the Command Staff positions of Safety, Liaison, and Public Information. Operational Area (OA): An intermediate level of the State emergency services organization, consisting of a county and all political subdivisions within the county.

Operations Section: The section responsible for all tactical operations at the incident. Includes Medical Care, Infrastructure, HazMat, Security and Business Continuity Branches as well as Staging Area, Task Forces, Strike Teams and Single Resources. Planning Section: Responsible for the collection, evaluation, and dissemination of information related to the incident, and for the preparation and documentation of the Incident Action Plan. The section also maintains information on the current and forecasted situation and on the status of resources assigned to the incident. Includes the Resources, Situation, Documentation, and Demobilization Units. Procurement Unit: functional unit within the Finance/Administration Section responsible for financial matters involving vendor contracts. Public Information Officer: A member of the Command Staff responsible for interfacing with the public and media or with other agencies with incident-related information requirements. Regional Disaster Medical Health Coordinator and Specialist (RDMHC/S): The EMS Authority and CDPH jointly appoint the RDMHC in each mutual-aid region. The RDMHC coordinates disaster information and medical/health mutual-aid and assistance between the MHOACs within that mutual-aid region and response to other mutual-aid regions in the state. The RDMHS provides the day-to-day planning and coordination of medical and health disaster response within the mutual-aid region. During disaster response, the combined RDMHC/S Program is the point-of-contact for MHOAC Programs within the mutual-aid region, as well as for the CDPH and EMSA. Resources Unit: A functional unit within the Planning Section responsible for recording the status of resources committed to the incident. The Unit also evaluates resources currently committed to the incident, the impact that additional responding resources will have on the incident, and anticipated resource needs. Safety Officer: A member of the Command Staff responsible for monitoring and assessing safety hazards or unsafe situations and for developing measures for ensuring personnel safety. The Safety Officer may have assistants. Section: The organizational level having responsibility for a major functional area of incident management, such as Operations, Planning, Logistics, Finance/Administration, and Intelligence (if established). The Section is organizationally situated between the Branch and the Incident Command.


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Service Branch: A Branch within the Logistics Section responsible for service activities at the incident. Includes the Communications, Information Technology/Information Services and Staff Food and Water Units. Situation Unit: A functional unit within the Planning Section responsible for the collection, organization, and analysis of incident status information and for analysis of the situation as it progresses. Includes the Patient Tracking and Bed Tracking Managers and reports to the Planning Section Chief. Staff Food and Water Unit: A functional unit within the Service Branch of the Logistics Section responsible for providing meals for incident personnel. Staging Area: Location established where resources can be placed while awaiting a tactical assignment. The Operations Section manages Staging Areas. Supply Unit: A functional unit within the Support Branch of the Logistics Section responsible for

ordering equipment and supplies required for incident operations. Support Branch: A Branch within the Logistics Section responsible for providing personnel, equipment, and supplies to support incident operations. Includes the Employee Health and Well-Being, Family Care, Supply, Facilities, Transportation, and Labor Pool and Credentialing Units. Technical Specialists: Personnel with special skills that can be used anywhere within the ICS organization. Unit: The organizational element having functional responsibility for a specific incident Operations,

Planning, Logistics, or Finance/Administration activity.


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Appendix B: AUTHORITIES AND REFERENCES

1. County California Health and Safety Code (sections 101000, 101025, 101030, 101375) provides that the local governing body is responsible for protection of the public health. 2. Health Officer California Health and Safety Code (section 101040) provides that “County Health Officers may

take any preventive measure that may be necessary to protect and preserve the public health from any public hazard during a ‘local emergency,’ ‘state of emergency,’ or ‘state of war’ emergency,’ within his or her jurisdiction. … ‘Preventive measure’ means abatement, correction, removal, or any other protective step that may be taken against any public health hazard that is caused by disaster and affects the public health.” Calaveras County Code, Title 8 (Health and Safety) provides authority to the County Health Officer in the event of a public health emergency. Specific language (section 8.04.010) allows the Health Officer to “quarantine any person or persons afflicted” or “exposed” to a contagious or infectious disease. Title 8 (section 8.04.020) also empowers the Health Officer to procure guards and supplies to make quarantine efforts effective. 3. Disaster Service Workers The state Emergency Services Act (8657), Labor Code (3211.92) and regulations (Disaster Service Worker Volunteer Program Regulation (Cal. Code of Regs., Title 19) allow for the

use of county or local government workers and “any unregistered person impressed into service …” to serve as Disaster Service Workers (DSWs) in the event of an emergency. Once registered, DSWs are provided with limited immunity from liability and certain workers compensation protections while providing disaster service. DSWs can not be registered retroactively.

County Code (Title 2, Chapter 2.72, section 2.72.060, A, 6, c) allows the Director of

Emergency Services “to require emergency services of any county officer or employees and in the event of a proclamation of a state of emergency in the county or the existence of a state of war emergency, to command the aid of as many citizens of the county as he deems necessary in the execution of his duties, such persons shall be entitled to all privileges, benefits, and immunities as are provided by state law for registered disaster workers. All volunteers registered and working for the County in an emergency situation are covered by the County’s Worker’s Compensation Policy. (This mirrors the state code). The supervisor of that volunteer is responsible, per the PHD policy, for reporting any service-related injury or illness that occurs to a volunteer, following County policies and procedures.

County Code (Title 2, Chapter 2.72, section 2.72.070) provides that “All officers and employees of the county, together with those volunteer forces enrolled to aid them during an emergency, and


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all groups, organizations, and persons who, by agreement or operation of law, including persons impressed into service under the provisions of subsection A (6)(c) of Section 2.72.060, may be charged with duties incident to the protection of life and property in the county during such emergency, shall constitute the emergency organization of the county.” County workers are not considered DSWs unless they are “performing disaster work that is outside the course and scope of their regular employment without pay …”

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