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HomeMy WebLinkAbout2016-069H EMERGENCY SUPPORT FUNCTION #8 PUBLIC HEALTH PRIMARY AGENCY: Indian River County Health Department Indian River County Fire Rescue (Co-responsibility during activation of the Special Needs Shelter) SUPPORT AGENCIES: Agency for Health Care Administration (ARCA) Area Dialysis Centers Area Durable Medical Equipment Companies (DMEs) Area Home Health Agencies (HHCAs) Area Hospitals Area Law Enforcement Agencies Area Social and Mental Health Agencies County and Municipal Utilities Department of Business and Professional Regulation (DBPR) Florida Department of Agriculture and Consumer Services Florida Department of Health (FDOH) Hospitals Home Health Care Community Indian River County Department of Emergency Services Indian River County Fire Rescue Indian River County Mosquito Control Indian River County Recreation Department Indian River County School District Indian River County Sheriff's Office Indian River Medical Center Medical Examiner District 19 Medical Reserve Corps North Treasure Coast Chapter of the American Red Cross Salvation Army Sebastian River Medical Center Senior Resource Association, Inc. Vero Beach Police Department VNA/Hospice Indian River County Comprehensive Emergency Management Plan Annex I - Page ESF#8-1 I. INTRODUCTION A. Purpose To establish a coordinated effort in providing and securing needed medical and health services in response to an actual or potential disaster. Provide a coordinated effort with ESF #8 of the State Disaster Plan and its delineation of supplemental assistance available to local jurisdictions. This ESF will jointly coordinate resources for establishing a shelter capable of providing refuge to citizens who are medically dependent with a physical or mental condition that requires management and supervision by a health care professional during the time of a disaster. B. Scope The scope of ESF#8 is far ranging and addresses a variety of activities. The functional areas as identified in the Indian River County CEMP, Basic Plan will be addressed within this Annex, the ESF-8 Standard Operating Procedures (SOPs)and Checklists, as well as each support agency's SOPs, as assigned. II. POLICIES A. It is recognized that health and medical functions and/or services will vary by event. These will be defined for planning and preparation purposes to be: 1. Those functions and services which are necessary for the basic health needs of the general population (i.e. potable water, proper waste disposal, food protection, essential medical care). 2. Those functions and services which address conditions associated with the event which may facilitate the transmission of communicable disease (i.e. flooding, garbage, wildlife). 3. The provision of organization, mobilization, coordination and direction of other response agencies under the ESF #8 umbrella as required by the event and post event. 4. Activation of the Indian River County Special Needs Shelter for Indian River County citizens whose medical condition does not qualify them for emergency admittance to an area hospital, but who have certain debilitating medical conditions which would require them to be cared for under the supervision of a health care professional(s)during the period of a hurricane or other disaster. Indian River County Comprehensive Emergency Management Plan Annex I - Page ESF#8-2 B. The Indian River County Health Department (IRCHD) will coordinate health and medical services within Indian River County. C. The Health Department Administrator (or designee) may request assistance through the State Department of Health or the Agency for Health Care Administration. D. In accordance with federal and state laws and policies, patients' medical information will not be released to the general public to ensure patient confidentiality. E. The Administrator of Indian River County Health Department is considered the County Health Officer. F. Federal and State assistance to the ESF will be provided under Public Law 93-288, Florida Statute Chapter 252 and the Florida Comprehensive Emergency Management Plan (FCEMP). G. All State and Federal emergency health and medical responses to an event must be requested by and are under the direction and control of ESF #8 operations. H. The co-primary agency and each support agency, participating under ESF #8, will retain control of its resources and personnel. I. Prior to the anticipated arrival of a major hurricane, Indian River Medical Center and Sebastian River Medical Center will admit only those citizens whose medical conditions warrants it. J. Appropriate information on casualties/patients will be provided to the American Red Cross for inclusion in the Disaster Welfare Information System for access by the public. K. All Indian River County citizens who have applied for, and have met the medical criteria for admission to the Special Needs Shelter, have been advised that all medical supplies, oxygen and medical equipment required by them must be brought with them when they report to the Special Needs Shelter. All supplies must be sufficient to sustain them for a minimum of 72 hours. L. It is preferred that each Special Needs Shelter patient is accompanied by only one caregiver. If additional family members accompany the patient, they may be located to a separate area of the shelter. Indian River County Comprehensive Emergency Management Plan Annex I - Page ESF#8-3 III. SITUATION A. Disaster Condition 1. A major or catastrophic disaster may result in a substantial number of disruptions to the Medical and Health infrastructure of the county. a. An event of this magnitude may cause a large number of medical emergencies as well as the need to protect the public's health from contaminated food and water supplies. b. Indian River County Emergency Management will maintain a database of Indian River County residents that may need assistance prior to an event such as a hurricane or during and after other types of emergencies, to assist in the special needs registration process. C. Disaster events may necessitate immediately opening a shelter to care for the persons with Special Needs. Shelters may need to be set up quickly, with no advance notice. d. Catastrophic disasters, such as hurricanes and slow-rising floods, provide warning and evacuation time, but may cause extended displacement and damage to the infrastructure. Shelters may be needed statewide to accommodate evacuees, and in some cases may be set up in neighboring counties. Damage from catastrophic disasters may cause extended displacement, the needs of which may extend into the recovery phase. 2. Hospitals, nursing homes, adult living facilities, pharmacies and other medical/health facilities may be severely damaged or destroyed. a. Facilities that survive with little or no structural damage may be rendered unusable due to the lack of utilities (power, water and sewer) and/or a lack of adequate staffing available. b. Facilities remaining in operation may be overwhelmed with minor injuries and seriously injured patients being transported there in the immediate aftermath of the disaster. c. Because of the massive demands on the medical/health system, shortages of medical supplies (pharmaceutical, disposable, etc.) and equipment will occur. Indian River County Comprehensive Emergency Management Plan Annex I - Page ESF#8-4 d. Disruptions in local communications and transport systems could prevent a timely re-supply of needed items. 3. Chronically ill but uninjured individuals may have difficulty obtaining daily medications, medical supplies and/or equipment due to destruction of normal supply locations and/or inability to travel. 4. Disasters such as hurricanes, floods, etc., may not generate high injury volumes such as an earthquake but will require relocation into temporary shelter(s), vector control, availability of potable water, wastewater control and resolving problems with solid waste facilities. 5. People with special needs will require relocation to shelters equipped to provide the required level of service. a. Coordination with nursing homes, ALFs and other licensed health care facilities will be a critical component of this ESF. 6. People with extraordinary needs may require follow-up immediately after the danger has subsided. 7. The damage and destruction from a catastrophic natural disaster or acts of terrorism will produce urgent needs for mental health crisis counseling for disaster victims and response personnel. 8. People refusing to evacuate will require contact and possible relocation to a medical facility. a. Re-supply of medications and other medical items will also be a required function. b. If injuries have been sustained, people may need relocation to a medical facility. c. Persons treated and released may become people with special needs, as result of their injuries and require sheltering in a Special Needs Shelter or other health care facility. B. Planning Assumptions 1. The most destructive natural hazard to which Florida is vulnerable is a hurricane. Consequently, advance warning is likely, with an opportunity to order evacuation in vulnerable areas. 2. Past experience has taught us that people are slow to evacuate. Indian River County Comprehensive Emergency Management Plan Annex I - Page ESF#8-5 3. During emergency response operations and for the first hours after the occurrence of a catastrophic event there may be little if any assistance available. 4. Initially, local resources will be used to relocate individuals to a place of safety. a. This will require transportation assistance and designation of shelters equipped to handle this population. 5. Receiving shelters will require necessary medical equipment, personnel and supplies for the care of people with special needs. a. Re-supply and relief staff will be an ongoing concern. 6. Resources within the affected disaster area will be inadequate to clear casualties and/or adequately treat them in local hospitals. a. Additional mobilized state capabilities will urgently be needed to supplement and assist in triage and treat casualties in the impacted area and then transport them to the closest appropriate hospital or other health care facility. b. Additionally, medical re-supply will be needed throughout the affected area. 7. In a major disaster, coordination will be required for the transportation of patients by air and ground to areas outside of the impacted area having sufficient hospital beds and treatment capabilities. 8. Damage to chemical and industrial plants, sewer lines, water distribution systems and secondary hazards such as fires, will result in toxic environmental and public health hazards for the surviving population and response personnel. This can include contaminated water supplies, crops, livestock, and food products. 9. Assistance in maintaining continuity of health and medical services will be required with specific emphasis on implementation of communicable disease services (prevention, surveillance, etc.). 10. Disruption of sanitation services and facilities, solid waste services and facilities, loss of power, and massing of people in shelters may increase the potential for disease and injury and/or require the identification of additional shelter space(s). 11. Normal medical and health services available to the affected population may be disrupted. Indian River County Comprehensive Emergency Management Plan Annex I - Page ESF#8-6 12. Fatalities and injuries will occur among medical, health and allied health professions in about the same ratio as in the general population. 13. Normal medical and health supply sources may be destroyed or damaged requiring prioritization of the remaining resources by a resource management organization. 14. Medical supplies of any kind from outside the affected area may be delayed from several hours to several days, making prioritizing mandatory. 15. There will be an immediate overload from requests for emergency medical aid. 16. Individual units may be working as independent entities due to a loss of communications and medical control. 17. Acts of terrorism involving chemical agents will result in large numbers of disaster victims as well as emergency response personnel requiring decontamination. 18. Widespread epidemiological consequences will occur as a result of biological acts of terrorism. a. Required vaccines, appropriate antidotes as well as other medications used to counteract the effects of biological and chemical agents, may be in short supply or not available through local resources. 19. Local hospitals can expect an influx of patients who feel that their medical condition warrants admission to the hospital rather than to the Special Needs Shelter. IV. CONCEPT OF OPERATIONS A. General 1. During declared local states of emergency, the Indian River County Health Department (IRCHD), as the lead agency for this ESF, will coordinate health and medical services. Indian River County Fire Rescue will be the co-lead when the Special Needs Shelter becomes activated. Indian River County Comprehensive Emergency Management Plan Annex I - Page ESF#8-7 2. Special Needs Shelter Description: The Special Needs Shelter is located at the Treasure Coast Elementary School, 8955 85th Street, Sebastian. The shelter has auxiliary power and is capable of receiving and providing safe refuge and medical supervision for citizens who meet the established medical criteria outlined in IV-A-3 below. All support agencies/organizations will be notified and tasked to provide 24-hour representation as necessary. 3. Public Relations: Prior to the hurricane season of each year (June 1), news releases will be issued through electronic and published media inviting residents whose medical conditions meet the criteria (outlined below) to register for the special needs shelter with their emergency local management office. Home health and various community agencies dealing with the elderly/disabled are encouraged to pre-register their medically eligible citizens for the Special Needs Shelter. For more specific information on client registration, see Annex V (Emergency Shelter Plan). 4. The Health Department Administrator or designee will designate individuals to work in the EOC. A listing of specific positions and contact numbers is included as an Attachment to the ESF #8 FOC Standard Operating Procedures (SOP). 5. As needed, special advisory groups of health/medical/social subject matter experts will be assembled and consulted by ESF #8, including the local Special Needs Task Force. 6. Transportation Registration — Registration for evacuation assistance will be provided for anyone who requires assistance with evacuation during an emergency to either a public or Special Needs Shelter. Individuals needing transportation should register with the Special Needs program prior to the hurricane season. B. Organization 1. ESF#8 will organize under the leadership of the co-primary agencies, which are the Indian River County Health Department and Indian River County Fire Rescue. 2. Support agencies will operate under the daily leadership of the representative located at the ESF #18 desk in the EOC. However, each agency represented will be expected to operationalize and direct its response resources in accordance with its agency's operating procedures. 3. Primary and support agencies will provide sufficient personnel to staff Indian River County Comprehensive Emergency Management Plan Annex I - Page ESF#8-8 the ESF 24-hours per day, seven days per week. The staff will be qualified persons able to facilitate decisions for the agency they represent. C. Notification The IRCDEM will provide notification for each ESF's primary agency. A representative from the primary agency will in turn notify each support agency and/or volunteer agency, as required. D. Response Actions 1. Initial Actions: • Provide leadership in directing, coordinating and integrating the overall efforts to provide medical and public health assistance. • Provide staff at the EOC on a 24-hour basis, during activations involving ESF #8. • Coordinate ESF #8 activities through the Emergency Operations Center. • Coordinate with ESF #1 (Transportation) for special needs pick-up and routes. • Coordinate pre-staging of all medical supplies, volunteers, food, supplies, etc. for the special needs shelter. • Provide a point of contact for state and national ESF #8 assets deployed to Indian River County. • Coordinate the pre-staging of amateur radio operators with ESF #2 (Communications) for the special needs shelter. • Assist and coordinate medical staffing and logistical support for the special needs shelters. • Request, coordinate and direct the activation and deployment of resources to support health/medical, and public safety needs • Conduct surveillance and monitoring activities, relating to health/medical conditions, which could impact the health of the general public. • Coordinate with the support agencies in directing and prioritizing health and medical activities. • Ensure the evacuation of patients from the disaster area when evacuation is deemed feasible and appropriate in coordination with other local ESFs. • Provide assistance to support agencies or other ESFs when requested, to include: L Assist the American Red Cross in evaluating the safety of food and drugs being provided for use by survivor victims. Indian River County Comprehensive Emergency Management Plan Annex I - Page ESF#8-9 ii. Assist hospitals and Fire Rescue in assessing health and medical needs of survivor victims as well as conducting ongoing surveillance of conditions, which could impact their general health. iii. Assist ESF #14 (Public Information) in providing emergency public health information to the general public. iv. Assist ESF #4 and 9 (Fire Rescue) in the identification of biological, chemical or radiological hazards that present a threat to the survivor victims. v. Provide backup laboratory support in response to biologic or hazardous materials discharges. vi. Recommend priorities with ESF #3 (Public Works) for staging and disposal of debris and other solid waste that pose hazards to the public's health (i.e. garbage, dead animals). vii. Assist ESF #10 (Hazardous Materials) providing remedial actions at discharge sites to minimize the spread of contaminants viii. Coordinate with ESF #7 (Resource Support) and ESF #15 (Volunteers and Donations) for supply information pertaining to potential volunteer groups, contract vendors, and other entities that may be able to supplement local resources. ix. Coordinate with American Red Cross, and participating faith-based organizations to provide crisis response and mental health services for persons who suffer from reactions to the disaster. 2. Recovery Actions • Maintain information on status of disaster and its impact on Indian River County Health Department, hospitals, Fire Rescue and other medical care facilities. • Provide epidemiological surveillance, case investigation and follow up to control infectious disease, including acts of bio- terrorism and food borne illness outbreaks. • Assist affected populations in clean up or follow up activities with technical advice or field service on health and safety issues related to returning to impacted areas. • Coordinate discharge planning and closure of shelters and alternative treatment facilities. • Coordinate with ESF#1 (Transportation)the return home of all special needs shelter evacuees. • Coordinate with American Red Cross and faith-based organizations to provide mental health information and referral for counseling of victims and community residents. Indian River County Comprehensive Emergency Management Plan Annex I - Page ESF#8-10 • Coordinate post event Critical Incident Stress Management for emergency services workers, in cooperation with law enforcement, Fire Rescue and the Florida State Critical Incident Stress Management network. • Maintain reports on hazard, injury, loss of life and condition of health personnel in the impacted area. • Primary and support agencies will resume normal operations as soon as possible. • Document and report activities undertaken during the emergency, including time, supplies, and any other pertinent information. • Participate in post event critiques of response activities and adjust plans and protocols as necessary. • All ESF #8 primary and support agencies will maintain cost records, and submit claims for reimbursement for any cost qualified expenses resulting from a Presidential declared disaster or where disaster grant-specific equipment or materials have been expended. V. RESPONSIBILITIES A. Primary Agency Indian River County Comprehensive Emergency Management Plan Annex I - Page ESF#8-11 1. Indian River County Health Department and Indian River County Fire Rescue are the co-primary agencies for this Emergency Support Function (ESF #8) and will coordinate all health and medical activities as assigned. 2. Coordinate with area hospitals to determine bed availability and treatment capabilities. 3. Coordinate with area hospitals to determine bed availability and treatment capabilities. 4. Coordinate with ESF #1 (Transportation) and area non-emergency transport providers the evacuation of the special needs population. S. Act as liaison between area hospitals and the EOC. 6. Coordinate with ESF #1 (Transportation) in providing transportation as needed for people with special needs. 7. Support medical care for people with special needs with serious medical problems. 8. Ensure that SOPs pertaining to worker health and safety are followed. B. Support Agencies 1. Agency for Health Care Administration (ANCA) - Will provide manpower and equipment as needs to support ESF #8 needs. 2. Area Dialysis Centers - Will provide manpower and equipment as needs to support ESF #8 needs. 3. Area Home Health and Hospice Agencies, Durable Medical Equipment Companies and other community service-based organizations. a. Provide for the registration of clients who have special needs during emergencies or disasters. b. Provide staff and medical supplies in support of special needs shelter operations, as requested. C. Provide staff and medical supplies in support of ongoing health and medical response operations, as requested. d. Assist in the emergency intake operations of the Special Needs Registry. Indian River County Comprehensive Emergency Management Plan Annex I - Page ESF#8-12 e. Ensure ongoing medical management of clients who have refused to evacuate. f. Provide transportation assistance for inter-facility transfers of shelter residents, as needed and as resources are available 4. Area Hospitals a. Coordinate providing emergency hospital care. b. Activate internal SOPs pertaining to worker health and safety. C. Assist with recruiting volunteers to staff alternate treatment sites. d. Provide for triage and/or disposition of evacuees in accordance with responsibilities. e. Assist and coordinate shelter space for People with Special Needs whose needs are above and beyond the capabilities of the Special Needs Shelters. 5. Area Law Enforcement a. Provide security and traffic control operations to support ESF #8 needs. 4. Area Social and Mental Health Agencies-Will provide manpower and equipment as needs to support ESF #8 needs. 5. County and Municipal Utilities a. Will assist with prioritization of electric restoration for those clients who are electrically dependent. b. Assist the IRCHD in assessing the potability of public and private water supply sources, as needed. C. Assist the IRCHD in assessing the condition and operations of waste water systems. 6. Department of Professional and Business Regulation a. Food inspectors for restaurants, mass feeding sites and food distribution centers. b. Licensure verification of medical/health care personnel within the state and from other states. C. Coordinate activities and information with ESF #8. Indian River County Comprehensive Emergency Management Plan Annex I - Page ESF#8-13 7. Florida Department of Agriculture and Consumer Services a. Provide inspection staff as needed, to ensure food and water safety. 8. Florida Department of Health a. Assist in the recruitment and licensure verification of volunteer nurses and physicians to staff the Special Needs Shelters. b. Deploy necessary resources (i.e. strike teams, supplies, equipment, alternate facilities) if requested C. Provide situational awareness. d. Coordinate the need to initiate waiver of rules and regulations regarding licensed professional personnel and capacities of residential health care facilities. e. Maintain and provide a listing of hospitals, nursing homes, ALFs, etc., which should include CEO names and 24 - hour phone numbers. f. Provide bed availability status of hospitals outside watch area. g. Determine status of hospitals, nursing homes and ALFs in impact area after storm clears. h. Determine need, in coordination with Indian River County Mosquito Control District, for mass spraying for vector control. 8. Indian River County Emergency Management a. Notification, activation and mobilization of all agencies assigned to the ESF/EOC. b. Maintenance of the Special Needs Registry. C. Provide administrative/fiscal support staff in support of special needs and EOC operations. d. Act as a conduit for meeting demand for resources to the State EOC. 9. Indian River County Recreation Department a. Will provide manpower and equipment as needs to support ESF #8 needs. 10. Indian River Mosquito Control District Indian River County Comprehensive Emergency Management Plan Annex I - Page ESF#8-14 a. Assist and coordinate in establishing vector control in the impact area(s). b. Advise ESF 8 on the status and potential of mosquito breeding. 11. Indian River County School District a. Coordinate with ESF #6 (Mass Care) and ESF #8 (Health and Medical) in identifying additional shelter space for people with special needs as needed. b. Identify, assign and coordinate transport equipment and personnel to provide transportation assistance to special needs shelters for evacuating special needs residents. C. May provide manpower and equipment to assist with required needs. d. Will provide personnel to assist with facility management. 12. Medical Examiner's Office a. Coordinate with ESF-6 (Mass Care) in identifying victims and arranging for mortuary services to residents of emergency shelters. b. Establish a Mortuary Response Team through the Florida Funeral Directors' Association. 13. Medical Reserve Corps a. Identify and assign casualty care personnel. b. Provide assistance in health and medical assessments of disaster victims and emergency workers. 14. North Treasure Coast Chapter of the American Red Cross a. Assist in the recruitment and licensure verification of volunteer nurses and physicians to staff the general shelters. b. Coordinate with ESF #11 (Food and Water) for the feeding of emergency workers and residents. C. Set up reception centers or shelters for airline crashes. Indian River County Comprehensive Emergency Management Plan Annex I - Page ESF#8-15 15. Salvation Army— Will provide manpower and equipment as needs to support ESF #8 needs. 16. Senior Resource Association, Inc. - Will provide manpower and equipment as needed to assist with the transportation of special needs clients. 17. VNA/Hospice - Will provide manpower and equipment as needs to support ESF #8 needs. May provide nurses and/or CNAs to aid in care giving. VI. ADDITIONAL RESOURCES ESF#8 will utilize personnel and resources from its primary and support agencies to respond to mission assignments related to emergencies. Additional resources available at other ESFs may be coordinated and mobilized to support ESF #8 missions. When requests begin to exceed the County's ESF's capability to respond, additional resources (i.e., state teams, federal agencies, contractual agreements, and mutual aid agreements) will be mobilized. Mutual aid agreements have been established for all contiguous counties as well as the existence of the Statewide Mutual Aid Agreement. During a significant event these agreements may be activated. The decision to activate these agreements will be made by the Emergency Management Director, or his designee. All personnel and resources mobilized by ESF#8 will remain under the direction and control of the ESF, unless otherwise notified. Indian River County Comprehensive Emergency Management Plan Annex I - Page ESF#8-16 SPECIAL NEEDS SHELTER ELIGIBILITY CRITERIA 1 A person who is dependent upon a health care professional to perform a daily assessment ofa medical condition and administer care /e.g., cardiac, diabetes). a. A person requiring periodic wound care assistance (i.g., dressing changes). b. A person who needs assistance with ostomy nnanagennent, continuous peritoneal dialysis and in-dwelling catheters of any kind' (e.g. N/G tube, colostomy bags etC.) c. A person requiring and needing assistance with ona|, subcutaneous or intromnuauu|ar, or topical medication 2. A person requiring minimal assistance with ambulation, position change,and transfer (i.a., able to move more that 10Ofeet with nrwithout an assistive devise) 3. Apn*gnant woman inthe third trimester after being cleared by|RyNCnurse midwife. Efforts will be made to accommodate her immediate family 4. A person who depends upon oxygen therapy. 5. AperSOn medically dependent On uninterrupted electricity for therapies including but not limited to oxygen, nebulizer, and feeding tubes. G. Ventilator dependent persons and person with multiple special needs requiring 8 higher level of care, will be [8hBrr8d to 8 Shi||8d nnediC8| f8Ci|ih/ 7. A person with mental Or cognitive limitations requiring 8SSiSt8nC8 who is 8CCOrnp@nied by an @pppOpri8t0fU||dnn8 C8r80iv8rfOrthe duration Oftheir stay inthe shelter. 8. A person requiring fU||tirne C8PB who is 8CCOmnp8ni8d by an 8ppn3ph8t8 fU||Urn8 caregiver for the duration of their stay in the shelter. S. A person xvhOSe weight does not exceed the safety weight restrictions Of provided COtS (after supply hospital beds and bariatric COtS are exhausted) 10. Every r88SOn8b|e effort ShOU|d be made to avoid admitting C|i8niS with known inf8[1iOUS conditions or those who require isolation, i.8.' Methicillin F{8SiSt8nt Staphylococcus Aureus (MRSA) or persons who require respiratory isolation such as infectious Tuberculosis /TB\. Note: The Special Needs Shelter does not provide kidney dialysis equipment. Persons requiring kidney dialysis must receive instructions from their private physician or dialysis facility. This information should be brought with the client tothe shelter.