Public Health Emergency Management System Emergency Operations Centers
Charatdao Bunthi, MD, MPH
Thailand MOPH US CDC Collaboration
Division of Global Health Protection
Centers for Disease Control and Prevention
Public Health Emergency
An occurrence or imminent threat of an illness or health condition, caused by bio terrorism, epidemic or pandemic disease, or (a) novel and highly fatal infectious agent or biological toxin, that poses a substantial risk of a significant number of human facilities or incidents or a significant number of human facilities or incidents or permanent or long-term disability (WHO/DCD, 2001).
A "public health emergency" may be defined as an event, either natural or manmade, that creates a health risk to the public.
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Public Health Emergency
Floods Earthquakes
Technological
TornadoesHurricanes
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TechnologicalHazards
Disease Outbreaks
Background
2012 - Public health emergency operations center (PHEOC) network (EOC-NET) established by World Health Organization (WHO)
Shared vision between members:
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…All public health EOCs will have the capacity and capability to perform core functions to ensure an effective response to public health events and emergencies…
Background cont.
A functioning PHEOC is an effective means of coordinating with partners responding to public health events and public health events and emergencies
Operates under the Incident Management System (IMS)
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Background cont.
Five essential functions can be activated or deactivated as needed with the evolution of an event:
Management – responsible for overall direction
Operations – coordination and technical guidance
Plans – collection of data, analysis, and planning of future Plans – collection of data, analysis, and planning of future actions
Logistics – acquisition and maintenance of resources in support of activities and responders
Finance and Administration – preparation and management of budget and administrative record
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What is an Emergency Operations Center (EOC)?
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Emergency Operations Center (EOC)
An EOC houses the centralized coordination efforts and resources in response to emergencies and disasters. An EOC is a physical place for response staff to conduct activities, such as:
What is an Emergency Operations Center
Collecting, organizing, analyzing and archiving information
Providing records of event activity sequence and activity sequence and communication timelines
Coordinating and prioritizing resources to support on-scene response operations
Supporting and facilitating agency decision making
Providing command and control functions
The Role of the EOC
The EOC
. . .provides a central location from which government at any level can provideinteragency coordination and executive decision making in support of the incident decision making in support of the incident response.
Emergency Operations Center
Building, facility, and equipment
Trained staff
Policies, processes and procedures
Situation Awareness(SA)
Standard OperatingProcedures (SOP)
Objectives of EOC
Timely, event-specific operational decision-making using the best available information, policy, technical advice and plans
Coordination of activities against common objectives with response partners
Collection, collation, analysis and presentation of event data Collection, collation, analysis and presentation of event data and information to support response planning and documentation
Acquisition and deployment of response resources, including services and material support to the EOC and to all responders
Monitoring financial commitments and providing administrative services for the EOC
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Essential Elements of a PHEOC
A physical facility
/location
A body of data and
information
A set of policies,
plans and procedures
A roster of skilled, trained
personnel
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Support from the EOCThe EOC plays a critical role in support of the on-scene response.
What is a EOC?
A emergency operations center (EOC) is the central location where responsible personnel gather to coordinate operational information and resources for strategic information and resources for strategic and tactical management of public health events and emergencies.
Incident Management System
Policy Guidance
Management/Comman
d
Operations Planning LogisticsFinance &
Administration
Core command, control and coordination functions
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Five Core Functions
Responsible for overall direction towards objectives
(including coordinating risk communication, safety, and liaison)
At field level, directly controls all response activities;
at higher levels, provides coordination and technical guidance
Conducts data collection, analysis, and planning of future actions
Management
Operations
Conducts data collection, analysis, and planning of future actions
based on likely course of the event and the resources available
Acquires, tracks, stores, maintains, and disposes of material resources, and also provides services to support the response
Manages budget, tracks resource costs, procures resources, produces and maintains administrative records
Planning
Logistics
Finance/ administration
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Organizational StructureIncident Management System (IMS)
Incident Manager
Operations Planning LogisticsFinance
Administration
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CDC Response Organization
CDC Zika Response Organization CDC Director
Dr. Frieden
Command and Specialty Staff
Liaison Officers (LNO)
2016 CDC Zika Virus Response Organization Chart24 MAY 2016 (0800)
CDC EOC Duty Officer (available) 24/7/365 at 770-488-7100 2016 Zika Virus Response (CDC): [email protected]
email: [email protected]: http://eoms.cdc.gov/
Logistics Support Section (LOG)
Operations Section (OPS)
Planning Support Section (Plans)
Finance and Procurement Section
Scientific Response Section (SRS)
Emergency Personnel Staffing Section (EPSS)
Situational Awareness Unit (SA)
Situational AwarenessJim Tyson Operations Section
John Turner
Planning Section Bill Howard
Logistics SectionReed Sheridan
Finance and Procurement Section
Reed Sheridan
Emergency PersonnelStaffing SectionKevin Gallagher
Current Ops LeadMark Channer
Situation Report Unit
PH Analytics Dr. Jacqueline
Burkholder
Deployment Coordinator
Gray SmithsonDon Flowers
Support BranchShawn Robinson
2016 ZIKA VIRUS
Chief of Staff Ed Rouse/Sherrie Bruce
JIC Deputy LeadCathy Young
JIC Lead / CO-leadSusan Robinson - John O’ Connor / Joanne
Cox
ADSNicole DowlingBryan Shelby
Policy
Namita Joshi
Joint Information Center (JIC)
Incident Manager
Lyle PetersenActing IM Michael Beach
Deputy Incident Manager Michael BeachScott Fridkin
Satish PillaiRachel Gorwitz
IM Assistant
Veronica ChewChaunte’ Stampley
Mardi Ithier
Executive AideYoulanda Outin
DRMUJeff NemhauserSachi Kuwabara
DOD LNO
Eric Sergienko
SecurityJorge Lazo
DSNSResource Mobilization
Health Information Technology
OMB-PRA Coordinator
Puerto Rico Coordination Stephanie Dulin
Matt Lozier
Emergency Management Capacity
Jennifer Brooks
Assistant Incident ManagerAmy Loy
Mac Kenzie
Pregnancy and Birth Defects
Denise JamiesonPeggy Honein
International Alex Macedo
Response Coordinator
Mark Pereschuk
Audio Visual Communications
Desi Alexander
EOC Support Branch Mike Sapp
IT Support
Informatics SupportDavid jackson
Administrative SupportTina Burton
Task Tracker
After Action Review / Lessons Learned
Shauna Mettee Zarecki
Plans Unit
Transportation Support Gary Goolsby
Commissioned Corps
Burkholder
EpidemiologyLing Zhou
EPI-X Amanda Evanson
Knowledge Mgmt Roger Harlan
Information OperationsCharmen Crawford
GIS Bob Neurath
Deployment BriefGeorge Roark
IMS Staffing CoordinatorGary D. JonesLarry Belleton
Don Flowers
Travel/VouchersPatricia Doggett
Communications & Equipment Team
Irene White
Facilities/ Task TrackerThomasina Greene
Clinical InquiriesMaleeka Glover
Outreach
Research & Evaluation
LOCS
Social Media
Media LNO
Communication Services
CDC-INFO
CDC Connects
Global
COCA
WEB
Triage
SA LNO
Clearance
Incident Action Plan
AtlantaKim Hummel
Content
Internal Communication
CommunicationClearance
Global Migration Doug HamiltonHolly Williams
BloodSafety
Matt KuehnertSridhar Basavaraju
Puerto Rico and Global
ResponseAudrey Lenhart
FT. CollinsAnn Powers
LAB
State CoordinationChris Kosmos
Finance BranchMary McDonald Zach Braden
Jorge LazoProcurement Branch
Christine Godfrey
EPA LNO
Susan Jennings
CONUS & Territories
other than PR
Janet McAllister
Vector Issues
PAHO LNO Craig Shapiro
Safety
Johanna Gilstrap
Employee Monitoring Panayotta Delinois
EPI Surveillance Margaret Cortese
Marc Fischer Annemarie Wasley
Sexual Transmission John Brooks
ModelingMichael Johansson
Clinical
Dana Meaney-
Delman
Operations
Tanya Williams
Puerto Rico Survey & Surveill ance
Carrie Shapiro-
Mendoza
Contraception Access
Lisa KooninEva Lathrop
Colombia
Diana Valencia
Children’s HealthEric Dziuban
OPERATIONS SECTION
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Role of Operations Section
Operations Section activities vary at different levels.
At the national level, the Operations Section is responsible for coordination and technical guidance of all response operations, and for implementing an of all response operations, and for implementing an existing or improvised response plan to support the site-level response.
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Role of Operations Section
At the sub-national or local/site level, Operations is all about direct response activities, such as: Vaccination
Contact tracing
Treating and transporting sick/injured/deceased people
Conducting disease surveillance and collecting epidemiological Conducting disease surveillance and collecting epidemiological data
Establishing emergency clinics and/or restoring functionality of damaged health infrastructure
Scaling up community outreach for health promotion and case management.
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Role of Operations Section
Operational activities vary depending on the type, scale and impact of an event—as does the sub-structure of the Operations Section.
WHO Framework for a Public Health Emergency Operations Center, 2015
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Modes of Operation
Note: Watch Mode is permanent and is ongoing even during a response.
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Watch Mode
Watch Mode generally aligns with “pre-incident” activities.
Staffed by core personnel who conduct routine operations.
Staff monitors conditions for events or incidents that might require a public health response.might require a public health response.
Event-Based Surveillance Also called “case finding or “case ascertainment”
Looking for new outbreaks or cases
Informs routine public health activities or emergency epi/surveillance
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Watch Mode
Public Information Officer/JIC
EOC Manager
Operations Planning LogisticsFinance
Operations
Watch Staff
Event Based Surveillance (EBS) Staff
Planning LogisticsFinance
Administration
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Alert Mode
Public Information Officer/JIC
EOC Manager
Operations Planning LogisticsFinance
AdministrationOperations
Watch Staff
Rapid Response
Teams
Planning LogisticsAdministration
EBS Staff
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Response Mode
Public Information Officer/JIC
Incident Manager
Operations Planning LogisticsFinance
AdministrationOperations
Watch Staff
Rapid Response
Teams
Planning
Situational Awareness
Team
LogisticsAdministration
EBS Staff
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Watch Officer
Information WATCH OFFICER
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•Collect•Triage•Report
Triaging Information
• When information flows to the Watch Officer, they use protocols to triage the information to determine disposition and collection requirements
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InformationWATCH
OFFICER
EOC
TriageReport
CIR
REMINDER
The watch mode is continuous - Even when the PHEOC is activated for a response, watch officers are continuing to monitor for other emerging incidents.
Collect
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Collect
TriageReport
COLLECTING, TRIAGING, AND REPORTING
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Collecting data
The Watch Officer responsible for handling an initial contact should collect basic information about an incident using a reporting form that includes:• Unique identifier
• Geographical area (i.e. district) name
• Date of reporting and contact details of reporter
• Date and time when event occurred
• Description of event
• Actions taken to date, if any
• Name of person taking the call
http://www.wpro.who.int/emerging_diseases/documents/docs/eventbasedsurv.pdf
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CIRs:
Are information items identified as being critical in facilitating situational awareness and decision making.
Trigger immediate, mandatory actions such as reporting (spot reports and situation reports).
Critical Information Requirements (CIRs)
(spot reports and situation reports).
Are often linked to decision points for execution of a plan.
Become more detailed (targeted to the specific threat/response) and can change during a public health emergency response.
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Examples of CIRs
Internal CIRs:
Accidental death or injury of MoH personnel.
Events affecting MoH facility/installation activities/operations.
Incidents of international significance affecting MoH staff.
External CIRs:
Disease outbreaks/deaths that are above the base line for the Disease outbreaks/deaths that are above the base line for the seasonal or geographic norms.
Any terrorist attacks.
Response-Specific CIRs:
A confirmed case of Ebola in an MoH staff member.
Best Practices:• Establish a list of standing CIRs
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Triaging Data
Confirm the report is accurate
Determine if the report meets a critical information requirement and with whom the information should be sharedshared Review CIRs
Review existing SOPs
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Reporting Data
Determine what type of report will be sent out Spot Report (generated within the EOC)
Situation Report (comes from external sources)
Distribute appropriate report in accordance with internal SOPsSOPs
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Spot Reports (SPOTREPs)
Used to provide critical information regarding an incident
Who, What, When, Where, Why (as they are known)
Ministry actions taken in response
Intended to be a short narrative with critical pertinent information
Created within the EOC
Used for notification of emerging events related to:
Critical Information Requirements (CIRs) Severe weather Practicum, earthquakes, other natural disasters Significant events with public health impacts
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SPOTREP Example
Situation Reports (SITREPs)
Are priority messages that provide a synopsis of a situation to designated decision makers
Contain confirmed / verified information and explicit details
Are created by Subject Matter Experts (SMEs) Are created by Subject Matter Experts (SMEs) when a circumstance has the potential to become a CIR, actually is a CIR, or when media coverage may arise
SITREP Example
EOC ACTIVATION
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EOC Activation Levels
The level of effort required during EOC Response Mode will change over the course of time, resulting in either a return of response activities to program management (and EOC deactivation), or a change in activation levels.
Transition between EOC activation levels is designated Transition between EOC activation levels is designated based upon a level of effort, and not strictly by the total number of personnel involved in the response.
Escalation and de-escalation of the EOC activation level is based on an increase or decrease in the level of effort required to manage the response.
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EOC Activation Levels
* Activation Levels only apply to Response Mode* An EOC can only operate at one Activation Level at a time for a specific event
Level 1
The highest level of activation, this level is
reserved for the largest-scale responses, which
often require substantial Ministry-
wide effort
Sta
ffin
g In
cre
ase
Level 2
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wide effort
Sta
ffin
g In
cre
ase
This level of activation often requires
significant staff augmentation
Level 3
The lowest level of activation and effort.
NOTE: Watch Staff is always in Watch Mode
*** EOC Activation ***
RESPONSE MANAGEMENT
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Response Mode
Occurs when the Incident Management System is activated.
Generally associated with “incident” activities.
Can occur at the direction of the Ministry/ Department Can occur at the direction of the Ministry/ Department director.
Activation approval usually follows a recommendation generated from a preliminary assessment team process.
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Response Activities
Monitor, track, and distribute as necessary internal and external Mission Assignments (MAs).
Monitor and track Requests for Information and Requests for Actions (RFIs/RFAs).for Actions (RFIs/RFAs).
Collaborate across Ministries and other partners.
Best Practice: Use a computer application such as WebEOC.(WebEOC is a web-based information management system that provides a single access point for the collection and dissemination of emergency or event-related information. ) 48
Response Activities
Distribute daily calendar of events (Staff Rhythm)
Develop and maintain event specific CIRs.
Coordinate meeting schedules and send calendar invitations and send calendar invitations to participants.
Coordinate space requirements.
Note:Response activities are managed by the Operations Section, but executed by all Staff Sections in the EOC.
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Response Activities
Distribute and Manage Response Documents: Incident Action Plans
(IAPs)
SPOT Reports SPOT Reports (SPOTREPs)
Situation Reports (SITREPs)
Shift Change Briefs
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Response Activities
Integrate response personnel. Manage facility access.
Manage EOC & conference room seating.
Provide operator support for Provide operator support for multimedia presentations.
Test secure and unsecure communication devices.
Display materials as directed throughout the facility.
Maintain an EOC Plan.
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Tasks
A formal task is any:
Request for Information (RFI) that requires the issuance of a policy, statement, or official response as opposed to information that is publicly available or considered common knowledge among professionals.
Request for Assistance (RFA) that requires resources Request for Assistance (RFA) that requires resources (material or personnel) being dedicated to fulfill the need.
Other action that warrants a formal response based on the requestor’s position of authority.
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Example of RFI and RFA
Request for Information (RFI) What are the guidelines for transport of Ebola specimens
collected from various district health centers?
What are recommended guidelines for health care workers working with SARS patients?
Request for Action (RFA) Requesting MoH to deploy SMEs in entomology and vector control to
districts impacted by a dengue outbreak.
Requesting MoH to supply vaccine to 3 districts affected by a yellow fever outbreak.
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Task ManagementSteps include:
Identify the requirement.
Prioritize the task.
Identify to whom to assign the task.
Ensure pertinent information is included in task description.
Determine completion date.
Track status.
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RESPONSE CHECKLISTS
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Response Checklists
Checklists are useful to track completion of daily and weekly tasks that are essential in maintaining the continuous and seamless operations.
Promote accountability
Allow for continuity of operations during multiple shifts Allow for continuity of operations during multiple shifts
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Considerations for Daily Operations Response Checklists
Include routine activities such as: Development of daily staff rhythm
Distribution of weekly SITREPs
Maintaining equipment
Include frequency of activities Include frequency of activities Daily, weekly, monthly
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SAMPLE CHECKLISTS
Frequency Time Task Instructions
Daily 6:00pm Send out next day’s staff rhythm
Distribute via email to IM, All SectionsPrint copy and place on wallplace on wall
M, W, F 10:00am Coordinate IM Update
Set up room and conference line for IM update
Thursday 5:00pm Distribute ResponseSITREP
DistributeSITREP to all response staff using distribution list
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Key Points
The Operations Section is the center of the response. It is a source of information but also sets the tone for how a response should be managed.
The work is fast paced, and it helps to have SOPs and systems in place for key activities, to ensure overall accountability and effectiveness, including but not limited accountability and effectiveness, including but not limited to: SPOTREPS/SITREPS
Preliminary Assessments
Response Checklists
Task Tracking
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PLANS SECTION
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Overview
The Plans Section - is responsible for evaluation of the situation (information gathering and analysis), assessment of the options for dealing with it, and keeping track of resources.
Incident Manager
Operations Planning LogisticsFinance
Administration
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EOC Plans Section
Plans
Section
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Advanced Planning Unit
Documentation Unit
Situational Awareness Unit
Plans Section Responsibilities
The Plans Section is responsible for: Aggregating and analyzing data
Predicting the probable evolution of events
Identifying the technical expertise that is needed
Tracking resource status Tracking resource status
Developing incident action plans
Reporting progress
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In Public Health Responses: Responsibility for data analysis during epidemiological investigations can be placed with the Plans or Operations Sections (or even as a separate Section).
PLANS AND PROCEDURES
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Types of Plans
An EOC operates on the basis of two types of plans:
1. Contingency plans, to include:a. All-hazards plan
b. Threat-specific response plans
c. Functional plans
2. An incident action plan
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Threat-specific response plans
Threat-specific response plans should be based on the prioritized list of threats and hazards determined through the national (or jurisdiction-specific) risk assessment process.
They may be included as Annexes to the All Hazards They may be included as Annexes to the All Hazards Plan.
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Incident Action Plans
A written incident action plan describes the specific objectives that must be accomplished in succession in order to achieve larger event management goals.
Incident action plans are developed within the Plans Section during a response, and provide all PHEOC Section during a response, and provide all PHEOC supervisory personnel with directions for current and future actions.
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Incident Action Plan
The purpose of the IAP is to:
Ensure response personnel are working toward the same goals
Provide direction for actions to be taken during the operational period identified in the planoperational period identified in the plan
Provide a means of communicating the incident objectivesfor operational and support activities
Ensure a coordinated response
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Incident Action Plan
Every incident must have an Incident Action Plan (IAP) that:
Covers a specified timeframe, called an operational period
Specifies the incident objectives - What do we want to do?
Identifies essential and critical information requirements Identifies essential and critical information requirements
States the activities - Who is responsible for doing it?
How do we communicate with each other?
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LOGISTICS SECTION
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Overview
The Logistics Section - provides facilities, services, and supplies in support of the incident.
Incident Manager
Operations Planning LogisticsFinance /
Administration
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Logistics Section Functions
Logistics
Section
Support Branch Service Branch
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Supply Unit
Facilities Unit
Ground Support Unit
Communication Unit
Medical Unit
Food Unit
Scope of Logistics
Logistics Management Resource Support
Material management Emergency supplies
Transportation management Facilities
Facilities management Office equipment and suppliesFacilities management Office equipment and supplies
Personal property management Telecommunications
IT management Contracting services
Maintenance management Transportation services
Support personnel
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Logistics Preparedness Actions
During preparedness phase:
Identify logistics requirements
Identify logistics resources
Balance logistics resources with logistics requirements (resource mapping)(resource mapping)
Establish and communicate logistics, policies, procedures, and plans
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Logistics Response and Recovery Actions
During response and recovery phase:
Support response to incident
Manage delivery of services
Anticipate ongoing sustainment needs
Coordinate demobilization of assets and equipment Coordinate demobilization of assets and equipment
Reconstitute resources as needed
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RESOURCE MANAGEMENT
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Resource Management
Four tasks:
Establishing systems for describing, inventorying, requesting, and tracking resources
Activating the systems prior to, during, and after an incidentincident
Dispatching resources prior to, during, and after an incident
Deactivating or recalling resources during or after an incident
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Resource Management Concepts
Standardize identification, allocation, and tracking
Classify by kind and type
Implement credentialing system
Incorporate resources from private sector and NGOs
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Resource Management During Incidents
Getting the right resources, to the right place, at the right time, can be a matter of life and death
Resources include: Personnel
Equipment Equipment
Supplies
Facilities
Prior to an incident, resources are inventoried and categorized by kind and type, including their size, capacity, capability, skills, and other characteristics
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Managing Resources
Preparedness activities must occur on a continual basis to ensure that resources are ready for mobilization
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Resource Typing
IMS resources are categorized by:
Kind - describe what the resources is
Type - describe the size, capability, and staffing qualifications of a specific kind of resource
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Resource Typing
Kind refers to broad classes that characterize like resources:
Teams
Equipment
Supplies Supplies
Vehicles
Aircraft
Type specifically defines the level of capability:
Type may vary by power, size, or capacity
Ensures Incident Manager requests, receives, and deploys the resources needed
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FINANCE AND ADMINISTRATION SECTION
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Overview
Finance and Administration Section - tracks expenditure, makes payments, and provides administrative services
Incident Manager
Operations Planning LogisticsFinance /
Administration
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Overview cont.
Activated when there is a specific need for financial and/or administrative services to support incident management activitiesmanagement activities
Acts in a support role
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Finance/Administration Section Responsibilities
Cash flow management
Track material and human resource costs
Budget preparation and monitoring
Production and maintenance of administrative records
Process compensation claims Process compensation claims
Preparation of procurement contracts
Incentive and insurance payments.
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JOINT INFORMATION CENTER
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What is a Joint Information Center (JIC)?
A JIC is a physical facility in which coordination of all communication related to an emergency response occurs.
What does the JIC do?
Leads the communication response to public health emergencies
Translates and delivers emergency risk communication messages to key audiences
Monitors news media, social media, and public inquiries to identify audience needs and guide communication strategy
Coordinates communication activitywith local, national, and international response organizations
Manages review of communication messages to ensure all response organizations are saying the same thing
JIC Products
Web and print
• Fact sheets, flyers, interim guidelines, posters , Q&As , FAQs
News media
• Talking points, news releases, media advisories
Social media
• Twitter, Facebook, blog posts
Call center prepared responses
• Helpline information
Target Audiences
Affected communities
Vulnerable populations
Clinicians
Public health Public health workforce
CDC employees
Policymakers
International agencies
Communication Channels News media
Social media
Internet
Public helpline
Global channels Global channels
Clinician list serve and conference calls
The EOC Foundation & Process
Assessment Deployment ReportingInformation/Co
ordination
EOC Handbook SOPs Forms
EOC Roles and AdvantagesRole of EOC
• Provide a central location and a system from which the MOH can rapidly respond to a disease outbreak or natural disaster, execute decision
Advantages of an EOC
• MOH systems are centralized and integrated into one room
• Allows field responders, impacted disaster, execute decision making, and provide interagency coordination
• The MOH EOC plays a critical role in supporting a response to the field
• Allows field responders, impacted provinces and regional centers to focus on the incident
• Provides a simple communuications channel from the field response and the MOH
• Allows for problems to be solved at the lowest level of response
Evolution of a Response
Questions
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