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Montana’s Western Regional Healthcare Coalition

Emergency Preparedness Framework

January 2019 Revised Version 2.1

Promulgation

The Western RHCC Executive Committee declares this Western RHCC Preparedness Plan to be in force and effective until superseded or rescinded and provides full authority to healthcare agencies and organizations within the Coalition to effectively plan for coordinated response to disaster occurrences within the Western Region of Montana.

Record of Change

Date Description of Change Initials

1/2/2019 Update Healthcare Coalition Boundaries

1/2/2019 Update requirements for members HVA

1/2/2019 Remove and Update Coalition HVA

1/2/2019 Update MHMAS Agreement

Western Region HCC Preparedness Plan J a n u a r y 2 0 1 9 V 2 P a g e 2 | 50

Record of DistributionDate Receiving Partner Agency/ Organization

1-2019 HPP LISTSERV

1-2019 Western Coalition Executive Committee

1-2019 HPP Coalition Website


Table of ContentsPromulgation.......................................................................................................................................................2Record of Change................................................................................................................................................2Record of Distribution.........................................................................................................................................3Section I: Purpose, Scope, and Assumptions....................................................................................................5

Purpose...........................................................................................................................................................5Scope...............................................................................................................................................................5Situation..........................................................................................................................................................5Assumptions....................................................................................................................................................6

Section II: Concept of Operations......................................................................................................................6Activation........................................................................................................................................................6Healthcare Coalition Risks and Vulnerabilities................................................................................................6

Functional Need and Vulnerable Populations.............................................................................................7Operational Functions.....................................................................................................................................7

Preparedness Capabilities...........................................................................................................................7Preparedness Response Plans.....................................................................................................................8

Section III: Roles & Responsibilities..................................................................................................................Section IV: Maintenance....................................................................................................................................8

Exercises......................................................................................................................................................8

Western Healthcare Coalition Executive Committee

Contributive Reviewers

Luke Fortune, M. Ed., Public Health Emergency Preparedness Planning Lead

Bryan Tavary, Healthcare Preparedness Program Healthcare Coalition Coordinator

Don McGiboney, Healthcare Preparedness Program Manager

Matt Matich, Public Health Emergency Preparedness Medical Countermeasures Coordinator

Margaret Souza, Public Health Emergency Preparedness Training Lead

Cindee McKee, Montana Hospital Association HPP Coordinator

Cynthia Grubb, East Region Healthcare Coalition chair

Jason Mahoney, East Region Healthcare Coalition chair

Jennifer Phillips, West Region Healthcare Coalition chair


Section I: Purpose, Scope, and AssumptionsPurposeThis Emergency Preparedness Plan is a strategic level plan intended to set the framework for operational and tactical response roles and activities in disaster and emergency situations. Strategic emergency preparedness sets policy objectives, establishes planning priorities, and provides overall guidance for organizations.

This is a provisional planning document for the Western Regional Healthcare Coalition (WRHCC). Its intent is to meet the emergency preparedness requirements put forth by the Montana Department of Public Health and Human Services (DPHHS) as an agent of the 2017-2022 Hospital Preparedness Program – Public Health Emergency Preparedness Cooperative Agreement from the US Health and Human Service (HSS) Assistant Secretary for Preparedness and Response (ASPR) Hospital Preparedness Program (HPP).

ScopeThe RHCC provides guidance and information to coordinate support for coalition members, local emergency responders, tribal emergency responders, State agency partners, and volunteer organizations to address the delivery of public health and medical services and programs to assist Montanans threatened by potential or actual disasters.

This healthcare coalition, as a recipient of federal funding, is a dedicated partner to DPHHS in support of Emergency Support Function 8: Public Health & Medical Services (ESF#8). This ESF is a responsibility assigned to DPHHS by the 2016 Montana Emergency Response Framework (MERF), maintained and published by the Montana Department of Emergency Services (DES).

This plan does not define or supplant any emergency operating procedures or responsibilities for any agency or organization in the RHCC. It is not a tactical plan or field manual, nor does it provide Standard Operating Procedures (SOP). Rather, it is a framework for organization and provides decision-making parameters to use against unknown and unpredictable threats in an all-hazards planning approach. This plan intentionally does not provide specific or qualitative thresholds for activation or demobilization of organizational structures or processes described herein. Such determinations are situation dependent and left to incident management.

ESF#8 planning includes addressing medical needs associated with mental health, behavioral health, and substance abuse considerations of incident victims and response workers. Services also cover the medical needs of individuals classified as having access, functional, or special needs.

SituationMontana is vulnerable to several hazards that might need assistance from both State and non-governmental organizations (NGO). These hazards include, but are not limited to, wildfires, earthquakes, floods, HazMat incidents, communicable disease outbreak or other public health events, and severe weather. The 2015 Threat & Hazard Identification and Risk Assessment (THIRA), compiled by DES, outlines the breadth of vulnerability to hazards endemic to Montana.


Victims of disasters or emergencies might encounter medical emergencies, face the spread of disease, or require mental and behavioral support to survive. Transient individuals, such as tourists, travelers, students, and the pre-disaster homeless, could be involved. Food and relief items could become scarce or compromised. A disaster could also adversely affect persons considered at-risk or having functional needs, including those with pre-existing disabilities, creating a need for medical care and public health support.

AssumptionsFor the purpose of designing responses in an all-hazard planning environment, this plan assumes the following:

A significant public health event can happen at any time and have the potential to impact several healthcare organizations within the RHCC

A healthcare related disaster or emergency that exceeds the response capacities of a local or tribal organization will require broader assistance

Not all healthcare organizations will have current emergency operation plans to share with the coalition or with local emergency managers

RHCC might be asked to provide leadership and coordination in carrying out emergency response and recovery efforts in the areas of public health and medical issues

City, county, and tribal emergency operation managers will need documents and resource lists that describe the relevant medical resources in their jurisdictions (e.g. local nursing homes, hospitals, quick response units, ambulance services, morgue locations, or mutual aid agreements for EMS and public health needs)

Disruption in communications and transportation might adversely affect availability of health care services

Section II: Concept of OperationsTribal and local emergency managers provide initial responses to the needs of emergency and disaster victims. When local resources and disaster coordination needs are exhausted, emergency managers will request assistance from the State. Local authorities retain responsibility for all response and recovery operations.

The RHCC will conduct ESF#8 coordination operations in concert with both local emergency management and DPHHS. Coordination and resource assistance for tribal and local emergency management is on an as-able basis.

ActivationPreparedness is always active. This plan is implemented upon approval by the WRHCC executive committee and carried forth by each document created in its support. This includes any preparative implementation of ESF #8 services for planning, mitigation, response, or recovery.


Healthcare Coalition Risks and VulnerabilitiesThe RHCC requires each facility within the coalition to conduct and maintain its own annual hazard vulnerability analysis (HVA). Additionally, coalition members should participate in or conduct a gap analysis to identify needs in preparation for disaster needs.

Collectively, the RHCC will define, identify, and prioritize risks, in collaboration with DPHHS using data from these and other existing assessments for health care readiness purposes. The coalition can determine any resource needs and gaps, identify individuals who may require additional assistance, highlight training and exercise needs, and develop strategies to address preparedness and response priorities in the region.

Functional Need and Vulnerable Populations The RHCC will work in its ESF #8 responsibilities with its coalition partners and DPHHS to coordinate timely and appropriate support to individuals with functional or special needs resulting from a disaster. Functional need populations are defined, for the purpose of ESF #8 response activities, as vulnerable or at-risk people having functional health needs beyond their capability to maintain during an emergency.

Operational FunctionsThe RHCC consults with its response partners and stakeholders to plan its operational functions for ESF#8 services. The coalition’s function in preparation for emergency and disaster response and recovery is to provide technical and advisory support to local and tribal governments’ emergency and disaster related health care planning needs. Planning takes an all-hazards approach in preparedness.

Preparedness CapabilitiesThis preparedness plan follows the 2017-2022 Health Care Preparedness and Response Capabilities established by ASPR. The RHCC is dedicated to supporting preparations for disasters and emergencies that might impact Montana’s communities, strengthening our health and emergency response systems, and enhancing our nation’s health security. Preparedness planning strengthens the coalition’s health care delivery system to save lives during emergencies and disaster events that exceed the day-to-day capacity and capability of individual systems. The concept of operations for preparedness planning, therefore, must meet the principles outlined in the following capabilities.

Capability 1 – Foundation for Health Care and Medical ReadinessThe community’s health care organizations and other stakeholders—coordinated through a sustainable HCC—have strong relationships, identify hazards and risks, and prioritize and address gaps through planning, training, exercising, and managing resources.

Capability 2 – Health Care and Medical Response and Recovery CoordinationHealth care organizations, the RHCC, and the DPHHS plan and collaborate to share and analyze information, manage and share resources, and coordinate strategies to deliver medical care to all populations during emergencies and planned events.


Capability 3 – Continuity of Health Care Service DeliveryHealth care organizations, with support from the RHCC and DPHHS, provide uninterrupted and optimal medical care to all populations in the face of damaged or disabled health care infrastructures. Health care workers are well-trained, well-educated, and well-equipped to care for patients during emergencies. Simultaneous response and recovery operations result in a return to normal or, ideally, improved operations.

Capability 4 – Medical SurgeHealth care organizations, including hospitals, EMS, and out-of-hospital providers deliver timely and efficient care to their patients even when the demand for health care services exceeds available supply. The RHCC, in collaboration with DPHHS, coordinates information and available resources for its members to maintain conventional surge response. When an emergency overwhelms the coalition’s collective resources, it supports the health care delivery system’s transition to contingency and crisis surge response and promotes a timely return to conventional standards of care as soon as possible.

Preparedness Response PlansThe RHCC will develop response plans to support the four capabilities described above. The following is not a comprehensive list of plans, nor is it inclusive of any of the necessary supporting planning documents.

Risk Communications Resource Management Multi-Agency Incident Management & Coordination Communicable Disease/Pandemic Influenza Non-Pharmaceutical Intervention (NPI) Chemical, Biological, Radiological, Nuclear, Explosive (CBRNE) Medical Surge Tactical Communications Mass Casualty Incident Management

Section III: Roles & ResponsibilitiesThe RHCC’s member organizations must cooperate and collaborate in preparedness planning to sustain community resilience. This collaborative planning is also essential for immediate and effective emergency response. Preparedness planning efforts for the coalition must encompass the unique notification, assistance, and support needs of access and functional needs populations, as well as those with behavioral and mental issues. The WRHCC will assist member facilities in identifying National Incident Management System (NIMS) components and planning considerations.

Agency capabilities are affected by available resources and the size and scope of the incident. As such, support is “as able.”

Every community has multiple organizations responsible for contributing to preparedness activities. Collaboration at the Local Emergency Planning Committee (LEPC) is an excellent step in the right direction.


Section IV: MaintenanceThe RHCC formally reviews all components of this preparedness plan on a five-year cycle. A preparedness planning review group, convened by the executive committee offers advice and suggestions on appropriate emergency planning and construction of the document. This process allows the coalition to determine if it meets all essential factors, remains, applicable, and affords the opportunity to update and change the plan as the coalition changes and grows.

Minor corrections, edits, updates, or adjustments in this document might occur on occasion without a formal review. Changes may also take place as part of improvement plans from exercise after action reports. All changes are tracked in a versioning method and in the Record of Change log.

ExercisesThis plan or any of its components could be exercised separately or in conjunction with other exercises. Exercises will be used under simulated, but realistic, conditions to validate policies and procedures for responding to specific emergency situations and to identify deficiencies that need to be corrected. Personnel participating in these exercises should be those who will make policy decisions or perform the operational procedures during an actual event (i.e. critical personnel). Exercises are conducted under no-fault pretenses.

Appendices

1 The Healthcare Coalition (HCC)

2 The Regional HCC HVA

3 The Communications Plan

4 Information Sharing and Assistance

5 Template for Development of a facility closed Point of Dispensing (POD) Plan

6 CHEMPACK

7 Infectious Disease Outbreak Planning

8 Training

9 Exercising

10 Access and Functional Needs (AFN) Planning and emPOWER


Appendix 1The Healthcare Coalition

The HCC is described in detailed within the By-Laws. The HCC interacts at all levels as the Emergency Support Function (ESF8).

CompositionAt a minimum; 2 hospitals, Emergency Medical Services (EMS), emergency management organizations, and public health agencies must be represented within each HCC.

Additional representation from the following is encouraged:

Assisted Living Facility Primary Care Specialists Behavioral and Mental HealthNursing Home End Stage Renal Home HealthSkilled Nursing Facility Rural Health Center HospiceOutpatient Surgical Community Health Center Academic FacilitiesTribal Health VA Medical Facility DOD Health FacilityTherapy Centers Foster Homes

Regional BoundaryThe Regional HCCs in Montana were initially established utilizing the preexisting boundaries established by the trauma referral patters for patient care. After one year, the Eastern Region, encompassing the entire eastern half of the state, was deemed to be too large of an area to be effective for travel, training, exercise, and planning. The Eastern region was divided in half so that both regions would cover approximately the same geographic size.


Planning Considerations and gap analysis, Identification of Objectives

Major impact areas suggested by US Health and Human Services (HHS) Assistant Secretary for Preparedness and Response (ASPR) funding opportunity.

Project Year 1701-01 establishes the following as initiatives or priorities for a HCC to focus on:o Medical Surgeo Patient Transportationo Evacuation Planso Coordinating Medical Resourceso Health Surveillanceo Information Sharingo Building Situational Awarenesso Improved Alerting and Communicationo Bed Availabilityo Patient Tracking

A regional Hazard Vulnerability Assessment (HVA) will accomplished. See HVA in appendix 2.Gaps will be identified through utilization of the ASPR Capability Assessment Tool (CAT).Executive Committee members are encouraged to include any topics relevant to the HCC.Upon completion of the aforementioned, a strategy will be established for short-, mid-, and long-term objectives to bridge gaps.

Short Mid Long

Establish Governance XEstablish Composition X XOutreach to Partners X X XEstablish Plan drafts X XTest Plans X X XExpand RHCC Capability X XConnect to ESF8 X X XBroaden SA/EEI XEstablish Regional Capability XEstablish AFN Planning X X XExpand CST X X

See Appendix 4 Information Sharing for Member Updates.

A Response Plan is in development for Project Year FY1701Supp (July 2018 to June 2019)


Information SharingSee Appendix 4. The HCC establishes a common operating picture, or situational awareness, that facilitates coordinated information sharing among all HCC stakeholders. This includes state, local, and federal agencies and their respective preparedness programs.

Information sharing is the ability to share real-time information related to the emergency, such as capacity, capability, and stress on health care facilities and situational awareness across the various response organizations and levels of government. Accomplishing these activities will enable the health care delivery systems, public health, emergency management, and other organizations that contribute to responses to coordinate efforts before, during, and after emergencies; maintain situational awareness; and effectively communicate with the public.

Each HCC must be able to access sand collect timely, relevant, and actionable information about their members during emergencies.

Essential Elements of Information (EEI) are reported to the Montana Healthcare Preparedness Program (HPP) within the Department of Health and Human Services (DPHHS) utilizing the electronic Hospital Incident Command System Form 251 located at http://montanahics251.com

EOPMember facilities will develop an Emergency Operations Plan describing procedures that staff will undertake to respond and recover from all hazards. It should provide guidance describing purpose and authority, situation and assumptions, Concept of Operations, Assignment of Roles and Responsibilities including the Incident Command System (ICS), authority and references. As well as procedures to follow during planned activities including Communications plans, Evacuation and Shelter in-Place, resources and assistance, alternate care site, public information officer, specific threat plans, continuity of operations, patient decontamination, to name a few.

PoliciesMember facilities will develop emergency preparedness policy documents supporting the EOP. Examples of policies include: Hazard Vulnerability Analysis (HVA), Use of NIMS, Staff Training, Exercises, Evaluations, and Improvement Plans, Notification of Emergency or Impending Emergency, Emergency Codes, Communications, Staff Call-Back, Notifying External Authorities, Resource Requests, The Media, HIPPA and HIPAA, Strategic National Stockpile, Transporting Patient, Foodservice Emergency Planning, Security, Legal Evidence and Chain of Custody, Labor Pool, Staff Health and Safety, Staff Rest Periods, Family Care and Support During an Emergency, Evacuation/Shelter In-Place, Facility Role during 1135 Waiver, Use of Volunteers, Credentialing/Privileging of Licensed Independent Providers During Disasters, Contaminated Patients, Communication of Threats/Incidents, Mail Room Security, Infection Prevention, Use of POD (Point of Dispensing), SNS, HAvBED

All-Hazards PlanningHealthcare facilities are accomplishing all-hazards planning activities to support the conditions of participation for emergency preparedness provided by the Centers for Medicare and Medicaid Services (CMS).


http://montanahics251.com/

HVAMember facilities will accomplish a Hazard Vulnerability Assessment (HVA). The preferred 2 methods are the Kaiser 5-point Excel Workbook or the Juvare web-based tool. See Appendix 2.

National Incident Management System (NIMS)Member facilities are encouraged to utilize the NIMS. Facilities received Federal money must utilize NIMS.

Facilities should pre-identify roles and responsibilities and document this in their All-Hazards Emergency Operations Plan (EOP).

Provide checklists outlining roles and responsibilities.

Progress will be collected annually by the Executive Committee.

Memorandum of Understanding (MOU) For Mutual AidA Montana Healthcare Mutual Aid System (MHMAS) Mutual Aid agreement, dated 2014, exists and was signed by all Montana hospital CEOs. This documented is managed by the Montana Hospital Association (MHA) under contract through DPHHS.

This document has been revised to accommodate the inclusion of any healthcare agency or organization CEO or Administrator to sign.

Emergency Management Assistance Compact (EMAC) and Requests for Assistance

Requests for assistance begin at the local level within any State by the responding personnel to their County Emergency Management office. If the County Emergency Management office cannot fulfill the request for resources it is routed to the Montana Disaster and Emergency Services (DES) Office, even from another State.

The DES Office will forward health and medical requests to MT DPHHS PHEP (HPP) Office for fulfillment. MT DPHHS PHEP (HPP) Office will staff the request and either obtain the resources from another Regional Healthcare Coalition facility or staff the request to ASPR or CDC Region 8. If a request is not within the purview of the DPHHS PHEP (HPP) Office, the request is sent back to DES for possible other agency EMAC coordination.

From time to time, requests for assistance from outside the state of Montana will be tasked. MT DES is the office of primary responsibility for staffing and delegating these requests. MT DPHHS PHEP (HPP) office will ask Montana facilities if they are able to fulfill and EMAC request. Results will be provided to DES.


Appendix 2The Regional HCC HVA

The RHCC annually collects member organization HVAs and averages the input to determine the most likely risks and hazards.


Appendix 3Communications Plan

DPHHS utilizes a Departmental Communications plan and is capable of creating telephone and internet stand-alone ability. This resource is available to requesting facilities if their communications fail. The limitation is that this resource is available to only one community at a time.

Healthcare Coalition facilities will utilize internal communications for their organization. External to their organization is the local EOC and communications requests are routed through local Emergency Management elements to the State Emergency Coordination Center (SECC).

Primary Communications

The primary communications are landline telephones and cellular telephones

Redundant Communications

Email, radios (700 mhz, 800 mhz, mutual aid frequencies, and HAM)

Emergency Communications

Runners will be used as a last resort for essential communications

Redundant communications will be test semi-annually.


Appendix 4Information Sharing

The HPP Office will provide the following for sharing of information:

The CD Epi Weekly MMWR

PHEP Weely SitRep

The MT DES SitReps

The RHCC will make changes to their infrastructure status utilizing the internet for the following applications:

HAvBED (montanahavbed.com)

HICS 251 (montanahics251.com)

Member Updates

The State of Montana mass alerting platform will be utilized to alert key staff of relevant situations that might or will impact patient and resident safety.

Juvare is being obtained for improving this capability. It will provide a web-based platform for sharing many elements of needed information.


Appendix 5Template for development of a facility closed Point of Dispensing (POD) plan

(Provided by Riverstone Health)

PARTNER ORGANIZATION AND CONTACT INFORMATIONConfidential Information

Please coordinate with and return to your local Public Health office. In the event of an emergency this will be the information that is utilized by Public Health to contact you.

ORGANIZATION

Name of Organization: ____________________________________________________

Street Address: _____________________________________________________

PO Box: _____________________________________________________

City: ______________________ State: __________ Zip: __________

Email: _____________________________________________________

Telephone: _____________________________________________________

Fax Number: _____________________________________________________

PRIMARY COORDINATOR

Name: _____________________________ Position/Title: ______________________

Work Phone: ____________________________ Home Phone: ___________________

Email: _____________________________ Cell/Pager: ________________


FIRST BACKUP COORDINATOR

Name_________________________ Position/Title: _____________

Work Phone: _____________________________ Home Phone: _________________

Email: _____________________________ Cell/Pager: _____________________

SECOND BACKUP COORDINATOR

Name ___________________________ Position/Title: _______________

Work Phone: _____________________ Home Phone: _____________________

Email: ______________________________ Cell/Pager: _______________

POPULATIONPlease complete and return to Public Health for planning purposes. Provide information about your organization at FULL capacity.

Number of Employees: ___________________________

Number of Household Family Members of Employees*: __________________________

Number of Clients/Residents Served (if applicable): ___________________________

Total (of all groups listed above): _____________________________

*If not known, estimates of family members can be calculated by multiplying the number of employees and clients by 2.5 (average number of persons per household)

Of the total above, please estimate the breakdown into the following age groups:

Adults aged 65+ Adults age 18 – 64 AND children over 80

lbs

Children (under 18 AND weigh less than

80 lbs)


LANGUAGES

In the event of an emergency, disease and medication information forms will be provided when you pick up the medication. If you need these to be in any language other than English, please specify languages below.

1. ___________________________

2. ___________________________

3. ___________________________

FREQUENTLY ASKED QUESTIONSWhat is the Strategic National Stockpile (SNS)?

The SNS is a national stash of medical supplies and treatment owned by the Centers for Disease Control and Prevention (CDC). The SNS serves as a national supply of medications and medical supplies for emergency situations.

What is the responsibility of the local health department?

The local health department is responsible for dispensing the medications in the SNS to the citizens of this County within 48 hours of requesting the supplies.

What is a Point of Dispensing (POD)?

A POD is a place where people get the medication that is sent in the SNS.

What is a Closed POD?

A Closed POD is a location that is operated by a private or public organization that dispenses medication to a specific population which may include its employees, their families and clients. A Closed POD is not open to the public.

What are the benefits of a Closed POD?


A Closed POD helps businesses ensure that their employees are protected and therefore able to continue working and/or return to work more quickly. The benefit to local health jurisdictions is that it reduces the number of people seeking medication at the public PODs.

What are the requirements for becoming a Closed POD?

Organizations with a significant number of employees or organizations that serve vulnerable populations are typically eligible to become Closed PODs. Public Health asks that you sign a Memorandum of Agreement prior to becoming a Closed POD.

How much is it going to cost?

Medication and training is free of charge.

Will there by training provided?

Yes. Training and exercise opportunities occur throughout the year. While there are currently no required trainings/exercises you will have the opportunity to participate in events as they arise.

When would we be asked to dispense medications at our own facility?

The only time Public Health would ask organizations to dispense medications would be if there is a great risk to the entire population of the local health jurisdiction and the preventative medications are needed to be taken immediately.

Who operates the Closed POD?

Your organization will operate the Closed POD with as much oversight from Public Health as possible.

Are medical personnel required?

Yes, to become a Closed Pod, you will need to have at least one medical personnel available to screen patients.

Will people be allowed to pick up medications for their families?

Yes, individuals attending the POD will be encouraged to pick up medications for their families.

How will the medication be packaged?

The medication will be packaged for individual use and will be taken orally. Drug information sheets will be provided with the medication.

Who needs to take the medication?

Assuming this is a major public health emergency the entire population of the local health jurisdiction will need to take the medication.


Is it possible that our organization will need to operate a Closed POD after-hours, during the weekend, or on a holiday?

Yes, public health emergencies can occur at any time. It is essential that your organization be prepared to operate a POD during non-working hours since health will be at risk if medications are delayed.

Is this legal?

Yes, it is legal. Public health officials depend on volunteers to assist during an emergency. Participating as a Closed POD is a voluntary program.

PREPARING A DISPENSING PLANIn order to dispense medication to a large number of people a basic plan needs to be put in place. This workbook is designed to walk you through these steps to put together as much pre-event material as possible. As a map to help navigate this process, below is a checklist of major pre-event and response activities that need to be accomplished for successfully dispensing medication.

CHECKLIST FOR CREATING THE DISPENSING PLAN:

Appoint a planning committee Determine your dispensing population Organize your dispensing staff Identify dispensing location and design Consider communications Putting it all together

APPOINT A PLANNING COMMITTEE

A planning committee can think through this process and ensure the correct people are involved, and ensure that they understand and accept their roles and responsibilities.

Consider the positions below as part of your planning committee. The below positions are meant as a guide and you may add/delete positions based on your organizations structure.


PRIMARY COORDINATOR

Name: _____________________________ Position/Title: ______________________

Work Phone: ____________________ Home Phone: ________________

Email: ___________________ Cell/Pager: ________________

FIRST BACKUP COORDINATOR

Name: __________________ Position/Title: ______________

Work Phone: _________________ Home Phone: ____________________

Email: ___________________ Cell/Pager: ____________________

SECOND BACKUP COORDINATOR

Name: __________________ Position/Title: ______________

Work Phone: _____________________ Home Phone: ________________

Email: ________________________ Cell/Pager: ____________________

HUMAN RESOURCES

Name: ____________________ Position/Title: _____________

Work Phone: ______________________ Home Phone: _____________

Email: __________________________ Cell/Pager: _______________


LEGAL COUNSEL

Name: __________________________ Position/Title: ______________

Work Phone: ___________________ Home Phone: ____________

Email: _______________________ Cell/Pager: ____________________

MEDICAL ADVISOR

Name: _____________________ Position/Title: ___________________________

Work Phone: _______________________ Home Phone: ____________________

Email: __________________________ Cell/Pager: ____________________

BUSINESS CONTINUITY

Name: __________________________ Position/Title: ____________________

Work Phone: __________________________ Home Phone: ____________________

Email: __________________________ Cell/Pager: ____________________

PUBLIC HEALTH LIAISON

Name: _____________________ Position/Title: ___________________

Work Phone: __________________________ Home Phone: _____

Email: ______________________Cell/Pager: _________________

OTHER

Name: __________________________ Position/Title: ____________________

Work Phone: __________________________ Home Phone: ____________________

Email: __________________________ Cell/Pager: ____________________

DISPENSING LOCATIONWestern Region HCC Preparedness Plan J a n u a r y 2 0 1 9 V 2 P a g e

24 | 50

Determine the location you will dispense the medication. Consider the following items in choosing your dispensing location:

Large and open Can accommodate tables and chairs Can be rearranged to desired design Easily accessible Able to accommodate people with disabilities Separate entrance and exit (ideally) Has a place to store medications

PRIMARY DISPENSING LOCATION

Name of Location:___________________________________________________

Street Address: _____________________________________________________

PO Box: __________________________________________________________

City: _____________________ State: ________________ Zip: _______________

Email: __________________________________________________________

Telephone: ___________________________________________

Fax Number: ____________________________________________

ALTERNATE DISPENSING LOCATION

Name of Location:__________________________________

Street Address: __________________________________________________________

PO Box: __________________________________________________________

City: ______________________ State: ____________ Zip: _________

Email: __________________________________________________________

Telephone: ____________________________________________

Fax Number: __________________________________________________________

FACILITY DESIGN & SUPPLIES


The design and layout of your POD will impact the amount of time it takes to serve your population. Have an idea of your layout ahead of time and what you will need for the POD to work, so it is quick and easy to setup. Below is a list of suggested supplies for each station of your POD:

Enter – Sign Start – Sign, a table with at least one chair, clip boards, pens, Medication

History Forms. Registration – Sign, table and chair for each staff, pens, alcohol based hand

sanitizer. Screening – Sign, table and chair for each staff, pens, alcohol based hand

sanitizer, Medication Information Sheets. Treatment – Sign, medication, inventory sheet, container to keep collected

forms, table and chair for each staff, alcohol based hand sanitizer. Support- Sign, pocket communicators, table and chair for each staff, medication

information sheets for special populations.

The visual below is an example of a POD in an employee break room.Design your floor plan to help ensure the maximum number of people receive

medication.Western Region HCC Preparedness Plan J a n u a r y 2 0 1 9 V 2 P a g e

26 | 50

A secure space should also be established to store excess medication.


Example Sketch of Primary Dispensing Facility Design

support

EXIT to GYM

treatment treatment

screening screening

registration registration


start


Sketch Your Dispensing Facility Design


DETERMINE POD ORGANIZATIONAL STRUCTURE

Determine the organizational structure for the Closed POD. If you have worked in the Incident Command System (ICS), a Closed POD is part of the Operations Section of the public health system. See HICS Form 207.

If you are unfamiliar with Incident Command, consider training. Contact Healthcare Coalition to learn about training opportunities

DETERMINE STAFFING NEEDS

The number of staff/volunteers needed to support your POD depends on the size of your facility, the floor plan, size of designated population and time allotted for dispensing operations. Review all the information you have collected above and complete the following chart.

POD Job Position # Staff Required Per Shift*

POD Manager 2

Start 3

Registration 3

Screening 3

Treatment 4

Support 4

Security 4

Inventory 2

Employee Service 1

Facilities 1

*A POD operating for 24 hours would need to staff 2 12 hour shifts or 3 – 8 hours shifts. POD staff can include employees, family members, volunteers,

or other designated individuals.


Will probably take 3 shifts to complete.

COMMUNICATIONSBEFORE THE EVENT

Determine how you are going to communicate with staff to let them know that you are a location for a Closed POD in the event of a public health emergency.

Consider including the following information in your communication:

Key roles and responsibilities of staff in an emergency Volunteer requirements, duties, and training opportunities Define the designated population that may come to the POD Describe how medication will be dispensed Explain what information they should be prepared to provide

Consider the following communication methods you might use to disseminate this information before the event:

Employee letter Employee newsletter Telephone message or call Website posting Mass email Meeting/presentation Radio Visit to client’s home

Describe how you will communicate with employees before the event (i.e. computer, meetings, etc.):

Type of Communication Key Messaging Points Person Responsible


COMMUNICATIONS

DURING THE EVENT

Determine how you are going to communicate during an event.

Consider communication with POD management staff and volunteers on the following messages:

POD activation (when and where to report) Assigned duties and how to perform those tasks

Consider communication with people you anticipate to go through the POD:

Where and when to receive medication What information they should have in order to receive medication Drug information sheets and frequently asked questions (this will be

provided to you by Public Health) How to stay informed about the emergency Alternate work schedule instructions as appropriate

Consider the following communication methods you might use to disseminate this information before the event:

Employee letter Employee newsletter Telephone message or call Website posting Mass email Meeting/presentation Radio Visit to client’s home


Describe how you will communicate with employees during the event:

Target Audience Type of Communicat

ion

Key Messaging Points

Person Responsible

POD management staff

POD volunteers

People going to POD

PUTTING IT ALL TOGETHER

StaffingUse your staffing needs list to determine who will be called to the POD. Use predetermined communications to activate POD staff and have them report to the POD location as soon as possible. At minimum you should have one registration/forms staff, one screening staff who has a medical background, and one treatment staff.

Set UpUse your predetermined POD design to set up tables, chairs, and signs in the appropriate locations in the POD. Make supplies available at each station. Secure a site to store excess medication.

Opening/Running the PODPOD flow is a simple process. Patients enter the POD, receive a Medical History Form, have that form reviewed for accuracy, receive the proper instructions, receive their medication, then exit the POD. Below is a diagram explaining the role of each POD staff and how it should function:


Other Jobs at the POD

Security- It is important to keep the patients and staff safe at the POD. A person who is designated to keep the area safe and secure is an important asset to your POD.

Employee Service- If your POD needs to stay open for a long period of time, staff will need breaks and meals. Someone should be responsible for the needs of staff who are working long hours.

Inventory- An inventory staff member can keep track of how much medication you dispense, make sure that all dispensers have enough medication, and make sure that the POD isn't going to run out. Inventory can also keep track of Medical History Forms and make sure that all of them get sent to Public Health.

DemobilizationYou probably want to get back to business as usual as soon as possible. Every available staff should help in the tear down process, so the location can be cleanup and ready for work as soon as possible. Public Health will assist in demobilization and collect excess medication, all Medical History Forms, inventory sheets, signs, and other supplies.

Planning for improbable events may not always seem like a first priority, but events throughout history have shown us that the time to be prepared is now. Once an event occurs, it's too late.


Appendix 6Medical Materials Assets

(excerpt from DPHHS MCM Plan)

Medical Materials Assets

CHEMPACK Host Facilities

All phone numbers are 406 area code

Location & Cache Address Primary 24/7 Pharmacy ContactAlternate 24/7 Emergency

Contact

Billings Fire Dept. Station #5 605 S. 24th Street

W.

Billings, 59102

(406) 657-3000 (Fire Dispatch)

Ask for On Duty HazMat Battalion Chief

(406) 657-3000 (Fire Dispatch)Ask for On Duty HazMat Battalion Chief

CHEMPACK

Holy Rosary Hospital

2600 Wilson StMiles City, 59301

(406) 233-2600 Ask for the pharmacist, or the pharmacist on call

(406) 233-2600 Ask for Administrator supervisor, if not available Administrator on-Call)

CHEMPACK

Frances Mahon Deaconess Hospital

621 3rd StGlasgow, 59230

(406) 228-3500 (Main Number) Ask for Pharmacy

(406) 228-3500 (Main Number) Ask for Maintenance on Call

CHEMPACK

Benefis Health Care

1101 26th St. SouthGreat Falls,59405

(406) 455-5430Ask for Pharmacist in-Charge

(406) 455-5000 Ask for Security

CHEMPACK

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Kalispell Regional Medical Center

310 Sunnyview LaneKalispell, 59901

(406) 752-5111 (Main Number)Ask to speak with Pharmacists in Charge

(406) 752-5111Ask for House Supervisor

CHEMPACK

St. Patrick Hospital

500 W. BroadwayMissoula, 59806

(406) 329-0321Ask for Pharmacist Lead

(406) 329-0321

Ask for PharmacistCHEMPACK

St. Peters Hospital

2475 E. BroadwayHelena, 59601

(406) 444-2350

Ask to speak with Pharmacist on Call

(406) 442-2480Ask for Security Supervisor

CHEMPACK

Bozeman Deaconess Hospital 915 Highland

Blvd.Bozeman, 59715

(406) 414-1050Pharmacist on Duty

585-5000 Ask for House SupervisorCHEMPACK

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ATTACHMENT 2: CHEMPACK

CHEMPACK Cache

Cache Owner Centers for Disease Control and Prevention

Cache Purpose Rapid provision of chemical nerve antidote

Authorized to Request Any hospital or appropriate jurisdictional authority

Request Channel Directly to host hospital

Intended UseRapid treatment of multiple victims that are potentially exposed to large nerve agent chemicals release

Target Population Individuals potentially exposed to nerve agent chemicals due to a chemical release

Transportation Preplanned and coordinated by requesting entity

Chain of Custody Chain of custody will be maintained and tracked - forms are with CHEMPACK Container

Patient Tracking All individuals receiving cache medications should be documented and tracked.

Reporting Requirements Report CHEMPACK activation as soon as reasonably possible to the DPHHS DOC

Charging/Billing Cache assets should not be charged to the patient/recipient

RestrictionsThe container may not be opened unless a public health emergency is perceived to exist and is beyond the local capacity to respond

DPHHS and CDC authorize breaking the CHEMPACK container seal and using the packaged products only when the competent authority, in coordination with an incident commander at the scene determines that an accidental or intentional nerve agent release and:

the materiel is medically necessary to save lives is beyond local emergency medical response capabilities has put multiple lives at risk

A competent requesting authority is defined as a public health, DES, hospital, EMS, or other medical professional or any organization identified and trained by the local public health jurisdiction.

Accessing CHEMPACK assets should be initiated when a nerve agent release involving multiple victims is suspected. The transportation or use of CHEMPACK assets to the scene should not be delayed while waiting for a confirmation of an exposure.

Opening a CHEMPACK container will result in the loss of that CHEMPACK asset for future use. There is no funding for restocking. The CHEMPACK is sustained through the CDC’s CHEMPACK sustainment program.

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CHEMPACK Contents*

EMS Configuration for up to 454 Casualties

Medication1 NDC # Unit Pack Cases QTY

Mark 1 auto-injector 6505-01-174-9919 240 5 1200

Atropine Sulfate 0.4mg/ml 20ml 63323-234-20 100 1 100

Pralidoxime 1gm inj 20ml 60977-141-01 276 1 276

Atropen 0.5 mg 11704-104-01 144 1 144

Atropen 1.0 mg 11704-105-01 144 1 144

Diazepam 5mg/ml auto-injector 6505-01-274-0951 150 2 300

Diazepam 5mg/ml vial, 10ml* 0409-3213-12 50 1 50

Sterile water for injection (SWFI) 20cc 0409-4887-20 100 2 200

1 Some medications within the CHEMPACK do not provide a medication name on case the label. To confirm the medication the NDC number must be checked.

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ATTACHMENT 4: HPP PPE CACHE

The Cache is maintained and rotated by Kreisers INC, a medical equipment and supply company. The quantity of the cache and manufactures the supplies may vary due as the cache is rotated through the system.

HPP PPE Cache

Cache Owner DPHHS, Hospital Preparedness Program

Cache PurposeTo provide rapid access to Personal Protective Equipment during a public health emergency and hospital surge situations when normal supply channels are inadequate

Authorized to Request Hospital authorized individuals

Request ChannelDirectly to Kreisers. Requests made to Kreisers should be reported to the DPHHS DOC by the requesting organization

Intended Use Provision of PPE due to shortages during hospital surge events

Target Population Healthcare workers & first responders

Transportation Shipment will be made by Kreisers INC

Chain of Custody N/A

Patient Tracking N/A

Reporting RequirementsRequests made to Kreisers and Cache PPE usage will be reported to the DPHHS DOC by the requesting organization

Charging/Billing Cache assets are not to be charged to patients

Restrictions

PPE Cache Contents

Respiratory Particulate Glove Exam Nitrile XLarge

Mask N95 Magic Arch 35/BX Gown Imperv Univ 30-54

Mask Isol. Yellow Gown Thumb Cape Reg Blue

Face Mask W/Ear loops Gown Thumb Cape Blue XL

Gloves Nitrile SM 10/200 Gown Imperv XL White

Gloves Nitrile MD 10/200 Gown Cover XL Xtraction

Glove Nitrile LG 10/200 Hand Saniti 2OZ Pump Btl

Glove Nitrile XLG 10/200 Hand Sanit Pump 12OZ

Glove Exam Nitrile Small Sani Cloth Wipes 8x14in

Glove Exam Nitrile Medium Dispatch Trigg Spray 32 OZ

Glove Exam Nitrile Large

RHCC Emergency Preparedness Framework January 2018 v.1 Page | 43

Appendix 7Infectious Disease Outbreak

Consider the following guidance in developing and coordinating facility-specific infectious disease outbreak plans. Additional information can be referenced in the DPHHS Pandemic Influenza plan.

Collaborate with HPP and PHEP to share situational awareness that facilitates coordinated information sharing among all relevant stakeholders. This includes state, local and territorial public health agencies and their respective preparedness programs, public health laboratories, communicable disease programs, and programs addressing healthcare-acquired infections. Information sharing is the ability to share real-time information related to the emergency, such as capacity, capability, and stress on health care facilities and situational awareness across the various response organizations and levels of government. Accomplishing these activities will enable the health care delivery systems, public health, and other organizations that contribute to responses to coordinate efforts before, during, and after emergencies; maintain situational awareness; and effectively communicate with the public.

Establish a common operating picture for effective response. HCCs provide situational awareness data, including data on bed availability, to HPP Participate in current and future federal health care situational awareness initiatives.

During an infectious disease outbreak, HPP and PHEP awardees, HCCs, and HCC members all have roles in planning for and responding to outbreaks that stress either the capacity or the capability of the public health or health care delivery systems. Coordinate the following activities to ensure the ability to surge to meet the demands during a highly infectious disease response.

Establish a common operating picture that facilitates coordinated infectious disease information sharing among all HCC members and relevant stakeholders, including state, local, and territorial public health agencies and their respective preparedness programs, state public health laboratories, communicable disease programs, and health care-associated infections (HAI) programs.

o Monitor known cases or exposed persons including how surveillance will be shared, o Conduct short- and long-term follow-up of known or suspected households, and o Ensure the security of storage and retrieval of sensitive information.

Establish key indicators, critical information requirements, and EEI that will assist with timing of notifications, alerting, and coordinating responses to emerging or re-emerging infectious disease outbreaks of significant public health and health care importance, including novel or high-consequence pathogens.

Ensure that information is directed to the public and to the many disciplines that comprise the responder community.

Coordinate public messaging and information sharing, including information related to monitoring and tracking of persons under investigation (PUIs), among PIOs for jurisdictional public health agencies, as well as PIOs at HCCs and health care organizations.


Ensure infectious disease response planning includes state and local emergency management, transportation, public safety, and other relevant agencies and community partners.

Continue planning with health care organizations and other stakeholders such as mortuary, autopsy personnel, and medical examiners, to coordinate the management of the deceased when bodies are considered infectious, including addressing the provision of body bags and other supplies, defining assistance, and developing relationships with crematoriums, funeral directors, and other partners to effectively plan for managing the deceased when bodies are considered infectious.

Identify, leverage, and share leading practices to optimize infectious disease preparedness and response activities.

Recommended additional activities.

HCCs and state HAI multidisciplinary advisory groups or similar infection control groups within the state should partner to develop a statewide plan for improving infection control within health care organizations.

Jurisdictional public health infection control and prevention programs including HAI programs and HCC members should jointly develop infectious disease response plans for managing individual cases and larger emerging infectious disease outbreaks.

HPP, PHEP, HCCs, and their members should collaborate on informatics initiatives to include but are not limited to electronic laboratory reporting, electronic test ordering, electronic case reporting, electronic death reporting, and syndromic surveillance.

HPP, PHEP, and HCCs should engage with the community to improve understanding of issues related to infection prevention measures, such as:

o Changes in hospital visitation policies, o Social distancing, and o Infection control practices in hospitals, such as:

PPE use, Hand hygiene, Source control, and Isolation of patients.

HPP, PHEP, HCCs, and their members should promote coordinated training and maintenance of competencies among public health first responders, health care providers, EMS, and others as appropriate, on the use of PPE, environmental decontamination, and management of infectious waste. Training should follow OSHA and state regulations.

HPP, PHEP, HCCs and their members should collaborate to develop and implement strategies to ensure availability of effective supplies of PPE, including:

o Working with suppliers and coalitions to develop plans for caching or redistribution and sharing and o Informing each other and integrating plans for purchasing, caching, and distributing PPE.


HPP, PHEP, HCCs, and their members should sustain planning for the management of Person under investigation (PUI) to:

Monitor health care personnel who may have had a risk exposure to a PUI by directly treating or caring for a PUI in a health care setting and

Clarify roles and responsibilities for key response activities related to the monitoring of PUIs, to include:

Assisting or assessing readiness of health care organizations in the event of a PUI and Conducting AARs and testing plans for PUI management to identify opportunities to

improve local, state, and national response activities. Reference the MT DPPHS Ebola Virus Disaster (EVD) Concept of Operations (ConOps).


Appendix 8Training

The RHCC will develop and update annually a multi-year training and exercise plan detailing the expected training opportunities and needs as well as designating exercise events.

Basic Disaster Life Support (BDLS)

Advanced Disaster Life Support (ADLS)

Advanced Burn Life Support (ABLS)

Certified Hospital Emergency Coordinator (CHEC)

Health Sector Emergency Preparedness (HSEP)

1st Quarter 2nd Quarter 3rd Quarter 4th QuarterJul 1 to Sep 30 Oct 1 to Dec 31 Jan 1 to Mar 30 Apr 1 to Jun 302018 2018 2019 2019

ABLS BDLS ADLSABLS ABLS

CHECHSEP


Appendix 9Exercise (testing and Evaluation)

The RHCC will develop and update annually a multi-year training and exercise plan detailing the expected training opportunities and needs as well as designating exercise events.

Redundant Communications (RedComms) Exercises East RHCCRedundant Communications (RedComms) Exercises East RHCCRedundant Communications (RedComms) Exercises East RHCC

Coalition Surge Test (CST) East RHCCCoalition Surge Test (CST) East RHCCCoalition Surge Test (CST) East RHCC

HAvBED Drill

Volunteers Registry (ESAR-VHP) Exercise

Highly Pathogenic Frontline Hospitals (EVD) Exercises

1st Quarter 2nd Quarter 3rd Quarter 4th QuarterJul 1 to Sep 30 Oct 1 to Dec 31 Jan 1 to Mar 30 Apr 1 to Jun 302018 2018 2019 2019

RedComms RedCommsHAvBED HAvBED HAvBED HAvBED

CST East RHCCCST East RHCCCST East RHCC

EVD AH EVD FLESAR-VHP


Appendix 10Access and Functional Needs Planning

County profile information can be accessed at the following website: http://mtdh.ruralinstitute.umt.edu/?page_id=6292

EXAMPLE:

Social Vulnerability Mapping can be obtained at https://svi.cdc.gov/map.aspx


https://svi.cdc.gov/map.aspx

http://mtdh.ruralinstitute.umt.edu/?page_id=6292

http://mtdh.ruralinstitute.umt.edu/?page_id=6292

Every 6 months MT DPHHS will receive indepth emPOWER data updated by CMS from the US PHS Regional Emergency Coordinator (REC). MT DPHHS HPP will forward this information to all Coalition membership to ensure facilities have the latest data for emergency planning activities at the local level. Generic emPOWER data can be obtained at https://empowermap.hhs.gov/


https://empowermap.hhs.gov/

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