public health planning carrie harter, mph – disease control adam dubois – preparedness southeast...
TRANSCRIPT
Public Health Planning
Carrie Harter, MPH – Disease Control
Adam DuBois – Preparedness
Southeast High School November 18, 2014
Preparedness Planning
• Different Types of Preparedness Plans• Operational Plans• Communication Plans• Safety Plans• Security Plan • Many, many others…
ThePreparedness Cycle
• Preparedness IS NOT a “one-and-done” process!
• Continuous cycle that starts each time you finish.
• Without documenting gaps in capabilities, improvements can not be made.
Emergency Management / Coordination
• National Incident Management System (NIMS)• Systematic, proactive approach to guide the management of incidents• https://www.fema.gov/national-incident-management-system
• Incident Command Structure (ICS)• Systematic tool used for the command, control and coordination of emergency
response.• Free Training Available:• https://training.fema.gov/EMIWeb/IS/courseOverview.aspx?code=IS-100.b
Emergency Management / Coordination
Emergency Management / Coordination
1. Transportation2. Communications3. Utility Operations4. Fire5. Information & Planning6. Mass Care7. Resource Support8. Health & Medical9. Search & Rescue10.Hazardous Materials11.Food & Water12.Energy13.Military Support14.Public Information15.Volunteers & Donations16.Law Enforcement17.Animal Protection18.Business & Industry
Manatee County
What is planning?
1. Evaluating a situation2. Developing incident objectives3. Selecting a strategy4. Deciding which resources should be used
to achieve the objectives in the safest, most efficient and cost-effective manner.
Planning is a process to assist in…
Planning
Step 1: Form TeamIdentify Core Team
• Management• Legal Services• Human Resources• Public Relations / Information• Risk Management• Environmental Health • Finance / Purchasing
• Operations• Facilities Management• Security• Medical Personnel• Information Technology• Logistics• Safety Personnel• Employees / Volunteers
• Any other person / group with interest
Step 1: Form TeamIdentify Core Team
Step 1: Form TeamEngage Partners
• Law Enforcement• Fire Department • Emergency Medical Services• Hazardous Materials• Local Emergency Management• Public Health• Public Works• Contractors• Vendors• Partner Groups• Churches
Understand The SituationIdentify Threats / Hazards
• Situation• Site – building, facilities, grounds, access controls
• Situational Climate• Knowledge of understanding, perceptions, behaviors, etc.
• Threats• People, places, or things that may pose a threat, or
become an incident.• Capacity
• What resources are available?• Where can we pull resources?• Skills / Training?• Needs?
Assess the following:
Identify Threats:• Gather information to identify a range of threats that might
be faced by the jurisdiction.
Understand The SituationIdentify Threats / Hazards
Prioritize Threats and Hazards (Risk Assessment)
Hazard Probability Magnitude Warning(hrs.)
Duration(hrs.)
Risk Priority
Fire 4. Highly Likely3. Likely2. Possible1. Unlikely
4. Catastrophic3. Critical2. Limited1. Negligible
4. Minimal3. 6-122. 12-241. 24+
4. 12+3. 6-122. 3-61. < 3
High MediumLow
HazMat Spill
4. Highly Likely3. Likely2. Possible1. Unlikely
4. Catastrophic3. Critical2. Limited1. Negligible
4. Minimal3. 6-122. 12-241. 24+
4. 12+3. 6-122. 3-61. < 3
High MediumLow
Zombie Apocalypse
4. Highly Likely3. Likely2. Possible1. Unlikely
4. Catastrophic3. Critical2. Limited1. Negligible
4. Minimal3. 6-122. 12-241. 24+
4. 12+3. 6-122. 3-61. < 3
High MediumLow
Use the compiled data to prioritize your threats and hazards
Understand The SituationIdentify Threats / Hazards
Prioritize Threats and Hazards (Risk Assessment)
Use the compiled data to prioritize your threats and hazards
Goals / Objectives
Goals are BROAD, GENERAL statements in response to threats• Try to develop at least 3 goals for each Hazard.
Example: (from Fire Hazard on prior slide)1. Prevent a fire from occurring in your home.2. Protect your family from injury.3. Provide medical attention if someone gets hurt.
Objectives are SPECIFIC, MEASURABLE actions necessarily to achieve your goal.
• Objective 1.1: Provide fire education to your family• Objective 1.2: Store combustibles in fireproof space
• Objective 2.1: Create a fire evacuation plan• Objective 2.2: Practice evacuation drills
• Objective 3.1: Call 911 immediately.• Objective 3.2: Begin first aid until EMS arrives.
Plan Development
• Course of action addresses the who, what, when, where, why, and how for each threat, hazard and function.
• Course of action are different for each scenario.
• Course of action typically created using the following steps.
1. Depict a scenario based on threats and hazards prioritized.
2. Determine the time available to respond.• Hurricane vs. Explosion
3. Identify decision points.• When do decisions need to be made?• What decisions?
Plan Development
4. Develop Courses of Action
• What is the action?• Who is responsible for the action?• When does it take place?• How long does the action take place?• What has to happen before?• What happens after?• What resources are needed?• What are the affects?
After developing courses of action, select the most appropriate.
The Plan
Basic (or Base) Plan• Overview of the approach• (How the entity operates, and what they want to do.)
Functional Annexes (Workforce Development)• Details of goals, objectives, courses of action.• Describes how to manage a function before, during, after an
incident.
Threat / Hazard Specific Annexes (Pandemic Influenza)• Details goals, objectives, courses of action for a specific
hazard identified.
Epidemiology Outbreak Annex
• Plan Activation:– Significant increase in a disease or syndrome– A disease with unusual
geographic/seasonal/age distribution– Evidence of higher morbidity or mortality rate
than usual with common illnesses or syndromes
– A single case of a rare disease (Ebola)
Epidemiology Outbreak Annex
• Surveillance (how we know when to activate our plan):– Reportable Diseases– ESSENCE
• Emergency Room Chief Complaints• Poison Control Data• Vital Statistics Data
– School Absenteeism Data
Epidemiology Outbreak Annex
• Plan Covers– Steps to identifying and managing an
outbreak• Case finding• Interviewing• Infection Control Recommendations
– Communication – Recovery
Isolation and Quarantine Plan
• Plan Activation:– Identification of a suspected or confirmed
disease of public health significance– County Health Officer can institute quarantine
orders
• Plan Covers:– Process for implementing isolation,
quarantine, and social distancing– Communications– Partnerships
Mass Prophylaxis Plan
• Plan Activation:– A single case of a disease is identified that
can not be attributed to a natural infection (Anthrax)
– Law enforcement or public health officials determine a terrorist release of a virulent public health agent
– Outbreak of a novel strain of influenza (Influenza A 2009:H1N1)
The Plan
Write the Plan
1. Summarize important information with checklists and visual aids.
2. Use plain language, avoid jargon and abbreviations.3. Write clearly, using an active voice.4. Use logical, consistent structuring5. Make the plan easy to read, or scan for information.6. Provide enough detail to convey an actionable plan.7. Create tools or documents that will supplement your
plan.1. Auxiliary aids2. Closed captioning
The Plan
Review the Plan for:
1. Compliance of laws 2. Usefulness3. Adequacy4. Feasibility5. Acceptableness6. Completeness
a. All courses of action for hazardsb. Integrates needs of the whole communityc. Provides a complete picture of what will happend. Estimates time for achieving objectivese. Ensures safetyf. Identifies success
The Plan
Approve and Share:
After the final review of your plan, • Present to leadership• Obtain approval• Share with community partners that have a role in the
plan• Share with other organizations that may support
operations• Protect your plan from those who do not need, or
authorized to have it
Plan ImplementationTrain Stakeholders• Hold a meeting and educate parties on the plan.• Visit sites in the plan to allow for visual recognition.• Provide literature on the plan, policies, and procedures involved
with activation• Post pertinent information• Familiarize partners to increase comfort and understanding• Train on specific roles
Exercise the Plan• Practice, Practice, Practice
• Tabletop (discussion based)• Drills (small, individual response to a scenario)• Functional Exercise (similar to drill, but involve multiple
partners)• Full Scale Exercise (full activation of plan)
Exercising Your Plan: “Zombitosis” Drill
“Zombitosis” Drill
• Homeland Security Exercise and Evaluation Program (HSEEP) Compliant– Process for:
• Planning• Evaluation• After-Action Report/Improvement Plan
• Completed to exercise our Mass Prophylaxis Plan (required every 36 months)
“Zombitosis” Drill
• Operations-based exercise versus discussion based– Considered a “drill” since it tested one
function and one agency– Exercised many components of our agency:
• Planners• Command Staff• Logistics• Operations (nursing)
“Zombitosis” Drill
“Zombitosis” Drill
Epidemiology Outbreak Response Plan
Plan Implementation
Review, Revise, and Maintain the Plan
• Close the loop in the planning process.• Focuses on adding information gained during
exercise.• Begins the planning cycle over.
• Planning is continuous…
“Planning P”
• Guide to the process and steps involved in planning for an incident.
• The “leg” of the P is the initial response period.
• “Top” of the P is the beginning of the first operational period cycle.
• Operational planning cycle is circular and continuous through the event.
“Planning P”
• Incident occurs, notification received, planning begins.
• Review the situation to provide input for management decisions.
• ICS 201 is a tool (form) used to collect information about a situation and the resources allocated.
ICS 201
http://training.fema.gov/emiweb/is/icsresource/icsforms.htm
“Planning P”
• Incident Command establish objectives for the event.
• Planners begin process to break down objectives into tactical assignments.
• Meeting to gather input or provide data.
“Planning P”
Tactics Meeting is to:
• Determine how strategies will be accomplished to achieve incident objectives.
• Assign resources to implement tactics.
• Identify methods for monitoring tactics and resources.
ICS 215/215A Forms Used in Tactics Meeting
ICS 215
http://training.fema.gov/emiweb/is/icsresource/icsforms.htm
• How we going to do it?
• What do we have to do it?
• What do we need to do it?
• When can we expect it here?
• Who is going to use it?
ICS 215A
http://training.fema.gov/emiweb/is/icsresource/icsforms.htm
• Where are operation taking place?
• What are any hazards or potential hazards?
• What can be done to mitigate these hazards?
“Planning P”
• Review ICS 215 (Resources)• Review ICS 215A (Safety)• Assess the current operations
effectiveness, resource efficiency, and address safety hazards.
• Gather any further information to support incident management decisions.
“Planning P”
• Review / Validate the operational plan.• Operations explains the amount and
type of resources needed.• Planning team’s “Resource Unit” will
work to accommodate.• Planning meeting assures all command
and general staff have understanding of the operational period.
• Planning team will advise when supporting documents are due for plan distribution.
“Planning P”
• Operations (or shift) briefing is conducted to present the incident action plan to supervisors of the tactical resources.
• Supervisors will then meet with their assigned resources to brief on assignments.
“Planning P”
• Operations section directs the implementation of the plan.
• Plan is evaluated for effectiveness during the process.
• Command staff and Planning team begin to plan for the next operational period.
Influenza A H1N1: 2009Putting Your Plan into
Action• April 24th 2009: CDC announces two
cases of novel swine influenza in children reporting no contact with pigs
• 2 phases to the response:– Outbreak response– Vaccination campaign
Influenza A H1N1: 2009Putting Your Plan into
Action• Outbreak timeline:
– CDC alert 4/24/09 (conference call) – Manatee County identified first case on May 7,
2009 – Reporting only deaths and serious hospitalizations
by August 3, 2009– Manatee County’s first death on September 7,
2009 (3 total)
Influenza A H1N1: 2009Putting Your Plan into
Action• Vaccine available in September 2009• CDC identified 5 target groups:
– Pregnant women– Household members and caregivers of children
under 6 months– Health-care and emergency medical services
personnel– Children and young adults ages 6 months to 24 years– Persons aged 25-64 years with underlying medical
conditions
Influenza A H1N1: 2009Putting Your Plan into
Action• DOH-Manatee focused on the target groups from
September – December:– Utilized Incident Command System (ICS) structure– 22 Incident Action Plans
An
na
Ma
ria
Bla
ck
bu
rn
Ba
ys
ho
re
Fre
ed
om
Bra
de
n R
ive
r
Kin
na
n
Till
ma
n
Ma
na
tee
Wa
ke
lan
d
On
ec
o
Ora
ng
e R
idg
e/B
ul..
.
Du
ett
e
Gu
llett
My
ak
ka
Ro
ge
rs G
ard
en
Ste
wa
rt
Pa
lm V
iew
Pa
lme
tto
Ab
el
Mc
Ne
al
Ba
llard
Da
ug
htr
ey
Mill
s
Witt
Will
is
Sa
mo
se
t
Se
a B
ree
ze
Mill
er
Mo
od
y
Pa
lma
So
la
Pri
ne
Ba
sh
aw
Will
iam
s
Ro
wle
tt
Ta
ra
0%
10%
20%
30%
40%
50%
60%
Percentage of Eligible Population Vaccinated at Elementary Schools (In Order of Clinic Date)
School
Pe
rce
nta
ge
Influenza A H1N1: 2009Putting Your Plan into
Action• Vaccine available to general public on December 19,
2009:– Clinic held at Civic Center– 1721 vaccinations given
• Next large clinic on January 9, 2010:– 1664 vaccinations given
Influenza A H1N1: 2009Putting Your Plan into
Action
Influenza A H1N1: 2009Putting Your Plan into
Action
Influenza A H1N1: 2009Putting Your Plan into
Action
Planning Tips / Traps
• All incidents are local first, be prepared for at least 72 hours.
• Be sure plans are scalable for smaller and larger events.
• Review plans and annexes on a routine basis.• Include partners in planning and exercising to
ensure understanding of roles.• Build plans for communicating internally and
externally.