San Francisco Bay Area Regional Emergency Coordination Plan

Transcription

1 ealth Coodination Plan San Fancisco Bay Aea Regional Emegency Coodination Plan RECP Medical and Health Subsidiay Plan Pepaed by Goveno s Office of Emegency Sevices Cities of Oakland, San Fancisco, and San Jose Counties of Alameda, Conta Costa, Main, Napa, San Mateo Santa Claa, Santa Cuz, Solano, and Sonoma With Suppot fom

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3 Regional Emegency Coodination Plan RECP Medical and Health Subsidiay Plan Table of Contents Table of Contents Foewod Acknowledgments Recod of Changes iii v vii Section 1 Intoduction 1-1 Pupose 1-1 Objectives 1-1 Scope and Applicability 1-2 Authoities, Requiements, and Regulations 1-4 Plan Development and Maintenance 1-6 Section 2 Planning Assumptions and Consideations 2-1 Section 3 Roles and Responsibilities 3-1 Opeational Aea Level 3-1 Regional Level 3-7 State Level 3-9 Fedeal Level 3-12 Section 4 Concept of Opeations 4-1 Response Plans 4-1 Medical and Health Response Unde the Standadized Emegency Management System 4-1 Local and Opeational Aea Medical Health Response 4-6 Regional Medical Health Suppot 4-7 State Medical Health Suppot 4-9 Fedeal Level Suppot 4-10 Medical Health Response System Desciption Summay 4-10 Management of Resouces 4-10 Response Management Confeence Calls 4-15 REOC Medical Health Banch Coodinato Confeence Calls 4-15 Regional Infomation Management 4-17 Mach 2008 i

4 RECP Medical and Health Subsidiay Plan Table of Contents Regional Emegency Coodination Plan Section 5 Initial Actions by Scenaio 5-1 Section 6 Citical Action Sheets 6-1 Appendix A List of Aconyms Appendix B Regional Disaste Medical Health Coodinato Notification Advisoy Citeia Appendix C REOC Medical Health Banch Diecto Checklist Appendix D REOC Medical Health Banch Diecto Confeence Call Pocedues and Roll Call Sheet ii Mach 2008

5 Regional Emegency Coodination Plan RECP Medical and Health Subsidiay Plan Foewod Foewod The San Fancisco Bay Aea is highly vulneable to both natual hazads and human-caused disastes, such as eathquakes, fies, industial accidents, and teoist incidents. Because the Bay Aea is home to nealy seven million esidents, majo components of the U.S. economy, and vital ai, sea, and gound tanspotation links, the effects of a significant disaste in the Bay Aea would extend thoughout the State of Califonia and acoss the nation. Given this vulneability, the State of Califonia and local govenments thoughout the Bay Aea have made significant investments in the planning and esouces necessay to espond to natual and human-caused emegencies and disastes. Such events, howeve, will likely exceed the emegency esponse capabilities of individual juisdictions in the Bay Aea, and a multijuisdictional egional esponse will be necessay. Moeove, the nationwide effot to impove pepaedness at all levels of govenment, as embodied in the National Pepaedness Goal, emphasizes the impotance of egional esponse. Consequently, the State of Califonia Goveno s Office of Emegency Sevices and its local govenment patnes developed the Bay Aea Regional Emegency Coodination Plan to povide a famewok fo collaboation and coodination duing egional events. The Regional Emegency Coodination Plan (RECP) has been pepaed in accodance with national and state emegency management systems and plans in paticula, the National Incident Management System, the Standadized Emegency Management System, the Maste Mutual Aid Ageement, the Califonia State Emegency Plan, and elevant mutual aid plans. The Regional Emegency Coodination Plan does not supesede o exclude any of these concepts o plans; athe, it places them in the context of a esponse to an event in the Bay Aea, duing which time the Regional Emegency Opeations Cente is activated. The Regional Emegency Coodination Plan builds on Califonia s existing Standadized Emegency Management System, though bette definition of egional components of that system, including coodination acoss disciplines and levels of govenment, esouce shaing, and egional decision-making. It also incopoates elements that peviously have not been addessed in detail at the egional level unde the Standadized Emegency Management System. A suite of documents, the Regional Emegency Coodination Plan compises a Base Plan and the following nine subsidiay plans that addess detailed elements fo specific disciplines and opeational activities: RECP Cae and Shelte Subsidiay Plan RECP Communications Subsidiay Plan RECP Fie and Rescue Subsidiay Plan Mach 2008 iii

6 RECP Medical and Health Subsidiay Plan Foewod Regional Emegency Coodination Plan RECP Hazadous Mateials Subsidiay Plan RECP Law Enfocement and Coone/Medical Examine Subsidiay Plan RECP Logistics Subsidiay Plan RECP Medical and Health Subsidiay Plan RECP Recovey Subsidiay Plan RECP Tanspotation Subsidiay Plan. Development of the Regional Emegency Coodination Plan was a collaboative effot among the Goveno s Office of Emegency Sevices, Coastal Region; the cities of Oakland, San Fancisco, and San Jose; and the Opeational Aea lead agencies fo the ten Bay Aea counties, as descibed in Section 1. Ove two hunded othe local, egional, state, Fedeal, and non-govenmental oganizations also paticipated in the pocess to develop the plan and its subsidiay components. Pepaation of the Regional Emegency Coodination Plan was suppoted by a gant fom the U.S. Depatment of Homeland Secuity Uban Aea Secuity Initiative. This pogam povides metopolitan aeas with funding fo egional planning, equipment, taining, and execises to pepae fo citical incident esponse. The Goveno s Office of Emegency Sevices (OES), Coastal Region will maintain the Regional Emegency Coodination Plan and is esponsible fo all futue evisions and modifications. Additional plans and tools that ae developed at the egional level, including poducts using futue U.S. Depatment of Homeland Secuity gants, will be incopoated into the Regional Emegency Coodination Plan, as appopiate. A note about a special design element in the suite of documents that compise the Bay Aea Regional Emegency Coodination Plan: the Base Plan and subsidiay plans each has a coesponding icon, which in the electonic vesion of each document seves as a hypelink. Clicking on an icon along the ight- and left-hand columns on each page will bing the eade diectly to that plan. iv Mach 2008

7 Regional Emegency Coodination Plan RECP Medical and Health Subsidiay Plan Acknowledgments Acknowledgments The RECP Medical and Health Subsidiay Plan is a poduct of the collaboative effots of the following entities: Alameda County Depatment of Public Health Alameda County Emegency Medical Sevices Alameda County Health Cae Sevices Agency Alameda County Medical Cente Alta Bates Summit Hospital Ameican Medical Response Association of Bay Aea Health Offices Califonia Association of Health Facilities Califonia Emegency Medical Sevices Authoity Califonia Office of Public Health Emegency Pepaedness Coastal Valleys Emegency Medical Sevices Conta Costa County Emegency Medical Sevices Conta Costa County Health Sevices Conell Hospital Fedeal Emegency Management Agency, Region IX Goveno s Office of Emegency Sevices, Coastal Region Hospital Council of Nothen/Cental Califonia Hospital Council, East Bay Section Kaise Pemanente, HCM Main County Emegency Medical Sevices Main County Health and Human Sevices Napa County Depatment of Public Health Napa County Health and Human Sevices Oakland Childen s Hospital Oakland Fie Depatment, Emegency Medical Sevices O Conno Hospital San Fancisco Depatment of Emegency Management San Fancisco Depatment of Public Health San Fancisco Emegency Medical Sevices Agency Mach 2008 v

8 RECP Medical and Health Subsidiay Plan Acknowledgments Regional Emegency Coodination Plan San Jose Fie Depatment San Mateo County Depatment of Public Health San Mateo County Emegency Medical Sevices Agency Santa Claa County Depatment of Public Health Santa Claa County Emegency Medical Sevices Agency Santa Claa County Office of Emegency Sevices Santa Claa Valley Medical Authoity Santa Cuz County Health Sevices Agency Santa Cuz Health Sevices Agency Solano County Emegency Medical Sevices Sonoma County Emegency Medical Sevices Agency Sonoma County Depatment of Public Health Stanfod Univesity Medical Cente Univesity of Califonia, Bekeley, School of Public Health Univesity of Califonia, San Fancisco U.S. Depatment of Health and Human Sevices ValleyCae Health System. SYA Goup, unde subcontact to URS Copoation, pepaed the RECP Medical and Health Subsidiay Plan, with consultant suppot fom M. Tey Gitlin and stakeholde management suppot fom CiclePoint. vi Mach 2008

9 Regional Emegency Coodination Plan RECP Medical and Health Subsidiay Plan Recod of Changes Recod of Changes Date Agency Comments Mach 2008 OES Coastal Region Final Mach 2008 vii

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11 Section 1 RECP Medical and Health Subsidiay Plan Intoduction

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13 Regional Emegency Coodination Plan RECP Medical and Health Subsidiay Plan Intoduction Section 1 Intoduction PURPOSE The Regional Emegency Coodination Plan (RECP) povides an all hazads famewok fo collaboation among esponsible entities and coodination duing emegencies in the San Fancisco Bay Aea. The RECP Medical and Health Subsidiay Plan povides a famewok fo coodination among the Goveno s Office of Emegency Sevices (OES) Regional Emegency Opeations Cente (REOC), the sixteen Opeational Aeas (counties) within OES Coastal Region, 1 and the State Opeations Cente (SOC) Medical Health Banch. The Plan also descibes how the REOC Medical and Health Banch, the Regional Disaste Medical Health Coodinato (RDMHC), and the Regional Disaste Medical Health Specialist (RDMHS) coodinate infomation and medical and health esouces though the Medical Health Mutual Aid System. The RECP does not eplace existing emegency esponse systems. Rathe, it builds on the Standadized Emegency Management System (SEMS) and the Califonia State Emegency Plan to povide methods fo coopeation among Opeational Aeas and OES Coastal Region. The RECP complies with the equiements of the National Incident Management System (NIMS), and is consistent with the National Pepaedness Goal. OBJECTIVES The RECP in geneal, and the RECP Medical and Health Subsidiay Plan in paticula, define the: Role of OES Coastal Region and the REOC in esponding to a egional emegency o disaste Opeational pioities that goven a egional esponse Roles, esponsibilities, and authoity of esponse oganizations fo egional decision-making and the cicumstances duing which egional decision-making is equied Pocesses fo equesting esouces and allocating limited esouces duing a egional emegency o disaste Manne in which the Medical Health Mutual Aid System functions within the egion, and with othe systems, fo equesting esouces duing a egional emegency o disaste Pocesses fo shaing infomation among the Opeational Aea Emegency Opeations Centes (EOCs); the REOC; state-level coodinating centes, including the SOC and the Joint Emegency Opeations Cente (JEOC) opeated by the Califonia Depatment of Public Health (CDPH) and the 1 OES Coastal Region is an administative egion unde OES that incopoates, and is esponsible fo, sixteen counties in and aound the San Fancisco Bay Aea. Mach

14 RECP Medical and Health Subsidiay Plan Intoduction Regional Emegency Coodination Plan Califonia Emegency Medical Sevices Authoity (EMSA); and othe state, Fedeal, and egional entities duing esponse to a egional emegency o disaste. The goal of the REOC Medical Health Banch is to suppot emegency esponse entities mobilized by city, county, and pivate-secto medical health agencies, including public health depatments, hospitals, and emegency medical sevices. SCOPE AND APPLICABILITY Geneal Applicability The RECP Medical and Health Subsidiay Plan was developed based on the concepts and methods of existing state emegency plans, medical and health esponse plans, and the Incident Command System. The RECP does not supesede o exclude any existing plans; athe, it places elevant plans in the context of a esponse to an incident within the egion, duing which time the REOC is activated. Moe specifically, it does not addess, o supesede, local pocedues fo: Tactical opeations and Incident Command Local esponse activities Established mutual aid elationships and pocedues at the local level. Futhemoe, this plan is not tactical; athe, the plan focuses on egional suppot and coodination fo medical and health opeations. Geogaphic Extent The RECP was developed fo OES Coastal Region, which encompasses the following sixteen counties as illustated in Figue 1. Ten of these counties (maked with *) suppoted the development of the RECP though collaboation with OES Coastal Region and the thee Bay Aea Uban Aea Secuity Initiative cities (Oakland, San Fancisco, and San Jose). Alameda* Napa* Conta Costa* San Benito Del Note San Fancisco* Humboldt San Mateo* Lake Santa Claa* Main* Santa Cuz* Mendocino Solano* Monteey Sonoma* 1-2 Mach 2008

15 Regional Emegency Coodination Plan RECP Medical and Health Subsidiay Plan Intoduction DEL NORTE OES Coastal Region HUMBOLDT MENDOCINO LAKE PACIFIC OCEAN MARIN SONOMA SAN FRANCISCO NAPA SOLANO CONTRA COSTA ALAMEDA SAN MATEO SANTA CLARA SANTA CRUZ LEGEND: SAN BENITO OES Coastal Region Bay Aea Counties MONTEREY Figue 1 OES Coastal Region and Bay Aea Counties Mach

16 RECP Medical and Health Subsidiay Plan Intoduction Regional Emegency Coodination Plan The RECP Medical and Health Subsidiay Plan applies to Medical Health Mutual Aid Region II, which encompasses medical and health esponse agencies fo the afoementioned sixteen counties. The RECP Medical and Health Subsidiay Plan also details the actions that pimay agencies and staff at vaious medical and health facilities take duing an emegency esponse. Such agencies and staff include: County (o city) public health and health offices County Emegency Medical Sevices (EMS) and EMS medical diectos and agency diectos/administatos Public and pivate pe-hospital medical cae povides, including ambulance sevices Public and pivate hospitals and medical centes Othe health cae povides, including skilled nusing facilities, clinics, sugey centes, and assisted living centes Medical Health Opeational Aea Coodinatos (MHOACs) The RDMHC and RDMHS. AUTHORITIES, REQUIREMENTS, AND REGULATIONS The RECP Base Plan povides geneally applicable authoities, equiements and egulations fo the RECP, including the RECP Medical and Health Subsidiay Plan. Authoities, equiements, and egulations that apply specifically to the RECP Medical and Health Subsidiay Plan ae as follows. Medical Response and Health Office Authoities Califonia Health and Safety Code, Sections , , , , , (b), , , , , , , , , , , , and Califonia Emegency Sevices Act, Section Califonia Health and Safety Code, Sections 1797 to 1799, including Section egading the RDMHC. Califonia Code of Regulations, Title 22. Califonia Code of Regulations, Title 17, Sections 2215, 2501, 2502, and Califonia Food and Agicultue Code, Sections 5763, 5301, and Califonia Govenment Code, Section 202. Califonia Penal Code, Sections 405, 409, and 409.5(c). Califonia Constitution, patient s constitutional ights. 1-4 Mach 2008

17 Regional Emegency Coodination Plan RECP Medical and Health Subsidiay Plan Intoduction Fedeal Authoities Robet T. Staffod Disaste Relief and Emegency Assistance Act (the Staffod Act), 42 United States Code (U.S.C.) and 5121 et seq., Section Title 42, U.S.C., Section 266, 249. Title 42, Code of Fedeal Regulations, Section Fedeal Tots Claims Act, Title 28, U.S.C., Section 2680(f). State and Local Plans and Guidelines Applicable state plans include the following: Califonia Disaste Medical Response Plan, including the Califonia Medical Mutual Aid Plan (EMSA), 2007 Califonia Disaste Medical Opeations Manual, EMSA, daft Januay 2008 Coone s Mutual Aid Plan, OES, 2006 Disaste Medical Systems Guidelines, EMSA, 2003 Fie Sevice and Rescue Emegency Mutual Aid Plan, OES, 2002 Mass Fatality Management Guide, OES, 2007 Standads and Guidelines fo Healthcae Suge Duing Emegencies, CDPH, Significant collaboative planning effots by state medical and health agencies, and local public health depatments, local emegency medical sevices agencies (LEMSAs), hospitals, and othe public and pivate agencies thoughout the San Fancisco Bay Aea fom the basis fo the RECP Medical and Health Subsidiay Plan. Applicable medical and health esponse plans in Califonia and the Bay Aea include: Ambulance Stike Team Guidelines (2003) Mission Suppot Team Opeations Manual (2008 daft) Region II Disaste Medical Health Coodinato Emegency Plan (1996) Multi-casualty incidents Mass casualty cae Field teatment Hospital disaste esponse and altenate cae sites Pandemic influenza Stategic National Stockpile eceiving, stoing, and staging Mass pophylaxis dispensing Mach

18 RECP Medical and Health Subsidiay Plan Intoduction Regional Emegency Coodination Plan Quaantine and isolation Chempack egional distibution Laboatoy testing and taining Metopolitan Medical Response System (MMRS). PLAN DEVELOPMENT AND MAINTENANCE OES Coastal Region is esponsible fo the maintenance, evision, and distibution of the RECP and its subsidiay plans. In coodination with the Mutual Aid Regional Advisoy Committee, OES Coastal Region will assess the need fo evisions annually. Refe to the RECP Base Plan fo futhe details egading plan development and maintenance. 1-6 Mach 2008

19 Section 2 RECP Medical and Health Subsidiay Plan Planning Assumptions and Consideations

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21 Regional Emegency Coodination Plan RECP Medical and Health Subsidiay Plan Planning Assumptions and Consideations Section 2 Planning Assumptions and Consideations The RECP Medical and Health Subsidiay Plan is based on the following development and implementation assumptions: Duing a lage-scale incident within the egion, the esponse capabilities of individual juisdictions likely will be exceeded and esouces fom both within and outside of the egion will be equied Juisdictions in the egion will easonably exhaust local esouces befoe calling fo outside assistance, and will ende the maximum pacticable assistance to sticken communities unde povisions of the Maste Mutual Aid Ageement Analysis of egional and statewide theat scenaios indicates that significant numbes of individuals with medical o health needs will equie assistance following a lage-scale incident City and county plans have been developed in accodance with state guidance to pioitize local esponse activities, such as isolation and quaantine, disease investigation, field teatment sites, casualty collection points, and mass pophylaxis Each county has an appointed MHOAC who coodinates and pioitizes esouces available within, o povided to, the Opeational Aeas in accodance with the Medical Health Mutual Aid System Delivey of cetain pe-positioned state and Fedeal supply caches, such as mateial fom the Stategic National Stockpile o mobile field hospitals, may be expected within pedetemined timefames when esouce-equesting pocedues ae followed Duing an emegency with egional o statewide impacts, the availability of hospital supplies will be limited due to typical just in time odeing and stoage pactices. Hospital esponse will be geatly affected by patient suge. Mach

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23 Section 3 RECP Medical and Health Subsidiay Plan Roles and Responsibilities

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25 Regional Emegency Coodination Plan RECP Medical and Health Subsidiay Plan Roles and Responsibilities Section 3 Roles and Responsibilities This section of the RECP Medical and Health Subsidiay Plan outlines the oles and esponsibilities of Opeational Aea, egional, state, and Fedeal agencies, and pesonnel involved in medical and health esponse activities duing a egional emegency o disaste. OPERATIONAL AREA LEVEL County Public Health Depatments Most county public health depatments ae county-level agencies esponsible fo poviding sevices to all cities within a county and to populations in unincopoated aeas. In the OES Coastal Region, the exceptions ae the City of Bekeley Public Health Depatment, which is independent of the County of Alameda Health Sevices Agency; and the City and County of San Fancisco Depatment of Public Health. County public health depatments ae esponsible fo: Coodination with Opeational Aea EOCs Epidemiological investigation and disease contol in the geneal o specific populations Long-tem health suveillance fo communicable disease and disease seconday to an incident involving bioteoism Laboatoy testing and efeal fo confimation though the Laboatoy Response Netwok Dispensing and administation of mass pophylaxis antibiotics and vaccines Coodination with hospitals Activation of altenate cae sites in coodination with LEMSAs and hospitals Isolation and quaantine activities Implementing social distancing measues Decisions to potect the geneal population, such as whethe to evacuate o shelte in-place, and egading fist espondes sent to an incident that might have involved the use of hamful biological incidents Health alets, wanings, and the dissemination of infomation to the public and health cae povides Coodination with LEMSA and hospitals egading teatment potocols fo unusual agents o events Coodination with the medical examine/coone fo buial pemits and safe handling of the deceased following exposue to hazadous mateials Assuance of food safety Mach

26 RECP Medical and Health Subsidiay Plan Roles and Responsibilities Regional Emegency Coodination Plan Management of exposue to hazadous mateials Coodination of mental health sevices Vecto contol Dinking wate safety. County Public Health Offices County public health offices ae the authoity designated within a county to take actions necessay to potect the public health, and ae esponsible fo the enfocement of public health laws and egulations. County public health offices: Coodinate investigations of and communicate infomation about the outbeak of disease Though the Laboatoy Response Netwok, coodinate the pocess to identify and communicate infomation about disease agents Detemine which disease contol measues, including pioity pophylaxis, mass pophylaxis, and isolation o quaantine, will be activated Ensue consistency in the odes of health office and instuctions to the public Detemine and communicate medical teatment potocols and level of cae Ensue safe management of liquid, solid, and hazadous waste Ovesee envionmental health esponse, which may be the esponsibility of a depatment that epots to the health office when SEMS is activated, but usually functions sepaately fom public health Communicate with the CDPH, U.S. Depatment of Health and Human Sevices, Centes fo Disease Contol and Pevention (CDC), and othe Fedeal laboatoies and agencies. Local Emegency Sevices Agencies The Califonia Health and Safety Code equies a statewide emegency medical sevices system, oganized at the county level. As the independent agencies esponsible fo local system leadeship, LEMSAs plan and implement the emegency medical sevices system; authoize pe-hospital pesonnel; appove pe-hospital taining pogams; coodinate medical disaste esponse; and develop tauma cae systems. LEMSAs ae designated by county boads of supevisos and may be pat of a health depatment o othe county depatment, independent county agencies, o multicounty agencies. In the Bay Aea, all LEMSAs ae pat of county health depatments, except fo the multicounty Coastal Valley EMS Agency (which includes Napa, Mendocino, and Sonoma counties) and the Solano County EMS Coopeative. 3-2 Mach 2008

27 Regional Emegency Coodination Plan RECP Medical and Health Subsidiay Plan Roles and Responsibilities LEMSAs diect all medical action towad stabilizing and mitigating an emegency. LEMSAs ae esponsible fo: Coodinating with in-patient and emegency cae povides On scene tiage, teatment, and stabilization Activating field teatment sites Tanspoting and tacking patients tanspoted though EMS Assigning patients to available hospital sevices Suge implementation thoughout the medical system Poviding EMS staff to suppot the Opeational Aea EOC Medical Health Banch Implementing the Opeational Aea Disaste Medical Health Plan and suge capacity plans, including assessments of immediate medical needs. LEMSAs may also assist with: Evacuation of in-patient medical facilities Coodinating the establishment of altenate cae sites Developing and implementing cae potocols fo unusual agents o events Tanspoting patients that must be quaantined o isolated Emegency suppot of mass dispensing sites, evacuation sheltes, and quaantine centes Povision of specific antidote teatments in contaminated aeas by specially tained and equipped EMS pesonnel Coodination of othe disaste and medical health esouces. Medical Health Opeational Aea Health Coodinato Each Opeational Aea has a MHOAC 2 who seves as a 24-hou, seven day a week, single point of contact fo disaste medical and health opeations. The MHOAC: Assists the Opeational Aea Coodinato with the coodination of medical and health esouces within the Opeational Aea Evaluates the availability of esouces within the Opeational Aea and identifies medical health esouce equiements as the status of an incident changes Coodinates the dispatch of equested esouces available within the Opeational Aea Repots to the RDMHC on the situation and esouce status of the Opeational Aea 2 The county public health office o the LEMSA administato (o designee) is usually assigned the position of MHOAC. Mach

28 RECP Medical and Health Subsidiay Plan Roles and Responsibilities Regional Emegency Coodination Plan Seves as the point of contact in the Opeational Aea fo coodination with the RDMHC, the REOC, and the CDPH and EMSA at the JEOC Assesses hospital and patient tanspotation status, esouce equests, and esouce availability infomation Coodinates medical and health mutual aid equests within the Opeational Aea Pioitizes available esouces within the Opeational Aea in accodance with the Incident Action Plan, and assists with the pioitization and assignment of incoming esouces and identifies shotfalls Requests mutual aid esouces fom the RDMHC to fulfill equests initiated by local juisdictions in the Opeational Aea and to einfoce depleted esouces in the Opeational Aea. If the MHOAC is not assigned fom the county public health depatment, the MHOAC must coodinate with the county public health office duing biological and disease incidents to ensue consistent messaging, and health esouce management. County Depatment Opeations Centes In addition to staffing the Opeational Aea EOC Medical Health Banch, the LEMSA o county health depatment may establish a Medical Health Depatment Opeations Cente to manage local medical and health esponse in conjunction with Opeational Aea activities. The esponsibilities and function of the Depatment Opeations Cente ae descibed in the LEMSA o county public health depatment emegency opeations plan. If activated, the Depatment Opeations Cente fo a county medical o public health depatment manages the following activities in coodination with the Opeational Aea EOC Medical Health Banch Coodinato and the MHOAC: Povides oveall coodination of incident esponse and medical and health esouces within the Opeational Aea Coodinates the opeations of teams investigating disease outbeaks, and epoting Coodinates mass dispensing opeations Coodinates isolation and quaantine opeations Coodinates the allocation of medical and health esouces within the Opeational Aea Receives epots fom hospitals, medical tanspot agencies, clinics, and skilled nusing facilities about bed capacity and functional status, and detemines stategies to manage shotfalls 3-4 Mach 2008

29 Regional Emegency Coodination Plan RECP Medical and Health Subsidiay Plan Roles and Responsibilities Notifies health cae povides and hospitals of teatment potocols, suveillance, case definitions, and disease epoting guidelines Assists the health office with the pepaation of health office odes, health alets, and othe public infomation. Hospitals and Medical Centes The ten-county Bay Aea includes eighty-five to ninety hospitals, 3 including public, pivate non-pofit, and pivate fo-pofit oganizations. Hospital and out-of-hospital povide capacity in the egion includes acute cae facilities, tauma centes, teaching/eseach medical centes, community hospitals, sugical centes, clinics, pediatic centes, and skilled nusing facilities. The following public hospitals, which ae owned and opeated by county govenments, opeate in the Bay Aea: Alameda County Medical Cente Conta Costa Regional Medical Cente San Fancisco Geneal Hospital Chinese Hospital San Fancisco San Mateo Medical Cente Santa Claa Valley Medical Cente. The following majo health cae copoate systems opeate hospitals in the Bay Aea: Kaise Pemanente (headquateed in Oakland) Sutte Health (headquateed in Sacamento) Tenant HealthCae (headquateed in Santa Ana) Catholic Healthcae West (headquateed in San Fancisco) Daughtes of Chaity Health System (headquateed in Los Altos) Kinded Healthcae (headquateed in Louisville, Kentucky) Adventist Health (headquateed in St. Helena) Sistes of St. Joseph of Oange (headquateed in Napa and Sonoma). In addition, the U.S. Depatment of Veteans Affais opeates the following medical centes in the egion: San Fancisco Veteans Affais Medical Cente Veteans Affais Palo Alto Health Cae System 3 The numbe of hospitals in the Bay Aea is appoximate because diffeent oganizations and agencies epot vaying numbes, depending on geogaphic boundaies of the infomation. Mach

30 RECP Medical and Health Subsidiay Plan Roles and Responsibilities Regional Emegency Coodination Plan Matinez Veteans Affais Outpatient Clinic and Cente fo Rehabilitation and Extended Cae. County hospitals and medical centes ae esponsible fo: Activating individual disaste plans, including planning fo the tansfe o evacuation of patients to simila facilities; spontaneous voluntees; and staff cedentialing Establishing extended emegency depatment capacity at o nea the facility Poviding medical suge capacity Poviding patient tacking within the hospital and duing patient fowading activities Establishing decontamination coidos fo spontaneous aivals Poviding situation status epots Coodinating with othe povides and public health depatments egading teatment potocols fo unusual incidents o agents Maintaining hospital infastuctue utilities fo sustained function duing emegencies Establishing altenate cae sites with CDPH and othe stakeholdes and poviding suppot fo staffing, tanspotation, and othe equiements Pefoming disease suveillance and epoting. Othe Health Cae Povides Public and pivate clinics, sugey centes, ugent cae centes, pediatic centes, skilled nusing facilities, and assisted living centes ae esponsible fo: Maintaining disaste plans and ecipocal ageements with simila facilities Repoting on the incidence of disease Repoting on status Possible assistance with the teatment of casualties, pophylaxis, and isolation o quaantine. Metopolitan Medical Response System Thee ae fou MMRS cities in the Bay Aea Femont, Oakland, San Fancisco, and San Jose. Each city maintains an MMRS Response Plan that details activation, command, and contol pocedues of the MMRS in thei espective aeas. 3-6 Mach 2008

31 Regional Emegency Coodination Plan RECP Medical and Health Subsidiay Plan Roles and Responsibilities Duing incidents involving weapons of mass destuction, including chemical, biological, nuclea, adiological, and explosive (CBRNE) devices, MMRS is esponsible fo: Poviding medical management o medical assistance in suppot of an emegency esponse Poviding technical assistance with the identification of CBRNE agents and coodinating the continuity of medical cae Suppoting coodination with designated egional, state, and Fedeal CBRNE incident esponse assets. REGIONAL LEVEL Regional Disaste Medical Health Coodinato At the egional level 4, the RDMHC 5 is chaged with coodinating medical and health esouces at the diection of the state. The RDMHC, suppoted by the RDMHS: Develops plans fo the povision of medical o public health mutual aid among the counties within the egion Coodinates with the MHOACs fom the affected Opeational Aeas to manage shaing of mutual aid esouces Coodinates medical mutual aid opeations with the REOC Manages and communicates infomation about the availability of medical esouces Fo disastes outside the egion, coodinates the acquisition of equested medical, public, and envionmental health esouces fom Opeational Aeas within the egion to send to the affected egion. If the RDMHC is located in an Opeational Aea that is affected by the emegency o disaste, the RDMHC s duties can be assumed by the REOC Medical Health Banch. The ultimate backup fo the RDMHC ae the state agencies EMSA and the CDPH. Regional Disaste Medical Health Specialist The RDMHS is established unde the geneal diection of EMSA and the CDPH and in coodination with the RDMHC. The RDMHS is an employee of a LEMSA, o othe agency, who is obligated by contact with the state to pefom cetain disaste-elated medical and health functions within a given mutual aid egion. 4 Fo puposes of managing mutual aid systems, Califonia is divided into mutual aid egions. As descibed in Section 1, the 10-county Bay Aea lies in Mutual Aid Region II. In geneal, the discussion of egional positions in this section is applicable to all mutual aid egions. 5 The EMSA Diecto and CDPH Diecto jointly appoint a RDMHC fo each mutual aid egion. The RDMHC is a county health office, a county coodinato of emegency sevices, administato of a LEMSA, o medical diecto of a LEMSA. Mach

32 RECP Medical and Health Subsidiay Plan Roles and Responsibilities Regional Emegency Coodination Plan The RDMHS, in suppot of the RDMHC: Coodinates and enhances the egion s medical and health mutual aid and mutual coopeation systems Acts as a liaison between the RDMHC and EMSA, the CDPH, the REOC, and the egion s Opeational Aeas Assists with locating, mobilizing, and deploying medical and health mutual aid esouces within the egion fo incidents within the egion; o in suppot of mutual aid equests fom othe egions in which an emegency o disaste has occued Suppots the development of the Opeational Aea medical and health esponse system Suppots state medical and health emegency management within an affected egion duing an emegency. The RDMHS is a epesentative of the state in the development of a coodinated egional medical and health esponse system. As such, the RDMHS woks with the RDMHC and eceives policy guidance and diection fom the RDMHC concening egional issues. As a egional epesentative of the state, the RDMHS also eceives policy guidance and diection fom EMSA and the CDPH. Cuently, the functions of the RDMHC, an unfunded position, and the RDMHS, a contactually funded position, ae complementay but not paallel. While the positions ae designed to exist within each mutual aid egion, they ae not mandated and thee ae no fomal o standadized backups fo the positions. REOC Medical Health Banch OES coodinates the egional level esponse to emegencies and disastes though the REOC. (Refe to the RECP Base Plan fo a detailed desciption of the REOC s esponsibilities.) The REOC Medical Health Banch: Acquies, pioitizes, and allocates medical and health esouces Coodinates non-medical and health esouces with othe banches in the REOC Optimizes medical and health esponse acoss the egion Povides the coodination necessay fo consistency in medical cae and public health disease contol measues. Sections 5 and 6 of the RECP Medical and Health Subsidiay Plan contain checklists that descibe initial actions and citical action sheets that guide coodination among medical and health esponse and othe disciplines, and offe consideations fo optimizing a esponse to any emegency. 3-8 Mach 2008

33 Regional Emegency Coodination Plan RECP Medical and Health Subsidiay Plan Roles and Responsibilities STATE LEVEL State Opeations Cente Medical Health Banch OES is esponsible fo coodinating the state s esponse to emegencies and disastes. OES coodinates the state-level esponse at the SOC. (Refe to the RECP Base Plan fo a detailed discussion of the SOC s esponsibilities.) The SOC Medical Health Banch: Ensues consistent statewide medical and health messaging Responds to medical and health esouce equests sent to the SOC Refes esouce equests to the JEOC o to othe state agencies fo disposition, as appopiate Pusues esouces fo medical and health esouces though the Emegency Management Assistance Compact, if appopiate In the event of a Pesidentially declaed emegency o disaste, coodinates equests fo Fedeal esouces with Emegency Suppot Function (ESF) #8 Public Health and Medical Sevices. Joint Emegency Opeations Cente Unde a Memoandum of Undestanding between CDPH and EMSA, CDPH maintains the JEOC, which seves as the state medical and health opeations cente duing a disaste. In emegencies and disastes with both medical and public health consequences, EMSA and CDPH co-locate and jointly manage the JEOC. The JEOC, in coodination with the SOC Medical Health Banch: Povides state policy and pogam diection Locates, acquies, and aanges fo delivey of state-owned and contolled disaste medical and health supplies, equipment, and pesonnel Assists with the coodination of esouces fom unaffected aeas of the state. In compliance with SEMS, all equests fo esouces must go though the REOC and the SOC to be eligible fo possible eimbusement of emegency esponse costs. The JEOC suppots the SOC in these activities. Emegency Medical Sevices Authoity EMSA is the lead state agency fo disaste medical esponse. EMSA also suppots the CDPH esponse to public and envionmental health emegencies. As descibed in the Califonia Medical Mutual Aid Plan, EMSA: Maintains the Califonia Medical Mutual Aid Plan fo coodinating statewide emegency medical esouces Mach

34 RECP Medical and Health Subsidiay Plan Roles and Responsibilities Regional Emegency Coodination Plan Maintains the Califonia Disaste Medical Response fo the use and dispatch of EMSA-employed o coodinated pesonnel, appaatus, and othe medical esouces, as necessay With CDPH, oganizes, staffs, and equips the SOC, the JEOC, and altenate facilities necessay to ensue effective statewide coodination and contol of mutual aid medical opeations Monitos ongoing emegency situations, anticipates needs, and pepaes fo use of inte-egional medical mutual aid esouces, establishing pioities, and authoizing dispatch Monitos and coodinates backup emegency medical coveage between egions when thee is a shotage of esouces Coodinates disaste medical mutual aid opeations thoughout the state Assists with coodinating the application and use of othe state agency esouces. EMSA may coodinate the deployment of: Califonia Disaste Medical Assistance Teams (CAL-MATs) Mission Suppot Teams Califonia Medical Voluntees Medical Reseve Cops Ambulance Stike Teams Mobile field hospitals. Refe to the Califonia Disaste Medical Response Plan fo details egading these esouces. Califonia Depatment of Public Health The CDPH is the lead state agency fo public health suveillance and esponse to public and envionmental health emegencies, including incidents o theats involving bioteoism. The CDPH advises all local health authoities, and is equied to contol and egulate the actions of Opeational Aea health offices when, in its judgment, the public health is jeopadized. Howeve, the pimay esponsibility fo the esponse to an outbeak of disease ests with public health offices. Public health offices must, nonetheless, espond to any equest fom the CDPH fo epoted infomation, and must also epot a local epidemic to the agency. The CDPH has the powe to goven the actions of public health offices though its odes, ules, and egulations, and to equie them to enfoce all CDPH odes, ules, and egulations, which geneally set minimum measues. Public health offices may take moe stingent measues whee cicumstances equie. 6 6 Excepted fom the Health Office Pactice Guide fo Communicable Disease in Califonia (Decembe 14, 2005) Mach 2008

35 Regional Emegency Coodination Plan RECP Medical and Health Subsidiay Plan Roles and Responsibilities The CDPH Licensing and Cetification Division ensues that health facilities ae in compliance with licensing and opeating egulations. In an emegency o disaste with both public health and medical equiements, EMSA and CDPH coodinate the acquisition and application of medical and health mutual aid esouces. EMSA and the CDPH shae esponsibility fo staffing of the medical health banches of the SOC, the REOC, and the JEOC. Laboatoy Response Netwok A netwok of laboatoies in Califonia suppots the public health system. The state s laboatoy at Richmond, which the CDPH manages, povides sevices fo communicable diseases, genetic diseases, envionmental health, vecto contol, and sanitation adiation. The state laboatoy is a component of the Laboatoy Response Netwok a national netwok of local, state, and Fedeal public health, food testing, veteinay diagnostic, and envionmental testing laboatoies that povide the infastuctue and capacity to espond to biological and chemical teoism and othe public health emegencies. The Laboatoy Response Netwok, which the CDC manages, compises moe than 150 laboatoies affiliated with Fedeal agencies, militay installations, intenational patnes, and state and local public health depatments. Thee ae thity-seven county public health laboatoies in Califonia; of these facilities, fouteen ae Laboatoy Response Netwok efeence laboatoies. Each local public health depatment in the Bay Aea, as well as many hospitals and medical centes, opeates a Level A (o sentinel ) laboatoy. Sentinel laboatoies may pefom initial isolation of a communicable o bio-teo micobiological agent and tanspot the sample to a efeence laboatoy in the aea. Level B laboatoies (o efeence laboatoies) have eagents and equipment to veify suspected bio-teo agents, and can ship specimens to advanced capacity laboatoies, such as a Level C laboatoy. Refeence laboatoies in the Bay Aea include the Santa Claa Public Health Depatment Laboatoy and the Sonoma County Public Health Depatment Laboatoy. A Level C laboatoy pefoms apid identification of micobiological agents. The state s laboatoy at Richmond is both a Level B and Level C laboatoy. Medical Pofessional Resouces Califonia s system of medical and health esponse is suppoted by pofessionals obtained though the following mechanisms. Medical Reseve Cops. The Medical Reseve Cops pogam is a component of the Citizens Cops national netwok. EMSA coodinates the Medical Reseve Cops pogam. As of Mach

36 RECP Medical and Health Subsidiay Plan Roles and Responsibilities Regional Emegency Coodination Plan Mach 2008, thee ae thity-seven Medical Reseve Cops oganizations in Califonia, thiteen of which ae located in the ten-county Bay Aea. 7 Califonia Medical Voluntees. The Califonia Medical Voluntees pogam is an emegency pesonnel management system developed by EMSA to enoll Califonia medical cae pesonnel with active unesticted licenses, as well as nonmedical administative and logistics pesonnel, as voluntees fo disaste sevice. The system validates enollee licenses and cedentials pio to an emegency and povides a mechanism fo contacting and mobilizing needed pesonnel. Refe to the Califonia Disaste Medical Response Plan fo moe infomation on these esouces. These voluntees may suppot: Hospitals, medical centes, and clinics to eplace o augment staff Disaste medicine, casualty cae, field teatment sites, and sheltes Pophylaxis dispensing and pe-sceening Isolation o quaantine medical suppot visits Investigations of the outbeak of disease. FEDERAL LEVEL When the esouces of a state ae exceeded by an incident, the Pesident of the United States may declae an emegency o disaste in accodance with the Staffod Act. Unde a Pesidential declaation of emegency o disaste, the Fedeal Govenment povides financial esouces and diect Fedeal assistance in esponse to equests fom the state. The Fedeal Emegency Management Agency (FEMA) coodinates the esponse to state equests fo assistance. In accodance with the National Response Famewok, the Fedeal Govenment oganizes its esouces accoding to ESFs, each of which is led by a Fedeal agency. (Fo futhe details on the ole of Fedeal agencies in emegencies and disastes, efe to the RECP Base Plan.) Emegency Suppot Function # 8 Public Health and Medical Sevices ESF # 8 povides the mechanism fo coodinated Fedeal assistance to supplement state, tibal, and local esouces in esponse to a public health and medical disaste; potential o actual incidents equiing a coodinated Fedeal esponse; and duing a developing potential health and medical emegency. The U.S. Depatment of Health and Human Sevices is the coodinating agency fo ESF # 8, pincipally though the 7 Up-to-date infomation egading the Medical Reseve Cops can be obtained at Mach 2008

37 Regional Emegency Coodination Plan RECP Medical and Health Subsidiay Plan Roles and Responsibilities Assistant Secetay fo Pepaedness and Response, and is the pimay agency fo the povision of esouces. Othe Fedeal agencies, such as the U.S. Depatment of Defense and the Veteans Administation, also may povide esouces and suppot. Specific esouces available though ESF #8 include: Assessment of public medical, health, and behavioal needs Health suveillance Medical cae pesonnel though Disaste Medical Assistance Teams (DMATs) and the Public Health Sevice Commissioned Cops Medical and health equipment and supplies (such as the Stategic National Stockpile, diagnostic equipment, and estocking of supplies) Patient evacuation and fowad movement of patients though the National Disaste Medical System Patient tacking though the National Disaste Medical System Patient cae Safety and secuity of human and veteinay dugs, biologics, and medical devices Distibution of mass pophylaxis Blood and blood poducts Food safety and secuity Agicultue safety and secuity Woke health and safety All-hazad public medical and health consultation, technical assistance, and suppot Assessment of exposue (including exposue to humans, animals, the envionment, and agicultue) Behavioal health cae Public medical and health infomation Vecto contol Potable wate/wastewate and disposal of solid waste Enfocement of intenational quaantines Management of mass fatalities, identification of victims, and decontamination of emains, including deployment of Disaste Motuay Opeational Response Teams Veteinay medical suppot. Mach

38 RECP Medical and Health Subsidiay Plan Roles and Responsibilities Regional Emegency Coodination Plan The U.S. Depatment of Health and Human Sevices coodinates the following majo esouces. National Disaste Medical System. The National Disaste Medical System supplements state and local emegency medical esponse duing a disaste o majo emegency. The National Disaste Medical System is managed by ESF #8. The majo components of the system ae medical esponse, patient evacuation, and definitive medical cae. The U.S. Depatment of Health and Human Sevices activates and deploys National Disaste Medical System health and medical pesonnel, equipment and supplies, outpatient sevices, veteinay sevices, and motuay sevices. The U.S. Depatment of Health and Human Sevices coodinates with the Veteans Administation and the U.S. Depatment of Defense to evacuate patients fom hospitals in affected aeas and admit them in hospitals that paticipate in the National Disaste Medical System. The U.S. Depatment of Homeland Secuity, though ESF # 1 Tanspotation, may aange fo the use of Fedeal agency aicaft and othe assets to povide ugent cae lift and othe tanspotation suppot. Disaste Medical Assistance Teams. A component of National Disaste Medical System, DMATs ae a national netwok of esponse teams compised of voluntees fom the medical, health, and mental health cae pofessions. DMATs povide austee medical cae in a disaste aea and eceive initial equipment and supplies fom the Fedeal Govenment. Thee ae six DMATs located in Califonia, one of which, CA-6, is located in the Bay Aea, and is suppoted by the counties of Alameda, Conta Costa, Main, San Fancisco, and San Mateo. Stategic National Stockpile. The Stategic National Stockpile is a national epositoy of antibiotics, chemical antidotes, antitoxins, life-suppot medications, intavenous supplies, aiway maintenance supplies, and medical and sugical items. The Stategic National Stockpile is designed to supplement and e-supply state and local public health agencies duing any national emegency within the United States o its teitoies. The Stategic National Stockpile is oganized fo flexible esponse. The fist line of suppot is povided by immediate esponse 12-hou push packages, which ae caches of phamaceuticals, antidotes, and medical supplies designed to povide apid delivey of a boad spectum of assets fo an illdefined theat in the ealy hous of an incident. Push packages ae positioned in stategically located, secue waehouses eady fo immediate deployment to a designated site within 12 hous of the Fedeal decision to deploy Stategic National Stockpile assets Mach 2008

39 Regional Emegency Coodination Plan RECP Medical and Health Subsidiay Plan Roles and Responsibilities If an incident equies additional phamaceuticals o medical supplies, follow-on vendo-managed inventoy supplies ae shipped to aive within 24 to 36 hous. If the agent is well defined, vendo-managed inventoy can be tailoed to povide phamaceuticals, supplies, o poducts specific to the suspected o confimed agent(s). In such cases, the vendo-managed inventoy could act as the fist option fo immediate esponse fom Stategic National Stockpile Pogam. Mach

40 RECP Medical and Health Subsidiay Plan Roles and Responsibilities Regional Emegency Coodination Plan This page intentionally left blank Mach 2008

41 Section 4 RECP Medical and Health Subsidiay Plan Concept of Opeations

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43 Regional Emegency Coodination Plan RECP Medical and Health Subsidiay Plan Concept of Opeations Section 4 Concept of Opeations This section of the RECP Medical and Health Subsidiay Plan descibes how local juisdictions, Opeational Aeas, the egion, and the state, Fedeal, and non-govenmental entities elate to one anothe in tems of health and medical authoity and coodination. This section also descibes the function of the REOC as the coodination point at which esouce equests among the affected Opeational Aea(s), othe Opeational Aeas, and the SOC ae executed. RESPONSE PLANS As descibed in Section 1, local esponse to medical and health elements of emegencies and disastes is based on local plans fo multicasualty incidents, hospital disaste esponse, mass pophylaxis dispensing, and othe functions; as well as on local depatment opeations plans and local and Opeational Aea emegency opeations plans. In addition, EMSA has pepaed a Califonia Disaste Medical Response Plan, including the Califonia Medical Mutual Aid Plan, and the Califonia Disaste Medical Opeations Manual, to guide state and local medical esponse effots. The RECP Medical and Health Subsidiay Plan, as implemented by the REOC and the RDMHC, suppots local esponse in accodance with these plans to optimize the use of esouces acoss the egion. MEDICAL AND HEALTH RESPONSE UNDER the Standadized Emegency Management System Medical Health Mutual Aid System As with fie and escue, law enfocement, and coone/medical examine esouces, Califonia opeates a statewide system of mutual aid fo medical and health esouces. This system opeates unde the Califonia Maste Mutual Aid Ageement, and supplements coopeative ageements, contacts, and othe mechanisms employed by LEMSAs, public health depatments, hospitals, and othe entities to augment emegency and disaste medical esouces. EMSA and the CDPH coodinate the Medical Health Mutual Aid System though the MHOACs and the RDMHC and RDMHS in each egion, whose esponsibilities ae descibed in Section 3. Medical and health mutual aid is initially equested at the local level, usually fom the scene, in concet with each Opeational Aea s Multi-Casualty Incident Plan. Mechanisms may be in multicasualty incident plans fo county-to-county esponse. In a local multicasualty incident, it may not be necessay fo the MHOAC to be involved. Howeve, when peexiting aangements outlined in an Opeational Aea s Multi-Casualty Incident Plan ae not enough, the MHOAC may become involved in the acquisition of esouces fom othe Opeational Aeas. Mach

44 RECP Medical and Health Subsidiay Plan Concept of Opeations Regional Emegency Coodination Plan Unde SEMS, if the Opeational Aea is unable to povide the necessay equested assistance, it will equest assistance fom the egional level. With egad to medical and health esouces, the MHOAC will contact the RDMHC fo the mutual aid egion to obtain suppot. If esouces ae not available fom othe Opeational Aeas within the mutual aid egion, the RDMHC will fowad the equest to the state. The state will seek the equested esouces fom: Othe state agencies Mutual aid fom unaffected aeas of the state Othe states, though the Emegency Management Assistance Compact, o othe mechanisms The Fedeal Govenment. Figue 2 summaizes this pocess. As descibed in Annex A of the Califonia Disaste Medical Response Plan, available esouces may include the following. Local medical and health esouces available though automatic o day-to-day mutual aid ageements with neighboing juisdictions. Local mobilization plans, which ae activated by equests to paticipating agencies, must povide fo notification of the MHOAC upon activation. The MHOAC must know about esouces that ae committed unde local plans when detemining esouce availability fo subsequent esponse. Pivate secto medical and health esouces include physicians, nuses, emegency medical technicians, and othe licensed medical pesonnel; hospitals, community clinics, and othe health facilities; gound and ai ambulances; and fixed-wing aicaft fo long-ange evacuation. These esouces can be pemanent elements of the local EMS and health cae system, o esouces that ae fomed only duing disastes, such as mobile field hospitals, Medical Response Teams, and Ambulance Stike Teams. Opeational Aea medical and health esouces ae made available though the appoved and adopted Opeational Aea Disaste Medical Mutual Aid Plan. Mobilization of Opeational Aea esouces is activated by the LEMSA, health office, o MHOAC, based on an assessment of the needs of the esponse, a equest fom Incident Command, o by diection of the Opeational Aea EOC. Regional medical and health esouces include all esouces available to an Opeational Aea. The RDMHC may activate mobilization of egional esouces in esponse to a equest fo assistance fom a MHOAC. 4-2 Mach 2008

45 Regional Emegency Coodination Plan RECP Medical and Health Subsidiay Plan Concept of Opeations Fedeal Agencies ESF #8 Emegency Management Assistance Compact SOC Medical Health Banch State Agencies JEOC REOC Medical Health Banch Othe Mutual Aid Region(s) Othe OES Administative Regions RDMHC RDMHS Opeational Aeas, State Agencies, and Tibal, Non-Govenmental, and Pivate Secto Entities Opeational Aeas, State Agencies, and Tibal, Non-Govenmental, and Pivate Secto Entities Opeational Aea EOC Medical Health Banch MHOAC Opeational Aeas, State Agencies, and Tibal, Non-Govenmental, and Pivate Secto Entities Affected Local Juisdictions Note: Medical/health oles ae indicated by a dashed text box Figue 2 Medical Health Resouce Requesting Pocess* * Souce: Standads and Guidelines fo Health Cae Suge Duing Emegencies, Califonia Depatment of Public Health Mach

46 RECP Medical and Health Subsidiay Plan Concept of Opeations Regional Emegency Coodination Plan Inte-egional medical and health mutual aid is mobilized though the RDMHC in the affected mutual aid egion. Selection of egion(s) fom which esouces ae to be dawn is made consideing the imminence of the theat to life and popety, conditions existing in the vaious egions, and the poximity to the affected Opeational Aea(s). Fo additional infomation on the medical aspects of the Medical Health Mutual Aid System, efe to the Califonia Medical Mutual Aid Plan efeenced in Section 1. Emegency Opeations Centes Coodination of medical and health esponse and the esouces necessay to suppot the esponse occus at EOCs that ae activated at the local, egional, and state levels. These centes include: Local govenment medical/health and public health Depatment Opeations Centes Local govenment EOCs Opeational Aea EOCs REOC JEOC SOC. Table 1 descibes majo components of the medical and health esponse system at evey level of SEMS, and identifies command and mutual aid systems used by these entities. Table 1: Standadized Emegency Management System Opeational Level Command System Mutual Aid System Local Govenment SEMS/NIMS Medical Mutual Aid System Medical Health DOC Local Govenment EOC SEMS/NIMS All Mutual Aid Systems Hospital Command Centes Hospital Incident Command System Medical Mutual Aid System Opeational Aea EOC SEMS/NIMS All Mutual Aid Systems REOC SEMS/NIMS All Mutual Aid Systems SOC SEMS/NIMS All Mutual Aid Systems JEOC SEMS/NIMS Medical Mutual Aid System Activation As descibed in Annex A of the Califonia Disaste Medical Response Plan, the Medical and Health Mutual Aid System may be activated by an Opeational Aea, OES, EMSA, o CDPH when an emegency o disaste occus, o when an imminent theat is identified. The fomal alet and notification pocess includes the following elements: 4-4 Mach 2008

47 Regional Emegency Coodination Plan RECP Medical and Health Subsidiay Plan Concept of Opeations The MHOAC of the affected o theatened Opeational Aea alets the RDMHC The RDMHC: Notifies EMSA o CDPH Notifies health offices, LEMSA administatos, and othe esouces in the egion outside of the affected Opeational Aea(s) that he o she deems appopiate fo the type and scope of the emegency Establishes a communication link with the Opeational Aea, EMSA, and CDPH (eithe at the JEOC o thei espective Depatment Opeations Centes), othe discipline-specific egional mutual aid coodinatos, and the REOC EMSA o CDPH: Notifies the RDMHCs in unaffected aeas Consults with OES about activation of the Medical Health Banch of the SOC. Appendix B contains notification advisoy citeia that the MHOAC uses when detemining whethe to notify the RDMHC. Medical and health esponse geneally consists of two distinct phases: immediate esponse and extended esponse. Immediate Response LEMSA Lead Role An immediate esponse is geneally equied duing an incident that causes mass casualties, in which the pioity is to save lives. Depending on the scale of the emegency, this phase may last fom seveal hous (fo local incidents) to seveal days o moe (fo a majo disaste). In this phase, a fie sevice agency usually is the lead agency in the field; ambulances play a majo ole in counties with contacted ambulance sevice; and the LEMSA is the lead agency fo the coodination and suppot of medical esouces. Duing this phase, the LEMSA: Ensues the availability of ambulance esouces fo the incident and fo sustaining non-incident emegency capacity Communicates with hospitals and assesses hospital status and capacity Coodinates and tacks patient flow to hospitals. While the RDMHC and RDMHS may become involved if an incident is lage, most of the initial ambulance mutual aid is county-to-county o though intenal agency backup. Mach

48 RECP Medical and Health Subsidiay Plan Concept of Opeations Regional Emegency Coodination Plan Extended Response Public Health Depatment Lead Role The extended phase of the medical and health esponse begins afte most of the seiously injued patients have been tanspoted. Depending on the natue and scale of an incident, the extended phase of opeations may last days to weeks, o even months. The focus of this phase inceasingly shifts to public health issues and the estoation of access to health cae. The county health office plays a majo ole duing this extended phase, paticulaly duing a lage-scale incident fo which a local emegency has been declaed. Medical health mutual aid is managed though the RDMHC and RDMHS in coodination with the REOC and JEOC. It must be noted that emegencies such as pandemic influenza and the outbeak of othe infectious diseases will unfold diectly into this second phase. The health office has the lead ole in the esponse to this type of emegency and the LEMSA suppots the esponse. LOCAL AND OPERATIONAL AREA MEDICAL HEALTH RESPONSE Pe-hospital emegency medical sevices ae povided in the field pimaily by fie sevice fist espondes and ambulances opeated eithe by the fie sevice o by pivate entities unde LEMSAadministeed contacts. As descibed in Section 2, the LEMSA o the public health depatment may establish a Depatment Opeations Centes, in addition to staffing the Opeational Aea EOC Medical Health Banch, to manage local medical and health esponse in conjunction with the activities of the Opeational Aea. As an incident escalates, o duing incidents with widespead effects o multiple scenes, a LEMSA/Public Health Depatment Opeations Centes is activated to: Suppot the esponse at the scene and field activities though coodination with hospitals, EMS, ambulance sevices, and health cae povides Povide logistics, management suppot, and coodination with the Opeational Aea EOC, if activated, fo additional suppot Assist with esouce equests and status epoting to the MHOAC. Local plans define the medical health decision-making authoity among the LEMSA Duty Office o LEMSA Diecto o Administato; the health office; and the offices o administatos of health cae facilities. Public medical and health esponse functions ae intetwined, and most decisions ae made in coodination with all medical and health espondes. Depending on the level of damage and esouces available, othe disciplines o functions also may paticipate in the decision-making pocess. 4-6 Mach 2008

49 Regional Emegency Coodination Plan RECP Medical and Health Subsidiay Plan Concept of Opeations If local esouces ae not sufficient to espond to an emegency, the LEMSA o public health depatment equests esouces to suppot medical and health on-scene opeations though the MHOAC. The MHOAC is esponsible fo coodinating the pocuement and allocation of public and pivate medical, health, and othe esouces equied to suppot medical and health opeations. The MHOAC may: Diectly equest esouces fom anothe MHOAC in an Opeational Aea within the egion: the equesting MHOAC will notify the RDMHC and RDHMS of the equest and the povision of the esouces Request esouces though the RDMHC and RDMHS if the MHOAC cannot locate available esouces. REGIONAL MEDICAL HEALTH SUPPORT Suppot at the egional level is coodinated by the RDMHC, with suppot fom the RDMHS, and the REOC Medical Health Banch. Regional Disaste Medical Health Coodinato The RDMHC, suppoted by the RDMHS, coodinates equests fo medical and health esouces within the egion. Fo incidents inside the egion, the RDMHC coodinates with MHOAC(s) fom the affected and unaffected Opeational Aeas to manage shaing of esouces. Fo incidents outside the egion, the RDMHC coodinates the acquisition of equested medical and health esouces fom Opeational Aeas within the egion to send to the affected egion. The RDMHC coodinates equests fo mutual aid with the REOC Medical and Health Banch. When esponding to an incident, the fist-line epoting fo the RDMHS may change fom EMSA and the CDPH to the RDMHC, o the altenate RDMHC, to best cay out egional and state mission tasks. Regional Emegency Opeations Cente Medical Health Banch In geneal, the position of Medical Health Banch Diecto at the REOC is staffed as follows: In situations that involve mass casualties and injuies, EMSA staffs this position; a CDPH epesentative may be assigned as the Deputy Medical Health Banch Diecto to coodinate public health suppot In situations that involve an outbeak of disease, a pandemic, o bioteoism, CDPH staffs this position; in such cases, an EMSA epesentative may be assigned as the Deputy Medical Health Banch Diecto to coodinate emegency medical suppot. Mach

50 RECP Medical and Health Subsidiay Plan Concept of Opeations Regional Emegency Coodination Plan If the EMSA o CDPH does not initially send a epesentative to the REOC, OES will staff the Medical Health Banch Diecto position, and coodination still occus between the RDMHC and that position. The REOC Medical Health Banch esponds to equests fo suppot fom the RDMHC and RDMHS by: Mission tasking state agencies to povide suppot Requesting esouces fom othe OES administative egions Coodinating equests fo non-medical and health esouces with othe banches within the Opeations Section of the REOC Fowading unmet esouce equests to the SOC. Vaiations in the paths fo communication include the following: The REOC Medical Health Banch Diecto may communicate with EMSA and CDPH epesentatives at the JEOC egading situational awaeness and available esouces; howeve, the REOC must oute esouce equests though the SOC The RDMHC may coodinate with the SOC if the REOC is not functional County public health offices communicate diectly with the CDPH egading public health infomation and diectives. As peviously mentioned, Sections 5 and 6 of the RECP Medical and Health Subsidiay Plan contain checklists fo the REOC Medical Health Banch that descibe initial actions, and citical action sheets that povide guidance fo coodination among medical and health esponse and othe disciplines. Appendix C povides a checklist fo actions by the REOC Medical Health Banch Diecto. Duing lage-scale incidents, esouce and opeational decisions fo the egion may be made at the REOC Medical Health Banch though a esouce management confeence call with the RDMHC and RDMHS, MHOACs, health offices, and LEMSA diectos.. The JEOC and the SOC Medical Health Banch also may be involved in decisions that affect the entie egion o the state, and may be included in the confeence call. Such calls ae descibed futhe in this section. If the Medical Health Banch eceives equests fo non-medical esouces that ae equied to suppot a medical o health field esponse, the Medical Health Banch Diecto coodinates these equests with the appopiate Opeations Section Banch. Regional mutual aid coodinatos fo the fie and escue, law enfocement, and coone/medical examine mutual aid systems ae esponsible fo in-egion coodination of esouces within these disciplines. (See the RECP subsidiay plans fo these disciplines fo additional infomation.) 4-8 Mach 2008

51 Regional Emegency Coodination Plan RECP Medical and Health Subsidiay Plan Concept of Opeations STATE MEDICAL HEALTH SUPPORT State Opeations Cente The SOC Medical Health Banch is staffed by epesentatives of EMSA and CDPH in a manne simila to the REOC, as peviously descibed. The SOC coodinates esouce equests that cannot be met at the egional level and pioitizes scace esouces. In esponse to esouce equests, the SOC: Coodinates equests fo medical and health esouces with EMSA and the CDPH at the JEOC Obtains esouces fom othe, unaffected egions of the state Mission tasks state agencies to povide suppot Coodinates equests fo non-medical and health esouces with othe banches within the Opeations Section of the SOC Obtains out-of-state esouces though the Emegency Management Assistance Compact and othe mechanisms Coodinates equests fo assistance with the Fedeal Govenment, if the Pesident has declaed an emegency o disaste. Joint Emegency Opeations Cente As discussed in Section 3, EMSA and the CDPH jointly staff the JEOC to coodinate state-level suppot fo medical and public health esponse. In coodination with the SOC Medical Health Banch, the JEOC: Povides policy and pogam diection fo medical and health esponse Leads state effots to locate, acquie, and aange delivey of state-owned and contolled disaste medical and health supplies, equipment, and pesonnel Assists with the coodination of esouces fom unaffected aeas of the state. As descibed in the Califonia Disaste Medical Response Plan, EMSA and the CDPH may suppot medical and health opeations by diecting staff to wok out of thei espective Depatment Opeations Centes, athe than at the JEOC, when the magnitude of an incident is not sevee. This situation might occu when only a theat of an incident has occued; when the JEOC is deactivating; o when thee is a educed need fo the coodination of medical and health esponse. State Medical Health Mutual Aid Coodination A state-level Medical Health Mutual Aid Coodinato has not been designated. This function is managed at the state level by EMSA and the CDPH at the JEOC, and in the Medical Health Banch at the SOC. Mach

52 RECP Medical and Health Subsidiay Plan Concept of Opeations Regional Emegency Coodination Plan FEDERAL LEVEL SUPPORT When the Pesident declaes an emegency o disaste, the Fedeal Govenment activates ESF #8 to coodinate Fedeal esouces to suppot state, local, tibal, and pivate secto medical and public health esponse. FEMA deploys a liaison to the SOC, followed by an Incident Management Assistance Team, to initiate coodination of the Fedeal esponse to state equests fo suppot. The U.S. Depatment of Health and Human Sevices deploys ESF #8 liaisons to the SOC and JEOC to establish joint medical and public health opeations. Joint State/Fedeal opeations tansition to the Joint Field Office when that facility is established. Though coodination with EMSA and the CDPH, Fedeal teams ae integated into state opeations o into the field-level Incident Command at the local level. If an incident is of such seveity that the need fo Fedeal suppot is eadily appaent, the Fedeal Govenment immediately activates the Catastophic Incident Supplement and begins activation and deployment of Fedeal esouces, befoe full situational awaeness of specific needs and shotfalls is known, and in anticipation of state equests fo suppot. These esouces may include National Disaste Medical System assets, DMATs, Public Health Sevice Commissioned Cops pesonnel, and CDC emegency esponse teams. These esouces will be deployed to the affected aea once the state has equested them. MEDICAL HEALTH RESPONSE SYSTEM DESCRIPTION SUMMARY Table 2 summaizes the oles and esponsibilities of the depatments and agencies at the local, egional, state, and Fedeal levels fo medical health esponse. MANAGEMENT OF RESOURCES Authoity to Commit State Resouces Resouce equests must go though the REOC o SOC, whee a mission task ode and numbe is assigned to esouce equests fo futue eimbusement of esouces committed duing a esponse. Although the RDMHC coodinates esouce equests within the egion, and with othe egions, thee is no single statewide Medical Health Mutual Aid Coodinato with the authoity to commit state esouces on behalf of OES. Rathe, the REOC Medical Health Banch Diecto, who as an official of EMSA o the CDPH, has the authoity to commit esouces fom within espective state depatments o agencies, and must coodinate with the SOC Medical Health Banch to locate, task, and commit esouces fom othe state depatments o agencies Mach 2008

53 Regional Emegency Coodination Plan RECP Medical and Health Subsidiay Plan Concept of Opeations Table 2: Oveview of Local, Regional, State and Fedeal Medical Health Response Response Agency Public Health (County) LEMSA Decision-Making Authoity Resouce Coodination Typical Response Opeations Opeations Cente(s) Response Plans LOCAL LEVEL MEDICAL HEALTH RESPONSE (CITY, COUNTY, OPERATIONAL AREA) Health Office MHOAC Health Office odes DOC Depatment Health Sevices RDMHC Food and wate safety Medical/ Opeations Plan Diecto Management of hazadous Health Isolation and mateials exposue Banch Quaantine Plan Vecto contol at the Altenate Cae Site Opeational Disease investigation Plans Aea EOC Isolation and quaantine Mass Pophylaxis Plan Use of local phamaceutical caches Stategic National Mass pophylaxis/ Stategic Stockpile Plan National Stockpile Pandemic Flu Plan Altenate cae sites Bioteoism Laboatoy testing Response Plan Potective action decisions Medical Health Health alets, wanings, and Banch Plan, infomation o Opeational Medical teatment potocols Aea Emegency Chempack pogam Opeations Plan Assistance to the coone fo safe Annex handling of the deceased EMS Duty MHOAC Emegency medical tanspot Depatment Multiple Casualty Office RDMHC Multiple casualty incident esponse Opeations Incident Plan EMS Diecto Medical suge Field teatment sites Cente Mass Casualty Plan extenal to Medical teatment potocols Medical/ Field Teatment Site hospitals Health Chempack planning Emegency Banch medical at the tanspot Opeational Aea EOC Hospital esouce management Public Health Laboatoy Public Health Laboatoy Diecto Laboatoy Response Netwok MHOAC RDMHC Bio-agent sampling and testing Depatment Opeations Cente (as a Goup in the Opeations Section o as a Unit in the Logistics Section) Numeous laboatoy pocedual and safety plans and manuals, including emegency opeations Mach

54 RECP Medical and Health Subsidiay Plan Concept of Opeations Regional Emegency Coodination Plan Table 2: Oveview of Local, Regional, State and Fedeal Medical Health Response (Continued) Response Agency Hospitals MMRS* OES Coastal Region RDMHC RDMHS SOC Decision-Making Authoity Hospital Incident Command System Incident Commande Hospital Chief Executive o Diecto On-Scene Incident Commande REOC Diecto REOC Medical Health Banch Diecto RDMHC Resouce Coodination Vendos Hospital system (pivate) Request esouces fom the Depatment Opeations Cente Local EOC and Opeational Aea EOC Local MMRS caches Fie/escue and law enfocement mutual aid systems Typical Response Opeations Medical suge Emegency depatment Altenate cae sites Medical cae/ austee cae Patient evacuation Sustained opeations Pophylaxis Decontamination Chempack stoage On-scene specialized adiological, chemical, biological, explosive esponse, and mass casualty esponse Opeations Cente(s) Hospital Incident Command System On-Scene Incident Command REGIONAL LEVEL MEDICAL HEALTH RESPONSE Othe Opeations Coodinate egional REOC (o emotely) Section banches fo esponse non-medical and health RDMHC fo medical and health MHOACs EMSA and CDPH Duty Office REOC SOC JEOC Boke esouces within the egion; obtain esouces fom RDMHCs in unaffected aeas and fom the state Allocate scace esouces Conta Costa County Opeational Aea EOC STATE AND FEDERAL LEVEL MEDICAL HEALTH RESPONSE SOC Diecto JEOC fo medical and Coodinate state- SOC SOC Medical health esouces level esponse Health Banch Othe Opeations Request Fedeal Diecto Section banches fo assistance non-medical health esouces Othe state agencies Out-of-state esouces Fedeal esouces Response Plans Emegency Opeations Plan Suge Capacity Plan Infection Contol Plan Bioteoism Response Plan Isolation and Quaantine Plan Recipocal Plans Decontamination Plan Pandemic Flu Plan County Multi-Hazad Plan MMRS Plan State Emegency Plan RECP Medical and Health Subsidiay Plan Regional Disaste Medical Health Coodination Plan RECP Medical and Health Subsidiay Plan Califonia Disaste Medical Opeations Manual State Emegency Plan State Mutual Aid Plans * As discussed in Section 3, the MMRS cities in the Bay Aea ae Femont, Oakland, San Fancisco, and San Jose Mach 2008

55 Regional Emegency Coodination Plan RECP Medical and Health Subsidiay Plan Concept of Opeations Table 2: Oveview of Local, Regional, State and Fedeal Medical Health Response (Continued) Response Agency Decision-Making Authoity EMSA EMSA Diecto JEOC SOC Resouce Coodination Typical Response Opeations Coodinate inteegional and state medical esponse Opeations Cente(s) JEOC SOC Medical Health Banch REOC Medical Health Banch Response Plans Califonia Disaste Medical Response Plan Califonia Disaste Medical Opeations Manual CDPH CDPH Diecto State Public Health Office JEOC SOC Coodinate inteegional and state public health esponse Coodinate public health activities with county public health offices Receive Stategic National Stockpile phamaceuticals Mass pophylaxis Chempack stoage JEOC SOC Medical Health Banch REOC Medical Health Banch Standads and Guidelines fo Healthcae Suge Duing Emegencies State Stategic National Stockpile Plan State Pandemic influenza Plan Fedeal agencies unde the National Response Famewok U.S. Depatment of Health and Human Sevices is the coodinating and pimay agency fo ESF #8 Fedeal Coodinating Office Assistant Secetay fo Pepaedness and Response, U.S. Depatment of Health and Human Sevices ESF #8 Incident Response Coodination Team Lead Othe ESFs fo non-medical and health esouces Fedeal suppot fo state, local, tibal, and pivate secto medical and health opeations National Response Coodination Cente Regional Response Coodination Cente State/Fedeal Joint Field Office National Response Famewok ESF #8 Annex Catastophic Incident Supplement Mach

56 RECP Medical and Health Subsidiay Plan Concept of Opeations Regional Emegency Coodination Plan Regional Decision-Making The REOC is the focus of decision-making fo egional esponse. Medical and health decisions must be made as esouces ae equested, eceived, and allocated thoughout the egion. Thee objectives may be consideed when the REOC Diecto o the Medical Health Banch Diecto makes decisions fo the egional esponse, as follows. Pioitize Allocation of Medical Health Resouces. The MHOAC, and RDMHC, and RDHMS pioitize and allocate medical health esouces acoss Opeational Aeas. The RDMHC and RDHMS may convene confeence calls with MHOACs to boke the allocation of available esouces acoss Opeational Aeas. If confeence calls ae not possible by telephone, evey effot must be made to communicate with MHOACs though voluntee amateu adio. The Opeational Aea EOC may help coodinate the assignment of adio esouces, as follows. The REOC Medical Health Banch Diecto may convene a confeence call fom the REOC to conside the allocation of esouces acoss the affected Opeational Aeas in the egion. The REOC Medical Health Banch Diecto coodinates esouce equests with the REOC Opeations Section Chief. Ultimately, the REOC Diecto is esponsible fo the commitment of esouces. The REOC Diecto may base his o he decisions on infomation fom the REOC Opeations Section Chief and fom the Regional Coodination Goup, as descibed in the RECP Base Plan. Optimize Use of Resouces and Medical Health Response. Duing mass casualty and public health emegencies, esponse activities ae initiated acoss all Opeational Aeas. These esponse activities involve the mobilization of pesonnel, facilities, equipment, supplies, tanspotation, and law enfocement. Response may entail the activation of mass dispensing sites, field teatment sites, isolation and quaantine opeations, and othe disease contol measues, egionwide. As conditions pemit, the REOC, in coodination with the JEOC and the SOC, convenes a confeence call with health offices, MHOACs, and the RDMHC to detemine possible situations in which Opeational Aeas can combine esouces, and centalize o distibute esponse activities geogaphically to optimize the use of staff and esouces acoss the egion. The Medical Health Banch Diecto/Coodinato at eithe the REOC o the SOC can convene the confeence call. Ensue Consistency in Medical Cae and Public Health Disease Contol Measues. Response duing a medical o health emegency equies that health cae povides eceive consistent infomation about medical cae and disease contol measues. The REOC Medical Health Banch woks with the 4-14 Mach 2008

57 Regional Emegency Coodination Plan RECP Medical and Health Subsidiay Plan Concept of Opeations CDPH, Health Offices, the RDMHC, the MHOACs, and the Opeational Aea Medical Health Banch Coodinatos to ensue that consistent infomation is communicated about: Medical cae and teatment potocols, and to ensue that this infomation is communicated quickly to hospitals, medical cae povides, and pe-hospital medical cae povides (ambulance sevices) Decisions to activate and implement specific disease contol measues Health alets, health office odes, and instuctions to the public Waives of legal obligations duing emegency esponse by medical cae povides; waives equie a county health office declaation of a public health emegency. Medical Supplies Management and Distibution The RDMHC and RDMHS eceives equests fo medical supplies fom MHOACs and may access othe county and state medical supply esouces though the system peviously descibed and as illustated on Figue 2. Phamaceuticals ae deliveed to the state fom the Stategic National Stockpile within 12 hous of a equest by the Goveno. Counties must set up and staff eceiving, stoing, and staging sites fo Stategic National Stockpile phamaceuticals and medical supplies, which ae distibuted within a county to mass pophylaxis/mass dispensing sites. Some counties have ageed to shae one eceiving, stoing, and staging aea among multiple counties. Chempack caches fo teatment of exposue to chemical agents ae stoed thoughout the egion. Specific distibution and deployment plans fo each cache ae maintained in each Opeational Aea. At the Fedeal level, ESF #8 povides medical supplies and phamaceuticals via the U.S. Depatment of Health and Human Sevices Pogam Suppot Cente, the Depatment of Defense, the Defense Logistics Agency, the U.S. Depatment of Veteans Affais, and the Stategic National Stockpile vendo-managed inventoy. RESPONSE MANAGEMENT CONFERENCE CALLS Confeence calls may be convened to conside egional esponse equiements, available esouces, esouce pioitization and allocation, and egional esponse opeations. REOC Medical Health Banch Coodinato Confeence Calls The REOC Medical Health Banch Diecto may convene a esponse management confeence call when the REOC is activated. The following paticipants may be included on the call: Mach

58 RECP Medical and Health Subsidiay Plan Concept of Opeations Regional Emegency Coodination Plan REOC Diecto Health offices MHOACs RDMHC and RDMHS JEOC Medical Health Banch Coodinato and EMSA and CDPH staff SOC Medical Health Banch Coodinato. The confeence calls also involve mutual aid coodinatos fom othe disciplines, as necessay, to implement decisions elated to medical esponse and contol of disease. These calls may involve: Region II Fie and Rescue Mutual Aid Coodinato, Law Enfocement Mutual Aid Coodinato, o Coone/Medical Examine Mutual Aid Coodinato REOC banch diectos and unit leades fo othe functional aeas, such as the Cae and Shelte Banch, Cae and Shelte Resouce Unit, Tanspotation Banch, and Communications Unit. Appendix D contains a REOC Medical Health Banch Diecto confeence call pocedues and oll call sheet. Regional Disaste Medical Health Coodinato Confeence Calls The RDMHC may convene confeence calls with MHOACs fom affected and unaffected Opeational Aeas to conside esponse equiements, and to boke esouces acoss Opeational Aeas. County Public Health Office Confeence Calls County Public Health Offices may convene confeence calls to discuss the outbeak of disease and detemine disease contol measues. These confeence calls may occu without activation of specific esponse oganizations o esponse opeations centes (such as Depatment Opeations Centes, Opeational Aea EOCs, the REOC, the SOC, o the JEOC). Confeence calls may involve only health offices, o may include epesentatives of the CDPH, CDC, o othe expets, as equied. Duing these confeence calls, the RDMHC detemines whethe the Medical Mutual Aid System should be activated, and infoms the REOC, when appopiate. JEOC Medical Health Banch Coodinato Confeence Calls The JEOC Medical Health Banch Coodinato convenes confeence calls with the REOC and the SOC Medical Health banches, the affected MHOACs, the RDMHC, and othe JEOC and SOC Banch coodinatos and unit leades to conside the statewide use of esouces, allocation of Fedeal esouces, and oveall coodination of a esponse Mach 2008

59 Regional Emegency Coodination Plan RECP Medical and Health Subsidiay Plan Concept of Opeations REGIONAL INFORMATION MANAGEMENT Infomation egading situational status, esouces needs, and the capacity to espond to an incident flows fom field units and facilities to the SEMS oganization via seveal communication systems, as follows. The Depatment Opeations Cente o Opeational Aea EOC eceives hospital capacity infomation and casualty statistics, o equests this infomation fom the field. The Depatment Opeations Cente Status Repots/Documentation Unit fowads situation epots to the MHOAC, who, in tun, consolidates and fowads the infomation to the RDMHC and RDMHS. The Depatment Opeations Cente, o the Medical Health Banch of the Opeational Aea EOC, may initiate medical health epoting in the Response Infomation Management System (RIMS), which is accessible to county, egional, and state SEMS levels. Incident Status and Bed Capacity Infomation Clinics, skilled nusing facilities, and othe medical povides elay status and capability infomation immediately following an incident, o when equested by the MHOAC o the Public Health Depatment Opeations Cente (o the Opeational Aea EOC Medical Health Banch). Incident status and hospital bed capacity infomation is used to detemine the distibution of casualties (multiple o mass casualties). The Public Health Depatment Opeations Cente (o Opeational Aea EOC Medical Health Banch) and the MHOAC fowads aea infomation back to hospitals, clinics, and medical povides. Field sites/activities (disease investigation teams, fist esponse specialized teams, field teatment sites, mass dispensing sites) povide status infomation and esouce equests to the MHOAC. The Planning Section at eithe the Public Health Depatment Opeations Cente o Opeational Aea EOC assembles RIMS situation epots fo fowading to the MHOAC, and then to the RDMHC and to the REOC Medical Health Banch Diecto. The REOC Medical Health Banch Diecto and the RDMHC and RDMHS use the infomation egading the numbes of casualties, facilities unde evacuation, patients waiting, doses povided, the numbe tiaged, and the numbe equiing isolation o quaantine along with the esouce equests to detemine the allocation of esouces within the egion. Situation epots fom the entie egion ae fowaded to the SOC and the JEOC fo statewide esponse and esouce decision-making. Mach

60 RECP Medical and Health Subsidiay Plan Concept of Opeations Regional Emegency Coodination Plan Health Alets, Waning, and Public Risk Communication Health alets, wanings, and isk communications ae sent to the pages, faxes, s, and telephones of local public health depatments and othe pedetemined individuals via the Califonia Health Alet Netwok. Simila infomation also may be sent to the CDPH via this netwok. Local public health depatments disseminate health alets and wanings to medical cae povides though vaious means. Each MHOAC should have a back-up position assigned to assume MHOAC duties if the pimay MHOAC is unable to epot fo duty. The RDMHC has assigned an in-county and out-of-county back-up to assume RDMHC duties if the pimay RDMHC is unavailable to epot fo duty. In addition, the REOC Medical Health Banch Diecto can pefom RDMHC duties, when necessay. Public health depatment emegency opeations plans descibe continuity of govenment fo the position of health office. In some counties, the health office s duties may be designated to an assistant o deputy health office. In counties without an assistant o deputy health office, a licensed physician may be designated to assume the duties of the health office. All of these positions and altenates ae available via a 24-hou contact numbe Mach 2008

61 Section 5 RECP Medical and Health Subsidiay Plan Initial Actions by Scenaio

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63 Regional Emegency Coodination Plan RECP Medical and Health Subsidiay Plan Initial Actions By Scenaio Section 5 Initial Actions by Scenaio The initial actions by scenaio sheets contained in this section wee developed specifically fo the REOC Medical Health Banch Diecto as basic guidance fo initial esponse to seveal emegency scenaios. The sheets ae used to oganize the actions that must be taken duing the fist 6+ hous following an emegency o disaste in esponse to esouce equests fom the MHOACs and the RDMHC and RDMHS. Initial actions ae descibed fo the following scenaios: Eathquake esponse CBRNE incident Outbeak of disease/biological incident. The initial actions by scenaio sheets coespond to the citical action sheets (see Section 6) that list actions equied fo specific esponse functions, as shown in Table 3. Table 3: Actions Requied fo Response Functions Initial Actions By Scenaio Initial Actions fo Eathquake Initial Actions fo CBRNE Incident Initial Actions fo Outbeak of Disease/Biological Incident Applicable Citical Action Sheets Mass Casualty Citical Action Sheet Hospital Evacuation Citical Action Sheet Hospital Coodination Citical Action Sheet Medical Needs Shelte Citical Action Sheet Mass Casualty Citical Action Sheet Hospital Evacuation Citical Action Sheet Hospital Coodination Citical Action Sheet Medical Needs Shelte Citical Action Sheet Mass Casualty Citical Action Sheet Quaantine and Isolation Citical Action Sheet Mass Dispensing Citical Action Sheet Medical Needs Shelte Citical Action Sheet Timing is citical in emegency esponse. In ode to espond to an emegency as effectively as possible, it would be pudent to pe-stage cetain esouces that could be automatically mobilized following an eathquake, a chemical o adiological incident, o the outbeak of disease. The initial action-by-scenaio sheets list esouces fo each scenaio that, if pe-staged, could be sent to affected aeas expeditiously, thus saving time in the citical fist few hous afte an incident. Cuently, such esouces and a system and policy to mobilize them ae not in place. Development of a system fo automatic activation of pe-staged esouces would equie local, state, and Fedeal agency ageements. This would also equie evision of state laws addessing eimbusement in the SEMS mission-tasking pocess, because the existing concept is that local esouces must be exhausted befoe state o Fedeal esouces can be mobilized. Mach

64 RECP Medical and Health Subsidiay Plan Initial Actions By Scenaio Regional Emegency Coodination Plan This page intentionally left blank. 5-2 Mach 2008

65 Regional Emegency Coodination Plan RECP Medical and Health Subsidiay Plan Initial Actions By Scenaio Situation/ Status Infomation Initial Actions by Scenaio Eathquake Eathquake Hous 0 to 6 Affected Aea and Population(s) Hospital Status in the Region Hospital Evacuations (unde way o complete) Hospital Infastuctue Suppot Needed (fuel, wate, stuctual epai, etc.) Clinic, Skilled Nusing Facility, Othe Congegate Cae Facility Status Numbe and Location of Field Teatment Sites Established Numbe and Location of Altenate Cae Sites Established Special Needs Populations Equipment (Medical and Non-Medical) Needed fo Teatment of Injuies (cush, tauma, fist aid) Pesonnel/Staffing Shotfalls Opeational Aea Deployment of Local Medical Caches (in pogess o complete) Mutual Aid Requests (in pogess) Declaations of Emegency (state and local) Communications Capability and Instuctions Availability of Tanspotation Resouces INITIAL ACTIONS TO SUPPORT REGIONAL RESPONSE MOBILIZE STATE RESOURCES Actions/Decisions Resouces/Mission Tasking Activate and Staff REOC Medical Health Banch Assign EMSA as Medical Health Banch Diecto (polonged disease outbeak esponse) EMSA Activated Field Teatment Sites CAL-MATs Mass Casualty Citical Action Sheet (see Section 6) Medical Reseve Cops Ambulance Stike Teams ESF #8 and DMATs Califonia Medical Voluntees (medical staffing) Stategic National Stockpile (medical equipment and supplies) State Law Enfocement Mutual Aid Coodinato (secuity at field teatment sites) SOC Tanspotation Banch (patient fowading) Hospitals, Altenate Cae Sites, and Field Teatment Sites CAL-MATs, CDPH, othe state agencies, and Califonia Medical Hospital Evacuation Citical Action Sheet (see Section 6) Voluntees (medical staffing) Hospital Coodination Citical Action Sheet (see Section 6) ESF #8 and DMATs (staffing) Medical Needs Shelte Citical Action Sheet (see Section 6) Stategic Nation Stockpile (medical equipment and supplies) Stategic National Stockpile (medical supplies) State Law Enfocement Mutual Aid Coodinato (secuity at Public Infomation/Risk Communication altenate cae sites and hospitals) SOC Tanspotation Banch (patient fowading fom hospitals to altenate cae sites o fo specialized cae) Hospital Paent Copoate Command Centes (to ensue access fo copoate esouces fo system hospitals and tanspot esouce availability) Coodination with all RDMHCs (state bed availability) Stategic National Stockpile (medical supplies) Pepae Stategic Nation Stockpile equest fo CDPH, OES, Office of Homeland Secuity (OHS) Diectos Confeence Call with the Goveno (REOC and SOC Medical Health Banches) Mach

66 RECP Medical and Health Subsidiay Plan Initial Actions By Scenaio Regional Emegency Coodination Plan Initial Actions By Scenaio Eathquake (Continued) Public Infomation/Risk Communications Confeence call with health offices and CDPH (consistent messaging/odes to the public) SOC Public Infomation Office (assist egional o statewide distibution of public infomation) ACTIONS AFTER INITIAL RESPONSE HOURS 6 TO 48+ Reassign CDPH as Medical Health Banch lead SOC Mass Fatality Banch (tanspotation, efigeation, and Mass Fatality (mogue) mass buial needs) Special Needs Populations Califonia Medical Voluntees, Medical Reseve Cops, CAL- Shelte Suppot MATs, and ESF #8 (staffing fo altenate cae sites and medical sheltes; medical and health efeals at sheltes; and health/ Outbeak of Disease safety inspections at sheltes) Envionmental/Sanitation/Wate Othe Regions and Opeational Aeas, CDPH, CDC (disease outbeak and sanitation contol) PRE-STAGED STATE MEDICAL AND HEALTH RESOURCES FOR POTENTIAL AUTOMATIC MOBILIZATION FOR EARTHQUAKE RESPONSE Resouce Activated/Mobilized By Stategic Nation Stockpile (medical supplies and equipment) CDPH and OES CAL-MATs EMSA Califonia Medical Voluntees Opeational Aea and EMSA Mobile Field Hospital(s) Hospitals, Public Health, CDPH, and EMSA State Equipment/Supply Caches (if any) EMSA Assessment Teams (sheltes) EMSA, CDPH, and OES Management Suppot Teams EMSA Envionmental/Sanitation Teams Public Health, Envionmental Health, and CDPH 5-4 Mach 2008

67 Regional Emegency Coodination Plan RECP Medical and Health Subsidiay Plan Initial Actions By Scenaio Situation/Status Infomation Initial Actions By Scenaio CBRNE Incident Chemical Radiological Incident Hou 0 to 6 Type of Incident (localized vesus widespead, teoism bomb blast with chemical o adiological injuies and deaths, o accidental chemical o adiological elease) Affected Aea and Population(s) Hospital Status in the Region Hospital Evacuations (unde way o complete) Hospital Infastuctue Suppot Needed (fuel, wate, stuctual epai, etc.) Numbe and Location of Established Field Teatment Sites Numbe and Location of Established Altenate Cae Sites Envionmental Hazads and No-enty Zones Special Needs Populations Equipment (Medical and Non-Medical) Needed fo Teatment of Injuies (e.g., adiation sickness, buns, ventilatos) Pesonnel/Staffing Shotfalls Opeational Aea Deployment of Local Medical Caches (in pogess o complete) Mutual Aid Requests in Pogess Declaations of Emegency (state and local) Communications Capability and Instuctions Availability of Tanspotation Resouces INITIAL ACTIONS TO SUPPORT REGIONAL RESPONSE MOBILIZE STATE RESOURCES Actions/Decisions Resouces/Mission Tasking Activate and Staff the REOC Medical Health Banch Assign CDPH as Medical Banch Diecto (chemical and adiological esponse) Field Teatment Sites and Altenate Cae Sites CAL-MATs Mass Casualty Citical Action Sheet (see Section 6) Califonia Medical Voluntees (medical staffing) Mobile Field Hospitals ESF #8 and DMATs Stategic National Stockpile (medical equipment and supplies) State Law Enfocement Mutual Aid Coodinato (secuity at field teatment sites) SOC Tanspotation Banch (patient fowading) Hospitals and Altenate Cae Sites CAL-MATs, Califonia Medical Voluntees, CDPH, and othe state Hospital Evacuation Citical Action Sheet (see agencies (medical staffing) Section 6) ESF #8 and DMATs (medical staffing) Hospital Coodination Citical Action Sheet (see Stategic Nation Stockpile (medical equipment and supplies) Section 6) State Law Enfocement Mutual Aid Coodinato (secuity at altenate Medical Needs Shelte Citical Action Sheet (see cae sites and hospitals) Section 6) SOC Tanspotation Banch (patient fowading fom hospitals to altenate cae sites o fo specialized cae) Hospital Paent Copoate Command Centes (to ensue access fo copoate esouces to system hospitals; with communication to the RDMHC fo esouce coodination ) Bed availability (fowading within the state and National Disaste Medical System) Stategic Nation Stockpile (medical supplies) Pepae Stategic Nation Stockpile equest fo CDPH, OES, OHS Diectos Confeence Call with the Goveno (REOC and SOC Medical Health Banch Diectos) Mach

68 RECP Medical and Health Subsidiay Plan Initial Actions By Scenaio Regional Emegency Coodination Plan Initial Actions By Scenaio CBRNE Incident (Continued) Decontamination and Pesonal Potective Equipment State Fie and Rescue Mutual Aid Coodinato (decontamination (PPE) equipment, supplies, and facilities) Some Opeational Aeas have decontamination equipment and PPE that is not unde Fie and Rescue contol PPE ecommendations CDPH Health Physicists Law enfocement (Califonia Highway Patol) and powe plant counties (adiological monitoing equipment fo health cae facilities) Ensue decontamination pocesses at hospitals ae simila thoughout the egion Public Infomation/Risk Communication Confeence call with health office and CDPH (consistent messaging Coodination of Infomation Fom Teoism Ealy and odes to the public) Waning Goup SOC Public Infomation Office (assist with egional o statewide distibution of public infomation) ACTIONS AFTER INITIAL RESPONSE AND INTO HOURS 6 TO 48+ Mass Fatality (mogue) SOC Mass Fatality Banch (tanspotation, efigeation, mass buial Special Needs Populations needs) Shelte Suppot Califonia Medical Voluntees, Medical Reseve Cops, CAL-MATs, Outbeak of Disease (sheltes) and ESF #8 (staffing fo altenate cae sites and medical needs sheltes, medical and health efeals at sheltes, and health and safety Envionmental/Sanitation/Wate inspections at sheltes) Othe egions and Opeational Aeas, CDPH, and CDC (disease outbeak and sanitation contol) PRE-STAGED STATE MEDICAL AND HEALTH RESOURCES POTENTIAL AUTOMATIC MOBILIZATION FOR CHEMICAL/ RADIOLOGICAL INCIDENT RESPONSE Resouce Activated/Mobilized By Chempacks Field, MHOAC, RDMHC, and RDHMS Potassium Iodide Supplies Health Office MHOAC, RDMHC, and RDMHS Stategic Nation Stockpile (equest fo medical supplies CDPH and OES and equipment) CAL-MATs EMSA Califonia Medical Voluntees EMSA State Medical Equipment and Supplies Caches REOC and SOC Management Suppot Teams EMSA Envionmental/Sanitation Teams Envionmental Health Radiological Response Teams CDPH 5-6 Mach 2008

69 Regional Emegency Coodination Plan RECP Medical and Health Subsidiay Plan Initial Actions By Scenaio Initial Actions By Scenaio Disease Outbeak/Biological Incident SITUATION/STATUS INFORMATION Disease Outbeak Hous 0 to 6 Type of Incident (bioteoism, pandemic, outbeak of disease in the egion)* Affected Aea and Population(s) (nationwide) Hospital Status in the Region Numbe and Location of Altenate Cae Sites Established Special Needs Populations Equipment (Medical and Non-Medical) Needed fo Teatment of Specific Disease Agent and Shotfalls Pesonnel and Staffing Shotfalls Opeational Aea Deployment of Local Medical Caches (in pogess o complete) Mutual Aid Requests (in pogess) Disease Contol Measues Unde Consideation by Health Offices (e.g., mass pophylaxis, isolation, quaantine, and social distancing) Emegency Declaations and Local Health Diectives Communications Capability and Instuctions Availability of Tanspotation Resouces (fo the above) INITIAL ACTIONS TO SUPPORT REGIONAL RESPONSE MOBILIZE STATE RESOURCES Actions/Decisions Resouces/Mission Tasking Activate and staff the REOC Medical Health Banch Assign CDPH as Medical Health Banch Diecto (disease outbeak esponse) Hospitals and Atenate Cae Sites Mass Casualty Citical Action Sheet (see Section 6) CDPH and othe state agencies (medical staffing) Califonia Medical Voluntees (medical staffing) Stategic National Stockpile (medical equipment and supplies) State Law Enfocement Mutual Aid Coodinato (secuity at altenate cae sites and hospitals) SOC Tanspotation Banch (patient fowading fom hospitals to altenate cae sites o fo specialized cae) Epidemiological Investigation/Laboatoy CDPH (disease investigation teams) CDC (Technical Assistance Response Unit and disease investigation teams) State Laboatoy Response Netwok Disease Contol Mass Pophylaxis/Dispensing Isolation and Quaantine Stategic National Stockpile (equest fo medical equipment and phamaceuticals) CDPH (biological PPE ecommendations) Austee Cae (when medical esouces ae limited o unavailable) PPE Mass Dispensing Citical Action Sheet (see Section 6) Isolation and Quaantine Citical Action Sheet (see Section 6) Stategic Nation Stockpile Pepae Stategic National Stockpile equest fo CDPH, OES, OHS Diectos confeence call with the Goveno (REOC and SOC Medical Health Banches) Public Infomation/Risk Communication (coodinated with Confeence call with health office and CDPH (consistent infomation fom Teoism Ealy Waning Goup messaging and odes to the public) SOC Public Infomation Office (assist with egional o statewide distibution of public infomation) *Note: One smallpox case tigges the REOC to pepae fo the widespead outbeak of disease. Mach

70 RECP Medical and Health Subsidiay Plan Initial Actions By Scenaio Regional Emegency Coodination Plan Initial Actions By Scenaio Disease Outbeak/Biological Incident (Continued) ACTIONS AFTER INITIAL RESPONSE HOURS 6 TO 48+ Mass Fatality (mogue) SOC Mass Fatality Banch (tanspotation, efigeation, and Special Needs Populations mass buial needs) Medical Needs Shelte Citical Action Sheet (see Section 6) Califonia Medical Voluntees (continue staffing fo altenative cae sites and medical needs sheltes) PRE-STAGED STATE MEDICAL AND HEALTH RESOURCES FOR POTENTIAL AUTOMATIC MOBILIZATION FOR DISEASE OUTBREAK RESPONSE Resouce Activated/Mobilized By Stategic National Stockpile CDPH and OES CAL-MATs EMSA Califonia Medical Voluntees EMSA Management Suppot Teams EMSA Disease Outbeak Investigation Teams CDPH Hazadous Mateials Response Teams Fie and Rescue Mutual Aid Coodinato Mobile Field Hospitals EMSA 5-8 Mach 2008

71 Section 6 RECP Medical and Health Subsidiay Plan Citical Action Sheets

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73 Regional Emegency Coodination Plan RECP Medical and Health Subsidiay Plan Citical Action Sheets Section 6 Citical Action Sheets This section of the RECP Medical and Health Subsidiay Plan contains six citical action sheets that ae to be used duing confeence calls to collect infomation petinent to each medical health function; to povide consistency acoss the egion in odes, teatment, messaging, and situation status; and to descibe consideations fo optimizing action planning and esponse. The citical action sheets include: Mass Casualty: to suppot Opeational Aea activation of mass casualty opeations and coodinate esponse acoss multiple Opeational Aeas Mass Dispensing: to suppot Opeational Aea activation of mass dispensing sites and coodinate esponse acoss multiple Opeational Aeas to optimize delivey of mass pophylaxis to the population Quaantine and Isolation: to suppot Opeational Aea activation of isolation and quaantine opeations and coodinate esponse acoss multiple Opeational Aeas Hospital Evacuation: to suppot hospital evacuation opeations and coodinate esponse acoss multiple Opeational Aeas; also includes evacuation of skilled nusing facilities, assisted living centes, and othe congegate cae facilities Coodination with Medical Cae: to suppot Opeational Aea activation of medical cae sheltes and coodinate esponse acoss multiple Opeational Aeas Coodination with Copoate Command Centes: to ensue that pivate-secto health cae and othe patnes ae able to access copoate facilities in the affected aea to assist with hospital evacuation and to povide needed supplies; povide coodination and communication with copoate command centes, as needed. The citical action sheets ae fo use in the REOC by the REOC Duty Office, the REOC Diecto, the REOC Opeations Section Chief, the REOC Medical Health Banch Diecto, and the REOC Planning Section, as those positions ae activated and staffed. Each county o Opeational Aea Medical Health Banch is esponsible fo implementing the medical potion of a esponse to an emegency. It is assumed that Medical Health Depatment Opeations Centes ae activated as well as Opeational Aea EOCs. The MHOAC manages esouce equests, which ae communicated to the RDMHC. OES Coastal Region initiates confeence calls with MHOACs, Health Offices, and the Opeational Aea EOC Medical Health Banch Coodinatos in all counties to addess esouce allocations when multiple Opeational Aeas ae involved. Mach

74 RECP Medical and Health Subsidiay Plan Citical Action Sheets Regional Emegency Coodination Plan The REOC may equest that inteagency and intedisciplinay epesentatives and outside expets paticipate in the confeence calls. Such paticipants may include law enfocement, tanspotation, legal counsel, logistics, public infomation offices, and medical and health subject aea expets. If the REOC Medical Health Banch is not staffed, and the RDMHC is not available in a timely manne, the REOC Diecto and othe pesonnel at the REOC may conduct citical actions, including convening confeence calls. 6-2 Mach 2008

75 Regional Emegency Coodination Plan RECP Medical and Health Subsidiay Plan Citical Action Sheets Citical Action Sheet Mass Casualty Collect Infomation/Assess Situation Convene a confeence call when status epots indicate a need fo REOC assistance. Gathe status and equiements fom Opeational Aea EOCs via phone calls o situation epots: Numbe and types (injuy, illness, buns, chemical, adiological exposue, espiatoy, cadiac aest, enteic illness) of casualties in each Opeational Aea Numbe of field teatment sites activated o unde consideation* Numbe of altenate cae sites activated o unde consideation Facility o site status and poblems Hospital status and poblems Staffing status/poblems Secuity status/poblems Tanspotation status/poblems fo mass casualty esponse Equipment/supplies status/poblems Public infomation status Patient tacking issues Special needs populations status/poblems Level of cae and health office odes. Gathe additional infomation about the situation and povide to Opeational Aeas. Infomation to be obtained fom the RDMHC and RDMHS in othe pats of the state, and fom legal counsel, the CDPH, CDC, the Sugeon Geneal, U.S. Public Health Sevice, U.S. Depatment of Homeland Secuity, and medical subject aea expets. Povide Resouces to Suppot Mass Casualty Opeations Suppot Opeational Aea esouce needs: Boke povision of esouces fom othe Opeational Aeas (MHOAC to RDMHC in the Medical Health Mutual Aid System) Boke povision of esouces fom othe egions and the state Refe esouce needs to discipline-specific mutual aid coodinatos (fie, law, and coone) Task state agencies to povide esouces (must be appoved by REOC Diecto) Request assistance fom othe states and Fedeal assets (REOC to the JEOC and SOC to the Fedeal esouces) Tack pogess of esouces and povide updates to the Opeations Section Chief and Logistics Section Chief SUPPORT ISSUANCE OF ConsistenT Health Office Odes Medical Potocols Suppot Opeational Aea health offices with issuance of consistent odes and medical potocols concening level of cae and acute medical cae: Convene confeence calls with County health offices and the State Health Office fo decision-making and infomation shaing; calls may be facilitated by the JEOC o the CDPH Shae guidance o diectives fom the CDPH, the State Public Health Office, and Fedeal officials Distibute legal infomation to authoities, as appopiate Distibute consistent medical potocols, which may be issued by the CDPH, the CDC, o othe officials, if diffeent fom standing potocols. * Field teatment sites ae fo tiage and stabilizing: patients ae tansfeed if longe duation of cae is necessay. Altenate cae sites povide fo the full spectum of cae, usually fo the duation of an illness and activated because usual cae sites (hospitals) ae ovewhelmed. Mach

76 RECP Medical and Health Subsidiay Plan Citical Action Sheets Regional Emegency Coodination Plan Citical Action Sheet Mass Casualty Povide ConsisteNT Public Infomation fo Mass Casualty Response Convene confeence call with public infomation offices (public health depatment, Opeational Aea o city public infomation offices) fom affected Opeational Aeas to coodinate dissemination of common infomation. Calls may be facilitated by state isk communications staff. Coect, evise, o update infomation to be included in Opeational Aea public infomation messages fo mass casualty esponse. Incident Action Planning OptimizE Response Opeations Fom confeence calls with health offices, MHOACs, the RDMHC and RDMHS, Opeational Aea Medical Health Banch Coodinatos, the CDPH, and othes, and status epots and esouce equests, conside altenate appoaches to solve esouce shotfalls and optimize use of esouces. Fo mass casualty opeations detemine whethe: Thee is a need to tansfe patients to facilities teating simila illness and conditions The field teatment site is ovewhelmed and patients can be fowaded out of the Coastal Region o out of the state OES Coastal Region can assist with the identification of non-taditional facilities fo field teatment site o altenate cae sites (hotels, vacant offices, cuise ships, bages and feies) OES Coastal Region can help obtain statewide waives to use non-taditional/unlicensed staff fo field teatment sites and altenate cae sites OES Coastal Region can help obtain waives of egulations that impede immediate delivey of phamaceuticals and othe necessay medical inteventions Additional suppot is equied fo special needs populations. Additional Infomation fo mass casualty esponse Mobile Field Hospital The Mobile Field Hospital is activated when thee is a need to eplace acute hospital cae fo a peiod of seveal weeks. The Mobile Field Hospital capacity in Califonia is cuently planned fo 600 beds deployed as thee, 200 bed hospitals. Mobile Field Hospital assets ae deployed by EMSA. Fedeal Medical Station The U.S. Depatment of Health and Human Sevices Fedeal Medical Station is a cache of medical supplies and equipment that can be used to set up a tempoay non-acute medical cae facility. Fedeal medical station assets ae managed and deployed fom the CDC Stategic National Stockpile Pogam. Each station contains beds, supplies, and medicine to teat 250 people fo up to 3 days. The Opeational Aea EOC povides logistical suppot fo the set up and management of the Fedeal medical station when it is deployed. Fedeal medical stations ae deployed pe fou levels of esponse; howeve, cuently deployable esouces ae only fo a Level 1 esponse (tents). 6-4 Mach 2008

77 Regional Emegency Coodination Plan RECP Medical and Health Subsidiay Plan Citical Action Sheets Citical Action Sheet Mass Dispensing Collect Infomation and Assess Situation Convene a confeence call when status epots indicate a need fo REOC assistance. Gathe mass dispensing status and equiements fom Opeational Aea EOCs via phone calls and/o situation epots: Numbe of mass dispensing sites activated in each Opeational Aea Patient flow ate pe hou Hous of opeation at dispensing sites and how many to be pophylaxed in next 24 hous Facility types (if these data ae needed based on assistance equests) Stategic National Stockpiles status (equest fom Goveno, delivey, the Stategic National Stockpile Receiving, Staging, and Stoing Site staging, distibution, secuity) Staffing status/poblems Secuity status/poblems Tanspotation to dispensing sites status/poblems Equipment and supplies status and poblems Public infomation status Special needs population status and poblems. Gathe additional infomation about the situation and povide to Opeational Aeas. Infomation will be obtained fom RDMHSs in othe pats of the state, and fom legal counsel, the CDPH, CDC, the Sugeon Geneal, U.S. Public Health Sevice, U.S. Depatment of Homeland Secuity, United States Amy Medical Reseach Institute fo Infectious Diseases, and medical subject aea expets. Povide Resouces to Suppot Mass Dispensing Opeations Suppot Opeational Aea esouce needs: Boke povision of esouces fom othe Opeational Aeas (MHOAC to RDMHC in the Medical Health Mutual Aid System) Boke povision of esouces fom othe egions (RDMHC to RDMHC and REOC) Refe esouce needs to discipline-specific mutual aid coodinatos (fie, law, and coone) Task state agencies to povide esouces (must be appoved by the REOC Diecto) Request assistance fom othe states and Fedeal assets (REOC to the JEOC and SOC to Fedeal esouces) Tack pogess of esouce povision and povide updates to Opeations Section Chief and Logistics Section Chief. SUPPORT ConsistenT Health Office Odes Medical Potocols Suppot Opeational Aea health offices in issuing consistent odes and medical potocols: State convenes confeence calls with County health offices, MHOACs, and the State Health Office fo decisionmaking and infomation shaing Shae guidance o diectives fom the Depatment of Health Sevices and State Public Health Office and Fedeal officials, including guidance on pioitization of population pophylaxis Distibute legal infomation to authoities, as appopiate Distibute consistent medical potocols, dosing infomation, advese eactions, containdications, altenative pophylaxis, etc.; consistent medical potocols may be issued by the CDPH, the CDC, o othe officials Mach

78 RECP Medical and Health Subsidiay Plan Citical Action Sheets Regional Emegency Coodination Plan Citical Action Sheet Mass Dispensing PROVIDE ConsistenT Public Infomation fo Mass Dispensing Convene confeence call with public infomation offices (public health depatment, Opeational Aea, o city public infomation offices) fom affected Opeational Aeas to coodinate dissemination of common infomation. Coect, evise, o update infomation to be included in Opeational Aea public infomation messages fo mass dispensing Incident Action Planning OptimizE Response Opeations Fom confeence calls with Health Offices, MHOACs, the RDMHC and RDMHS, Opeational Aea Medical Health Banch Coodinatos, and othes, and status epots and esouce equests, conside altenate appoaches to solve esouce shotfalls and optimize use of esouces. Fo mass dispensing, detemine whethe: Dispensing sites can be combined acoss Opeational Aeas and whethe thee ae any dispensing sites nea juisdictional bodes that can be combined Any Opeational Aea dispensing opeations ae complete and can be accommodated to additional site flow Thee ae any suggestions fo additional staffing acoss Opeational Aeas; whethe non-taditional and unlicensed pofessionals can dispense; and whethe a statewide waive is needed Any altenate methods (e.g., dive-though and steet delivey) ae eady to activate o ae in use The Health Office can econside the equiement fo tageted o mass population to eceive pophylaxis. Additional infomation fo mass dispensing The CDPH equies county public health depatments to pepae plans to dispense medications and/o vaccines to the entie population within 6 to 10 days. Pe-designated mass dispensing sites in local juisdictions ae activated fo the 6 to 10 day timefame. Plans also ae in place to povide tageted o mass emegency pophylaxis within 48 hous of the health office s ode. Othe distibution methods, including doo-to-doo, mail delivey, and dive-though delivey, ae needed fo the 48 hou timefame. Each county has detemined the numbe of sites that will be activated fo diffeent scenaios. Local phamaceutical stockpiles ae used initially fo pioity pophylaxis of emegency wokes. County plans include pioity pophylaxis policies and pocedues. The Stategic National Stockpile aives within 12 hous. The Stategic National Stockpile is equested by the Goveno in a confeence call involving the JEOC and SOC and the Goveno s Office. The eceiving, staging, and stoing site is located at a pe-designated facility in the county. The Opeation Aea EOC Logistics Section is the lead fo the set-up and management of the eceiving, staging, and stoing site. Opeational Aea EOC suppot to mass dispensing sites involves the tanspot of medical supplies and phamaceuticals and e-supply, secuity in oute and at dispensing sites, staffing, voluntee management, and woke and voluntee suppot sevices. 6-6 Mach 2008

79 Regional Emegency Coodination Plan RECP Medical and Health Subsidiay Plan Citical Action Sheets Citical Action Sheet Quaantine and Isolation Collect Infomation/Assess Situation Convene a confeence call when status epots indicate a need fo REOC assistance. Gathe quaantine isolation status and equiements fom Opeational Aea EOCs via phone calls o situation epots: Numbes needing isolation o quaantine in each Opeational Aea Type of isolation o quaantine (home, hospital, othe facility) Stategic National Stockpile status, if equied (equest fom Goveno, delivey, eceiving, staging, and stoing staging, distibution, secuity) Legal and cout due pocess status/poblems Staffing status/poblems Secuity status/poblems Tanspotation fo isolation and quaantine esponse status and poblems Equipment and supplies status and poblems Public infomation status Special needs populations status and poblems Health Office odes issued. Gathe additional infomation about the situation and povide to Opeational Aeas. Infomation will be obtained fom RDMHCs in othe pats of the state, and fom legal counsel, the CDPH, CDC, the Sugeon Geneal, U.S. Public Health Sevice, U.S. Depatment of Homeland Secuity, and medical subject aea expets. Povide Resouces to Suppot Quaantine isolation Opeations Contact Opeational Aeas and detemine esouce needs. Suppot Opeational Aea esouce needs: Boke povision of esouces fom othe Opeational Aeas (MHOAC to RDMHC in the Medical Health Mutual Aid System) Boke povision of esouces fom othe egions (RDMHC to RDMHC and REOC) Refe esouce needs to discipline-specific mutual aid coodinatos (fie, law, and coone) Task state agencies to povide esouces (must be appoved by REOC Diecto) Request assistance fom othe states and Fedeal assets (REOC to the JEOC and SOC to Fedeal esouces) Tack pogess of esouce povision and povide updates to Opeations Section Chief and Logistics Section Chief. SUPPORT ConsistenT Health Office Odes Medical Potocols Suppot Opeational Aea health offices with issuance of consistent odes and medical potocols: Convene confeence calls with County health offices and State Health Office fo decision-making and infomation shaing Shae guidance o diectives fom Depatment of Health Sevices and State Public Health Office and Fedeal officials Distibute legal infomation to authoities, as appopiate Distibute consistent medical potocols, which may be issued by the CDPH, the CDC, o othe officials. Mach

80 RECP Medical and Health Subsidiay Plan Citical Action Sheets Regional Emegency Coodination Plan Citical Action Sheet Quaantine and Isolation PROVIDE ConsistenT Public Infomation fo Isolation and Quaantine Convene confeence call with public infomation offices (public health depatment, Opeational Aea, o city public infomation offices) fom affected Opeational Aeas to coodinate dissemination of common infomation. Coect, evise, o update infomation to be included in Opeational Aea public infomation messages fo isolation and quaantine. Incident Action Planning OptimizE Response Opeations Fom confeence calls with health offices, MHOACs, RDMHC, Opeational Aeas, Medical Health Banch Coodinatos, and othes, and status epots and esouce equests, conside altenate appoaches to solve esouce shotfalls and optimize use of esouces. Fo isolation and quaantine, detemine whethe: The logistics and esouces of suppot sevices can be combined acoss Opeational Aeas if home isolation is implemented, The Health Office would conside combining individuals with simila illnesses o conditions in facilities fo isolation o quaantine if this optimizes delivey of suppot sevices and use of esouces When detemining a egional coodination ole, conside whethe: The pivate secto (gocey stoes and phamacies) can be mobilized to assist with the delivey of suppot sevices duing home isolation o quaantine Online shopping (goceies and phamacies) can be inceased and facilitated Telecommuting can facilitate home quaantine Online banking can be facilitated fo new uses Thee is a need to coodinate with school disticts fo altenate school aangements Additional suppot is equied fo special needs populations, and what type Mass pophylaxis is occuing simultaneously (see Mass Dispensing Citical Action Sheet) Legal actions (due pocess cout heaings) can be accomplished en masse instead of by individual (this may equie a statewide waive o uling) Law enfocement pesonnel can be assigned acoss juisdictions Facilities can be meged (see the Mass Casualty Citical Action Sheet altenate cae sites) ADDITIONAL infomation fo quaantine and isolation opeations The Quaantine and Isolation Coodination Citical Action Sheet is activated when one o moe of the following situation occus: An isolation o quaantine ode is issued by the health office in one juisdiction when the disease agent is highly communicable and the numbe of ill patients exceeds the capacity to isolate in existing hospital isolation beds An anticipated o actual incident (disease outbeak) equies activation Opeational Aea(s) equest isolation and quaantine suppot Aea health offices detemine the need to povide mass isolation o quaantine. Isolation and quaantine ae two public health stategies designed to potect the public by peventing exposue to infected o potentially infected pesons. Both isolation and quaantine may be conducted voluntaily o compelled on a mandatoy basis though legal authoity. 6-8 Mach 2008

81 Regional Emegency Coodination Plan RECP Medical and Health Subsidiay Plan Citical Action Sheets Citical Action Sheet Quaantine and Isolation The health office is esponsible fo issuing odes to isolate o quaantine individuals o goups of individuals. Due pocess is equied when such odes ae contested. Public health depatment plans fo isolation and quaantine addess social distancing and home isolation o quaantine as the most likely equiements. The plans also addess situations whee individuals o goups would need to be isolated at existing hospitals o othe facilities. Definitions: 1. Communicable Disease An illness due to a specific micobiological o paasitic agent o its toxic poducts which aises though tansmission of that agent o its poducts fom an infected peson, animal, o inanimate esevoi to susceptible host, eithe diectly o indiectly though an intemediate plant o animal host, vecto, o the inanimate envionment (17 CCR 2500 (a) (7)). 2. Isolation Isolation is defined as sepaation of infected pesons fom othe pesons fo the peiod of communicability in such places and unde such conditions as will pevent the tansmission of the infectious agent (17 CCR 2515). 3. Stict Isolation If the disease equies stict isolation, the health office shall ensue that instuctions ae given to the patient and membes of the household, defining the aea within which the patient is to be isolated and stating the measues to be taken to pevent the spead of disease (17 CCR 2516). 4. Modified Isolation If the disease is one in which only a modified isolation is equied, the local Health Office shall issue appopiate instuctions, pescibing the isolation technique to be followed. The isolation technique will depend upon the disease (17 CCR 2518). Quaantine 5. Quaantine is defined as the limitation of feedom of movement of pesons o animals that have been exposed to a communicable disease fo a peiod of time equal to the longest usual incubation peiod of the disease, in such manne as to pesent effective contact with those not so exposed (17 CCR 2520). Mach

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83 Regional Emegency Coodination Plan RECP Medical and Health Subsidiay Plan Citical Action Sheets Citical Action Sheet Hospital Evacuation Collect Infomation/Assess Situation Convene a confeence call when status epots indicate a need fo REOC assistance. Gathe status and equiements fom Opeational Aea EOCs via phone calls and/o situation epots: Numbe of hospitals evacuating in each Opeational Aea Numbe of patients and type of beds/level of cae equied Numbe of altenate cae sites activated o unde consideation Coodinate with the CDPH fo licensing and cetification issues Staffing status/poblems Secuity status/poblems Tanspotation status/poblems fo evacuation Equipment/supplies status/poblems Public infomation status Special needs populations status/poblems Status of skilled nusing facilities as potential sites to eceive evacuated hospital patients. Povide Resouces to Suppot Hospital Evacuation Opeations Contact Opeational Aeas and detemine esouce needs. Suppot Opeational Aea esouce needs: Boke povision of esouces fom othe Opeational Aeas (MHOAC to RDHMC in the Medical Health Mutual Aid System); fo example, availability of simila beds and esouces so patients can be moved just once Boke povision of esouces fom othe egions (RDMHC to RDMC and REOC) Contact pivate- and public-secto hospital ownes/opeatos fo esouce availability (hospital beds); include CDPH licensing and cetification fo lifting of egulations Refe esouce needs to discipline-specific mutual aid coodinatos (fie, law, and coone) Task state agencies to povide esouces (must be appoved by REOC Diecto) Request assistance fom othe states and Fedeal assets (REOC to the JEOC and the SOC to Fedeal esouces) Tack pogess of esouce povision and povide updates to Opeations Section Chief and Logistics Section Chief. Incident Action Planning OptimizE Response Opeations Fom confeence calls with Health Offices, MHOACs, RDMHC, Opeational Aea Medical Health Banch Coodinatos, the CDPH, and othes, and status epots and esouce equests, conside altenate appoaches to solve esouce shotfalls and optimize use of esouces. Fo hospital evacuation opeations, conside: Whethe logistical suppot can be bought in a timely manne to avoid evacuation Requesting CAL-MATs and DMATs to assist with cae duing evacuation and at eceiving sites Requesting activation of the National Disaste Medical System The need fo tansfe of patients to cohot simila illnesses and conditions Whethe patients can be sent out of the Coastal Region o out of the state Requests fo ai ambulance tanspot o militay medical evacuation ai tanspotation. Mach

84 RECP Medical and Health Subsidiay Plan Citical Action Sheets Regional Emegency Coodination Plan Citical Action Sheet Hospital Evacuation ADDITIONAL infomation fo hospital evacuation opeations Hospitals may be evacuated in situations of significant damage, long-tem powe outage, and failue of back-up systems. Hospitals may be patially evacuated in cetain mass casualty incidents o when potions of a hospital ae equied fo isolation. Acute cae hospitals, skilled nusing facilities, assisted living centes, and othe congegate cae facilities may need to be evacuated. The REOC may become involved when two o moe hospitals equie assistance to evacuate patients. Cuent hospital planning includes activation of altenate cae sites fo evacuation o to incease capacity. Altenate cae sites ae established by a hospital, with suppot fom the Medical Health Banch of the Opeational Aea EOC Mach 2008

85 Regional Emegency Coodination Plan RECP Medical and Health Subsidiay Plan Citical Action Sheets Citical Action Sheet Coodination with Medical Cae Sheltes Collect Infomation/Assess Situation Convene a confeence call when status epots indicate a need fo REOC assistance. Gathe medical cae shelte status and equiements fom Opeational Aea EOCs via phone calls and/o situation epots: Numbe equiing medical cae in each Opeational Aea Types of medical cae needed (dialysis, espiatoy, elde cae, suppotive cae) Numbe of medical cae sheltes activated o unde consideation Coodinate with the CDPH fo licensing and cetification issues Facility o site status and poblems Staffing status/poblems Secuity status/poblems Tanspotation status/poblems fo medical cae sheltes Equipment/supplies status/poblems Public infomation status Level of cae consistency acoss the egion. Gathe additional infomation on the situation and povide to Opeational Aeas. Infomation will be obtained fom the RDMHC and RDMHS in othe pats of the state, fom legal counsel, the CDPH, and medical and mental health subject aea expets. Povide Resouces to Suppot MEDICAL CARE SHELTERS Opeations Suppot Opeational Aea esouce needs: Boke povision of esouces fom othe Opeational Aeas (MHOAC to RDMHC in the Medical Health Mutual Aid System) Boke povision of esouces fom othe egions (RDMHC to RDMHC and REOC) Boke esouces fom povide agencies: Medical Reseve Cops, Community Emegency Response Teams, DMATs, and state and Fedeal health cae wokes Refe esouce needs to discipline-specific mutual aid coodinatos (fie, law, and coone) Task state agencies to povide esouces (must be appoved by REOC Diecto) Request assistance fom othe states and Fedeal assets (REOC to the JEOC and the SOC to Fedeal esouces) Tack pogess of esouce povision and povide updates to the Opeations Section Chief and Logistics Section Chief. SUPPORT ConsistenT Public Infomation fo Medical Cae Sheltes Convene a confeence call with public infomation offices (public health depatment, Opeational Aea, o city public infomation offices) fom affected Opeational Aeas to coodinate dissemination of common infomation. Coect, evise, o update infomation to be included in Opeational Aea public infomation messages fo medical cae shelte esponse. Mach

86 RECP Medical and Health Subsidiay Plan Citical Action Sheets Regional Emegency Coodination Plan Citical Action Sheet Coodination with Medical Cae Sheltes Incident Action Planning OptimizE Response Opeations Fom confeence calls with health offices, MHOACs, RDMHC, Opeational Aea Medical Health Banch Coodinatos, and othes, and status epots and esouce equests, conside altenate appoaches to solve esouce shotfalls and optimize use of esouces. Fo medical cae shelte opeations, conside whethe: Thee is a need to tansfe patients to cohot simila illnesses o conditions Patients can be sent out of the Coastal Region o out of state if medical cae shelte capacity is ovewhelmed OES Coastal Region can assist with the identification of non-taditional facilities fo medical cae sheltes (hotels, vacant offices, and cuise ships) OES Coastal Region can help obtain statewide waives to use non-taditional/unlicensed staff fo medical cae sheltes Coastal Region can help obtain waives of egulations that impede immediate delivey of phamaceuticals and othe necessay medical inteventions Additional suppot is equied fo special needs populations. futhe infomation fo coodination with medical cae sheltes Taditional sheltes that follow established pocedues will not accept pesons who ae unable to cae fo themselves and equie a cae give in attendance. Medical cae sheltes may be activated to eceive evacuated patients fom skilled nusing facilities o esidents fom an evacuation aea who ae caed fo by family membes o home health cae povides, o who although not unde cae, now equie assistance. Pesons equiing medical shelteing duing geneal evacuation may include individuals fom esidential cae facilities. Hospitalization is not equied. Each Opeational Aea/Medical Health Banch is esponsible fo implementing medical cae shelte esponse. Medical cae sheltes ae coodinated by the Cae and Shelte Banch and the Medical Health Banch of the EOC. Assessment teams, including EMSA, the CDPH, OES, and local authoities, inspect buildings that ae to be used as sheltes Mach 2008

87 Regional Emegency Coodination Plan RECP Medical and Health Subsidiay Plan Citical Action Sheets Citical Action Sheet Coodination with Hospital Copoate Command Centes Collect Infomation/Assess Situation The JEOC convenes a confeence call of hospital copoate offices when status epots indicate a need fo REOC assistance to hospitals. Gathe status and equiements fom Opeational Aea EOCs via phone calls o situation epots: Numbe of hospitals needing esouces o evacuating in each Opeational Aea Numbe of patients and type of beds/level of cae equied Numbe of altenate cae sites activated o unde consideation Staffing status/poblems Secuity status/poblems Tanspotation status/poblems fo evacuation Equipment/supplies status/poblems Public infomation status Special needs population s status/poblems. Povide Resouces to Suppot Hospital Opeations Contact Opeational Aeas and detemine esouce needs. Suppot Opeational Aea esouce needs: Contact hospital paent copoate command centes to detemine availability of outside pivate esouces Contact Ameican Medical Response and othe copoate ambulance company command centes to detemine availability of outside pivate esouces Coodinate with Opeational Aeas to mitigate potential poblems o delay in access to the disaste aea by ai o gound tanspotation aanged and managed by the paent copoation Infom appopiate mutual aid coodinatos about hospital paent copoate esouces so that these esouces can be included in the logistics plan to delive esouces to the aea by ailift and gound tanspotation Request status epots fom the hospital paent copoation command cente concening the status of opeations to bing outside esouces in to affected hospitals. Incident Action Planning Optimize Response Opeations Conside whethe outside, pivate copoate logistical suppot and esouces (e.g., geneatos, medical supplies, and staff) can be bought in a timely manne to avoid evacuation of a hospital. Conside equesting assistance fom hospital paent copoate command centes to mobilize clinical staff fom outside the aea to help duing hospital evacuations and/o to staff fo altenate cae sites, field teatment sites, and mobile field hospitals. Conside whethe patients can be sent out of the OES Coastal Region o out of state to affiliated hospitals within a egional o national copoate hospital system. Mach

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89 Appendix A RECP Medical and Health Subsidiay Plan List of Aconyms

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91 Regional Emegency Coodination Plan RECP Medical and Health Subsidiay Plan List of Aconyms Appendix A List of Aconyms CAL-MAT CBRNE CCR CDC CDPH DMAT EMS EMSA EOC ESF FEMA JEOC LEMSA MHOAC MMRS NIMS OES OHS PPE RDMHC RDMHS RECP REOC RIMS SEMS SOC U.S.C. Califonia Disaste Medical Assistance Team Chemical, Biological, Radiological, Nuclea, Explosive Califonia Code of Regulations Centes fo Disease Contol and Pevention Califonia Depatment of Public Health Disaste Medical Assistance Team Emegency Medical Sevices Emegency Medical Sevices Authoity Emegency Opeations Cente Emegency Suppot Function Fedeal Emegency Management Agency Joint Emegency Opeations Cente Local Emegency Medical Sevices Agency Medical Health Opeational Aea Coodinato Metopolitan Medical Response System National Incident Management System Goveno s Office of Emegency Sevices Goveno s Office of Homeland Secuity Pesonal Potective Equipment Regional Disaste Medical Health Coodinato Regional Disaste Medical Health Specialist Regional Emegency Coodination Plan Regional Emegency Opeations Cente Response Infomation Management System Standadized Emegency Management System State Opeations Cente United States Code Mach 2008 A-1

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93 Appendix B RECP Medical and Health Subsidiay Plan Regional Disaste Medical Health Coodinato Notification Advisoy Citeia

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95 Regional Emegency Coodination Plan RECP Medical and Health Subsidiay Plan Regional Disaste Medical Health Coodinato Notification Advisoy Citeia Appendix B Regional Disaste Medical Health Coodinato Notification Advisoy Citeia The Regional Disaste Medical Health Coodinato (RDMHC) Medical Health Notification Advisoy is an alet that signifies that an incident has occued, o conditions exist, that may tax the medical/health esouces of the affected Opeational Aea. Medical Health Opeational Aea Coodinatos (MHOACs) ae esponsible fo contacting the RDHMC when an emegency o disaste has occued o when an imminent theat is identified. Examples of conditions waanting notification of the RDMHC may include: Sustained powe outage affecting the majoity of hospitals Staffing shotage significantly affecting the numbe of available hospitals beds Divesion of ambulances fom the majoity of hospitals Planned event with potential fo majo impact on medical/health esouces (e.g., numbe of people plus weathe conditions and/ o plus in-county esouce esponse availability) Evacuation(s) o anticipated evacuation of an in-patient esouce (e.g., skilled nusing facility, hospital) Declaation of local emegency Activation of Opeational Aea Emegency Opeations Cente Activation of an Opeational Aea Medical and Health Depatment Opeations Cente Hospital activating intenal and/o extenal emegency plans Any othe situation that theatens to ovewhelm the local medical/health esouces. Mach 2008 B-1

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97 Appendix C RECP Medical and Health Subsidiay Plan REOC Medical Health Banch Diecto Checklist

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99 Regional Emegency Coodination Plan RECP Medical and Health Subsidiay Plan REOC Medical Health Banch Diecto Checklist Appendix C REOC Medical Health Banch Diecto Checklist This Appendix povides a checklist fo use by the Regional Emegency Opeations Cente (REOC) Medical Health Banch Diecto. The REOC medical and health function is esponsible fo coodinating esouces within the egion, pioitizing esouces, distibuting esouces, and monitoing egionwide medical and health status. The REOC Medical and Health function is compised of epesentatives of two state agencies Emegency Medical Sevices Authoity (EMSA), epesenting medical, and the Califonia Depatment of Public Health (CDPH), epesenting health (i.e., public health). These agencies wok closely togethe to fulfill the tasks of the REOC medical and health function and may seve as the REOC Medical Health Banch Diecto. In many situations, the State Opeations Cente (SOC) activation of the Opeations Section may be minimal and the ole of the medical health function will be focused on monitoing statewide medical and health status and esouces at the REOC. Repots to: REOC (Deputy) Opeations Section Chief Supevises: Medical & Health Assistants Coodinates with State, Pivate, and fedeal agencies, as follows. State Califonia Depatment of Health Sevices Emegency Medical Sevices Authoity Califonia Depatment of Social Sevices Califonia Depatment of Mental Health Califonia National Guad Califonia Highway Patol Califonia Occupational Safety and Health Administation Califonia Depatment of Foesty and Fie Potection Califonia Envionmental Potection Agency Pivate Califonia Healthcae Association Califonia Ambulance Association Emegency Medical Sevices Administatos Association of Califonia Ameican Red Coss Salvation Amy Fedeal Depatment of Health and Human Sevices Centes fo Disease Contol and Pevention Office of the Assistant Secetay fo Public Health and Emegency Pepaedness National Disaste Medical System Mach 2008 C-1

100 RECP Medical and Health Subsidiay Plan REOC Medical Health Banch Diecto Checklist Regional Emegency Coodination Plan Depatment of Veteans Affais ESF #8 Public Health and Medical Sevices REOC Medical Health Responsibilities Activation Phase Repot to the REOC (Deputy) Opeations Section Chief. Begin a Medical Health Banch Diecto Duty Log. Opeational Phase Establish and maintain communications with the SOC Medical Health Banch Coodinato. Coodinate the medial and health esouces of the pivate and public sectos, and state and Fedeal esouces among egions. Monito and tack all medical and health esouces fom initial assignment to elease. Assist in obtaining fedeal esouces as needed following the equest fo fedeal esouces potocol. Ensue all tasked medical and health esouces ae pefoming the tasks assigned. Coodinate the mobilization and tanspotation of Disaste Medical Assistance Teams within the egion. Coodinate the mobilization of the Disaste Motuay Opeational Response Teams with the REOC Coone Unit and/ o Law Enfocement Banch. Establish and maintain a tacking system of injued pesons who ae moved fom state-opeated egional evacuation points to medical teatment facilities in unaffected aeas of the egion. Establish contact and coodinate with necessay state and fedeal agencies. Evaluate and pioitize medical and health equest fom egions based on citeia established by the Opeations Section Chief and detemine appopiate esponse ecommendations. Obtain medical and health pesonnel, supplies, and equipment though established mutual aid pocedues. Monito medical and health esouce availability. Repot infomation about medical and health concens, events, and occuences to the REOC Diecto. Notify the REOC (Deputy) Opeations Section Chief about any equest to alte a mission. C-2 Mach 2008

101 Regional Emegency Coodination Plan RECP Medical and Health Subsidiay Plan REOC Medical Health Banch Diecto Checklist Coodinate with Fedeal ESF #8 Public Health and Medical Sevices. Bief the REOC (Deputy) Opeations Section Chief, as needed. Demobilization Phase Notify the SOC and state, and Fedeal countepat agencies that the REOC Medical Health Banch is demobilizing and whom they should contact fo futue coodination. Tun in final epots to the REOC (Deputy) Opeations Section Chief. Complete and tun in any outstanding time sheets and tavel claims. Closeout and tun in logs and documentation to the REOC Documentation Unit. Ensue section aea is cleaned. Tansfe outstanding pojects to appopiate full time staff o appopiate Joint Field Office staff. Tun in the completed exit suvey to REOC Pesonnel Unit. Tun in checkout equipment is etuned to the appopiate Unit. Check out at the REOC check-in aea. Paticipate in the afte action pocess. Applicable Pocedues REOC Activation (REOC 01) REOC Medical Health Banch Diecto Mach 2008 C-3

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103 Appendix D RECP Medical and Health Subsidiay Plan REOC Medical Health Banch Diecto Confeence Call Pocedues and Roll Call Sheet