Van Buren/Cass District Health Department

Transcription

1 Van Buren/Cass District Health Department Local Strategic National Stockpile (SNS) Plan Revised: 7/6/16 Page 1

2 Table of Contents Revision Tracking Log... 3 Attachments... 5 Section 1 Introduction and Planning... 8 Section 2 Command and Control Section 3 Requesting the SNS Section 4 Tactical Communications Section 5 Public Information and Communication Section 6 Security Section 7 Distribution Node (DN) Section 8 Inventory Management Section 9 Distribution (Transportation) Section 10 Dispensing Section 11 Treatment Center Coordination Section 12 Training, Exercise, and Evaluation Section 14 Emergency Contact Information Section 15 Emergency Preparedness Acronyms Page 2

3 SNS Revision Tracking Log Date Update(s) Made/Comments Initials 1/14 Included Whole community inclusion information into plan Jz 1/14 Revised tiered approach for dispensing Jz 7/14 Updated SNS Legal Issues Briefing Paper jz 7-14 Reorganized SNS to be in alignment with PPHR Jz Identified Roles/ Responsibilities Personnel & Material Resource Tracking Staffing needs Updated Adverse Reactions Included sample of flow diagram Addressed dispensing to individuals whom MCM is contraindicated Expanded on SNS legal issues Expanded on MCM tracking via MCIR 9/28/15 Annual Updates Updated MDHHS (MDCH) Updated Rules of Engagement for Security Updated Pharmacy Labeling Recommendations Inserted POD Audio/Video Files into Public Information Section (from CD) 12/11/2015 Updated Forms/Policies for Local SNS Plans Att. 001 MISNS Executive Summary (Redacted) Att. 1.5c MI Right of a Minor Laws Att. 1.5d Rules of Engagement Att. 1.6 SNS Legal Issues Att. 3.3a SNS Item Order Form Att. 3.3b LHD SNS Request Justification Form Att Tiered Approach for Dispensing Guidance 10.0 MDHHS NAPH Form Anthrax Cipro.Doxy 10.0 MDHHS NAPH Form Anthrax Cipro.Doxy.Red Tier 10.0 MDHHS NAPH Form Antiviral 10.0 MDHHS NAPH Form Plague Cipro.Doxy 10.0 MDHHS NAPH Form Tularemia Cipro.Doxy 3.0 SNS Transfer Form State to Local 6.0 State Sample_Local Security Guidance 2/2016 Updated contact info jz JZ JZ Page 3

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5 Attachments I. Section 1 Introduction and Planning Attachment 1.1a EOP Basic Plan Attachment 1.1b EOP Signature Page Attachment 1.1c EOP Table of Contents Attachment 1.1d NIMS Compliancy Documentation Attachment 1.3 Local Planning Committee Meeting Documentation Attachment 1.4 Memorandums of Agreement/Understanding (MOA/MOU) Attachment 1.5a Head of Household Policy Attachment 1.5b - Unaccompanied Minor Guidance Attachment 1.5c Michigan Laws Related to Rights of a Minor Attachment 1.5d Rules of Engagement Attachment 1.6 Legal Issues Briefing Paper Attachment 1.7 Federal Medical Stations Overview Attachment 1.8 IND and EUA Protocols Attachment 1.9 Medical Waste Management System Overview II. Section 2 Command and Control Attachment 2.4 Functional Lead Staff Quarterly Call-down Drill Results Attachment 2.5 Local Incident Command Charts III. Section 3 Requesting the SNS Attachment 3.3a SNS Item Order Form Attachment 3.3b LHD Request Justification Form Attachment 3.5 POD to Local Re-supply Request Procedures IV. Section 4 Tactical Communications Attachment 4.2 Communications Support Staff Job Action Guidelines (JAG) Attachment 4.3 Communication Systems Quarterly Test Results Attachment 4.4 Inter-Agency Communication Systems Matrix Attachment 4.5 Communication Pathways Quarterly Test Results Attachment 4.6b - Functional Lead Staff Communication Training Documentation V. Section 5 Public Information and Communication Attachment 5.1a Training Documentation for PIC Personnel Attachment 5.1b PIC Job Action Guides Attachment 5.2a Risk Communication Coordination Guidelines Attachment 5.2b Media Policy for DN and POD Sites Attachment 5.4 Messaging Templates Attachment 5.5 Public Information Partners and Media Contacts Attachment 5.6b Drug Fact Sheets Attachment 5.6c Category A Agent Fact Sheets Attachment 5.7a Translated Fact Sheets VI. Section 6 Security Page 5

6 Attachment 6.1b Security Lead Training Attachment 6.2 Security Escort Plans Attachment 6.3 Security Site Plans for DN and PODs Attachment 6.4b Badging Just-in-Time Training VII. Section 7 Distribution Node Attachment 7.1 DN Site Plans Attachment 7.2 DN Site Checklists Attachment 7.3 DN Written Agreements Attachment 7.5 DN Lead Job Action Guides Attachment 7.6 DN Lead Training Documentation Attachment 7.12 DN Lead Quarterly Call-Down Drill Results Attachment 7.13 DN Just-in-Time Training Attachment 7.14 DN Material Handling Equipment Inventory Attachment 7.17 DN Volunteer/Staff Management Plan Attachment 7.18 Cold Storage and Cold Chain Management for SNS Vaccines VIII. Section 8 Inventory Management Attachment 8.1a Primary Inventory Management System Attachment 8.1b Back-up Inventory Management System Attachment 8.1c Paper Inventory Management System Attachment 8.2b Inventory Management Staff Training Documentation Attachment 8.3 Chain of Custody Forms Attachment 8.6 MCIR Handbook Attachment 8.7a IMATS User Manual Attachment 8.7b IMATS Local Task List IX. Section 9 Distribution (Transportation) Attachment 9.1a Distribution Manager JAG Attachment 9.2 Distribution Strategy Attachment 9.3 Written Agreement with Primary Distribution Agency Attachment 9.4 Written Agreement with Back-up Distribution Agency Attachment 9.5 Local Air Transportation Plan Attachment 9.6 POD Material Handling Equipment (MHE) Inventory Attachment 9.7 Distribution Just in Time Training X. Section 10 Dispensing Attachment 10.1 POD Policies and Procedures Attachment 10.3 Closed POD Plans Attachment 10.4 Tiered Approach for Dispensing Guidance Attachment 10.5 Essential Personnel Closed POD Plan Attachment 10.6 Alternate Dispensing Modalities for Homebound and At-Risk Attachment 10.7 Open POD Site Plans Attachment 10.8 POD Supplies Attachment 10.9 POD Core Management Team Training Documentation Attachment POD Just-in-Time Training Materials Attachment POD Page 6

7 XI. Section 11 Treatment Center Coordination XII. Section 12 Training, Exercise, and Evaluation Attachment 12.3 Training and Exercise Planning Workshop (TEPW) Documentation Attachment 12.4 Local Multi-Year Training and Exercise Plan (MYTEP) Attachment 12.5 HSEEP Compliant After Action Reports Attachment 12.6 SNS Training Documentation XIII. Section 13 Demobilization XIV. Section 14 Emergency Contact Information Page 7

8 Section 1 Introduction and Planning Plan Organization The Van Buren/Cass District Health Department plan for distribution of the Strategic National Stockpile (SNS) was developed and is maintained to provide a comprehensive guidance for the receipt, distribution and dispensing of MISNS assets as quickly and efficiently as possible. Through deployment of the MISNS, the Van Buren/Cass District Health Department will work to protect the health of first responders and the general public within (describe your local jurisdiction). The Van Buren/Cass District Health Department SNS plan is an annex to the Emergency Operations Plan and is updated at least annually. Copies of the plan can be found in the office of the EPC and the Health Officer as well as on our Intranet, and Google Drive and with the Office of Public Health Preparedness at the Michigan Department of Community Health. The Van Buren/Cass District Health Department SNS plan been developed and is maintained to comply with National Incident Management System (NIMS) requirements. All supporting documentation can be found in the plan attachments for each section. Plan Maintenance The local public health Emergency Preparedness Coordinator (EPC) is responsible for maintaining and updating the SNS plan on a continual basis. The plan is also reviewed and updated annually based upon deficiencies noted during the SNS program assessments conducted by the State, and as a result of deficiencies identified during training and exercises. A revision tracking log is maintained as changes to the plan are made. Internal SNS planning and coordination is conducted in conjunction with Van Buren/Cass District Health Department administrative team staff meetings. In addition the SNS plan is thoroughly vetted by local County Emergency Managers and the Local Emergency Planning Council (LEPC) which is comprised of representatives from several disciplines including, public works, human services, volunteer organizations, schools, law enforcement, fire, emergency medical services, hospitals, private sector, and faith based organizations. Assistance with planning has also been rendered from 5 th District Medical Response Coalition Partners and Regional Epidemiologist as well as guidance and training from the Michigan Department of Community Health, Office of Public Health Preparedness. Copies of the entire Van Buren/Cass District Health Department SNS Plan is provided to County Emergency Managers, and to the Office of Public Health Preparedness at least annually or as requested. An updated copy of the SNS is also available on the agency Intranet for staff review. Requests to review the SNS plan by the public, the media or others who do not have a valid need to know will be at the discretion of the Van Buren/Cass District Health Department Health Officer or other authorized official. Page 8

9 Purpose The purpose of this plan is to provide a guide to the Van Buren/Cass District Health Department, and other assisting agencies, in responding to an incident that requires large-scale distribution and/or administration of medication or vaccination. Activation of the plan may or may not require a request for deployment of the Strategic National Stockpile (SNS). A description of the SNS program and its scope as well as guidance for an SNS component of mass medication dispensing is an important part of this plan. If confronted with an intentional or unintentional large scale exposure to a biological agent that threatens the public health, the priorities of the Health Department will be to assure the continuation and delivery of essential public health services while providing assistance to meet emergency needs for the affected population. This plan is the framework and guidelines for ensuring that an effective system of health and medically related emergency management is in place to contain adverse outcomes of such a large scale event. The VBCDHD SNS Plan is a direct reflection of local roles and responsibilities that have been integrated into the State of Michigan SNS Plan. (o8i) Requesting the SNS will require the coordination of many local, State, and Federal agencies. Those agencies can be found as partners within this plan. It is important to note that any plan of this type represents an evolutionary process that must be periodically reviewed and updated to ensure that its assumptions, resources, priorities, and strategies are consistent with current knowledge and changing infrastructure. In addition, in the event of actual largescale biological threat, the judgments of the public health leadership, based on epidemiology and extent of population exposure and/or infection, may alter or override anticipated strategies and plans. This plan specifies the activities, procedures and responsibilities that must occur or be assigned to maximize the effectiveness of the coordinated response to a biological, chemical, technological or natural disaster requiring the Strategic National Stockpile. This plan will detail what must occur at the local level from the time the material is received from federal authorities to when it is distributed, including the storage, and return of unused material. Mass prophylaxis will be provided to the population at risk within 48 hours of the decision to deploy the SNS in response to a large-scale public health emergency. In a worst-case scenario, Michigan will need to prophylax the entire population of 9,876,187 (2011 U.S. Census estimate). The Van Buren/Cass District Health Department would focus response on our 128,551 residents. Background: An act of terrorism against the U.S. civilian population or a major natural disaster may create a largescale public health emergency that would require rapid access to large quantities of pharmaceuticals and medical supplies. State and local governments do not have the resources to create sufficient pharmaceutical and medical stockpiles in preparation for such events. Therefore, a national stockpile has been created. In 1999 Congress charged the Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC) with the responsibility of establishing the National Pharmaceutical Stockpile (NPS) Program. The mission of the program was to establish and maintain strategically located stockpiles of large quantities of essential medical materiel that could be delivered Page 9

10 quickly to states and communities impacted by a terrorist attack, or other large-scale public health emergency. The Homeland Security Act of 2002 tasked the Department of Homeland Security (DHS) with defining the goals of the program as well as management of the assets. Effective March 1, 2003, the NPS became the Strategic National Stockpile (SNS), managed jointly by DHS and HHS. With the signing of the BioShield legislation on June 21, 2004 the SNS Program was returned to the HHS for oversight and guidance. In June 2005, the SNS Program was placed specifically under the Division of Strategic National Stockpile (DSNS) has the mission to deliver critical medical assets to the site of a national emergency. DSNS manages this SNS national repository of antibiotics, chemical antidotes, antitoxins, life-support medications, and medical supplies that can be used to supplement state and local resources during a large-scale public health emergency. The Division of State and Local Readiness (DSLR) administers the Public Health Emergency Preparedness (PHEP) Cooperative Agreement, which supports preparedness nationwide in state, local, tribal, and territorial public health departments. As of 2009, the cooperative agreement has provided nearly $7 billion to these public health departments to upgrade their ability to effectively respond to the public health consequences of all hazards, including infectious diseases, natural disasters, and biological, chemical, nuclear, and radiological events. The cooperative agreement currently funds 62 grantees including all 50 states, eight U.S. territories and freely associated states, and four localities. Overview of Emergency Medical Countermeasures in the SNS The SNS is a national repository of antibiotics, chemical antidotes, antitoxins, vaccines, antiviral drugs, and other life-saving Medical Countermeasures (MCM). The SNS is designed to supplement and resupply state and local public health agencies and healthcare facilities in the event of an emergency. It is organized for flexible response with five types of assets including the 12-Hour Push Pack (PPK), Managed Inventory (which includes vaccines), purchasing capabilities, MWMS and Federal Medical Stations (FMS). This plan focuses on operations involving the delivery of large quantities of materiel in PPKs and Managed Inventory. The PPKs are designed to provide rapid delivery to the State RSS (within 12 hours of the federal decision to deploy) of a broad range of assets for an undefined threat in the early hours of an event and are pre-positioned in strategically located warehouses throughout the United States. The PPKs consists of multiple containers of medical materiel and will be delivered via truck convoy or commercial cargo aircraft. One 12-Hour PPK: Contains more than 90 product categories including: Adult and pediatric oral drug preparations Intravenous drug preparations Emergency medications Intravenous (IV) catheters and administration sets Airway supplies Fluids for re-hydration Bandages Will arrive in 130 cargo containers (10,500 cubic feet of materiel) Weighs 100,000 lbs. (50 tons) Fills a wide-body jumbo cargo aircraft (747 or 767) If transported by ground, fills seven 53 foot semi tractor-trailers Is valued at $3,000,000 Page 10

11 Managed Inventory is intended to support a second phase response once the threat has been identified and/or the PPK needs replenishing. Managed Inventory could also be used as a first line of response if the threat is apparent from the beginning and the agent (e.g. anthrax) is known and well defined. Managed Inventory shipments of pharmaceuticals and/or medical supplies can be expected to arrive at the State RSS facility hours after requested and can be tailored for a specific event. Products shipped can be specific for suspected/confirmed agents. A Federal Medical Station (FMS) is a cache of medical supplies and equipment that can be used to set up a temporary non-acute medical care facility. FMS assets are managed and deployed by CDC s DSNS under the direction of HHS. Each FMS has beds, supplies, and medicine to treat 250 people for up to three days. The State of Michigan will work with the technical teams from DSNS to support FMS functions. The Medical Waste Management System (MWMS) provides a comprehensive medical waste solution for MCM received from the SNS. This resource is designed for rapid deployment and includes an array of services and products necessary to efficiently collect, package, store, dispose, and document the disposal of medical waste. See Attachment 1.7 Federal Medical Stations Overview See Attachment 1.9 Medical Waste Management System Overview Critical Functions: Command and Control: Coordination of each of the SNS functional areas Requesting the SNS: Actions the State of Michigan and local jurisdictions must take to officially request the SNS. Tactical Communications: Management of the communications between all SNS functions to ensure a smooth delivery of SNS material to those who need it. Public Information: Management of information provided to the public about what it must do to get prescribed drugs if they are asymptomatic and treatment if they are symptomatic. Security: Management of actions that safeguard the SNS and protect those who work to deliver it. Distribution Node Operations: Management of the SNS supplies includes receiving, staging and storing, and controlling inventory; Distribution Node facility; and recovering SNS assets from PODs. Inventory Management and Tracking: The ability to track SNS assets, to include down the lot number for pharmaceuticals and vaccines. Distribution: Coordination and movement of SNS supplies, including initial shipments and replenishment shipments for dispensing sites. Dispensing: The process of distributing SNS supplies for the purpose of mass prophylaxis and/or treatment of the symptomatic and/or asymptomatic population. Training, Exercise and Evaluation: Assessing the capabilities of responders and determining training needs; exercising the plan, determining the shortfalls, and revising the plan as appropriate. Demobilization: Activities conducted to deactivate SNS resources and implement appropriate recovery actions following an event. Page 11

12 Concept of Operations: (o9) (o9i) Staff Roles and Responsibilities: Roles and responsibilities for SNS functions as related to ESF 8: Public Health and Medical Services include all duties described in this plan including acquiring medical supplies and materials and distributing them to the public to save lives and promote health. (o9ii) Response Actions: (1) Acquire SNS Assets, (2) Arrange for and distribute materiel to the public, (3) Track assets, (4) Document results. (o9iii) When Response actions will occur: Response actions will begin as soon as possible after the activation of the SNS plan. (o9iv) Authority: These actions will occur under the authority of the Health Officer or his designee. (o9v) Documentation: Ensure response actions are documented and reported to the EOC utilizing form 201 or other approved documentation method. Lead Agencies: A. Lead and Support Agencies The departments, agencies and organizations list may not be all-inclusive. Additional organizations may be needed based on the incident. Lead Agencies: Michigan Department of Community Health Office of Public Health Preparedness 3423 N. Martin Luther King Jr. Blvd. PO Box Lansing, MI Business Hours: After Hours: (o8ii) Responsibilities: Provide assistance to VBCDHD as provided for in the state plan Credentialing process Standing orders Transportation of SNS to dispensing sites Michigan State Police Emergency Management Division 4000 Collins Rd. Lansing, MI To be contacted through the local EOC. Support Agencies: o Michigan Department of Military and Veterans Affairs o Michigan Department of Transportation o Michigan Department of Agriculture o Michigan Department of Attorney General o Michigan Department of Corrections o Michigan Department of Environmental Quality o Michigan Department of Information Technology o Michigan Department of Management and Budget o Michigan Department of Natural Resources o Michigan Office for Services to the Aging o Department of Human Services (formerly FIA) o Michigan Pharmacists Association o American Red Cross o Local Public Health Preparedness Coordinators o o o o o Local Emergency Managers Local Law Enforcement Agencies Local Public Health Agencies and Administrators Local Hospitals, Clinics and Community Care Centers Local City Officials/Administrators Page 12

13 B. Centers for Disease Control (CDC) Confer with local and state officials to make determination regarding deployment of the SNS. Ship the SNS Transportation of SNS to requesting State C. Van Buren/Cass District Health Department (VBCDHD) (o8ii) Develop local plan for emergency immunization/medication dispensing including identification of available and needed resources (personnel and supplies), procedures for securing the SNS, identification of pharmacies that will provide medication prior to SNS and identification of priority personnel and immediate family members for receipt of vaccine/medication. Security of SNS assets during receipt, distribution and dispensing Distribution and dispensing of SNS assets to the public Manage the clinic functions at dispensing sites Investigation of outbreak Establish provisions for public notification, and risk communication Page 13 Support Agency: Pokagon Band of Potawatomi Indians E. Van Buren and/or Cass County Emergency Management (EMD) Activate EOC Approve Request SNS by Chief Elected Official Manage logistics and resources functions at dispensing sites Warning and Notification Support dispensing site operations by securing resources per the county emergency operations plan, and providing multi-agency coordination from the EOC Law Enforcement: The law enforcement organization is responsible for accomplishing the following tasks per the Van Buren County Emergency Operations Plan Section G-2. It shall ensure that adequate notification procedures exist, that personnel are trained, that supplemental procedures exist as necessary, and that resources are available to carry out these tasks. o Access Control (Barricades, Traffic Rerouting, Entry to controlled area, Railroad Access Control, Air Traffic Control) o Security (EOC, Command Post, PIC, Critical Resources/Facilities, Disaster Site, Shelters, Staging Area) o Mortuary Services o Radiological Monitoring o Account for safety of Population o Curfew Restrictions o Clearing house for unidentified property o Emergency Assistance o Removal of Vehicles o Safety of prisoners o Staging Area o Urban Search and Rescue o Animal Control o Criminal investigation in the case of a bioterrorist incident Fire Departments: The fire services organization is responsible for accomplishing the following tasks per the Van Buren County Emergency Operations Plan Section H-2. It shall ensure that adequate notification procedures exist, that personnel are trained, that supplemental procedures exist as necessary, and that resources are available to carry out these tasks. o o o o o Access Control (assist LE) Traffic Control (assist LE) Safety Inspections Emergency Generators/Lighting Gas Shutoff o o o Decontamination/Radiological Monitoring Paramedics/EMTs assist in clinic operations if possible Traffic flow, crowd control and security support

14 Planning Process The planning process for the SNS includes an annual review of the plan by a multi-disciplinary planning advisory committee which is made up of the agencies listed in the above sections titled Lead Agencies and Support Agencies. The Strategic National Stockpile Plan planning began with a request from MDHHS/OPHP. This request included a template for developing a local plan. This living document is in constant revision and is dependent upon many variables. The planning process involves collaborative meetings with stakeholders such as local emergency management, law enforcement, fire, public works, hospitals, EMS, etc. to determine what resources are needed in our jurisdiction to open a dispensing site. This planning process also includes working with the Administrators of probable sites to host the dispensing. Mutual Aid agreements will need to be developed and implemented to make this process complete. As pharmaceutical caches are established, they will be included in the plan. As other factors change, such as availability of facilities, contact information, essential personnel, and gross numbers with the VBCDHD jurisdiction, the plan will reflect those changes. There is a tribal presence in Van Buren and Cass Counties with the Four Winds Casino (Hartford & Dowagiac) being owned by the Pokagon Band of the Potawatomi Indians. As their tribal headquarters are located in Cass County, the majority of public health communications and coordination will occur thru Van Buren/Cass District Health Department. Local Planning Committee: As previously described in this section, the Van Buren/Cass District Health Department engages several key partners in the SNS planning process. Planning for annual updates to the SNS plan occurs at least annually. Those invited to participate are: Volunteer representatives (Medical Reserve Corps, Red Cross, Salvation Army) County Emergency Managers Central Dispatch Services Law Enforcement Hospital representatives Emergency Medical Services Tribal Representative Local units of government County Road Commission School representatives Human Services Regional/State Partners (Region V Epi/OPHP) An overview of the entire SNS plan is provided to the planning committee. Specific elements of the plan are targeted toward those agencies that hold a primary function or responsibility within the plan. For example, the lead agency for security is law enforcement. Law enforcement will have the opportunity to review the established security plans and determine specific changes or updates to that section of the plan. SNS Policies and Procedures: Local plans as well as State and local policies which support SNS planning and operations at Dispensing Sites are discussed in subsequent sections of the SNS plan. These include the following: Dispensing Multiple Regimens to a Head of Household Procedure, Unaccompanied Minor Guidance, minimum identification requirements, and IND/EUA protocols. Page 14

15 The Dispensing Multiple Regimens to a Head of Household Procedure describes the minimum identification requirements necessary for individuals to obtain medication for persons within their household, under the authorization of the Michigan Public Health Code. The Unaccompanied Minor Guidance also summarizes information within various legal codes that allow for volunteers to dispense medication to an unaccompanied minor during a public health or medical emergency without parental consent. In addition to the Michigan Public Health Code, liability protections also exist under Emergency Management Act 390, The Good Samaritan Act, and the Public Readiness and Emergency Preparedness (PREP) Act. The PREP Act requires that an Emergency Use Authorization be issued by the FDA for MCM released during a public health emergency they are approved, but will be used for an unapproved use. Investigational New Drugs also have specific requirements for dispensing with proper liability protection. The following documents can be found in the attachment folder for section 1: See Attachment 1.1a EOP Basic Plan See Attachment 1.1b EOP Signature Page See Attachment 1.1c EOP Table of Contents See Attachment 1.1d NIMS Compliancy Documentation See Attachment 1.3 Local Planning Committee Meeting Documentation See Attachment 1.4 MOUs See Attachment 1.5a Dispensing Multiple Regimens to a Head of Household See Attachment 1.5b Unaccompanied Minor Guidance See Attachment 1.5c Michigan Laws Related to Rights of a Minor See Attachment 1.5d Rules of Engagement See Attachment 1.8 IND and EUA Protocols SNS Legal Planning Considerations Legal Issues to Support SNS Operations The State of Michigan has investigated the following legal issues which support SNS operations: Medical practitioners authorized to issue standing orders and protocols for dispensing sites. Personnel authorized to dispense medications during a state of emergency. Procurement of private property. Liability/workers compensation Staff compensation Rules of engagement for law enforcement See Attachment 1.6 SNS Legal Issues Page 15

16 Section 2 Command and Control By definition, an incident that requires the SNS to be deployed is one that either causes a depletion of existing resources statewide or is expected to exhaust all local, regional, and State resources necessary for responding to the incident and additional resources are needed. This situation will render the need for Michigan s State Emergency Operations Center (SEOC) and the Local Emergency Operation Centers (LEOC) to become activated in order to coordinate Command and Control. All command and control activities within Michigan will follow the Incident Command System (ICS) as required by the National Incident Management System (NIMS) under Homeland Security Presidential Directive 5. Local jurisdictions involved in SNS activities will identify a public health representative to serve as a liaison to the State for coordinating SNS planning, operational, and logistical response efforts, including but not limited to: (o9) Activate public health roles and responsibilities for providing medical countermeasures as soon as authority has been granted by the Health Officer. This may or may not require notification of other partners. (o9iii) Communicate State and federal SNS guidance information to local leadership Communicate SNS information and guidance to local partners Provide SNS operational status reports to LEOC Track and report local SNS inventory levels Identify triggers for inventory replenishment and resupply Participate in the Joint Information Center (JIC) and assist in the development of local risk communication strategies Determine the quantity of SNS materiel necessary to supply each identified dispensing site (this may be determined by factors such as but not limited to: case count, demographics, epidemiological, and intelligence) Provide information to the State to assist in determining apportionment when demand exceeds existing supplies Track and report the status of deliveries from the local Distribution Node to local dispensing sites Ensure that relevant SNS information is forwarded to the SEOC and/or CHECC as necessary. Local SNS Coordinators: The SNS Coordinator and the back-up SNS Coordinator are the most knowledgeable individuals of the local plan and operations for the jurisdiction. Names and contact information for the primary and backup SNS Coordinators can be found in Section 14. These individuals are responsible for overseeing the functional elements of planning for the receipt, distribution and dispensing of emergency medical countermeasures by working with local subject matter experts to ensure the jurisdiction will have a successful response if the SNS is activated. SNS Coordinator Roster can be found in Section 14: Tab 2.1 Page 16

17 Local SNS Functional Planning Leads: The Local SNS Functional Planning Leads are subject matter experts that the EPC communicates with for planning purposes prior to an incident, and are likely the decision makers capable of providing information on their area of expertise to be included in the SNS Plan, as well as guidance for response operations in an emergency. The Van Buren/Cass District Health Department identifies these roles as the health department SNS Response Team; these individuals oversee all operations under their assigned role in public health and medical incidents and planned events. This group is responsible for interacting with other local, regional, and state entities for notifications and assistance as needed with MCM distribution and dispensing planning and response. See Contact List in Section 14 Database Tab 2.2. Quarterly Notification Tests for SNS Functional Planning Leads: Based on requirements of the TAR tool, a quarterly call-down drill of SNS functional planning leads will be completed by the SNS coordinators. Times of contact will be documented and phone numbers will be updated. After action reports can be found in Attachment 2.4 folder. See Attachment 2.4 folder Functional Lead Staff Call-down Drill Results Incident Command Structure (ICS): In any event requiring a public health emergency response, Van Buren/Cass District Health Department will begin response by activating the Emergency Operations Plan. The Van Buren/Cass District Health Department adheres to the nationally and locally recognized Incident Command Structure (ICS) principles outlined in the National Incident Management System (NIMS), aligned with ESF 8 under the direction of the local Health Department and Emergency Operations Center (EOC). VBCDHD will adhere to the nationally and locally recognized Incident Command Structure (ICS) principles outlined in the National Incident Management System (NIMS) and the local Emergency Operations Plan (EOP) under the direction of the local Emergency Operations Center (EOC) during all emergencies. Whether an NEHC and/or dispensing site is needed, the ICS will allow management personnel to be in constant communication with one another, as well as with VBCDHD Incident Command Team, the Michigan Department of Community Health-Emergency Coordination Center (CHECC), local EOC s, and State Emergency Operations Center (SEOC). This Command Structure will have redundant communication capabilities, as well as computers with internet access. Roles and Responsibilites under ESF 8: (o9i) The Van Buren/Cass District Health Departments is the lead agency for ESF 8 as it relates to public health within Van Buren/Cass. The overall responsibilities of the VBCDHD during a public health incident includes activating the Public Health Command Center to establish a common set of operational objectives, coordinating public health incident information across all disciplines, and implementing strategies for a county-wide health and medical response. Ensure response actions are documented and reported to the EOC utilizing form 201 or other approved documentation method. (o9v) Notification Procedures: VBCDHD is responsible for notifying local health care providers, neighboring health departments, and other surveillance and/or treatment sites as deemed necessary of the request for and distribution of the SNS. Notification will take place to partners as soon as authority has been granted by the Health Officer. VBCDHD will contact these agencies by means laid out by the Crisis Risk Emergency Communications Guideline (CERC). Decision Making Authority: (o9iv) VBCDHD s Incident Commander (with indicated resources and support from MDHHS/OPHP, Emergency Management and the Chief Elected Official) has Page 17

18 overall decision making responsibility for the SNS and mass prophylaxis component of an incident. Management and demobilization of an NEHC/dispensing site will be coordinated through the VBCDHD ADMINISTRATION and the Local EOC. Chain of Command: Because VBCDHD covers two counties, the VBCDHD Incident Commander will activate the Incident Management Team (IM team) and establish the internal VBCDHD Incident Command structure. The IC will identify dispensing site core management staff, establish communications and provide guidance with County Emergency Managers and activated EOCs. Incident Management Team Prophylaxis/Treatment: In the event of a public health emergency that requires prophylaxis/treatment for the population, VBCDHD will ensure that all IM Team members and their families will receive proper prophylaxis/treatment. o Members will be contacted by the incident commander or designee and directed to report to a designated VBCDHD county office. Once staff arrives, they will receive a determined amount of medication for themselves and their family members (estimate of 4 family members per household). o The incident commander or designee will keep an inventory of all medication being dispensed out to the IM Team. PD DHS-PH Unified Command Information Officer EM/PH Safety Officer VB Sheriff Liaison Officer Plan/Intel Section Operations Section PH Deputy VB Sheriff Finance/Admin. Section PH Logistics Section Traffic & Transportation Group Security Group POD PH Traffic Control Team Crowd Control Team Transportation Team Force Protection The organizational chart identifies how ICS will be implemented during the request of the SNS. The personnel of the Van Buren/Cass District Health Department, other county agencies and volunteers will staff the local SNS team. The organization of the local SNS response team will adhere to the Incident Command System structure reflecting that of the Emergency Management System. Page 18

19 The Health Officer of the Health Department will assume the role of Incident Commander. The Liaison Officer from the Van Buren/Cass District Health Department will be appointed to the local EOC functions of: 1. Answer EOC questions about the SNS. 2. Provide a conduit for information to and from the EOC leadership team to the Incident Commander and the SNS team. 3. Provide status reports to the EOC concerning stockpile inventories, distribution logistics, security patterns, restocking orders, and any problems encountered. All dispensing sites will operate following the Incident Command System (ICS) and will fit into the existing local emergency command structure. The SNS dispensing team will be involved in all aspects of the site operation including the receipt of assets at the site, the dispensing of material and medications and the recovery of unused assets. All dispensing sites will operate following the Incident Command System (ICS) and will fit into the existing local emergency command structure. The SNS dispensing team will be involved in all aspects of the site operation including the receipt of assets at the site, the dispensing of material and medications and the recovery of unused assets. Event Command and Control During an event that utilizes the SNS or the operations of a dispensing site, the Emergency Management Director will be the Incident Commander. The National Incident Management System (NIMS) was developed to expand and contract as needed. An incident involving the Strategic National Stockpile will be considered a Large Scale Event. Many agencies will be involved in the opening of a dispensing site. The key individuals who will be part of the command and control function include: Public Health, Emergency Management, Sheriff s Department, Road Commission, RACES (Communications), POD Site Manager. Coordination between Local and State Command and Control and SNS Operations: Due to all emergencies beginning locally, the local health department affected will take a lead role in the command function within the local jurisdiction amidst a public health emergency. The State of Michigan, through the Office of the Governor, MSP-EMHSD, and the MDHHS-OPHP, will provide guidance and resources to the local jurisdictions as necessary throughout the duration of the incident. The SEOC in collaboration with the CHECC will provide assistance and guidance for addressing legal issues, protocol concerns, additional resource needs, and risk communication information. The SEOC will communicate SNS information to LEOCs through established communication protocols. Van Buren and Cass County EOC s will have a local public health representative to communicate directly with the IM Team. This person is a liaison for the health department. The liaison will communicate directly with Distribution Nodes and Dispensing Sites if necessary. Due to limited amount of staffing, there may only be one liaison to cover both Van Buren and Cass Counties. Page 19

20 The following diagram illustrates the overall flow of communication and coordination of SNS operations: Figure A: Communication Coordination Diagram In addition to the diagram below, the local health department will coordinate and communicate with the Pokagon Band of Potawatomi Indians. The Van Buren/Cass District Health Department personnel shall take leadership roles for the dispensing site ICS for a Public Health Emergency is as follows: Incident Commander: Dispensing Site Manager: Health and Safety Officer: Public Information Officer: Operations Section Chief: Logistics Section Chief: Communications Chief: Finance Section Chief: Liaison Officer Health Officer Nursing Director Medical Director Health Officer or Medical Director Environmental Health Director Administrative Secretary Health Promotions Manager Finance Manager Emergency Preparedness Coordinator A diagram of the Dispensing Site Incident Command System for a Public Health Emergency is depicted below. Page 20

21 Liaison Officer (EOC) Health Officer Site Manager Health and Safety Officer Public Information Officer Operations Chief Logistics Chief Administration/Finance Communications Chief Note: The structure of the Incident Command may vary based on the nature of the incident. During a public health emergency the structure may look very different than an act of terrorism. Annual Notification of Volunteers: During a public health emergency staffing resources at Van Buren/Cass District Health Department would be limited and a request may be made through the local EOC for assistance with staffing of local dispensing sites to meet the needs of the event. Thru local emergency management and LEPC meetings, VBCDHD remains in contact with agencies that would assist or provide volunteers for a public health emergency. Groups such as the America Red Cross, MRC and CERT may provide documentation to VBCDHD regarding the annual updates of contact information and call down notifications they complete. MI-Volunteer Registry/Medical Reserve Corp MI-Volunteer Registry will include a database of volunteers, both licensed and non-licensed. This database is available to the Health Department, the Emergency Operations Center and MDHHS 24/7. Alerts and messages can be sent to volunteers informing them of an incident. A protocol to handle essential personnel not listed in the database Pre-determined staging sites to gather personnel and distribute ID badges (Hartford Office or local EOC) A notification system to alert volunteers and direct them to a staging site or designated clinic site A process for collection of ID badges at end of shift Tracking/documentation of released and returned badges (o2)vbcdhd may use pharmacists, doctors, nurses, and other professionals such as interpreters and sign language personnel to support mass dispensing site operations. The Van Burn and/or Cass County Emergency Management Division through its various annexes and partners, Medical Reserve Corps, (MI Volunteer Registry), 5th District Medical Response Coalition, American Red Cross, Van Buren and/or Cass County Office of Human Services, Volunteer Database. United Way, and others, will be responsible for the recruitment, training, deployment, and retention of not only medical personnel, but also volunteers needed to support dispensing site operations. To that end, the Medical Reserve Corps will ensure that program administration, to include contact information of volunteers, is maintained. The 5 th District Medical Response Coalition is responsible for administration of the Medical Reserve Corps. Page 21

22 Additionally, volunteers in Van Buren & Cass County and throughout Region 5 will be identified and accessed through the Michigan Volunteer Registry available online at Currently there are more than 645 registered volunteers in the 5 th District. The registry has the capabilities to register, track, credential, and alert volunteers at any time. (o2) Page 22

23 Section 3 Requesting the SNS Process for Communication with Key Local Officials to Request the SNS: The decision to deploy the SNS is a collaborative effort between local, state, and federal officials. The process begins at the local level when officials identify a potential or actual event/problem that threatens the health of the community (such as an unusual number of people reporting to area hospitals with similar symptoms or the discovery of a significant number of dead animals). Evidence of a credible biological or chemical threat to the region may also initiate an SNS request. Efforts to identify the causative agent typically involve the MDHHS Bureau of Laboratories (BOL), as well as laboratory and epidemiological capabilities of the CDC. If the need to request the SNS is identified, the Health Officer, or designee, contacts local Emergency Management and the Chief Elected Official (CEO) represented at the Emergency Operations Center (EOC) to discuss the request. If the SNS is requested there are specific persons who must be notified that the request has been made. These individuals are key players in the set-up of the dispensing sites or make significant decisions in the dispensing process. The Public Health Leadership Team will be involved in making the decision to request the SNS. Once that decision has been made, the set up procedures and the staff involved need to be notified of the request. Redundant communication methods are in place to locate and notify essential personnel in the event that the SNS is requested. Those communication steps include: 1. MI-HAN: The first step in notification should be a high alert from the Michigan Health Alert Network (MI-HAN). This alert should be specific to the need for the request of the SNS and the populations affected. Other information should then be developed and posted on the portal. 2. Phones: The second step to the notification process should be phone calls to direct individuals on their roles in the arrival and set up of the Distribution Node and Dispensing Sites The third step, a final and redundant step, is to send all notification information including a schedule of events and where to report by to essential personnel. 4. During NORMAL Business Hours: An announcement will be made to all staff. notices will be sent and printed material will be available that outlines the staffs responsibility to report to the dispensing site(s), shift times and any other significant information including when/how to receive prophylaxis. During AFTER Hours, this information will be available at the health department, the dispensing site and the Emergency Operations Center for distribution. 5. It will be the responsibility of the ranking manager/supervisor in the health department to notify the Board of Health and County Administration once the decision to order the SNS assets has been made. Page 23

24 Quick Reference Notifications for the Request of the SNS Health Officer(VBCDHD) Medical Director (VBCDHD) Jeff Elliott Larry Wile Home: Office: Cell: Home/Cell: Nursing Director (VBCDHD) Emergency Preparedness Coordinator (VBCDHD) Emergency Management Director, Van Buren County Emergency Management Director, Cass County Health Officer, Kalamazoo County Health Officer, Allegan County Health Officer, St. Joseph County Health Officer Berrien County Region 5 Epidemiologist Dispensing Site Administrator Van Buren County Site(s) Dispensing Site Administrator Cass County Site(s) Michigan State Police MDHHS-24/7 Emergency Sue Bailey sueb@vbcassdhd.org Jennifer Zordan jzordan@vbcassdhd.org Bob Kirk kirkr@vbco.org David Smith davids@cassco.org Dr. Gillian Stoltman stoltg@kalcounty.com Rashmi Ganesan rganesan@allegancounty.org Steve Todd, RS, MPA todds@bhsj.org Mike Mortimore mmortimore@bchdmi.org Bethany Reimink reiminkb@michigan.gov Jeff Mills, Superintendent, Van Buren ISD jmills@vbisd.org Robert Colby, Superintendent Cass ISD rcolby@lewiscassisd.org 24/7 Emergency Duty Officer 24/7 Emergency Office: Cell: Home: Office: Cell: Office: Pager: Cell: Home: Office: Cell: (260) Office: Cell: Home: Cell: Office: ext. 107 Home: Office: Office: Cell: Office: Home: Cell: Office: (269) Primary Number: Alt Number: /6862 Non Emergency SEOC Fax: Day: After Hours: Updated: 12/2008, 2/2009, 2/2010, 6/2012, 10/2012, 12/2012, 12/2013,12/14, 12/15, 7/16 Page 24

25 Personnel Authorized to Request SNS: Table C (also found in Section 14: Tab3.2 Authorized Personnel) depicts individuals who have been authorized by the Health Officer to request SNS assets for Van Buren/Cass District Health Department. Table C Personnel Authorized to Primary Contact Information Request the SNS Jeff Elliott Cell: Home: Back-up Contact Information jeffe@vbcassdhd.org Dr. Larry Wile Cell: lwilejr@yahoo.com Dr. Rick Johansen Cell: rjohansen@bchdmi.org Sue Bailey Cell: sueb@vbcassdhd.org Jennifer Zordan Cell: Home: jzordan@vbcassdhd.org SNS Request Justification Guidelines: A request for State assistance will be generated at the local level using the Emergency Management System. The State will support such a request if it is clearly shown that local public health and/or medical resources have been exhausted (or it is anticipated that available resources will be exhausted) and additional resources are needed. Considerations that may justify requesting the SNS include, but are not limited to: (o8vi) Overt release of a chemical or biological, radiological, nuclear, or explosive (CBRNE) incident Medical emergency caused by a natural disaster Claim of release by intelligence or law enforcement. Indication from intelligence or law enforcement of a likely attack. Clinical, laboratory or epidemiological indications including: Large number of ill persons with similar disease or syndrome, or deaths Unusual illness in a population single case of disease from uncommon agent, and/or a disease with unusual geographic seasonal distribution and/or an endemic disease or unexplained increase in incidence Higher than normal morbidity and mortality from a common disease or syndrome Failure of a common disease to respond to usual therapy Multiple unusual or unexplained disease entities in the same patient Multiple atypical presentations of disease agents Similar genetic type in agents isolated from temporally or spatially distinct sources Unusual, genetically engineered, or antiquated strain of an agent Simultaneous clusters of similar illness in non-contiguous areas Atypical aerosol, food or water transmission Three people presenting the same symptoms near the same time Deaths or illness among animals that precedes or accompanies human death Unexplainable increase in emergency medical service requests Page 25

26 Unexplained increase in antibiotic prescriptions or over-the-counter medication use Local Inventories: (o8vi) VBCDHD inventory: VBCDHD has limited number of prophylaxis medications and supplies to cover staff and families during the initial phase of an emergency. These inventories are located in the Emergency Preparedness cabinet in the locked bathroom of the Hartford Office. This inventory is tracked within the MCIR All Hazards Module. Region 5 inventory: The 5 th District Medical Response Coalition has a limited number prophylactic supplies and medications to cover health care preparedness staff during the initial phase of an emergency. These inventories are located in a secure warehouse within the region and can be accessed by contacting the Regional Medical Coordination Center. SNS Request Process: The process for requesting the SNS is to submit the SNS Item Order Form and the LHD Request Justification Form to the SEOC/CHECC. The SNS Sharepoint Site (mirequest.org) is the primary mechanism for requesting the SNS, and sending an to the CHECC with the required documentation is the back-up method. Instructions for ing an SNS request to the CHECC can be located on the first page of the SNS Item Order Form. Tertiary mechanisms for submitting an SNS request may include: fax, WebEOC, radio, and etc. MISNS Request SharePoint Site User Guides are available on the MIHAN via the following location: System Folder > Local Health > SNS > MISNS Request SharePoint Training The most current versions of the SNS request forms are maintained on the MIHAN in the Emergency Response folder, as well as the SNS Folder, via the following pathways: Home > Documents > Emergency Response > Strategic National Stockpile (SNS) Request Forms -Or- Home > Documents > Local Health > SNS > SNS Request Documents These documents can also be found on our website intranet at See Attachment 3.3a SNS Item Order Form See Attachment 3.3b LHD SNS Request Justification Form Initial SNS Request Process When a local jurisdiction determines that local public health resources have been exhausted, or it is anticipated that available resources will be exhausted and additional resources are needed, the initial request for assistance will be submitted to the SEOC from the Local Emergency Operations Center (LEOC). Information will need to be gathered from each affected local jurisdiction in order to discern the magnitude of the emergency. To assist in gathering the necessary information, the local jurisdiction will initially submit a completed Local Health Department SNS Request Justification Form, along with the SNS Item Order Form to the SEOC from the LEOC. The initial local request for SNS assets will follow the established emergency management system protocols. Authority and Process Page 26

27 Only the top elected official of each affected county may request the SNS. It is intended that the local request for the SNS will be made in consultation with the Van Burn/Cass District Health Department Health Officer, the local Emergency Management office of the affected county (counties) and other affected agency officials. Local resource considerations for asking for SNS deployment include: Number of current casualties. Projected needs considering the population of the area (including transients), and consideration of whether the disease is infectious or non-infectious. Hospital capacity at the time of the event, including intensive care unit beds and ventilator needs. State resources identified, including pharmacy distributors, oxygen availability, other nearby hospitals, and in-state alternative care centers. Local resources such as pharmacy distribution, oxygen availability, and transport capacity. Existing county plans detailed in this manual for receiving, distributing and dispensing the stockpile supplies and their ability to be fully activated. Eligibility for receiving oral drugs will be determined by MDHHS and Van Buren/Cass District Health Department Health Officer and Medical Director(s) working within a unified command structure based upon reports from EMS, hospitals, Infection Control Practitioners (ICP s), law enforcement (LE), and physicians regarding the number of potential casualties. The Chairman of the Board of Commissioners of the requesting county will make the official request for SNS material through the Michigan State Police Regional Emergency Management Coordinator and the MDHHS Director as per the schematic diagram below. The Emergency Management Coordinator and MDHHS Director will initiate a formal contact with the Governor of Michigan who in turn will request release of the SNS from the CDC. The request to the CDC and the departments of HHS and HS make the decision to deploy the SNS. If there is agreement at the federal level, the SNS will be deployed. These actions are depicted in the following schematic. The Local Health Department Health Officer in coordination with the Local Emergency Operations Center (EOC) requests the SNS from the State EOC/Office of Community Health Emergency Communications Center (CHECC). The CHECC relays the request to the Governor. The Governor then requests the SNS from CDC officials. Responsibilities The following State and Local officials have responsibilities associated with requesting the SNS: The local Chief Elected Official or his/her designee (e.g., Emergency Management Coordinator) has the authority to request assistance from the State. The State Emergency Operations Center (SEOC) will be activated, if not already activated, upon request for SNS materiel. The Community Health Emergency Coordination Center (CHECC) will be activated, if not already activated, upon request for SNS materiel. The Director of the MDHHS Office of Public Health Preparedness (OPHP) is responsible for making recommendations on whether to request the SNS. MDHHS officials will consult with MSP-EMHSD officials and verify the severity of the situation. After a decision is made to request the SNS, MSP-EMHSD officials will contact the Governor s office and recommend that an official request be made to the CDC. Page 27

28 The CHECC will recommend that the Governor declare a state of disaster, state of emergency, or heightened state of alert before or concomitant with a request for DSNS assets. The Governor has sole authority to officially request SNS from the CDC. MSP-EMHSD will notify representatives of the Federal Emergency Management Agency (FEMA) and the Federal Bureau of Investigation (FBI) of the request for the SNS. The Michigan Intelligence Operations Center (MIOC) maintains 24-hour contact information for these officials. The OPHP State SNS Coordinator will be the primary designee for coordinating with the CDC on issues regarding the SNS deployment. To request DSNS assets with a Presidential Declaration, an Action Request Form (ARF) will be completed at the SEOC, in coordination with the CHECC, and submitted to FEMA. Page 28

29 Communications with Local EOC & State Officials Establish an expedited communications process for rapidly informing local and state officials, including the governor, of an actual or potential health emergency. It is important to begin communications among local, state and federal officials as early as possible. Some of the information you should have available when calling to request SNS assets includes: A clear, concise description of the situation Any results of specimen testing Information on the decisions already made regarding the response to the event o Target population for prophylaxis, quarantine measures, and facilities to be used throughout the response process Information on the availability of state and/or local response assets A description of the SNS assets needed to support a response to the situation. Share evidence of terrorism or suspected terrorism Page 29

30 Figure B SNS Initial Request Flow Chart Page 30

31 On-going SNS Request Process/Re-supply Requests for SNS Once the very first initial local SNS request has been received at the State, and the Governor has requested the SNS from the CDC, all ongoing local SNS requests will flow directly through the CHECC rather than the EOC system. Local Health Departments will submit their ongoing requests directly to the CHECC. This same process will hold true for re-supply requests for SNS from the local jurisdiction to the State. Through a MIHAN alert, the CHECC will notify the Local Health Officers, Emergency Preparedness Coordinators, and Healthcare Coalition Regional Coordinators of the switch to the ongoing SNS request process and will instruct local partners to send all ongoing requests for SNS assistance directly to the CHECC. The MIHAN alert will provide specific instructions for submission based upon the event, including the appropriate forms necessary for submission (i.e. SNS Item Order Form, Local Health Department SNS Request Justification Form, and any other requested paperwork). These forms will be submitted to the CHECC SNS Coordinator. Redundant methods for on-going request submission will be determined by the CHECC at the time of the event. Available redundant communications capabilities include OPHP Sharepoint site, fax, WebEOC, radio, landline/cell phones, and . Utilize the MISNS SharePoint (mirequest.org) to request assets from the CHECC as required by in the State of Michigan SNS Plan. Figure C SNS Ongoing Request Flow Chart MICHIGAN DEPARTMENT OF COMMUNITY HEALTH STATEGIC NATIONAL STOCKPILE ONGOING REQUEST FLOW CHART Page 31

32 Process for Re-supply of SNS at the PODs The trigger point for re-supply has been identified as 50% of stock. At the 50 percent of the medical supplies/prophylaxis have been dispensed, the POD manager shall request resupply from the Public Health Leadership Team (PHLT). The PHLT will coordinate with the county EOC, Dispensing Node and CHECC to resupply the requesting POD. Once the very first initial local SNS request has been received from any partner, and the Governor has requested the SNS from the CDC, all ongoing local SNS requests will flow directly through the CHECC rather than the EOC system. Local Health Departments will submit their ongoing requests directly to the CHECC. Treatment Centers will submit their requests to the MCC, which will forward the request to the CHECC as appropriate. Through a MIHAN alert, the CHECC will notify the Local Health Officers, Emergency Preparedness Coordinators, and Regional Coordinators of the switch to the ongoing SNS request process and will instruct local partners to send all ongoing requests for SNS assistance directly to the CHECC. The MIHAN alert will provide specific instructions for submission based upon the event, including the appropriate forms necessary for submission (i.e. SNS Item Order Form, Local Health Department SNS Request Justification Form/Treatment Center SNS Request Justification Form, and any other requested paperwork). These forms will be submitted to the CHECC SNS Coordinator. Redundant methods for request submission will be determined by the CHECC at the time of the event. Available redundant communications capabilities include O. PHP SharePoint site, fax, E-Team, radio, landline/cell phones, and . Sample MIHAN Message (to be modified based upon the event): The initial Strategic National Stockpile request has been received at the State Emergency Operations Center and approved by the Governor for submission to the Centers for Disease Control and Prevention. From this point forward, please all ongoing Strategic National Stockpile requests directly to the Community Health Emergency Coordination Center. Please include (insert specific request forms) and the requesting agency name in the subject line. The CHECC will report all ongoing SNS requests to the State EOC during scheduled briefings. The State EOC will communicate this information through established communication protocols. (Note: To follow incident command protocols, all request s submitted to the CHECC SNS Coordinator inbox are automatically transmitted to a folder in the CHECC Deputy Coordinator inbox. This will allow incident command to review submitted requests as necessary.) Communications with Distribution Nodes/ Dispensing Sites and other partners The request for re-supply of DSNS assets and or other supplies, equipment or personnel will be done through the EOC. Distribution Node/Dispensing sites (DN/DS Manager) will communicate with the Incident Commander, the Public Health Leadership Team and the EOC. The formal lines of communication will be determined at the time of the event based on the scale and size. This may include land lines, cell phones, fax, , etc. If the Public Health Leadership Team is not activated, the Dispensing Site Manager will communicate directly with the Incident Commander and the EOC. Page 32

33 VAN BUREN/CASS DISTRICT HEALTH DEPARTMENT PARTNERSHIP MATRIX MDCH/OPHP CHECC Local Health Departments Distributio n Nodes/Dis State EOC (SEOC) Regio n V Local EOC s Hospitals Care Centers Security Transportatio n Page 33

34 Section 4 Tactical Communications Communication/IT Support Staff: Tactical communications are a critical part of SNS operations management and crucial to the success of the response. Any tactical communication system must have the capability to transfer information from all levels and to all players in the response community. In an event that requires the activation of the Public Health Leadership Team and the development of incident action plans, a communications plan using the ICS 205 must also be developed that details all aspects of internal and external tactical communication. Section 14: Tab: 4.1 Tactical Comm. provides a list of IT Support staff that can be called upon to support tactical communications during an emergency. Support Staff JAGs: Staff well versed in communications systems and technology is assigned to Communication/IT support for SNS operations. The Job Action Guideline (JAG) for these positions is detailed in Attachment 4.2 folder. Redundant Communication Systems in Place at Each Response Agency: Communication methods utilized by Van Buren/Cass District Health Department must be convenient, fast and reliable. More important, it must be accessible at all times. VBCDHD ensures communication/it capabilities are accessible and maintained. Improvement to agency infrastructure included the installation of natural gas powered generators capable of providing 100% of the power needed to maintain all health department communications systems including phones and computers. Local communication equipment available in order to ensure redundancy include: 800MHz radios, land-line phones, Cell phones, Fax/Broadcast Fax, Internet, video conferencing, HAM/RACES and two-way radios. In addition, the health department may utilize the Van Buren or Cass County Emergency Alert System, which are emergency notification systems, to alert first responders as well as the public regarding potential threats through radio and television partners of the Emergency Operations Center. The Van Buren/Cass District Health Department participates in several communication drills that include: Regional 800 MHz Radio Drills Local Quarterly Notification Drills MDHHS/OPHP Quarterly 800 MHz drill Quarterly MICIMS exercises Monthly 5 th District Partner drills through EMResource. Documentation of these drills are maintained and kept on file. Copies of the communication systems test results can be found in Attachment 4.3 folder. Page 34

35 Communication Pathways Established between Response Agencies: AGENCY LANDLINE CELL 800Mhz RACES MIHAN FAX MICIMS Web COUNTY EOC X X X X X X X X X OPHP X X X X X X X X X SURROUNDING LHD'S X X X some X X X some X DISTRIBUTION NODE X X X X X X X X X DISPENSING SITES X X X X X X TREATMENT CENTERS X X X X X X X some X SECURITY (LE) X X X X X X some TRANSPORTATION X X X X some Communication pathways have been established between command/management locations and potential support agencies. An Inter-Agency Communication Systems Matrix was developed and is located in Attachment 4.4. In addition, local public health agencies in Region 5 have developed a Public Health Coordination Plan that facilitates communication coordination between the local health departments. The public health coordination plan is located in Attachment 4.5. Statewide communication systems between partner agencies have also been developed and include the Michigan Health Alert Network and MI-CIMS (WebEOC). The Michigan Health Alert Network or MIHAN is a secure web-based notification system created by the State of Michigan to alert key personnel of conditions that could adversely impact the health and safety of Michigan's citizens. The system also provides situational awareness about important but non-emergency health-related information. MIHAN participants include key points of contact from the State of Michigan, local public health, hospitals, EMS agencies, Federally Qualified and Rural Health Clinics, Long Term Care facilities, and emergency management. MI-CIMS (WebEOC) is an incident management system that gives organizations a common platform from which they can enhance their ability to respond to and recover from incidents and events occurring within their jurisdiction. It provides users a common operating picture and resource management tool through a single collaboration platform. Page 35

36 Figure D: SNS Tactical Communications Matrix Van Buren/Cass District Health Department - Communication Matrix 800 Radios Landline Cellphones Website Conferencing EMSystems After Hours Fax MI-HAN VBCDHD Video Telephones Communication 911 Disptach yes yes yes yes yes yes yes Clinics yes yes* yes yes DHS (formerly FIA) yes yes yes yes yes yes Emergency Mgmt yes yes yes yes yes yes yes yes yes Fire yes yes yes yes yes yes yes Funeral Directors yes yes* yes Hospitals yes yes yes yes* yes yes yes yes yes Humane Socieity yes Infection Control yes yes yes yes yes yes yes yes Judges yes yes yes Law Enforcement yes yes yes* yes yes yes Media yes yes yes* yes yes Medical Control Authority yes yes yes yes yes yes yes yes Medical Examiners yes yes yes yes yes yes yes Physicians yes yes* yes Prosecuting Attorney yes yes yes yes Red Cross yes yes yes yes yes yes Schools yes yes yes yes* yes yes yes Mental Health yes yes yes yes yes yes yes Veterinarians yes yes yes Public Works yes yes yes yes HRSA Region 5 yes yes yes yes yes yes yes yes yes yes Region 5 Emergency Mgmt yes yes yes yes yes* yes yes yes Region 5 Epidemiologist yes yes yes yes yes yes yes yes yes Region 5 PH Departments yes yes yes yes yes* yes yes yes yes yes Tribal Coordinator yes yes yes yes yes Regional DEQ yes yes yes yes OPHP yes yes yes yes yes yes yes yes yes yes MSP yes yes yes yes yes yes Dept. of Ag. yes yes yes yes DEQ yes yes yes MDCH yes yes yes yes yes yes yes yes Regional Epi's yes yes yes yes yes yes yes yes yes Page 36

37 Medical Communications Pathways during emergencies between the State, Regional and local response agencies is illustrated in the diagram below: Equipment Storage and Maintenance: All communication equipment is organized, maintained, and located at the Hartford office of the Van Buren/Cass District Health Department. 800 mhz Radios and spare batteries are stored on chargers located in the EPC office. The Van Buren/Cass District Health Department participates in several communication drills that include: Region 5/6 LPH partners 800 MHz dill conducted monthly MDHHS/OPHP quarterly 800 MHz drill Documentation of 800 MHz radio drills is maintained and kept on file. Copies of the communication systems quarterly test results can be found in Attachment 4.3 folder Quarterly Communication Test (systems and between agencies): As indicated in the Equipment Storage and Maintenance section, several quarterly tests are conducted to ensure redundant communication methods are maintained and functioning. Documentation of the quarterly tests is located in Attachment 4.3. Communications between 5 th district Health Departments is tested on a quarterly basis thru the MIHAN and 800 MHz systems. Confirmation of the tests can be found in the After Action Report. See Attachment 4.5 folder Communication Pathways Quarterly Test Results Page 37

38 Communications Training for Local SNS Functional Lead Planners: All new hires of the VBCDHD who may be in a leadership position receive training on redundant communications upon hire and periodically thereafter. At a minimum, all leadership staff is trained on the use of 800 MHz radio, receive training upon establishment of a MIHAN account. The training is validated in training records. Additionally, all staff identified for local SNS functions, has been determined. A communication training record for these key staff is located in Attachment 4.6a. Attachment 4.6a - Function Lead Staff Communication Training Matrix Attachment 4.6b - Functional Lead Staff Communication Training Documentation Page 38

39 Section 5 Public Information and Communication In the event of a public health outbreak, emergency scenario and/or an SNS deployment the VBCDHD will respond by utilizing the Crisis Risk Emergency Communications (CERC) Plan and the Emergency Operations Guideline (EOP) to communicate with the stakeholders, the residents of Van Buren and/or Cass County, the media, and the State of Michigan. The CERC is designed to define the roles and responsibilities of all parties involved in communicating during an emergency response situation. This plan and appendices delineate actions to be taken by the Public Information Officer(s) (PIO) & Public Health Leadership Team (PHLT), as well as developing key partners within the community to take action against unforeseen events. The communication plan also helps to effectively communicate with the public and media at all levels. The Public Information Officer for the Van Buren/Cass District Health Department is Rick Johansen, MD. The secondary PIO is Jeff Elliott. Contact information for these individuals can be located in the Contact Information Database. The VBCDHD Risk Communications Plan can be found the office of the EPC for Van Buren/Cass District Health Department. This plan includes a list of local media that will be used for the dissemination of public information in the event of an emergency. Media Contacts can be found in Appendix C of the CERC Plan. Immediate communications contact information is updated quarterly and can be found in Appendix L of this plan. For further information please refer to: EOP: Functional Annexes Annex B Public Information and Communication Personnel Training: The PIO/Local Health Department Communication team members may be trained in the following courses and is tracked via the EOP: Deliverables: CDC Courses: CDC Crisis and Emergency Risk Communication Basic CDC Crisis and Emergency Risk Communication for Pandemic Influenza FEMA Courses: IS-100.b Introduction to Incident Command System IS-200.b ICS for Single Resources and Initial Action Incidents IS-250.a Emergency Support Function 15 (ESF 15) External Affairs: A New Approach to Emergency Communication and Information Distribution IS-700.a National Incident Management System (NIMS), An Introduction IS-701.a NIMS Multiagency Coordination System (MACS) Course IS-702.a National Incident Management System (NIMS) Public Information Systems IS-800.b National Response Framework, An Introduction ICS 300: Intermediate ICS for Expanding Incidents (EMI Course Number: G300) ICS 400: Advanced ICS Command and General Staff Complex Incidents (EMI Course Number: G400) See Attachment 5.1a folder Training Documentation for PIC Personnel Page 39

40 PIO and PIC Liaison Job Action Guides: The PIO will be the Medical Director, Health Officer and/or designee for the Van Buren and/or Cass County Health Department. If neither person can fulfill the role the Health Officer will appoint a manager or supervisor to the role. The PIO will be responsible for developing and disseminating all communication in regard to emergency response. The PIO will be working directly with the PHLT, specifically the Health Officer and/or Deputy Health Officer and/or Medical Director, and EPC to disseminate accurate information to the media and the public in a timely manner. The PIO is responsible for training and assisting the designated spokesperson(s) during an emergency. The PIO is responsible for gathering information about the emergency from federal, state, and local sources, as well as verifying the information in conjunction with the PHLT. All information needs to be approved by either the Health Officer or the designated person(s) before it can be disseminated to the public. The overall role of the PIO is to assist the Health Officer or designee, develop communication tools (press releases, fact sheets, message points, etc.), organize the communication procedures (press conference, interviews), and to disseminate information to the Public Health staff. See Attachment 5.1b folder PIC Job Action Guides Local CERC Plan (stored in EOP): The Local Crisis and Emergency Risk Communication (CERC) Plan is maintained in the Van Buren/Cass District Health Department EOP (Functional Annex B) and contains messaging protocols, tools, and templates specific to SNS distribution and dispensing operations. The Van Buren and/or Cass County Health Department (VBCDHD) Crisis and Emergency Risk Communication Plan is designed to define the roles and responsibilities of parties involved in communicating during an emergency response situation. This following plan and appendices will delineate the action to be taken by the Public Information Officer(s) (PIO) & Public Health Leadership Team (PHLT) in response to an emergency situation, as well as developing key partners within the community to take action against unforeseen events. The communication plan also helps to effectively communicate with the public and media at all levels. Objectives: To effectively establish partners with surrounding businesses, foundations, and prevention groups. To develop sample communication documents to adapt during an emergency situation. To delineate the communication roles and responsibilities of the PIO(s), PHLT, and spokesperson(s). To establish and maintain contact lists (external, internal, and the media). To develop guidelines, forms, checklists in order to help facilitate communication throughout a crisis event. To ultimately create a communication plan that will effectively communicate an emergency situation to the media and surrounding publics. Page 40

41 Coordination between Local Jurisdictions to Ensure Message Consistency: A. Internal Coordination In the event of an emergency situation the Van Buren and/or Cass County Health Department will implement its PHLT. The team will follow the Emergency Operations Plan Activation and Notification policy to notify and organize staff in the event of a crisis. In the event that a situation involves expands beyond the health department response capabilities the Health Officer will coordinate with the Van Buren and/or Cass County office of Emergency Management. B. External Coordination The VBCDHD s PHLT will utilize the local, regional, and state contact lists to enact the appropriate community response teams in the event of a crisis. Also, the Michigan Health Alert Notification (HAN) and JBlast Fax will be used to contact the appropriate groups. C. Information Sharing with Region 5 LHD s Region 5: CERC: Public Health Coordination Plan The Region 5 EPC s have incorporated REGIONAL communication and information sharing into daily procedures in order to effectively communicate with the public and media at both emergent and non-emergent levels. Communication and information sharing will be accomplished by the sharing of press releases and media information with other Region 5 Local Health Department key staff, PIO s and EPC s. Routine coordination may ensure that health departments are communicating potential emergencies with one another and to allow for collaboration of communication when deemed necessary. It will also ensure that the community and media are receiving consistent messages from Region 5 public health entities. The PIO s will share communication and information through s, faxing and other designated communication tools. In the event of a regional emergency situation the Region 5 Public Information Officers will work in conjunction with one another and the State of Michigan Office of Public Health Preparedness to coordinate information dissemination to the public and media. D. Virtual Joint Information Center (V-JIC) The Public Health Coordination plan will act as an established Virtual Joint Information Center for the Region 5 Local Public Health Departments, the Region 5 Epidemiologist, and the Regional Healthcare Coalition to communication in an event of an emergency. Please refer to the section Information Sharing with Region 5 LHD s for information and access of the Virtual Joint Information Center. E. State & Federal Coordination Van Buren/Cass District Health Department currently follows the NIMS chain of command for communicating with state and federal partners. All information will flow one of the following two ways: 1) EOC Activation Health Department to the County of Van Buren EOC who will them communicate with the State of Michigan Homeland Security Division - JIC 2) Health Department Activation (only) Health Department to the Subject Matter Experts at Office of Public Health Preparedness or Michigan Department of Community Health (EPC, etc.) Means of Communication: Video Conferencing, HAN, Telephone, Page 41

42 NOTE: In the event of a regional outbreak or emergency situation, VBCDHD will communicate directly with regional partners via the Public Health Coordination Plan the State of Michigan may elect to communicate with the region via this network of communicate. See Attachment 5.2a folder Risk Communication Coordination Guidelines Media Policy for DN and POD Sites PIC Liaison (Public Information and Communication Function) ICS Communication Team The function of the Public Information and Communication role at the POD and Node Sites is to aid the PIO in directing the media and media inquiries to the appropriate location. Assignment: The PIC function will be assigned to the Clinic Site Manager at each site. The clinic site manager will be in direct communication with the PIO and PIO Communication Team with directives on where to send the media and talking points to address with the media. The clinic site manager will serve as the main point of contact for the media at each site; they will communicate messages provided by the PIO and coordinate with the PIO by providing hourly updates on the status of the communication at the clinics. The clinic site manager will also be responsible for monitoring all printed materials and reporting the status of documents to the PIO Communication Team. The Clinic Site Manager will communicate with their POD staff on procedures in regard to the media which have been delineated by the PIO and ICS Command Team. The PIO will determine the Page 42

43 procedures at the time of the incident (i.e., where the JIC will be located, when and where press briefings will be held, etc.). See Attachment 5.2b folder Media Policy for DN and POD Sites Establishing a Hotline/Call-Bank to Handle Questions/Concerns from the Public: The Health Department does not have hotline capacity. The VBCDHD will enact a hotline service (211) to communicate during a public health emergency with the assistance of the Emergency Operations Center. The PIO will provide the hotline service with the appropriate information that should be given out during a public health emergency. Predetermined message templates have been developed to expedite the process. Additional Hotline services are available thru the EOC and can be used when needed. These hotlines can be found in the CERC plan. See Attachment 5.2c folder HotlineCall-bank Procedures Risk Communication Messages: During a large-scale public health emergency, it may be necessary to dispense medication quickly and efficiently to the population of Van Buren and/or Cass County, requiring the activation of the Strategic National Stockpile. During such an event, the Public Information Team will prepare and distribute information about the biological agent involved, and will provide instructions for obtaining medication both for those who are well and for those who are sick. To ensure consistency, communication activities for a mass medication event will follow the guidelines and procedures outlined in the VBCDHD Risk Communication Plan. However, the following information will be included in communication materials specific to a mass medication event: Information about the agent and its threat to the public including: Whether or not the agent is contagious Who should be concerned about exposure Who should seek prophylaxis at dispensing sites Who should seek treatment at treatment centers Directions to and information about dispensing site locations including: Hours of operation Most accessible route to each dispensing site Modes of transportation available to dispensing sites Information about the dispensing process What types of identification are needed What type of information is required to pick of medications for other family members: For Children: weight, age, health information, drug allergies, and current medications For Adults: health information, drug allergies, and current medications Medication information the public will receive at the dispensing site including: Reasons for using specific drugs or changing drug regimens Importance of taking all of the medication Danger of over-medicating Twenty-four hour contact information for medication questions Medication is intended for humans and not pets Samples of these communication pieces are dispensing site video scripts, medication fact sheets, agent fact sheets. Materials will be supplied as needed by the health department and the supporting facility Page 43

44 (dispensing site) or requests from the EOC. These can be found in the CERC Plan and in the Public Information annex of this plan. Spanish documents from the CDC are also available. Sample SNS Messaging Templates: SNS Communication Pathways SNS & Mass Prophylaxis Messages: SNS Dispensing Site Press Release Templates Message Mapping Patient Education After Vaccination Dispensing Site Maps Clinic Signs (directions are indicated within the signage) Fact Sheets See Attachment 5.4 folder Messaging Templates Risk Communication Methods: Communication at the POD sites will follow the ICS SNS structure. Positions within the structure will be decided by the Incident Commander and Command Staff. All communication will follow appropriately up and down the chains to ensure one message is being stated at all times. The ICS Structure will be provided to each person at the beginning of their shift with a Job Action Sheet (JAS) that will identify who that person immediately reports to. POD sites will utilize 2-way radios to communicate with support staff and command staff at the site. 800 MHz radios will also be utilized for communications to PHCC and EOC. Megaphones/Microphones are available to assist staff with crowd control and message dissemination. This equipment is kept in the OCHD PHP storage room. Additionally, the following communication vehicles may be used between the RSS, EOC, dispensing sites, and treatment centers. Communication equipment will be available at each of the sites; the equipment includes but is not limited to landlines, cell phones, signage, PA Systems, Bullhorns, and two-way radios. Two-Way Radio Devices/Cell Phones: Two-way radios and/or cell phones will be issued to each section leader at the beginning of each shift and collected at the end of the shift (all cell phone numbers will be provided on a sheet in the event of an emergency). Radio Channels: The site Incident Commander will announce the radio channel to be used at the beginning of each shift. Radio messages will be short and begin by identifying position according to the ICS assignment (JAS) and name. PA Systems/ Bullhorn: Voice amplifications systems will be utilized by only designated personnel. All messages need to remain short and spoken calmly and clearly into the device. The PIO will be responsible for dispatching messages as assisted by Amateur Radio Operators if other communication systems are unavailable. IMPORTANT: All radios (two-way, 800 MHz, back-up batteries, and cell phones) will be kept charged when not in use. Technical problems with radios and cell phones will be reported to the Logistics Chief. Page 44

45 The VBCDHD s PHLT is responsible for working with the PIO(s) to disseminate information to the county in response to public health emergencies. All VBCDHD employees are expected to adapt to these procedures. It is the responsibility of the PHLT members and PIO(s) to disseminate information in following manners: 1) The Blast Fax Notification Procedure and 800 MHz Radio communication will be used to disseminate information to the all healthcare providers, hospitals, other LHD s, utility companies, schools and other appropriate agencies by fax. 2) The Michigan Health Alert Network (HAN) will also be used to disseminate information to local partners that are licensed to receive MIHAN messages and alerts. See MIHAN Protocol 3) The Media will be contacted via the Blast Fax Notification Procedures. In the absence of fax the media will be contacted via . If no methods are available to communicate with the media, the PIO may suggest/request interviews or a press conference, both need to have previous approval from the Health Officer or designee. 4) The VBCDHD website will also be used to disseminate information to the public. The IT Director will assist the PIO(s) in posting information on the website. 5) The VBCDHD will coordinate with Emergency Management to enact a hotline service (211) to communicate during a public health emergency. The PIO will provide the hotline service with the appropriate information that should be given out during a public health emergency. 6) The VBCDHD will utilize the Diverse Populations Contact list and procedures to contact agencies that handle functional needs populations. 7) The PIO should also assure that the PH Staff receives all press releases and messages that are being communicated. Staff should also be given message points that state the VBCDHD s position in the emergency situation, these message points are to only be used when approached by a media personnel. See Attachment 5.5 folder Public Information Partners and Media Contacts Contact List Risk Communication Materials: The Van Buren/Cass District Health Department will rely on many partners to produce Risk communications materials. Some may be produced in-house while others will require coordination with partner agencies. Accessibility: Multiple copies of dispensing site station signs are pre-printed, additional copies will be printed at the time of need A print out of the signs is located in the CERC Plan Larger Signs and arrows are available in the dispensing carts Reproduction: Access is available for copiers at the all health department locations as well as Dispensing sites to reproduce multiple copies in the event of an emergency Paper is stored at all times in the storage room with access to acquire more through the local Intermediate School District or Office supply chain Generators are accessible at the Hartford and Cass Office of the LHD Copiers are available for use at all POD and Node sites Multiple Dispensing Sites Method: Additional materials such as dosing instructions and labels for medication are expected to arrive with the Strategic National Stockpile shipment. Page 45

46 Electronic copies of materials will be stored on multiple jump drives and on the health department intranet site. Paper copies of fact sheets, dispensing site instructions, directional signs, etc. will be provided to each dispensing site as part of each Point of Dispensing (POD) Packet. PODs will be responsible for making copies for distribution to patients. In the event of a power failure, the PIO will provide paper copies. Category A Agent & Medications used for prophylaxis and treatment. All Category A Agents, as well as other priority disease fact sheets have been translated into the priority languages for Berrien County (English, Spanish); as well as access to the Centers for Disease Control (CDC) Post exposure Prophylaxis for Anthrax, Plague and Tularemia treatment guidelines. In the event that information needs immediate translation either verbal or written, translations organizations are identified in the Diverse Populations contact list. Follow-up Communication & Medication Compliance: This information is dependent on the medication given at the POD sites. All patients will be provided with medication guidelines, alternative methods for dispensing (if applicable) and patient information sheets. This information will be provided to the media outlets and our 211 hotline service to ensure medication compliance. NOTE: All information in regard to alternative methods of dispensing will be given at the clinics and to the media outlets. This information is located in the dispensing medication section of the SNS Plan for the Berrien County Health Department. See Attachment 5.6a folder POD Directional Signs See Attachment 5.6b folder Drug Fact Sheets See Attachment 5.6c folder Category A Agency Fact Sheets Page 46

47 Risk Communication for At-Risk Populations: Dispensing to special populations is a challenge for local public health. Resources requested from the Emergency Operations Center will assist the local health department is reaching populations such as inmates of correctional facilities, homeless, patients in long-term care, hospitalized patients, homebound and undocumented aliens. These populations have been identified and communications have been established and outlined in the CERC Plan. The Department of Human Services is responsible for tracking most of these populations. A contact list can also be found for these population/facilities in the CERC Plan. The homebound population in Van Buren and Cass Counties is a difficult number to note. The local Emergency Operations Centers in both counties have an identified person or persons assigned to special populations who have seats in the EOC. During drill events directly related to SNS operations and the activation of the EOC, both counties have identified less than 20 homebound patients who cannot receive care or evacuation by family members. This list is concurrent with the Area Agency on Aging, Department of Human Services and the medical community. Due to the fluency of these members, a complete list is almost immediately out of date. As homebound individuals are identified, during an even, they will be place on a contact list. It is a coordinated responsibility of Emergency Management, Law Enforcement, and Health & Medical Services to ensure that homebound individuals are taken care of. This is part of the agreement between Emergency Management and Public Health. Persons speaking languages other than English as a primary language are also at risk. Through the county EOC arrangements have been made with Van Buren Intermediate School District, who has language experts available within a 30 minute time period. These language experts will assist in duplicating material in appropriate format for those population groups. These language experts also have knowledge on how to best communicate to some of these at risk groups. See Attachment 5.7a folder Translated Fact Sheets See Attachment 5.7b folder Agreements with Translator Services See Attachment 5.7c folder Agreements with Organizations Servicing At-Risk Page 47

48 Section 6 Security In a public health emergency, the SNS distribution system, as an important component of the public health response, may be significantly impacted. Local law enforcement officers will be fully taxed and will need to assist with safeguarding the Distribution Node (DN) and dispensing operations within their jurisdictions and/or possibly within mutual aid jurisdictions. In instances where there has been a release of a toxic substance or an outbreak of a serious disease, it is very likely that there will be mass evacuations which may significantly degrade trafficability on many of the state s major highways especially the interstate system which could potentially impact delivery and distribution operations. Local law enforcement agencies are responsible to perform multiple missions associated with SNS distribution operations, to include securing distributions from DNs to PODs, securing PODs, crowd control in the vicinity of PODs, traffic control, etc. Planning, controlling, and orchestrating such operations is the responsibility of the local jurisdiction and is coordinated by Local Emergency Management in coordination with the State Emergency Operations Center (SEOC). The County Sheriff would coordinate and orchestrate the law enforcement and security operations associated with distributing and dispensing SNS assets within their County. County Sheriffs operate under the principals of National Incident Management System (NIMS) in their coordination with the Michigan State Police, the SEOC, and with LEOCs. Security Lead and Back-up: The security support for local public health responses is prefaced by offering all law enforcement agencies the opportunity to view the CDC approved security orientation training to SNS functions. This 6 minute video can be found on the SNS extranet. Documentation of law enforcement security orientation can be found in the section 6 folder. Security support for SNS operations would be made as a request through the local EOC. In the event that SNS material is being requested, the local EOC would be active. The Law Enforcement annex head would receive the request and issue support as necessary and available. See Attachment 6.1b Security Lead Training See Attachment 6.1c Security Orientation video/ Table E Security Leads: Section 14 Contact Database Local Security Support Agencies: Table F provides a list of security support agencies that have been trained and oriented on SNS support operations to assist during an emergency as necessary. Additional local law enforcement agencies have been oriented through the Emergency Management communications. These agencies can be found in the documentation in the folder for section 6. In section 6 there is a list of local security contacts for departments. Again, these contacts will be made through emergency management channels. Page 48

49 Table F Security Support Agencies Primary Contact Back-up Contact Information Information Van Buren County Sheriff s Department mHz: 80Comm 800mHz: 80E911 Cass County Sheriff sdepartment mHz: 14Comm 800mHz: 14E911 Michigan State Police OPS Desk: MIOC: Security Escort Plans: If the material and personnel must be transported to a site away from the Distribution Node or Dispensing Site, security will be provided by local law enforcement as determined by the EOC or the on-scene law enforcement commander. See Attachment 6.2 folder Security Escort Plans DN and POD Security Site Plans Security plans for DN and PODs can be found in the individual POD or DN Site Plans. See Attachment 6.3 folder DN and POD Security Site Plans Badging Procedures It is the policy of the Van Buren/Cass District Health Department that personnel working during an SNS operation, in any stage, where a credentialed badge with picture ID. Health Department employees will not be permitted to assist in operations without their agency issued identification badge. All employees have been credentialed through the hiring process. Any volunteer or other personnel that is used in SNS operations will be asked to wear their agency issued identification badge on the outermost layer of their clothing between the waist and the shoulders. If the issued badge does not have their picture id present, the volunteer will be asked to wear their State issued identification card in a dual pocket lanyard partnered with their agency issued identification. It is not the policy of the Van Buren/Cass District Health Department to issue identification badges on site for operations. If identification badges are needed, back up badging procedures will be accessed. Back-up Badging Procedure Van Buren County Office of Domestic Preparedness and Cass County Emergency Management both have a FireTrax badging system that could be used in the event of a county-wide emergency. The counties have already developed and distributed badges to first responder personnel. Public Health personnel would likely be given FireTrax badges at the onset of an event. Just in Time Training for FireTrax can be obtained by contacting the Van Buren county Emergency Management office or Central Dispatch. As part of the agreement between Emergency Management and Public Health, identification of personnel is a task that will be coordinated by Central Dispatch. If there is a situation in which training is required or JITT is required for FireTrax, Central Dispatch will coordinate this training. All badges for all personnel responding to a public health event involving medical material and resources should include the following items: Name, Role (or Job), Venue, Access. Most badges will also have a photo of the worker if the photo is on file. If no photo is on file, then the worker will be Page 49

50 asked to place a picture ID with the badge to gain access to the venue. Example of a pre-printed access badge to be paired with State Issued ID: Name and Photo will be on State Issued Identification card. Name Role Pod Site Open Access Name Role Pod Site Moderate Access Name Role Pod Site Restricted Access If needed the Van Buren/Cass District Health Department will develop a local liability waiver form for volunteers and decide when the form will be signed by individual volunteer staff for response to the event. Clinic staff will have a separate entrance where they will enter and leave the Dispensing Site which will be the main entrance. This entrance will have security personnel who will check for local health department, local response agency, or other approved ID badges or identification. Ideally, security will have a list of staff members scheduled to work and will check their names off the list as they arrive. Security personnel will provide staff with a name tag/id badge from their respective agency. Staff will then be instructed where to report to begin their shift. VBCDHD also has the Identysis Badging System that can produce identification badges. Similar badging systems are available for use from the 5 th District Medical Response Coalition & Kalamazoo County Health & Community Services. Spontaneous volunteers, unless they have valid identification and credentials from their respective agency (i.e., health department, hospital, and law enforcement) or are a member of the Red Cross, Salvation Army, United Way or other known volunteer agency, will not be allowed to assist. Spontaneous volunteers will be referred to the Red Cross for screening and further utilization. See Attachment 6.4a folder Badging Procedures See Attachment 6.4b folder Badging Just in Time Training Page 50

51 Section 7 Distribution Node (DN) In order to address the critical timing issues associated with distributing the SNS materiel to local jurisdictions, a node strategy for distribution of the SNS is expected to be the most efficient. This model will provide for the delivery of SNS materiel (by the state) from the RSS to a single Distribution Node (DN) located within each LHD jurisdiction. The 45 Local Health Departments are required to arrange for further delivery of the material to identified dispensing sites within their jurisdiction. Local jurisdictions are responsible for selecting a facility that will function as a DN. MDHHS-OPHP maintains facility information for identified DN in the SNS Plan. It is important that all DN staff and volunteers are adequately cared for during an emergency. To maintain an efficient operation, it is necessary to provide adequate nourishment and rest for all DN staff. Facilities that will house Distribution Node operations have been pre-identified and are located in various locations throughout Van Buren or Cass County. Each facility has met specific criteria established by the Centers for Disease Control and Prevention (CDC) and the State. Site-specific plans have been developed. Information regarding the names and locations of DN facilities is considered Controlled Unclassified Information (CUI). Distribution Node Activation Upon determination that the DN must be activated, the facility will be contacted through the Van Buren and/or Cass County Emergency Operations Center (EOC). This call will likely come from the Public Health Annex Head. The VBCDHD Incident Commander (IC), or designee, will facilitate the activation of appropriate VBCDHD staff to deploy to the DN. A DN Manager will be determined based upon available supervisory staff, and will be the contact person for the Distribution Node Operation. Distribution Node Strategy: Van Buren and Cass Counties are both rural and have small population pockets. Population pockets are located on the Eastern (Mattawan) and Western (South Haven) borders of Van Buren County and centrally located (Dowagiac/Cass) in Cass County. The Distribution Node was determined to be centrally located and accessible by road to all PODs. The Distribution Node was also chosen as the most readily available warehouse to be utilized during an event. PODS are set up at one local college in Cass County and, the Intermediate School District in Van Buren County, both centrally located within each county. Each POD site has multiple buildings that could potentially serve as POD sites other than the buildings noted in the plans. Distribution Node sites where chosen due to their proximity to major traffic routes as well as security concerns. Page 51

52 Local Implementation of the Distribution Node Model In Van Buren and/or Cass County, the local distribution node (DN) is located at the Van Buren Intermediate School District shipping/receiving center at 633 Blackman, Lawrence MI. This facility features sufficient open space, is located strategically near major highways to dispensing sites, is in an easy to secure area, has 2 loading docks and is sufficiently electrically powered and temperature and humidity controlled. There are two access points to/from the compound and it is located outside of a flood plain. Vehicles will have easy access for movement throughout the campus and entry/exit of personnel and equipment is easily controlled and protected. Additionally, the space features an area for credentialing or verifying Distribution Node personnel, does not contain petroleum or other flammable liquids, has restrooms and break areas, and has the ability to be locked down. The Van Buren and/or Cass County Health Department (VBCDHD) will utilize the Statewide Distribution Node Model and the described location to efficiently secure, monitor and redistribute state and federal assets received by the VBCDHD for prophylaxis, vaccination, and treatment of the Van Buren and/or Cass County population. Include Maps: Example Below See Attachment 7.1 folder DN Site Plans Distribution Nodes Site Evaluation: The Primary and Alternate DN have been evaluated by the MISNS Team, Van Buren County Emergency Management and the Health Department to determine the capabilities of each site. In addition each site completed a detailed survey of supplies and access to resources. See Attachment 7.2 folder DN Site Checklists Page 52