Healthcare Hazard Vulnerability Assessment

Transcription

1 2018 Healthcare Hazard Vulnerability Assessment Region 3 Healthcare Coalition Alliance Approved: 1/1/2018

2 Healthcare Hazard Vulnerability Assessment June 2018 Region 3 Healthcare Coalition Alliance REGION 3 HEALTHCARE HAZARD VULNERABILITY ASSESSMENT 2018 TABLE OF CONTENTS INTRODUCTION... 2 BACKGROUND... 2 PURPOSE... 2 METHODS and PROCESS... 3 HAZARD RISK AND VULNERABILITY REVIEW... 4 Table 1: Region 3 Healthcare Hazards DATA USED TO DETERMINE HAZARD SEVERITY... 5 Table 2: REGION 3 empower DATA... 5 REGION 3 SOCIAL VULNERABILITY DATA... 5 Figure 1: Region 3 Alliance SVI Vulnerability Levels... 6 HAZARD RANKING... 7 Table 3: Prioritized Healthcare Hazards for Region USE OF HEALTHCARE HVA DATA... 7 Table 4: Future Training and Exercise Goals... 8 DISTRIBTION OF REGION 3 HEALTHCARE HVA RESULTS LIST of RESOURCES HVA PLANNING MEETINGS Table 5: List of Planning Meetings Annex: CHAMP Preparedness Plan Page 1

3 Healthcare Hazard Vulnerability Assessment June 2018 Region 3 Healthcare Coalition Alliance REGION 3 HEALTHCARE COALITION ALLIANCE 2018 HEALTHCARE HAZARD VULNERABILITY ASSESSMENT INTRODUCTION The Region 3 Healthcare Coalition Alliance is made up of three existing Healthcare Coalitions: Northeast Florida Healthcare Coalition (NEFLHCC), North Central Florida Health Care Coalition (NCFHCC) and Coalition for Health and Medical Preparedness (CHAMP). The 18 counties served by the Alliance include: Alachua, Baker, Bradford, Clay, Columbia, Dixie, Duval, Flagler, Gilchrist, Hamilton, Lafayette, Levy, Marion, Nassau, Putnam, St. Johns, Suwannee, and Union Counties. Planning for response and recovery for this 12,000 square mile geographic area can be challenging as it includes immense diversity from rural to urban areas and includes both coastal and inland counties. BACKGROUND Each Coalition developed a Hazard Identification and Risk Assessment (HIRA) as a contract deliverable for Fiscal Year and expanded into a more comprehensive assessment for These early HIRA reports presented by each Coalition provided the first unified assessment of hazard risk, vulnerability, capabilities, resources, and gaps as they impact and relate to the healthcare system in each sub-region. The HIRA described the methodology used for the assessment, which served as the basis for the Community Hazard Vulnerability Assessment (CVA). With the creation of the Region 3 Healthcare Coalition Alliance, and as a contract deliverable for , the Alliance developed this Region 3 Healthcare Hazard Vulnerability Assessment. The Alliance created a team of emergency management, public health and planning subject matter experts (SME) to combine and evaluate the regional data to create this 2018 Region 3 Healthcare Hazard Vulnerability Assessment (HVA). PURPOSE The Region 3 Healthcare Hazard Vulnerability Assessment is used to identify hazards that will have the highest impact on the regional healthcare system. This assessment of hazards and vulnerabilities to the healthcare system will be used to further develop an assessment of risk and gaps in the response capabilities of the regional healthcare system. Page 2

4 Healthcare Hazard Vulnerability Assessment June 2018 Region 3 Healthcare Coalition Alliance METHODS and PROCESS The SME team met to review various HVA tools and determined the Regional Hazard Vulnerability Assessment found on the ASPR Tracie website and developed by the South Carolina Department of Health and Environmental Control was the template that best meet the needs of Region 3. The SME Team then reviewed previous Coalition CVA documents; county Comprehensive Emergency Management Plans (CEMP) and healthcare facility HVA documents to determine a baseline of the primary natural, manmade and technological hazards events impacting the healthcare system for these north Florida counties. Using the de-identified data from empower Attachment 1 empower data and the Social Vulnerability Index (SVI) Attachment 2 SVI data each identified regional hazard was then scored on Probability and Severity to determine the Level of Risk Region 3 faces as a result of each event type occurring in the Region. Probability = Likelihood it will occur Severity = Magnitude + Mitigation Magnitude (Human + Property + Business Impacts) Magnitude (Regional Preparedness + Internal and Regional Resources) After scoring all hazards across all categories, the Risk or Relative Threat to Region 3 was determined as a percentage. The hazards were then ordered from highest to lowest and grouped into Major, Moderate and Minor severity levels. Page 3

5 Healthcare Hazard Vulnerability Assessment June 2018 Region 3 Healthcare Coalition Alliance The hazard severity levels were presented to each Coalition Board for feedback and approval in its respective April 2018 Board meeting. Each Board approved the process and agreed with the results. Each succeeding annual update will consist of a review of the previous year s data (updating where appropriate), and integration of relevant new information as it becomes available. The annual Region 3 Healthcare HVA update will also take into account lessons learned and corrective actions identified through plan updates and revisions, exercises, and real-world events. HAZARD RISK AND VULNERABILITY REVIEW Review of hazard risk and vulnerability data from the multiple data sources identified the following hazards for healthcare in Region 3. These were the hazards used to complete the Regional HVA Tool. Table 1: Region 3 Healthcare Hazards Region 3 Healthcare Hazards Cause Hazard Flooding with potential for disruption / harm Natural Hazards (Acts of nature) Human Caused (Intentional Actions) Technological (failure of systems) Temperature Extremes Hurricane / Tropical Storm (including storm surge) Pandemic Infectious Disease Multi-Jurisdictional Wild Fire Tornado or Microburst Winter Weather Event Armed Individual/Active Shooter incident MCI Incident General Injuries MCI involving chemical, biological or radiological materials MCI involving conventional weapons Cyber Terrorism Multiple Facility Evacuations Widespread Supply Chain Interruption Widespread Transportation Disruption / Failure Regional Fuel Shortage(s) Regional Electrical Failure (i.e. blackout) Regional Communications Disruption Regional Sewer / Water Treatment Failure Regional Water Disruption / Interruption Page 4

6 Healthcare Hazard Vulnerability Assessment June 2018 Region 3 Healthcare Coalition Alliance DATA USED TO DETERMINE HAZARD SEVERITY Historical data found in each county CEMP and facility HVA provided the information for probability. The use of empower and SVI data assisted in determining the severity scores for each hazard. Table 2: REGION 3 empower DATA County Medicare Beneficiaries Electric Dependent Beneficiaries Alachua 40,023 1,719 Baker 4, Bradford 4, Clay 36,812 1,700 Columbia 13, Dixie Duval 144,458 6,618 Flagler 32,820 1,123 Gilchrist 3, Hamilton 2, Lafayette Levy 9, Marion 100,023 4,531 Nassau 18, Putnam 17, St. Johns 48,203 1,807 Suwannee 9, Union 2, Totals Data from April 2018 REGION 3 SOCIAL VULNERABILITY DATA The Social Vulnerability Index (SVI) uses U.S. Census data to determine the social vulnerability of every Census tract. Census tracts are subdivisions of counties for which the Census collects statistical data. The SVI ranks each tract on 14 social factors, including poverty, lack of vehicle access, and crowded housing, and groups them into four related themes. Each tract receives a separate ranking for each of the four themes, as well as an overall ranking. The map below provides an overall view of the social vulnerability rankings in Region 3. Individual county maps are included in Attachment 2. Page 5

7 Figure 1: Region 3 Alliance SVI Vulnerability Levels Healthcare Hazard Vulnerability Assessment June 2018 Region 3 Healthcare Coalition Alliance Page 6

8 Healthcare Hazard Vulnerability Assessment June 2018 Region 3 Healthcare Coalition Alliance HAZARD RANKING Results of the probability and severity scoring using the Regional HVA tool determined the following priority levels of hazards. Table 3: Prioritized Healthcare Hazards for Region 3 Region 3 Healthcare Hazards Level of Risk Hazard Hurricane / Tropical Storm (including storm surge) Regional Electrical Failure (i.e. blackout) Flooding with potential for disruption / harm Major Cyber Terrorism Infectious Disease MCI Incident General Injuries Regional Communications Disruption Multi-Jurisdictional Wild Fire Widespread Supply Chain Interruption Armed Individual/Active Shooter incident (Large Scale) Moderate Tornado or Microburst Pandemic Multiple Facility Evacuations Regional Sewer / Water Treatment Failure Regional Water Disruption / Interruption Widespread Transportation Disruption / Failure Regional Fuel Shortage(s) Temperature Extremes Minor MCI involving chemical, biological or radiological materials MCI involving conventional weapons Winter Weather Event USE OF HEALTHCARE HVA DATA Future activities planned for this analysis include identifying the capabilities of the regional healthcare system to respond to the identified impacts found in the HVA. Evaluation of these capabilities will better define the gaps across the region, which will better inform the future planning, training and exercises and special funding projects for the Region 3 Healthcare Coalition Alliance. Page 7

9 Healthcare Hazard Vulnerability Assessment June 2018 Region 3 Healthcare Coalition Alliance The annual work plan is determined from the grant requirements, as well as the gaps found using this HVA data. The focus for upcoming years will be COOP, Active Assailant, Evacuations and funding member projects to fill identified gaps. Future training and exercise priorities are based in the results of the HVA. Upcoming training includes: COOP Training for Healthcare Facilities; Crisis Leadership; Nursing Home Incident Command; Active Assailant; Basic and Advanced Healthcare Emergency Management; State Patient Movement Plan Training; Stop the Bleed Bleeding Control; and Healthcare Leadership for Mass Casualty Incidents. Upcoming exercise topics include: Communication Drill; FLHealthSTAT Drill; Coalition Surge Tool and various other Hospital Exercises; Hurricane Response in Healthcare Facilities; COOP Exercises for Healthcare; and various exercises to meet the needs of members. The Annual Training Summit provided by the NEFLHCC provides the opportunity to provide training, as well as tabletop exercises, for the planning and training priorities for the current contract funding year. Table 4: Future Training and Exercise Goals Year Training Goal 2019 Overview of Continuity of Operations for for health care Build resilience in healthcare services in a catastrophic event Attend FEPA 2019 Crisis Leadership Training 2019 Provide situation awareness to the Region during times of a disaster/emergency 2019 Build resilience in healthcare services in a catastrophic event Attend Florida Week at CDP 2019 Overview of Continuity of Operations for for health care Attend the Preparedness Summit 2019 Ensure responder health and safety through planning, training and exercises Attend Georgia Emergency Management Summit 2019 Conduct Awareness training on workplace violence or active shooters. Emphasis on training and developing policies and procedures 2019 Provide situation awareness to the Region during times of a disaster/emergency 2019 Attend the Governors Hurricane Conference 2019 Attend FEPA 2019 Educate new hires and provide refresher training on Nursing Home Incident Command 2019 Awareness training on Stop the Bleed, to accompany distribution of kits 2019 Examine planning tools to mitigate impacts from large scale incidents 2019 Annual HCC Training Summit 2019 Provide training on CMS rules and changes to healthcare facilities 2019 Enhance the ability of conducting multijurisdictional, multidisciplinary exchange of Page 8

10 Healthcare Hazard Vulnerability Assessment June 2018 Region 3 Healthcare Coalition Alliance health-related information and situational awareness data among federal, state, and local levels of government with the private sector with the use of EMResource and WebEOC 2019 Attend the National HCC Conference 2019 Conduct Awareness training on workplace violence or active shooters. Emphasis on training and developing policies and procedures 2020 Education on coordinated plans to provide mass distribution of medical countermeasures in response to a large scale public health incident 2020 Attend FEPA 2020 Better educate local healthcare community on the role of ESF Build resilience in healthcare services in a catastrophic event Attend Georgia Emergency Management Summit 2020 Attend the Preparedness Summit 2020 Training Healthcare Facilities on concepts of ICS Enhance the ability of conducting multijurisdictional, multidisciplinary exchange of 2020 health-related information and situational awareness data with the use of EMResource and WebEOC 2020 Attend the Governors Hurricane Conference 2020 Build resilience in healthcare services in a catastrophic event Educate new hires and provide refresher training on HICS 2020 Attend FEPA 2020 Preparing to respond to a mass casualty incident 2020 Annual HCC Training Summit 2020 Provide training on CMS rules and changes to healthcare facilities 2020 Attend the National HCC Conference 2020 Training of Agency leaders on Healthcare Response 2020 Training Healthcare Facilities on concepts of ICS 2020 Build resilience in healthcare services in a catastrophic event Education on decontamination and care 2021 Attend FEPA 2021 Attend Florida Week at CDP 2021 Build resilience in healthcare services in a catastrophic event Awareness Training on the State's Ambulance Deployment Plan 2021 Attend Georgia Emergency Management Summit 2019 Attend the Preparedness Summit 2021 Awareness Training on the State's Patient Movement Plan 2021 Attend the Governors Hurricane Conference 2021 Educate new hires and provide refresher training on Nursing Home IC 2021 Attend FEPA 2021 Ensure responder health and safety through planning, training and exercises Provide training on CMS rules and changes to healthcare facilities 2021 Annual HCC Training Summit 2021 Attend the National HCC Conference Page 9

11 Healthcare Hazard Vulnerability Assessment June 2018 Region 3 Healthcare Coalition Alliance Year Exercise Goal 2019 Allow healthcare facilities to exercise Active Shooter Plans developed in Contract Requirement 2019 Contract Requirement 2019 Coordination of healthcare facilities with local EM and ESF Exercise a minimum of 20% of staffed acute care beds in the region 2019 Conduct Region 3 Full Scale Exercise 2019 Conduct an exercise to ehnace communication and coordiantion with hospitals and the HCC 2019 Contract Requirement 2019 Contract Requirement 2019 This exercise is intended to meet a CHD expectation Exercise Emergency Plans for Healthcare facilities 2019 Meet contract deliverable to conduct a full scale exercise within 5 years 2020 Contract Requirement 2020 Contract Requirement 2020 Operationalize Active Shooter Plans that have been developed by healthcare facilities 2020 Exercise a minimum of 20% of staffed acute care beds in the region 2020 Contract Requirement 2020 Contract Requirement 2020 Exercise Emergency Plans for Healthcare facilities 2021 Contract Requirement 2021 Contract Requirement 2021 Conduct a COOP Activation exercise that will follow COOP training offered in the district 2021 Exercise a minimum of 20% of staffed acute care beds in the region 2021 Contract Requirement 2021 Contract Requirement 2021 Conduct an exercise to ehnace communication and coordiantion with hospitals and the HCC 2021 Exercise Emergency Plans for Healthcare facilities DISTRIBTION OF REGION 3 HEALTHCARE HVA RESULTS This Region 3 Healthcare Hazard Vulnerability Assessment will be combined with the Jurisdictional Risk Assessment and provided to all Coalition Board members. Coalition membership includes Emergency Management, EMS and Public Health officials and other organizations involved in the healthcare delivery system. Copies of these reports will also be posted on each Coalition s website for use by Coalition members. Members are encouraged to use this data to develop projects that will improve the capabilities of the regional healthcare response. Page 10

12 Healthcare Hazard Vulnerability Assessment June 2018 Region 3 Healthcare Coalition Alliance LIST of RESOURCES Health and Human Services empower Map 2.0 Agency for Toxic Substances and Disease Registry (ATSDR) Social Vulnerability Index Florida Department of Health, CHARTS, vulnerable populations profile reports DOH Public Health risk Assessment (PHRAT) for 11 counties in the region Comprehensive Emergency Management Plans for counties in the region County Mitigation Plans for counties in the region HVA PLANNING MEETINGS Table 5: List of Planning Meetings January 19, 2018 SME Team Meeting Develop initial strategy/approach January 24 SME Team PHRAT Analysis February 15 SME Team HVA Tool Template Analysis February 21 In-person meeting SME & NEFLHCC Presentation of HVA template for approval February 23 to NCFHCC Seek jurisdictional information February 26 In-person meeting SME & NCFHCC Presentation of HVA template for approval April 6 SME Team Meeting Finalize Prioritization & Severity of Hazards April 18 NEFLHCC Board, Alliance Staff & Coalition Staff Presented HVA Draft to NEFHCC Board for approval April 23 NCFHCC Board, Alliance Staff & Coalition Staff Presented HVA Draft to NCFHCC Board for approval May 21 NCFHCC Board, Alliance Staff & Coalition Staff Presented HVA Final to NEFHCC Board for approval May 24 NEFLHCC Board, Alliance Staff & Coalition Staff Presented HVA Final to NCFHCC Board for approval Attachment 1: Region 3 Alliance empower Data Attachment 2: Region 3 Alliance SVI data Annex: CHAMP HVA Page 11

13 empower Map Page 1 of 2 12/15/2017 Skip to main content HHS.govU.S. Department of Health & Human ServicesPHE.GOV Skip to main content HHS empower Map 2.0 Over 2.5 million Medicare beneficiaries rely upon electricity-dependent medical and assistive equipment, such as ventilators and wheel chairs, and cardiac devices in our communities. Severe weather and disasters that cause power outages can be life threatening for these individuals. How can we empower community and electricity-dependent Medicare beneficiary health resilience? Every hospital, first responder, electric company, and community member can use the map to find the monthly total of Medicare beneficiaries with electricity-dependent equipment claims at the U.S. state, territory, county, and zip code level and turn on real-time natural hazard and NOAA severe weather tracking services to identify areas and populations that may be impacted and are at risk for prolonged power outages. Together, we can all develop emergency plans and response activities for the whole community and assist our at-risk community members prior to, during and after an emergency. Resource List HHS empower Map Factsheet State Public Health Authority {Coming Soon} Select map attributes to display data Esri, HERE, Garmin, USGS, NGA, EPA, USDA, NPS Natural Hazards Select Natural Hazard Region for Health Data State Florida County Alachua ZIP Code Select ZIP Code Map Style Select Basemap Reset Map Medicare Data Totals Geographical Area: Alachua Beneficiaries: 39,347 Electricity-Dependent Beneficiaries: 1,713 Electricity-Dependent Scale

14 empower Map Page 2 of 2 12/15/ ,101 Natural Hazard Legend Electricity-Dependant States/Territories Counties ZIP Codes Geographic Area Beneficiaries Electricity-Dependent Beneficiaries , , , , , , , , , , , , , Note (1): The map only shows de-identified claims data for Medicare Fee-for-Service and Medicare Advantage (Parts A, B and C) beneficiaries that include Americans aged 65 and over and disabled Americans under age 65. This may be an under representation as some claims may not be recorded due to a submission lag or if the Medicare DME rental cap has been reached. Note (2): The electricity-dependent number, by location, represents the total number of beneficiaries with claims in our databases from the prior month for: ventilator, BiPAP, internal feeding, IV infusion pump, suction pump, at-home dialysis, electric wheelchair, and electric bed equipment in the past 13 months; oxygen concentrator equipment in the past 36 months; and an implanted cardiac device (i.e. LVAD, RVAD, BIVAD, TAH) in the past 5 years. As privacy protection is very important, deidentification methodologies have been implemented including: removal of all personal identifiers; aggregating data totals at the geographic level; and replacing any small cell size between 1 and 10 with an 11. Some zip codes may not be represented on the map as they do not have geographical boundaries to map (e.g. post office boxes, a large building, etc.). In these instances, we add their total to the geographical zip code where the post office box or building can be found. Note (3): The map has been provided to inform and support community partner emergency preparedness, mitigation, response, recovery, and resilience activities. Use of this tool and data signifies your agreement to: use it for the specified purposes; make no attempt to identify any individual in this data; and send an to empower@hhs.gov if a small size between 1 and 10 is identified at any geographic level. Send any additional questions to empower@hhs.gov. Note (4): Information regarding the Natural Hazards can be found from the different sources' webpages: National Oceanic and Atmospheric Administration (NOAA) National Weather Service active weather alerts can be found at: Hurricanes, Radar, Flood, Precipitation, and Storm Prediction: Long Duration and Short Duration Hazards: Wildfire: Seismic Activity: HOME PHE.GOV Office of the Assistant Secretary for Preparedness & Response Privacy, Accessibility, Disclaimer U.S. Department of Health & Human Services 200 Independence Avenue, S.W. Washington, D.C Last updated: 30 December 2016 First published: 23 June 2015

15 empower Map of 3 12/14/2017, 8:32 AM Skip to main content HHS.govU.S. Department of Health & Human ServicesPHE.GOV Skip to main content Over 2.5 million Medicare beneficiaries rely upon electricity-dependent medical and assistive equipment, such as ventilators and wheel chairs, and cardiac devices in our communities. Severe weather and disasters that cause power outages can be life threatening for these individuals. How can we empower community and electricity-dependent Medicare beneficiary health resilience? Every hospital, first responder, electric company, and community member can use the map to find the monthly total of Medicare beneficiaries with electricity-dependent equipment claims at the U.S. state, territory, county, and zip code level and turn on real-time natural hazard and NOAA severe weather tracking services to identify areas and populations that may be impacted and are at risk for prolonged power outages. Together, we can all develop emergency plans and response activities for the whole community and assist our at-risk community members prior to, during and after an emergency. HHS empower Map Factsheet {Coming Soon}

16 empower Map of 3 12/14/2017, 8:32 AM Natural Hazards Region for Health Data State County ZIP Code Map Style Reset Map Medicare Data Totals Geographical Area: Baker Beneficiaries: 4,323 Electricity-Dependent Beneficiaries: 293 Electricity-Dependent Scale ,101 Natural Hazard Legend States/Territories Counties ZIP Codes Geographic Area Beneficiaries Electricity-Dependent Beneficiaries , ,

17 empower Map of 3 12/14/2017, 8:32 AM Geographic Area Beneficiaries Electricity-Dependent Beneficiaries Note (1): The map only shows de-identified claims data for Medicare Fee-for-Service and Medicare Advantage (Parts A, B and C) beneficiaries that include Americans aged 65 and over and disabled Americans under age 65. This may be an under representation as some claims may not be recorded due to a submission lag or if the Medicare DME rental cap has been reached. Note (2): The electricity-dependent number, by location, represents the total number of beneficiaries with claims in our databases from the prior month for: ventilator, BiPAP, internal feeding, IV infusion pump, suction pump, at-home dialysis, electric wheelchair, and electric bed equipment in the past 13 months; oxygen concentrator equipment in the past 36 months; and an implanted cardiac device (i.e. LVAD, RVAD, BIVAD, TAH) in the past 5 years. As privacy protection is very important, de-identification methodologies have been implemented including: removal of all personal identifiers; aggregating data totals at the geographic level; and replacing any small cell size between 1 and 10 with an 11. Some zip codes may not be represented on the map as they do not have geographical boundaries to map (e.g. post office boxes, a large building, etc.). In these instances, we add their total to the geographical zip code where the post office box or building can be found. Note (3): The map has been provided to inform and support community partner emergency preparedness, mitigation, response, recovery, and resilience activities. Use of this tool and data signifies your agreement to: use it for the specified purposes; make no attempt to identify any individual in this data; and send an to empower@hhs.gov if a small size between 1 and 10 is identified at any geographic level. Send any additional questions to empower@hhs.gov. Note (4): Information regarding the Natural Hazards can be found from the different sources' webpages: National Oceanic and Atmospheric Administration (NOAA) National Weather Service active weather alerts can be found at: Hurricanes, Radar, Flood, Precipitation, and Storm Prediction: /rest/services. Long Duration and Short Duration Hazards: Wildfire: /rest/services/livefeeds/wildfire_activity/mapserver. Seismic Activity: /11e49b2f31b04811a339cf /rest/services/LiveFeeds/USGS_Seismic_Data/MapServer. HOME PHE.GOV Office of the Assistant Secretary for Preparedness & Response Privacy, Accessibility, Disclaimer U.S. Department of Health & Human Services 200 Independence Avenue, S.W. Washington, D.C Last updated: 30 December 2016 First published: 23 June 2015

18 empower Map Page 1 of 2 12/20/2017 Skip to main content HHS.govU.S. Department of Health & Human ServicesPHE.GOV Skip to main content HHS empower Map 2.0 Over 2.5 million Medicare beneficiaries rely upon electricity-dependent medical and assistive equipment, such as ventilators and wheel chairs, and cardiac devices in our communities. Severe weather and disasters that cause power outages can be life threatening for these individuals. How can we empower community and electricity-dependent Medicare beneficiary health resilience? Every hospital, first responder, electric company, and community member can use the map to find the monthly total of Medicare beneficiaries with electricity-dependent equipment claims at the U.S. state, territory, county, and zip code level and turn on real-time natural hazard and NOAA severe weather tracking services to identify areas and populations that may be impacted and are at risk for prolonged power outages. Together, we can all develop emergency plans and response activities for the whole community and assist our at-risk community members prior to, during and after an emergency. Resource List HHS empower Map Factsheet State Public Health Authority {Coming Soon} Select map attributes to display data Esri, HERE, Garmin, USGS, NGA, EPA, USDA, NPS Natural Hazards Select Natural Hazard Region for Health Data State Florida County Bradford ZIP Code Select ZIP Code Map Style Select Basemap Reset Map Medicare Data Totals Geographical Area: Bradford Beneficiaries: 4,687 Electricity-Dependent Beneficiaries: 339 Electricity-Dependent Scale

19 empower Map Page 2 of 2 12/20/ ,101 Natural Hazard Legend Electricity-Dependant States/Territories Counties ZIP Codes Geographic Area Beneficiaries Electricity-Dependent Beneficiaries , Note (1): The map only shows de-identified claims data for Medicare Fee-for-Service and Medicare Advantage (Parts A, B and C) beneficiaries that include Americans aged 65 and over and disabled Americans under age 65. This may be an under representation as some claims may not be recorded due to a submission lag or if the Medicare DME rental cap has been reached. Note (2): The electricity-dependent number, by location, represents the total number of beneficiaries with claims in our databases from the prior month for: ventilator, BiPAP, internal feeding, IV infusion pump, suction pump, at-home dialysis, electric wheelchair, and electric bed equipment in the past 13 months; oxygen concentrator equipment in the past 36 months; and an implanted cardiac device (i.e. LVAD, RVAD, BIVAD, TAH) in the past 5 years. As privacy protection is very important, deidentification methodologies have been implemented including: removal of all personal identifiers; aggregating data totals at the geographic level; and replacing any small cell size between 1 and 10 with an 11. Some zip codes may not be represented on the map as they do not have geographical boundaries to map (e.g. post office boxes, a large building, etc.). In these instances, we add their total to the geographical zip code where the post office box or building can be found. Note (3): The map has been provided to inform and support community partner emergency preparedness, mitigation, response, recovery, and resilience activities. Use of this tool and data signifies your agreement to: use it for the specified purposes; make no attempt to identify any individual in this data; and send an to empower@hhs.gov if a small size between 1 and 10 is identified at any geographic level. Send any additional questions to empower@hhs.gov. Note (4): Information regarding the Natural Hazards can be found from the different sources' webpages: National Oceanic and Atmospheric Administration (NOAA) National Weather Service active weather alerts can be found at: Hurricanes, Radar, Flood, Precipitation, and Storm Prediction: Long Duration and Short Duration Hazards: Wildfire: Seismic Activity: HOME PHE.GOV Office of the Assistant Secretary for Preparedness & Response Privacy, Accessibility, Disclaimer U.S. Department of Health & Human Services 200 Independence Avenue, S.W. Washington, D.C Last updated: 30 December 2016 First published: 23 June 2015

20 empower Map of 4 12/14/2017, 8:33 AM Skip to main content HHS.govU.S. Department of Health & Human ServicesPHE.GOV Skip to main content Over 2.5 million Medicare beneficiaries rely upon electricity-dependent medical and assistive equipment, such as ventilators and wheel chairs, and cardiac devices in our communities. Severe weather and disasters that cause power outages can be life threatening for these individuals. How can we empower community and electricity-dependent Medicare beneficiary health resilience? Every hospital, first responder, electric company, and community member can use the map to find the monthly total of Medicare beneficiaries with electricity-dependent equipment claims at the U.S. state, territory, county, and zip code level and turn on real-time natural hazard and NOAA severe weather tracking services to identify areas and populations that may be impacted and are at risk for prolonged power outages. Together, we can all develop emergency plans and response activities for the whole community and assist our at-risk community members prior to, during and after an emergency. HHS empower Map Factsheet {Coming Soon}

21 empower Map of 4 12/14/2017, 8:33 AM Natural Hazards Region for Health Data State County ZIP Code Map Style Reset Map Medicare Data Totals Geographical Area: Clay Beneficiaries: 36,106 Electricity-Dependent Beneficiaries: 1,689 Electricity-Dependent Scale ,101 Natural Hazard Legend States/Territories Counties ZIP Codes Geographic Area Beneficiaries Electricity-Dependent Beneficiaries , ,

22 empower Map of 4 12/14/2017, 8:33 AM Geographic Area Beneficiaries Electricity-Dependent Beneficiaries , , , , Note (1): The map only shows de-identified claims data for Medicare Fee-for-Service and Medicare Advantage (Parts A, B and C) beneficiaries that include Americans aged 65 and over and disabled Americans under age 65. This may be an under representation as some claims may not be recorded due to a submission lag or if the Medicare DME rental cap has been reached. Note (2): The electricity-dependent number, by location, represents the total number of beneficiaries with claims in our databases from the prior month for: ventilator, BiPAP, internal feeding, IV infusion pump, suction pump, at-home dialysis, electric wheelchair, and electric bed equipment in the past 13 months; oxygen concentrator equipment in the past 36 months; and an implanted cardiac device (i.e. LVAD, RVAD, BIVAD, TAH) in the past 5 years. As privacy protection is very important, de-identification methodologies have been implemented including: removal of all personal identifiers; aggregating data totals at the geographic level; and replacing any small cell size between 1 and 10 with an 11. Some zip codes may not be represented on the map as they do not have geographical boundaries to map (e.g. post office boxes, a large building, etc.). In these instances, we add their total to the geographical zip code where the post office box or building can be found. Note (3): The map has been provided to inform and support community partner emergency preparedness, mitigation, response, recovery, and resilience activities. Use of this tool and data signifies your agreement to: use it for the specified purposes; make no attempt to identify any individual in this data; and send an to empower@hhs.gov if a small size between 1 and 10 is identified at any geographic level. Send any additional questions to empower@hhs.gov. Note (4): Information regarding the Natural Hazards can be found from the different sources' webpages: National Oceanic and Atmospheric Administration (NOAA) National Weather Service active weather alerts can be found at: Hurricanes, Radar, Flood, Precipitation, and Storm Prediction: /rest/services. Long Duration and Short Duration Hazards: Wildfire: /rest/services/livefeeds/wildfire_activity/mapserver. Seismic Activity: /11e49b2f31b04811a339cf /rest/services/LiveFeeds/USGS_Seismic_Data/MapServer. HOME PHE.GOV Office of the Assistant Secretary for Preparedness & Response Privacy, Accessibility, Disclaimer U.S. Department of Health & Human Services

23 empower Map Page 1 of 2 12/20/2017 Skip to main content HHS.govU.S. Department of Health & Human ServicesPHE.GOV Skip to main content HHS empower Map 2.0 Over 2.5 million Medicare beneficiaries rely upon electricity-dependent medical and assistive equipment, such as ventilators and wheel chairs, and cardiac devices in our communities. Severe weather and disasters that cause power outages can be life threatening for these individuals. How can we empower community and electricity-dependent Medicare beneficiary health resilience? Every hospital, first responder, electric company, and community member can use the map to find the monthly total of Medicare beneficiaries with electricity-dependent equipment claims at the U.S. state, territory, county, and zip code level and turn on real-time natural hazard and NOAA severe weather tracking services to identify areas and populations that may be impacted and are at risk for prolonged power outages. Together, we can all develop emergency plans and response activities for the whole community and assist our at-risk community members prior to, during and after an emergency. Resource List HHS empower Map Factsheet State Public Health Authority {Coming Soon} Select map attributes to display data Esri, HERE, Garmin, FAO, USGS, NGA, EPA, NPS Natural Hazards Select Natural Hazard Region for Health Data State Florida County Columbia ZIP Code Select ZIP Code Map Style Select Basemap Reset Map Medicare Data Totals Geographical Area: Columbia Beneficiaries: 13,751 Electricity-Dependent Beneficiaries: 911 Electricity-Dependent Scale

24 empower Map Page 2 of 2 12/20/ ,101 Natural Hazard Legend Electricity-Dependant States/Territories Counties ZIP Codes Geographic Area Beneficiaries Electricity-Dependent Beneficiaries , , , , Note (1): The map only shows de-identified claims data for Medicare Fee-for-Service and Medicare Advantage (Parts A, B and C) beneficiaries that include Americans aged 65 and over and disabled Americans under age 65. This may be an under representation as some claims may not be recorded due to a submission lag or if the Medicare DME rental cap has been reached. Note (2): The electricity-dependent number, by location, represents the total number of beneficiaries with claims in our databases from the prior month for: ventilator, BiPAP, internal feeding, IV infusion pump, suction pump, at-home dialysis, electric wheelchair, and electric bed equipment in the past 13 months; oxygen concentrator equipment in the past 36 months; and an implanted cardiac device (i.e. LVAD, RVAD, BIVAD, TAH) in the past 5 years. As privacy protection is very important, deidentification methodologies have been implemented including: removal of all personal identifiers; aggregating data totals at the geographic level; and replacing any small cell size between 1 and 10 with an 11. Some zip codes may not be represented on the map as they do not have geographical boundaries to map (e.g. post office boxes, a large building, etc.). In these instances, we add their total to the geographical zip code where the post office box or building can be found. Note (3): The map has been provided to inform and support community partner emergency preparedness, mitigation, response, recovery, and resilience activities. Use of this tool and data signifies your agreement to: use it for the specified purposes; make no attempt to identify any individual in this data; and send an to empower@hhs.gov if a small size between 1 and 10 is identified at any geographic level. Send any additional questions to empower@hhs.gov. Note (4): Information regarding the Natural Hazards can be found from the different sources' webpages: National Oceanic and Atmospheric Administration (NOAA) National Weather Service active weather alerts can be found at: Hurricanes, Radar, Flood, Precipitation, and Storm Prediction: Long Duration and Short Duration Hazards: Wildfire: Seismic Activity: HOME PHE.GOV Office of the Assistant Secretary for Preparedness & Response Privacy, Accessibility, Disclaimer U.S. Department of Health & Human Services 200 Independence Avenue, S.W. Washington, D.C Last updated: 30 December 2016 First published: 23 June 2015

25 empower Map Page 1 of 2 12/20/2017 Skip to main content HHS.govU.S. Department of Health & Human ServicesPHE.GOV Skip to main content HHS empower Map 2.0 Over 2.5 million Medicare beneficiaries rely upon electricity-dependent medical and assistive equipment, such as ventilators and wheel chairs, and cardiac devices in our communities. Severe weather and disasters that cause power outages can be life threatening for these individuals. How can we empower community and electricity-dependent Medicare beneficiary health resilience? Every hospital, first responder, electric company, and community member can use the map to find the monthly total of Medicare beneficiaries with electricity-dependent equipment claims at the U.S. state, territory, county, and zip code level and turn on real-time natural hazard and NOAA severe weather tracking services to identify areas and populations that may be impacted and are at risk for prolonged power outages. Together, we can all develop emergency plans and response activities for the whole community and assist our at-risk community members prior to, during and after an emergency. Resource List HHS empower Map Factsheet State Public Health Authority {Coming Soon} Select map attributes to display data Esri, HERE, Garmin, USGS, NGA, EPA, USDA, NPS Natural Hazards Select Natural Hazard Region for Health Data State Florida County Dixie ZIP Code Select ZIP Code Map Style Select Basemap Reset Map Medicare Data Totals Geographical Area: Dixie Beneficiaries: 3,577 Electricity-Dependent Beneficiaries: 290 Electricity-Dependent Scale

26 empower Map Page 2 of 2 12/20/ ,101 Natural Hazard Legend Electricity-Dependant States/Territories Counties ZIP Codes Geographic Area Beneficiaries Electricity-Dependent Beneficiaries , Note (1): The map only shows de-identified claims data for Medicare Fee-for-Service and Medicare Advantage (Parts A, B and C) beneficiaries that include Americans aged 65 and over and disabled Americans under age 65. This may be an under representation as some claims may not be recorded due to a submission lag or if the Medicare DME rental cap has been reached. Note (2): The electricity-dependent number, by location, represents the total number of beneficiaries with claims in our databases from the prior month for: ventilator, BiPAP, internal feeding, IV infusion pump, suction pump, at-home dialysis, electric wheelchair, and electric bed equipment in the past 13 months; oxygen concentrator equipment in the past 36 months; and an implanted cardiac device (i.e. LVAD, RVAD, BIVAD, TAH) in the past 5 years. As privacy protection is very important, deidentification methodologies have been implemented including: removal of all personal identifiers; aggregating data totals at the geographic level; and replacing any small cell size between 1 and 10 with an 11. Some zip codes may not be represented on the map as they do not have geographical boundaries to map (e.g. post office boxes, a large building, etc.). In these instances, we add their total to the geographical zip code where the post office box or building can be found. Note (3): The map has been provided to inform and support community partner emergency preparedness, mitigation, response, recovery, and resilience activities. Use of this tool and data signifies your agreement to: use it for the specified purposes; make no attempt to identify any individual in this data; and send an to empower@hhs.gov if a small size between 1 and 10 is identified at any geographic level. Send any additional questions to empower@hhs.gov. Note (4): Information regarding the Natural Hazards can be found from the different sources' webpages: National Oceanic and Atmospheric Administration (NOAA) National Weather Service active weather alerts can be found at: Hurricanes, Radar, Flood, Precipitation, and Storm Prediction: Long Duration and Short Duration Hazards: Wildfire: Seismic Activity: HOME PHE.GOV Office of the Assistant Secretary for Preparedness & Response Privacy, Accessibility, Disclaimer U.S. Department of Health & Human Services 200 Independence Avenue, S.W. Washington, D.C Last updated: 30 December 2016 First published: 23 June 2015

27 empower Map of 4 12/14/2017, 8:33 AM Skip to main content HHS.govU.S. Department of Health & Human ServicesPHE.GOV Skip to main content Over 2.5 million Medicare beneficiaries rely upon electricity-dependent medical and assistive equipment, such as ventilators and wheel chairs, and cardiac devices in our communities. Severe weather and disasters that cause power outages can be life threatening for these individuals. How can we empower community and electricity-dependent Medicare beneficiary health resilience? Every hospital, first responder, electric company, and community member can use the map to find the monthly total of Medicare beneficiaries with electricity-dependent equipment claims at the U.S. state, territory, county, and zip code level and turn on real-time natural hazard and NOAA severe weather tracking services to identify areas and populations that may be impacted and are at risk for prolonged power outages. Together, we can all develop emergency plans and response activities for the whole community and assist our at-risk community members prior to, during and after an emergency. HHS empower Map Factsheet {Coming Soon}

28 empower Map of 4 12/14/2017, 8:33 AM Natural Hazards Region for Health Data State County ZIP Code Map Style Reset Map Medicare Data Totals Geographical Area: Duval Beneficiaries: 142,252 Electricity-Dependent Beneficiaries: 6,698 Electricity-Dependent Scale ,101 Natural Hazard Legend States/Territories Counties ZIP Codes Geographic Area Beneficiaries Electricity-Dependent Beneficiaries , ,

29 empower Map of 4 12/14/2017, 8:33 AM suction pump, at-home dialysis, electric wheelchair, and electric bed equipment in the past 13 months; oxygen concentrator equipment in the past 36 months; and an implanted cardiac device (i.e. LVAD, RVAD, BIVAD, TAH) in the past 5 years. As privacy protection is very important, de-identification methodologies have been implemented including: removal of all personal identifiers; aggregating data totals at the geographic level; and replacing any small cell size between 1 and 10 with an 11. Some zip codes may not be represented on the map as they do not have geographical boundaries to map (e.g. post office boxes, a large building, etc.). In these instances, we add their total to the geographical zip code where the post office box or building can be found. Note (3): The map has been provided to inform and support community partner emergency preparedness, mitigation, response, recovery, and resilience activities. Use of this tool and data signifies your agreement to: use it for the specified purposes; make no attempt to identify any individual in this data; and send an to empower@hhs.gov if a small size between 1 and 10 is identified at any geographic level. Send any additional questions to empower@hhs.gov. Note (4): Information regarding the Natural Hazards can be found from the different sources' webpages: National Oceanic and Atmospheric Administration (NOAA) National Weather Service active weather alerts can be found at: Hurricanes, Radar, Flood, Precipitation, and Storm Prediction: /rest/services. Long Duration and Short Duration Hazards: Wildfire: /rest/services/livefeeds/wildfire_activity/mapserver. Seismic Activity: /11e49b2f31b04811a339cf /rest/services/LiveFeeds/USGS_Seismic_Data/MapServer. HOME PHE.GOV Office of the Assistant Secretary for Preparedness & Response Privacy, Accessibility, Disclaimer U.S. Department of Health & Human Services 200 Independence Avenue, S.W. Washington, D.C Last updated: 30 December 2016 First published: 23 June 2015

30 empower Map of 4 12/14/2017, 8:34 AM Skip to main content HHS.govU.S. Department of Health & Human ServicesPHE.GOV Skip to main content Over 2.5 million Medicare beneficiaries rely upon electricity-dependent medical and assistive equipment, such as ventilators and wheel chairs, and cardiac devices in our communities. Severe weather and disasters that cause power outages can be life threatening for these individuals. How can we empower community and electricity-dependent Medicare beneficiary health resilience? Every hospital, first responder, electric company, and community member can use the map to find the monthly total of Medicare beneficiaries with electricity-dependent equipment claims at the U.S. state, territory, county, and zip code level and turn on real-time natural hazard and NOAA severe weather tracking services to identify areas and populations that may be impacted and are at risk for prolonged power outages. Together, we can all develop emergency plans and response activities for the whole community and assist our at-risk community members prior to, during and after an emergency. HHS empower Map Factsheet {Coming Soon}

31 empower Map of 4 12/14/2017, 8:34 AM Natural Hazards Region for Health Data State County ZIP Code Map Style Reset Map Medicare Data Totals Geographical Area: Flagler Beneficiaries: 32,454 Electricity-Dependent Beneficiaries: 1,106 Electricity-Dependent Scale ,101 Natural Hazard Legend States/Territories Counties ZIP Codes Geographic Area Beneficiaries Electricity-Dependent Beneficiaries ,811 81

32 empower Map of 4 12/14/2017, 8:34 AM Geographic Area Beneficiaries Electricity-Dependent Beneficiaries , , , Note (1): The map only shows de-identified claims data for Medicare Fee-for-Service and Medicare Advantage (Parts A, B and C) beneficiaries that include Americans aged 65 and over and disabled Americans under age 65. This may be an under representation as some claims may not be recorded due to a submission lag or if the Medicare DME rental cap has been reached. Note (2): The electricity-dependent number, by location, represents the total number of beneficiaries with claims in our databases from the prior month for: ventilator, BiPAP, internal feeding, IV infusion pump, suction pump, at-home dialysis, electric wheelchair, and electric bed equipment in the past 13 months; oxygen concentrator equipment in the past 36 months; and an implanted cardiac device (i.e. LVAD, RVAD, BIVAD, TAH) in the past 5 years. As privacy protection is very important, de-identification methodologies have been implemented including: removal of all personal identifiers; aggregating data totals at the geographic level; and replacing any small cell size between 1 and 10 with an 11. Some zip codes may not be represented on the map as they do not have geographical boundaries to map (e.g. post office boxes, a large building, etc.). In these instances, we add their total to the geographical zip code where the post office box or building can be found. Note (3): The map has been provided to inform and support community partner emergency preparedness, mitigation, response, recovery, and resilience activities. Use of this tool and data signifies your agreement to: use it for the specified purposes; make no attempt to identify any individual in this data; and send an to empower@hhs.gov if a small size between 1 and 10 is identified at any geographic level. Send any additional questions to empower@hhs.gov. Note (4): Information regarding the Natural Hazards can be found from the different sources' webpages: National Oceanic and Atmospheric Administration (NOAA) National Weather Service active weather alerts can be found at: Hurricanes, Radar, Flood, Precipitation, and Storm Prediction: /rest/services. Long Duration and Short Duration Hazards: Wildfire: /rest/services/livefeeds/wildfire_activity/mapserver. Seismic Activity: /11e49b2f31b04811a339cf /rest/services/LiveFeeds/USGS_Seismic_Data/MapServer. HOME PHE.GOV Office of the Assistant Secretary for Preparedness & Response Privacy, Accessibility, Disclaimer U.S. Department of Health & Human Services

33 empower Map Page 1 of 2 12/20/2017 Skip to main content HHS.govU.S. Department of Health & Human ServicesPHE.GOV Skip to main content HHS empower Map 2.0 Over 2.5 million Medicare beneficiaries rely upon electricity-dependent medical and assistive equipment, such as ventilators and wheel chairs, and cardiac devices in our communities. Severe weather and disasters that cause power outages can be life threatening for these individuals. How can we empower community and electricity-dependent Medicare beneficiary health resilience? Every hospital, first responder, electric company, and community member can use the map to find the monthly total of Medicare beneficiaries with electricity-dependent equipment claims at the U.S. state, territory, county, and zip code level and turn on real-time natural hazard and NOAA severe weather tracking services to identify areas and populations that may be impacted and are at risk for prolonged power outages. Together, we can all develop emergency plans and response activities for the whole community and assist our at-risk community members prior to, during and after an emergency. Resource List HHS empower Map Factsheet State Public Health Authority {Coming Soon} Select map attributes to display data Esri, HERE, Garmin, USGS, NGA, EPA, USDA, NPS Natural Hazards Select Natural Hazard Region for Health Data State Florida County Gilchrist ZIP Code Select ZIP Code Map Style Select Basemap Reset Map Medicare Data Totals Geographical Area: Gilchrist Beneficiaries: 3,481 Electricity-Dependent Beneficiaries: 226 Electricity-Dependent Scale

34 empower Map Page 2 of 2 12/20/ ,101 Natural Hazard Legend Electricity-Dependant States/Territories Counties ZIP Codes Geographic Area Beneficiaries Electricity-Dependent Beneficiaries , , Note (1): The map only shows de-identified claims data for Medicare Fee-for-Service and Medicare Advantage (Parts A, B and C) beneficiaries that include Americans aged 65 and over and disabled Americans under age 65. This may be an under representation as some claims may not be recorded due to a submission lag or if the Medicare DME rental cap has been reached. Note (2): The electricity-dependent number, by location, represents the total number of beneficiaries with claims in our databases from the prior month for: ventilator, BiPAP, internal feeding, IV infusion pump, suction pump, at-home dialysis, electric wheelchair, and electric bed equipment in the past 13 months; oxygen concentrator equipment in the past 36 months; and an implanted cardiac device (i.e. LVAD, RVAD, BIVAD, TAH) in the past 5 years. As privacy protection is very important, deidentification methodologies have been implemented including: removal of all personal identifiers; aggregating data totals at the geographic level; and replacing any small cell size between 1 and 10 with an 11. Some zip codes may not be represented on the map as they do not have geographical boundaries to map (e.g. post office boxes, a large building, etc.). In these instances, we add their total to the geographical zip code where the post office box or building can be found. Note (3): The map has been provided to inform and support community partner emergency preparedness, mitigation, response, recovery, and resilience activities. Use of this tool and data signifies your agreement to: use it for the specified purposes; make no attempt to identify any individual in this data; and send an to empower@hhs.gov if a small size between 1 and 10 is identified at any geographic level. Send any additional questions to empower@hhs.gov. Note (4): Information regarding the Natural Hazards can be found from the different sources' webpages: National Oceanic and Atmospheric Administration (NOAA) National Weather Service active weather alerts can be found at: Hurricanes, Radar, Flood, Precipitation, and Storm Prediction: Long Duration and Short Duration Hazards: Wildfire: Seismic Activity: HOME PHE.GOV Office of the Assistant Secretary for Preparedness & Response Privacy, Accessibility, Disclaimer U.S. Department of Health & Human Services 200 Independence Avenue, S.W. Washington, D.C Last updated: 30 December 2016 First published: 23 June 2015

35 empower Map Page 1 of 2 12/20/2017 Skip to main content HHS.govU.S. Department of Health & Human ServicesPHE.GOV Skip to main content HHS empower Map 2.0 Over 2.5 million Medicare beneficiaries rely upon electricity-dependent medical and assistive equipment, such as ventilators and wheel chairs, and cardiac devices in our communities. Severe weather and disasters that cause power outages can be life threatening for these individuals. How can we empower community and electricity-dependent Medicare beneficiary health resilience? Every hospital, first responder, electric company, and community member can use the map to find the monthly total of Medicare beneficiaries with electricity-dependent equipment claims at the U.S. state, territory, county, and zip code level and turn on real-time natural hazard and NOAA severe weather tracking services to identify areas and populations that may be impacted and are at risk for prolonged power outages. Together, we can all develop emergency plans and response activities for the whole community and assist our at-risk community members prior to, during and after an emergency. Resource List HHS empower Map Factsheet State Public Health Authority {Coming Soon} Select map attributes to display data Esri, HERE, Garmin, USGS, NGA, EPA, USDA, NPS Natural Hazards Select Natural Hazard Region for Health Data State Florida County Hamilton ZIP Code Select ZIP Code Map Style Select Basemap Reset Map Medicare Data Totals Geographical Area: Hamilton Beneficiaries: 2,829 Electricity-Dependent Beneficiaries: 157 Electricity-Dependent Scale

36 empower Map Page 2 of 2 12/20/ ,101 Natural Hazard Legend Electricity-Dependant States/Territories Counties ZIP Codes Geographic Area Beneficiaries Electricity-Dependent Beneficiaries , Note (1): The map only shows de-identified claims data for Medicare Fee-for-Service and Medicare Advantage (Parts A, B and C) beneficiaries that include Americans aged 65 and over and disabled Americans under age 65. This may be an under representation as some claims may not be recorded due to a submission lag or if the Medicare DME rental cap has been reached. Note (2): The electricity-dependent number, by location, represents the total number of beneficiaries with claims in our databases from the prior month for: ventilator, BiPAP, internal feeding, IV infusion pump, suction pump, at-home dialysis, electric wheelchair, and electric bed equipment in the past 13 months; oxygen concentrator equipment in the past 36 months; and an implanted cardiac device (i.e. LVAD, RVAD, BIVAD, TAH) in the past 5 years. As privacy protection is very important, deidentification methodologies have been implemented including: removal of all personal identifiers; aggregating data totals at the geographic level; and replacing any small cell size between 1 and 10 with an 11. Some zip codes may not be represented on the map as they do not have geographical boundaries to map (e.g. post office boxes, a large building, etc.). In these instances, we add their total to the geographical zip code where the post office box or building can be found. Note (3): The map has been provided to inform and support community partner emergency preparedness, mitigation, response, recovery, and resilience activities. Use of this tool and data signifies your agreement to: use it for the specified purposes; make no attempt to identify any individual in this data; and send an to empower@hhs.gov if a small size between 1 and 10 is identified at any geographic level. Send any additional questions to empower@hhs.gov. Note (4): Information regarding the Natural Hazards can be found from the different sources' webpages: National Oceanic and Atmospheric Administration (NOAA) National Weather Service active weather alerts can be found at: Hurricanes, Radar, Flood, Precipitation, and Storm Prediction: Long Duration and Short Duration Hazards: Wildfire: Seismic Activity: HOME PHE.GOV Office of the Assistant Secretary for Preparedness & Response Privacy, Accessibility, Disclaimer U.S. Department of Health & Human Services 200 Independence Avenue, S.W. Washington, D.C Last updated: 30 December 2016 First published: 23 June 2015

37 empower Map Page 1 of 2 12/20/2017 Skip to main content HHS.govU.S. Department of Health & Human ServicesPHE.GOV Skip to main content HHS empower Map 2.0 Over 2.5 million Medicare beneficiaries rely upon electricity-dependent medical and assistive equipment, such as ventilators and wheel chairs, and cardiac devices in our communities. Severe weather and disasters that cause power outages can be life threatening for these individuals. How can we empower community and electricity-dependent Medicare beneficiary health resilience? Every hospital, first responder, electric company, and community member can use the map to find the monthly total of Medicare beneficiaries with electricity-dependent equipment claims at the U.S. state, territory, county, and zip code level and turn on real-time natural hazard and NOAA severe weather tracking services to identify areas and populations that may be impacted and are at risk for prolonged power outages. Together, we can all develop emergency plans and response activities for the whole community and assist our at-risk community members prior to, during and after an emergency. Resource List HHS empower Map Factsheet State Public Health Authority {Coming Soon} Select map attributes to display data Esri, HERE, Garmin, USGS, NGA, EPA, USDA, NPS Natural Hazards Select Natural Hazard Region for Health Data State Florida County Lafayette ZIP Code Select ZIP Code Map Style Select Basemap Reset Map Medicare Data Totals Geographical Area: Lafayette Beneficiaries: 1,000 Electricity-Dependent Beneficiaries: 90 Electricity-Dependent Scale

38 empower Map Page 2 of 2 12/20/ ,101 Natural Hazard Legend Electricity-Dependant States/Territories Counties ZIP Codes Geographic Area Beneficiaries Electricity-Dependent Beneficiaries , Note (1): The map only shows de-identified claims data for Medicare Fee-for-Service and Medicare Advantage (Parts A, B and C) beneficiaries that include Americans aged 65 and over and disabled Americans under age 65. This may be an under representation as some claims may not be recorded due to a submission lag or if the Medicare DME rental cap has been reached. Note (2): The electricity-dependent number, by location, represents the total number of beneficiaries with claims in our databases from the prior month for: ventilator, BiPAP, internal feeding, IV infusion pump, suction pump, at-home dialysis, electric wheelchair, and electric bed equipment in the past 13 months; oxygen concentrator equipment in the past 36 months; and an implanted cardiac device (i.e. LVAD, RVAD, BIVAD, TAH) in the past 5 years. As privacy protection is very important, deidentification methodologies have been implemented including: removal of all personal identifiers; aggregating data totals at the geographic level; and replacing any small cell size between 1 and 10 with an 11. Some zip codes may not be represented on the map as they do not have geographical boundaries to map (e.g. post office boxes, a large building, etc.). In these instances, we add their total to the geographical zip code where the post office box or building can be found. Note (3): The map has been provided to inform and support community partner emergency preparedness, mitigation, response, recovery, and resilience activities. Use of this tool and data signifies your agreement to: use it for the specified purposes; make no attempt to identify any individual in this data; and send an to empower@hhs.gov if a small size between 1 and 10 is identified at any geographic level. Send any additional questions to empower@hhs.gov. Note (4): Information regarding the Natural Hazards can be found from the different sources' webpages: National Oceanic and Atmospheric Administration (NOAA) National Weather Service active weather alerts can be found at: Hurricanes, Radar, Flood, Precipitation, and Storm Prediction: Long Duration and Short Duration Hazards: Wildfire: Seismic Activity: HOME PHE.GOV Office of the Assistant Secretary for Preparedness & Response Privacy, Accessibility, Disclaimer U.S. Department of Health & Human Services 200 Independence Avenue, S.W. Washington, D.C Last updated: 30 December 2016 First published: 23 June 2015

39 empower Map Page 1 of 2 12/20/2017 Skip to main content HHS.govU.S. Department of Health & Human ServicesPHE.GOV Skip to main content HHS empower Map 2.0 Over 2.5 million Medicare beneficiaries rely upon electricity-dependent medical and assistive equipment, such as ventilators and wheel chairs, and cardiac devices in our communities. Severe weather and disasters that cause power outages can be life threatening for these individuals. How can we empower community and electricity-dependent Medicare beneficiary health resilience? Every hospital, first responder, electric company, and community member can use the map to find the monthly total of Medicare beneficiaries with electricity-dependent equipment claims at the U.S. state, territory, county, and zip code level and turn on real-time natural hazard and NOAA severe weather tracking services to identify areas and populations that may be impacted and are at risk for prolonged power outages. Together, we can all develop emergency plans and response activities for the whole community and assist our at-risk community members prior to, during and after an emergency. Resource List HHS empower Map Factsheet State Public Health Authority {Coming Soon} Select map attributes to display data Esri, HERE, Garmin, FAO, USGS, NGA, EPA, NPS Natural Hazards Select Natural Hazard Region for Health Data State Florida County Levy ZIP Code Select ZIP Code Map Style Select Basemap Reset Map Medicare Data Totals Geographical Area: Levy Beneficiaries: 9,585 Electricity-Dependent Beneficiaries: 526 Electricity-Dependent Scale

40 empower Map Page 2 of 2 12/20/ ,101 Natural Hazard Legend Electricity-Dependant States/Territories Counties ZIP Codes Geographic Area Beneficiaries Electricity-Dependent Beneficiaries , , , , , Note (1): The map only shows de-identified claims data for Medicare Fee-for-Service and Medicare Advantage (Parts A, B and C) beneficiaries that include Americans aged 65 and over and disabled Americans under age 65. This may be an under representation as some claims may not be recorded due to a submission lag or if the Medicare DME rental cap has been reached. Note (2): The electricity-dependent number, by location, represents the total number of beneficiaries with claims in our databases from the prior month for: ventilator, BiPAP, internal feeding, IV infusion pump, suction pump, at-home dialysis, electric wheelchair, and electric bed equipment in the past 13 months; oxygen concentrator equipment in the past 36 months; and an implanted cardiac device (i.e. LVAD, RVAD, BIVAD, TAH) in the past 5 years. As privacy protection is very important, deidentification methodologies have been implemented including: removal of all personal identifiers; aggregating data totals at the geographic level; and replacing any small cell size between 1 and 10 with an 11. Some zip codes may not be represented on the map as they do not have geographical boundaries to map (e.g. post office boxes, a large building, etc.). In these instances, we add their total to the geographical zip code where the post office box or building can be found. Note (3): The map has been provided to inform and support community partner emergency preparedness, mitigation, response, recovery, and resilience activities. Use of this tool and data signifies your agreement to: use it for the specified purposes; make no attempt to identify any individual in this data; and send an to empower@hhs.gov if a small size between 1 and 10 is identified at any geographic level. Send any additional questions to empower@hhs.gov. Note (4): Information regarding the Natural Hazards can be found from the different sources' webpages: National Oceanic and Atmospheric Administration (NOAA) National Weather Service active weather alerts can be found at: Hurricanes, Radar, Flood, Precipitation, and Storm Prediction: Long Duration and Short Duration Hazards: Wildfire: Seismic Activity: HOME PHE.GOV Office of the Assistant Secretary for Preparedness & Response Privacy, Accessibility, Disclaimer U.S. Department of Health & Human Services 200 Independence Avenue, S.W. Washington, D.C Last updated: 30 December 2016 First published: 23 June 2015

41 empower Map of 4 12/20/2017, 11:07 AM Skip to main content HHS.govU.S. Department of Health & Human ServicesPHE.GOV Skip to main content Over 2.5 million Medicare beneficiaries rely upon electricity-dependent medical and assistive equipment, such as ventilators and wheel chairs, and cardiac devices in our communities. Severe weather and disasters that cause power outages can be life threatening for these individuals. How can we empower community and electricity-dependent Medicare beneficiary health resilience? Every hospital, first responder, electric company, and community member can use the map to find the monthly total of Medicare beneficiaries with electricity-dependent equipment claims at the U.S. state, territory, county, and zip code level and turn on real-time natural hazard and NOAA severe weather tracking services to identify areas and populations that may be impacted and are at risk for prolonged power outages. Together, we can all develop emergency plans and response activities for the whole community and assist our at-risk community members prior to, during and after an emergency. HHS empower Map Factsheet {Coming Soon}

42 empower Map of 4 12/20/2017, 11:07 AM Natural Hazards Region for Health Data State County ZIP Code Map Style Reset Map Medicare Data Totals Geographical Area: Marion Beneficiaries: 98,787 Electricity-Dependent Beneficiaries: 4,664 Electricity-Dependent Scale ,101 Natural Hazard Legend States/Territories Counties ZIP Codes Geographic Area Beneficiaries Electricity-Dependent Beneficiaries ,

43 empower Map of 4 12/20/2017, 11:07 AM Geographic Area Beneficiaries Electricity-Dependent Beneficiaries , , , , , , , , , , , , , , , , , , , , Note (1): The map only shows de-identified claims data for Medicare Fee-for-Service and Medicare Advantage (Parts A, B and C) beneficiaries that include Americans aged 65 and over and disabled Americans under age 65. This may be an under representation as some claims may not be recorded due to a submission lag or if the Medicare DME rental cap has been reached. Note (2): The electricity-dependent number, by location, represents the total number of beneficiaries with claims in our databases from the prior month for: ventilator, BiPAP, internal feeding, IV infusion pump, suction pump, at-home dialysis, electric wheelchair, and electric bed equipment in the past 13 months; oxygen concentrator equipment in the past 36 months; and an implanted cardiac device (i.e. LVAD, RVAD, BIVAD, TAH) in the past 5 years. As privacy protection is very important, de-identification methodologies have been implemented including: removal of all personal identifiers; aggregating data totals at the geographic level; and replacing any small cell size between 1 and 10 with an 11. Some zip codes may not be represented on the map as they do not have geographical boundaries to map (e.g. post office boxes, a large building, etc.). In these instances, we add their total to the geographical zip code where the post office box or building can be found. Note (3): The map has been provided to inform and support community partner emergency preparedness,

44 empower Map of 4 12/20/2017, 11:07 AM mitigation, response, recovery, and resilience activities. Use of this tool and data signifies your agreement to: use it for the specified purposes; make no attempt to identify any individual in this data; and send an to empower@hhs.gov if a small size between 1 and 10 is identified at any geographic level. Send any additional questions to empower@hhs.gov. Note (4): Information regarding the Natural Hazards can be found from the different sources' webpages: National Oceanic and Atmospheric Administration (NOAA) National Weather Service active weather alerts can be found at: Hurricanes, Radar, Flood, Precipitation, and Storm Prediction: /rest/services. Long Duration and Short Duration Hazards: Wildfire: /rest/services/livefeeds/wildfire_activity/mapserver. Seismic Activity: /11e49b2f31b04811a339cf /rest/services/LiveFeeds/USGS_Seismic_Data/MapServer. HOME PHE.GOV Office of the Assistant Secretary for Preparedness & Response Privacy, Accessibility, Disclaimer U.S. Department of Health & Human Services 200 Independence Avenue, S.W. Washington, D.C Last updated: 30 December 2016 First published: 23 June 2015

45 empower Map of 4 12/14/2017, 8:34 AM Skip to main content HHS.govU.S. Department of Health & Human ServicesPHE.GOV Skip to main content Over 2.5 million Medicare beneficiaries rely upon electricity-dependent medical and assistive equipment, such as ventilators and wheel chairs, and cardiac devices in our communities. Severe weather and disasters that cause power outages can be life threatening for these individuals. How can we empower community and electricity-dependent Medicare beneficiary health resilience? Every hospital, first responder, electric company, and community member can use the map to find the monthly total of Medicare beneficiaries with electricity-dependent equipment claims at the U.S. state, territory, county, and zip code level and turn on real-time natural hazard and NOAA severe weather tracking services to identify areas and populations that may be impacted and are at risk for prolonged power outages. Together, we can all develop emergency plans and response activities for the whole community and assist our at-risk community members prior to, during and after an emergency. HHS empower Map Factsheet {Coming Soon}

46 empower Map of 4 12/14/2017, 8:34 AM Natural Hazards Region for Health Data State County ZIP Code Map Style Reset Map Medicare Data Totals Geographical Area: Nassau Beneficiaries: 18,493 Electricity-Dependent Beneficiaries: 799 Electricity-Dependent Scale ,101 Natural Hazard Legend States/Territories Counties ZIP Codes Geographic Area Beneficiaries Electricity-Dependent Beneficiaries

47 empower Map of 4 12/14/2017, 8:34 AM Geographic Area Beneficiaries Electricity-Dependent Beneficiaries , , , , Note (1): The map only shows de-identified claims data for Medicare Fee-for-Service and Medicare Advantage (Parts A, B and C) beneficiaries that include Americans aged 65 and over and disabled Americans under age 65. This may be an under representation as some claims may not be recorded due to a submission lag or if the Medicare DME rental cap has been reached. Note (2): The electricity-dependent number, by location, represents the total number of beneficiaries with claims in our databases from the prior month for: ventilator, BiPAP, internal feeding, IV infusion pump, suction pump, at-home dialysis, electric wheelchair, and electric bed equipment in the past 13 months; oxygen concentrator equipment in the past 36 months; and an implanted cardiac device (i.e. LVAD, RVAD, BIVAD, TAH) in the past 5 years. As privacy protection is very important, de-identification methodologies have been implemented including: removal of all personal identifiers; aggregating data totals at the geographic level; and replacing any small cell size between 1 and 10 with an 11. Some zip codes may not be represented on the map as they do not have geographical boundaries to map (e.g. post office boxes, a large building, etc.). In these instances, we add their total to the geographical zip code where the post office box or building can be found. Note (3): The map has been provided to inform and support community partner emergency preparedness, mitigation, response, recovery, and resilience activities. Use of this tool and data signifies your agreement to: use it for the specified purposes; make no attempt to identify any individual in this data; and send an to empower@hhs.gov if a small size between 1 and 10 is identified at any geographic level. Send any additional questions to empower@hhs.gov. Note (4): Information regarding the Natural Hazards can be found from the different sources' webpages: National Oceanic and Atmospheric Administration (NOAA) National Weather Service active weather alerts can be found at: Hurricanes, Radar, Flood, Precipitation, and Storm Prediction: /rest/services. Long Duration and Short Duration Hazards: Wildfire: /rest/services/livefeeds/wildfire_activity/mapserver. Seismic Activity: /11e49b2f31b04811a339cf /rest/services/LiveFeeds/USGS_Seismic_Data/MapServer. HOME PHE.GOV Office of the Assistant Secretary for Preparedness & Response Privacy, Accessibility, Disclaimer

48 empower Map of 4 12/14/2017, 8:36 AM Skip to main content HHS.govU.S. Department of Health & Human ServicesPHE.GOV Skip to main content Over 2.5 million Medicare beneficiaries rely upon electricity-dependent medical and assistive equipment, such as ventilators and wheel chairs, and cardiac devices in our communities. Severe weather and disasters that cause power outages can be life threatening for these individuals. How can we empower community and electricity-dependent Medicare beneficiary health resilience? Every hospital, first responder, electric company, and community member can use the map to find the monthly total of Medicare beneficiaries with electricity-dependent equipment claims at the U.S. state, territory, county, and zip code level and turn on real-time natural hazard and NOAA severe weather tracking services to identify areas and populations that may be impacted and are at risk for prolonged power outages. Together, we can all develop emergency plans and response activities for the whole community and assist our at-risk community members prior to, during and after an emergency. HHS empower Map Factsheet {Coming Soon}

49 empower Map of 4 12/14/2017, 8:36 AM Natural Hazards Region for Health Data State County ZIP Code Map Style Reset Map Medicare Data Totals Geographical Area: Saint Johns Beneficiaries: 46,955 Electricity-Dependent Beneficiaries: 1,840 Electricity-Dependent Scale ,101 Natural Hazard Legend States/Territories Counties ZIP Codes Geographic Area Beneficiaries Electricity-Dependent Beneficiaries ,387 72

50 empower Map of 4 12/14/2017, 8:36 AM Geographic Area Beneficiaries Electricity-Dependent Beneficiaries , , , , , , , , , Note (1): The map only shows de-identified claims data for Medicare Fee-for-Service and Medicare Advantage (Parts A, B and C) beneficiaries that include Americans aged 65 and over and disabled Americans under age 65. This may be an under representation as some claims may not be recorded due to a submission lag or if the Medicare DME rental cap has been reached. Note (2): The electricity-dependent number, by location, represents the total number of beneficiaries with claims in our databases from the prior month for: ventilator, BiPAP, internal feeding, IV infusion pump, suction pump, at-home dialysis, electric wheelchair, and electric bed equipment in the past 13 months; oxygen concentrator equipment in the past 36 months; and an implanted cardiac device (i.e. LVAD, RVAD, BIVAD, TAH) in the past 5 years. As privacy protection is very important, de-identification methodologies have been implemented including: removal of all personal identifiers; aggregating data totals at the geographic level; and replacing any small cell size between 1 and 10 with an 11. Some zip codes may not be represented on the map as they do not have geographical boundaries to map (e.g. post office boxes, a large building, etc.). In these instances, we add their total to the geographical zip code where the post office box or building can be found. Note (3): The map has been provided to inform and support community partner emergency preparedness, mitigation, response, recovery, and resilience activities. Use of this tool and data signifies your agreement to: use it for the specified purposes; make no attempt to identify any individual in this data; and send an to empower@hhs.gov if a small size between 1 and 10 is identified at any geographic level. Send any additional questions to empower@hhs.gov. Note (4): Information regarding the Natural Hazards can be found from the different sources' webpages: National Oceanic and Atmospheric Administration (NOAA) National Weather Service active weather alerts can be found at: Hurricanes, Radar, Flood, Precipitation, and Storm Prediction: /rest/services. Long Duration and Short Duration Hazards: Wildfire: /rest/services/livefeeds/wildfire_activity/mapserver. Seismic Activity: /11e49b2f31b04811a339cf /rest/services/LiveFeeds/USGS_Seismic_Data/MapServer. HOME

51 empower Map Page 1 of 2 12/20/2017 Skip to main content HHS.govU.S. Department of Health & Human ServicesPHE.GOV Skip to main content HHS empower Map 2.0 Over 2.5 million Medicare beneficiaries rely upon electricity-dependent medical and assistive equipment, such as ventilators and wheel chairs, and cardiac devices in our communities. Severe weather and disasters that cause power outages can be life threatening for these individuals. How can we empower community and electricity-dependent Medicare beneficiary health resilience? Every hospital, first responder, electric company, and community member can use the map to find the monthly total of Medicare beneficiaries with electricity-dependent equipment claims at the U.S. state, territory, county, and zip code level and turn on real-time natural hazard and NOAA severe weather tracking services to identify areas and populations that may be impacted and are at risk for prolonged power outages. Together, we can all develop emergency plans and response activities for the whole community and assist our at-risk community members prior to, during and after an emergency. Resource List HHS empower Map Factsheet State Public Health Authority {Coming Soon} Select map attributes to display data Esri, HERE, Garmin, USGS, NGA, EPA, USDA, NPS Natural Hazards Select Natural Hazard Region for Health Data State Florida County Suwannee ZIP Code Select ZIP Code Map Style Select Basemap Reset Map Medicare Data Totals Geographical Area: Suwannee Beneficiaries: 9,868 Electricity-Dependent Beneficiaries: 618 Electricity-Dependent Scale

52 empower Map Page 2 of 2 12/20/ ,101 Natural Hazard Legend Electricity-Dependant States/Territories Counties ZIP Codes Geographic Area Beneficiaries Electricity-Dependent Beneficiaries , , Note (1): The map only shows de-identified claims data for Medicare Fee-for-Service and Medicare Advantage (Parts A, B and C) beneficiaries that include Americans aged 65 and over and disabled Americans under age 65. This may be an under representation as some claims may not be recorded due to a submission lag or if the Medicare DME rental cap has been reached. Note (2): The electricity-dependent number, by location, represents the total number of beneficiaries with claims in our databases from the prior month for: ventilator, BiPAP, internal feeding, IV infusion pump, suction pump, at-home dialysis, electric wheelchair, and electric bed equipment in the past 13 months; oxygen concentrator equipment in the past 36 months; and an implanted cardiac device (i.e. LVAD, RVAD, BIVAD, TAH) in the past 5 years. As privacy protection is very important, deidentification methodologies have been implemented including: removal of all personal identifiers; aggregating data totals at the geographic level; and replacing any small cell size between 1 and 10 with an 11. Some zip codes may not be represented on the map as they do not have geographical boundaries to map (e.g. post office boxes, a large building, etc.). In these instances, we add their total to the geographical zip code where the post office box or building can be found. Note (3): The map has been provided to inform and support community partner emergency preparedness, mitigation, response, recovery, and resilience activities. Use of this tool and data signifies your agreement to: use it for the specified purposes; make no attempt to identify any individual in this data; and send an to empower@hhs.gov if a small size between 1 and 10 is identified at any geographic level. Send any additional questions to empower@hhs.gov. Note (4): Information regarding the Natural Hazards can be found from the different sources' webpages: National Oceanic and Atmospheric Administration (NOAA) National Weather Service active weather alerts can be found at: Hurricanes, Radar, Flood, Precipitation, and Storm Prediction: Long Duration and Short Duration Hazards: Wildfire: Seismic Activity: HOME PHE.GOV Office of the Assistant Secretary for Preparedness & Response Privacy, Accessibility, Disclaimer U.S. Department of Health & Human Services 200 Independence Avenue, S.W. Washington, D.C Last updated: 30 December 2016 First published: 23 June 2015

53 empower Map Page 1 of 2 12/20/2017 Skip to main content HHS.govU.S. Department of Health & Human ServicesPHE.GOV Skip to main content HHS empower Map 2.0 Over 2.5 million Medicare beneficiaries rely upon electricity-dependent medical and assistive equipment, such as ventilators and wheel chairs, and cardiac devices in our communities. Severe weather and disasters that cause power outages can be life threatening for these individuals. How can we empower community and electricity-dependent Medicare beneficiary health resilience? Every hospital, first responder, electric company, and community member can use the map to find the monthly total of Medicare beneficiaries with electricity-dependent equipment claims at the U.S. state, territory, county, and zip code level and turn on real-time natural hazard and NOAA severe weather tracking services to identify areas and populations that may be impacted and are at risk for prolonged power outages. Together, we can all develop emergency plans and response activities for the whole community and assist our at-risk community members prior to, during and after an emergency. Resource List HHS empower Map Factsheet State Public Health Authority {Coming Soon} Select map attributes to display data Esri, HERE, Garmin, USGS, NGA, EPA, USDA, NPS Natural Hazards Select Natural Hazard Region for Health Data State Florida County Union ZIP Code Select ZIP Code Map Style Select Basemap Reset Map Medicare Data Totals Geographical Area: Union Beneficiaries: 1,963 Electricity-Dependent Beneficiaries: 148 Electricity-Dependent Scale

54 empower Map Page 2 of 2 12/20/ ,101 Natural Hazard Legend Electricity-Dependant States/Territories Counties ZIP Codes Geographic Area Beneficiaries Electricity-Dependent Beneficiaries , Note (1): The map only shows de-identified claims data for Medicare Fee-for-Service and Medicare Advantage (Parts A, B and C) beneficiaries that include Americans aged 65 and over and disabled Americans under age 65. This may be an under representation as some claims may not be recorded due to a submission lag or if the Medicare DME rental cap has been reached. Note (2): The electricity-dependent number, by location, represents the total number of beneficiaries with claims in our databases from the prior month for: ventilator, BiPAP, internal feeding, IV infusion pump, suction pump, at-home dialysis, electric wheelchair, and electric bed equipment in the past 13 months; oxygen concentrator equipment in the past 36 months; and an implanted cardiac device (i.e. LVAD, RVAD, BIVAD, TAH) in the past 5 years. As privacy protection is very important, deidentification methodologies have been implemented including: removal of all personal identifiers; aggregating data totals at the geographic level; and replacing any small cell size between 1 and 10 with an 11. Some zip codes may not be represented on the map as they do not have geographical boundaries to map (e.g. post office boxes, a large building, etc.). In these instances, we add their total to the geographical zip code where the post office box or building can be found. Note (3): The map has been provided to inform and support community partner emergency preparedness, mitigation, response, recovery, and resilience activities. Use of this tool and data signifies your agreement to: use it for the specified purposes; make no attempt to identify any individual in this data; and send an to empower@hhs.gov if a small size between 1 and 10 is identified at any geographic level. Send any additional questions to empower@hhs.gov. Note (4): Information regarding the Natural Hazards can be found from the different sources' webpages: National Oceanic and Atmospheric Administration (NOAA) National Weather Service active weather alerts can be found at: Hurricanes, Radar, Flood, Precipitation, and Storm Prediction: Long Duration and Short Duration Hazards: Wildfire: Seismic Activity: HOME PHE.GOV Office of the Assistant Secretary for Preparedness & Response Privacy, Accessibility, Disclaimer U.S. Department of Health & Human Services 200 Independence Avenue, S.W. Washington, D.C Last updated: 30 December 2016 First published: 23 June 2015

55 HHS empower Initiative - August 2017 Update State of Florida De-Identified Aggregated U.S. State, County, Zip Code Table of Contents Data Overview * Cells with counts between 1-10 are masked to 11. Reference Dates Data Description Notes ** Beneficiary addresses do not include beneficiaries in nursing homes or long term care facilities. *** The Power Dependent Layer includes beneficiaries who have a claim for an oxygen concentrator in the last 36 months, a ventilator, bi-level positive airway pressure device (BiPAP), enteral feeding, IV infusion pump, suction pump, motorized wheelchair, scooter, or electric bed in the last 13 months, at-home ESRD in the last 3 months, or a cardiac device in the last 5 years. Individuals are counted once regardless of how many types of DME they utilize. U.S. Territory/State Level Data County Level Data Zip Code Level Data Geographic Indicators: Geographic Indicators: Geographic Indicators: State Level Data County FIPS Code Zip Code County Name County FIPS Code State FIPS Code County Name State (Two-letter abbreviation) State FIPS Code Number of Zip Codes in County State (Two-letter abbreviation) Totals*: Totals*: Totals*: # Medicare Beneficiaries in Territory/State # Medicare Beneficiaries in County # Medicare Beneficiaries in Zip Code # Medicare Fee-for-Service Beneficiaries [Part A/Part B] in State # Medicare Advantage Beneficiaries [Part C] in State # Dual-Eligible Medicare Beneficiaries in Territory/State Residence Indicators*: Residence Indicators*: Residence Indicators*: Number of Beneficiary Addresses (Excludes P.O. Boxes and Unknowns) Number of Beneficiary Addresses (Excludes P.O. Boxes and Unknowns) Number of Beneficiary Addresses (Excludes P.O. Boxes and Unknowns) At Risk Populations*: Lookback Periods At Risk Populations*: Lookback Periods At Risk Populations*: Lookback Periods In-Facility ESRD 3 months In-Facility ESRD 3 months In-Facility ESRD 3 months Oxygen Services (Tanks) 13 months Oxygen Services (Tanks) 13 months Oxygen Services (Tanks) 13 months Home Health Services 3 months Home Health Services 3 months Home Health Services 3 months Power Dependent [All Devices and DME]*** Varied Power Dependent [All Devices and DME]*** Varied Power Dependent [All Devices and DME]*** Varied Power Dependent Cardiac Devices 5 years Power Dependent Cardiac Devices 5 years Power Dependent Cardiac Devices 5 years Ventilators 13 months Ventilators 13 months Ventilators 13 months BiPAPs 13 months BiPAPs 13 months BiPAPs 13 months Oxygen Concentrators 36 months Oxygen Concentrators 36 months Oxygen Concentrators 36 months Enteral Feeding 13 months Enteral Feeding 13 months Enteral Feeding 13 months IV Infusion Pumps 13 months IV Infusion Pumps 13 months IV Infusion Pumps 13 months Suction Pumps 13 months Suction Pumps 13 months Suction Pumps 13 months At-Home ESRD 3 months At-Home ESRD 3 months At-Home ESRD 3 months Motorized Wheelchairs or Scooters 13 months Motorized Wheelchairs or Scooters 13 months Motorized Wheelchairs or Scooters 13 months Electric Beds 13 months Electric Beds 13 months Electric Beds 13 months De-Identification Methods/Privacy Protection De-Identification Methods/Privacy Protection De-Identification Methods/Privacy Protection Removed all personal identifiers and information. Removed all personal identifiers and information. Removed all personal identifiers and information. Aggregated data to the territory/state level. Aggregated data to the county level using sums of actual and masked zip code values. Aggregated data to the zip code level. Masked all data variables with a cell size between 1-10 to 11. Masked all data variables with a cell size between 1-10 to 11. Masked all data variables with a cell size between 1-10 to 11. Aggregated data to the territory/state level using sums of actual and masked zip code values Number of masked counties provided to allow calculating actual range. for territories/states with only 1 masked zip code.

56 HHS empower Initiative - August 2017 Update Data Overview REFERENCE DATES Category Enrollment and Death Description We restrict the Medicare population beneficiaries alive as of the most recent Medicare Enrollment Database (EDB) available. We additionally restrict to beneficiaries who are enrolled in either original Medicare (Parts A/B, also known as fee-for-service or FFS), or Medicare Advantage (Part C), as of the most recent month available in the EDB. Data as of 6/1/2017 DATA DESCRIPTION End-Stage Renal Disease (ESRD) In-Facility Dialysis Data: This data is comprised of all Medicare beneficiaries that have been identified as having received dialysis treatment in an outpatient facility in the past 3 months. Oxygen Services [Tanks] Data: This data is comprised of all Medicare beneficiaries that have been identified as living at home (i.e., not in a Long Term Care facility/nursing Home) with a rental of oxygen tank services. The rental cap period is 36 months. Oxygen tanks contain oxygen and provide supplemental oxygen required for certain respiratory conditions. Nursing home Nursing home residence is determined by using a combination of nursing home-related Medicare FFS/Medicare Advantage claims and the Long-Term Care Minimum Data Set (MDS) assessments as of this date. 5/1/2017 Home Health Services Data: This data is comprised of all Medicare beneficiaries that have been identified as living at home (i.e., not in a Long Term Care facility/nursing Home) with a home health visit in the past 3 months. Home health visits can be for intermittent skilled nursing care, physical therapy, speech-language pathology services, or continued occupational therapy services. Power Dependent Devices and Durable Medical Equipment Users End-Stage Renal Disease (ESRD) Power-dependent device and durable medical equipment use is determined by the presence of Medicare FFS/Medicare Advantage claims during various lookback periods, all ending on this date. ESRD patients are identified as receiving In-facility dialysis treatment or athome dialysis DME by the presence of Medicare FFS claims/medicare Advantage in the 3 months prior to this date. 7/28/2017 7/28/2017 Power-dependent Devices and DME Data: This data is comprised of all Medicare beneficiaries that have been identified as living at home (i.e., not in a Long Term Care facility/nursing Home) with a rental claim for the specified equipment. The reimbursement cap period for most types of DME is 13 months. The only exceptions are oxygen concentrators, at-home dialysis, and cardiac devices*: * Oxygen concentrators have a 36 month rental cap. * At-home dialysis is identified through Medicare claims indicating receipt of dialysis treatments at home, not through Medicare DME claims. We use a 3 month lookback. Medicare requires that a dialysis facility be responsible for providing dialysis services to all patients receiving dialysis at-home should their equipment not function. * Cardiac devices such as ventricular assist devices (VADs) and/or total artificial hearts (TAHs) are implanted within an individual to support continued cardiac function and require direct access to power to charge the device and its back-up battery. We use a lookback period of 5 years to identify individuals with an implanted cardiac device. Additional DME and Devices Information: NOTES * Power-dependent medical equipment users are included in counts only if they are not residing in a nursing home. * All cells with values from 1-10 have been replaced [masked] with 11. * County level summary counts reflect sums of masked and unmasked zip codes. * Territory/state summary counts reflect: For territories/states that have contain zero or more than one masked zip code - actual totals. For territories/states with exactly one masked zip code - sum of the masked and unmasked zip codes. Sums that include exactly one masked zip code are indicated in the State Actual Data tab by an asterisk. Zip Codes: Some zip codes do not appear separately in the aggregate-level counts as we were unable to locate specific geospatial boundary data for their given area. Most of the zip codes that fall within this category are P.O. Box zip codes, though in some U.S. Territories these include residential zip codes with a very high prevalence of P.O. Boxes. As many individuals will reside within the geographic area, we f Cardiac devices include left, right, and bi-ventricular assist devices (VADs), and total artificial hearts (TAHs). VADs and TAHs are mechanical pumps that are used to support or replace heart function in people who have some form of heart failure. A ventilator provides life-maintaining/saving oxygen for an individual Vests provide high frequency chest wall oscillation (inflating and deflating of the chest) to thin mucus and ultimately clear it from the lung airways. A bi-level positive airway pressure device (BiPAP) provides pressure controlled ventilation in a system allowing unrestricted spontaneous breathing at any moment of the ventilatory cycle. An oxygen concentrator extracts and concentrates oxygen from the air and delivers it to the patient via tubes or masks. Concentrators may be used to provide life-maintaining/saving oxygen 24-7 or in some cases are used during different periods of a day to provide supplemental oxygen required for certain respiratory conditions. An enteral feeding tube is a medical device used to provide nutrition to patients who cannot obtain nutrition by mouth, are unable to swallow safely, or need nutritional supplementation. An IV infusion pump is used to deliver fluids, medication, or nutrients into a patient's circulatory system. Often, they are used to deliver antibiotics, chemotherapy drugs, and pain relievers into a patient's body in controlled amounts. A suction pump is a medical device used by those who have difficulty raising or clearing mucosal secretions inside the air passages. They are often prescribed for conditions pertaining to air passages, the throat or mouth, dysfunction of the swallowing muscles, or tracheostomies. A motorized wheelchair or scooter is useful for those unable to propel a manual wheelchair. They are used by both people with mobility impairments as well as those with cardiovascular or fatigue-based conditions. An electric bed is a bed designed with features including adjustable height for the entire bed, the head, and the feet, adjustable side rails, and electronic buttons to operate both the bed and other nearby electronic devices. f " "

57 HHS empower Initiative - August 2017 Update De-Identified Aggregated U.S. State # Medicare Beneficiaries by Plan/Enrollment Type Demographic Information Services Services Services All Power Dependent State # Medicare Beneficiaries in State # Medicare Fee-for-Service Beneficiaries [Part A/Part B] in State # Medicare Advantage Beneficiaries [Part C] in State # Dual-Eligible Medicare Beneficiaries in State # Beneficiary Addresses (Excludes P.O. Boxes and Unknowns) # In-Facility ESRD Dialysis (3 months) # O2 services [tanks] (13 months) # Home health (3 months) # Electricity- Dependent Devices and DME FL 3,980,898 2,169,471 1,811, ,138 3,744,931 20,179 55, , ,742

58 Overall Vulnerability Florida [Data Classfied by Florida Census Tracts] 2014 Social vulnerability refers to the human factors within a community that negatively affect its ability to manage circumstances harmful to health. Communities must prepare for and respond to hazardous events such as environmental disasters, chemical exposures, and disease outbreaks. Preparing for these events prevents or decreases both human suffering and financial loss. The Social Vulnerability Index (SVI) 1 compares and ranks every community in the U.S. at the Census tract level, on many social factors. These factors, including poverty, lack of car access, and crowded housing, are further grouped into four related themes. Each community receives a separate ranking for each of the four, as well as an overall ranking. To learn more, please visit SVI home page. Highest (Top 4th) Vulnerability (SVI 2014) Lowest (Bottom 4th) Zero population census tracts Data sources: 1 ATSDR GRASP. Projection: WGS 1984 Web Mercator (Auxiliary Sphere). Reference: Flanagan, B.E., et al., A Social Vulnerability Index for Disaster Management. Journal of Homeland Security and Emergency Management, (1). Print Date: 3/31/2018.

59 SocialVulne rabilityind e x 2014 Bak e r County,Florid a PART 1 SVI2014 BAKERCOUNT Y,FLORIDA PART 2 Ove rallsocialvulne rability 1 SVIT h e m e s Socioe conom icstatus 5 House h old Com position B A K E R Hig he st (Top 4t h) Vulne ra bilit y (SVI2014) 2 Lowe st (Bot tom 4t h) Hig he st (Top 4t h) Vulne ra bilit y (SVI2014) 2 Lowe st (Bot tom 4t h) 90 Jacksonville Race /Eth nicity/language 7 Housing/T ransportation Lake City Oakleaf Plantation 100 Hig he st (Top 4t h) Vulne ra bilit y (SVI2014) 2 Lowe st (Bot tom 4t h) Da t a Una va ila ble 3 Mile s AL MAPPRO DUCED 7/26/2016 G R A S P GA FL Social vulne rability re fe rs t o a com m unit y s ca pa cit yt o pre pa re for a nd re spond t o t he st re ss of ha za rd ous e ve nt s ra ng ing from na t ura l d isa st e rs, such a s t orna d oe s or d ise a se out bre a ks, t o hum a n-ca use d t hre a t s,such a s t oxic che m ica lspills.the SocialVulne rability Ind e x (SVI2014) 4 CountyMap d e pict s t he socia l vulne ra bilit yof com m unit ie s, a t ce nsus t ra ct le ve l,wit hin a spe cifie d count y.svi2014g roups fifte e n ce nsusd e rive d factors int o four th e m e s t ha t sum m a rize t he e xt e nt t o which t he a re a Agency for Toxic Substances and Disease Registry Division of Toxicology and Human Health Sciences FINAL-FOREXT ERNALUSE is socia lly vulne ra ble t o d isa st e r.the fa ct ors includ e e conom icd a t a a s we lla s d a t a re g a rd ing e d uca t ion, fa m ily cha ra ct e rist ics,housing,la ng ua g e a bilit y, e t hnicit y,a nd ve hicle a cce ss.o ve ra ll Socia l Vulne ra bilit y com bine s a ll t he va ria ble s t o provid e a com pre he nsive a sse ssm e nt. Hig he st (Top 4t h) Vulne ra bilit y (SVI2014) 2 Lowe st (Bot tom 4t h) Hig he st (Top 4t h) FINAL-FOREXT ERNALUSE Vulne ra bilit y (SVI2014) 2 Lowe st (Bot tom 4t h) DataSource s: 2 ATSDRGRASP. Note s: 1 O ve ra llsocia lvulne ra bilit y:all15va ria ble s. 3 Ce nsus tra ct s with 0popula tion. 4 The SVIcom bine s pe rce nt ile ra nking s of USCe nsus Am e rica n Com m unit ysurve y(acs) va ria ble s,for the sta te of inte re st,a t the ce nsus tra ct le ve l. 5 Socioe conom icsta tus:pove rty,une m ploye d,pe r Ca pit a Incom e,no Hig h SchoolDiplom a. 6 House hold Com position/disa bilit y: Ag e d 65a nd O ve r,ag e d 17a nd Y oung e r,sing le -pa re nt House hold,ag e d 5a nd ove r wit h a Disa bilit y. 7 Ra ce /Ethnicit y/la ng ua g e :Minority,Eng lish La ng ua g e Ability. 8 Housing /Tra nsporta tion: Multi-unit,Mobile Hom e s,crowd ing,no Ve hicle,group Qua rte rs. Proje ction:nad1983florid a GDLAlbe rs. Re fe re nce :Fla na g a n,b.e.,e t a l.,asocia lvulne ra bilityind e xfor Disa ste r Ma na g e m e nt.journa lof Hom e la nd Se curit ya nd Em e rg e ncyma na g e m e nt,2011.8(1).

60 Overall Vulnerability Florida [Data Classfied by Florida Census Tracts] 2014 Social vulnerability refers to the human factors within a community that negatively affect its ability to manage circumstances harmful to health. Communities must prepare for and respond to hazardous events such as environmental disasters, chemical exposures, and disease outbreaks. Preparing for these events prevents or decreases both human suffering and financial loss. The Social Vulnerability Index (SVI) 1 compares and ranks every community in the U.S. at the Census tract level, on many social factors. These factors, including poverty, lack of car access, and crowded housing, are further grouped into four related themes. Each community receives a separate ranking for each of the four, as well as an overall ranking. To learn more, please visit SVI home page. Highest (Top 4th) Vulnerability (SVI 2014) Lowest (Bottom 4th) Zero population census tracts Data sources: 1 ATSDR GRASP. Projection: WGS 1984 Web Mercator (Auxiliary Sphere). Reference: Flanagan, B.E., et al., A Social Vulnerability Index for Disaster Management. Journal of Homeland Security and Emergency Management, (1). Print Date: 3/31/2018.

61 Social V uln erability In dex 2014 Clay Coun ty,florida PART1 SV I2014 CLAYCOUNTY,FLORIDA PART2 Overall Social V uln erability 1 SV IThemes Socioecon omicstatus 5 HouseholdComposition Bellair-Meadowbrook 295 Oakleaf Terrace Plantation Jacksonville Lakeside Fleming Island Fruit Cove 1 95 Middleburg C L A Y 17 World Golf Village 235 Hig he st (Top 4t h) Vulne ra bilit y (SVI2014) 2 Lowe st (Bot tom 4t h) Hig he st (Top 4t h) Vulne ra bilit y (SVI2014) 2 Race/Ethn icity/lan g uag e 7 Housin g /Tran sportation 8 Lowe st (Bot tom 4t h) Hig he st (Top 4t h) Vulne ra bilit y (SVI2014) 2 Lowe st (Bot tom 4t h) Da t a Una va ila ble 3 Mile s AL MAPPRO DUCED 7/26/2016 G R A S P GA FL Social vuln erability re fe rs t o a com m unit y s ca pa cit yt o pre pa re for a nd re spond t o t he st re ss of ha za rd ous e ve nt s ra ng ing from na t ura l d isa st e rs, such a s t orna d oe s or d ise a se out bre a ks, t o hum a n-ca use d t hre a t s,such a s t oxic che m ica lspills.the Social V uln erability In dex (SV I2014) 4 Coun ty Map d e pict s t he socia l vulne ra bilit yof com m unit ie s, a t ce nsus t ra ct le ve l,wit hin a spe cifie d count y.svi2014g roups fifteen cen susderivedfactorsint o four themest ha t sum m a rize t he e xt e nt t o which t he a re a Agency for Toxic Substances and Disease Registry Division of Toxicology and Human Health Sciences FINAL-FOREXTERNALUSE is socia lly vulne ra ble t o d isa st e r.the fa ct ors includ e e conom icd a t a a s we lla s d a t a re g a rd ing e d uca t ion, fa m ily cha ra ct e rist ics,housing,la ng ua g e a bilit y, e t hnicit y,a nd ve hicle a cce ss.o ve ra ll Socia l Vulne ra bilit y com bine s a ll t he va ria ble s t o provid e a com pre he nsive a sse ssm e nt. Hig he st (Top 4t h) Vulne ra bilit y (SVI2014) 2 Lowe st (Bot tom 4t h) Hig he st (Top 4t h) FINAL-FOREXTERNALUSE Vulne ra bilit y (SVI2014) 2 Lowe st (Bot tom 4t h) DataSources: 2 ATSDRGRASP. Notes: 1 O ve ra llsocia lvulne ra bilit y:all15va ria ble s. 3 Ce nsus tra ct s with 0popula tion. 4 The SVIcom bine s pe rce nt ile ra nking s of USCe nsus Am e rica n Com m unit ysurve y(acs) va ria ble s,for the sta te of inte re st,a t the ce nsus tra ct le ve l. 5 Socioe conom icsta tus:pove rty,une m ploye d,pe r Ca pit a Incom e,no Hig h SchoolDiplom a. 6 House hold Com position/disa bilit y: Ag e d 65a nd O ve r,ag e d 17a nd Y oung e r,sing le -pa re nt House hold,ag e d 5a nd ove r wit h a Disa bilit y. 7 Ra ce /Ethnicit y/la ng ua g e :Minority,Eng lish La ng ua g e Ability. 8 Housing /Tra nsporta tion: Multi-unit,Mobile Hom e s,crowd ing,no Ve hicle,group Qua rte rs. Projection :NAD1983Florid a GDLAlbe rs. Referen ce:fla na g a n,b.e.,e t a l.,asocia lvulne ra bilityind e xfor Disa ste r Ma na g e m e nt.journa lof Hom e la nd Se curit ya nd Em e rg e ncyma na g e m e nt,2011.8(1).

62 Overall Vulnerability Florida [Data Classfied by Florida Census Tracts] 2014 Social vulnerability refers to the human factors within a community that negatively affect its ability to manage circumstances harmful to health. Communities must prepare for and respond to hazardous events such as environmental disasters, chemical exposures, and disease outbreaks. Preparing for these events prevents or decreases both human suffering and financial loss. The Social Vulnerability Index (SVI) 1 compares and ranks every community in the U.S. at the Census tract level, on many social factors. These factors, including poverty, lack of car access, and crowded housing, are further grouped into four related themes. Each community receives a separate ranking for each of the four, as well as an overall ranking. To learn more, please visit SVI home page. Highest (Top 4th) Vulnerability (SVI 2014) Lowest (Bottom 4th) Zero population census tracts Data sources: 1 ATSDR GRASP. Projection: WGS 1984 Web Mercator (Auxiliary Sphere). Reference: Flanagan, B.E., et al., A Social Vulnerability Index for Disaster Management. Journal of Homeland Security and Emergency Management, (1). Print Date: 3/31/2018.

63 Overall Vulnerability Florida [Data Classfied by Florida Census Tracts] 2014 Social vulnerability refers to the human factors within a community that negatively affect its ability to manage circumstances harmful to health. Communities must prepare for and respond to hazardous events such as environmental disasters, chemical exposures, and disease outbreaks. Preparing for these events prevents or decreases both human suffering and financial loss. The Social Vulnerability Index (SVI) 1 compares and ranks every community in the U.S. at the Census tract level, on many social factors. These factors, including poverty, lack of car access, and crowded housing, are further grouped into four related themes. Each community receives a separate ranking for each of the four, as well as an overall ranking. To learn more, please visit SVI home page. Highest (Top 4th) Vulnerability (SVI 2014) Lowest (Bottom 4th) Zero population census tracts Data sources: 1 ATSDR GRASP. Projection: WGS 1984 Web Mercator (Auxiliary Sphere). Reference: Flanagan, B.E., et al., A Social Vulnerability Index for Disaster Management. Journal of Homeland Security and Emergency Management, (1). Print Date: 3/31/2018.

64 Social V uln erability In dex 2014 Duval Coun ty,florida PART1 SV I2014 DUV ALCOUNTY,FLORIDA PART2 Overall Social V uln erability Yulee Fernandina Beach SV IThemes Socioecon omicstatus 5 HouseholdComposition Jacksonville 111 D U V A L 95 D U V A L Atlantic Beach Oakleaf Plantation Bellair-Meadowbrook Terrace Lakeside Jacksonville Beach Palm Valley Hig he st (Top 4t h) Vulne ra bilit y (SVI2014) 2 Lowe st (Bot tom 4t h) Hig he st (Top 4t h) Vulne ra bilit y (SVI2014) 2 Race/Ethn icity/lan g uag e 7 Housin g /Tran sportation 8 Lowe st (Bot tom 4t h) Middleburg 21 Fleming Island 16 Fruit Cove Hig he st (Top 4t h) Vulne ra bilit y (SVI2014) 2 Lowe st (Bot tom 4t h) Da t a Una va ila ble 3 Mile s AL MAPPRO DUCED 7/26/2016 G R A S P GA FL Social vuln erability re fe rs t o a com m unit y s ca pa cit yt o pre pa re for a nd re spond t o t he st re ss of ha za rd ous e ve nt s ra ng ing from na t ura l d isa st e rs, such a s t orna d oe s or d ise a se out bre a ks, t o hum a n-ca use d t hre a t s,such a s t oxic che m ica lspills.the Social V uln erability In dex (SV I2014) 4 Coun ty Map d e pict s t he socia l vulne ra bilit yof com m unit ie s, a t ce nsus t ra ct le ve l,wit hin a spe cifie d count y.svi2014g roups fifteen cen susderivedfactorsint o four themest ha t sum m a rize t he e xt e nt t o which t he a re a Agency for Toxic Substances and Disease Registry Division of Toxicology and Human Health Sciences FINAL-FOREXTERNALUSE is socia lly vulne ra ble t o d isa st e r.the fa ct ors includ e e conom icd a t a a s we lla s d a t a re g a rd ing e d uca t ion, fa m ily cha ra ct e rist ics,housing,la ng ua g e a bilit y, e t hnicit y,a nd ve hicle a cce ss.o ve ra ll Socia l Vulne ra bilit y com bine s a ll t he va ria ble s t o provid e a com pre he nsive a sse ssm e nt. Hig he st (Top 4t h) Vulne ra bilit y (SVI2014) 2 Lowe st (Bot tom 4t h) Hig he st (Top 4t h) FINAL-FOREXTERNALUSE Vulne ra bilit y (SVI2014) 2 Lowe st (Bot tom 4t h) DataSources: 2 ATSDRGRASP. Notes: 1 O ve ra llsocia lvulne ra bilit y:all15va ria ble s. 3 Ce nsus tra ct s with 0popula tion. 4 The SVIcom bine s pe rce nt ile ra nking s of USCe nsus Am e rica n Com m unit ysurve y(acs) va ria ble s,for the sta te of inte re st,a t the ce nsus tra ct le ve l. 5 Socioe conom icsta tus:pove rty,une m ploye d,pe r Ca pit a Incom e,no Hig h SchoolDiplom a. 6 House hold Com position/disa bilit y: Ag e d 65a nd O ve r,ag e d 17a nd Y oung e r,sing le -pa re nt House hold,ag e d 5a nd ove r wit h a Disa bilit y. 7 Ra ce /Ethnicit y/la ng ua g e :Minority,Eng lish La ng ua g e Ability. 8 Housing /Tra nsporta tion: Multi-unit,Mobile Hom e s,crowd ing,no Ve hicle,group Qua rte rs. Projection :NAD1983Florid a GDLAlbe rs. Referen ce:fla na g a n,b.e.,e t a l.,asocia lvulne ra bilityind e xfor Disa ste r Ma na g e m e nt.journa lof Hom e la nd Se curit ya nd Em e rg e ncyma na g e m e nt,2011.8(1).

65 SocialVulne rabilityinde x 2014 Flagle rcounty,florida PART1 SVI2014 FLAGLERCOU NTY,FLORIDA PART2 Ove ralsocialvulne rability 1 SVIThe m e s Socioe conom icstatus 5 House holdcom position Palatka Palm Coast 20 F L A G L E R Hig he st (Top 4t h) Vulne ra bilit y (SVI2014) 2 Lowe st (Bot tom 4t h) Hig he st (Top 4t h) Vulne ra bilit y (SVI2014) 2 Lowe st (Bot tom 4t h) Race /Ethnicity/Language 7 Housing/Transportation Ormond Beach Daytona Beach Hig he st (Top 4t h) Vulne ra bilit y (SVI2014) 2 Lowe st (Bot tom 4t h) Da t a Una va ila ble 3 Mile s AL MAPPRO DUCED 7/26/2016 G R A S P GA FL Social vulne rability re fe rs t o a com m unit y s ca pa cit yt o pre pa re for a nd re spond t o t he st re ss of ha za rd ous e ve nt s ra ng ing from na t ura l d isa st e rs, such a s t orna d oe s or d ise a se out bre a ks, t o hum a n-ca use d t hre a t s,such a s t oxic che m ica lspills.the SocialVulne rability Inde x (SVI2014) 4 CountyMap d e pict s t he socia l vulne ra bilit yof com m unit ie s, a t ce nsus t ra ct le ve l,wit hin a spe cifie d count y.svi2014g roups fifte e n ce nsusde rive dfactors int o fourthe m e s t ha t sum m a rize t he e xt e nt t o which t he a re a Agency for Toxic Substances and Disease Registry Division of Toxicology and Human Health Sciences FINAL-FOREXTERNALU SE is socia lly vulne ra ble t o d isa st e r.the fa ct ors includ e e conom icd a t a a s we lla s d a t a re g a rd ing e d uca t ion, fa m ily cha ra ct e rist ics,housing,la ng ua g e a bilit y, e t hnicit y,a nd ve hicle a cce ss.o ve ra ll Socia l Vulne ra bilit y com bine s a ll t he va ria ble s t o provid e a com pre he nsive a sse ssm e nt. Hig he st (Top 4t h) Vulne ra bilit y (SVI2014) 2 Lowe st (Bot tom 4t h) Hig he st (Top 4t h) FINAL-FOREXTERNALU SE Vulne ra bilit y (SVI2014) 2 Lowe st (Bot tom 4t h) DataSource s: 2 ATSDRGRASP. Note s: 1 O ve ra llsocia lvulne ra bilit y:all15va ria ble s. 3 Ce nsus tra ct s with 0popula tion. 4 The SVIcom bine s pe rce nt ile ra nking s of USCe nsus Am e rica n Com m unit ysurve y(acs) va ria ble s,for the sta te of inte re st,a t the ce nsus tra ct le ve l. 5 Socioe conom icsta tus:pove rty,une m ploye d,pe r Ca pit a Incom e,no Hig h SchoolDiplom a. 6 House hold Com position/disa bilit y: Ag e d 65a nd O ve r,ag e d 17a nd Y oung e r,sing le -pa re nt House hold,ag e d 5a nd ove r wit h a Disa bilit y. 7 Ra ce /Ethnicit y/la ng ua g e :Minority,Eng lish La ng ua g e Ability. 8 Housing /Tra nsporta tion: Multi-unit,Mobile Hom e s,crowd ing,no Ve hicle,group Qua rte rs. Proje ction:nad1983florid a GDLAlbe rs. Re fe re nce :Fla na g a n,b.e.,e t a l.,asocia lvulne ra bilityind e xfor Disa ste r Ma na g e m e nt.journa lof Hom e la nd Se curit ya nd Em e rg e ncyma na g e m e nt,2011.8(1).

66 Overall Vulnerability Florida [Data Classfied by Florida Census Tracts] 2014 Social vulnerability refers to the human factors within a community that negatively affect its ability to manage circumstances harmful to health. Communities must prepare for and respond to hazardous events such as environmental disasters, chemical exposures, and disease outbreaks. Preparing for these events prevents or decreases both human suffering and financial loss. The Social Vulnerability Index (SVI) 1 compares and ranks every community in the U.S. at the Census tract level, on many social factors. These factors, including poverty, lack of car access, and crowded housing, are further grouped into four related themes. Each community receives a separate ranking for each of the four, as well as an overall ranking. To learn more, please visit SVI home page. Highest (Top 4th) Vulnerability (SVI 2014) Lowest (Bottom 4th) Zero population census tracts Data sources: 1 ATSDR GRASP. Projection: WGS 1984 Web Mercator (Auxiliary Sphere). Reference: Flanagan, B.E., et al., A Social Vulnerability Index for Disaster Management. Journal of Homeland Security and Emergency Management, (1). Print Date: 3/31/2018.

67 Overall Vulnerability Florida [Data Classfied by Florida Census Tracts] 2014 Social vulnerability refers to the human factors within a community that negatively affect its ability to manage circumstances harmful to health. Communities must prepare for and respond to hazardous events such as environmental disasters, chemical exposures, and disease outbreaks. Preparing for these events prevents or decreases both human suffering and financial loss. The Social Vulnerability Index (SVI) 1 compares and ranks every community in the U.S. at the Census tract level, on many social factors. These factors, including poverty, lack of car access, and crowded housing, are further grouped into four related themes. Each community receives a separate ranking for each of the four, as well as an overall ranking. To learn more, please visit SVI home page. Highest (Top 4th) Vulnerability (SVI 2014) Lowest (Bottom 4th) Zero population census tracts Data sources: 1 ATSDR GRASP. Projection: WGS 1984 Web Mercator (Auxiliary Sphere). Reference: Flanagan, B.E., et al., A Social Vulnerability Index for Disaster Management. Journal of Homeland Security and Emergency Management, (1). Print Date: 3/31/2018.

68 Overall Vulnerability Florida [Data Classfied by Florida Census Tracts] 2014 Social vulnerability refers to the human factors within a community that negatively affect its ability to manage circumstances harmful to health. Communities must prepare for and respond to hazardous events such as environmental disasters, chemical exposures, and disease outbreaks. Preparing for these events prevents or decreases both human suffering and financial loss. The Social Vulnerability Index (SVI) 1 compares and ranks every community in the U.S. at the Census tract level, on many social factors. These factors, including poverty, lack of car access, and crowded housing, are further grouped into four related themes. Each community receives a separate ranking for each of the four, as well as an overall ranking. To learn more, please visit SVI home page. Highest (Top 4th) Vulnerability (SVI 2014) Lowest (Bottom 4th) Zero population census tracts Data sources: 1 ATSDR GRASP. Projection: WGS 1984 Web Mercator (Auxiliary Sphere). Reference: Flanagan, B.E., et al., A Social Vulnerability Index for Disaster Management. Journal of Homeland Security and Emergency Management, (1). Print Date: 3/31/2018.

69 Overall Vulnerability Florida [Data Classfied by Florida Census Tracts] 2014 Social vulnerability refers to the human factors within a community that negatively affect its ability to manage circumstances harmful to health. Communities must prepare for and respond to hazardous events such as environmental disasters, chemical exposures, and disease outbreaks. Preparing for these events prevents or decreases both human suffering and financial loss. The Social Vulnerability Index (SVI) 1 compares and ranks every community in the U.S. at the Census tract level, on many social factors. These factors, including poverty, lack of car access, and crowded housing, are further grouped into four related themes. Each community receives a separate ranking for each of the four, as well as an overall ranking. To learn more, please visit SVI home page. Highest (Top 4th) Vulnerability (SVI 2014) Lowest (Bottom 4th) Zero population census tracts Data sources: 1 ATSDR GRASP. Projection: WGS 1984 Web Mercator (Auxiliary Sphere). Reference: Flanagan, B.E., et al., A Social Vulnerability Index for Disaster Management. Journal of Homeland Security and Emergency Management, (1). Print Date: 3/31/2018.

70 Social V uln erability In dex 2014 Nassau Coun ty,florida PART1 SV I2014 NASSAUCOUNTY,FLORIDA PART2 Overall Social V uln erability 1 SV IThemes Socioecon omicstatus 5 HouseholdComposition Kingsland St Marys 95 Yulee Fernandina Beach N A S S A U Jacksonville Hig he st (Top 4t h) Vulne ra bilit y (SVI2014) 2 Lowe st (Bot tom 4t h) Hig he st (Top 4t h) Vulne ra bilit y (SVI2014) 2 Race/Ethn icity/lan g uag e 7 Housin g /Tran sportation 8 Lowe st (Bot tom 4t h) Atlantic Beach Jacksonville Palm Beach Valley Hig he st (Top 4t h) Vulne ra bilit y (SVI2014) 2 Lowe st (Bot tom 4t h) Da t a Una va ila ble 3 Mile s AL MAPPRO DUCED 7/26/2016 G R A S P GA FL Social vuln erability re fe rs t o a com m unit y s ca pa cit yt o pre pa re for a nd re spond t o t he st re ss of ha za rd ous e ve nt s ra ng ing from na t ura l d isa st e rs, such a s t orna d oe s or d ise a se out bre a ks, t o hum a n-ca use d t hre a t s,such a s t oxic che m ica lspills.the Social V uln erability In dex (SV I2014) 4 Coun ty Map d e pict s t he socia l vulne ra bilit yof com m unit ie s, a t ce nsus t ra ct le ve l,wit hin a spe cifie d count y.svi2014g roups fifteen cen susderivedfactorsint o four themest ha t sum m a rize t he e xt e nt t o which t he a re a Agency for Toxic Substances and Disease Registry Division of Toxicology and Human Health Sciences FINAL-FOREXTERNALUSE is socia lly vulne ra ble t o d isa st e r.the fa ct ors includ e e conom icd a t a a s we lla s d a t a re g a rd ing e d uca t ion, fa m ily cha ra ct e rist ics,housing,la ng ua g e a bilit y, e t hnicit y,a nd ve hicle a cce ss.o ve ra ll Socia l Vulne ra bilit y com bine s a ll t he va ria ble s t o provid e a com pre he nsive a sse ssm e nt. Hig he st (Top 4t h) Vulne ra bilit y (SVI2014) 2 Lowe st (Bot tom 4t h) Hig he st (Top 4t h) FINAL-FOREXTERNALUSE Vulne ra bilit y (SVI2014) 2 Lowe st (Bot tom 4t h) DataSources: 2 ATSDRGRASP. Notes: 1 O ve ra llsocia lvulne ra bilit y:all15va ria ble s. 3 Ce nsus tra ct s with 0popula tion. 4 The SVIcom bine s pe rce nt ile ra nking s of USCe nsus Am e rica n Com m unit ysurve y(acs) va ria ble s,for the sta te of inte re st,a t the ce nsus tra ct le ve l. 5 Socioe conom icsta tus:pove rty,une m ploye d,pe r Ca pit a Incom e,no Hig h SchoolDiplom a. 6 House hold Com position/disa bilit y: Ag e d 65a nd O ve r,ag e d 17a nd Y oung e r,sing le -pa re nt House hold,ag e d 5a nd ove r wit h a Disa bilit y. 7 Ra ce /Ethnicit y/la ng ua g e :Minority,Eng lish La ng ua g e Ability. 8 Housing /Tra nsporta tion: Multi-unit,Mobile Hom e s,crowd ing,no Ve hicle,group Qua rte rs. Projection :NAD1983Florid a GDLAlbe rs. Referen ce:fla na g a n,b.e.,e t a l.,asocia lvulne ra bilityind e xfor Disa ste r Ma na g e m e nt.journa lof Hom e la nd Se curit ya nd Em e rg e ncyma na g e m e nt,2011.8(1).

71 Overall Vulnerability Florida [Data Classfied by Florida Census Tracts] 2014 Social vulnerability refers to the human factors within a community that negatively affect its ability to manage circumstances harmful to health. Communities must prepare for and respond to hazardous events such as environmental disasters, chemical exposures, and disease outbreaks. Preparing for these events prevents or decreases both human suffering and financial loss. The Social Vulnerability Index (SVI) 1 compares and ranks every community in the U.S. at the Census tract level, on many social factors. These factors, including poverty, lack of car access, and crowded housing, are further grouped into four related themes. Each community receives a separate ranking for each of the four, as well as an overall ranking. To learn more, please visit SVI home page. Highest (Top 4th) Vulnerability (SVI 2014) Lowest (Bottom 4th) Zero population census tracts Data sources: 1 ATSDR GRASP. Projection: WGS 1984 Web Mercator (Auxiliary Sphere). Reference: Flanagan, B.E., et al., A Social Vulnerability Index for Disaster Management. Journal of Homeland Security and Emergency Management, (1). Print Date: 3/31/2018.

72 Social Vulne rability Ind e x2014 St.Joh ns County,Florid a PART 1 SVI2014 ST.JOHNSCOUNT Y,FLORIDA PART 2 Ove rall Social Vulne rability 1 SVIT h e m e s Socioe conom icstatus 5 House h old Com position Oakleaf Plantation Jacksonville 202 Palm Valley Jacksonville Beach 21 Middleburg Lakeside Fleming Island Fruit Cove 16 World Golf Village 1 17 S T. 95 J O H N S St Augustine 312 Hig he st (Top 4t h) Vulne ra bilit y (SVI2014) 2 Lowe st (Bot tom 4t h) Hig he st (Top 4t h) Vulne ra bilit y (SVI2014) 2 Lowe st (Bot tom 4t h) Race /Eth nicity /Language 7 Housing/T ransportation Palatka Palm Coast Hig he st (Top 4t h) Vulne ra bilit y (SVI2014) 2 Lowe st (Bot tom 4t h) Da t a Una va ila ble 3 Mile s AL MAPPRO DUCED 7/26/2016 G R A S P GA FL Social vulne rability re fe rs t o a com m unit y s ca pa cit yt o pre pa re for a nd re spond t o t he st re ss of ha za rd ous e ve nt s ra ng ing from na t ura l d isa st e rs, such a s t orna d oe s or d ise a se out bre a ks, t o hum a n-ca use d t hre a t s,such a s t oxic che m ica lspills.the Social Vulne rability Ind e x(svi2014) 4 County Mapd e pict s t he socia l vulne ra bilit yof com m unit ie s, a t ce nsus t ra ct le ve l,wit hin a spe cifie d count y.svi2014g roups fifte e n ce nsusd e rive d factors int o four th e m e s t ha t sum m a rize t he e xt e nt t o which t he a re a Agency for Toxic Substances and Disease Registry Division of Toxicology and Human Health Sciences FINAL-FOREXT ERNALUSE is socia lly vulne ra ble t o d isa st e r.the fa ct ors includ e e conom icd a t a a s we lla s d a t a re g a rd ing e d uca t ion, fa m ily cha ra ct e rist ics,housing,la ng ua g e a bilit y, e t hnicit y,a nd ve hicle a cce ss.o ve ra ll Socia l Vulne ra bilit y com bine s a ll t he va ria ble s t o provid e a com pre he nsive a sse ssm e nt. Hig he st (Top 4t h) Vulne ra bilit y (SVI2014) 2 Lowe st (Bot tom 4t h) Hig he st (Top 4t h) FINAL-FOREXT ERNALUSE Vulne ra bilit y (SVI2014) 2 Lowe st (Bot tom 4t h) DataSource s: 2 ATSDRGRASP. Note s: 1 O ve ra llsocia lvulne ra bilit y:all15va ria ble s. 3 Ce nsus tra ct s with 0popula tion. 4 The SVIcom bine s pe rce nt ile ra nking s of USCe nsus Am e rica n Com m unit ysurve y(acs) va ria ble s,for the sta te of inte re st,a t the ce nsus tra ct le ve l. 5 Socioe conom icsta tus:pove rty,une m ploye d,pe r Ca pit a Incom e,no Hig h SchoolDiplom a. 6 House hold Com position/disa bilit y: Ag e d 65a nd O ve r,ag e d 17a nd Y oung e r,sing le -pa re nt House hold,ag e d 5a nd ove r wit h a Disa bilit y. 7 Ra ce /Ethnicit y/la ng ua g e :Minority,Eng lish La ng ua g e Ability. 8 Housing /Tra nsporta tion: Multi-unit,Mobile Hom e s,crowd ing,no Ve hicle,group Qua rte rs. Proje ction:nad1983florid a GDLAlbe rs. Re fe re nce :Fla na g a n,b.e.,e t a l.,asocia lvulne ra bilityind e xfor Disa ste r Ma na g e m e nt.journa lof Hom e la nd Se curit ya nd Em e rg e ncyma na g e m e nt,2011.8(1).

73 Overall Vulnerability Florida [Data Classfied by Florida Census Tracts] 2014 Social vulnerability refers to the human factors within a community that negatively affect its ability to manage circumstances harmful to health. Communities must prepare for and respond to hazardous events such as environmental disasters, chemical exposures, and disease outbreaks. Preparing for these events prevents or decreases both human suffering and financial loss. The Social Vulnerability Index (SVI) 1 compares and ranks every community in the U.S. at the Census tract level, on many social factors. These factors, including poverty, lack of car access, and crowded housing, are further grouped into four related themes. Each community receives a separate ranking for each of the four, as well as an overall ranking. To learn more, please visit SVI home page. Highest (Top 4th) Vulnerability (SVI 2014) Lowest (Bottom 4th) Zero population census tracts Data sources: 1 ATSDR GRASP. Projection: WGS 1984 Web Mercator (Auxiliary Sphere). Reference: Flanagan, B.E., et al., A Social Vulnerability Index for Disaster Management. Journal of Homeland Security and Emergency Management, (1). Print Date: 3/31/2018.

74 Overall Vulnerability Florida [Data Classfied by Florida Census Tracts] 2014 Social vulnerability refers to the human factors within a community that negatively affect its ability to manage circumstances harmful to health. Communities must prepare for and respond to hazardous events such as environmental disasters, chemical exposures, and disease outbreaks. Preparing for these events prevents or decreases both human suffering and financial loss. The Social Vulnerability Index (SVI) 1 compares and ranks every community in the U.S. at the Census tract level, on many social factors. These factors, including poverty, lack of car access, and crowded housing, are further grouped into four related themes. Each community receives a separate ranking for each of the four, as well as an overall ranking. To learn more, please visit SVI home page. Highest (Top 4th) Vulnerability (SVI 2014) Lowest (Bottom 4th) Zero population census tracts Data sources: 1 ATSDR GRASP. Projection: WGS 1984 Web Mercator (Auxiliary Sphere). Reference: Flanagan, B.E., et al., A Social Vulnerability Index for Disaster Management. Journal of Homeland Security and Emergency Management, (1). Print Date: 3/31/2018.

75 2017/2018 ABSTRACT A hazard vulnerability assessment (HVA) is part of a systematic planning process for disaster preparedness and will help CHAMP fully understand the picture for health and medical planning in Marion County. HAZARD VULNERABILITY ASSESSMENT

76 Table of Contents Introduction...2 Review...3 Materials and Methods...4 Discussion...5 Conclusion...6 References...7 Attachment 1 Keiser Tool (Naturally Occurring Events, Technologic Events, Human Related Events, Hazardous Materials Events)... 8 Attachment 2 Baseline Health Indicators Attachment 3 Hazard Probability Score...12 Attachment 4 Risk Ranking Descending Order. 13 Attachment 5 Risk Ranking Alphabetical Order. 14 Attachment 6 Social Vulnerability Index...15 Attachment 7 HHS empower Map of Electric Dependent Medicare Beneficiary..16 Attachment 8 Florida Department of Health Access and Functional Needs Profile, Marion County,

77 Introduction Sentinel Crisis Solutions, Inc. was tasked with updating the Hazard Vulnerability Assessment (HVA) for the Marion County Coalition for Health and Medical Preparedness (CHAMP). Sentinel Crisis Solutions utilized information from the 2015/2016 HVA, state hazard assessment, Marion County Hazard Mitigation Plan, and statistics from state and local resources to determine needed changes for The Kaiser tool was utilized and factors in planning/mitigation along with potential of hazards. For 2018 additional input was gathered from several local agency HVA processes and Marion County Emergency Management. This new information was instrumental in updating the CHAMP HVA. This gives a picture of the risks facing the health and medical community. This information is valuable in assisting CHAMP with continued planning efforts for the Marion county health and medical community. Review A hazard is a situation that poses a level of threat to life, health, property, or environment. Most hazards are dormant or potential, with only a theoretical risk of harm; however, once a hazard becomes "active", it can create an emergency situation. A hazardous situation that has come to pass is called an incident. Hazard and possibility interact together to create risk. Risk is defined as the expectation of loss. A hazard vulnerability assessment (HVA) is part of a systematic planning process for disaster preparedness and will help CHAMP fully understand the picture for health and medical planning in Marion County. Hazards can be naturally occurring such as geological, meteorological or biological. They can also be human-caused, such as by accidental or intentional means. For health agencies, planning for disasters requires a multi-faceted approach. The systematic identification of potential hazards in the community is a valuable first step in the establishment of appropriate preparedness measures. Effective plans that utilize local resources to deal with potential disasters are necessary for the agency to determine realistic and appropriate measures to respond to these hazards. 3

78 Materials and Methods The 2018 update utilized the Keiser Permanente Hazard Vulnerability Assessment tool. Although the Keiser instrument is developed for a facility it is adaptable to the health and medical community. The Keiser tool improves the process of determining risks by including preparedness planning and resources in determining overall risk. It measures the magnitude of the hazard in 3 areas Human Impact, Property Impact, and Business Impact. It incorporates planning and mitigation in 3 areas also including Preparedness, Internal Response and External Response. See Attachment 1. For further explanation of each of the six areas mentioned above see the instruction sheet at the end of attachment 1. Baseline data was updated and the data sources are displayed on the Baseline Indicators worksheet. Attachment 2 During February and March, HVA workshops were conducted for CHAMP members and discussion from the participating agencies were incorporated into the 2018 update. The CHAMP HVA was also discussed with Emergency Management and the County Mitigation Strategy Plan was reviewed. The State of Florida Enhanced Hazard Mitigation Plan also contained county hazard information. Some probabilities were changed based on this information. Hazards were given a value of 0, 1, 2, 3 to indicate their probability of occurrence. Scoring definition listed in Attachment 3. A formula built into the Keiser tool then calculated the Risk Percentage utilizing the probability and severity scoring. The risk percentage shows the likelihood that risks would occur if the health-care system was faced with the hazard. Some individual factors in some hazards were changed based on member input resulting in changes to the top five hazards. The hazards probability and risk percentage are listed In descending order on Attachment 4 and in alphabetical order on Attachment 5. Other factors to consider in addressing hazards are the number of people in the county and the vulnerable populations. Marion County s estimated population from the US Census Bureau for July 1, 2017 is 354,353. The Social Vulnerability Index 2014 displays the areas of the county with the highest index. Social vulnerability refers to the human factors within a community that negatively affect its ability to manage circumstances harmful to health. The Social Vulnerability Index include factors such as poverty, lack of car access, and crowded housing. Attachment 6 4

79 The HHS empowermap also displays vulnerable populations by demonstrating monthly total of Medicare beneficiaries with electricity d=dependent equipment claims at the US state, territory, county and zip code level and turn on real-time natural hazard and NOAA sever weather tracking services to identify areas and populations that may be impacted and are at risk for prolonged power outages. Attachment 7 The Florida Department of Health Access and Functional Needs Profile, Marion County, 2016 also gives pertinent numbers regarding citizens with access and functional needs. Attachment 8 Discussion The 2018 updated information can now be utilized to help determine preparedness activities that the CHAMP should pursue. There are several ways to consider the results. First and most obvious is to prioritize the hazards highest to lowest by risk. The top 4 are hurricane or tropical storm (67%), power failure and sink hole (both 50%), wildfire (44%), tied for fourth are epidemic (41%), communications failure (41%) and cyber/it failure(41%). Due to several hazards having equal scores there are 8 in the top 4 and the next drop in risk significantly so we have only included the top 4 scores (past HVA included the top 5). These top 4 remain the same (as the previous HVA top 5) with the exception of wildfires. The State of Florida Enhance Hazard Mitigation Plan rates Marion County as high for wildfires and there have been several wildfires in the last several years. A power failure was caused by a wildfire in part of the county last year. A large part of the county is rural and also Marion County contains a large part of the Ocala National Forest. Flood was removed from the top 5 based on the same resource from the state and the fact their has not been any wide spread flooding in the past several years. Hurricanes/tropical storms often result in power and communications failure, therefore, assuring hurricane/tropical storm preparation also will help mitigate power and communications failure. This can help save time and resources for CHAMP and its members. All planning should include consideration for those with increased vulnerability and special needs. By preparing for these special populations all citizens are safer. 5

80 Conclusion Information from the 2018 Hazard Vulnerability Assessment can be utilized to build upon emergency preparedness plans. Agencies and organizations can also utilize this information to enhance their understanding of known hazards and how they may impact the health and medical system. Information from this process can be used as one of the tools to determine allocation of resources. The 2018 CHAMP HVA was performed utilizing the Keiser Permanente Assessment Tool. This tool lists the probability of known events, assesses the Human, Property and Business impact then factors in the Mitigation through Preparedness, Internal Response and External Response. Utilizing this HVA tool, hazard events were prioritized based on risk. The top 5 hazard events are; hurricanes/tropical storms, power failure, sinkholes, wildfires, epidemic, communications failure and cyber/it attack. (8 are listed due to tying risk scores.) Addressing these areas will also assist in other hazards that may be high in probability but lower in risk such as severe thunderstorms and tornadoes. Many conditions of thunderstorms and tornadoes are found in tropical storms and may cause similar actions such as response to power failure or need for shelters. Hurricane/tropical storms, sinkholes and wildfires can cause transportation disruptions which would address another specific hazard. Epidemic response would be similar to biological terrorism and in some cases chemical terrorism because isolation/quarantine or mass prophylaxis could be necessary in all of them. Utilizing the Keiser tool mitigation/preparedness portion allows reflection on the gaps in these areas for each hazard. For hurricanes/tropical storms the risk score is higher due to experiences by all CHAMP members in the 2017 Hurricane Irma event. The CHAMP members and county Emergency Management will be reviewing and updating their plans based on the after action reports. Power failure has not been addressed in planning except through the possibility during hurricanes/tropical storms. Media has reported in the past that the electric grid is aging. This could possibly lead to long term power outages. Again sinkholes are high because the state has determined Marion County at probability 3 which means it could occur frequently. CHAMP and the health and medical community have begun to address planning for sink holes that could threaten a medical facility or a large population area. Wildfires can bring many issues with threats to lives, facilities, power and transportation as examples. CHAMP members need to evaluate their facilities and supply chains to determine how wildfires can directly affect them and plan accordingly. 6

81 Epidemics continue in the top 5. The recent Ebola activity in the United States helps demonstrate that more planning and training needs to be conducted in regard to recognition, reporting, communication, isolation and quarantine. All health and medical agencies would be involved. Communication failure can occur on its own or as part of any hazard. There is always a need for improving communication. Cyber/IT failure continues to be at risk. The world continues to be more and more dependent on the internet, computers and electronics. Media has reported stories on consequences of electrical grid disruption. CHAMP needs to assure they can communicate and distribute needed information without computers or cell phones. To address these gaps CHAMP members need to become familiar with current county and individual agency plans to address these hazards. Areas that overlap need to be identified to assure maximum use of resources. Also, areas for improvement need to be addressed and plans put in place for mitigation. CHAMP members can improve their individual and county plans by sharing best practices with each other resulting in stronger plans for all. 7

82 References Keiser Hazard Vulnerability Analysis Tool, California Hospital Association, State of Florida Enhanced Hazard Mitigation Plan, August 2013, Section 3, %20State%20Risk%20Assessment%20FINAL.pdf US Census Bureau Florida Charts, Marion County Local Mitigation Strategy Plan Health and Human Services HHS empower Map Factsheet Agency for Toxic Substances and Disease Registry 8

83 Attachment 1 EVENT SCORE PROBABILITY Likelihood this will occur 0 = N/A 1 = Low 2 = M oderate 3 = High HAZARD AND VULNERABILITY ASSESSMENT TOOL TECHNOLOGIC EVENTS HUMAN IMPACT Possibility of death or injury 0 = N/A 1 = Low 2 = M oderate 3 = High PROPERTY IMPACT Physical losses and damages 0 = N/A 1 = Low 2 = M oderate 3 = High SEVERITY = (MAGNITUDE - MITIGATION) BUSINESS PREPARED- IMPACT NESS Interuption of services 0 = N/A 1 = Low 2 = M oderate 3 = High Preplanning 0 = N/A 1 = High 2 = M oderate 3 = Low or none INTERNAL RESPONSE Time, effectivness, resouces 0 = N/A 1 = High 2 = M oderate 3 = Low or none EXTERNAL RESPONSE Community/ Mutual Aid staff and supplies 0 = N/A 1 = High 2 = M oderate 3 = Low or none RISK Relative threat* 0-100% Electrical Failure % Transportation Failure % Water Failure % Sewer Failure % Communications Failure % Cyber Attack % Hazmat Incident, Fixed Facility % AVERAGE SCORE % EVENT SCORE Mass Casualty Incident (trauma) Mass Casualty Incident (medical/infectious) PROBABILITY Likelihood this will occur 0 = N/A 1 = Low 2 = M oderate 3 = High HAZARD AND VULNERABILITY ASSESSMENT TOOL HUMAN RELATED EVENTS HUMAN IMPACT Possibility of death or injury 0 = N/A 1 = Low 2 = M oderate 3 = High PROPERTY IMPACT Physical losses and damages 0 = N/A 1 = Low 2 = M oderate 3 = High SEVERITY = (MAGNITUDE - MITIGATION) BUSINESS IMPACT Interuption of services 0 = N/A 1 = Low 2 = M oderate 3 = High PREPARED- NESS Preplanning 0 = N/A 1 = High 2 = M oderate 3 = Low or none INTERNAL RESPONSE Time, effectivness, resouces 0 = N/A 1 = High 2 = M oderate 3 = Low or none EXTERNAL RESPONSE Community/ Mutual Aid staff and supplies 0 = N/A 1 = High 2 = M oderate 3 = Low or none RISK Relative threat* 0-100% % % Terrorism, Biological % Civil Disturbance % Animal Disease % AVERAGE % 9

84 EVENT SCORE Hazmat Incident, transportation Small Casualty Hazmat Incident (From historic events at your MC with < 5 victims) Terrorism, Chemical Radiologic Exposure, Fixed Facility Radiologic Exposure, Transportation Terrorism, Radiologic PROBABILITY Likelihood this will occur 0 = N/A 1 = Low 2 = M oderate 3 = High HAZARD AND VULNERABILITY ASSESSMENT TOOL EVENTS INVOLVING HAZARDOUS MATERIALS HUMAN IMPACT Possibility of death or injury 0 = N/A 1 = Low 2 = M oderate 3 = High PROPERTY IMPACT Physical losses and damages 0 = N/A 1 = Low 2 = M oderate 3 = High SEVERITY = (MAGNITUDE - MITIGATION) BUSINESS IMPACT Interuption of services 0 = N/A 1 = Low 2 = M oderate 3 = High PREPARED- NESS Preplanning 0 = N/A 1 = High 2 = M oderate 3 = Low or none INTERNAL RESPONSE Time, effectivness, resouces 0 = N/A 1 = High 2 = M oderate 3 = Low or none EXTERNAL RESPONSE Community/ Mutual Aid staff and supplies 0 = N/A 1 = High 2 = M oderate 3 = Low or none RISK Relative threat* 0-100% % % % % % % AVERAGE % HAZARD AND VULNERABILITY ASSESSMENT TOOL NATURALLY OCCURRING EVENTS SEVERITY = (MAGNITUDE - MITIGATION) EVENT PROBABILITY Likelihood this will occur HUMAN IMPACT Possibility of death or injury PROPERTY IMPACT Physical losses and damages BUSINESS IMPACT Interuption of services PREPARED- NESS Preplanning INTERNAL RESPONSE Time, effectivness, resouces EXTERNAL RESPONSE Community/ Mutual Aid staff and supplies RISK Relative threat* SCORE 0 = N/A 1 = Low 2 = M oderate 3 = High 0 = N/A 1 = Low 2 = M oderate 3 = High 0 = N/A 1 = Low 2 = M oderate 3 = High 0 = N/A 1 = Low 2 = M oderate 3 = High 0 = N/A 1 = High 2 = M oderate 3 = Low or none 0 = N/A 1 = High 2 = M oderate 3 = Low or none 0 = N/A 1 = High 2 = M oderate 3 = Low or none 0-100% Hurricane % Tornado % Severe Thunderstorm % Sinkhole % Extreme Cold % Winter Storm % Earthquake % Fire Large, Urban % Extreme Heat % Flood, External % Drought % Wildfire % Erosion % Epidemic % AVERAGE SCORE % 10

85 Medical Center Hazard and Vulnerability Analysis INSTRUCTIONS: Evaluate potential for event and response among the following categories using the hazard specific scale. Issues to consider for probability include, but are not limited to: 1 Known risk 2 Historical data 3 Manufacturer/vendor statistics Issues to consider for response include, but are not limited to: 1 Time to marshal an on-scene response 2 Scope of response capability 3 Historical evaluation of response success Issues to consider for human impact include, but are not limited to: 1 Potential for staff death or injury 2 Potential for patient death or injury Issues to consider for property impact include, but are not limited to: 1 Cost to replace 2 Cost to set up temporary replacement 3 Cost to repair Issues to consider for business impact include, but are not limited to: 1 Business interruption 2 Employees unable to report to work 3 Customers unable to reach facility 4 Company in violation of contractual agreements 5 Imposition of fines and penalties or legal costs 6 Interruption of critical supplies 7 Interruption of product distribution Issues to consider for preparedness include, but are not limited to: 1 Status of current plans 2 Training status 3 Insurance 4 Availability of back-up systems 5 Community resources Issues to consider for internal resources include, but are not limited to: 1 Types of supplies on hand 2 Volume of supplies on hand 3 Staff availability 4 Coordination with MOB's Issues to consider for external resources include, but are not limited to: 1 Types of agreements with community agencies 2 Coordination with local and state agencies 3 Coordination with proximal health care facilities 4 Coordination with treatment specific facilities Complete all worksheets including Natural, Technological, 11 Human and Hazmat. The summary section will automatically provide your specific and overall relative threat.

86 Baseline Health Indicators Attachment 2 Baseline Health Indicator Hazard All-hazards Data Date 2016/2017 Range Marion County Population 354,353 per US Census Assessment Marion County, Florida Estimate July 1, 2017 Location Health Indicator Measurement Baseline Baseline - Source Fatalities 100,00 pop./day Provision Report by County EMS Transports 100,00 pop./day Marion County Fire Rescue Outpatient Visits Hospital ED Visits Trauma Center (levels 1 & 2) Visits 100,00 pop./day 100,00 pop./day 100,00 pop./day Physicians Workforce Annual Report State # Munroe Regional Health System and Ocala Health System Marion County Fire Rescue Trauma Center (levels 1 & 2) ALS Systems/100,000 Marion County Fire Rescue Visits pop. Outpatient Visits PCPs/100,000 pop Florida DOH CHARTS Hospital ED Services Available ED Munroe Regional Health Systems beds/100,000 & Ocala Health Systems Hospital OR Services ORs functioning/100,000 Munroe Regional Health Systems 11 pop. & Ocala Health Systems Hospital Negative Pressure Negative Pressure Munroe Regional Health Systems 25.4 Rooms Rooms/100,000 & Ocala Health Systems Ancillary Services Pharmacies/100,000 pop Telephone Book Water Supply Contamination Water Supply Availability Population Displacement Public Utilities Transportation Duration (in days) of widespread boil water order Duration (in days) of widespread service disruption Residents Evacuated/100,000 Duration (in hours) of widespread electricity disruption Duration (in days) major transportation corridors disrupt NA NA NA 70 NA Marion County Health Department Environmental Health Marion County Health Department Environmental Health Marion Community Emergency Management US Energy Information Personnel % personnel available/day NA Equipment Loss Value (in dollars) computer equipment loss NA Laboratory Services Labs/100,00 pop Telephone Book Community Services Internal Communications Interagency Communications Key Partners available to respond Staff that can be available 24/7 Agencies health/medical can communicate with in disaster 85 NA 3 Marion County Emergency Management Marion County Health Department 12

87 Attachment 3 Hazard Probability Scale 0 = Improbable The probability of the occurrence of the hazard is 0 (These were deleted from tool) 1 = Remote The hazard is not likely to occur in the system Lifecyle, but it is possible 2 = Occasional The hazard is likely to occur at least once in the system lifecycle 3 = Frequent The hazard is likely to occur several times in the system lifecycle 13

88 Attachment 4 Risk Ranking Descending Order HAZARD PROBABLITIY RISK HURRICANE/TROPICAL STORM 3 67 POWER FAILURE 3 50 SINKHOLES 3 50 WILDFIRE 2 44 EPIDEMIC 2 41 COMMUNICATION FAILURE 2 41 CYBER ATTACK 2 41 TORNADO 2 37 SEVERE THUNDERSTORM 3 33 TRANSPRTATION DISRUPTION 2 30 RADIOLOGIC TERRORISM 1 28 EXCESSIVE HEAT 2 22 HAZARDOUS MATERIALS 2 22 INCIDENT/TRANPORTATION RADIOLOGIC INCIDENT/TRANSPORTATION 1 22 HAZARDOUS MATERIAL/FIXED FACILITY 2 20 ANIMAL DISEASE 1 20 BIOLOGIC TERRORISM 1 20 CHEMICAL TERRORISM 1 20 EXTREME COLD 2 19 RADIOLOGIC INICDENT/FIXED FACILITY 1 19 MASS CASULATY 1 15 FLOOD 1 17 SEWER FAILURE 1 17 WATER FAILURE 1 17 CIVIL DISORDER 1 15 DROUGHT 1 11 FIRE, LARGE SCALE/URBAN 1 11 SEVERE WINTER STORM 1 11 EARTHQUAKE 1 9 EROSIAN

89 Attachment 5 Risk Ranking Alphabetical Oder HAZARD PROBABLITIY RISK ANIMAL DISEASE 1 20 BIOLOGIC TERRORISM 1 20 CHEMICAL TERRORISM 1 20 CIVIL DISORDER 1 15 COMMUNICATION FAILURE 2 41 CYBER ATTACK 2 41 DROUGHT 1 11 EARTHQUAKE 1 9 EPIDEMIC 2 41 EROSIAN 1 0 EXCESSIVE HEAT 2 22 EXTREME COLD 2 19 FIRE, LARGE SCALE/URBAN 1 11 FLOOD 1 17 HAZARDOUS MATERIAL/FIXED FACILITY 2 20 HAZARDOUS MATERIALS 2 22 INCIDENT/TRANPORTATION HURRICANE/TROPICAL STORM 3 67 MASS CASULATY 1 15 POWER FAILURE 3 50 RADIOLOGIC INCIDENT/TRANSPORTATION 1 22 RADIOLOGIC INICDENT/FIXED FACILITY 1 19 RADIOLOGIC TERRORISM 1 28 SEVERE THUNDERSTORM 3 33 SEVERE WINTER STORM 1 11 SEWER FAILURE 1 17 SINKHOLES 3 50 TORNADO 2 37 TRANSPRTATION DISRUPTION 2 30 WATER FAILURE 1 17 WILDFIRE

90 Attachment 6 Social Vulnerability Index 16

91 Attachment 7 HHS Empower Map Electric Dependent Medicare Beneficiary 17