On the Brink of Disaster: How the Rhode Island Department of Health Prepares for and Responds to Public Health Emergencies

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2 On the Brink of Disaster: How the Rhode Island Department of Health Prepares for and Responds to Public Health Emergencies Alysia Mihalakos, MPH Interim Chief, CEPR Rhode Island Department of Health November 13, 2013

3 What Is Emergency Preparedness? To achieve the vision of the Federal Emergency Management Agency (FEMA): FEMA will work to prepare the Nation for disasters by encouraging individuals, government entities, and public and private groups at all levels to become informed of the risks they face, to make decisions that help keep people, property, and institutions out of harm's way, and to possess the capability and knowledge needed to act when disasters occur."

4 Public Health Emergency Preparedness All-Hazards Approach Biological Chemical Radiation Natural Disasters Mass Casualty Incidents

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6 The Development of a Center for Emergency Preparedness and Response (CEPR) Implemented January 26, 2006 Responsible for planning and coordination of public health emergency management efforts Oversees work on the following grants: Public Health Emergency Preparedness grant (CDC) ($4,443,500 in GYE14) Hospital Preparedness Program grant (HPP) ($1,517,061 in GYE14)

7 1. Community/Healthcare Preparedness 13. Surveillance & Epidemiology Day-to-Day Capabilities 12. Public Health Laboratory Testing 10. Medical Surge Immediate Response Capabilities 3. Emergency Operations Coordination 6. Information Sharing Incident-Specific Capabilities 2. Community/ Healthcare Recovery 5. Fatality Management 7. Mass Care 8. Medical Countermeasure Dispensing 9. Medical Materiel Mgmt & Distribution 11. Non-Pharmaceutical Interventions Intermediate Response Capabilities 4. Emergency Public Information & Warning Support Capabilities 14. Responder Safety & Health 15. Volunteer Management

8 CEPR Mission The Center for Emergency Preparedness and Response is dedicated to creating and promoting a state of readiness and prompt response to protect the health of Rhode Islanders during catastrophic events and large-scale disasters and emergencies

9 CEPR Accomplishes Its Mission... By coordinating education, assessment, planning, response, and support services involving public health providers, private medical providers, public safety agencies, and government officials

10 Chief Deputy Chief (Programs) Administration/ Grants Management Hospital Preparedness Pandemic Flu Medical Emergency Distribution System RI Special Needs Emergency Registry Internal Planning (EOP/COOP) Training Exercises

11 What CEPR is NOT!

12 Planning EOP: Emergency Operations Plan The plan that each jurisdiction maintains for responding to appropriate hazards COOP: Continuity of Operations Purpose: To ensure that the capability exists to continue essential agency functions across a wide range of potential emergencies DOC Manual Contains information on DOC operations, capabilities, staffing, and procedures

13 HEALTH EMERGENCY OPERATIONS PLAN Draft Organizational Chart Introductory Material Purpose, Scope, Situation, & Assumptions Concept of Operations Organization & Assignment of Responsibilities Base Plan Outlines the organizational framework for the activation and management of all-hazards response and recovery activities by HEALTH Information Collection & Dissemination Communications Administration, Finance, & Logistics Plan Development & Maintenance Direction, Control, & Coordination Authorities & References Functional Annexes Focus on HEALTH s critical emergency functions performed during incident response Incident-Specific Annexes Provide hazard-specific details on HEALTH s response activities for selected scenarios Support Plan Annexes Describe plans that enhance or support HEALTH s response activities Appendices Contain additional resource information for incident management, reference, and improved response Incident Command System Overview Pandemic Influenza Medical Emergency Distribution System Plan ESF #8 Desk Reference Guide Continuity of Operations Plan Disease Outbreak (SARS, Smallpox, Foodborn) Healthcare Service Region Support Plan Command Resource Guide Department Operations Center Manual Natural Disaster Warehouse Operation Plan Operations Resource Guide Health Information Center Manual Drinking Water Laboratory Emergency Plans Planning Resource Guide Emergency Public Information Plan Ingestion Pathway Hospital Diversion Plan Logistics Resource Guide Tactical Communications Plan Radiological Ambulatory Strike Team Plan Finance/Administration Resource Guide Special Populations Plan Chemical Mass Fatality Respiratory Protection Plan Biological Detection System Plan Center for Emergency Preparedness and Response On-Call System Protocol ***NOTE*** HEALTH s EOP is the internal portion of the ESF #8 Annex, which serves as the Public Health & Medical Services component of the Rhode Island State EOP, maintained by RIEMA Cyberterrorism Complex Regulatory Issue Family Assistance Center Plan Mass Casualty Incident Plan CHART LEGEND Developed or active In development or revision Not yet developed Support plan outside HEALTH

14 Reviewing the Incident Command System

15 What is ICS? The Incident Command System (ICS) is: A standardized management tool for meeting the demands of small or large emergency situations Used for all-hazard events Representative of best practices The standard for emergency management across the nation

16 Why was ICS developed? In the early 1970s, ICS was developed to manage rapidly moving wildfires and to address the following problems: Too many people reporting to one supervisor; Different emergency response organizational structures; Lack of reliable incident information; Inadequate and incompatible communications; Lack of structure for coordinated planning among agencies; Unclear lines of authority; Terminology differences among agencies; Unclear or unspecified incident objectives.

17 What are the benefits of an ICS? An ICS enables integrated communication and planning by establishing a manageable span of control An ICS divides an emergency response into five manageable functions essential for emergency response operations: Command, Operations, Planning, Logistics, and Finance and Administration

18 How the structure works The modular organization of the ICS allows responders to scale their efforts and apply the parts of the ICS structure that best meet the demands of the incident The number of personnel and the organization structure are dependent on the size and complexity of the incident

19 General Organization of ICS

20 But how to apply this to public health? Evaluated three different scenarios: An influenza pandemic A large-scale hurricane A large mass casualty/mass fatality event

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22 ICS Vests & Identification In ICS, all staff members wear vests that clearly identify their position titles Positions appointed in ICS do not correlate with regular Departmental positions Wearing vests and using specific position titles aids the clear identification of roles and responsibilities within ICS All employees should also display their HEALTH badges at this time

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24 So, we have plans and we ve learned ICS inside of the Department

25 External Partnerships Hospitals Health centers Nursing homes Assisted living facilities Trade organizations RI Emergency Management Agency RI Dept. of Behavioral Healthcare, Developmental Disabilities, and Hospitals RI Department of Transportation RI State Police RI Department of Environmental Management RI Chapter of the American Red Cross RI Responds (RI Disaster Medical Assistance Team/ Medical Reserve Corps) Municipalities RI Association of Emergency Managers Region 1 Directors of Public Health Preparedness

26 Public Health Emergency Management Suite (PHEMS)

27 RI Special Needs Emergency Registry

28 RI Responds A comprehensive and complementary advance registration system that targets healthcare professionals with appropriate emergency response volunteer opportunities Build off the expertise of existing healthcare volunteer groups (RI-1 DMAT, RI Medical Reserve Corps) A coherent system (

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30 The DOC

31 So we exercise! URI Anthrax Operation Wildfire Water Contamination Ingestion Pathways TOPOFF III APEX 05 Hurricane Yvette Tall Ships IEMC BDS Antiviral Distribution TTX Operation Midnight Challenge Operation Summer Wind Operation Enterprise Operation Jurassic Park Operation Big Green Gainer Dam Hurricane Zara Mass Fatality TTX 10 Operation Round Robin Operation Supply the Peeps Operation PF Operation Life is Good Operation Green Day Operation Redbrick

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38 And there are events! 2004 Flu Vaccine Shortage Hurricane Katrina Blackstone Water Bocce Club August Heat Emergency Mycoplasma Hep A at Cheesecake/TX Roadhouse Cannon Central Falls TB Kent Gas Leak Prime Drug Eleanor Slater Power Outage 2008 Winter Storm Airplane Slides off the Runway H1N1 Cannon Bldg Flooding March 2010 Statewide Flooding Luxeburger Seven Moons IUD Response Hurricane Earl

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40 Bocce Club Outbreak 04/03/06

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44 Water from the Pawtuxet River encircles homes in West Warwick, R.I., on Wednesday. Rhode Island rivers overflowed their banks, causing flooding and road closures after three days of recordbreaking rains. (Charles Krupa/Associated Press)

45 A few more Green Powder Holiday Storm 2010 Nor easter Winter Storm Clipper Winter Storm Bulls Eye Winter Storm Arctic Winter Storm March Salmonella Outbreak Measles Response Tropical Storm Irene Superstorm Sandy Blizzard Nemo

46 ICS 34 real events from June exercises from September 2013 = 93.6% of respondents to the COOP Survey felt confident in their understanding and knowledge of ICS

47 QUESTIONS?

48 Contact Information Alysia Mihalakos, MPH Interim Chief Center for Emergency Preparedness and Response Rhode Island Department of Health (voice)