Mississippi Incident Specific Annex Ebola Virus Disease Coordinating Agencies Mississippi Emergency Management Agency Mississippi State Department of Health Primary Agencies Mississippi State Department of Health University of Mississippi Medical Center Support Agencies Mississippi Board of Animal Health Mississippi Department of Education Mississippi Department of Environmental Quality Mississippi Department of Finance and Administration Mississippi Department of Human Services Mississippi Department of Mental Health Mississippi Department of Public Safety Mississippi Department of Transportation Mississippi Wireless Communications Commission Mississippi Military Department Mississippi Institutions of Higher Learning Mississippi State Board of Community and Junior Colleges Office of the State Medical Examiner Non-Governmental Organizations American Red Cross Mississippi Voluntary Organizations Active in Disasters Mississippi Licensed Hospitals Mississippi ESF-8 Healthcare Coalition Federal Coordinating Agency Department of Health and Human Services Federal Cooperating Agencies Federal Emergency Management Agency Centers for Disease Control and Prevention National Institute of Health National Institute of Occupational Safety and Health U.S. Environmental Protection Agency U.S. Food and Drug Administration Department of Defense Introduction The Mississippi State Department of Health (MSDH) is the lead agency for disease prevention and control. During normal operations, MSDH responds to numerous infectious disease outbreaks of varying types and magnitude. If an event occurs that presents an imminent threat to the public, or exceeds MSDH day-to-day capacity, the Mississippi Emergency Management Agency (MEMA) may, at the discretion of the Governor, activate the State Comprehensive Emergency Management Plan (CEMP). Upon activation, MEMA and MSDH will coordinate state-level emergency management activities and the engagement with other stakeholders, including local, state and tribal governments, non-governmental organizations, other states, the federal government, and the private sector. Purpose Ebola Virus Disease (EVD), previously known as Ebola hemorrhagic fever, is a rare and deadly disease caused by infection with one of the Ebola virus strains. Ebola can cause disease in humans and nonhuman primates (monkeys, gorillas, and chimpanzees). The purpose of this annex is to establish a framework for a coordinated state response to one or more suspected or confirmed cases of Ebola Virus Disease within the state. EVD IA-1
Scope In conjunction with the Mississippi CEMP, this annex establishes specific policies and guidelines for the State and counties when responding to a: monitored international traveler who becomes symptomatic for Ebola Virus Disease (EVD), contact of a suspect or confirmed Ebola patient, or suspected or confirmed case of Ebola Virus Disease. This annex provides structures for implementing state-level policy and operational coordination. It can be partially or fully implemented in anticipation of a significant event, or in response to an incident. Selective implementation allows for a scaled response, delivery of the exact resources needed, and a level of coordination appropriate to the incident. It is also used when Mississippi s capabilities are exceeded and Federal government response is requested. Situation Overview Ebola viruses are found in several African countries. Ebola was first discovered in 1976 near the Ebola River in what is now the Democratic Republic of the Congo. Since then, outbreaks have appeared sporadically in Africa. The natural reservoir host of Ebola virus remains unknown. However, on the basis of evidence and the nature of similar viruses, researchers believe that the virus is animal-borne and that bats are the most likely reservoir. Four of the five virus strains occur in an animal host native to Africa. The 2014 Ebola epidemic is the largest in history, affecting multiple countries in West Africa. Symptoms of Ebola include: Fever Severe headache Muscle pain Weakness Fatigue Diarrhea Vomiting Abdominal (stomach) pain Unexplained hemorrhage (bleeding or bruising) Symptoms may appear anywhere from 2 to 21 days after exposure to Ebola, but the average is 8 to 10 days. Signs and symptoms of EVD are also symptoms of other, more common illnesses like influenza. This may become a complicating factor during influenza season. Recovery from Ebola depends on good supportive clinical care and the patient s immune response. People who recover from Ebola infection develop antibodies that last for at least 10 years. Ebola virus causes severe viral hemorrhagic fever with a high fatality rate. Ebola virus can be transmitted by direct contact with blood, body fluids, or skin of EVD patients or persons who have died of EVD. Several U.S. healthcare personnel working in West Africa have become infected with EVD and have returned to the United States for evaluation and treatment. In addition, people in several states who have had recent travel to West Africa and have developed fever and other symptoms have been evaluated at U.S. hospitals for possible EVD. The U.S. has seen imported cases, locally acquired cases in healthcare workers and deaths from EVD. EVD IA-2
Assumptions State agencies and non-governmental organizations will develop plans to accomplish roles and responsibilities listed in this annex. The spread of disease will be minimized through active monitoring of international travelers and contacts of suspected or confirmed cases of Ebola Virus Disease (EVD). There are sufficient statutory authorities to enact appropriate isolation and quarantine measures as needed. Currently there is no known cure or approved vaccine for EVD. Space will be available in the state isolation and treatment facility or regional bio-containment unit to receive suspected or confirmed cases of EVD. Every licensed hospital in the state will have sufficient personal protective equipment, trained staff, processes and procedures to identify a potential EVD patient, isolate that patient, properly handle any medical waste and contact the Mississippi State Department of Health (MSDH) for further guidance. Confirmed EVD patient waste will be transported, with appropriate federal permits, to an approved medical incinerator. Federal teams and assets will be available to assist the state if there is a confirmed case of EVD. The State Joint Information System will be activated to provide the timely release of accurate information coordinated across involved agencies should the state identify a suspected or confirmed case of EVD. Bodies of confirmed EVD patients will be cremated and the ashes returned to appropriate family members. Concept of Operations This annex incorporates the concepts and requirements found in federal and state laws, regulations and guidance. It takes into consideration the regulations and guidelines found in the state CEMP, National Response Framework (NRF), and National Incident Management System (NIMS). Furthermore, this annex identifies the responsibilities and actions required to protect lives, property, and the environment as it relates to Ebola Virus Disease. This plan takes into account the involvement of various local, state, tribal, and federal government agencies, non-governmental organizations and the private sector that should develop, exercise, and maintain individual emergency operations plans. The Mississippi Emergency Management Agency (MEMA) will coordinate the mobilization of state resources to assist local and state response efforts and coordinate requests for additional support from federal and interstate resources. The Mississippi State Department of Health (MSDH) will be the coordinating agency for response operations and will work within existing coordination and communication structures as appropriate. However, a request may be made for the Governor to declare a state of emergency (MS Code 33-15-11) to enact emergency powers and enhance the ability to support response operation for any of the following reasons: EVD IA-3
The scope of coordination exceeds the capacity of MSDH to manage it, requiring the activation of the State Emergency Operations Center (SEOC). The scope of response becomes, or is anticipated to become, too costly to accommodate with existing funds. The response includes significant federal involvement requiring specific coordination systems to be in place. There is a need for agencies and/or individuals to operate outside of existing rules/regulations for a temporary period of time. Organization and Assignment of Responsibilities Local and Tribal Government Local and Tribal governments have responsibility for emergency actions, direction, control and coordination through both its elected and appointed officials. Tribal, county and municipal governments will function in an Ebola Virus Disease (EVD) event in accordance with local laws and community requirements. To prepare for an EVD event, these jurisdictions and public health entities are responsible for coordinating healthcare activities within the community and should work with local hospitals and other local ESF-8 partners to: Improve information sharing and communication with medical care providers and healthcare organizations. Ensure managers of 9-1-1 Public Safety Answering Points (PSAPs), EMS Agencies, EMS systems, law enforcement agencies, fire service agencies and other responding agencies review the most current Centers for Disease Control and Prevention (CDC) and Mississippi State Department of Health (MSDH) guidance for EVD. Conduct contingency planning, training and exercises for an EVD event. Monitor costs associated with an EVD event. Coordinate with MEMA consistent with the Concept of Operations in the CEMP Base Plan. In the event of a suspected or confirmed EVD patient, the local or tribal government is primarily responsible for the safety and security of the residents and properties related to the patient. This includes the decontamination of any settings where an individual with confirmed Ebola has been known to have spent time while symptomatic and the sheltering, housing, and support needs for any contacts of the EVD patient that are identified by MSDH. State Various state agencies and non-governmental organizations are tasked to offer support and resources for preparedness, response and recovery from an EVD event. The Governor is responsible for declaring that a state of emergency exists, and at such time, directs all available state and local resources, as reasonably necessary, to cope with the event utilizing EVD IA-4
National Incident Management System (NIMS) and the Incident Command System (ICS) doctrine. This includes the designation of a state level Incident Commander (IC) as needed. The State of Mississippi is responsible for providing assistance to any political subdivision within the state that requests emergency assistance. The Mississippi Emergency Management Agency (MEMA) will coordinate and mobilize state resources as needed. The MEMA Director will execute intrastate and interstate agreements and compacts as needed. The MEMA Director will work with the Office of the Governor to request federal or state funding as required. The Mississippi State Department of Health (MSDH) will be the coordinating agency for response operations and will work within existing coordination and communication structures as appropriate. Federal The role of the federal government in an EVD event will differ in many respects from its role in most other natural or manmade events. The federal government will bear primary responsibility for certain critical functions, including the support of disease containment efforts overseas and limitation of the arrival of an EVD high-risk contact or patient to our shores; provision of clear guidance to local, state and tribal entities, the private sector and the public on protective measures and responses. Requests for federal assistance will be made by MSDH with coordination by MEMA through the structures identified in the Comprehensive Emergency Management Plan (CEMP) Basic Plan. As the situation warrants, teams of infection control specialists, epidemiologists, resources of the Strategic National Stockpile (SNS), and/or additional support staff may be requested to include but not limited to: Centers for Disease Control and Prevention (CDC) Rapid Ebola Response Team (REP) Preparatory Team to review hospitals that will handle Ebola cases CDC Ebola Response Team (CERT) Support to hospitals with a suspected or confirmed case of EVD (approximately 20 person team) CDC Strategic National Stockpile Personal Protective Equipment cache that can be deployed to support a suspected or confirmed case of EVD Department of Defense (DOD) Medical Support Team 20 critical care nurses, five doctors trained in infectious disease, five trainers in infectious disease protocols Deployed to provide medical care if a hospital needs staff augmentation EVD IA-5
Primary State Agencies Mississippi State Department of Health (MSDH)/University of Mississippi Medical Center (UMMC) MSDH will be responsible for coordination of all operational components of the EVD event including assistance to fatality management. Coordination functions and command responsibilities related to public health operations will be accomplished at the MSDH Public Health Command and Coordination Center and liaised to the State Emergency Operations Center. UMMC will be responsible to provide standardized, safe, quality care to Mississippians that are suspected or confirmed with an infectious illness, specifically Ebola Virus Disease (EVD), and other emerging infectious diseases. Preparedness MSDH Plan, recruit, train, and exercise personnel to include traveler and contact monitors, coordination teams, transportation teams, and fatality management teams. Review and upgrade capabilities and capacities as needed. UMMC Plan, recruit, train, and exercise personnel to care for a suspected or confirmed EVD patient. Review and upgrade capabilities and capacities as needed. Pre-Incident MSDH Ensure current MSDH All-Hazard Response Plan, Concept of Operations, Ebola Virus Disease (EVD) Response Preparedness Plan, Emergency Operating Guidelines, Job Action Sheets, Protective Equipment Checklists and Response Policies are available and consistent with current federal guidance. Conduct information sharing sessions on EVD with the Mississippi ESF#8 Healthcare Coalition, local and state Emergency Management, Mississippi First Responders (Fire, Law Enforcement, EMS), 9-1-1 Managers, Hospitals, Healthcare Providers, Education institutions, Coroners, Funeral Home Directors, ESF Emergency Coordinating Officers (ECOs) and other governmental, nongovernmental and private sector partners. Develop guidance for various audiences including recommendations for personal protective equipment. Be prepared to support local jurisdictions, healthcare providers, healthcare facilities, and coroners for issues and unmet needs. EVD IA-6
Begin active monitoring of international travelers from countries identified by CDC to have a current outbreak of EVD. Investigate and actively monitor any contacts to suspected or confirmed EVD cases. Be prepared to coordinate the transportation, medical care, clean-up of patient residence and, handling of pets of any suspected or confirmed EVD case. Review weekly, for public information through media and the MSDH website: Frequently Asked Questions (FAQ) Ebola Hotline Guidance MSDH Guidance on EVD Prepare and coordinate strategic communications plans for EVD and develop messages. Update contact information for all local, state, tribal and federal partners. Notify and request support agencies and organizations to participate in ESF #8 Public Health Command and Coordination Center activities as needed. UMMC Prepare to receive suspected or confirmed EVD patients as identified by the MSDH Identify surge capacity and resources for additional patients. Support MSDH by providing HOTLINE resource for inquiries from the public, first responders, healthcare providers and healthcare facilities. Response MSDH Execute Health Officer Orders for controlled movement or quarantine as needed. Investigate and actively monitor any contacts to suspected or confirmed EVD cases. Deploy coordination and transportation teams to transport the suspected or confirmed EVD patient to an appropriate healthcare facility. Provide technical assistance and coordination to support agencies, partners and hospitals as required. Arrange or provide for confirmatory testing of MSDH suspected EVD patients. Conduct information sharing sessions with the Mississippi ESF#8 Healthcare Coalition, local and state Emergency Management, Mississippi First Responders (Fire, Law Enforcement, EMS), 9-1-1 Managers, Hospitals, Healthcare Providers, Education institutions, Coroners, Funeral Home Directors, ESF Emergency Coordinating Officers (ECOs) and other governmental, non-governmental and private sector partners. EVD IA-7
Support local jurisdictions, healthcare providers, healthcare facilities, and coroners for issues and unmet needs. Coordinate public information and activate the State Joint Information System as required. Request federal resources as needed to support the response. UMMC Provide medical care to suspected or confirmed EVD patients as identified by MSDH. Support MSDH quarantine order for suspected or confirmed EVD patients. Activate surge capacity and resources for additional resources as needed. Draw specimens for analysis by the designated laboratory. Provide medical control to authorized ambulance services contracted via memorandum of agreement (MOA) and State transportation teams. Assist in medical communications through Mississippi MEDCOM as appropriate. EVD IA-8
Support Agencies Agency MS Board of Animal Health Functions In coordination with MSDH, identify pets and other household animals (e.g., service animals) that may have been exposed to a suspected or confirmed EVD case. Identify and coordinate with ESF#7 for suitable locations and resources for the safe quarantine and care of exposed or potentially exposed animals. Coordinate with ESF#7 for the cremation or disposal of animal carcasses. Organize according to NIMS to ensure rapid response to animal care needs. Coordinate the development, education, and activation of the Mississippi Animal Response Team (MART). Education Environmental Quality Maintain a plan, in coordination with MSDH, to deliver timely and accurate information to public and private elementary and secondary education systems throughout the state. In coordination with MSDH, develop guidance to ensure the safe decontamination of vehicles that transport suspected or confirmed EVD patients and homes or quarantine settings that have housed a confirmed EVD patient. Coordinate with ESF#7 to identify contractors to provide decontamination services as needed. Coordinate with MDOT to secure appropriate permits to transport EVD medical waste to an approved incinerator facility. Provide technical assistance to wastewater treatment plants. Finance and Administration Human Services Mental Health Expedite the identification and procurement of logistics and supplies. Coordinate needs with ESF#7. In coordination with ESF#7, support the request for resources in establishing support services for contacts of suspected or confirmed EVD patients. In coordination with MSDH, provide mental health services to EVD patients following treatment, families, contacts, and responders, including crisis counseling. EVD IA-9
Agency Public Safety Functions In coordination with MSDH, assist in site security and transportation of a suspected or confirmed EVD patient. Liaise with local law enforcement Transportation MS Wireless Communications Commission Mississippi Military Department MS Institutions of Higher Learning In coordination with Federal Department of Transportation and Environmental Quality, coordinate appropriate permits for the transportation of EVD waste to an approved incinerator. In coordination with ESF#7, provide additional encrypted radio equipment to facilitate the coordinated transportation of suspected or confirmed EVD patients. In coordination with ESF#7 and MSDH, provide an isolation capability for persons identified by MSDH to include lodging, food, laundry and other support needs. Coordinate processing of travel requests for students traveling to or from a country identified by CDC to have a current outbreak of Ebola with the MSDH. Provide multilingual support as needed. Mississippi State Board of Community and Junior Colleges Office of the State Medical Examiner Coordinate processing of travel requests for students traveling to or from a country identified by CDC to have a current outbreak of Ebola with the MSDH. In coordination with MSDH, work with hospitals, coroners and Funeral Home Directors on the safe cremation of deceased EVD patients. Review and Maintenance As a minimum, the MSDH ECO will coordinate a biennial review of this annex with all primary, support agencies, and non-governmental organizations. Additional reviews may be conducted if experience with a significant incident or regulatory changes indicate a need. Recommended changes will be submitted through the ECO to MEMA for approval, publication, and distribution. EVD IA-10
APPENDIX 1 Mississippi Hospitals by Types of Facilities Distribution of Mississippi Hospitals by Type of Facility and County EVD IA-11