MEMORANDUM OF UNDERSTANDING BETWEEN CALAVERAS COUNTY PUBLIC HEALTH DEPARTMENT AND February 2013 This Memorandum of Understanding (hereinafter referred to as "MOU") is made between Calaveras County through the Public Health Department (hereinafter referred as "County") and, a licensed general acute care hospital (hereinafter referred to as "Hospital"). This collaboration supports improved communication and coordination of healthcare activities in Calaveras County during all phases of emergency response (Planning, Response, Recovery, Mitigation), including: resource sharing, situation status reporting, resource requesting, joint information center, and procedures on case and lab test reporting. The County recognizes the hospital s ability and expertise in responding to healthcare incidents and its vital role in the provision of healthcare services to residents of Calaveras County. This document is a statement of understanding and is not intended to create binding or legal obligations. I. Definition of Terms Alternate Care Site (ACS) Emergency Operations Center (EOC) Healthcare Surge Event Hospital Command Center Hospital Liaison Medical Disaster MHOAC A location designated by the patient transferring healthcare facility or local/state/federal Emergency Management officials where patients will be sent for treatment and/or observation should the disaster overwhelm capacity of participating healthcare facilities of this MOU. The physical location at which the coordination of information and resources to support incident management (on-scene operations) activities normally takes place. An EOC may be a temporary facility or may be located in a more central or permanently established facility, perhaps at a higher level of organization within a jurisdiction. A proclamation by the local health officer or designee determines, subsequent to a significant event or circumstance, that the healthcare delivery system has been impacted, resulting in an excess in demand over capacity or capability in the local healthcare system. An area established within a hospital during an emergency that is the facility s primary source of administrative authority and decision making. An individual designated by the Hospital s Incident Commander to communicate and coordinate with the MHOAC, Public Health Department, Operational Area EOC, and other emergency management representatives. An event that a facility cannot appropriately resolve solely by using its own resources and may involve temporarily utilizing medical and support personnel, pharmaceuticals, supplies, or equipment, and/or information from other sources. This type of event may also necessitate the need for evacuation and transport of patients to other healthcare facilities. Medical Health Operational Area Coordinator (MHOAC). An individual jointly appointed by the Local Health Officer and EMS Director who is responsible in the event of a disaster or major incident where mutual aid is requested, for obtaining and coordinating services and allocations of resources within the Operational Area (county).
Public Health DOC The physical location at which the coordination of Public Health information and resources to support incident management (on-scene operations) activities takes place during a significant incident that has potential impact the local healthcare delivery system. II. Medical Health Operational Area Coordinator (MHOAC) Program The MHOAC Program is based on the functional activities described in Health and Safety Code 1797.153. Within each Operational Area, the Health and Safety Code authorizes the county health officer and local emergency medical services administrator to jointly act as the MHOAC or appoint another individual to fulfill the responsibilities. In Calaveras County, the Mountain-Valley EMS Agency s on-call Duty Officer shall be the primary contact for MHOAC on a 24-hour/7-day per week basis. Local healthcare providers may contact the MHOAC for any incident requiring medical or health mutual-aid or resource assistance through the Calaveras County Sheriff s Office Dispatch. During any incident that warrants activation of the Public Health DOC, the MHOAC functions shall be transferred to the Public Health DOC. Upon such DOC activation, local healthcare providers shall be notified and provided with the MHOAC/DOC contact information, including primary telephone number, fax number, email address, and/or alternative methods for contact and communications. III. Public Health Department Operations Center During any incident that has significant impact or potentially significant impact on the local healthcare delivery system, the Public Health Department may elect to activate its Department Operations Center (DOC) to coordinate the management of local medical and health resource requests, support for public health and medical emergency operations, and coordination of Public Health information. Upon such activation, the Public Health DOC would become the primary point of contact for local healthcare providers, and coordinate resource requests, support, and information management with the Calaveras Operational Area EOC. IV. General Terms of This Agreement 1. Emergency Operations Plans (EOP) Develop and maintain an Emergency Operations Plan consistent with: o The State Emergency Plan, o The California Public Health and Medical Emergency Operations Manual, and o The Calaveras County Emergency Operations Plan; Incorporate the standards and principles of the Hospital Incident Command System (HICS), Standardized Emergency Management System (SEMS), and National Incident Management System (NIMS). Review and update the EOP at least annually, and ensure all personnel are instructed in its requirements. Exercise the EOP at least twice a year, and Develop a written report and evaluation of all drills. Develop and maintain a Public Health Emergency Operations Plan consistent with: o The State Emergency Plan, o The California Public Health and Medical Emergency Operations Manual, and o The Calaveras County Emergency Operations Plan; Incorporate the standards and principles of the Standardized Emergency Management System (SEMS), and National Incident Management System (NIMS).
Review and update the EOP at least annually, and ensure all personnel are instructed in its requirements. Exercise the EOP at least twice a year, and Develop a written report and evaluation of all drills. 2. Resource Sharing Share the following resources with county, to the extent possible, during a disaster or emergency incident, in accordance with Title 22 of the California Code of Regulations (Attachment A) : Personnel that have been appropriately credentialed Equipment Supplies Pharmaceuticals Information Share the following resources with Hospital, to the extent possible, during a disaster or emergency incident: Personnel that have been appropriately credentialed Equipment Supplies Pharmaceuticals Information 3. Situation Status Reporting: Notify the MHOAC or Public Health Department immediately by telephone for any unusual incident or event that significantly impacts or threatens public health, environmental health, or medical services, including, but not limited to: The incident significantly impacts or is anticipated to impact public health or safety; The incident disrupts or is anticipated to disrupt the Public Health and Medical System; Resources are needed or anticipated to be needed beyond the capabilities of the Operational Area, including those resources available through existing agreements (day-today agreements, memoranda of understanding, or other emergency assistance agreements); The incident produces media attention or is politically sensitive; The incident leads to a Regional or State request for information; and/or Whenever increased information flow from the Operational Area to the State will assist in the management or mitigation of the incident s impact. Appoint a Hospital Liaison for the MHOAC, and submit Situation Status of Hospital reports to County upon request in a format approved by County, and based upon standards established by the California Public Health and Medical Emergency Operations Manual. Notify the Hospital by telephone for any unusual incident or event that significantly impacts or threatens public health, environmental health, or medical services, including, but not limited to: The incident significantly impacts or is anticipated to impact public health or safety; The incident disrupts or is anticipated to disrupt the Public Health and Medical System;
Resources are needed or anticipated to be needed beyond the capabilities of the Operational Area, including those resources available through existing agreements (day-today agreements, memoranda of understanding, or other emergency assistance agreements); The incident produces media attention or is politically sensitive; The incident leads to a Regional or State request for information; and/or Whenever increased information flow from the Operational Area to the State will assist in the management or mitigation of the incident s impact. Provide a form and format for reporting Situation Status of Hospital to County, based upon standards established by the California Public Health and Medical Emergency Operations Manual. 4. Resource Requesting: Appoint a Hospital Liaison for coordination of Resource Requests with County. Direct all requests for medical and health resources during a significant event or disaster to the MHOAC, utilizing a form and format provided by County. The MHOAC program activities are conducted in coordination with appropriate emergency management agencies. The following information may be confirmed by the MHOAC in order to process the medical and health resource requests: o The resource need is immediate and significant (or anticipated to be so). o The supply of the requested resource has been exhausted or exhaustion is imminent. o The resource or an acceptable alternative is not available from: The internal, corporate supply chain. Other commercial vendors. Through existing agreements. Relevant payment/reimbursement issues have been addressed. Provide a standard form and format for submitting a Resource Requests to the MHOAC. Receive and evaluate requests for medical and health resources during a significant event or disaster from Hospital. 5. Joint Information Center: Appoint a Hospital Liaison for coordination of Public Information with County. Coordinate with the MHOAC, Calaveras Public Health DOC, Calaveras County EOC, Joint Information Center, and other relevant organizations its media response to the disaster. Hospital is encouraged to develop and coordinate a response outline prior to any disaster. Inform Hospital of the activation of the Public Health Department Operations Center (DOC), Calaveras County EOC, and Joint Information Center in response to a disaster or significant incident. County will work with Hospital to develop and coordinate a response outline prior to any disaster. 6. Communicable Disease Case & Laboratory Test Reporting:
Instruct hospital and clinic personnel how to report suspected or confirmed cases of the agent of concern to the health department. Complete a Confidential Morbidity Report (CMR) when required. Submit an approved lab slip for specimens to be transported to the San Joaquin Public Health Lab. Fax pertinent case reporting paperwork to the Public Health Department as soon as possible after completion to (209) 754-1709. Maintain an Information Sharing Log that tracks activities and information sharing with the Public Health Department. The Log will be kept identical to the Information Sharing Log at the Public Health Department, and emailed each weekday (Mon Fri) to the CD Program Manager at the Public Health Department. Contact the Healthcare Clinical Laboratory at a specified time each weekday (Mon Fri) to obtain a verbal report of testing results not already received, and noted on Log. Notify hospital providers, including those working at the clinics, of test results. Notify the Hospital s Infection Preventionist or designee of required data and timeline to report a communicable disease of concern. Provide written instructions for reporting, including: o the name of the disease or agent of concern, o criteria for reporting persons with compatible illness and/or laboratory confirmed illness, o specific data to be reported, and o the mechanism and process for reporting. Directly notify local medical providers who are not part of the hospital or hospital clinic system of reporting requirements. Maintain an Information Sharing Log that tracks activities and information sharing with the Hospital. The Log will be kept identical to the Information Sharing Log at the Hospital, and emailed each weekday (Mon Fri) to the Infection Preventionist at the hospital. Contact the San Joaquin Public Health Laboratory at a specified time each weekday (Mon Fri) to obtain a verbal report of testing results not already received, and noted on Log. 7. Alternate Care Site (ACS): Appoint a Hospital Liaison for coordination of ACS activities with County. Assist County in the operations and management of government activated Alternate Care Sites, to the extent possible, during a significant healthcare surge event, including but not limited to: o Participating in a Threat Assessment Group to provide expertise and make recommendation to the Public Health Officer regarding the need, number, and type of ACS; as well as recommending triage parameters for types of patients to be received at these sites. o Development of an ACS Activation Plan, including staffing, supply, and security needs. o Overall management strategies for operating an ACS, including the medical and ancillary services required to operate an ACS. Coordinate with Hospital in the activation, operations, and management of government activated Alternate Care Sites, including but not limited to: o Conducting a Medical and Health Threat Assessment to provide expertise and make recommendation to the Public Health Officer regarding the need, number, and type of ACS; as well as recommending triage parameters for types of patients to be received at these sites.
o o Participate in ACS Activation, including staffing, supply, and security needs. Overall management direction for operating an ACS, including the medical and ancillary services required to operate an ACS. 8. Personal Protective Equipment (PPE): Maintain a Personal Protective Equipment (PPE) program that meets or exceeds current standards established by the Occupational Health and Safety Administration (OSHA), including: o Performing a hazard assessment of the workplace to identify and control physical and health hazards o Identifying and providing appropriate PPE for employees. o Training employees in the use and care of the PPE. o Maintaining PPE, including replacing worn or damaged PPE. o Periodically reviewing, updating and evaluating the effectiveness of the PPE program. Maintain a Personal Protective Equipment (PPE) program that meets or exceeds current standards established by the Occupational Health and Safety Administration (OSHA), including: o Performing a hazard assessment of the workplace to identify and control physical and health hazards o Identifying and providing appropriate PPE for employees. o Training employees in the use and care of the PPE. o Maintaining PPE, including replacing worn or damaged PPE. o Periodically reviewing, updating and evaluating the effectiveness of the PPE program. V. Term and Termination The terms of this Agreement will commence on the date this Agreement is signed by both parties, and will continue in full force and effect for five (5) years of date of last signatory unless terminated or modified by mutual written agreement. Each party may elect to terminate its participation in this MOU by providing thirty (30) days written notice to the other party of its intent to terminate. IV. Notices Notices to this MOU shall be sent to: V. Hold Harmless/Indemnification It is agreed that the County shall defend, save harmless, and indemnify Hospital, its officers, agents and employees, from any and all claims for injuries or damages to persons and/or property which arise out of the terms and conditions of this MOU and which result from the negligent acts or omissions of the County, its officers, agents or/and employees. It is further agreed that the Hospital shall defend, save harmless and indemnify County, its officers, agents and employees, from any and all claims for injuries or damages to persons and/or property which arise out of the terms and conditions of this MOU and which result from the negligent acts or omissions of the Hospital, its officers, agents and/or employees.
In the event of concurrent negligence of the County, its officers, agents, or employees and the Hospital, its officers, agents or employees, then the liability for any and all claims for injuries or damages to persons and/or property which arise out of the terms and conditions of this MOU shall be apportioned under the California theory of comparative negligence as established presently, or as may be hereafter modified. VI. Financial & Legal County will assume legal responsibility for the loaned personnel, equipment, and supplies during the time that the resources are in County s possession or under County s control. County will reimburse Hospital for the Hospital s actual costs of providing personnel and supplies as authorized by County. Costs includes, but are not limited to, all the use of, and return costs related to borrowed resources, the replacement of any damaged or lost equipment, and cost of loaned personnel s salary and benefits. Reimbursement will be made within ninety days following receipt of the invoice. Documentation of costs incurred will be in a format jointly approved by both parties. VII. Approvals Approved as to form: By: (Name) Date Counsel for Hospital By: (Name) Date Calaveras County Counsel IN WITHNESS WHEREOF, the undersigned have executed this Agreement on behalf of By: (Name) Date Hospital Chief Executive Officer By: (Name) Date Calaveras County Health Department Director
Attachment A: Title 22 70741 22 CCR 70741 (2011) 70741. Disaster and Mass Casualty Program (a) A written disaster and mass casualty program shall be developed and maintained in consultation with representatives of the medical staff, nursing staff, administration and fire and safety experts. The program shall be in conformity with the California Emergency Plan of October 10, 1972 developed by the State Office of Emergency Services and the California Emergency Medical Mutual Aid Plan of March 1974 developed by the Office of Emergency Services, Department of Health. The program shall be approved by the medical staff and administration. A copy of the program shall be available on the premises for review by the Department. (b) The program shall cover disasters occurring in the community and widespread disasters. It shall provide for at least the following: (1) Availability of adequate basic utilities and supplies, including gas, water, food and essential medical and supportive materials. (2) An efficient system of notifying and assigning personnel. (3) Unified medical command. (4) Conversion of all usable space into clearly defined areas for efficient triage, for patient observation and for immediate care. (5) Prompt transfer of casualties, when necessary and after preliminary medical or surgical services have been rendered, to the facility most appropriate for administering definite care. (6) A special disaster medical record, such as an appropriately designed tag, that accompanies the casualty as he is moved. (7) Procedures for the prompt discharge or transfer of patients already in the hospital at the time of the disaster who can be moved without jeopardy. (8) Maintaining security in order to keep relatives and curious persons out of the triage area. (9) Establishment of a public information center and assignment of public relations liaison duties to a qualified individual. Advance arrangements with communications media will be made to provide organized dissemination of information. (c) The program shall be brought up-to-date, at least annually, and all personnel shall be instructed in its requirements. There shall be evidence in the personnel files, e.g., orientation checklist or elsewhere, indicating that all new employees have been oriented to the program and procedures within a reasonable time after commencement of their employment. (d) The disaster plan shall be rehearsed at least twice a year. There shall be a written report and evaluation of all drills. The actual evacuation of patients to safe areas during the drill is optional.