EMERGENCY SUPPORT FUNCTION (ESF) 8 HEALTH AND MEDICAL ESF COORDINATOR Tacoma Pierce County Health Department JOINT PRIMARY AGENCIES Disaster Medical Control Center Tacoma Pierce County Health Department SUPPORT AGENCIES Air Ambulance Agencies Amateur Radio Medical Services Team American Red Cross, Rainier Chapter Associated Ministries Blood Bank City Emergency Operations Centers Law Enforcement Agencies Long Term Care Providers Mental Health Providers Metropolitan Medical Response System Palliative Care and Hospice Providers Pierce County Chaplaincy Program Pierce County Department of Emergency Management Pierce County Fire Districts and Municipal Fire Departments Pierce County Hospitals Pierce County Medical Examiner s Office Pierce County Medical Reserve Corps Pierce County Medical Society Pierce County Mortuary Service Providers Pierce Transit Public and Private Emergency Medical Service Agencies Public Safety Answering Points Washington State Dental Association Washington State Department of Health Centers for Disease Control and Prevention National Disaster Medical System Puget Sound Federal Coordinating Center U. S. Department of Health and Human Services U. S. Department of Defense ESF 8: Health and Medical/October 2010 1 of 13
I. INTRODUCTION A. Purpose 1. To organize, mobilize, coordinate, and direct public health and medical resources and support in an emergency or disaster within the incorporated and unincorporated areas of Pierce County (Region V). 2. To provide for the coordination of pre-hospital, hospital, medical community, and fatalities management. 3. To provide for the care of the sick, injured and dead resulting from an emergency or disaster. 4. To facilitate the coordinated use of medical resources such as personnel, facilities, equipment, and supplies. 5. To provide for the coordination of crisis response, and spiritual and mental health services for persons who suffer from reactions to the emergency or disaster. 6. To provide for critical incident stress management services for emergency service workers. 7. To provide for the systems and methods required for surveillance, mitigation, and interventions to reduce the impact(s) from events potentially or actually affecting public health in Pierce County, including food safety, environmental health, and communicable diseases. B. Scope This ESF identifies Emergency Medical Services (EMS), public health, medical and related services provided to citizens of Pierce County along with guidelines for the coordination of these services. These guidelines are not intended to circumvent the use of training, practice, experience, and judgment of the primary and support agencies involved in the delivery of this ESF. This plan does not address catastrophic failure where total infrastructure collapse has occurred or where coordination is unable to occur because of communication system failure. It is intended that this document will interface with work being completed on the WA State Regional Catastrophic Preparedness Grant Program Puget Sound Region (RCPGP), as appropriate. ESF 8: Health and Medical/October 2010 2 of 13
II. POLICIES A. Pierce County Emergency Medical Services (EMS), Emergency Medical Responders (EMRs), Emergency Medical Technicians (EMTs) and Paramedics who provide emergency medical assistance in Pierce County shall operate under the current revision of the Pierce County Emergency Medical Services, Emergency Medical Program Director Patient Care Protocols and Pierce County Patient Care Procedures. B. Pierce County EMS will operate within the guidelines established in the Pierce County Fire Chiefs Mass Casualty Incident (MCI) Plan. When an incident meets the MCI plan thresholds, EMS personnel are allowed to operate within the established written patient care protocols and procedures. C. During a MCI, patient transport is directed through the Disaster Medical Control Center (DMCC) and all area hospitals will receive MCI patients, unless incapacitated. Good Samaritan Hospital is the DMCC for Pierce County. Madigan Health Care System is the alternate. D. The Director of Health or designee, as the county health officer, is authorized to implement measures as necessary to control communicable disease exposure or contamination of food, water and environmental resources (RCW 70.05). E. The Pierce County Chaplaincy Program (PCC) provides stress management and emotional and spiritual support to county emergency responders and their families. Inpatient and outpatient mental health services are provided by OptumHealth Pierce Regional Support Network (RSN); a Mental Health Crisis Line (Protocol), a Mental Health Recovery Response Center (Recovery Innovations), and an Evaluation and Treatment Center (Telecare). The Associated Ministries provides spiritual support to victims. F. The Pierce County Medical Examiner has independent authority in all cities/towns and all unincorporated areas of Pierce County, with the exclusive jurisdiction over human remains in all unnatural or unlawful civilian deaths; persons who come to their death suddenly when in apparent good health without medical attendance within the thirty-six hours preceding death; and all unclaimed bodies. Deaths on military reservations or of active duty military personnel are the shared jurisdiction of the military (and/or the Armed Forces Medical Examiner) and the Pierce County Medical Examiner, defaulting to the Pierce County Medical Examiner if military jurisdiction is not assumed. Medical Examiner jurisdiction may include some cases of suspected contagious disease that may be a public health hazard (RCW 68.50.010). G. Medical personnel unable to report to their designated work location should report to the nearest health care facility or follow directions from the Continuity of Operations (COOP) plan of the parent organization or directions through the media. H. The National Disaster Medical System (NDMS) is a federally coordinated system that augments the nation s emergency medical response capability. The NDMS establishes a single, integrated national medical response capability for assisting state and local authorities in dealing with the medical and health effects of major ESF 8: Health and Medical/October 2010 3 of 13
peacetime disasters. Madigan Health Care System (MHCS) is the military Western Region Medical Command and Primary Patient Reception Center as identified in the NDMS plan. I. All policies will be NIMS/ICS compliant. III. SITUATION A. Emergency/Disaster Condition and Hazards The Pierce County Hazard Identification and Risk Assessment (HIRA) and other assessments list the natural, technological and social emergencies which are potential threats to the life safety and the associated damage to property, the economy and the environment. The Threat Response System website has additional information of possible weapons of mass destruction (WMD) targets within the county. All listed hazards pose a risk, of various degrees, to the public health and medical conditions and services within Pierce County. In an incident involving environmental quality issues, such as a hazardous materials incident or a flood event, people with compromised immune systems or serious health issues may require greater care. As response and recovery continues from a disaster that requires longer sheltering, the health of evacuees and victims may degrade, which may require establishment of alternate care facilities in the community. B. Planning Assumptions 1. If the health and medical system is functioning, the need for alternate care facilities will not be necessary. 2. Alternate care facilities will be activated if the health and medical system cannot support the levels of needed medical care. 3. Natural, technological, biological and social emergencies or disasters can overwhelm county health and medical facilities and services requiring emergency coordination of resources. 4. Health and medical facilities may be severely damaged, destroyed or rendered unusable. 5. Infrastructure (transportation, communication, utilities, etc.) may be damaged and impact the ability of the county s health and medical services to be effective. 6. Infrastructure damage and disruption may increase the potential for disease and injury. 7. The high risk population will have a variety of medical conditions and will include people who require specialized medical support. ESF 8: Health and Medical/October 2010 4 of 13
8. People in the high risk population or the general population whose health degrades during the response and/or recovery operation will require additional medical support that could include hospitalization. 9. Disruption of sanitation services and facilities, loss of power, and massing of people in shelters may increase the potential for disease and injury. 10. Contamination of food and water supplies may increase the potential for disease and injury. 11. Availability of medical care personnel may be limited due to injury, illness, personal concerns/needs or limited access to work locations. 12. Medical facilities still operational after the emergency or disaster will be overwhelmed by mild to seriously injured victims in the immediate aftermath of the occurrence. 13. Communicable disease will need ongoing tracking and identification before, during, and after medical intervention. 14. Hospitals, long-term care facilities, other inpatient and outpatient facilities and pharmacies will rely on existing emergency service contracts with appropriate vendors for medical equipment, pharmaceuticals, linens and other day-to-day supplies. These facilities are expected to plan and stock for four days of selfsufficiency. 15. The damage and destruction caused by an emergency or disaster will produce urgent needs for mental health crisis counseling and spiritual support for disaster victims and emergency response personnel. 16. The Pierce County Medical System (emergency medical, public health and related services) will be restored to normal operations during the recovery period as soon as possible and within the limitations and capabilities allowed by county government following the emergency or disaster. 17. Hospitals and other medical agencies may require physical protection of their staff, facility and its contents. 18. Recovery operations will include a public health assessment of food, water, and sanitation systems prior to approval for use by business or the public. IV. CONCEPT OF OPERATIONS A. General 1. The level of ESF 8 activation will be dependent on the magnitude of the emergency or disaster. 2. Tacoma-Pierce County Health Department (TPCHD) will provide 24-hour duty officer coverage in support of public health and medical response activities and ESF 8: Health and Medical/October 2010 5 of 13
will work in cooperation with the City/Pierce County Department of Emergency Management Duty Officer who will be providing support to all other field response activities. 3. Public Health Area Command, comprised of representatives from TPCHD, hospitals, clinics, PC EMS and others as deemed necessary, will evaluate, prioritize and coordinate requests for medical resources. 4. ESF 8 agencies (primary and support) will maintain a workable emergency operational plan identifying critical personnel and responsibilities, emergency chain of command, appropriate emergency notification procedures and alternate work locations. 5. All ESF 8 agencies will maintain coordinated emergency operations plans with other ESF 8 agencies. 6. ESF 8 agencies will establish Continuity of Operations Plans (COOP) procedures and lines of succession which are updated regularly. 7. ESF 8 agencies will maintain communications systems (telecommunications and radio) that are consistent with the PC EMS/Public Health and Medical Communication Plan. 8. TPCHD will provide health related educational and technical information releases in coordination with the Joint Information System/Joint Information Centers (JIS/JIC). 9. When the PC EOC is activated, ESF 8 agencies will coordinate public emergency information through the Pierce County JIC. B. Tacoma-Pierce County Health Department 1. Manage all Pierce County public health, medical and mental health response and recovery efforts. 2. Support the DMCC and PC EMS with EMS related activities. 3. Coordinate with Mass Fatality Planners. 4. Designate and activate a Public Health Area Command for ESF 8 response actions involving multiple health and medical organizations or agencies. Public Health Area Command will prioritize and manage health and medical resources during the incident to include SNS and Medical Reserve Corps assets. If resource needs cannot be met locally or through local mutual aid agreements, Public Health Area Command may transmit a request for assistance through the Pierce County EOC to the State EOC. The state may access state agency resources, interstate mutual aid, private industry resources, or turn to federal agencies to accomplish the mission. ESF 8: Health and Medical/October 2010 6 of 13
5. Activate community level health and medical surge capacities 6. Coordinate patient evacuation from medical and long-term care facilities. 7. Coordinate with the Puget Sound Federal Coordinating Center for patient movement actions in or out of Pierce County. 8. Conduct damage assessments of TPCHD facilities to determine operational status and relay the information to the PC EOC. 9. Assign a liaison to the City/PC EOC when requested. 10. Maintain public health and sanitation supervision within the county to include inspection of potentially degraded sanitation systems prior to being used. 11. Receive and process registered emergency workers for use as emergency response organization staff in support of the Medical System response. 12. Control and prevent the spread of dangerous, contagious or infectious diseases. 13. Provide information as to the cause, nature and prevention of disease and disability and the preservation, promotion and improvement of public health within the county. 14. Prevent, control or abate nuisances, which are detrimental to public health. 15. Inspect, as necessary, the expansion or modification of existing public water systems, and the construction of new public water systems, to assure that the expansion, modification, or construction conforms to system design and plans. 16. Promote the public s health by developing and issuing public health education materials (fact sheets). 17. Institute disease control measures consistent with recommended American Public Health Association/Centers for Disease Control and Prevention guidelines. The county public health officer will make reasonable efforts to obtain voluntary compliance but has the authority to impose involuntary detention when necessary. The county health officer may invoke the powers of police officers and sheriff s deputies to enforce orders given to preserve public health (RCW 70.05). 18. Ensure all facilities operating under ESF 6 and ESF 8 meet public health standards. 19. Determine the need to activate alternate care facilities in the community and provide direction to the medical community through Public Health Area Command. C. Disaster Medical Control Center ESF 8: Health and Medical/October 2010 7 of 13
The Disaster Medical Control Center (DMCC) is located at Good Samaritan Hospital. Madigan Health Care System (MHCS) is the alternate location. Rare circumstances, such as an inability to provide communications, may create the need to transfer primary DMCC responsibilities to the Pierce County alternate DMCC, Madigan Health Care System (MHCS), or the King County DMCC. After the decision to transfer responsibilities to either of the DMCC alternates, the Pierce County DMCC will use existing procedures to inform the TPCHD Duty Officer or Public Health Area Command and the PC Duty Officer of this transfer of responsibility. D. Public and Private Emergency Medical Service Agencies 1. In disaster conditions all Pierce County fire departments and districts and private ambulance companies will provide emergency medical services. The DMCC will direct and coordinate these services for pre-hospital patient distribution. All Pierce County EMS agencies will respond to the emergency or disaster to establish field triage areas, direct triage and START (Simple Triage and Rapid Transport) procedures, and initiate communications with the designated DMCC as outlined in the Pierce County Fire Chiefs Mass Casualty Incident Plan. 2. The Metropolitan Medical Response System (MMRS) assets will supplement field operations resources during emergencies or disasters when indicated. The field incident commander (IC) can declare a mass casualty incident (MCI) and request MMRS from Tacoma Communications Center. The IC will notify DMCC of the MCI. (MMRS capacity is 100 casualties or more. These resources are contained in a 36 foot trailer.) 3. Ground ambulance transportation may be supplemented by air ambulance transportation when indicated and as resources allow. Pierce Transit or other private transportation agencies may supplement the transport of designated patients resulting from a mass casualty incident V. RESPONSIBILITIES A. Disaster Medical Control Center 1. Assign a management or supervisory person and designated alternates to provide countywide hospital coordination in the event of a mass casualty incident or a disaster. 2. Provide initial alert notifications utilizing county/regional alerting tools. 3. Conduct initial and ongoing bed counts in the event of an MCI, and work with EMS and hospitals to coordinate placement of multiple patients to appropriate health care facilities 4. Coordinate activities with the FCC during National Disaster Medical System (NDMS) activations. B. City Emergency Management Departments 1. Coordinate Emergency Medical Services with the PC EMS office within its jurisdictional boundaries 2. Coordinate multi-organizational/agency response within city jurisdictions. ESF 8: Health and Medical/October 2010 8 of 13
3. Provide logistics support. 4. Disseminate public information C. Pierce County Department of Emergency Management 1. Coordinate emergency medical services outside the cities with stand-alone emergency management departments. 2. Coordinate activities involving the Pierce County Medical Examiner s Office. 3. Coordinate multi-organization/agency response within county and outside city jurisdictions with emergency management departments. 4. Provide logistics support. 5. Open Joint Information Center. D. The Pierce County Medical Examiner 1. Identification, documentation and disposition of human remains. 2. Designate temporary morgues if the normally established morgues are overwhelmed and coordinate with local funeral directors to identify staff to support these temporary morgues. 3. Notify local agencies of the locations of morgues and coordinate transportation of the deceased to these sites. 4. Coordinate operations with the Washington State Patrol Latent Print and Missing Persons Units, area funeral directors, Federal Disaster Mortuary Response Team (DMORT), the Washington State Dental Association, and other associated agencies and organizations. 5. Process internal damage assessments to determine ready status and relay the information to the PC EOC. E. Pierce County Mortuary Service Providers Provide services as requested by the Pierce County Medical Examiner s Office. F. Hospitals/Hospital Systems 1. Activate emergency management plans as necessary to support medical care. 2. Coordinate medical care through Public Health Area Command to include any incident with potential impact to the health and medical systems in Pierce County. 3. Provide liaison to the PC EOC/Public Health Area Command when requested. 4. Perform patient triage and expedite patient treatment and care. 5. Notify the Public Health Duty Officer of any incident that has the potential to impact medical care delivery. 6. Provide surge capacity through activation of emergency plans/procedures to include: cohorting patients, early discharge, and cancellation of elective procedures, and alternate care facilities. 7. Coordinate with the Public Health Area Command, city emergency management and the PC EOC. 8. Provide a safe environment, which includes decontamination, safe ingress and egress (facility lockdown), having adequate supplies and resources, coordination of care and resources through other hospital systems and medical community, and the protection of staff. ESF 8: Health and Medical/October 2010 9 of 13
9. Conduct an internal damage assessment of facilities and determine the status of patients and personnel, communications capabilities, utilities and other essential resources. Relay this information to the Public Health Duty Officer and the PC EOC for damage assessment declaration. 10. Forward non-medical requests to the appropriate city/county EOC. 11. Conduct decontamination of patients prior to the delivery of medical care when required. G. Long Term Care Providers 1. Activate command centers to coordinate system medical care. 2. Provide surge capacity through activation of emergency plans/procedures to include: cohorting patients; relieve hospital surge overflow, and alternate care facilities. 3. Coordinate with the Public Health Area Command, city emergency management and the PC EOC. H. Medical Reserve Corps 1. Provide qualified emergency workers to supplement medical capabilities to include physicians, nurses, and other technical medically qualified personnel. 2. Provide qualified emergency workers to supplement non-medical staff focused on medical coordination and support. I. Pierce County Medical Society 1. Assist in the procurement of physician services. 2. Provide information to member physicians on current emergency response policy and procedures. 3. Coordinate with the Public Health Area Command. J. Washington State Dental Association 1. Identify Forensic dentists who may assist with the identification of the deceased using dental records. 2. Provide information to member Forensic dentists on current emergency response policy and procedures. 3. Coordinate with Public Health Area Command. K. Palliative Care and Hospice Providers 1. Coordinate with the Public Health Area Command and provide specialized medical services as requested. 2. Conduct an internal damage assessment of facilities and determine the status of patients and personnel, communications capabilities, utilities and other essential resources. Relay this information to the Public Health Duty Officer and the PC EOC for damage assessment declaration. L. Public and Private Emergency Medical Service Agencies ESF 8: Health and Medical/October 2010 10 of 13
1. Coordinate with the Public Health Area Command and PC EOC to provide medical services as requested. 2. Conduct an internal damage assessment of facilities and determine the status of personnel, communications capabilities, utilities and other essential resources. Relay this information to the Public Health Duty Officer and the PC EOC for damage assessment declaration. 3. Request mutual aid when resources indicate. The EMS and fire liaisons in the PC EOC will consult with zone coordinators to determine the need for regional and state pre-hospital patient care resources. The Pierce County Fire Resource Plan, South Puget Sound Fire Defense Plan and the Washington State Fire Services Resource Mobilization Plan will be implemented when indicated. M. Mental Health Providers 1. Coordinate with Public Health Area Command and provide specialized medical services as requested. 2. Conduct an internal damage assessment of facilities and determine the status of patients and personnel, communications capabilities, utilities and other essential resources. Relay this information to the Public Health Duty Officer and the PC EOC for damage assessment declaration. N. Law Enforcement Agencies 1. Provide security and crowd control at area hospitals and medical clinics, point of distribution (POD) locations, and alternate care facilities as resources allow. 2. Transport laboratory specimens or samples to appropriate lab for analysis, if requested. 3. Enforce community containment measure restrictions as identified by the TPCHD Health Officer. 4. Provide crowd and traffic control at law enforcement and crime scene investigations. 5. Function as incident command for law enforcement-lead agency incidents. 6. Provide security at temporary morgue sites as resources allow. 7. Assist in the contacting and transporting of critical hospital personnel when requested and as resources allow. 8. Notify the Public Health Duty Officer of any incident with the potential for impacting public health and/or medical systems in Pierce County. O. Pierce County Chaplaincy Program 1. Provide and coordinate on-scene defusing and support to emergency workers. 2. Screen and coordinate outside agencies or persons offering to assist w/stress management. 3. Assist relatives and friends in relieving emotions; encouraging expression of their feelings. 4. Provide support and comfort; and encourage funeral planning. P. County Fire Districts/Municipal Fire Departments ESF 8: Health and Medical/October 2010 11 of 13
1. Decontaminate patients in the field before treatment and/or transport of disaster victims. Field decontamination may be needed for large numbers of victims. 2. Provide personnel to perform decontamination operations at local medical care facilities, if resources allow. 3. Notify the Medical Examiner of the existence and location of fatalities at the scene and will not move or remove any remains without medical examiner authorization (RCW 68.50.010). 4. Establish Incident Command for on-scene emergency operations; 5. Provide fire suppression and patient rescue activities at incident sites. 6. Provide a structure where medications can be distributed to first responder agencies using the Pierce County Fire Chiefs Point of Distribution (POD) plan. 7. Notify the Public Health Duty Officer of any incident with the potential for impacting public health and/or medical systems in Pierce County Q Public Safety Answering Points 1. Receive 9-1-1 calls and dispatch public safety resources. 2. Have policies and procedures in place for high incident response load (HIRL) anticipated during an emergency or disaster. R. Associated Ministries 1. Appoint an Emergency Coordinator who will be responsible for the establishment of the Associated Ministries Emergency Response Plan for Pierce County. 2. Facilitate coordination among the Pierce County congregations involved with Associated Ministries. 3. Maintain contact with the PC EOC on its progress, needs and assistance. S. American Red Cross 1. Establish and operate emergency shelters in accordance with public health standards and regulations; 2. Establish procedures whereby names of victims will be obtained for health and welfare communications by appropriate agencies and immediate family; 3. Assist disaster victims with replacement of personal medical supplies, glasses, dentures, hearing aids, wheelchairs, prosthesis, etc.; 4. Assist with the notification of next of kin at the request of the Medical Examiner; and 5. Provide EMS responders to assist at disaster sites, if available. T. Amateur Radio Medical Services Team 1. Provide radio communication support to hospitals and other health care facilities; and 2. Coordinate/collaborate with other amateur radio emergency communications teams at city, county and agency command centers. U. Washington State Department of Health 1. Provide assistance to Public Health Area Command in disease/suspicious substance identification through the State Public Health Laboratory; 2. Coordinate response actions with other local health jurisdictions ESF 8: Health and Medical/October 2010 12 of 13
3. Provide radiological monitoring, analysis, and assessment assistance and expertise. V. Washington State Department of Agriculture Provide agricultural oversight for safety of food crops and domestic animals. W. U. S. Department of Health and Human Services 1. Provide support to the Public Health Area Command as requested; and 2. Coordinate Federal response to a public health incident with ESF 8 Coordinator. REFERENCES TERMS AND DEFINITIONS Metropolitan Medical Response System Plan National Disaster Medical System Plan PC EMS/Medical/Health Emergency Communications Plan Pierce County EOC Plan Tacoma-Pierce County All-Hazards Plan Pierce County Fire Chiefs Mass Casualty Incident Plan Pierce County Joint Information Center Plan Pierce County Mass Fatality Plan Medical Program Director Patient Care Procedures Medical Program Director Patient Care Protocols See Appendices 1 and 2 VIII. ATTACHMENTS None ESF 8: Health and Medical/October 2010 13 of 13