Medical & Health Communications and Information Sharing Plan **DRAFT** Revised: 09/22/14
(leave blank) MEDICAL HEALTH COMMUNICATIONS PLAN (revised: 09/22/14) - Page 2 of 26
Table of Contents 1. Introduction... 6 2. Purpose... 9 3. Assumptions... 9 4. Responsibilities & Authorities... 11 a. OFFICE OF EMERGENCY SERVICES... 11 b. MEDICAL HEALTH OPERATIONAL AREA COORDINATOR (MHAOC)... 11 c. REGIONAL DISASTER MEDICAL HEATLH COORDINATOR (RDMHC)... 11 d. MOUNTAIN-VALLEY EMS AGENCY... 11 e. PUBLIC HEALTH DEPARTMENT... 12 5. Concepts of Operations... 14 a. OFFICE OF EMERGENCY SERVICES... 14 i. California State Warning Center... 14 ii. R.A.C.E.S.... 14 b. MHOAC... 14 i. Activation... 14 ii. Medical Health Situation Status Reporting... 15 iii. Medical Health Resource Requesting... 16 c. PUBLIC HEALTH COMMUNICATIONS... 16 i. Duty Officer... 16 ii. Public Health Risk Communications... 16 iii. CAHAN:... 17 iv. Health-Net Radios... 17 d. EMERGENCY MEDICAL SERVICES... 17 i. Mountain-Valley EMS Agency... 17 ii. EMS Radio System... 17 e. HOSPITAL COMMUNICATIONS... 18 i. EMRESOURCE (EMSYSTEMS)... 18 APPENDIX A: MEDICAL / HEALTH DOC... 20 APPENDIX B: OES... 21 APPENDIX C: EMS... 22 APPENDIX D: PUBLIC HEALTH... 23 APPENDIX E: MARK TWAIN MEDICAL CENTER... 24 APPENDIX F: SONORA REGIONAL MEDICAL CENTER... 25 MEDICAL HEALTH COMMUNICATIONS PLAN (revised: 09/22/14) - Page 3 of 26
APPENDIX G: MARK TWAIN CONVALESCENT HOSPITAL... 26 MEDICAL HEALTH COMMUNICATIONS PLAN (revised: 09/22/14) - Page 4 of 26
INTRODUCTION
1. Introduction Sharing information with horizontal and vertical response partners supports situational awareness and decision-making at all levels of emergency management. Timely communication of incident information, including impact to the Public Health and Medical System, current and anticipated resource needs, and the capacity to respond are essential to developing a common operating picture. This plan addresses how information flows within the Public Health and Medical System and between the Public Health and Medical System and emergency management when the system is affected beyond ordinary day-to-day activities. Three conditions are identified, along with triggers for transitioning from one operating condition to the next: o Day-to-Day Activities; o Unusual Events; and o Emergency System Activation. Day-to-Day Activities Information routinely flows between Public Health and Medical System participants, including but not limited to local health departments (LHDs), local environmental health departments (EHDs), local emergency medical services agencies (LEMSAs), health care facilities and State and federal agencies in accordance with statutory and regulatory requirements. When an operational problem occurs in the course of ordinary day-to-day activities, relevant information should be reported to the appropriate local and State agencies in accordance with statutory and regulatory requirements and local policies and procedures. Unusual Events Beyond ordinary day-to-day activities, unusual events may occur that do not rise to the level of an emergency but warrant enhanced situational awareness and notification of partners. An unusual event may be self-limiting or a precursor to emergency system activation. An unusual event is defined as an incident that significantly impacts or threatens public health, environmental health or medical services. The triggers that prompt transition from routine, day-to-day information flow to enhanced information sharing associated with unusual events include: o The incident significantly impacts or is anticipated to impact public health or safety; o The incident disrupts or is anticipated to disrupt the Public Health and Medical System; o Resources are needed or anticipated to be needed beyond the capabilities of the Operational Area, including those resources available through existing agreements (day-to-day agreements, memoranda of understanding, or other emergency assistance agreements); o The incident produces media attention or is politically sensitive; o The incident leads to a Regional or State request for information; and/or o Whenever increased information flow from the Operational Area to the State will assist in the management or mitigation of the incident s impact. Emergency System Activation For the purpose of this plan, emergency system activation occurs when an incident leads to activation of Department Operations Centers (DOCs) and/or Emergency Operation Centers
(EOCs). Emergency system activation should trigger an enhanced level of information sharing to support the needs of the incident. Particularly during a large-scale disaster that triggers the activation of multiple DOCs and EOCs, the need for accurate and reliable information grows significantly. MEDICAL HEALTH COMMUNICATIONS PLAN (revised: 09/22/14) - Page 7 of 26
PURPOSE & ASSUMPTIONS
2. Purpose The purpose of this plan is to provide an overview of the medical and health communications systems in Calaveras County, including redundancies and back-up communications systems needed for day-to-day coordination of the healthcare system, as well as systems used during an unusual event or emergency system activation affecting the local healthcare system. In addition to providing an overview of the communications systems, this plan will address the information sharing plans for situation status reporting within the healthcare system, as well as the resource ordering path for medical and health resources. 3. Assumptions The healthcare system has reliable and redundant communications systems. The Incident Command System (ICS) is used by all agencies to ensure consistent and effective communications between the different groups and organizations that will be supporting the response to any emergency incident. Accurate and up-to-date contact information is maintained by all agencies to facilitate a quick response to any emergency. Information sharing during an unusual event or emergency system activation will follow the California Public Health and Medical Emergency Operations Plan, as well as procedures outlined in this plan.
RESPONSIBLITIES & AUTHORITIES
4. Responsibilities & Authorities a. OFFICE OF EMERGENCY SERVICES The County Office of Emergency Services (OES) is the lead County agency responsible for the coordination of large scale emergency incidents. Among the planning and incident management actions of OES are: Manage the County's Emergency Operations Center (EOC) Coordinate centralized press releases Liaison with state, federal, and local agencies Development and on-going use of several emergency management preplans, including: o Emergency Operations Plan (EOP) - This multi-hazard functional plan outlines the functions, responsibilities, and regional risk assessments of Calaveras County for large scale emergencies. o RACES Plan - The Calaveras County Radio Amateur Civil Emergency Services (RACES) Plan provides authority for the participation of amateur radio operators providing essential communications during periods of natural, state or local emergency. RACES operations are in accordance with FCC rules and regulations. b. MEDICAL HEALTH OPERATIONAL AREA COORDINATOR (MHAOC) The MHOAC Program as described in Health and Safety Code 1797.153 is responsible to: Plan for the provision of medical and health mutual aid within the operational area, Assist the OES coordinator in the coordination of medical and health disaster resources within the operational area. Act as the 24-hour point of contact for coordination with the RDMHC/S, the State Department of Public Health, and the State EMS Authority. Provide medical-health situation status reports to County OES, regional and state agencies during an unusual event, emergency system activation, or upon request of the state. c. REGIONAL DISASTER MEDICAL HEATLH COORDINATOR (RDMHC) The RDMHC is an appointed position in each of the six Mutual Aid Regions established by Health and Safety Code 1797.152. The RDMHC coordinates disaster information and medical and health mutual aid and assistance within the Mutual Aid Region or in support of other affected Mutual Aid Regions. d. MOUNTAIN-VALLEY EMS AGENCY Mountain-Valley EMS Agency (MVEMSA) as the local EMS agency is responsible to: Coordinate and direct the EMS system in the county. Establish policies and procedures approved by the medical director of the local EMS agency to assure medical control of the EMS system. In collaboration with the Public Health Officer, act as the MHOAC. Provide 24/7/365 Duty Officer coverage for the MHOAC Program.
e. PUBLIC HEALTH DEPARTMENT The Calaveras County Public Health Department is responsible to: Support the medical/health incident response at the field and operational area (OA) level. Develop and maintain the medical and health emergency operations plan. Detect public health threats. Disseminate accurate and timely health threat information and protective measures. Notify and alert participants in public health emergency response. Provide accurate and relevant public health and medical information to clinicians and other responders. MEDICAL HEALTH COMMUNICATIONS PLAN (revised: 09/22/14) - Page 12 of 26
CONCEPTS OF OPERATIONS
5. Concepts of Operations a. OFFICE OF EMERGENCY SERVICES The County Office of Emergency Services (OES) is the lead County agency responsible for the coordination of large scale emergency incidents. i. California State Warning Center The California State Warning Center (CSWC) monitors events occurring within California and is the official point-of-contact for emergency notifications received from the National Warning System. The CDPH and/or EMSA Duty Officer Programs routinely receive notifications from the CSWC concerning incidents that may have implications for public health, environmental health, and emergency medical services. In the event of a hazardous material release or oil spill, the CSWC notifies LHDs/EHDs directly through a HazMat Spill Report in addition to the CDPH and EMSA Duty Officer Programs. ii. R.A.C.E.S. The Calaveras County Radio Amateur Civil Emergency Services (RACES) Plan provides authority for the participation of amateur radio operators providing essential communications during periods of natural, state or local emergency. RACES operations are in accordance with FCC rules and regulations. b. MHOAC The Medical Health Operational Area Coordinator (MHOAC) Program is a shared function between the Mountain-Valley EMS Agency (MVEMSA) and Calaveras County Public Health Department. MVEMSA has agreed to provide the 24/7 Duty Officer function for the MHOAC Program, including all initial Medical/Health Situation Status Reporting and Medical/Health Resource Requesting on behalf of the county. Should an incident warrant the activation of the Calaveras Medical Health Departmental Operations Center (DOC), the MHOAC function would be transitioned to the DOC for coordination of all incident-related medical and health communications and resource support. i. Activation Triggers for Notification or Activation of the MHOAC, include: Incident significantly impacts or is anticipated to impact public health or safety; Incident disrupts or is anticipated to disrupt the Public Health and Medical Systems; Resources are needed or anticipated to be needed beyond the capabilities of the Operational Area, including those resources available through existing agreements; Incident produces media attention or is politically sensitive; 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.
Any agency that is impacted by an event or situation that triggers notification/activation of the MHOAC shall contact the EMS Duty Officer at 1-800-945-2273 or Authorized Dispatch Center. ii. Medical Health Situation Status Reporting The MHOAC Program is the principal point-of-contact within the Operational Area for information related to the public health and medical impact of an unusual event or emergency. It is expected that the MHOAC Program will assess local healthcare providers and prepare the Medical and Health Situation Report for the Operational Area. The Medical and Health Situation Report is shared with relevant partners representing the Public Health and Medical System, including the RDMHC Program, CDPH and/or EMSA Duty Officer Programs, and local, regional and State emergency management agencies at all SEMS levels so that relevant medical and health information can be incorporated into more comprehensive situation reports. Minimum Data Elements for the Medical Health Situation Status Report Initial Report Type Update Final Advisory: No Action Required Report Status Alert: Action Required Date Report Creation Date/Time Time Operational Area Incident Time Mutual Aid Region Incident Location Incident Information Incident Name Estimated Population Affected Incident Date Public Health and Medical Incident Level Name Agency Report Creator Information Position Telephone, Cell, Pager, Email, etc. Initial Report Type Update Final The Public Health and Medical System is in usual day-to-day status. GREEN Situation resolved; no assistance is required. The Public Health and Medical System is managing the incident using YELLOW Current Condition of the Public Health and Medical System Prognosis ORANGE RED BLACK GREY No Change Improving Worsening local resources or existing agreements. No assistance is required. The Public Health and Medical System requires assistance from within the local jurisdiction/operational Area. The Public Health and Medical System requires assistance from outside the local jurisdiction/operational Area. The Public Health and Medical System requires significant assistance from outside the local jurisdiction/operational Area. UNKNOWN MEDICAL HEALTH COMMUNICATIONS PLAN (revised: 09/22/14) - Page 15 of 26
iii. Medical Health Resource Requesting Each of the participants in the Public Health and Medical System within an Operational Area should understand the process used to request resources during emergencies. Familiarization with this process will expedite the mobilization and delivery of available resources. The resource requesting process should always follow the progression outlined by SEMS; e.g., a local government would not submit a request directly to the federal level. Within the Operational Area, the MHOAC Program coordinates public health and medical information and resources during emergencies; within the Mutual Aid Region, the Regional Disaster Medical and Health Coordination (RDMHC) Program coordinates public health and medical information and resources during emergencies. These jurisdictional agencies and functional coordination programs interact with State agencies including CDPH, EMSA and DHCS to provide critical resources, technical expertise and information coordination during emergencies. The Public Health Department has developed a local Medical and Health Resource Request form, based upon the minimum data set developed by the state (see DOC Manual). Prior to submitting a request for resources, the requesting agency must ensure that: The resource need is immediate and significant (or anticipated to be so) The supply of the requested resource has been exhausted, or exhaustion is imminent The resource or an acceptable alternative is unavailable from internal, corporate supply chain, other commercial vendor, or existing agreements. Relevant payment/reimbursement issues have been addressed. c. PUBLIC HEALTH COMMUNICATIONS i. Duty Officer After hours callers are referred by the PHD s standard voice message to contact Sheriff s Dispatch for a public health emergency. Dispatch contacts the Public Health Duty Officer. The Public Health Duty Officer is responsible for returning the call within 15 minutes of receiving contact information, or as soon as practical if en-route. Alternate coverage for the County Health Officer is arranged with neighboring jurisdictions (El Dorado and Amador) as needed to ensure 24/7 Health Officer availability. ii. Public Health Risk Communications The PHD will need to rapidly develop expanded incoming phone capacity, including telephone hotlines, for responding to public calls. Based on federal standards, the PHD could require phone capacity to handle approximately 445 calls simultaneously. The current expanded call plan will establish additional incoming phone lines in the Sequoia Room at the Calworks Building in San Andreas. MEDICAL HEALTH COMMUNICATIONS PLAN (revised: 09/22/14) - Page 16 of 26
Refer to the Communications Procedure in the DOC for more detailed information on communications policies and procedures, equipment inventories, and operating instructions for communications equipment. Refer to Hotline Procedure in the Crisis and Emergency Risk Communication Plan for process to expand incoming phone capacity. iii. CAHAN: The California Health Alert Network (CAHAN) is a secure, web-based communication and information system available on a 24 hour-per-day, 365 day-per-year basis for distribution of health alerts, dissemination of guidance documents, coordination of disease investigation efforts, preparedness planning, and other activities that strengthen State and local emergency preparedness and response. CDPH administers CAHAN to facilitate alerting and collaboration between State agencies and programs, federal agencies, LHDs, EHDs, LEMSAs, hospitals, community clinics, long term care facilities, Indian Health entities and other Public Health and Medical System partners. Primary CAHAN functions include alerting via multiple communication methods (pager, email, fax, land line and cellular telephone); a role-based directory that allows communication between specific groups; and the ability to share information in a collaborative environment. The Calaveras County Public Health Department s CAHAN Coordinator is responsible for maintaining the lists and contact information for local healthcare representatives within the CAHAN system. iv. Health-Net Radios When the radios are alerted by the Public Health Department master base station all facilities can communicate on the same system. In the event of a system failure of the EMS radios all county-based ambulances can communicate with the emergency department via the HealthNet radio system. d. EMERGENCY MEDICAL SERVICES i. Mountain-Valley EMS Agency Mountain-Valley EMS Agency maintains a 24-hour Duty Officer responsible for ii. EMS Radio System MEDICAL HEALTH COMMUNICATIONS PLAN (revised: 09/22/14) - Page 17 of 26
e. HOSPITAL COMMUNICATIONS i. EMRESOURCE (EMSYSTEMS) EMResource is a Communications and Resource Management system that streamlines communications between emergency managers and healthcare providers by monitoring healthcare assets, and emergency department capacities throughout the region; this webbased system facilitates NDMS and HAvBED reporting and broadcasting. Additional incident-specific resources can easily be tracked, such as decontamination capability, ventilators, pharmaceuticals, and specialty services. Because EMResource was designed by clinicians for clinicians, this system equips all those involved in emergency medical response with essential real-time communication tools. When the application is used 24/7 in all regional emergency departments, emergency medical services facilities, and dispatch centers, it becomes a highly effective mode of communication. ii. X-Matters X-Matters is a web-based mass notification system maintained by the Dignity Health System Office. It is customizable at each Dignity Health facility to create tiered notification levels based on event specific information, risk notification, or general employee information. Target groups can be created by facility administrators for specific alerts such as Triage Alert, Stroke Team Alert, or Patient Decon. Team Alert. Each employee creates a personal profile listing the sequence, priority, and devices they wish to notified on. iii. Handheld Radio Cache Mark Twain Medical Center maintains a 15-radio cache of handheld radios to deploy throughout the hospital in the event of normal system failure. Additionally, the disaster preparedness department has access to additional radios to communicate directly with EMS dispatch, SO dispatch, and fire-based resources. iv. Satellite Phone MEDICAL HEALTH COMMUNICATIONS PLAN (revised: 09/22/14) - Page 18 of 26
APPENDICES MEDICAL HEALTH COMMUNICATIONS PLAN (revised: 09/22/14) - Page 19 of 26
APPENDIX A: MEDICAL / HEALTH DOC Communication Links Routine Communication Devices Alternate Communication Devices DOC to Mountain Valley Emergency Medical Services Agency (MVEMSA) DOC DOC to EOC DOC to SNS Receiving, Storage and Staging (RSS) Warehouse DOC to Points of Distribution (PODS) Telephone Cell phone Fax machine Web-based email Telephone Cell phone Fax machine Web-based email Telephone Cell phone Web-based email Telephone Cell phone Web-based email SNS to Delivery Vehicles and POD sites Telephone Cell phone DOC to Alternate Care Site DOC to California Department of Public Health (CDPH) (CD control, labs, EPO) Telephone Cell phone Web-based email Telephone Cell phone Videoconferencing Web-based email RACES system VHF Radio (HealthNet System) RACES system VHF Radio (HealthNet System) RACES system VHF Radio (HealthNet System) Field Radio (possible) Fax machine (possible) RACES system VHF Radio (HealthNet System) Field Radio (possible) Fax machine (possible) RACES system Field Radio (possible) Fax machine (possible) RACES system VHF Radio (HealthNet System) Field Radio (possible) Fax machine (possible) RACES based internet email system DOC to local Medical/Health Providers Telephone Cell phone Fax Fax broadcast California Health Alert Network (CAHAN) RACES system Field Radio (possible) VHF Radio (HealthNet System)
APPENDIX B: OES Information Sharing Protocol Routine Communication Devices Alternate Communication Devices MEDICAL HEALTH COMMUNICATIONS PLAN (revised: 09/22/14) - Page 21 of 26
APPENDIX C: EMS Information Sharing Protocol Routine Communication Devices Alternate Communication Devices MEDICAL HEALTH COMMUNICATIONS PLAN (revised: 09/22/14) - Page 22 of 26
APPENDIX D: PUBLIC HEALTH Information Sharing Protocol Internal staff alert / coordination / call-back On-site coordination Health Alerts to Providers Health Alerts to Public Coordination with local healthcare providers Coordination with OES Routine Communication Devices Alternate Communication Devices MEDICAL HEALTH COMMUNICATIONS PLAN (revised: 09/22/14) - Page 23 of 26
APPENDIX E: MARK TWAIN MEDICAL CENTER Information Sharing Protocol Routine Communication Devices Alternate Communication Devices Hospital-to-hospital Coordination (patient transfer, consults, etc.) MCI Patient Bed (ER) Assessment / Patient Distribution (local, regional) Field (ambulance) to hospital communications MHOAC (LEMSA/PHD) Notification /Information Sharing Coordination with Satellite / Outpatient facilities Internal Coordination / Staff Communications IP phones, VPN e-mail, and fax machines EMResource IP phones EMS Radios IP phones IP phones, VPN e-mail, and fax machines IP phones, VPN e-mail, and fax machines VPN E-mail system X-Matters mass notification system Satellite Phone EMS radios HAM radio Satellite Phone Health Net Radio System HAM Radio Satellite Phone Health Net Radio System Satellite Phone HAM radio Health Net Radio Satellite Phone HAM radio Health Net Radio 15-radio cache to handheld radios MEDICAL HEALTH COMMUNICATIONS PLAN (revised: 09/22/14) - Page 24 of 26
APPENDIX F: SONORA REGIONAL MEDICAL CENTER Information Sharing Protocol Hospital-to-hospital Coordination (patient transfer, consults, etc.) MCI Patient Bed (ER) Assessment / Patient Distribution (local, regional) Field (ambulance) to hospital communications MHOAC (LEMSA/PHD) Notification /Information Sharing Coordination with Satellite / Outpatient facilities Internal Coordination / Staff Communications Routine Communication Devices Telephone Fax E-mail EMSystems/EMResource Telephone UHF local med net (ER)radio/telephone CAHAN Telephone Fax Telephone Fax Alternate Communication Devices Satellite phone HAM Radio (ER) Satellite phone HAM Radio (ER) HAM Radio (ER) Tiger text Satellite phone HAM Radio (ER) In Development MEDICAL HEALTH COMMUNICATIONS PLAN (revised: 09/22/14) - Page 25 of 26
APPENDIX G: MARK TWAIN CONVALESCENT HOSPITAL Information Sharing Protocol Staff alert / coordination / call-back On-site coordination Coordination with local healthcare providers Coordination with MHOAC Coordination with Patient Families Routine Communication Devices Alternate Communication Devices MEDICAL HEALTH COMMUNICATIONS PLAN (revised: 09/22/14) - Page 26 of 26