Montana’s Central Regional Healthcare Coalition€¦ · might impact Montana’s communities, strengthening our health and emergency response systems, and enhancing our nation’s

Montana’s Central Regional

Healthcare Coalition

Emergency Preparedness Framework

July 2018

Version 3

Central Region HCC Preparedness Plan J u l y 2 0 1 8 V 3 P a g e 2 | 49

Promulgation

The Central RHCC Executive Committee declares this Central RHCC Preparedness Plan to be in force and

effective until superseded or rescinded and provides full authority to healthcare agencies and organizations

within the Coalition to effectively plan for coordinated response to disaster occurrences within the Central

Region of Montana.

Record of Change

Date Description of Change Initials

May 2018 Modified all language from 3 Regions into 4 regions and updated training

and exercise dates DM


Record of Distribution

Date Receiving Partner Agency/ Organization

July CAT Upload for ASPR

July Distributed on listserv to all members


Table of Contents

Promulgation ........................................................................................................................................................ 2

Record of Change .................................................................................................................................................. 2

Record of Distribution ........................................................................................................................................... 3

Section I: Purpose, Scope, and Assumptions ...................................................................................................... 5

Purpose ............................................................................................................................................................. 5

Scope ................................................................................................................................................................. 5

Situation ............................................................................................................................................................ 5

Assumptions ...................................................................................................................................................... 6

Section II: Concept of Operations ....................................................................................................................... 6

Activation .......................................................................................................................................................... 6

Healthcare Coalition Risks and Vulnerabilities ................................................................................................. 6

Functional Need and Vulnerable Populations .............................................................................................. 7

Operational Functions....................................................................................................................................... 7

Preparedness Capabilities ............................................................................................................................. 7

Preparedness Response Plans....................................................................................................................... 8

Section III: Roles & Responsibilities .................................................................................................................... 8

Section IV: Maintenance ..................................................................................................................................... 8

Exercises ........................................................................................................................................................ 9

Central Healthcare Coalition Executive Committee

Contributive Reviewers

Luke Fortune, M. Ed., Public Health Emergency Preparedness Planning Lead

Bryan Tavary, Healthcare Preparedness Program Healthcare Coalition Coordinator

Don McGiboney, Healthcare Preparedness Program Manager

Matt Matich, Public Health Emergency Preparedness Medical Countermeasures Coordinator

Margaret Souza, Public Health Emergency Preparedness Training Lead

Cynthia Grubb, Central Region Healthcare Coalition chair

Jason Mahoney, South Region Healthcare Coalition chair

Jennifer Phillips, West Region Healthcare Coalition chair


Section I: Purpose, Scope, and Assumptions

Purpose This Emergency Preparedness Plan is a strategic level plan intended to set the framework for operational and

tactical response roles and activities in disaster and emergency situations. Strategic emergency

preparedness sets policy objectives, establishes planning priorities, and provides overall guidance for

organizations.

This is a provisional planning document for the Central Regional Healthcare Coalition (RHCC). Its intent is to

meet the emergency preparedness requirements put forth by the Montana Department of Public Health and

Human Services (DPHHS) as an agent of the 2017-2022 Hospital Preparedness Program – Public Health

Emergency Preparedness Cooperative Agreement from the US Health and Human Service (HSS) Assistant

Secretary for Preparedness and Response (ASPR) Hospital Preparedness Program (HPP).

Scope The RHCC provides guidance and information to coordinate support for coalition members, local emergency

responders, tribal emergency responders, State agency partners, and volunteer organizations to address the

delivery of public health and medical services and programs to assist Montanans threatened by potential or

actual disasters.

This healthcare coalition, as a recipient of federal funding, is a dedicated partner to DPHHS in support of

Emergency Support Function 8: Public Health & Medical Services (ESF#8). This ESF is a responsibility assigned

to DPHHS by the 2016 Montana Emergency Response Framework (MERF), maintained and published by the

Montana Department of Emergency Services (DES).

This plan does not define or supplant any emergency operating procedures or responsibilities for any agency

or organization in the RHCC. It is not a tactical plan or field manual, nor does it provide Standard Operating

Procedures (SOP). Rather, it is a framework for organization and provides decision-making parameters to use

against unknown and unpredictable threats in an all-hazards planning approach. This plan intentionally does

not provide specific or qualitative thresholds for activation or demobilization of organizational structures or

processes described herein. Such determinations are situation dependent and left to incident management.

ESF#8 planning includes addressing medical needs associated with mental health, behavioral health, and

substance abuse considerations of incident victims and response workers. Services also cover the medical

needs of individuals classified as having access, functional, or special needs.

Situation Montana is vulnerable to several hazards that might need assistance from both State and non-governmental

organizations (NGO). These hazards include, but are not limited to, wildfires, earthquakes, floods, HazMat

incidents, communicable disease outbreak or other public health events, and severe weather. The 2015

Threat & Hazard Identification and Risk Assessment (THIRA), compiled by DES, outlines the breadth of

vulnerability to hazards endemic to Montana.

Victims of disasters or emergencies might encounter medical emergencies, face the spread of disease, or

require mental and behavioral support to survive. Transient individuals, such as tourists, travelers, students,

and the pre-disaster homeless, could be involved. Food and relief items could become scarce or


compromised. A disaster could also adversely affect persons considered at-risk or having functional needs,

including those with pre-existing disabilities, creating a need for medical care and public health support.

Assumptions For the purpose of designing responses in an all-hazard planning environment, this plan assumes the

following:

• A significant public health event can happen at any time and have the potential to impact several

healthcare organizations within the RHCC

• A healthcare related disaster or emergency that exceeds the response capacities of a local or tribal

organization will require broader assistance

• Not all healthcare organizations will have current emergency operation plans to share with the

coalition or with local emergency managers

• RHCC might be asked to provide leadership and coordination in carrying out emergency response

and recovery efforts in the areas of public health and medical issues

• City, county, and tribal emergency operation managers will need documents and resource lists that

describe the relevant medical resources in their jurisdictions (e.g. local nursing homes, hospitals,

quick response units, ambulance services, morgue locations, or mutual aid agreements for EMS and

public health needs)

• Disruption in communications and transportation might adversely affect availability of health

care services

Section II: Concept of Operations Tribal and local emergency managers provide initial responses to the needs of emergency and disaster

victims. When local resources and disaster coordination needs are exhausted, emergency managers will

request assistance from the State. Local authorities retain responsibility for all response and recovery

operations.

The RHCC will conduct ESF#8 coordination operations in concert with both local emergency management and

DPHHS. Coordination and resource assistance for tribal and local emergency management is on an as-able

basis.

Activation Preparedness is always active. This plan is implemented upon approval by the WHCC executive committee

and carried forth by each document created in its support. This includes any preparative implementation of

ESF #8 services for planning, mitigation, response, or recovery.

Healthcare Coalition Risks and Vulnerabilities The RHCC requires each facility within the coalition to conduct and maintain its own annual hazard

vulnerability analysis (HVA). Additionally, coalition members should participate in or conduct a gap analysis

to identify needs in preparation for disaster needs.

Collectively, the RHCC (at a regional level) will define, identify, and prioritize risks, in collaboration with

DPHHS using data from these and other existing assessments for health care readiness purposes. The


coalition can determine any resource needs and gaps, identify individuals who may require additional

assistance, highlight training and exercise needs, and develop strategies to address preparedness and

response priorities in the region.

Functional Need and Vulnerable Populations

The RHCC will work in its ESF #8 responsibilities with its coalition partners and DPHHS to coordinate timely

and appropriate support to individuals with functional or special needs resulting from a disaster. Functional

need populations are defined, for the purpose of ESF #8 response activities, as vulnerable or at-risk people

having functional health needs beyond their capability to maintain during an emergency.

Operational Functions The RHCC consults with its response partners and stakeholders to plan its operational functions for ESF#8

services. The coalition’s function in preparation for emergency and disaster response and recovery is to

provide technical and advisory support to local and tribal governments’ emergency and disaster related

health care planning needs. Planning takes an all-hazards approach in preparedness.

Preparedness Capabilities

This preparedness plan follows the 2017-2022 Health Care Preparedness and Response Capabilities

established by ASPR. The RHCC is dedicated to supporting preparations for disasters and emergencies that

might impact Montana’s communities, strengthening our health and emergency response systems, and

enhancing our nation’s health security. Preparedness planning strengthens the coalition’s health care

delivery system to save lives during emergencies and disaster events that exceed the day-to-day capacity and

capability of individual systems. The concept of operations for preparedness planning, therefore, must meet

the principles outlined in the following capabilities.

Capability 1 – Foundation for Health Care and Medical Readiness

The community’s health care organizations and other stakeholders—coordinated through a sustainable

HCC—have strong relationships, identify hazards and risks, and prioritize and address gaps through

planning, training, exercising, and managing resources.

Capability 2 – Health Care and Medical Response and Recovery Coordination

Health care organizations, the RHCC, and the DPHHS plan and collaborate to share and analyze

information, manage and share resources, and coordinate strategies to deliver medical care to all

populations during emergencies and planned events.

Capability 3 – Continuity of Health Care Service Delivery

Health care organizations, with support from the RHCC and DPHHS, provide uninterrupted and optimal

medical care to all populations in the face of damaged or disabled health care infrastructures. Health

care workers are well-trained, well-educated, and well-equipped to care for patients during emergencies.

Simultaneous response and recovery operations result in a return to normal or, ideally, improved

operations.

Capability 4 – Medical Surge

Health care organizations, including hospitals, EMS, and out-of-hospital providers deliver timely and

efficient care to their patients even when the demand for health care services exceeds available supply.

The RHCC, in collaboration with DPHHS, coordinates information and available resources for its members


to maintain conventional surge response. When an emergency overwhelms the coalition’s collective

resources, it supports the health care delivery system’s transition to contingency and crisis surge

response and promotes a timely return to conventional standards of care as soon as possible.

Preparedness Response Plans

The RHCC will develop response plans to support the four capabilities described above. The following is not a

comprehensive list of plans, nor is it inclusive of any of the necessary supporting planning documents.

• Risk Communications

• Resource Management

• Multi-Agency Incident Management & Coordination

• Communicable Disease/Pandemic Influenza

• Non-Pharmaceutical Intervention (NPI)

• Chemical, Biological, Radiological, Nuclear, Explosive (CBRNE)

• Medical Surge

• Tactical Communications

• Mass Casualty

• Incident Management

Section III: Roles & Responsibilities The RHCC’s member organizations must cooperate and collaborate in preparedness planning to sustain

community resilience. This collaborative planning is also essential for immediate and effective emergency

response. Preparedness planning efforts for the coalition must encompass the unique notification,

assistance, and support needs of access and functional needs populations, as well as those with behavioral

and mental issues. The WRHCC will assist member facilities in identifying National Incident Management

System (NIMS) components and planning considerations.

Agency capabilities are affected by available resources and the size and scope of the incident. As such,

support is “as able.”

Every community has multiple organizations responsible for contributing to preparedness activities.

Collaboration at the Local Emergency Planning Committee (LEPC) is an excellent step in the right direction.

Section IV: Maintenance The RHCC formally reviews all components of this preparedness plan on a five-year cycle. A preparedness

planning review group, convened by the executive committee offers advice and suggestions on appropriate

emergency planning and construction of the document. This process allows the coalition to determine if it

meets all essential factors, remains, applicable, and affords the opportunity to update and change the plan as

the coalition changes and grows.

Minor corrections, edits, updates, or adjustments in this document might occur on occasion without a formal

review. Changes may also take place as part of improvement plans from exercise after action reports. All

changes are tracked in a versioning method and in the Record of Change log.


Exercises

This plan or any of its components could be exercised separately or in conjunction with other exercises.

Exercises will be used under simulated, but realistic, conditions to validate policies and procedures for

responding to specific emergency situations and to identify deficiencies that need to be corrected. Personnel

participating in these exercises should be those who will make policy decisions or perform the operational

procedures during an actual event (i.e. critical personnel). Exercises are conducted under no-fault pretenses.

Appendices

1 The Healthcare Coalition (HCC)

2 The Regional HCC HVA

3 The Communications Plan

4 Information Sharing and Assistance

5 Template for Development of a facility closed Point of Dispensing (POD) Plan

6 CHEMPACK

7 Infectious Disease Outbreak Planning

8 Training

9 Exercising

10 Access and Functional Needs (AFN) Planning and emPOWER

Central Region HCC Preparedness Plan J u l y 2 0 1 8 V 3 P a g e 10 |

49

Appendix 1

The Healthcare Coalition

The HCC is described in detailed within the By-Laws. The HCC interacts at all levels as the Emergency

Support Function (ESF8).

Composition

At a minimum; 2 hospitals, Emergency Medical Services (EMS), emergency management organizations,

and public health agencies must be represented within each HCC.

Additional representation from the following is encouraged:

Assisted Living Facility Primary Care Specialists Behavioral and Mental Health

Nursing Home End Stage Renal Home Health

Skilled Nursing Facility Rural Health Center Hospice

Outpatient Surgical Community Health Center Academic Facilities

Tribal Health VA Medical Facility DOD Health Facility

Therapy Centers Foster Homes

Regional Boundary

The Regional HCCs in Montana are established utilizing the preexisting boundaries established primarily

by the trauma referral patterns for patient care as well as an attempt to equalize land mass.

Planning Considerations and gap analysis, Identification of Objectives

Major impact areas suggested by US Health and Human Services (HHS) Assistant Secretary for

Preparedness and Response (ASPR) funding opportunity.

Project Year 1701-01 and 1701SUPP establishes the following as initiatives or priorities for a

HCC to focus on: o Medical Surge


49

o Patient Transportation

o Evacuation Plans

o Coordinating Medical Resources

o Health Surveillance

o Information Sharing

o Building Situational Awareness

o Improved Alerting and Communication

o Bed Availability

o Patient Tracking

A regional Hazard Vulnerability Assessment (HVA) will accomplished. See HVA in appendix 2.

Gaps will be identified through utilization of the ASPR Capability Assessment Tool (CAT).

Executive Committee members are encouraged to include any topics relevant to the HCC.

Upon completion of the aforementioned, a strategy will be established for short-, mid-, and long-term

objectives to bridge gaps.

Short Mid Long

Establish Governance X

Establish Composition X X

Outreach to Partners X X X

Establish Plan drafts X X

Test Plans X X X

Expand RHCC Capability X X

Connect to ESF8 X X X

Broaden SA/EEI X

Establish Regional Capability X

Establish AFN Planning X X X

Expand CST X X

See Appendix 4 Information Sharing for Member Updates.

A Response Plan is in development for Project Year FY1701Supp (July 2018 to June 2019)


49

Information Sharing

See Appendix 4. The HCC establishes a common operating picture, or situational awareness, that

facilitates coordinated information sharing among all HCC stakeholders. This includes state, local, and

federal agencies and their respective preparedness programs.

Information sharing is the ability to share real-time information related to the emergency, such as

capacity, capability, and stress on health care facilities and situational awareness across the various

response organizations and levels of government. Accomplishing these activities will enable the health

care delivery systems, public health, emergency management, and other organizations that contribute to

responses to coordinate efforts before, during, and after emergencies; maintain situational awareness; and

effectively communicate with the public.

Each HCC must be able to access sand collect timely, relevant, and actionable information about their

members during emergencies.

Essential Elements of Information (EEI) are reported to the Montana Healthcare Preparedness Program

(HPP) within the Department of Health and Human Services (DPHHS) utilizing the electronic Hospital

Incident Command System Form 251 located at http://montanahics251.com

EOP

Member facilities will develop an Emergency Operations Plan describing procedures that staff will

undertake to respond and recover from all hazards. It should provide guidance describing purpose and

authority, situation and assumptions, Concept of Operations, Assignment of Roles and Responsibilities

including the Incident Command System (ICS), authority and references. As well as procedures to follow

during planned activities including Communications plans, Evacuation and Shelter in-Place, resources

and assistance, alternate care site, public information officer, specific threat plans, continuity of

operations, patient decontamination, to name a few.

Policies

Member facilities will develop emergency preparedness policy documents supporting the EOP. Examples

of policies include: Hazard Vulnerability Analysis (HVA), Use of NIMS, Staff Training, Exercises,

Evaluations, and Improvement Plans, Notification of Emergency or Impending Emergency, Emergency

Codes, Communications, Staff Call-Back, Notifying External Authorities, Resource Requests, The Media,

HIPPA and HIPAA, Strategic National Stockpile, Transporting Patient, Foodservice Emergency

Planning, Security, Legal Evidence and Chain of Custody, Labor Pool, Staff Health and Safety, Staff Rest

Periods, Family Care and Support During an Emergency, Evacuation/Shelter In-Place, Facility Role

during 1135 Waiver, Use of Volunteers, Credentialing/Privileging of Licensed Independent Providers

During Disasters, Contaminated Patients, Communication of Threats/Incidents, Mail Room Security,

Infection Prevention, Use of POD (Point of Dispensing), SNS, HAvBED

All-Hazards Planning

Healthcare facilities are accomplishing all-hazards planning activities to support the conditions of

participation for emergency preparedness provided by the Centers for Medicare and Medicaid Services

(CMS).

HVA

Member facilities will accomplish a Hazard Vulnerability Assessment (HVA). The preferred document is

http://montanahics251.com/


49

the Kaiser 5-point Excel Workbook. See Appendix 2.

National Incident Management System (NIMS)

Member facilities are encouraged to utilize the NIMS. Facilities received Federal money must utilize

NIMS.

Facilities should pre-identify roles and responsibilities and document this in their All-Hazards Emergency

Operations Plan (EOP).

Provide checklists outlining roles and responsibilities.

Progress will be collected annually by the Executive Committee.

Memorandum of Understanding (MOU) For Mutual Aid

A Montana Healthcare Mutual Aid System (MHMAS) Mutual Aid agreement, dated 2017 replaces te

previous version dated 2014, which was signed by all Montana hospital CEOs. This documented is

managed by the Montana Hospital Association (MHA) under contract through DPHHS. The update is

being distributed for signature by facility CEOs or Administrators.

This document is in revision status to accommodate the inclusion of any healthcare agency or

organization CEO or Administrator to sign.

Emergency Management Assistance Compact (EMAC) and Requests for Assistance

Requests for assistance begin at the local level within any State by the responding personnel to their

County Emergency Management office. If the County Emergency Management office cannot fulfill

the request for resources it is routed to the Montana Disaster and Emergency Services (DES) Office,

even from another State.

The DES Office will forward health and medical requests to MT DPHHS PHEP (HPP) Office for

fulfillment. MT DPHHS PHEP (HPP) Office will staff the request and either obtain the resources

from another Regional Healthcare Coalition facility or staff the request to ASPR or CDC Region 8. If

a request is not within the purview of the DPHHS PHEP (HPP) Office, the request is sent back to

DES for possible other agency EMAC coordination.

From time to time, requests for assistance from outside the state of Montana will be tasked. MT DES

is the office of primary responsibility for staffing and delegating these requests. MT DPHHS PHEP

(HPP) office will ask Montana facilities if they are able to fulfill and EMAC request. Results will be

provided to DES.


49

Appendix 2

The Regional HCC HVA

The RHCC annually collects member organization HVAs and averages the input to determine the

most likely risks and hazards.


49

Appendix 3

Communications Plan

DPHHS utilizes a Departmental Communications plan and is capable of creating telephone

and internet stand-alone ability. This resource is available to requesting facilities if their communications fail.

The limitation is that this resource is available to only one community at a time.

Healthcare Coalition facilities will utilize internal communications for their organization.

External to their organization is the local EOC and communications requests are routed through local

Emergency Management elements to the State Emergency Coordination Center (SECC).

Primary Communications

The primary communications are landline telephones and cellular telephones

Redundant Communications

Email, radios (700 mhz, 800 mhz, mutual aid frequencies, and HAM)

Emergency Communications

Runners will be used as a last resort for essential communications

Redundant communications will be test semi-annually.


49

Appendix 4

Information Sharing

The HPP Office will provide the following for sharing of information:

The CD Epi Weekly MMWR

PHEP Weely SitRep

The MT DES SitReps

The RHCC will make changes to their infrastructure status utilizing the internet for the following

applications:

HAvBED (montanahavbed.com)

HICS 251 (montanahics251.com)

Member Updates

The State of Montana mass alerting platform will be utilized to alert key staff of

relevant situations that might or will impact patient and resident safety.

Juvare, formerly Intermedix, is being developed for improving this capability. It will provide a

web-based platform for sharing many elements of needed information.

Central Region HCC Preparedness Plan J u l y 2 0 1 8 V 3

P a g e 17 | 49

Appendix 5

Template for development of a facility closed Point of Dispensing (POD) plan

(Provided by Riverstone Health)

PARTNER ORGANIZATION AND CONTACT INFORMATION

Confidential Information

Please coordinate with and return to your local Public Health office. In the event of an emergency

this will be the information that is utilized by Public Health to contact you.

ORGANIZATION

Name of Organization: ____________________________________________________

Street Address: _____________________________________________________

PO Box: _____________________________________________________

City: ______________________ State: __________ Zip: __________

Email: _____________________________________________________

Telephone: _____________________________________________________

Fax Number: _____________________________________________________

PRIMARY COORDINATOR

Name: _____________________________ Position/Title: ______________________

Work Phone: ____________________________ Home Phone: ___________________

Email: _____________________________ Cell/Pager: ________________


P a g e 18 | 49

FIRST BACKUP COORDINATOR

Name_________________________ Position/Title: _____________

Work Phone: _____________________________ Home Phone: _________________

Email: _____________________________ Cell/Pager: _____________________

SECOND BACKUP COORDINATOR

Name ___________________________ Position/Title: _______________

Work Phone: _____________________ Home Phone: _____________________

Email: ______________________________ Cell/Pager: _______________

POPULATION

Please complete and return to Public Health for planning purposes. Provide information about your

organization at FULL capacity.

Number of Employees: ___________________________

Number of Household Family Members of Employees*: __________________________

Number of Clients/Residents Served (if applicable): ___________________________

Total (of all groups listed above): _____________________________

*If not known, estimates of family members can be calculated by multiplying the number of employees and clients by 2.5 (average

number of persons per household)

Of the total above, please estimate the breakdown into the following age groups:

Adults aged 65+ Adults age 18 – 64 AND

children over 80 lbs

Children (under 18 AND

weigh less than 80 lbs)


P a g e 19 | 49

LANGUAGES

In the event of an emergency, disease and medication information forms will be provided when you

pick up the medication. If you need these to be in any language other than English, please specify

languages below.

1. ___________________________

2. ___________________________

3. ___________________________

FREQUENTLY ASKED QUESTIONS

What is the Strategic National Stockpile (SNS)?

The SNS is a national stash of medical supplies and treatment owned by the Centers for Disease

Control and Prevention (CDC). The SNS serves as a national supply of medications and medical

supplies for emergency situations.

What is the responsibility of the local health department?

The local health department is responsible for dispensing the medications in the SNS to the citizens

of this County within 48 hours of requesting the supplies.

What is a Point of Distribution (POD)?

A POD is a place where people get the medication that is sent in the SNS.

What is a Closed POD?

A Closed POD is a location that is operated by a private or public organization that dispenses

medication to a specific population which may include its employees, their families and clients. A

Closed POD is not open to the public.


P a g e 20 | 49

What are the benefits of a Closed POD?

A Closed POD helps businesses ensure that their employees are protected and therefore able to

continue working and/or return to work more quickly. The benefit to local health jurisdictions is

that it reduces the number of people seeking medication at the public PODs.

What are the requirements for becoming a Closed POD?

Organizations with a significant number of employees or organizations that serve vulnerable

populations are typically eligible to become Closed PODs. Public Health asks that you sign a

Memorandum of Agreement prior to becoming a Closed POD.

How much is it going to cost?

Medication and training is free of charge.

Will there by training provided?

Yes. Training and exercise opportunities occur throughout the year. While there are currently no

required trainings/exercises you will have the opportunity to participate in events as they arise.

When would we be asked to dispense medications at our own facility?

The only time Public Health would ask organizations to dispense medications would be if there is a

great risk to the entire population of the local health jurisdiction and the preventative medications are

needed to be taken immediately.

Who operates the Closed POD?

Your organization will operate the Closed POD with as much oversight from Public Health as

possible.

Are medical personnel required?

Yes, to become a Closed Pod, you will need to have at lCentral one medical personnel available to

screen patients.

Will people be allowed to pick up medications for their families?

Yes, individuals attending the POD will be encouraged to pick up medications for their families.

How will the medication be packaged?

The medication will be packaged for individual use and will be taken orally. Drug information sheets

will be provided with the medication.

Who needs to take the medication?

Assuming this is a major public health emergency the entire population of the local health

jurisdiction will need to take the medication.


P a g e 21 | 49

Is it possible that our organization will need to operate a Closed POD after-hours, during the

weekend, or on a holiday?

Yes, public health emergencies can occur at any time. It is essential that your organization be

prepared to operate a POD during non-working hours since health will be at risk if medications are

delayed.

Is this legal?

Yes, it is legal. Public health officials depend on volunteers to assist during an emergency.

Participating as a Closed POD is a voluntary program.

PREPARING A DISPENSING PLAN

In order to dispense medication to a large number of people a basic plan needs to be put in place.

This workbook is designed to walk you through these steps to put together as much pre-event

material as possible. As a map to help navigate this process, below is a checklist of major pre-event

and response activities that need to be accomplished for successfully dispensing medication.

CHECKLIST FOR CREATING THE DISPENSING PLAN:

Appoint a planning committee

Determine your dispensing population

Organize your dispensing staff

Identify dispensing location and design

Consider communications

Putting it all together

APPOINT A PLANNING COMMITTEE

A planning committee can think through this process and ensure the correct people are involved, and

ensure that they understand and accept their roles and responsibilities.

Consider the positions below as part of your planning committee. The below positions are meant as

a guide and you may add/delete positions based on your organizations structure.


P a g e 22 | 49

PRIMARY COORDINATOR

Name: _____________________________ Position/Title: ______________________

Work Phone: ____________________ Home Phone: ________________

Email: ___________________ Cell/Pager: ________________

FIRST BACKUP COORDINATOR

Name: __________________ Position/Title: ______________

Work Phone: _________________ Home Phone: ____________________

Email: ___________________ Cell/Pager: ____________________

SECOND BACKUP COORDINATOR

Name: __________________ Position/Title: ______________

Work Phone: _____________________ Home Phone: ________________

Email: ________________________ Cell/Pager: ____________________

HUMAN RESOURCES

Name: ____________________ Position/Title: _____________

Work Phone: ______________________ Home Phone: _____________

Email: __________________________ Cell/Pager: _______________


P a g e 23 | 49

LEGAL COUNSEL

Name: __________________________ Position/Title: ______________

Work Phone: ___________________ Home Phone: ____________

Email: _______________________ Cell/Pager: ____________________

MEDICAL ADVISOR

Name: _____________________ Position/Title: ___________________________

Work Phone: _______________________ Home Phone: ____________________

Email: __________________________ Cell/Pager: ____________________

BUSINESS CONTINUITY

Name: __________________________ Position/Title: ____________________

Work Phone: __________________________ Home Phone: ____________________

Email: __________________________ Cell/Pager: ____________________

PUBLIC HEALTH LIAISON

Name: _____________________ Position/Title: ___________________

Work Phone: __________________________ Home Phone: _____

Email: ______________________Cell/Pager: _________________

OTHER

Name: __________________________ Position/Title: ____________________

Work Phone: __________________________ Home Phone: ____________________

Email: __________________________ Cell/Pager: ____________________


P a g e 24 | 49

DISPENSING LOCATION

Determine the location you will dispense the medication. Consider the following items in choosing

your dispensing location:

• Large and open

• Can accommodate tables and chairs

• Can be rearranged to desired design

• Easily accessible

• Able to accommodate people with disabilities

• Separate entrance and exit (ideally)

• Has a place to store medications

PRIMARY DISPENSING LOCATION

Name of Location:___________________________________________________

Street Address: _____________________________________________________

PO Box: __________________________________________________________

City: _____________________ State: ________________ Zip: _______________

Email: __________________________________________________________

Telephone: ___________________________________________

Fax Number: ____________________________________________

ALTERNATE DISPENSING LOCATION

Name of Location:__________________________________

Street Address: __________________________________________________________

PO Box: __________________________________________________________

City: ______________________ State: ____________ Zip: _________

Email: __________________________________________________________

Telephone: ____________________________________________

Fax Number: __________________________________________________________


P a g e 25 | 49

FACILITY DESIGN & SUPPLIES

The design and layout of your POD will impact the amount of time it takes to serve your population.

Have an idea of your layout ahead of time and what you will need for the POD to work, so it is quick

and easy to setup. Below is a list of suggested supplies for each station of your POD:

• Enter – Sign

• Start – Sign, a table with at lCentral one chair, clip boards, pens, Medication History Forms.

• Registration – Sign, table and chair for each staff, pens, alcohol based hand sanitizer.

• Screening – Sign, table and chair for each staff, pens, alcohol based hand sanitizer, Medication Information Sheets.

• Treatment – Sign, medication, inventory sheet, container to keep collected forms, table and chair for each staff, alcohol based hand sanitizer.

• Support- Sign, pocket communicators, table and chair for each staff, medication information sheets for special populations.


The visual below is an example of a POD in an employee break room.

Design your floor plan to help ensure the maximum number of people receive medication.

A secure space should also be established to store excess medication.


P a g e 27 | 49

Example Sketch of Primary Dispensing Facility Design

support

EXIT

to

GYM

treatment

treatment

screening

screening

registration

registratio

n


P a g e 28 | 49

start


P a g e 29 | 49

Sketch Your Dispensing Facility Design


P a g e 30 | 49

DETERMINE POD ORGANIZATIONAL STRUCTURE

Determine the organizational structure for the Closed POD. If you have worked in the Incident

Command System (ICS), a Closed POD is part of the Operations Section of the public health

system. See HICS Form 207.

If you are unfamiliar with Incident Command, consider training. Contact Healthcare Coalition to

learn about training opportunities

DETERMINE STAFFING NEEDS

The number of staff/volunteers needed to support your POD depends on the size of your facility,

the floor plan, size of designated population and time allotted for dispensing operations. Review all

the information you have collected above and complete the following chart.

POD Job Position # Staff Required Per Shift*

POD Manager 2

Start 3

Registration 3

Screening 3

Treatment 4

Support 4

Security 4

Inventory 2

Employee Service 1

Facilities 1

*A POD operating for 24 hours would need to staff 2 12 hour shifts or 3 – 8 hours shifts. POD staff can include

employees, family members, volunteers, or other designated individuals.

Will probably take 3 shifts to complete.


P a g e 31 | 49

COMMUNICATIONS

BEFORE THE EVENT

Determine how you are going to communicate with staff to let them know that you are a location for

a Closed POD in the event of a public health emergency.

Consider including the following information in your communication:

• Key roles and responsibilities of staff in an emergency

• Volunteer requirements, duties, and training opportunities

• Define the designated population that may come to the POD

• Describe how medication will be dispensed

• Explain what information they should be prepared to provide

Consider the following communication methods you might use to disseminate this information

before the event:

• Employee letter

• Employee newsletter

• Telephone message or call

• Website posting

• Mass email

• Meeting/presentation

• Radio

• Visit to client’s home

Describe how you will communicate with employees before the event (i.e. computer, meetings, etc.):

Type of Communication Key Messaging Points Person Responsible


P a g e 32 | 49


P a g e 33 | 49

DURING THE EVENT

Determine how you are going to communicate during an event.

Consider communication with POD management staff and volunteers on the following messages:

• POD activation (when and where to report)

• Assigned duties and how to perform those tasks

Consider communication with people you anticipate to go through the POD:

• Where and when to receive medication

• What information they should have in order to receive medication

• Drug information sheets and frequently asked questions (this will be provided to you by Public Health)

• How to stay informed about the emergency

• Alternate work schedule instructions as appropriate

Consider the following communication methods you might use to disseminate this information

before the event:

• Employee letter

• Employee newsletter

• Telephone message or call

• Website posting

• Mass email

• Meeting/presentation

• Radio

• Visit to client’s home


P a g e 34 | 49

Describe how you will communicate with employees during the event:

Target Audience Type of

Communication

Key Messaging

Points

Person Responsible

POD management staff

POD volunteers

People going to POD

PUTTING IT ALL TOGETHER

Staffing

Use your staffing needs list to determine who will be called to the POD. Use predetermined

communications to activate POD staff and have them report to the POD location as soon as

possible. At minimum you should have one registration/forms staff, one screening staff who has a

medical background, and one treatment staff.

Set Up

Use your predetermined POD design to set up tables, chairs, and signs in the appropriate locations in

the POD. Make supplies available at each station. Secure a site to store excess medication.

Opening/Running the POD

POD flow is a simple process. Patients enter the POD, receive a Medical History Form, have that

form reviewed for accuracy, receive the proper instructions, receive their medication, then exit the

POD. Below is a diagram explaining the role of each POD staff and how it should function:


P a g e 35 | 49


P a g e 36 | 49

Other Jobs at the POD

• Security- It is important to keep the patients and staff safe at the POD. A person who is designated to keep the area safe and secure is an important asset to your POD.

• Employee Service- If your POD needs to stay open for a long period of time, staff will need breaks and meals. Someone should be responsible for the needs of staff who are working long hours.

• Inventory- An inventory staff member can keep track of how much medication you dispense, make sure that all dispensers have enough medication, and make sure that the POD isn't going to run out. Inventory can also keep track of Medical History Forms and make sure that all of them get sent to Public Health.

Demobilization

You probably want to get back to business as usual as soon as possible. Every available staff should

help in the tear down process, so the location can be cleanup and ready for work as soon as possible.

Public Health will assist in demobilization and collect excess medication, all Medical History Forms,

inventory sheets, signs, and other supplies.

Planning for improbable events may not always seem like a first priority, but events throughout history have shown us

that the time to be prepared is now. Once an event occurs, it's too late.

37 | P a g e

Appendix 6

Medical Materials Assets

(excerpt from DPHHS MCM Plan)

Medical Materials Assets

CHEMPACK Host Facilities

All phone numbers are 406 area code

Location & Cache Address Primary 24/7 Pharmacy Contact Alternate 24/7 Emergency

Contact

Billings Fire Dept.

Station #5 605 S. 24th Street

W.

Billings, 59102

(406) 657-3000 (Fire Dispatch)

Ask for On Duty HazMat

Battalion Chief

(406) 657-3000 (Fire

Dispatch)

Ask for On Duty HazMat

Battalion Chief CHEMPACK

Holy Rosary Hospital

2600 Wilson St

Miles City, 59301

(406) 233-2600

Ask for the pharmacist, or the

pharmacist on call

(406) 233-2600

Ask for Administrator

supervisor,

if not available Administrator

on-Call)

CHEMPACK

Frances Mahon

Deaconess Hospital 621 3rd St

Glasgow, 59230

(406) 228-3500 (Main Number)

Ask for Pharmacy

(406) 228-3500 (Main

Number)

Ask for Maintenance on Call CHEMPACK

Benefis Health Care 1101 26th St.

Central

Great Falls,59405

(406) 455-5430

Ask for Pharmacist in-Charge

(406) 455-5000

Ask for Security CHEMPACK

38 | P a g e

Kalispell Regional

Medical Center 310 Sunnyview

Lane

Kalispell, 59901

(406) 752-5111 (Main Number)

Ask to speak with Pharmacists in

Charge

(406) 752-5111

Ask for House Supervisor CHEMPACK

St. Patrick Hospital 500 W. Broadway

Missoula, 59806

(406) 329-0321

Ask for Pharmacist Lead

(406) 329-0321

Ask for Pharmacist CHEMPACK

St. Peters Hospital 2475 E. Broadway

Helena, 59601

(406) 444-2350

Ask to speak with Pharmacist on

Call

(406) 442-2480

Ask for Security Supervisor CHEMPACK

Bozeman Deaconess

Hospital 915 Highland

Blvd.

Bozeman, 59715

(406) 414-1050

Pharmacist on Duty

585-5000

Ask for House Supervisor CHEMPACK

39 | P a g e

ATTACHMENT 2: CHEMPACK

• DPHHS and CDC authorize breaking the CHEMPACK container seal and using the packaged products only when the competent authority, in coordination with an incident commander at the scene determines that an accidental or intentional nerve agent release and: ✓ the materiel is medically necessary to save lives ✓ is beyond local emergency medical response capabilities ✓ has put multiple lives at risk

• A competent requesting authority is defined as a public health, DES, hospital, EMS, or other medical professional or any organization identified and trained by the local public health jurisdiction.

• Accessing CHEMPACK assets should be initiated when a nerve agent release involving multiple victims is suspected. The transportation or use of CHEMPACK assets to the scene should not be delayed while waiting for a confirmation of an exposure.

• Opening a CHEMPACK container will result in the loss of that CHEMPACK asset for future use. There is no funding for restocking. The CHEMPACK is sustained through the CDC’s CHEMPACK sustainment program.

CHEMPACK Cache

Cache Owner Centers for Disease Control and Prevention

Cache Purpose Rapid provision of chemical nerve antidote

Authorized to Request Any hospital or appropriate jurisdictional authority

Request Channel Directly to host hospital

Intended Use Rapid treatment of multiple victims that are potentially exposed to large nerve agent

chemicals release

Target Population Individuals potentially exposed to nerve agent chemicals due to a chemical release

Transportation Preplanned and coordinated by requesting entity

Chain of Custody Chain of custody will be maintained and tracked - forms are with CHEMPACK Container

Patient Tracking All individuals receiving cache medications should be documented and tracked.

Reporting Requirements Report CHEMPACK activation as soon as reasonably possible to the DPHHS DOC

Charging/Billing Cache assets should not be charged to the patient/recipient

Restrictions The container may not be opened unless a public health emergency is perceived to exist and

is beyond the local capacity to respond

40 | P a g e

1 Some medications within the CHEMPACK do not provide a medication name on case the label. To confirm the medication the NDC number must

be checked.

CHEMPACK Contents*

EMS Configuration for up to 454 Casualties

Medication1 NDC # Unit Pack Cases QTY

Mark 1 auto-injector 6505-01-174-9919 240 5 1200

Atropine Sulfate 0.4mg/ml 20ml 63323-234-20 100 1 100

Pralidoxime 1gm inj 20ml 60977-141-01 276 1 276

Atropen 0.5 mg 11704-104-01 144 1 144

Atropen 1.0 mg 11704-105-01 144 1 144

Diazepam 5mg/ml auto-injector 6505-01-274-0951 150 2 300

Diazepam 5mg/ml vial, 10ml* 0409-3213-12 50 1 50

Sterile water for injection (SWFI) 20cc 0409-4887-20 100 2 200

ATTACHMENT 4: HPP PPE CACHE

The Cache is maintained and rotated by Kreisers INC, a medical equipment and supply company. The quantity

of the cache and manufactures the supplies may vary due as the cache is rotated through the system.

HPP PPE Cache

Cache Owner DPHHS, Hospital Preparedness Program

Cache Purpose

To provide rapid access to Personal Protective Equipment during a public health

emergency and hospital surge situations when normal supply channels are

inadequate

Authorized to Request Hospital authorized individuals

Request Channel Directly to Kreisers. Requests made to Kreisers should be reported to the DPHHS

DOC by the requesting organization

Intended Use Provision of PPE due to shortages during hospital surge events

Target Population Healthcare workers & first responders

Transportation Shipment will be made by Kreisers INC

Chain of Custody N/A

Patient Tracking N/A

Reporting Requirements Requests made to Kreisers and Cache PPE usage will be reported to the DPHHS

DOC by the requesting organization

Charging/Billing Cache assets are not to be charged to patients

Restrictions

RHCC Emergency Preparedness Framework January 2018 v.1 Page | 42

PPE Cache Contents

Respiratory Particulate Glove Exam Nitrile XLarge

Mask N95 Magic Arch 35/BX Gown Imperv Univ 30-54

Mask Isol. Yellow Gown Thumb Cape Reg Blue

Face Mask W/Ear loops Gown Thumb Cape Blue XL

Gloves Nitrile SM 10/200 Gown Imperv XL White

Gloves Nitrile MD 10/200 Gown Cover XL Xtraction

Glove Nitrile LG 10/200 Hand Saniti 2OZ Pump Btl

Glove Nitrile XLG 10/200 Hand Sanit Pump 12OZ

Glove Exam Nitrile Small Sani Cloth Wipes 8x14in

Glove Exam Nitrile Medium Dispatch Trigg Spray 32 OZ

Glove Exam Nitrile Large


Appendix 7

Infectious Disease Outbreak

Consider the following guidance in developing and coordinating facility-specific infectious disease outbreak

plans. Additional information can be referenced in the DPHHS Pandemic Influenza plan.

Collaborate with HPP and PHEP to share situational awareness that facilitates coordinated information

sharing among all relevant stakeholders. This includes state, local and territorial public health agencies

and their respective preparedness programs, public health laboratories, communicable disease

programs, and programs addressing healthcare-acquired infections. Information sharing is the ability to

share real-time information related to the emergency, such as capacity, capability, and stress on health

care facilities and situational awareness across the various response organizations and levels of

government. Accomplishing these activities will enable the health care delivery systems, public health,

and other organizations that contribute to responses to coordinate efforts before, during, and after

emergencies; maintain situational awareness; and effectively communicate with the public.

• Establish a common operating picture for effective response.

• HCCs provide situational awareness data, including data on bed availability, to HPP

• Participate in current and future federal health care situational awareness initiatives. During an infectious disease outbreak, HPP and PHEP awardees, HCCs, and HCC members all have roles in planning for and responding to outbreaks that stress either the capacity or the capability of the public health or health care delivery systems. Coordinate the following activities to ensure the ability to surge to meet the demands during a highly infectious disease response.

• Establish a common operating picture that facilitates coordinated infectious disease information sharing among all HCC members and relevant stakeholders, including state, local, and territorial public health agencies and their respective preparedness programs, state public health laboratories, communicable disease programs, and health care-associated infections (HAI) programs.

o Monitor known cases or exposed persons including how surveillance will be shared,

o Conduct short- and long-term follow-up of known or suspected households, and

o Ensure the security of storage and retrieval of sensitive information.

• Establish key indicators, critical information requirements, and EEI that will assist with timing of notifications, alerting, and coordinating responses to emerging or re-emerging infectious disease outbreaks of significant public health and health care importance, including novel or high-consequence pathogens.

Ensure that information is directed to the public and to the many disciplines that comprise the responder community.

• Coordinate public messaging and information sharing, including information related to monitoring and tracking of persons under investigation (PUIs), among PIOs for jurisdictional public health agencies, as well as PIOs at HCCs and health care organizations.


• Ensure infectious disease response planning includes state and local emergency management, transportation, public safety, and other relevant agencies and community partners.

Continue planning with health care organizations and other stakeholders such as mortuary, autopsy personnel, and medical examiners, to coordinate the management of the deceased when bodies are considered infectious, including addressing the provision of body bags and other supplies, defining assistance, and developing relationships with crematoriums, funeral directors, and other partners to effectively plan for managing the deceased when bodies are considered infectious.

• Identify, leverage, and share leading practices to optimize infectious disease preparedness and response activities.

Recommended additional activities.

• HCCs and state HAI multidisciplinary advisory groups or similar infection control groups within the state should partner to develop a statewide plan for improving infection control within health care organizations.

• Jurisdictional public health infection control and prevention programs including HAI programs and HCC members should jointly develop infectious disease response plans for managing individual cases and larger emerging infectious disease outbreaks.

• HPP, PHEP, HCCs, and their members should collaborate on informatics initiatives to include but are not limited to electronic laboratory reporting, electronic test ordering, electronic case reporting, electronic death reporting, and syndromic surveillance.

• HPP, PHEP, and HCCs should engage with the community to improve understanding of issues related to infection prevention measures, such as:

o Changes in hospital visitation policies,

o Social distancing, and o Infection control practices in hospitals, such as:

▪PPE use, ▪Hand hygiene, ▪Source control, and ▪Isolation of patients.

• HPP, PHEP, HCCs, and their members should promote coordinated training and maintenance of competencies among public health first responders, health care providers, EMS, and others as appropriate, on the use of PPE, environmental decontamination, and management of infectious waste. Training should follow OSHA and state regulations.

• HPP, PHEP, HCCs and their members should collaborate to develop and implement strategies to ensure availability of effective supplies of PPE, including:

o Working with suppliers and coalitions to develop plans for caching or redistribution and sharing and o Informing each other and integrating plans for purchasing, caching, and distributing

PPE.


HPP, PHEP, HCCs, and their members should sustain planning for the management of Person under investigation (PUI) to:

• Monitor health care personnel who may have had a risk exposure to a PUI by directly treating or caring for a PUI in a health care setting and

• Clarify roles and responsibilities for key response activities related to the monitoring of PUIs, to include:

• Assisting or assessing readiness of health care organizations in the event of a PUI and

• Conducting AARs and testing plans for PUI management to identify opportunities to improve local, state, and national response activities.

• Reference the MT DPPHS Ebola Virus Disaster (EVD) Concept of Operations (ConOps).


Appendix 8

Training

The RHCC will develop and update annually a multi-year training and exercise plan detailing the expected

training opportunities and needs as well as designating exercise events.

Basic Disaster Life Support (BDLS)

Advanced Disaster Life Support (ADLS)

Advanced Burn Life Support (ABLS)

Certified Hospital Emergency Coordinator (CHEC)

Health Sector Emergency Preparedness (HSEP)

1st Quarter 2nd Quarter 3rd Quarter 4th Quarter

Jul 1 to Sep 30 Oct 1 to Dec 31 Jan 1 to Mar 30 Apr 1 to Jun 30

2018 2018 2019 2019

ABLS BDLS ADLS

ABLS ABLS

Community Resiliency

CHEC

HSEP

IP/QI


Appendix 9

Exercise (testing and Evaluation)

The RHCC will develop and update annually a multi-year training and exercise plan detailing the expected

training opportunities and needs as well as designating exercise events.

Redundant Communications (RedComms) Exercises West RHCC x2

Redundant Communications (RedComms) Exercises Central RHCC x2



Coalition Surge Test (CST) West RHCC

Coalition Surge Test (CST) Central RHCC



HAvBED Drill x4

Volunteers Registry (ESAR-VHP) Exercise

Highly Pathogenic Frontline Hospitals (EVD) Exercises

Highly Pathogenic Assessment Hospital (EVD) Exercise

1st Quarter 2nd Quarter 3rd Quarter 4th Quarter

Jul 1 to Sep 30 Oct 1 to Dec 31 Jan 1 to Mar 30 Apr 1 to Jun 30

2018 2018 2019 2019

RedComms x4 RedComms x4

HAvBED HAvBED HAvBED HAvBED

CST West RHCC

CST Central RHCC

CST Central RHCC

CST Central RHCC

EVD AH EVD FL

ESAR-VHP


Appendix 10

Access and Functional Needs Planning

County profile information can be accessed at the following website:

http://mtdh.ruralinstitute.umt.edu/?page_id=6292

EXAMPLE:

Social Vulnerability Mapping can be obtained at https://svi.cdc.gov/map.aspx

http://mtdh.ruralinstitute.umt.edu/?page_id=6292

https://svi.cdc.gov/map.aspx


Every 6 months MT DPHHS will receive indepth emPOWER data updated by CMS from the US PHS Regional

Emergency Coordinator (REC). MT DPHHS HPP will forward this information to all Coalition membership to

ensure facilities have the latest data for emergency planning activities at the local level. Generic emPOWER

data can be obtained at https://empowermap.hhs.gov/

https://empowermap.hhs.gov/

Documents

Montana’s Central Regional Healthcare Coalition€¦ · might impact Montana’s communities, strengthening our health and emergency response systems, and enhancing our nation’s