Public Health Emergency Management System Emergency ... · Are information items identified as being critical in facilitating situational awareness and decision making. Trigger immediate,

Public Health Emergency Management System Emergency Operations Centers

Charatdao Bunthi, MD, MPH

Thailand MOPH US CDC Collaboration

Division of Global Health Protection

Centers for Disease Control and Prevention

Public Health Emergency

An occurrence or imminent threat of an illness or health condition, caused by bio terrorism, epidemic or pandemic disease, or (a) novel and highly fatal infectious agent or biological toxin, that poses a substantial risk of a significant number of human facilities or incidents or a significant number of human facilities or incidents or permanent or long-term disability (WHO/DCD, 2001).

A "public health emergency" may be defined as an event, either natural or manmade, that creates a health risk to the public.

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Public Health Emergency

Floods Earthquakes

Technological

TornadoesHurricanes

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TechnologicalHazards

Disease Outbreaks

Background

2012 - Public health emergency operations center (PHEOC) network (EOC-NET) established by World Health Organization (WHO)

Shared vision between members:

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…All public health EOCs will have the capacity and capability to perform core functions to ensure an effective response to public health events and emergencies…

Background cont.

A functioning PHEOC is an effective means of coordinating with partners responding to public health events and public health events and emergencies

Operates under the Incident Management System (IMS)

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Background cont.

Five essential functions can be activated or deactivated as needed with the evolution of an event:

Management – responsible for overall direction

Operations – coordination and technical guidance

Plans – collection of data, analysis, and planning of future Plans – collection of data, analysis, and planning of future actions

Logistics – acquisition and maintenance of resources in support of activities and responders

Finance and Administration – preparation and management of budget and administrative record

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What is an Emergency Operations Center (EOC)?

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Emergency Operations Center (EOC)

An EOC houses the centralized coordination efforts and resources in response to emergencies and disasters. An EOC is a physical place for response staff to conduct activities, such as:

What is an Emergency Operations Center

Collecting, organizing, analyzing and archiving information

Providing records of event activity sequence and activity sequence and communication timelines

Coordinating and prioritizing resources to support on-scene response operations

Supporting and facilitating agency decision making

Providing command and control functions

The Role of the EOC

The EOC

. . .provides a central location from which government at any level can provideinteragency coordination and executive decision making in support of the incident decision making in support of the incident response.

Emergency Operations Center

Building, facility, and equipment

Trained staff

Policies, processes and procedures

Situation Awareness(SA)

Standard OperatingProcedures (SOP)

Objectives of EOC

Timely, event-specific operational decision-making using the best available information, policy, technical advice and plans

Coordination of activities against common objectives with response partners

Collection, collation, analysis and presentation of event data Collection, collation, analysis and presentation of event data and information to support response planning and documentation

Acquisition and deployment of response resources, including services and material support to the EOC and to all responders

Monitoring financial commitments and providing administrative services for the EOC

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Essential Elements of a PHEOC

A physical facility

/location

A body of data and

information

A set of policies,

plans and procedures

A roster of skilled, trained

personnel

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Support from the EOCThe EOC plays a critical role in support of the on-scene response.

What is a EOC?

A emergency operations center (EOC) is the central location where responsible personnel gather to coordinate operational information and resources for strategic information and resources for strategic and tactical management of public health events and emergencies.

Incident Management System

Policy Guidance

Management/Comman

d

Operations Planning LogisticsFinance &

Administration

Core command, control and coordination functions

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Five Core Functions

Responsible for overall direction towards objectives

(including coordinating risk communication, safety, and liaison)

At field level, directly controls all response activities;

at higher levels, provides coordination and technical guidance

Conducts data collection, analysis, and planning of future actions

Management

Operations

Conducts data collection, analysis, and planning of future actions

based on likely course of the event and the resources available

Acquires, tracks, stores, maintains, and disposes of material resources, and also provides services to support the response

Manages budget, tracks resource costs, procures resources, produces and maintains administrative records

Planning

Logistics

Finance/ administration

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Organizational StructureIncident Management System (IMS)

Incident Manager

Operations Planning LogisticsFinance

Administration

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CDC Response Organization

CDC Zika Response Organization CDC Director

Dr. Frieden

Command and Specialty Staff

Liaison Officers (LNO)

2016 CDC Zika Virus Response Organization Chart24 MAY 2016 (0800)

CDC EOC Duty Officer (available) 24/7/365 at 770-488-7100 2016 Zika Virus Response (CDC): [email protected]

email: [email protected]: http://eoms.cdc.gov/

Logistics Support Section (LOG)

Operations Section (OPS)

Planning Support Section (Plans)

Finance and Procurement Section

Scientific Response Section (SRS)

Emergency Personnel Staffing Section (EPSS)

Situational Awareness Unit (SA)

Situational AwarenessJim Tyson Operations Section

John Turner

Planning Section Bill Howard

Logistics SectionReed Sheridan

Finance and Procurement Section

Reed Sheridan

Emergency PersonnelStaffing SectionKevin Gallagher

Current Ops LeadMark Channer

Situation Report Unit

PH Analytics Dr. Jacqueline

Burkholder

Deployment Coordinator

Gray SmithsonDon Flowers

Support BranchShawn Robinson

2016 ZIKA VIRUS

Chief of Staff Ed Rouse/Sherrie Bruce

JIC Deputy LeadCathy Young

JIC Lead / CO-leadSusan Robinson - John O’ Connor / Joanne

Cox

ADSNicole DowlingBryan Shelby

Policy

Namita Joshi

Joint Information Center (JIC)

Incident Manager

Lyle PetersenActing IM Michael Beach

Deputy Incident Manager Michael BeachScott Fridkin

Satish PillaiRachel Gorwitz

IM Assistant

Veronica ChewChaunte’ Stampley

Mardi Ithier

Executive AideYoulanda Outin

DRMUJeff NemhauserSachi Kuwabara

DOD LNO

Eric Sergienko

SecurityJorge Lazo

DSNSResource Mobilization

Health Information Technology

OMB-PRA Coordinator

Puerto Rico Coordination Stephanie Dulin

Matt Lozier

Emergency Management Capacity

Jennifer Brooks

Assistant Incident ManagerAmy Loy

Mac Kenzie

Pregnancy and Birth Defects

Denise JamiesonPeggy Honein

International Alex Macedo

Response Coordinator

Mark Pereschuk

Audio Visual Communications

Desi Alexander

EOC Support Branch Mike Sapp

IT Support

Informatics SupportDavid jackson

Administrative SupportTina Burton

Task Tracker

After Action Review / Lessons Learned

Shauna Mettee Zarecki

Plans Unit

Transportation Support Gary Goolsby

Commissioned Corps

Burkholder

EpidemiologyLing Zhou

EPI-X Amanda Evanson

Knowledge Mgmt Roger Harlan

Information OperationsCharmen Crawford

GIS Bob Neurath

Deployment BriefGeorge Roark

IMS Staffing CoordinatorGary D. JonesLarry Belleton

Don Flowers

Travel/VouchersPatricia Doggett

Communications & Equipment Team

Irene White

Facilities/ Task TrackerThomasina Greene

Clinical InquiriesMaleeka Glover

Outreach

Research & Evaluation

LOCS

Social Media

Media LNO

Communication Services

CDC-INFO

CDC Connects

Global

COCA

WEB

Triage

SA LNO

Clearance

Incident Action Plan

AtlantaKim Hummel

Content

Internal Communication

CommunicationClearance

Global Migration Doug HamiltonHolly Williams

BloodSafety

Matt KuehnertSridhar Basavaraju

Puerto Rico and Global

ResponseAudrey Lenhart

FT. CollinsAnn Powers

LAB

State CoordinationChris Kosmos

Finance BranchMary McDonald Zach Braden

Jorge LazoProcurement Branch

Christine Godfrey

EPA LNO

Susan Jennings

CONUS & Territories

other than PR

Janet McAllister

Vector Issues

PAHO LNO Craig Shapiro

Safety

Johanna Gilstrap

Employee Monitoring Panayotta Delinois

EPI Surveillance Margaret Cortese

Marc Fischer Annemarie Wasley

Sexual Transmission John Brooks

ModelingMichael Johansson

Clinical

Dana Meaney-

Delman

Operations

Tanya Williams

Puerto Rico Survey & Surveill ance

Carrie Shapiro-

Mendoza

Contraception Access

Lisa KooninEva Lathrop

Colombia

Diana Valencia

Children’s HealthEric Dziuban

OPERATIONS SECTION

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Role of Operations Section

Operations Section activities vary at different levels.

At the national level, the Operations Section is responsible for coordination and technical guidance of all response operations, and for implementing an of all response operations, and for implementing an existing or improvised response plan to support the site-level response.

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At the sub-national or local/site level, Operations is all about direct response activities, such as: Vaccination

Contact tracing

Treating and transporting sick/injured/deceased people

Conducting disease surveillance and collecting epidemiological Conducting disease surveillance and collecting epidemiological data

Establishing emergency clinics and/or restoring functionality of damaged health infrastructure

Scaling up community outreach for health promotion and case management.

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Operational activities vary depending on the type, scale and impact of an event—as does the sub-structure of the Operations Section.

WHO Framework for a Public Health Emergency Operations Center, 2015

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Modes of Operation

Note: Watch Mode is permanent and is ongoing even during a response.

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Watch Mode

Watch Mode generally aligns with “pre-incident” activities.

Staffed by core personnel who conduct routine operations.

Staff monitors conditions for events or incidents that might require a public health response.might require a public health response.

Event-Based Surveillance Also called “case finding or “case ascertainment”

Looking for new outbreaks or cases

Informs routine public health activities or emergency epi/surveillance

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Watch Mode

Public Information Officer/JIC

EOC Manager


Operations

Watch Staff

Event Based Surveillance (EBS) Staff

Planning LogisticsFinance

Administration

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Alert Mode


EOC Manager


AdministrationOperations

Watch Staff

Rapid Response

Teams

Planning LogisticsAdministration

EBS Staff

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Response Mode


Incident Manager


AdministrationOperations

Watch Staff

Rapid Response

Teams

Planning

Situational Awareness

Team

LogisticsAdministration

EBS Staff

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Watch Officer

Information WATCH OFFICER

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•Collect•Triage•Report

Triaging Information

• When information flows to the Watch Officer, they use protocols to triage the information to determine disposition and collection requirements

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InformationWATCH

OFFICER

EOC

TriageReport

CIR

REMINDER

The watch mode is continuous - Even when the PHEOC is activated for a response, watch officers are continuing to monitor for other emerging incidents.

Collect

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Collect

TriageReport

COLLECTING, TRIAGING, AND REPORTING

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Collecting data

The Watch Officer responsible for handling an initial contact should collect basic information about an incident using a reporting form that includes:• Unique identifier

• Geographical area (i.e. district) name

• Date of reporting and contact details of reporter

• Date and time when event occurred

• Description of event

• Actions taken to date, if any

• Name of person taking the call

http://www.wpro.who.int/emerging_diseases/documents/docs/eventbasedsurv.pdf

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CIRs:

Are information items identified as being critical in facilitating situational awareness and decision making.

Trigger immediate, mandatory actions such as reporting (spot reports and situation reports).

Critical Information Requirements (CIRs)

(spot reports and situation reports).

Are often linked to decision points for execution of a plan.

Become more detailed (targeted to the specific threat/response) and can change during a public health emergency response.

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Examples of CIRs

Internal CIRs:

Accidental death or injury of MoH personnel.

Events affecting MoH facility/installation activities/operations.

Incidents of international significance affecting MoH staff.

External CIRs:

Disease outbreaks/deaths that are above the base line for the Disease outbreaks/deaths that are above the base line for the seasonal or geographic norms.

Any terrorist attacks.

Response-Specific CIRs:

A confirmed case of Ebola in an MoH staff member.

Best Practices:• Establish a list of standing CIRs

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Triaging Data

Confirm the report is accurate

Determine if the report meets a critical information requirement and with whom the information should be sharedshared Review CIRs

Review existing SOPs

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Reporting Data

Determine what type of report will be sent out Spot Report (generated within the EOC)

Situation Report (comes from external sources)

Distribute appropriate report in accordance with internal SOPsSOPs

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Spot Reports (SPOTREPs)

Used to provide critical information regarding an incident

Who, What, When, Where, Why (as they are known)

Ministry actions taken in response

Intended to be a short narrative with critical pertinent information

Created within the EOC

Used for notification of emerging events related to:

Critical Information Requirements (CIRs) Severe weather Practicum, earthquakes, other natural disasters Significant events with public health impacts

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SPOTREP Example

Situation Reports (SITREPs)

Are priority messages that provide a synopsis of a situation to designated decision makers

Contain confirmed / verified information and explicit details

Are created by Subject Matter Experts (SMEs) Are created by Subject Matter Experts (SMEs) when a circumstance has the potential to become a CIR, actually is a CIR, or when media coverage may arise

SITREP Example

EOC ACTIVATION

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EOC Activation Levels

The level of effort required during EOC Response Mode will change over the course of time, resulting in either a return of response activities to program management (and EOC deactivation), or a change in activation levels.

Transition between EOC activation levels is designated Transition between EOC activation levels is designated based upon a level of effort, and not strictly by the total number of personnel involved in the response.

Escalation and de-escalation of the EOC activation level is based on an increase or decrease in the level of effort required to manage the response.

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EOC Activation Levels

* Activation Levels only apply to Response Mode* An EOC can only operate at one Activation Level at a time for a specific event

Level 1

The highest level of activation, this level is

reserved for the largest-scale responses, which

often require substantial Ministry-

wide effort

Sta

ffin

g In

cre

ase

Level 2

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wide effort

Sta

ffin

g In

cre

ase

This level of activation often requires

significant staff augmentation

Level 3

The lowest level of activation and effort.

NOTE: Watch Staff is always in Watch Mode

*** EOC Activation ***

RESPONSE MANAGEMENT

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Response Mode

Occurs when the Incident Management System is activated.

Generally associated with “incident” activities.

Can occur at the direction of the Ministry/ Department Can occur at the direction of the Ministry/ Department director.

Activation approval usually follows a recommendation generated from a preliminary assessment team process.

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Response Activities

Monitor, track, and distribute as necessary internal and external Mission Assignments (MAs).

Monitor and track Requests for Information and Requests for Actions (RFIs/RFAs).for Actions (RFIs/RFAs).

Collaborate across Ministries and other partners.

Best Practice: Use a computer application such as WebEOC.(WebEOC is a web-based information management system that provides a single access point for the collection and dissemination of emergency or event-related information. ) 48

Response Activities

Distribute daily calendar of events (Staff Rhythm)

Develop and maintain event specific CIRs.

Coordinate meeting schedules and send calendar invitations and send calendar invitations to participants.

Coordinate space requirements.

Note:Response activities are managed by the Operations Section, but executed by all Staff Sections in the EOC.

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Response Activities

Distribute and Manage Response Documents: Incident Action Plans

(IAPs)

SPOT Reports SPOT Reports (SPOTREPs)

Situation Reports (SITREPs)

Shift Change Briefs

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Response Activities

Integrate response personnel. Manage facility access.

Manage EOC & conference room seating.

Provide operator support for Provide operator support for multimedia presentations.

Test secure and unsecure communication devices.

Display materials as directed throughout the facility.

Maintain an EOC Plan.

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Tasks

A formal task is any:

Request for Information (RFI) that requires the issuance of a policy, statement, or official response as opposed to information that is publicly available or considered common knowledge among professionals.

Request for Assistance (RFA) that requires resources Request for Assistance (RFA) that requires resources (material or personnel) being dedicated to fulfill the need.

Other action that warrants a formal response based on the requestor’s position of authority.

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Example of RFI and RFA

Request for Information (RFI) What are the guidelines for transport of Ebola specimens

collected from various district health centers?

What are recommended guidelines for health care workers working with SARS patients?

Request for Action (RFA) Requesting MoH to deploy SMEs in entomology and vector control to

districts impacted by a dengue outbreak.

Requesting MoH to supply vaccine to 3 districts affected by a yellow fever outbreak.

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Task ManagementSteps include:

Identify the requirement.

Prioritize the task.

Identify to whom to assign the task.

Ensure pertinent information is included in task description.

Determine completion date.

Track status.

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RESPONSE CHECKLISTS

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Response Checklists

Checklists are useful to track completion of daily and weekly tasks that are essential in maintaining the continuous and seamless operations.

Promote accountability

Allow for continuity of operations during multiple shifts Allow for continuity of operations during multiple shifts

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Considerations for Daily Operations Response Checklists

Include routine activities such as: Development of daily staff rhythm

Distribution of weekly SITREPs

Maintaining equipment

Include frequency of activities Include frequency of activities Daily, weekly, monthly

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SAMPLE CHECKLISTS

Frequency Time Task Instructions

Daily 6:00pm Send out next day’s staff rhythm

Distribute via email to IM, All SectionsPrint copy and place on wallplace on wall

M, W, F 10:00am Coordinate IM Update

Set up room and conference line for IM update

Thursday 5:00pm Distribute ResponseSITREP

DistributeSITREP to all response staff using distribution list

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Key Points

The Operations Section is the center of the response. It is a source of information but also sets the tone for how a response should be managed.

The work is fast paced, and it helps to have SOPs and systems in place for key activities, to ensure overall accountability and effectiveness, including but not limited accountability and effectiveness, including but not limited to: SPOTREPS/SITREPS

Preliminary Assessments

Response Checklists

Task Tracking

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PLANS SECTION

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Overview

The Plans Section - is responsible for evaluation of the situation (information gathering and analysis), assessment of the options for dealing with it, and keeping track of resources.

Incident Manager


Administration

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EOC Plans Section

Plans

Section

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Advanced Planning Unit

Documentation Unit

Situational Awareness Unit

Plans Section Responsibilities

The Plans Section is responsible for: Aggregating and analyzing data

Predicting the probable evolution of events

Identifying the technical expertise that is needed

Tracking resource status Tracking resource status

Developing incident action plans

Reporting progress

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In Public Health Responses: Responsibility for data analysis during epidemiological investigations can be placed with the Plans or Operations Sections (or even as a separate Section).

PLANS AND PROCEDURES

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Types of Plans

An EOC operates on the basis of two types of plans:

1. Contingency plans, to include:a. All-hazards plan

b. Threat-specific response plans

c. Functional plans

2. An incident action plan

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Threat-specific response plans

Threat-specific response plans should be based on the prioritized list of threats and hazards determined through the national (or jurisdiction-specific) risk assessment process.

They may be included as Annexes to the All Hazards They may be included as Annexes to the All Hazards Plan.

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Incident Action Plans

A written incident action plan describes the specific objectives that must be accomplished in succession in order to achieve larger event management goals.

Incident action plans are developed within the Plans Section during a response, and provide all PHEOC Section during a response, and provide all PHEOC supervisory personnel with directions for current and future actions.

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The purpose of the IAP is to:

Ensure response personnel are working toward the same goals

Provide direction for actions to be taken during the operational period identified in the planoperational period identified in the plan

Provide a means of communicating the incident objectivesfor operational and support activities

Ensure a coordinated response

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Every incident must have an Incident Action Plan (IAP) that:

Covers a specified timeframe, called an operational period

Specifies the incident objectives - What do we want to do?

Identifies essential and critical information requirements Identifies essential and critical information requirements

States the activities - Who is responsible for doing it?

How do we communicate with each other?

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LOGISTICS SECTION

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Overview

The Logistics Section - provides facilities, services, and supplies in support of the incident.

Incident Manager

Operations Planning LogisticsFinance /

Administration

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Logistics Section Functions

Logistics

Section

Support Branch Service Branch

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Supply Unit

Facilities Unit

Ground Support Unit

Communication Unit

Medical Unit

Food Unit

Scope of Logistics

Logistics Management Resource Support

Material management Emergency supplies

Transportation management Facilities

Facilities management Office equipment and suppliesFacilities management Office equipment and supplies

Personal property management Telecommunications

IT management Contracting services

Maintenance management Transportation services

Support personnel

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Logistics Preparedness Actions

During preparedness phase:

Identify logistics requirements

Identify logistics resources

Balance logistics resources with logistics requirements (resource mapping)(resource mapping)

Establish and communicate logistics, policies, procedures, and plans

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Logistics Response and Recovery Actions

During response and recovery phase:

Support response to incident

Manage delivery of services

Anticipate ongoing sustainment needs

Coordinate demobilization of assets and equipment Coordinate demobilization of assets and equipment

Reconstitute resources as needed

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RESOURCE MANAGEMENT

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Resource Management

Four tasks:

Establishing systems for describing, inventorying, requesting, and tracking resources

Activating the systems prior to, during, and after an incidentincident

Dispatching resources prior to, during, and after an incident

Deactivating or recalling resources during or after an incident

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Resource Management Concepts

Standardize identification, allocation, and tracking

Classify by kind and type

Implement credentialing system

Incorporate resources from private sector and NGOs

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Resource Management During Incidents

Getting the right resources, to the right place, at the right time, can be a matter of life and death

Resources include: Personnel

Equipment Equipment

Supplies

Facilities

Prior to an incident, resources are inventoried and categorized by kind and type, including their size, capacity, capability, skills, and other characteristics

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Managing Resources

Preparedness activities must occur on a continual basis to ensure that resources are ready for mobilization

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Resource Typing

IMS resources are categorized by:

Kind - describe what the resources is

Type - describe the size, capability, and staffing qualifications of a specific kind of resource

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Resource Typing

Kind refers to broad classes that characterize like resources:

Teams

Equipment

Supplies Supplies

Vehicles

Aircraft

Type specifically defines the level of capability:

Type may vary by power, size, or capacity

Ensures Incident Manager requests, receives, and deploys the resources needed

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FINANCE AND ADMINISTRATION SECTION

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Overview

Finance and Administration Section - tracks expenditure, makes payments, and provides administrative services

Incident Manager

Operations Planning LogisticsFinance /

Administration

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Overview cont.

Activated when there is a specific need for financial and/or administrative services to support incident management activitiesmanagement activities

Acts in a support role

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Finance/Administration Section Responsibilities

Cash flow management

Track material and human resource costs

Budget preparation and monitoring

Production and maintenance of administrative records

Process compensation claims Process compensation claims

Preparation of procurement contracts

Incentive and insurance payments.

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JOINT INFORMATION CENTER

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What is a Joint Information Center (JIC)?

A JIC is a physical facility in which coordination of all communication related to an emergency response occurs.

What does the JIC do?

Leads the communication response to public health emergencies

Translates and delivers emergency risk communication messages to key audiences

Monitors news media, social media, and public inquiries to identify audience needs and guide communication strategy

Coordinates communication activitywith local, national, and international response organizations

Manages review of communication messages to ensure all response organizations are saying the same thing

JIC Products

Web and print

• Fact sheets, flyers, interim guidelines, posters , Q&As , FAQs

News media

• Talking points, news releases, media advisories

Social media

• Twitter, Facebook, blog posts

Call center prepared responses

• Helpline information

Target Audiences

Affected communities

Vulnerable populations

Clinicians

Public health Public health workforce

CDC employees

Policymakers

International agencies

Communication Channels News media

Social media

Internet

Public helpline

Global channels Global channels

Clinician list serve and conference calls

The EOC Foundation & Process

Assessment Deployment ReportingInformation/Co

ordination

EOC Handbook SOPs Forms

EOC Roles and AdvantagesRole of EOC

• Provide a central location and a system from which the MOH can rapidly respond to a disease outbreak or natural disaster, execute decision

Advantages of an EOC

• MOH systems are centralized and integrated into one room

• Allows field responders, impacted disaster, execute decision making, and provide interagency coordination

• The MOH EOC plays a critical role in supporting a response to the field

• Allows field responders, impacted provinces and regional centers to focus on the incident

• Provides a simple communuications channel from the field response and the MOH

• Allows for problems to be solved at the lowest level of response

Evolution of a Response

Questions

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