Public Health Planning Carrie Harter, MPH – Disease Control Adam DuBois – Preparedness Southeast High School November 18, 2014

Public Health Planning

Carrie Harter, MPH – Disease Control

Adam DuBois – Preparedness

Southeast High School November 18, 2014

Preparedness Planning

• Different Types of Preparedness Plans• Operational Plans• Communication Plans• Safety Plans• Security Plan • Many, many others…

ThePreparedness Cycle

• Preparedness IS NOT a “one-and-done” process!

• Continuous cycle that starts each time you finish.

• Without documenting gaps in capabilities, improvements can not be made.

Emergency Management / Coordination

• National Incident Management System (NIMS)• Systematic, proactive approach to guide the management of incidents• https://www.fema.gov/national-incident-management-system

• Incident Command Structure (ICS)• Systematic tool used for the command, control and coordination of emergency

response.• Free Training Available:• https://training.fema.gov/EMIWeb/IS/courseOverview.aspx?code=IS-100.b

https://www.fema.gov/national-incident-management-system

https://www.fema.gov/national-incident-management-system

https://training.fema.gov/EMIWeb/IS/courseOverview.aspx?code=IS-100.b

https://training.fema.gov/EMIWeb/IS/courseOverview.aspx?code=IS-100.b



1. Transportation2. Communications3. Utility Operations4. Fire5. Information & Planning6. Mass Care7. Resource Support8. Health & Medical9. Search & Rescue10.Hazardous Materials11.Food & Water12.Energy13.Military Support14.Public Information15.Volunteers & Donations16.Law Enforcement17.Animal Protection18.Business & Industry

Manatee County

What is planning?

1. Evaluating a situation2. Developing incident objectives3. Selecting a strategy4. Deciding which resources should be used

to achieve the objectives in the safest, most efficient and cost-effective manner.

Planning is a process to assist in…

Planning

Step 1: Form TeamIdentify Core Team

• Management• Legal Services• Human Resources• Public Relations / Information• Risk Management• Environmental Health • Finance / Purchasing

• Operations• Facilities Management• Security• Medical Personnel• Information Technology• Logistics• Safety Personnel• Employees / Volunteers

• Any other person / group with interest

Step 1: Form TeamIdentify Core Team

Step 1: Form TeamEngage Partners

• Law Enforcement• Fire Department • Emergency Medical Services• Hazardous Materials• Local Emergency Management• Public Health• Public Works• Contractors• Vendors• Partner Groups• Churches

Understand The SituationIdentify Threats / Hazards

• Situation• Site – building, facilities, grounds, access controls

• Situational Climate• Knowledge of understanding, perceptions, behaviors, etc.

• Threats• People, places, or things that may pose a threat, or

become an incident.• Capacity

• What resources are available?• Where can we pull resources?• Skills / Training?• Needs?

Assess the following:

Identify Threats:• Gather information to identify a range of threats that might

be faced by the jurisdiction.


Prioritize Threats and Hazards (Risk Assessment)

Hazard Probability Magnitude Warning(hrs.)

Duration(hrs.)

Risk Priority

Fire 4. Highly Likely3. Likely2. Possible1. Unlikely

4. Catastrophic3. Critical2. Limited1. Negligible

4. Minimal3. 6-122. 12-241. 24+

4. 12+3. 6-122. 3-61. < 3

High MediumLow

HazMat Spill

4. Highly Likely3. Likely2. Possible1. Unlikely


4. Minimal3. 6-122. 12-241. 24+

4. 12+3. 6-122. 3-61. < 3

High MediumLow

Zombie Apocalypse

4. Highly Likely3. Likely2. Possible1. Unlikely


4. Minimal3. 6-122. 12-241. 24+

4. 12+3. 6-122. 3-61. < 3

High MediumLow

Use the compiled data to prioritize your threats and hazards


Prioritize Threats and Hazards (Risk Assessment)

Use the compiled data to prioritize your threats and hazards

Goals / Objectives

Goals are BROAD, GENERAL statements in response to threats• Try to develop at least 3 goals for each Hazard.

Example: (from Fire Hazard on prior slide)1. Prevent a fire from occurring in your home.2. Protect your family from injury.3. Provide medical attention if someone gets hurt.

Objectives are SPECIFIC, MEASURABLE actions necessarily to achieve your goal.

• Objective 1.1: Provide fire education to your family• Objective 1.2: Store combustibles in fireproof space

• Objective 2.1: Create a fire evacuation plan• Objective 2.2: Practice evacuation drills

• Objective 3.1: Call 911 immediately.• Objective 3.2: Begin first aid until EMS arrives.

Plan Development

• Course of action addresses the who, what, when, where, why, and how for each threat, hazard and function.

• Course of action are different for each scenario.

• Course of action typically created using the following steps.

1. Depict a scenario based on threats and hazards prioritized.

2. Determine the time available to respond.• Hurricane vs. Explosion

3. Identify decision points.• When do decisions need to be made?• What decisions?

Plan Development

4. Develop Courses of Action

• What is the action?• Who is responsible for the action?• When does it take place?• How long does the action take place?• What has to happen before?• What happens after?• What resources are needed?• What are the affects?

After developing courses of action, select the most appropriate.

The Plan

Basic (or Base) Plan• Overview of the approach• (How the entity operates, and what they want to do.)

Functional Annexes (Workforce Development)• Details of goals, objectives, courses of action.• Describes how to manage a function before, during, after an

incident.

Threat / Hazard Specific Annexes (Pandemic Influenza)• Details goals, objectives, courses of action for a specific

hazard identified.

Epidemiology Outbreak Annex

• Plan Activation:– Significant increase in a disease or syndrome– A disease with unusual

geographic/seasonal/age distribution– Evidence of higher morbidity or mortality rate

than usual with common illnesses or syndromes

– A single case of a rare disease (Ebola)


• Surveillance (how we know when to activate our plan):– Reportable Diseases– ESSENCE

• Emergency Room Chief Complaints• Poison Control Data• Vital Statistics Data

– School Absenteeism Data


• Plan Covers– Steps to identifying and managing an

outbreak• Case finding• Interviewing• Infection Control Recommendations

– Communication – Recovery

Isolation and Quarantine Plan

• Plan Activation:– Identification of a suspected or confirmed

disease of public health significance– County Health Officer can institute quarantine

orders

• Plan Covers:– Process for implementing isolation,

quarantine, and social distancing– Communications– Partnerships

Mass Prophylaxis Plan

• Plan Activation:– A single case of a disease is identified that

can not be attributed to a natural infection (Anthrax)

– Law enforcement or public health officials determine a terrorist release of a virulent public health agent

– Outbreak of a novel strain of influenza (Influenza A 2009:H1N1)

The Plan

Write the Plan

1. Summarize important information with checklists and visual aids.

2. Use plain language, avoid jargon and abbreviations.3. Write clearly, using an active voice.4. Use logical, consistent structuring5. Make the plan easy to read, or scan for information.6. Provide enough detail to convey an actionable plan.7. Create tools or documents that will supplement your

plan.1. Auxiliary aids2. Closed captioning

The Plan

Review the Plan for:

1. Compliance of laws 2. Usefulness3. Adequacy4. Feasibility5. Acceptableness6. Completeness

a. All courses of action for hazardsb. Integrates needs of the whole communityc. Provides a complete picture of what will happend. Estimates time for achieving objectivese. Ensures safetyf. Identifies success

The Plan

Approve and Share:

After the final review of your plan, • Present to leadership• Obtain approval• Share with community partners that have a role in the

plan• Share with other organizations that may support

operations• Protect your plan from those who do not need, or

authorized to have it

Plan ImplementationTrain Stakeholders• Hold a meeting and educate parties on the plan.• Visit sites in the plan to allow for visual recognition.• Provide literature on the plan, policies, and procedures involved

with activation• Post pertinent information• Familiarize partners to increase comfort and understanding• Train on specific roles

Exercise the Plan• Practice, Practice, Practice

• Tabletop (discussion based)• Drills (small, individual response to a scenario)• Functional Exercise (similar to drill, but involve multiple

partners)• Full Scale Exercise (full activation of plan)

Exercising Your Plan: “Zombitosis” Drill

“Zombitosis” Drill

• Homeland Security Exercise and Evaluation Program (HSEEP) Compliant– Process for:

• Planning• Evaluation• After-Action Report/Improvement Plan

• Completed to exercise our Mass Prophylaxis Plan (required every 36 months)


• Operations-based exercise versus discussion based– Considered a “drill” since it tested one

function and one agency– Exercised many components of our agency:

• Planners• Command Staff• Logistics• Operations (nursing)



Epidemiology Outbreak Response Plan

Plan Implementation

Review, Revise, and Maintain the Plan

• Close the loop in the planning process.• Focuses on adding information gained during

exercise.• Begins the planning cycle over.

• Planning is continuous…

“Planning P”

• Guide to the process and steps involved in planning for an incident.

• The “leg” of the P is the initial response period.

• “Top” of the P is the beginning of the first operational period cycle.

• Operational planning cycle is circular and continuous through the event.

“Planning P”

• Incident occurs, notification received, planning begins.

• Review the situation to provide input for management decisions.

• ICS 201 is a tool (form) used to collect information about a situation and the resources allocated.

ICS 201

http://training.fema.gov/emiweb/is/icsresource/icsforms.htm



“Planning P”

• Incident Command establish objectives for the event.

• Planners begin process to break down objectives into tactical assignments.

• Meeting to gather input or provide data.

“Planning P”

Tactics Meeting is to:

• Determine how strategies will be accomplished to achieve incident objectives.

• Assign resources to implement tactics.

• Identify methods for monitoring tactics and resources.

ICS 215/215A Forms Used in Tactics Meeting

ICS 215


• How we going to do it?

• What do we have to do it?

• What do we need to do it?

• When can we expect it here?

• Who is going to use it?



ICS 215A


• Where are operation taking place?

• What are any hazards or potential hazards?

• What can be done to mitigate these hazards?



“Planning P”

• Review ICS 215 (Resources)• Review ICS 215A (Safety)• Assess the current operations

effectiveness, resource efficiency, and address safety hazards.

• Gather any further information to support incident management decisions.

“Planning P”

• Review / Validate the operational plan.• Operations explains the amount and

type of resources needed.• Planning team’s “Resource Unit” will

work to accommodate.• Planning meeting assures all command

and general staff have understanding of the operational period.

• Planning team will advise when supporting documents are due for plan distribution.

“Planning P”

• Operations (or shift) briefing is conducted to present the incident action plan to supervisors of the tactical resources.

• Supervisors will then meet with their assigned resources to brief on assignments.

“Planning P”

• Operations section directs the implementation of the plan.

• Plan is evaluated for effectiveness during the process.

• Command staff and Planning team begin to plan for the next operational period.

Influenza A H1N1: 2009Putting Your Plan into

Action• April 24th 2009: CDC announces two

cases of novel swine influenza in children reporting no contact with pigs

• 2 phases to the response:– Outbreak response– Vaccination campaign


Action• Outbreak timeline:

– CDC alert 4/24/09 (conference call) – Manatee County identified first case on May 7,

2009 – Reporting only deaths and serious hospitalizations

by August 3, 2009– Manatee County’s first death on September 7,

2009 (3 total)


Action• Vaccine available in September 2009• CDC identified 5 target groups:

– Pregnant women– Household members and caregivers of children

under 6 months– Health-care and emergency medical services

personnel– Children and young adults ages 6 months to 24 years– Persons aged 25-64 years with underlying medical

conditions


Action• DOH-Manatee focused on the target groups from

September – December:– Utilized Incident Command System (ICS) structure– 22 Incident Action Plans

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Action• Vaccine available to general public on December 19,

2009:– Clinic held at Civic Center– 1721 vaccinations given

• Next large clinic on January 9, 2010:– 1664 vaccinations given


Action


Action


Action

Planning Tips / Traps

• All incidents are local first, be prepared for at least 72 hours.

• Be sure plans are scalable for smaller and larger events.

• Review plans and annexes on a routine basis.• Include partners in planning and exercising to

ensure understanding of roles.• Build plans for communicating internally and

externally.

Questions?

Carrie Harter – Disease [email protected]

Adam DuBois – Public Health [email protected]

mailto:[email protected]

mailto:[email protected]

Documents

Public Health Planning Carrie Harter, MPH – Disease Control Adam DuBois – Preparedness Southeast High School November 18, 2014