Northern Panhandle
All-Hazards Public Health
Plan
Revised: 12/2014
1
TABLE OF CONTENTS
Page(s)
Signature Page
4
Record of Changes
5
Purpose
6
Scope and Applicability
6
Authority and References
6
Situation and Assumptions
7
Concept of Operations - Command and Control / ICS Chart
9
Communication Plan
12
Continuity of Operations
13
Roles and Responsibilities by Response Function
13
Surveillance and Epidemiologic Investigation
Specimen Collection, Transport and Testing
Mass Delivery of Prophylactic Medications or Vaccines - SNS
Surge Capacity Patient Care
Mass Fatality Management
Disaster Phone Bank Services
Crisis and Emergency Risk Communications
Environmental Health Functions
Notification and Support of Local Health Departments
Family Assistance Center
13
17
21
27
32
33
34
36
43
44
Roles and Responsibilities by Agency - (Note: These are the same roles
and responsibilities noted above, but organized by agency)
46
Disaster Recovery
62
Continued Plan Development and Maintenance
63
Appendixes
64
Contact List
Organizational Chart
Applicable MOU List
2
TABLE OF CONTENTS
Page Two
Annexes
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
Surveillance and Epi Investigation Plan
Mass Immunization and Prophylaxis SNS Plan
Environmental Health
Risk Communications
Pandemic Influenza Plan
Mass Mortuary Annex
Notification Protocol
Agent Specific Protocols
Regional Hospital Plan
Safety Plan
3
BROOKE COUNTY HEALTH DEPARTMENT
ALL HAZARDS PLAN
PROMULGATION STATEMENT
Preparedness to cope with the effects of any incident, where natural or man-made,
large or small, includes many diverse but interrelated elements. These are woven into an
integrated system involving state, federal, and local partners.
An incident that is out of the ordinary daily events necessitates a sudden
escalation in the needs of the community and a reorganization of the personnel needed to
address the event. Failure to follow an integrated plan can result in chaos making the
incident more difficult to handle.
Planning for incident management must be a cooperative effort to avert or
minimize the effects of natural, technological, or man-made disasters; protect lives; and
restore the stricken area to its pre-incident status with a minimum of social and economic
disruption.
This plan is a statement of policy regarding emergency response and assigns tasks
and responsibilities to Brooke County Health Department employees. It is developed
pursuant to WV Code Chapter 16, Public Health and WV 64 CSR 7 Reportable Disease
Regulations.
The following plan will be used by the Northern Panhandle region during all
hazard events effecting county residents within the Northern Panhandle.
All agencies represented in this Local Health Department version of our Regional
All Hazards Plan can be found as referenced in Memorandums of Understanding on file
in each Local Health Department
Respectfully submitted,
____________________________
Authorized Local Health Department Representative
4
BROOKE COUNTY HEALTH DEPARTMENT
ALL HAZARDS PLAN
RECORD OF CHANGES
CHANGE
NUMBER
DATE OF
CHANGE
PAGE
DATE
NUMBER(S) ENTERED
12/2004
n/a
CHANGES MADE BY
(SIGNATURE)
Reviewed by M. Bolen
n/a
5
Brooke County Health Department
Public Health Threat Response Plan
(All-Hazards Plan)
I
PURPOSE:
The purpose of this plan is to ensure the mobilization, management and delivery
of public health services under disaster or emergency conditions as may be
required to meet the affected population. This is an all-hazard plan delineating
how public health responsibilities will align with other responding agencies
II
SCOPE:
The scope of this plan is to define the local health department’s role and function
in addressing major threats to the public’s health. It is applicable to this
department and those who support public health response efforts during activation
of this plan.
III
AUTHORITY AND REFERENCES:
WV Code, Chapter 15, Article
5, Emergency Services
WV Code Chapter 16, Public
Health
WV 64 CSR 7 Reportable
Disease Regulations
Defines authority of state to undertake actions
to protect life and safety in response to
disaster.
Defines roles and responsibilities of the
Commissioner / State Health Officer as well
as those of Local Health Officers and Boards
of Health. Specifically defines authorities of
State Health Officer / Commissioner to
undertake actions necessary to control spread
of disease. Contains authorities to undertake
specific actions related to specific diseases
(e.g. TB) or procedures (e.g. immunizations).
Defines practices through which diseases and
conditions are reported to public health,
responsibilities of reporting parties in
reporting and in assisting in investigation, and
defines state and local health officer
authorities related to quarantine, isolation, and
placarding. Also delineates circumstances
under which confidential disease information
may be shared.
6
Chapter 27, Article 1A
WV Code 29 B, Article 1,
Section 4, subsection (i)
IV
Creates the Department of Mental Health and
divisions for promoting the development of
behavioral health. Allows for the
establishment and authority of the Data
Integration and Security Division within
WVDHHR.
Defines certain plans and documents
maintained for purposes of emergency
response to be exempt from Freedom of
Information Act Requests for security
purposes.
SITUATIONS AND ASSUMPTIONS:
A.
SITUATION Most disasters, be they naturally occurring or intentional,
have the potential to seriously impact human health. Advance
preparation and coordinated response can reduce, although may
not fully prevent, the occurrence of disease, injury, disability, and
death. WV is vulnerable to any of the following serious public
health threats:
1.
5.
Biological Disasters: both naturally occurring outbreaks of disease,
including pandemics, and intentionally disseminated disease.
Natural Disasters: most commonly related to weather, e.g., floods,
hurricanes, tornados, blizzards, ice storms, etc.
Chemical Disasters: both accidental (e.g., spills, releases) and
intentional (e.g., chemical terrorism).
Radiologic Disasters: both accidental (e.g., nuclear power plant
releases, spills, etc.) and intentional (e.g., radiologic terrorism).
Other: explosives, incendiary devices, etc.
B.
ASSUMPTIONS –
1.
Public health disasters will likely present a massive challenge to the
emergency preparedness system. Advanced planning can save lives,
reduce injury, disability and disease, as well as prevent significant
economic loss.
Although advance planning can mitigate the problems caused by the
event, there may be critical shortages of health care resources such as
staffed hospital beds, ventilators, morgue capacity, medication or
vaccines, etcetera.
Effective response to a serious public health threat will require the
coordinated efforts of a wide variety of public, private and non-profit
organizations – including those outside the traditional health field.
2.
3.
4.
2.
3.
7
4.
5.
6.
7.
8.
9.
10.
11.
12.
However, many of these resources may be directly affected by the event
and, as a result, be unable to respond or respond in a limited fashion.
Large scale emergencies and disaster events may affect large areas,
beyond jurisdictional boundaries, which will require the implementation
of mutual aid agreements and memorandums of understanding with
bordering counties, regions and states.
During the first 48-72 hours after an incident emergency measures to
protect the life and health, as well as responses to other human services,
will be totally dependent upon local resources.
There may be critical shortages on public health, health care, and other
response workers due to illness or disaster impact, or other reasons.
Volunteers, within the scope of their training, will help perform essential
tasks and their involvement must be anticipated and coordinated to
maximize their efforts.
The Strategic National Stockpile (SNS), a supply of vaccines, antibiotics,
other antidotes, medical equipment and supplies will be available to West
Virginia from the federal government within 12 hours of approval by the
director of CDC, but may not be sufficient to fully meet the need of the
State, thereby creating a possible reduction in needed resources at the
county level.
Information from epidemiological investigations/disease surveillance will
be critical for supporting effective decision making and resource
allocation.
Terrorism/CBRNE (chemical, biological, radiological, nuclear, explosive)
attacks may or may not be preceded by a warning or threat, and may at
first appear to be normal disease occurrences.
In addition to epidemiological and medical investigations, it may be
necessary to gather evidence for law enforcement reasons. In a terrorist
event, the Federal Bureau of Investigation (FBI) will be responsible for
coordinating this aspect of the event. Public health workers will need to
coordinate collection and handling of evidence with law enforcement
entities to assure sufficient chain of custody is maintained.
An incident command structure will be used by this agency to respond to
major public health threats, and it is assumed that all local, state and
federal responders have met nationally recognized training standards (ie:
NIMS).
8
V
CONCEPT OF OPERATIONS:
A.
COMMAND AND CONTROL:
1.
Incident Command –
a.
The health department follows NIMS when establishing an
incident command structure.
b.
Incident Management of Health Response –
Primary responsibility for management of public health threats on
the local level lays with the health officer of that jurisdiction or
his/her designee.
c.
Coordination of Public Health Multi-Jurisdictional Events Events involving multiple jurisdictions are coordinated regionally
through regional public health response plans and memorandums
of understanding which are in place.
d.
Use of Executive Orders and Public Health Orders –
Where deemed necessary to prevent disease or address a public
health threat, the State Health Officer has the authority to issue
public health orders guiding response and enabling use of
resources. In addition, the Governor, at the advice of the State
Health Officer, may issue executive orders directing actions of or
providing authority to individuals and agencies within both the
private and public sector.
e.
State Health Officer Assumption of Command –
Where deemed necessary, the State Health Officer may assume full
command of the health response within the jurisdiction, given the
local health response is inadequate to protect the health and safety
of the residents of that jurisdiction.
9
INCIDENT MANAGEMENT STRUCTURE
Incident Commander
Safety Officer
PIO
Liaison Officer
Planning
Operations
Emergency
PH Ops
Logistics
Incident
Action
Planning
Medical Ops
Finance /
Administration
IT and
Communications
PH Nursing
Epi/Surveillance
SNS
Demobilizing
/ Planning
Env Health
Materials
Supply &
Transport
Purchasing
Cost &
Time
Tracking
Claims
Documentation
Behavioral Health /
Crisis Counseling
Human
Resources
Data
Management
Resource
Tracking
Continuity
of PH Ops
Facilities
Management
Legal
Volunteer
Credentialing & Deployment
Staff
Support
10
2.
Requests for Support a.
b.
c.
d.
Response is undertaken at the lowest level possible, typically at the
county level.
When local resources are depleted or exceeded, regional resources
or mutual aid will be engaged, as per developed plans and
memorandums of understanding.
The local emergency management agency will be used to request
resources, and when the emergency operations center is not
activated the local health officer may request resources through
WVDHHR-BPH.
Federal assets associated with the Strategic National Stockpile are
mobilized at the request of the State Health Officer in conjunction
with the Governor.
B. OPERATION CENTERS:
1.
The local health response is operationally mobilized out of its physical
facility when the response needed does not require stand-up of the
emergency management agency’s emergency operations center.
2.
Responses integrated into larger jurisdictional involvement will operate
from the local emergency management agency’s emergency operations
center.
3.
Responses integrated into a regional response will be operated from the
regional emergency management agency’s emergency operations center,
where the capability exists to stand-up a mobile command center.
C.
FIELD PRESENCE:
1.
Personnel visits or field placements may be made to affected areas to:
a. Assess damage or impact of public health threat.
b. Undertake ongoing health/disease surveillance.
c. Evaluate needed resources of impacted area.
d. Coordinate response or resources across jurisdictions.
e. Deliver necessary equipment or supplies.
f. Adequacy or effectiveness of response.
g. Educate those impacted on necessary steps for recovery; availability of
resources; and address public health concerns.
h. Inspect establishments holding public health permits which have been
affected by an event that lead to the closing of that facility.
11
i. Establish a field headquarters to adequately manage a local health
response.
j. Stand-up a point of distribution for distribution of Strategic National
Stockpile assets.
D. Notification –
1. Receipt of Health Alert Network Alerts –
Upon receipt of Health Alert Network alerts from WVDHHR-BPH,
information is forwarded to appropriate partners via blast faxes, email,
etc.
2. Notification of Partners –
When local health department becomes aware of a suspect event of a
potential terrorist nature, an emergency conference call is convened with
applicable state and local partners to assess the situation and determine a
mutually agreed upon course of action. The same procedure may occur
with non-terrorism emergencies.
3. Notification of Media and Public –
Public notification of events or provision of guidance/information is
undertaken by one or more of the following:
a. News release
b. Press conference
c. Interviews
d. Public service announcements
VI
COMMUNICATION PLAN:
A.
INTERNAL COMMUNICATIONS –
1.
A calling tree has been established for the purpose of activating/notifying
staff of the necessity of disaster response. Several methods may be used
to carry out this function
a.
b.
Landlines and cellular phones will be used as the primary means of
contacting internal staff.
WARN may be used to contact them via multiple communication
forms, such as home phones, cellular phones and work phones and
email.
B.
EXTERNAL COMMUNICATIONS –
1.
The local health department is a member of the county emergency
operations center, coordinated by the local emergency management
agency.
12
2.
3.
4.
VII
In a local event, the local health department or emergency management
agency would contact the Bureau for Public Health offices for support and
resources. There are established notification protocols that are
followed for suspect biological, chemical or radiological agents, and
disease surveillance and control.
For larger incidents or those occurring in another state or section of the
country, the Centers for Disease Control and Prevention (CDC) maintains
a Health Alert Network (HAN) that communicates advisories and alerts to
state health departments for appropriate dissemination and disposition.
Division of Threat Preparedness houses a HAN coordinator that maintains
the HAN system, and broadcasts messages to local health departments.
The local health departments maintain a HAN coordinator and backup for
receipt of HAN alerts, which are re-broadcast to local partners/providers
as necessary.
The Public Information Officer (PIO)/Risk Communicator for the local
health department provides information and education to local media and
the public in an event.
CONTINUITY OF OPERATIONS:
The local health department maintains a continuity of operations plan, which
details the process for sustaining operations. There are identified components
which relate to threat preparedness, including: essential services/non-essential
services and recovery.
VIII
ROLES AND RESPONSIBILITIES BY RESPONSE FUNCTION:
Below are brief overviews of the task assignments for various public health
response functions, undertaken with the assistance and support of multiple
response partners from public, private, and non-profit sectors.
A.
SURVEILLANCE AND EPIDEMIOLOGIC INVESTIGATION –
1.
Purpose –
a.
To provide early detection of disease outbreaks or other health
events.
b.
To collect data and information to support and evaluate disease
prevention and control measures.
c.
To provide guidance on disease prevention and control measures.
2.
Leadership roles –
a.
Local lead: Local health department
b.
State lead (Infectious Diseases): Division of Surveillance and
Disease Control
c.
State lead (Chemical/Radiological): Office of Environmental
Health Services.
13
d.
3.
State lead (Explosions, Conventional Weapons): Office of
Emergency Medical Service.
Overview of Roles and Responsibilities –
a.
Local health department:
i.
Develop and maintain local and state relationships
necessary for disease surveillance and epidemiological
response.
ii.
Disseminate information on diseases/conditions under
public health surveillance.
iii.
Receive disease and outbreak reports.
iv.
Investigate cases, contacts and outbreaks.
v.
Report cases, contacts and outbreak investigation findings.
vi.
Implement prevention and control measures.
vii.
Educate patients and providers.
b.
Division of Surveillance and Disease Control –
i.
Develops standard operating procedures and educational
materials for epidemiological investigations as well as for
disease prevention and control.
ii.
Provides leadership in training and drilling of
epidemiologic response.
iii.
Establishes and maintains federal, state, and local
relationships/partnerships necessary to support disease
surveillance and epidemiological response.
iv.
Makes recommendations to incident command on disease
control and prevention activities.
v.
Provides timely summarization of data and information on
number of cases, identified risk factors or exposures,
characteristics of at-risk populations including contacts at
risk for development of disease, complications including
deaths and hospitalizations, and the impact of disease
prevention and control activities.
vi.
Collaborates with Vital Records to receive reports on
deaths so these can be summarized and reported in a timely
fashion.
vii.
Supplements local health department response, if needed
and if possible.
viii. Liaisons with Centers for Disease Control and Prevention
epidemiologists and epidemiologists from other states.
ix.
Prioritizes response activities to achieve maximum health
benefit when resources are limited.
x.
Advocates for/provides recommendations for life-saving
interventions prioritized according to available resources.
xi.
In BPH notification protocol, notifies State Health
Officer/BPH Leadership of investigation findings (lab
14
c.
d.
e.
f.
results, key epidemiological findings, etc.) for suspect and
confirmed cases.
xii.
Integrates/Coordinates efforts with the Office of Lab
Services (OLS), Office of the Commissioner, Division of
Threat Preparedness (DTP), Office of Environmental
Health Services (OEHS), DHHR Disaster Coordinator, and
others as applicable.
viii. Allocates personnel and other resources as back-up/surge
capacity for other epidemiologists in the Bureau, to include
assistance with data management and data analysis,
epidemiological investigation, case ascertainment,
hypothesis testing, study design, and other aspects of
epidemiological investigation.
Hospitals and Health Care Providers –
i.
Undertake timely reporting of cases and suspect outbreaks.
ii.
Implement prevention and control measures as
recommended by the Bureau for Public Health/local health
departments.
iii.
Assist with patient/public information dissemination.
The Officer of Emergency Medical Services –
i.
Develop and maintain relationships and operating
procedures with local EMS providers and regional Medical
Command Centers necessary for timely surveillance of
potential disease outbreaks or clusters of suspicious
symptoms and the accurate reporting of information to
state/local epidemiology staff.
ii.
Track numbers of cases of trauma, with emphasis on
potential terrorist incidents, such as explosions, incendiary
incidents or attacks with other conventional weapons that
produce significant numbers of trauma patients or fatalities.
iii.
Assure appropriate communications channels exist between
EMS Providers, Medical Command Center Staff, EMS
medical Directors and state/regional/local epidemiology
staff regarding patient treatment/management, especially
for those affected by bio-terrorism incidents or naturally
occurring emerging disease outbreaks.
Office of Laboratory Services –
i.
Provides education and guidance on specimen collection
and transport.
ii.
Accepts specimens and undertakes testing in support of epi
and law enforcement investigation using current
technologies.
iii.
Maintains chain of custody, as applicable.
iv.
Supports timely reporting of laboratory data including
antimicrobial susceptibility data.
Office of Environmental Health Services –
15
i.
g.
For chemical incidents, serves as lead for surveillance and
epi investigations (ATSDR Partners Program, supported by
the Division of Surveillance and Disease Control).
ii.
For radiological incidents, serves as lead for surveillance
and epi investigation (Radiological Health Program,
supported by the Division of Surveillance and Disease
Control).
iii.
Assists epidemiological investigation through provision of
the environmental component of investigation in biologic
incidents (division of Public Health Sanitation).
iv.
Provides timely follow up of environmental risks identified
from epidemiological data.
v.
Provides timely reporting of results of environmental
investigations.
vi.
Develops standard operating procedures and educational
materials for environmental component of disease
prevention and control.
vii.
Provides leadership in environmental health staff at local
level in epidemiological investigations.
viii. Establishes and maintains federal, state, and local
relationships/partnerships necessary to support disease
surveillance and environmental health epidemiological
response.
ix.
Supplements the local environmental health and
epidemiological response, if needed and if possible.
x.
Liaisons with the Food and Drug Administration and food
safety officials with other states.
xi.
Advocates for/provides recommendations for life-saving
interventions.
xii.
Implements prevention and control measures.
xiii. Provides educational information on risk and exposure
assessments to radiological (Radiological Health Program)
or chemical (ATSDR Program) contaminants following
disaster situations.
xiv. WV ATSDR Partnership staff in concert with laboratory
and epidemiology staff and other agencies (DEP and EPA,
etc.), will provide guidance to prevent ongoing and future
exposures, and resultant health effects, from hazardous
substances releases.
xv.
WV ATSDR Partnership staff determines human health
effects associated with exposures to hazardous substance.
xvi. Provides regulatory control and guidance for management
of radioactive contaminated air, soil, water, or food sources
affecting the environmental and the general public food
chain.
WV State Police (WVSP) and local law enforcement (LLE) –
16
i.
ii.
h.
i.
j.
Provides security as needed for investigation teams.
Trains and supports epidemiological investigation team in
maintenance of chain of custody.
iii.
Works with epidemiological investigation teams to
coordinate public health and criminal investigation.
iv.
Provides secure transportation for biologics or other
therapeutics, when necessary.
West Virginia Poison Center (WVPC) –
i.
Provides real-time toxicosurveillance for the State of WV.
ii.
Maintenance of public health data base of poison exposure
and information calls coming into WVPC.
iii.
Notification of the BPH and/or local health departments of
public health concerns identified via the WVPC emergency
phones (e.g., identified potential outbreaks, potential
release of a hazardous material into a community).
iv.
Shares and coordinates public health information relating to
acute toxic exposures or prevention of toxic exposures with
the BPH and local health departments.
v.
In coordination with BPH, provides information aimed at
preventing disease, reducing injury to the public and
providers (via usual operations or surge capacity phone
bank).
Department of Agriculture –
i.
Shares animal surveillance information that has potential
human health implication with WVBPH and DSDC.
ii.
Coordinates animal disease surveillance, investigation, and
prevention efforts, as applicable.
iii.
Serves as subject matter experts in animal disease
surveillance cases.
WV Department of Environmental Protection –
i.
Provides hazardous materials expertise and services,
especially during a chemical or chemical agent release.
B. SPECIMEN COLLECTION, TRANSPORT, AND TESTING –
1.
2.
3.
4.
Purpose –
Provide rapid and effective laboratory services in support of the response
to public health threats and emergencies, including biological threats and
other infectious disease outbreaks, chemical threats, and radiological
threats.
State lead – Biologic, chemical: Office of Laboratory Services (OLS).
State lead – Radiological: Office of Environmental Health Services
(OEHS).
Local lead: Local health department (Directors/Threat Preparedness
Coordinators).
17
5.
General concepts associated with specimen collection, transport and
testing:
a.
In overt events, laboratory specimen testing will be based on a
joint threat assessment. Specimens not considered
credible threats generally will not be tested.
b.
Specimens associated with credible threats will be collected by
hazmat trained personnel, as applicable. If not available locally,
the WV Office of Emergency Services will work to identify and
deploy appropriately trained and equipped hazmat teams or other
state assets that can support specimen collection and packaging.
All such specimens should be packaged in such a manner that they
can be safely transported by non-hazmat trained personnel or
shipped.
c.
Specimens suggestive of covert events will likely first arise from
Sentinel laboratories.
d.
The WVDHHR Office of Laboratory Services and other members
of the Laboratory Response Network (LRN) serve as the
confirmatory laboratories for specimens associated with suspect
biological or chemical terrorism events.
e.
Select federal laboratories, including CDC and USAMRID, serve
as reference laboratories for WVDHHR OLS.
6.
OVERVIEW OF ROLES AND RESPONSIBILITIES –
a.
The WV DHHR Office of Laboratory Services (WVOLS) –
i.
Aids in the coordination and initiation of the overall system
for specimen collection, transport, submission, and
analysis.
ii.
Provides subject matter expertise to ensure that
environmental samples collected as part of a biological,
chemical or other exposure investigation are appropriately
handled, packaged, and submitted to WVOLS and/or other
designated laboratories.
iii.
Ensures adequate and secure laboratory facilities, reagents,
and equipment to rapidly detect and correctly identify
chemical or biological agents that may contribute to a
public health threat as part of the LRN.
iv.
In coordination with other local, state, and federal agencies,
provides or arranges for laboratory analysis of
environmental or clinical specimens during a disaster.
v.
WVOLS will report laboratory results of environmental
specimens to the lhd, IDEP, WVOES, WVOEHS, the
submitting law enforcement official, and the FBI and/or
Postal Inspector service, as appropriate. WVOLS will
report laboratory results for clinical specimens to the lhd,
18
b.
c.
d.
IDEP, WVOES, and the submitting Sentinel Level
Laboratory.
vi.
Serves as the connection between local and federal
laboratories for information, communication and laboratory
capabilities.
vii.
Provides guidance to clinical and other laboratories in
specimen collection, rule out/rule in testing, and shipment.
WV Local Health Departments (lhd) –
i.
In conjunction with the following agencies: WVOLS,
DSDC (IDEP), WVDEP, WVOEHS, WV Poison Center,
and others as necessary according to event, shall work to
ensure that both clinical and environmental samples
collected as part of a bioterrorism, chemical terrorism, or
other exposure, disease investigation are properly
submitted to WVOLS and/or other designated laboratories,
by means of a threat assessment and notification conference
call, or by other appropriate measures.
ii.
During a cover event that involves intentional food or water
contamination with either a chemical or biological agent,
sanitarians may potentially collect samples using
appropriate personal protective equipment as applicable.
WV Sentinel Level Laboratories –
i.
Sentinel Level Laboratories raise suspicion following the
application of commonly performed clinical laboratory
tests with the objective being to “rule out” suspect
bioterrorism, chemical terrorism, or other disease causing
agents.
ii.
Packages and ships and agents in question as directed by
the WVOLS according to the Infectious Substance
Guidelines provided by the Department of Transportation
(DOT) or International Air Transport Association (IATA).
iii.
The Sentinel Level Laboratory is NOT responsible for and
SHOULD NOT make the decision that a bioterrorism or
chemical terrorism event has occurred.
iv.
Sentinel Level Laboratories serve as a potential resource
for OLS surge capacity personnel and facilities.
Division of Surveillance and Disease Control (DSDC) –
i.
Through the Infectious Disease Epidemiology Program
(IDEP) and in conjunction with local health departments,
ensure that clinical samples collected as part of a
bioterrorism or other exposure investigation is
appropriately submitted to WVOLS and/or other designated
laboratories.
ii.
Shares information obtained through surveillance efforts
with WVOLS to ensure proper preparation for specimen
workload.
19
e.
f.
g.
h.
i.
WV Emergency Management Agency (WVEMA) –
i.
Related to suspect terrorism, assigns and EOC Message
Number to both clinical and environmental specimens
submitted to WVOLS as a means to log and track suspected
bioterrorism and chemical terrorism event specimens.
WV State Police (WVSP) and Local Law Enforcement (LLE) –
i.
May, in the course of managing or investigating suspect
biological, chemical or other terrorism events collect
environmental specimens that are deemed credible but do
not require HazMat level collection skills and equipment.
When undertaken, this should be done in accordance with
WVOLS specimen collection guidelines.
ii.
Serves as the most common mode for transport and
delivery of environmental specimens to the WV DHHR
OLS.
iii.
WVSP reports and responds to a positive identification
screen for explosives performed on environmental
specimens at WVOLS.
WV First Responders, including Local Fire Departments and
HazMat Teams –
i.
If deemed a credible threat and necessary, an appropriate
HazMat trained team/individual performs preliminary
screening analysis for radiological, biological, and/or
chemical agents, collects environmental specimens an then
packages environmental specimen for transport to the
WVOLS.
ii.
Handles safety/contamination issues at the incident site.
Federal Bureau of Investigation (FBI) and the U.S. Postal
Inspection Service –
i.
The FBI and the U.S. Postal Inspection Service may
manage or be involved in the investigation of
environmental specimens alleged to contain a bioterrorism
or chemical terrorism agent.
ii.
Should be notified to investigate, potentially collect, and
deliver environmental specimens to the WVOLS.
iii.
At times, perform laboratory tests of environmental
specimens associated with potential criminal activity.
Army National Guard 35th Civil Support Team (CST) –
i.
Where local HazMat trained resource is needed but not
available and event is deemed credible, provide HazMat
trained personnel, at the request of WVOES, to perform
preliminary screening analysis for radiological, biological,
and/or chemical agents (if indicated), collect environmental
specimens and/or package environmental specimens for
transportation to the WV DHHR OLS and/or other
designated laboratories for confirmatory identification.
20
j.
k.
1.
2.
3.
ii.
Coordinates all confirmatory testing with WVOLS>
West Virginia Regional Response Teams (RRT) –
i.
Where local HazMat trained resource is needed but not
available and event is deemed credible, provide Hazmat
trained personnel, at the request of WVOES, to perform
preliminary screening analysis for radiological, biological,
and/or chemical agents (if indicated), collect environmental
specimens and/or package environmental specimens for
transportation to the WV DHHR OLS and/or other
designated laboratories for confirmatory identification.
WV Bureau for Public Health Office of Environmental Health
Services (WVOEHS) –
Environmental Engineering and Public Health Sanitation
Division –
i.
Provides subject matter expertise related to handling food
and water specimens, food contamination, and dairy
livestock contamination due to biological terrorism.
ii.
During a covert event that involves intentional food or
water contamination with a chemical or biological agent,
WVOEHS engineers and sanitarians may potentially collect
samples using appropriate level PPE as applicable.
iii.
Provides support and back up to the local health
departments and the public and private drinking water
systems including individual domestic wells located in the
state. They may direct public water systems to implement
certain pre-emptive/preventative/treatment measures.
Radiation, Toxics and Indoor Air Division –
i.
Provides technical assistance or guidance on toxics and
radiological testing issues and on proper toxics and
radiological specimen collection.
ii.
When necessary, provides filed analysis to identify toxic
agents and radiation sources.
iii.
Coordinates local/county/qualified expert roster/other state
and federal assistance in laboratory evaluation of the
sample, including scope and content of potential
radioactive contamination.
iv.
Responds to a positive identification screen for
radioactivity performed on environmental specimens at
WVOLS.
WV Agency for Toxic Substances and Disease Register (ATSDR)
Partnership Program –
i.
Provides hazardous materials expertise to ensure that
appropriate environmental and clinical samples collected as
part of a hazardous material incident, including chemical
terrorism exposure investigations, are appropriately
submitted to WVOLS and/or other designated laboratories.
21
l. West Virginia Department of Agriculture (WVDA) –
i.
Collaborates with the WVOLS, WVOEHS, and lhds in
ensuring that food is safe for human consumption.
ii.
Serves as the lead agency for animal disease surveillance
and control.
iii.
Provides subject matter expertise related to handling raw
animal food product specimens, raw animal food product
contamination, and livestock contamination due to
biological terrorism.
iv.
If deems necessary, performs preliminary screening
analysis for either food contamination and/or livestock
contamination due to biological terrorism utilizing a
WVDA mobile response laboratory.
m.
West Virginia Department of Environmental Protection (WVDEP)
i.
Provides subject matter expertise to ensure that
environmental samples collected as part of a biological and
chemical terrorism exposure investigation are appropriately
handled and packaged.
ii.
Provides assistance in environmental laboratory services,
including preliminary analysis, aiding in toxic chemical
identification, and in evaluation of safe water supplies.
iii.
Where local HazMat trained resource is needed but not
available and event is deemed credible, provide HazMat
trained personnel, at the request of WVOES, to perform
preliminary screening analysis for radiological, biological,
and/or chemical agents (if indicated), collect environmental
specimens and/or package environmental specimens for
transportation to the WV DHHR OLS and/or other
designated laboratories for confirmatory identification.
n.
West Virginia Poison Center –
i.
Provides toxicological expertise in determining appropriate
laboratory data needed from humans or small animals to
evaluate health effects or establish a diagnosis following a
terrorism event or other toxicological exposure.
o.
State Fire Marshal’s Office –
i.
Reports and responds to a positive identification screen for
explosives performed on environmental specimens at
WVOLS.
p.
West Virginia Colleges and Universities –
i.
Provides subject matter expertise related to health and
laboratory diagnosis.
ii.
Serves as a potential resource for surge capacity personnel
and facilities.
22
C.
Mass Delivery of Prophylactic Medications or Vaccines (SNS) –
1.
Purpose –
Delivers prophylactic medication or vaccine and/or additional
medical equipment and supplies, as efficiently an effectively as
possible to a targeted, at risk population with the goal of
decreasing incidence and severity of disease and saving lives.
2.
State Lead. –
Division of Threat Preparedness, Strategic National Stockpile
Program, in conjunction with the WV Immunization Program.
3.
General Concepts –
a.
Local assets of medications or vaccine are first utilized.
When these are no longer sufficient, state assets of
medications or vaccines are utilized. When state assets
have been, or are expected to be exhausted, material from
the Strategic National Stockpile is requested.
b.
The state is responsible for requesting SNS assets through
CDC and for receiving and distributing assets, including
medications and vaccinations from the Strategic National
Stockpile either via push pack or vendor managed
inventory to distribution sites or facilities as appropriate.
c.
Localities, either individually or in groupings are
responsible for retrieving supplies from distribution sites
(when used) and dispensing of medications or vaccines to
the at risk population residing in their jurisdiction.
d.
Deployed with SNS are the CDC Technical Assistance and
Response Unit. These individuals assist with logistic
support in managing assets at the state level and with
facilitating communications between the state and CDC.
e.
CHEMPACK assets are SNS assets pre-deployed from
CDC within West Virginia to assist in providing rapid
treatment in a chemical exposure. DHHR/DTP is
responsible for working with hospitals and EMS agencies
to maintain these pre-deployed assets and to coordinate
their further deployment in an event.
f.
SNS deployment and distribution requires significant
assistance from/close coordination with public information
systems at both state and local levels. At the state level, the
WV Poison Center serves as a surge capacity phone bank
for managing SNS deployment/distribution questions in an
event.
g.
SNS deployment/distribution requires significant
coordination with local health departments, hospitals and
other health care facilities assisting with distribution at the
community level.
23
4.
Roles and Responsibilities –
a.
Division of Threat Preparedness, Strategic National
Stockpile Program (SNS) –
i.
Assure plans and personnel are in place for
requesting, receiving and distributing assets,
including medications and vaccinations from the
SNS either via push pack or vendor managed
inventory.
ii.
Oversee request, receipt, delivery, distribution and
tracking of SNS assets.
iii.
Maintain Receipt, Staging and Storage team.
iv.
Provide guidance and technical assistance to local
health departments and others involved in
dispensing of prophylactic medications or vaccine.
b.
Division of Surveillance and Disease Control (DSDC) –
i.
Establish through data from disease surveillance
and epi investigation that mass
medication/vaccination, including though not
limited to use of SNS assets, is warranted.
ii.
Make recommendations as to assets needed (type
and dosage of medication/vaccination indicated,
special populations to plan for, estimated number
exposed/potentially exposed, etc.).
iii.
Use surveillance/investigation data to identify at
risk populations for prophylaxis with medication or
vaccine.
iv.
As possible, evaluate effectiveness of use of
medications/vaccination program.
c.
WV Poison Center –
i.
Support hospital pharmacies in developing and
drilling plans for dispensing medications/vaccines
to their staff/patients.
ii.
Set up and maintain a surge capacity phone bank to
receive and triage calls related to
medication/vaccination dispensing in an event.
iii.
Provide pharmaceutical expertise to SNS planning
and tool development.
iv.
Provide toxicological expertise on treatment of
chemical and radiological exposure.
v.
Train teams of personnel capable of dispensing
medications/vaccines.
d.
WVBPH Office of Environmental health Services
(WVOEHS) Radiation, Toxics and Indoor Air Division –
i.
Radiological Health Program regulatory controls,
guidance and direction to the local health
departments in Ohio, Brooke, Marshall and
24
e.
f.
g.
h.
i.
Hancock counties for thyroid prophylaxis using
potassium iodide (KI) in the event of a release of
radioactive iodine from a nuclear power plant
excursion which would affect the residents,
workers, transients or those institutionalized persons
within the 50 mile emergency planning zone for
Beaver Valley Power Station in Beaver County,
Pennsylvania.
Office of Laboratory Services –
i.
Provide laboratory confirmation of agent in
question, including antimicrobial susceptibilities,
thus enabling proper choice of medication/vaccine.
State Health Officer –
i.
Verify/confirm need for SNS assets.
ii.
Work in conjunction with the Governor’s Office to
formally request SNS from CDC.
Local Health Departments –
i.
Maintain plans for receiving and dispensing
medications/vaccines to all residents of their
jurisdiction in accordance with the WV SNS LHD
Dispensing Plan Template.
ii.
Maintain pre-established MOUs and other
necessary arrangements for sufficient facilities to
accomplish dispensing.
iii.
Maintain and train teams of personnel capable of
dispensing medications/vaccines.
iv.
Either individually or in regional groupings,
dispense medications or vaccines to the at risk
population residing in their jurisdiction, when
necessary.
v.
Work with health care facilities and other
institutions to assure target groups within
institutionalized populations are prophylaxed.
vi.
Return all unused assets to WVDHHR.
vii.
Coordinate all risk communication/public
information across jurisdictions and with the state
SNS program.
Local Health Officer –
i.
Serve as local physician of record for distributing
vaccines/medications.
ii.
Liaison with health care personnel to support triage
and treatment of potentially ill individuals
presenting to dispensing clinics.
Hospitals –
i.
Maintain plans to provide medication/vaccine to
hospital staff and patients.
25
ii.
j.
k.
l.
m.
n.
Work with local health departments to determine
how prophylaxis will be delivered to first
responders and families of employees (by hospital
or lhd).
iii.
Coordinate hospital based dispensing efforts with
local health department covering the jurisdiction.
iv.
Coordinate communications related to dispensing
clinics with state and local health agencies to assure
consistent communication and coordination of
timing.
v.
Where applicable, maintain ChemPak supplies in
accordance with established agreement.
WV Emergency Management Agency –
i.
Support logistics of SNS response, including
potential support of asset staging and transport (role
for RRT teams?).
ii.
Identify and coordinate security assets needed (to
potentially include WV State Police, WV National
Guard, and other security personnel) to support SNS
material receipt staging, storage and distribution.
iii.
Receive request for supplies from local EMA
offices and coordinate with state SNS program.
WV State Police –
i.
Assist with security of material and personnel
involved in its receipt, staging and transport.
ii.
Lead agency for planning security (at state level).
Local Law Enforcement –
i.
Work with local health department to ensure
security of assets and personnel associated with
dispensing medications/vaccines.
ii.
Assists in logistics related to movement/transport of
assets (ie: traffic control).
Governor’s Office –
i.
Assist in placing formal request with CDC, as
needed.
Office of Behavioral Health Services/Data Integration and
Security Division –
i.
Support SNS personnel at distribution sites by
providing psychosocial support, behavioral health
triage, and crisis intervention services through
Crisis Outreach Workers for the psychological
victims and engage and screen survivors and
personnel for psychological risk factors.
26
D.
Surge Capacity Patient Care –
1.
Purpose –
To maximize efficient transport and effective care for
casualties of a public health threat, in an effort to mitigate
impact of the disaster on human health.
2.
Lead State Agency –
Office of Emergency Medical Services, with the support of
the Division of Threat Preparedness Healthcare System
Preparedness Coordinator. The State EMS Medical
Director serves as the state level physician evaluating and
overseeing the clinical care system during a disaster.
3.
Overview of Concepts –
Surge capacity patient care plans are outlined in Regional
Health Care System Response Plans. Each, by reference
here, is incorporated into this response plan.
4.
Roles and Responsibilities –
a.
WVDHHR Office of Emergency Medical Services
i.
Assists local and regional EMS response
teams in coordinating patient triage and
transport.
ii.
Plans for and oversees the movement of
medical supplies, equipment, vehicles and
personnel (including EMS assets) to the
affected area during an event.
iii.
Assists in arranging for and coordinating
arrival and set up of incoming federal health
care assets (eg: DMAT, Metropolitan
Medical Response System groups, etc.).
iv.
Assesses need for surge capacity healthcare
personnel and works to link facilities in need
with personnel available.
v.
Maintains and operates the WVDHHR
Mobile Command Center.
b.
Medical Command Centers –
i.
Coordinate transport and distribution of
patients across facilities. Track bed capacity
and other medical resources.
ii.
Undertake disease surveillance, looking for
unusual trends or using run data to identify
potential magnitude of the problem in
approximately real time. This may also
include tracking numbers of ill or injured
individuals.
27
iii.
c.
d.
e.
The WV Office of Emergency Medical
Services Mobile Command Center can serve
as a mobile medical command center when
additional medical command is needed or is
otherwise unavailable.
WV Regional Response Team – EMS
i.
The purpose of the Regional Response Team
– Emergency Medical Services (RRT-EMS)
is to provide a coordinated, specialized
emergency medical response to large scale,
multi-casualty incidents and other states of
emergency.
ii.
May serve in the following capacities during
a Federally-declared disaster, state of
emergency or authorized response:
a. Compliment other DMAPS
Regional Response Team
disciplines.
b. Supplement a local emergency
medical services agency.
c. Assist a local health department.
d. Assist a local hospital.
iii.
Is an asset of a geographical area of the state
that may be utilized anywhere in the state
upon proper notification, alone or jointly
with other agencies. It functions similarly to
the Disaster Medical Assistance Teams
(DMATS) of the National Disaster Medical
System.
Division of Surveillance and Disease Control,
Infectious Disease Epi Program –
i.
Provides guidance to providers on
recommended treatment.
ii.
Provides surveillance data potentially
impacting patient triage or treatment.
iii.
Helps develop and disseminate Health
Alerts to physicians and other partners.
WV Poison Center –
i.
Provides guidance on clinical management
of chemical exposures.
ii.
Maintains surge capacity phone bank
capable of triaging provider calls to
applicable clinical and public health experts.
28
iii.
f.
Supports hospital pharmacies in
implementation of SNS plans within their
facilities.
iv.
Provides toxicological expertise regarding
antidote administration.
Office of Environmental Health Services –
i.
Radiation Toxics and Indoor Air Division –
Radiological Health Program –
a.
Provides radionuclide
characterization (alpha, beta and
gamma) or isotope identification and
support to first responders or health
care providers.
b.
Provides regulatory control and
or medical management or
contaminated patients or deceased
radioactive patients.
c.
Provides emergency services, first
responders, and health care workers
with precautionary procedures or
pertinent details from incident
investigations.
d.
Provides regulatory control and
guidance for management of
radioactive contaminated air, soil,
water, or food sources affecting the
environment and the general public
food chain.
ii.
WV Agency Toxic Substance Disease
Registry Partnership –
a.
WV ATSDR Partnership staff in
concert with laboratory and
epidemiology staff and other
agencies (DEP and EPA, etc.), will
provide guidance to prevent ongoing
and future exposures, and resultant
health effects, from hazardous
substances releases.
b.
WV ASTDR Partnership staff
determines human health effects
associated with exposures to
hazardous substances.
c.
Provided educational information on
risk and exposure assessments to
radiological or chemical
29
g.
h.
contaminants following disaster
situations.
iii.
Public Health Sanitation Division –
a.
Inspect mass treatment sites for
proper collection and disposal of
infectious waste materials.
Hospitals –
i.
Maintain and regularly exercise a current
facility disaster plan.
ii.
Maintain strong systems for disease
detection and reporting to public health.
iii.
Participate in Regional Healthcare System
Response as per developed plans and
MOUs.
iv.
Work in advance to establish mechanisms
for sharing of staff/incorporating health
professional volunteers into
emergency/disaster scenario response.
v.
Utilize established teams to undertake
patient/responder decontamination at the
facility, as necessary.
vi.
Provide patient care in accordance with
recommended event specific guidelines as
available.
vii.
Support staffing and equipping of off site
health care facilities, as possible.
viii. Assure safety of health care staff.
ix.
Coordinate public information and
communication activities with public health.
x.
Assure appropriate clinical specimens
needed for agent identification/confirmation
are collected and submitted to WVOLS or
other laboratory at their direction.
Primary Care Centers/Other Community Partners –
i.
Maintain and regularly exercise a current
agency disaster plan.
ii.
Maintain strong systems for disease
detection and reporting to public health.
iii.
Participate in Regional Healthcare System
Response as per developed plans and
MOUs. Sample activities include
supporting hospitals in off site patient triage,
providing care to ambulatory patients,
providing surge capacity staff to support
hospitals, alternative care facilities or public
health efforts.
30
iv.
i.
j.
k.
Share information with public health entities
on common concerns/beliefs of patients, so
that more effective communication
messages can be crafted.
v.
Assure safety of health care staff.
vi.
Coordinate public information and
communication activities with public health.
Local Fire Departments and HazMat Teams –
i.
As deemed necessary by the incident
commander or local health officer, to
provide scene or facility supports for patient
and responder decontamination through
mobilization of established county based
decon teams and equipment.
Office of Behavioral Health Services/Data
Integration and Security Division –
i.
Support hospitals, public health agencies,
and communities in assuring provision of
behavioral health response to psychological
victims and disaster and recovery workers
and their families.
ii.
Maintain community based teams to assess
psychological impact of disaster and triage
affected individuals as needed.
iii.
Assess psychological impact of disaster on
responders, triage affected individuals into
care as needed.
iv.
In conjunction with the Medical Examiners
Office, American Red Cross, and others,
support Family Assistance Centers and
Respite Centers.
v.
Communicate common messages, beliefs
and concerns heard from impacted
individuals to public health so that risk
communication messages addressing
community concerns can be developed.
Academic Centers –
i.
Provide expert consultation and subject
matter expertise to public health.
ii.
Provide consultation to health care providers
and support medical referrals, as appropriate
and necessary.
31
E.
Mass Fatality Management –
1.
Purpose –
To identify victim remains, to provide death investigation
and certification, to maintain appropriate chain of custody
of evidence, and to safely handle and dispose of human
remains.
2.
Lead State Agency – Office of the Chief Medical Examiner
3.
Roles and Responsibilities –
a.
Office of the Chief Medical Examiner –
i.
Review local, state and federal resources.
ii.
In collaboration with public health and
public safety officials; provide guidance to
hospitals, funeral directors and the public
regarding disposition of remains.
iii.
In collaboration with the Incident
Commander, select a temporary morgue
site/s, if required, and set up work stations.
iv.
Provide proper storage and disposal of
human remains.
v.
Insure appropriate safety standards in the
morgue.
vi.
Establish victim identification, determine
cause and manner of death and complete
death certificates.
vii.
Duplicate, reconcile and archive temporary
morgue records.
viii. Convert temporary morgue numbers to
working OCME numbers.
b.
Forensic Dental Unit –
i.
Participate in recovery of remains.
ii.
Participate in morgue triage.
iii.
Coordinate ante mortem, postmortem and
comparison team functions.
iv.
Verify victim identification with the chief
medical examiner or designee.
c.
County Medical Examiners –
i.
Notify the OCME in the event of multiple
fatality incident or mass casualty incident.
ii.
Remain on scene or at the incident
command center until the emergency
response team arrives.
iii.
Review local resources.
iv.
Return to normal duties when the State
OCME Response Team arrives on scene.
d.
Environmental Health –
32
i.
e.
F.
Provides consultative services of OCME on
sanitation, radiological and any chemical or
biological disease issue/s that require
specialized knowledge for consideration of
temporary morgue sites and the handling or
disposition of remains.
Office of Behavioral Health Services/Data
Integration and Security Division –
i.
Support the Office of the Chief Medical
Examiner in the establishment of staffing of
the Family Assistance Center.
Disaster Phone Bank Services –
1.
Purpose –
To provide toll-free consultation to hospitals, clinicians and
the general public during a bioterrorism event or other
public health emergency.
2.
State Lead –
WV Poison Control Center in partnership with the Bureau
for Public Health.
3.
Roles and Responsibilities –
a.
WV Bureau for Public Health –
i.
The DHHR Disaster Coordinator will
request the activation of the Disaster
Hotline.
ii.
Applicable technical area experts (EDEP,
OEMS, ATSDR, Partnership Program and
Radiological Health Program) will assist
with developing messages and responses to
common questions for the public and
providers.
iii.
Accepts referral calls triaged through the
phone bank.
iv.
Maintains back up (reserve) continuity of
operations site for Poison Center (Division
of Threat Preparedness).
b.
Poison Center –
i.
Implement the phone bank at the request of
the DHHR Disaster Coordinator to address
common public or provider questions.
ii.
The WVBPH surge capacity phone bank is
maintained by the WV Poison Center. It is
staffed by trained volunteers under the direct
supervision of a Poison Specialist.
iii.
Maintain the phone bank systems to assure
rapid and effective implementation.
33
iv.
v.
G.
Maintain trained volunteers to staff the surge
capacity phone bank.
Refer necessary calls to applicable Public
Health authority or clinical consultant.
Crisis and Emergency Risk Communications –
1.
Purpose –
Emergency risk communications is used when there is a
clear threat to the public health and it is necessary to
communicate with the public and other stakeholders, often
through the media, about preventive and protective actions
to be taken. The goal of such communication is to allow
the public to make informed decisions about their health
and well being during the crisis or emergency. The State
Health Officer, State Epidemiologist and others serve as
subject matter experts to develop recommendations for the
public.
2.
State Lead –
WV Department of Health and Human Resources
(WVDHHR), Bureau for Public Health (BPH), Division of
Threat Preparedness (DTP).
3.
General Concepts –
a.
Communication will be open, honest, accurate and
timely. The release of information will follow the
Freedom of Information Act guidelines; however, in
the threat preparedness arena of public health,
certain information is restricted for security reasons.
b.
It will be necessary to translate scientific
information into message for non-scientific
audiences. Communication must be clear and
simple to provide the greatest benefit to the public.
c.
Local health departments are the first one of local
communications with the public and media with
backup being provided as needed by regional health
department groups or state and federal agencies.
Local health departments may request assistance
from any of these partners when their resources are
overwhelmed.
d.
It is important to share information among
communications partners so those consistent
messages are delivered to the public and media.
WVDHHR is the coordinating entity to accomplish
this task related to health.
e.
During a public health emergency or crisis, it may
be necessary to establish a Joint Information Center.
If so, this center will be situated locally or
34
4.
regionally or for statewide use, depending upon the
extent of the emergency. Risk communication staff
from all levels may be part of the Joint Information
Center. Recognizing that one spokesperson is
usually best in terms of consistency, it may be
necessary for communications designees to
designate one person for this role.
Roles and Responsibilities –
a.
WVDHHR Office of Communications –
i.
Serves as liaison between DHHR and
Governor’s Office.
ii.
Conducts media interview.
iii.
Writes and distributes news releases.
iv.
Advises DHHR Secretary on developing
emergency and assists with clearance and
dissemination of all communication
materials.
b.
Division of Threat Preparedness –
i.
Develop materials (fact sheets, news
releases, public service announcements,
brochures, etc.), as much as possible before
an emergency. A password-protected
document stockpile available on the DTP
web site will be available to local health
departments.
ii.
Coordinate risk communications during an
event between local and state providers and
other partners in the health care system.
iii.
Develop key messages with assistance from
subject matter experts, State Health Officer
and local health departments.
iv.
Serve as/provide spokesperson for statewide
event. May perform duties in the field, if
necessary.
v.
Makes recommendations to Incident
Commander concerning contact with media
and public.
vi.
Serve/provide as public information officer
in public health or overall command center.
vii.
Establish Joint Information Center if needed.
c.
Local and Regional Health Departments –
i.
Notify key local partners and state officials.
ii.
Serve as spokesperson for local or regional
event.
35
iii.
d.
H.
Request assistance from region or state and
make recommendations about community’s
needs.
Hospitals and Health Care Providers –
i.
Follow risk communication/public
information plans and protocols outlined in
Regional Healthcare System Response
Plans.
ii.
Coordinate public information with public
health and other response partners.
Environmental Health Functions –
1.
Purpose –
a.
Monitor environmental factors that contribute to
disease outbreaks/harmful health effects.
b.
Ensure the control and abatement of environmental
factors that contribute to disease outbreaks/harmful
health effects.
c.
Provide guidance on disease prevention through the
control of environmental factors.
2.
Leadership Roles –
a.
Lead State Agency – Office of Environmental
Services, WVBPH.
b.
Lead Local Agency – Local health departments
3.
General Concepts –
a.
Environmental health program responsibilities are
found in the program areas of:
i.
Food
a.
Mass feeding sites
b.
Affected facilities and supplies
c.
Commercial manufacturers
ii.
Drinking water
a.
Public
b.
Private
c.
Emergency supplies
iii.
Sewage
a.
Public
b.
Private
iv.
Solid waste
a.
Disposal of contaminated material
b.
Infectious medical wastes
v.
Housing/recreational facilities
a.
Emergency housing
b.
Demolition and asbestos abatement
c.
Affected commercial facilities
d.
Play grounds/parks/athletic facilities
36
vi.
4.
Epidemiology
a.
Epidemiological investigation
b.
Vector/pest control
c.
Indoor air quality
d.
Risk exposure/assessment
vii.
Communication
Overview of Roles and Responsibilities –
a.
Office of Environmental Health Services –
i.
Readiness staff will:
1.
Work with BPH Commissioner and
DEP to ensure that weight and
content restriction at permitted waste
disposal facilities are lifted as needed
for disposal of contaminated items to
prevent a public health crisis.
2.
Collect and maintain open flow of
information between state and local
environmental health field staff in
the disaster area regarding damages,
needs, threats, recovery/mitigation
accomplishments, etc.
3.
Report disaster assessments to the
state EOC for allocation of state
resources/appropriate response.
4.
Provide link/conduit for all
environmental health
information/response needs from
other state agencies in the EOC back
to state and local environmental
health field staff in the disaster area.
ii.
Division of Environmental Engineering –
1.
Assist in conducting damage
assessments of drinking water
treatment system infrastructure.
2.
Provide technical and regulatory
guidance to public drinking water
treatment systems.
3.
Sample/monitor public drinking
water supplies.
4.
Issue boil water advisories/orders.
5.
Assist in the repair/recovery of
affected public drinking water
supplies.
6.
Assist DEP in conducting damage
assessments to waste water treatment
systems.
37
iii.
iv.
Division of Public Health Sanitation –
1.
Conduct inspections and sampling of
affected commercial food
manufacturing facilities.
2.
Provide sanitarian assistance to local
health departments when requested
and when possible in carrying out all
environmental health duties assigned
to local health department.
3.
Provide assistance in conducting
disease outbreak investigations. This
may include victim interviews,
record keeping, environmental
investigation and sampling,
conducting/coordinating trace back
investigations, etc.
4.
Provide guidance to affected
individuals on hygiene and
preventive measures.
5.
Institute environmental control
measures including embargo, seizure
and sampling of suspected products.
6.
Inspect affected facilities that
produce medical wastes.
7.
Inspect mass treatment sites for
proper collection and disposal of
infectious waste materials.
8.
Investigate/inspect dairy farms and
processing facilities related to animal
disease outbreaks (in conjunction
with Dept. of Ag).
Division of Radiation, Toxics and Indoor
Air –
1.
Respond to incidents of radioactive
material at waste disposal sites/other
locations, as possible.
2.
Provide guidance on disposal of
radioactive waste material.
3.
Provide guidance and oversight of
distribution of mass medications in
the event of radioactive incident.
4.
Provide educational material and
guidance on the control of mold
growth.
5.
Inspect public schools for mold
growth prior to occupancy.
38
6.
v.
Inspect public buildings for mold
growth when re-occupied and upon
receiving written request from local
officials.
7.
Provide guidance and enforcement of
federal regulations regarding the
abatement of asbestos in the
demolition of condemned structures
and repair of damaged structures.
8.
Provide educational information on
risk and exposure assessments to
radiological and chemical
contaminants following disaster
situations.
9.
WV ATSDR Partnership staff in
concert with laboratory and
epidemiology staff and other
agencies (DEP and EPA, etc.), will
provide guidance to prevent ongoing
and future exposures, and resultant
health effects, from hazardous
substance releases.
10.
WV ATSDR Partnership staff
determines human health effects
associated with exposures to
hazardous substances.
11.
WV ATSDR Partnership staff
reviews and analyzes chemical
testing results to assess potential
human exposure pathways and
effects.
Local Health Departments –
1.
Will communicate with OEHS staff
regarding damages, needs, threats,
recovery/mitigation
accomplishments, etc.
2.
Provide guidance/distribute
educational information to residents
with affected private water supplies.
3.
Sample/test/monitor emergency
water supplies and affected private
water supplies.
4.
Distribute educational information or
provide guidance and oversight of
disposal of contaminated food
39
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
product at both residential and
commercial facilities.
Undertake inspections and sampling
of products at affected commercial
food facilities.
Undertake inspections of mass
feeding sites and food storage
facilities.
Provide guidance on the cleanup and
disposal of equipment in affected
food facilities.
Undertake inspections of emergency
shelters including emergency
shower/bathing facilities and
provisions for/locations of
emergency power and heat sources.
Provide guidance on the disposal or
cleaning of contaminated household
items.
Undertake inspections of affected
hotel/motel/bed and breakfasts.
Provide guidance/oversight and
compliance inspections for the
construction of temporary housing
developments and mobile home
parks.
Provide guidance/oversight and
compliance inspections of affected
permitted facilities such as
campgrounds, recreational water
facilities, and play areas, including
but not limited to playgrounds and
ball fields.
Work in concert with National Guard
and DEP in inspections/monitoring
of waste disposal sites and locations
to minimize public health impacts.
Undertake inspections/installation,
monitoring of portable/public toilets
in affected areas.
Provide guidance and undertake
inspections of repairs made to
affected septic systems.
Provide guidance and monitor
numbers and sign of pests of public
40
vi.
vii.
viii.
health importance following an
event.
17.
Provide assistance in conducting
disease outbreak investigations. This
may include victim interviews,
record keeping, environmental
sampling, etc.
18.
Provide guidance to victims on
hygiene and preventive measures.
19.
Institute environmental control
measures including embargo, seizure
and sampling of suspected products.
Department of Environmental Protection –
1.
Work in concert with lhd and OEHS
inspections/monitoring of waste
disposal sites and locations to
minimize public health impacts.
2.
Maintain open communications and
coordinate activities with
WVBPH/OEHS during chemical or
other HazMat drills and events.
3.
Provides chemical and radiological
sample results to lhd and the OEHS
ATSDR Cooperative Partners
Program.
Department of Agriculture –
1.
Work in concert with OEHS in
monitoring and controlling disease
outbreaks related to dairy farms.
2.
Work in concert with OEHS in
monitoring and control of possibly
contaminated food supplies stored in
bulk warehouses or distribution
centers for the Donated Foods
Program from entering the food
supply.
3.
Work in concert with OEHS and lhd
in the removal of domesticated
animal carcasses from waterways
that serve as drinking water sources.
Division of Surveillance and Disease
Control –
1.
Allocated personnel and other
resources as back-up/surge capacity
for other epidemiologists in the
Bureau, to include assistance with
41
2.
3.
4.
5.
ix.
data management and data analysis,
epidemiological investigation, case
ascertainment, hypothesis testing,
study design and other aspects of
epidemiological investigation.
Establishes and maintains federal,
state, and local relationships and
partnerships necessary to support
disease surveillance and
epidemiological response.
Makes recommendations to incident
command on disease control and
prevention activities.
Provides timely summarization of
data and information on number of
cases, identified risk factors or
exposures, characteristics of at-risk
populations including contacts at risk
for development of disease,
complications including deaths and
hospitalizations, and the impact of
disease prevention and control
activities.
In BPH notification protocol, notifies
State health Officer/BPH Leadership
of investigation findings (lab results,
key epidemiological findings, etc.)
for suspect and confirmed cases.
Lab –
1.
Aids in the coordination and
initiation of the overall system for
specimen collection, transport,
submission and analysis.
2.
Provided subject matter expertise to
ensure that environmental samples
collected as part of a biological and
chemical terrorism exposure
investigation are appropriately
handled, packaged, and are
appropriately submitted to WVOLS
and/or other designated laboratories.
3.
In coordination with other local, state
and federal agencies, provides or
arranges for laboratory analysis of
environmental or clinical specimens
during a disaster.
42
4.
I.
WVOLS will report laboratory
results of environmental and clinical
specimens as per the notification
protocol.
Notification and Support of LHDs –
1.
Purpose –
The WV Division of Local Health serves as the state liaison
to local health departments. The mission of the Division is
to enhance the framework and provide support for local
health department employees and local boards of health
as they deliver public health services and improve
community health.
2.
Leadership Roles –
Lead State Agency: Office of Community Health Systems,
Division of Local Health, in close partnership with the
Office of Environmental Health Services, Division of
Surveillance and Disease Control and Division of Threat
Preparedness.
3.
General Concepts –
a.
The Division of Local Health –
i.
Maintains a current database of emergency
contact information for local health
departments and distributes the list to
appropriate state offices/agencies as
revisions/updates are made.
Maintains a database of trained and certified
smallpox vaccinators that will allow planners to
contact and deploy qualified smallpox vaccinators
to areas of the state where vaccination clinics are
needed, should a smallpox event occur.
iii.
Regularly drills lhds 24/7 notification capability.
iv.
Coordinates communications between local health
departments and BPH, including coordination of
disaster related conference calls.
v.
During a natural or intentional disaster, provide
local and state governmental agencies with accurate
information regarding phone, fax, e-mail and
physical addresses for lhds and agencies within the
BPH. This includes information regarding contact
after normal business hours.
b.
During Disaster: DLH and OEHS service as primary
liaisons between BPH and LHDs by undertaking the
following activities:
i.
DLH and OEHS personnel contact affected counties
daily during the disaster period OEHS collects
43
ii.
iii.
J.
environmental health data and DLH most other
disaster related data. The information obtained
from the counties is entered into a database and a
report generated. The report is sent to EOC for
inclusion in daily briefings.
The DLH and OEHS act as reference point to
identify and, when appropriate, secure additional
volunteer public health staff for disaster affected
areas. This is accomplished by conducting surveys
of BPH agencies and local health departments in
unaffected areas to identify available additional
staff and referral of those identified to the areas
affected by the disaster.
DLH or OEHS staff may be deployed to the field to
assist.
Family Assistance Center –
1.
Purpose –
To assure a safe, secure, and supportive environment for
families of victims; to provide families with ready access to
needed resources; to gather information from families
necessary to identify victims of event; to assure that family
members are notified of victim identification before
information is released publicly.
2.
Lead State Agency – Office of the Chief Medical
Examiner, WVBPH, in partnership with
BHHF/OBHS/DISD.
3.
General Concepts –
a.
The Family Assistance Center should provide a
secure and supportive environment for families of
victims.
b.
Set up and staffing requires the active involvement
and participation of many agencies.
c.
Communications with the media should be
controlled to protect families and workers.
4.
Roles and Responsibilities –
a.
Office of the Chief Medical Examiner –
i.
Collect ante mortem information from
family members to assist in victim
identification and convey to the morgue.
ii.
With communications staff, assure that
family members have been informed of
victim identification prior to public release
of that information.
b.
Office of Behavioral Health and Health Facilities –
44
i.
c.
d.
e.
f.
K.
Assist in the collection of ante mortem
information from family members to assist
with identification and covey to the morgue.
ii.
Provide individuals and families with
information, crisis intervention, and comfort
specific to the needs of the individual and
the situation.
iii.
Crisis Outreach Workers will assist with the
provision of services (ie: privacy, protection
from the media, etc.).
Red Cross –
i.
Provide a secure and supportive
environment for families of victims.
Clergy –
i.
Provide family/friend support and a secure
and supportive environment.
Hospice Volunteers –
i.
Provide family/friend support and a secure
and supportive environment.
Communications Staff (DTP, BPH, local) –
i.
Assure that family members have been
informed of victim identification before
public release of that information.
ii.
Arrange for information release to the media
as appropriate.
iii.
Work with media to address needs as much
as possible, holding as highest priority the
privacy and safety of all family
members/workers within the Family
Assistance Center.
Respite Centers –
a.
Purpose –
A center for disaster workers to obtain rest and
relief from their work. The intent is to ensure and
enhance the maintenance of the safety, health and
optimal functioning levels of the disaster workforce.
b.
Lead State Agency – Office of Behavioral Health
Services/Data Integration and Security Division.
c.
General Concepts –
i.
The Respite Center should provide a secure
and supportive environment for disaster
workers.
ii.
The Respite Center may include the
following: food, recreation, phones,
45
d.
IX.
showers, sleep areas, clean clothing,
behavioral health intervention, etc.
iii.
Set up and staffing requires the active
involvement and participation of many
agencies.
Roles and Responsibilites – (to be developed)
ROLES AND RESPONSIBILITIES BY AGENCY:
Below, responsibilities associated with health and medical response are
compiled by agency.
West Virginia Department of Health and Humans Resources –
A.
OFFICE OF BEHAVIORAL HEALTH SERVICES –
1.
Maintain community based teams to assess psychological impact
of disaster and to triage affected individuals as needed.
Assess psychological impact of a disaster on responders; triage
affected individuals into care as needed.
Support SNS personnel at distribution sites by providing
psychosocial support, behavioral health triage, and crisis
intervention services through Crisis Outreach Workers; engage and
screen survivors and personnel for psychological risk factors.
Support hospitals, public health agencies and communities in
assuring provision of behavioral health response to psychological
victims and disaster and recovery workers and their families.
In conjunction with the Office of the Chief Medical Examiners,
American Red Cross, and others, support Family Assistance and
Respite Centers.
Support the Office of the Chief Medical Examiner in the
establishment and staffing of the Family Assistance Center.
7.
Assist in the collection of ante mortem information from family
members for identification.
Communicate common messages/beliefs/concerns heard from
impacted individuals to public health, so that risk communication
messages addressing community concerns can be developed.
Provide individuals and families with information, crisis
intervention and comfort specific to the needs of the individual and
the situation.
Crisis Outreach Workers will assist with the provision of services
such as security, privacy, protection from the media, etc.
2.
3.
4.
5.
6.
7.
8.
9.
10.
46
B.
OFFICE OF THE CHIEF MEDICAL EXAMINER –
1.
5.
6.
7.
Establish victim identification, determine cause and manner of
death and complete death certificates.
Maintain appropriate chain of custody of evidence and safely handle
and dispose of human remains.
In collaboration with public health and public safety officials,
provide guidance to hospitals, funeral directors, and the public
regarding disposition of remains.
In collaboration with the Incident Commander, select a temporary
morgue site, if required, and set up work stations.
Insure appropriate safety standards in the morgue.
Duplicate, reconcile and archive temporary morgue records.
Convert temporary morgue numbers to working OCME numbers.
C.
OFFICE OF EMERGENCY MEDICAL SERVICES –
1.
Develops and maintains relationships and operating procedures
with local EMS providers and regional Medical Command Centers
necessary to timely surveillance of potential disease outbreaks or
clusters of suspicious symptoms and the accurate reporting of
information to state/local epidemiology staff.
Tracks numbers of cases of trauma, with emphasis on potential
terrorist incidents, such as explosions, incendiary incidents or
attacks with other conventional weapons that produce significant
numbers of trauma patients or fatalities.
Assures appropriate communication channels exist between EMS
Providers, Medical Command Center staff, EMS Medical
Directors and state/regional/local epidemiology staff regarding
patient treatment/management, especially for those affected by
bioterrorism incidents or naturally occurring emerging disease
outbreaks.
Assists local and regional EMS response teams in coordinating
patient triage and transport.
Plans for and oversees the movement of medical supplies,
equipment, vehicles and personnel (including EMS assets) to the
affected area during an event.
Assists in arranging for the coordinating arrival and set up of
incoming federal health care assets (eg: DMAT, Metropolitan
Medical Response System groups, etc.).
Assesses need for surge capacity health care personnel and work to
link facilities in need with personnel available.
Maintains and operates the WVDHHR Mobile Command Center.
2.
3.
4.
2.
3.
4.
5.
6.
7.
8.
47
D.
MEDICAL COMMAND CENTERS –
1.
Coordinate the transport and distribution of patients across
facilities.
Track bed capacity and other medical resources.
Undertakes disease surveillance; looks for unusual trends or use run
data to identify the potential magnitude of the problem in
approximate real time. This may also include tracking numbers of
ill or injured individuals.
The WVOEMS Mobile Command Center can serve as a mobile
medical command center when additional medical command is
needed or is otherwise unavailable.
2.
3.
4.
E.
WV REGIONAL RESPONSE TEAM (EMS) –
1.
The Regional Response Team (RRT) – Emergency Medical
Services is an asset of a geographical area of the state that may be
utilized anywhere in the state upon proper notification, alone or
jointly with other agencies. If functions similarly to the Disaster
Medical Assistance Teams (DMAPS) of the National Disaster
Medical System.
The purpose of the Regional Response Team – Emergency
Medical Services is to provide a coordinated, specialized
emergency medical response to large scale, multi-casualty
incidents and other states of emergency.
The Regional Response Team – Emergency Medical Services may
serve in the following capacities during a federally declared
disaster, state of emergency or authorized response:
i.
Compliment other DMAPS Regional Response
Team disciplines.
ii.
Supplement a local emergency medical services
agency.
iii.
Assist a local hospital.
2.
3.
F.
OFFICE OF ENVIRONMENTAL HEALTH SERVICES (OEHS) –
1.
Works with Bureau for Public Health Commissioner and
Department of Environmental Protection (DEP) to ensure that
weight and content restrictions, at permitted waste disposal
facilities are lifted as needed for disposal of contaminated items to
prevent a public health crisis.
Collects and maintains open flow of information between state and
local environmental health field staff in the disaster area regarding
damages, needs, threats, recovery/mitigation accomplishments, etc.
Reports disaster assessments to the state EOC for allocations of
state resources/appropriate response.
2.
3.
48
4.
5.
6.
7.
8.
9.
10.
Provides link/conduit for all environmental health
information/response needs from other state agencies in the EOC
back to state and local environmental health field staff in the
disaster area.
Provides timely reporting of results of environmental
investigations.
Develops standard operating procedures and educational materials
for environmental component of disease prevention and control.
Provides leadership to environmental investigations.
Supplements the local environmental health and epidemiological
response if needed and if possible.
Ensures implementation of prevention and control measures.
Provides consulting services to the Office of the Chief Medical
Examiner on sanitation, radiological and any chemical or
biological disease issues that require specialized knowledge for
consideration for temporary morgue sites and the handling or
disposition of remains.
G.
OEHS – DIVISION OF ENVIRONMENTAL ENGINEERING –
1.
Assists in conducting damage assessments of drinking water
treatment system infrastructure.
Provides technical and regulatory guidance to public drinking
water treatment systems.
Directs public water systems to implement certain preemptive/preventative/treatment measures.
Liaisons with the Environmental Protection Agency and other state
drinking water administrators.
Samples/monitors public drinking water supplies using appropriate
PPE.
Ensures boil water advisories/order are issued.
Assists the Department of Environmental Protection in conducting
damage assessments to wastewater treatment infrastructure when
requested, and as available.
2.
3.
4.
5.
6.
7.
H.
OEHS – PUBLIC HEALTH SANITATION –
1.
Assists epidemiological investigation through provision of the
environmental component of investigation in biologic incidents.
Establishes and maintains federal, state and local relationships and
partnerships necessary to support disease surveillance and
environmental health epidemiological response.
Conducts inspections and sampling of affected commercial food
and bottled water manufacturing facilities.
2.
3.
49
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Provides sanitarian assistance to local health departments, when
requested and when possible, in carrying out all environmental
health duties assigned to local health departments.
Provides assistance in conducting disease outbreak investigations.
This may include victim interviews, record keeping, environmental
investigation and sampling, conducting/coordinating trace back
investigations, etc.
Institutes environmental control measures including embargo,
seizure and sampling of suspected food and water products.
Liaisons with the Food and Drug Administration and food safety
officials with other states.
Inspects mass treatment sites for proper collection and disposal of
infectious waste materials.
Investigates/inspects dairy farms and processing facilities related
to animal disease outbreaks (in conjunction with the Department of
Agriculture).
Provides guidance to affected individuals on hygiene and
preventive measures.
Provides subject matter expertise related to food and water
specimens, when contamination is the result of chemical or
biological agent.
Provides support and back-up to the lhds and private drinking
water systems including individual domestic wells located in the
state.
Sanitarians may potentially collect food and water samples using
appropriate level PPE as applicable.
I.
OEHS – RADIATION, TOXICS AND INDOOR AIR DIVISION –
1.
Provides regulatory control and guidance for management of
radioactive contaminated air, soil, water or food sources affecting
the environment and the general public food chain.
Provides educational information on risk and exposure assessments
to radiological (Radiological Health Program) or chemical
(ATSDR Program) contaminants following disaster situations.
For Radiological incidents, serves as lead for surveillance and epi
investigation, supported by the Division of Surveillance and
Disease Control and CDC.
Provides technical assistance or guidance on toxics and
radiological testing issues and on proper specimen collection.
When necessary, provides guidance in field analysis to identify
toxic agents and radiation sources. Provides radionuclide
characterization (alpha, beta and gamma) or isotope identification
and support to first responders or health care providers.
2.
3.
4.
5.
50
6.
7.
8.
9.
10.
11.
12.
13.
14.
Coordinated local/county/qualified expert roster/other state and
federal assistance in laboratory evaluation of the sample including
scope on content of potential radioactive contamination.
Responds to a positive identification screen for radioactivity
performed on environmental specimens at WVOLS.
Responds to incidents of radioactive waste material.
Provides guidance on disposal of radioactive waste material.
Provides guidance to first responders and other medical staff on
prophylaxis of persons exposed to radioactive materials. This
includes providing regulatory control, guidance and direction to
the lhds in Ohio, Brooke, Marshall and Hancock counties for
thyroid prophylaxis using potassium iodide in the event of a
release of radioactive iodine from a nuclear power plant excursion
which would affect the residents, workers, transients or those
institutionalized persons within the 50 mile emergency planning
zone for Beaver Valley Power Station in Beaver County,
Pennsylvania.
Provides regulatory control and guidance for medical management
of radioactive contaminated patients or deceased radioactive
patients.
Provides emergency services to first responders and health care
workers with precautionary procedures or pertinent details from
incident investigations.
Provides educational materials/guidance on control of mold
growth.
Provides regulatory control and guidance to prevent ongoing and
future exposures to asbestos from asbestos related building
materials in affected structures.
J.
OEHS – AGENCY FOR TOXIC SUBSTANCES AND DISEASE
REGISTRY (ATSDR) COOPERATIVE PARTNERS PROGRAM –
1.
For chemical incidents, serves as lead for surveillance and epi
investigations, supported by the Division of Surveillance and
Disease Control and the CDC.
Liaisons with the CDC, DEP, lhds, WVOLS and other agencies or
states for chemical incidents.
Provides hazardous materials expertise to ensure that appropriate
environmental and clinical samples collected as part of a hazardous
material incident, including chemical terrorism exposure
investigations, are appropriately submitted to WVOEHS and/or
other designated laboratories.
In concert with laboratory and epidemiology staff and other
agencies (DEP and EPA, etc.), provides guidance to prevent
ongoing and future exposures and resultant health effects from
hazardous substances releases.
2.
3.
4.
51
5.
6.
Determines human health effects associated with exposures to
hazardous substances.
Provides educational information on risk and exposure assessments
to radiological or chemical contaminants following disaster
situations.
K.
OFFICE OF LABORATORY SERVICES –
1.
2.
Serves as state lead for specimen collection, transport and testing.
Selects Federal Level Laboratories, including CDC and
USAMRID to serve as reference laboratories for WVOLS.
Provides education and guidance on specimen collection and
testing.
Accepts specimens and undertakes testing in support of epi and
law enforcement investigation using current technologies.
Maintains chain of custody as applicable.
Supports timely reporting of laboratory data including
antimicrobial susceptibility data.
Aids in the coordination and initiation of the overall system for
specimen collection, transport, submission and analysis.
Provides subject matter expertise to ensure that environmental
samples collected as part of a biological and chemical terrorism or
samples other exposure investigation are appropriately handled,
packaged and submitted to WVOLS and/or other designated
laboratories.
Ensures adequate and secure laboratory facilities, reagent and
equipment to rapidly detect and correctly identify chemical or
biological agents that may contribute to the threat as part of the
Laboratory Response Network.
In coordination with other local, state and federal agencies,
provides or arranges for biological and chemical laboratory
analysis of environmental or clinical specimens during a disaster.
Serves as the connection between local and federal laboratories for
information, communication and laboratory capabilities.
Provides guidance to clinical and other laboratories in specimen
collection, rule out/rule in testing and shipment.
Provide laboratory confirmation of agent in question, including
antimicrobial susceptibilities, thus enabling proper choice of
medication/vaccine.
Provide regular reports to Public Information Officer.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
L.
OFFICE OF COMMUNITY HEALTH SYSTEMS – THE DIVISION OF
LOCAL HEALTH –
1.
In conjunction with the Office of Environmental Health Services
serves as primary liaisons between the Bureau for Public Health
52
8.
and Local Health Departments in a disaster. During the disaster,
information and disaster related data is collected daily from lhds,
entered into a database and generated into a report. The report is
sent to the state EOC for inclusion in daily briefings.
During a natural or intentional disaster, provides local and state
governmental agencies with accurate information regarding phone,
fax, email and physical addresses for lhds and agencies within
BPH. This includes information regarding contact after normal
business hours.
Coordinates communications between lhds and BPH, including
coordination of disaster related conference calls.
In conjunction with WVOLS, DSDC and IDEP, DEP, OEHS and
the WV Poison Center, works to ensure that both clinical and
environmental samples are collected as part of a bioterrorism,
chemical terrorism, or other exposure/disease investigation are
properly submitted to WVOLS and/or other designated
laboratories, by means of a threat assessment and designated
laboratories, by means of a threat assessment and notification
conference call, or by other appropriate measures.
May be deployed to the field to assist as needed in a disaster.
Acts as a reference point to identify and, when appropriate, secure
appropriate, secure additional volunteer public health staff for
disaster affected areas.
Maintains a database of trained and certified smallpox vaccinators
that will allow planners to contact and deploy qualified smallpox
vaccinators to areas of the state where vaccination clinics are
needed, should a smallpox event occur.
Regularly drills lhds 24/7 notification capability.
M.
DIVISION OF SURVEILLANCE AND DISEASE CONTROL (DSDC) –
1.
Provides timely summarization of data and information on a
number of cases, identified risk factors or exposures,
characteristics of at-risk populations including contacts at risk for
development of disease complications including deaths and
hospitalizations, and the impact of disease prevention and control
activities.
Supplements lhd response, if needed and if possible.
Makes recommendations to Incident Command on disease control
and prevention activities.
Prioritizes response activities to achieve maximum health benefit
when resources are limited.
Develops standard operating procedures and educational materials
for epidemiological investigations as well as for disease prevention
and control (protocols, information sheets, investigation forms,
etc.).
2.
3.
4.
5.
6.
7.
2.
3.
4.
5.
53
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
Establishes and maintains federal, state and local relationships and
partnerships necessary to support disease surveillance and
epidemiological response.
Liaisons with CDC and prevention epidemiologist and
epidemiologists from other states.
Allocates personnel and other resources as back-up/surge capacity
for other epidemiologists to include assistance with data
management and data analysis, epidemiological investigation, case
ascertainment, hypothesis testing, study design and other aspects of
epidemiological investigation.
Establishes through data from disease surveillance and epi
investigation that mass education/vaccination, including though
not limited to use of SNS assets is warranted.
Make recommendations as to assets needed (type and dosage of
medication/vaccination indicated, special populations to plan for,
estimated number exposed/potentially exposed, etc.).
Uses surveillance/investigation data to identify at risk populations
for prophylaxis with medication or vaccine.
Provides guidance to providers on recommended treatment.
Provides surveillance data potentially impacting patient triage or
treatment.
Helps develop and disseminate health alerts to physicians and
other partners.
Through IDEP and in conjunction with lhds, ensures clinical
samples are collected as part of a bioterrorism or other exposure
investigation are appropriately submitted to WVOLS and/or other
designated laboratories.
In BPH notification protocol, notifies State Health Officer/BPH
leadership of investigation findings (lab results, key
epidemiological findings, etc.) for suspect and confirmed cases.
N.
DIVISION OF THREAT PREPAREDNESS –
1.
Coordinates activation of the Health Emergency Operations
Center.
Assists in staffing the DHHR incident command structure.
Staffs the Health Desk at the State Emergency Operations Center
when activated, rotating shifts with other designated BPH
programs.
In conjunction with the Office of Emergency Medical Services
coordinates emergency response functions for public health at the
state level.
Assures plans and personnel are in place for requesting, receiving
and distributing assets, including medications and vaccinations
from the SNS.
2.
3.
4.
5.
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6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Oversees request, receipt, delivery, distribution and tracking of
SNS assets.
Maintains Receipt, Staging and Storage team.
Provides guidance and technical assistance to lhds and others
involved in dispensing of prophylactic medications or vaccine.
Develops materials (fact sheets, news releases, public service
announcements, brochures, etc.) as mush as possible before an
emergency. A pass-word protected document stock pile available
on the DTP website will be available to lhds.
Coordinates risk communications during an event between local
and state providers and other partners in the health care system.
Reports information on casualties and deaths.
Develops key messages with assistance from subject matter
experts, Office of Behavioral Health Services, State Health Officer,
lhds, hospitals and other health care providers.
Serves as/provides spokesperson for statewide event. May
perform duties in the field if necessary.
Makes recommendations to Incident Commander concerning
contact with media and public.
Serves as/provides a public information officer in public health or
overall command center.
Establish Joint Information Center, if needed.
O.
LOCAL HEALTH DEPARTMENTS –
1.
Disseminate information on disease/conditions under public
health surveillance.
Receive disease and outbreak reports.
Investigate and report cases, contacts and outbreak investigation
findings.
Implement prevention and control measures.
Educate patients and providers.
Maintain plans for receiving and dispensing medications or
vaccinations to all residents of their jurisdiction in accordance
with the WV Strategic National Stockpile, local health department
Dispensing Plan Template.
Maintain pre-established MOUs and other necessary arrangements
for sufficient facilities to accomplish dispensing.
Maintain and train teams of personnel capable of dispensing meds/
vaccines.
Either individually or in regional groupings, dispense medications
or vaccines to the at-risk population residing in their jurisdiction,
when necessary.
Work with health care facilities and other institutions to assure
target groups within institutionalized populations are prophylaxed.
Coordinate all risk communication/public information across
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
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12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
jurisdictions with the State Strategic National Stockpile program.
Notify key local partners and state officials.
Serve as spokesperson for local or regional event.
Request assistance from region or state and make
recommendations about community’s needs.
Communicate with Office of Environmental Health staff regarding
damages, needs, threats, recovery/mitigation accomplishments, etc.
Provide guidance/distribute educational information to residents
with affected private water supplies.
Sample/test/monitor emergency water supplies and affected private
water supplies.
Distribute educational information/provide guidance and oversight
of disposal of contaminated food product at both residential and
commercial facilities.
Undertake inspections and sampling of products at affected food
facilities.
Undertake inspections of mass feeding sites and food storage
facilities.
Provide guidance on the clean up and disposal of equipment in
affected food facilities.
Undertake inspections of emergency shelters including emergency
shower/bathing facilities and provisions for/locations of
emergency power and heat sources.
Provide guidance on the disposal or cleaning of contaminated
household items.
Undertake inspections of affected hotel/motel/bed and
breakfasts.
Provide guidance on clean up and conduct inspections of affected
permitted facilities such as campgrounds, recreational water
facilities, and play areas including but not limited to playgrounds,
soccer football fields, etc.
Work in concert with National Guard and Department of
Environmental Protection in inspection/monitoring of waste
disposal sites and locations to minimize public health impacts.
Undertake inspection/installation, monitoring of portable /public
toilets in affected areas.
Provide guidance and undertake inspections of repairs made to
affected septic systems.
Provide guidance and monitor numbers and signs of pests of public
health importance following an event.
Provide assistance in conducting disease outbreak investigations.
This may include victim interviews, record keeping, environmental
sampling, etc.
Provide guidance to victims on hygiene and preventive measures.
Institute environmental control measures including embargo,
seizure and sampling of suspected products.
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33.
Assist responding agencies in jurisdiction or region on
dissemination of information in conjunction with a chemical/other
spill/release.
P.
WV DEPARTMENT OF AGRICULTURE –
1.
Shares animal surveillance information that has potential human
health implications with the WVBPH DSDC.
Coordinates animal disease surveillance, investigation, and
prevention efforts, as applicable.
Collaborates with the WVOLS, WV OEHS, and lhds in ensuring
that food is safe for human consumption.
Serves as the lead agency for animal disease surveillance and
control.
Provides subject matter expertise to handling raw animal food
product specimens, raw animal food contamination, and livestock
contamination due to biological terrorism.
If deemed necessary, performs preliminary screening analysis for
either food contamination and/or livestock contamination due to
biological terrorism utilizing a WVDA mobile response laboratory.
Works in concert with OEHS in monitoring and controlling of
disease outbreaks related to dairy farms.
Works with OEHS in monitoring and control of possibly
contaminated food supplies stored in bulk warehouses, distribution
centers or the donated food program from entering the food supply.
Works with OEHS and lhds on the removal of domesticated animal
carcasses from waterways that serve as drinking water sources.
2.
3.
4.
5.
6.
7.
8.
9.
Q.
WV DEPARTMENT OF ENVIRONMENTAL PROTECTION –
1.
Provides subject matter expertise to ensure that environmental
samples collected as part of a biological and chemical terrorism
exposure investigation are appropriately handled and packaged.
Provides assistance in environmental laboratory services, including
preliminary analysis, aiding in toxic chemical identification, and in
evaluation of safe water supplies.
Where a local HazMat trained resource is needed but not available,
provides HazMat trained personnel , at the request of the WV
Division of Homeland Security and Emergency Management, to
collect environmental specimens and/or package specimens for
transportation to WV DHHR WVOLS and/or other designated
laboratories for confirmatory identification.
Works in concert with lhds and OEHS in inspections/monitoring of
waste disposal sites and locations to minimize public health
impacts.
Maintains open communications and coordinates activities with
2.
3.
4.
5.
57
6.
WVBPH/OEHS during chemical or other hazardous materials
drills and events.
Provides chemical and radiological sample results to lhds and the
WV OEHS ATSDR Cooperative Partners Program.
R.
WEST VIRGINIA SENTINEL LEVEL LABORATORIES (PRIMARILY
COMMERCIAL, HOSPITAL, CLINICAL, AND OTHER HEALTH
CARE INSTITUTION LABORATORIES) –
1.
Sentinel Level Laboratories raise suspicion following the
application of commonly performed clinical laboratory tests with
the objective being to “rule out” suspect bioterrorism, chemical
terrorism, or other disease causing agents.
Package and ship any agents in question as directed by the
WVOLS according to the Infectious Substance Guidelines
provided by the Department of Transportation or International Air
Transport Association.
Serve as a potential resource for WVOLS surge capacity personnel
and facilities.
2.
3.
S.
WEST VIRGINIA POISON CENTER –
1.
Answers emergency calls 24 hours a day, 7 days a week, from the
lay public, health care providers, and first responders regarding
actual or potential exposures to poisons (e.g. chemical, drug,
biological, plants, venomous creatures). Provides
recommendations on triage, first aid (including the need for
decontamination), and medical management. (Staff includes,
toxicology trained physicians, nurses, and a pharmacist for direct
consultations.)
Sends information, via facsimile, to hospitals and treatment
centers regarding the medical management of chemical, drug, and
biological poisons. Has the capability of mass facsimile
transmission following large scale events. Information is
customized based on event circumstances.
Serves as an emergency resource for chemical information (e.g.,
identification, chemical characteristics).
Following public health emergencies (e.g., activation of the
Strategic National Stockpile Plan), operates a surge capacity phone
bank to answer questions from the public and health care
responders regarding treatments, adverse reactions to treatments,
and clarifications of public health announcements. Will triage all
other calls to the appropriate agency utilizing established
protocols.
Shares and coordinates public health information relating to acute
2.
3.
4.
5.
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6.
7.
8.
toxic exposures or prevention of toxic exposures with the WVBPH
and lhds.
Provides subject matter expertise related to the diagnosis,
treatment, and management of health threats resulting from
weapons of mass destruction.
Maintains real time toxic surveillance for the State of West
Virginia. Notifies the WVBPH and/or lhds of public health
concerns identified via the WVPC emergency phones (e.g.,
potential outbreaks, potential releases of hazardous material into a
community).
Maintains a public health database of poison exposures and
information calls coming into the Poison Center.
T.
HOSPITALS AND HEALTH CARE PROVIDERS –
1.
2.
Initiate timely reporting of cases and suspect outbreaks.
Implement prevention and control measures as recommended by
the WVBPH/lhds.
Assist with patient /public information dissemination in
coordination with the Threat Preparedness Public Information
Officer and DHHR Communications Director.
Maintain plans to provide medication/vaccine to hospital staff and
patients.
Work with lhds to determine how prophylaxis will be delivered to
first responders and families of employees (by hospital or lhd).
Coordinate hospital-based dispensing efforts with the lhd covering
the jurisdiction.
Coordinate communications related to dispensing clinics with state
and local health agencies to assure consistent communication and
coordination of timing.
Where applicable, maintain CHEMPAK assets in accordance with
established agreement.
Maintain and regularly exercise a current facility disaster plan.
Participate in Regional Health Care System Response as per
developed plans and MOUs.
Work in advance to establish mechanisms for sharing of staff or
incorporating health professional volunteers into emergency/
disaster scenario response.
Utilize established teams to undertake patient/responder
decontamination at the facility, as necessary.
Provide patient care in accordance with recommended event
specific guidelines as available.
Support staffing and equipping of off site health care facilities, as
possible.
Assure safety of health care staff.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
59
16.
Assure appropriate clinical specimens needed for agent
identification/confirmation are collected and submitted to WVOLS
or other laboratory at their direction.
U.
PRIMARY CARE CENTERS/OTHER COMMUNITY PROVIDERS –
1.
2.
Maintain and regularly exercise a current agency disaster plan.
Maintain strong systems for disease detection and reporting to
public health.
Implement prevention and control measures as recommended by
the WVBPH/lhds.
Assist with patient/public information dissemination in
coordination with the Threat Preparedness Public Information
Officer and DHHR Communications Director.
Participate in Regional Healthcare System Response as per
developed plans and MOUs. Sample activities include supporting
hospitals in off site patient triage, providing support to ambulatory
patients, providing surge capacity staff to support hospitals,
alternative care facilities, or public health efforts.
Provide patient care in accordance with recommended event
specific guidelines as available.
Assure safety of health care staff.
Assure appropriate clinical specimens needed for agent
identification/confirmation are collected and submitted to WVOLS
or other laboratory at their direction.
Share information with public health entities on common concerns
and beliefs of patients, so that more effective communication
messages can be crafted.
Follow risk communication/public information plans and
protocols outlined in Regional Healthcare System Response Plans.
Work in advance with lhds and hospitals to determine how
prophylaxis will be delivered to at risk health care workers and
their families (by hospital, lhd, or facility).
3.
4.
5.
6.
7.
8.
9.
10.
11.
V.
WV STATE POLICE AND LOCAL LAW ENFORCEMENT –
1.
2.
Provide security as needed for investigation teams.
Provide secure transport for biologics or other therapeutics, when
necessary.
Train and support epidemiological investigation teams and
laboratory workers in maintenance of chain of custody.
Work with epidemiological investigation teams to coordinate
public health and criminal investigation.
Participate in cross discipline threat assessments as per
Notification and Threat Assessment Protocol.
In the course of managing or investigating suspect biological,
3.
4.
5.
6.
60
7.
8.
chemical or other terrorism events, collect environmental
specimens that are deemed credible but do not require HazMat
level collection skills and equipment. When undertaken, this
should be done in accordance with WVOLS specimen collection
guidelines.
Serves as the most common mode for transport and delivery of
environmental specimens to the WV DHHR Office of Laboratory
Services.
WVSP reports and responds to a positive identification screen for
explosives performed on environmental specimens at WVOLS.
W.
WV FIRST RESPONDERS, INCLUDING LOCAL FIRE
DEPARTMENTS AND HAZMAT TEAMS –
1.
2.
If deemed a credible threat and necessary, an appropriate HazMat
trained individual/team performs preliminary screening analysis
for radiological, biological, and/or chemical agents, collects
environmental specimens, and then packages environmental
specimens for transport to the WVOLS.
Handles safety/contamination issues at the incident site.
X.
FEDERAL BUREAU OF INVESTIGATIONS (FBI) –
1.
5.
Participate in cross discipline threat assessments as per
Notification and Threat Assessment Protocol.
Manages or is involved in the investigation of environmental
specimens alleged to contain a bioterrorism or chemical terrorism
agent.
Should be notified to investigate, potentially collect, and deliver
environmental specimens to the WVOLS.
At times, perform laboratory test of environmental specimens
associated with potential criminal activity.
Serves as lead entity in investigation of terrorist activity.
Y.
THE US POSTAL INSPECTION SERVICE –
1.
Participate in cross discipline threat assessments as per
Notification and Threat Assessment Protocol.
Manages or is involved in the investigation of environmental
specimens alleged to contain a bioterrorism or chemical terrorism
agent.
Should be notified to investigate, potentially collect, and deliver
environmental specimens to the WVOLS.
At times, perform laboratory test of environmental specimens
associated with potential criminal activity.
2.
3.
4.
2.
3.
4.
61
Z.
ARMY NATIONAL GUARD –
1.
Where local HazMat trained resource is needed but not available
and event is deemed credible, provide HazMat trained personnel, at
the request of WVDHSEM, perform preliminary screening
analysis for radiological, biological, and or chemical agents (if
indicated), collects environmental specimens, and/or packages
environmental specimens for transportation to the WVDHHR
Office of Laboratory Services and/or other designated laboratories
for confirmatory identification.
As available, provides support for public health lead emergency
response functions through state Emergency Operations Center
request, (i.e., assisting security for mass immunization and
prophylaxis, enforcement of quarantine measures, transportation
and delivery of supplies, delivery of services, etc.).
2.
AA.
WV REGIONAL RESPONSE TEAMS –
1.
Where local HazMat trained resource is needed but not available
and event is deemed credible, provide HazMat trained personnel, at
the request of WVDHSEM to perform preliminary screening
analysis for radiological, biological, and/or chemical agents (if
indicated), collect environmental specimens and/or package
environmental specimens for transportation to the WV DHHR
OLS and/or other designated laboratories for confirmatory
identification.
BB.
WV COLLEGES AND UNIVERSITIES –
1.
Provide subject matter expertise related to diagnosis, treatment,
and management of health threats.
Serve as a potential resource for WVOLS surge capacity personnel
and facilities.
Work with WVDHHR, through the state EOC, to support health
and medical functions via sharing of staff and facilities, where
feasible.
2.
3.
X.
DISASTER RECOVERY:
A.
At some point in time, the event will lessen in intensity and impact, and
health and medical agencies will begin the process of recovery. Each
agency and organization should have accessed its own Continuity of
Operations Plan (COOP) or Disaster Recovery Plan during the event in an
attempt to maintain some continuous level of operational capability.
These plans should also provide assistance and guidance in returning to
normal operations.
62
B.
C.
D.
In many events, health and medical organizations will have depleted
significant levels of supplies and resources, including available staff.
Some organizations will recover and return to normal operations sooner
than others. It will be incumbent on those agencies to assist the groups
that are not as far along in their progress with the sharing of resources and
personnel. Sharing of resources may be facilitated through state or local
EOCs, WVDHHR, or lhds. It may also be done independently.
Staff should be monitored for the need of crisis counseling and stress
debriefing. Personnel should be reviewed to reset reasonable work shifts
and replace vacant positions. Resources should be inventoried, procured
and restocked.
Information regarding the return to routine operations should be
disseminated to the public. The obvious goal is to protect the public by
quickly standing up the level of health and medical capability and
readiness that existed before the event, as soon as possible. State agencies
should carefully analyze the health and medical delivery across the state,
looking carefully for voids and areas that need support and re-allocation of
resources.
1.
After Action/Follow-up –
As per Threat Preparedness protocol, a real event or exercise is
followed by an After Action Report that outlines the type and
duration of the event, the sequence of response functions, and
outcomes. The report states lessons learned from the event and
corrective actions to take to advance preparedness and improve
efficiency of response.
XI.
CONTINUED PLAN DEVELOPMENT AND MAINTENANCE:
A.
The local health department is responsible for maintaining and
disseminating this Public Health Threat Response Plan (all-hazards plan)
to its partners and stakeholders as applicable.
B.
Agencies listed under the “Roles and Responsibilities by Response
Function”, in this plan, are responsible for continued development and
maintenance of their specific areas of responsibility as outlined within
this plan, including applicable appendices and indexes. It is suggested that
this plan and accompanying documents be reviewed annually. Changes
made to plans on the local level will be annexed to the jurisdictional EMA
emergency operation plan and shared with appropriate partners.
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C.
The lhd will use after-action reports to evaluate this plan and revisions will
be made accordingly.
64