Date of last revision: December 9th, 2013

Promulgation StatementThe Toledo-Lucas County Health Department’s (hereinafter TLCHD) mission is to continually strive for an improved quality of life for all citizens through health promotion, disease and injury prevention, and pursuit of a clean and safe environment. This document provides planning and program guidance for implementing the TLCHD Emergency Operations Plan.

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David Grossman, M.D. Larry J. Vasko, RS, MPH Health Commissioner Deputy Health Commissioner Toledo-Lucas County Health Department Toledo-Lucas County Health Department

Effective Date: _________________________

Security & Privacy Statement

This document is for official use only. Portions of this plan contain information that raises personal privacy issues or other concerns, and those portions may be exempt from mandatory disclosure under the Freedom of Information Act. It is to be controlled, stored, handled, transmitted, distributed, and disposed of in accordance with official documents and it is not to be released to the public or other personnel who do not have a valid “need to know” without prior approval of TLCHD Health Commissioner or department head(s).

Some of the information in this plan, if made public, could endanger the lives and/or privacy of employees. In addition, the disclosure of information in this plan could compromise the security of essential equipment, services, and systems of TLCHD or otherwise impair its ability to carry out essential functions. Distribution of the TLCHD Emergency Operations Plan in whole or in part is limited to those personnel who need to know the information in order to successfully implement the plan.

TLCHD, Community Response Services and Preparedness (CRS&P) Department will distribute copies of the TLCHD Emergency Operations Plan on a need to know basis. A hard copy of this plan will be available in room 250B. In addition, an electronic read-only copy will available on the g-drive. Copies of the plan will be distributed to other collaborating organizations as necessary to promote information sharing and facilitate coordinated interagency preparedness planning. Further distribution of the plan, in hardcopy or electronic form, is not allowed without approval from TLCHD Health Commissioner or Deputy Health Commissioner.

Policy

It is the policy of the TLCHD to respond quickly at all levels in the event of an emergency or threat. This includes human, natural, technological, and other emergencies or threats, in order to continue essential internal operations and to provide support to the operations of client and external agencies.

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RECORD OF CHANGES

Date Page Number Brief Description of Change MadePerson(s) Making Change

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RECORD OF DISTRIBUTION

Date of DeliveryNo. of Copies Delivered Method of Delivery

Name, Title & Department of Recipient

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Toledo Lucas County Health DepartmentDisaster Response Plan

Signature Page

By signing this, you acknowledge the role of your department in a disaster. You agree to continue to provide training so that your staff understands their individual roles and responsibilities in a disaster. This could possibly mean working out of classification and performing duties outside the scope of normal job descriptions.

As a supervisor, it is your responsibility to maintain call down lists of all subordinate personnel and have a plan in place to communicate and relay pertinent information to all employees in your department in an emergency.

It is also the responsibility of the supervisors to maintain current lists of overtime callouts.

You will adhere to the training recommendations and requirements set by the Community Response and Preparedness team and mandate all staff to do the same.

Department Supervisor Signature DateHealth Commissioner David Grossman, MDDeputy Health Commissioner

Larry Vasko

Administrative Services Joanne MelamedCommunity Preparedness and Response &Environmental Health

Eric Zgodinski

Health Services Barb Gunning

Table of Contents

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I. Introduction……………………………………………………………….. Tab 1 a. Purpose b. Plan Organization

i. Health Department Plan

II. Situation and Assumptions………………………………………... Tab 2 a. Situation b. Assumptions

III. Policies………………………………………………………………. Tab 3

IV. Concept of Operations…………………………………………….. Tab 4

a. ICS and NIMSb. Activation of TLCHD Emergency Response Plan

i. Response Coordination ii. Notifications

V. Infectious Diseases………………………………………………… Tab 5

a. Protocol b. Class A, B, & C diseasesc. Radiological Emergenciesd. Method of Identificatione. Health Department Responsibilities

VI. Resource Coordination……………………………………………. Tab 6 a. Pharmaceuticals and vaccinations b. Decontamination c. Evacuation, Sheltering and Quarantined. Coronere. Poison Control Centerf. Red Crossg. Hospitals

VII. Special Teams……………………………………………………… Tab 7 a. Epi Response Team b. Crisis Communication Team c. Safety Committee

VIII. Phases of Emergency Management……………………………...Tab 8

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IX. Organization of Responsibilities………………………………….. Tab 9 a. Duties out of Job Classification b. Shelter Operationsc. Epidemiological Surveillance/Investigationsd. Clinic Setup/Managemente. Environmental Surety

i. Vector/Rodent Control ii. Waste/Debris Managementiii. Water Supply iv. Bioterrorism Preparedness & Response

X. Responsibilities of State and Federal Agencies………………… Tab 10

XI. Public Health Information………………………………………….. Tab 11

XII. Testing the EOP…………………………………………………… Tab 12

XIII. Debriefing Post Event………………………………………………Tab 13

XIV. After Action Review…………………………………………………Tab 14

XV. Voluntary and Temporary Staff…………………………………… Tab 15

XVI. Personal Preparedness…………………………………………….Tab 16

XVII. Plan Maintenance………………………………………………….. Tab 17

XVIII. Approval…………………………………………………………….. Tab 17

XIX. Annexes……………………………………………………………...Tab 18

XX. Appendixes…………………………………………………………. Tab 19

XXI. Authorities and Reference………………………………………… Tab 20 a. Plans for Reference

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Tab 1. Introduction

A. Purpose

Lucas County has potential terrorist targets for using Weapons of Mass Destruction (WMD), involving Nuclear, Biological and Chemical (NBC) Agents. In addition, it is necessary for the Toledo-Lucas County Health Department to be prepared to respond to not only these emergencies but also to infectious disease outbreaks, natural disasters, radiological emergencies and Hazardous Materials incidents in order to minimize public health effects and manage the consequences through appropriate responses. (Throughout this document “Weapons of Mass Destruction” may be abbreviated as “WMD”, the Toledo-Lucas County Health Department may be abbreviated as “TLCHD”; Hazardous Materials may be abbreviated as “HazMat”.) The purpose of this plan is to prepare TLCHD employees to respond to any public health emergency through coordinated, appropriate and timely response actions in conjunction with local, regional and state partners. The goal is to prepare the TLCHD staff and the Lucas County community to respond in an appropriate and timely manner to a bioterrorism threat, disaster or other public health emergency.

The TLCHD has an overall responsibility for protecting the population of Lucas County on a daily basis, as well as during a public health emergency and to reduce the incidence of morbidity and mortality. The TLCHD Health Commissioner is responsible for managing any Health Department emergency response in coordination with Lucas County Emergency Management Agency, Emergency Medical Services, local hospitals, law enforcement, local fire departments, mental health providers and state and federal agencies.

The TLCHD Emergency Response Plan provides an all hazards approach in planning for Natural, Radiological, Nuclear, Biological or Chemical Weapons of Mass Destruction (WMD) and Hazardous Material incidents.

The TLCHD Emergency Operations Plan is integrated into the County Plan as an addendum to ESF 8.

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Tab 2. Situation and Assumptions

A. Situation

1. There is one combined general health district which serves Toledo and Lucas County which is located at 635 N. Erie Street, Toledo, Ohio 43624.

2. There is a satellite office at the Western Lucas Clinic located at 330 Oak Terrace Boulevard, Holland, Ohio 43528.

3. The Ohio Department of Health maintains a Strategic Stockpile of critical medical assets that can be delivered to local and regional healthcare organizations.

B. Assumptions

1. Health and medical facilities may be severely damaged, destroyed, or rendered unusable.

2. Infrastructure (transportation, communication, utilities, etc) may be damaged and impact the ability of local health and medical services to be effective.

3. Infrastructure damage and disruption may increase the potential for disease and injury.

4. Disruption of sanitation services and facilities, loss of power, and massing of people in shelters may increase the potential for disease and injury.

5. Availability of medical care personnel may be limited due to injury, personal concerns/needs or limited access to work locations.

6. Medical care facilities that are still operational after the emergency or disaster will be overwhelmed by the “worried well, walking wounded” and seriously injured victims.

7. Some communicable diseases may need ongoing tracking and identification before and during medical intervention.

8. Damage and destruction caused by an emergency or disaster will produce urgent needs for mental health crisis counseling and spiritual supports for disaster victims and emergency response personnel.

9. Publicly supported emergency medical, health, and related services will be restored to normal operations during the recovery period as soon as possible and within the limitations and capabilities allowable by city/county government following the emergency or disaster.

10.Power outages may interrupt both potable water supply and sanitary disposal systems in rural areas.

11.Disease outbreaks, epidemics, and pandemics can quickly stress existing health and medical infrastructure in a highly mobile urban society. The health department coordinates with local hospitals and physicians for epidemiological surveys to quickly identify harmful pathogens.

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Tab 3 Policies1. Training. All staff must complete NIMS coursework according to the role that they may serve in a disaster. The majority of staff will fall under the Tier 4 Category because it is likely that the majority of staff will be in leadership roles at POD sites during a Public Health emergency.

Introduction to Incident Command System (IS-100.b)

Incident Command System for Single Resources and Initial Action Incidents (IS-200.b)

Intermediate Incident Command System (ICS-300)

Advanced Incident Command System (ICS-400)

National Incident Management System, An Introduction(IS-700a)

National Response FrameworkAn Introduction (IS-800.b)

Ohio EMA Basic PIO series, G290 and G291And IS 704

FEMA Professional Development Series(IS 139, IS 230a, IS 235, IS 240, IS 241, IS 242, IS 244)

FEMA courseIS-775: EOCManagementand Operations

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Tier One: Personnel who, in the event of a public health emergency, will not be working within the emergency operations center/ multi-agency coordination system or will not be sent out to the field as responders.

X X

Tier Two: Personnel who, in a public health emergency, will be assigned to fill one of the functional seats in the emergency operations center during the response operation.

X X X X X

Tier Three: X X X X X

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Personnel who, in a public health emergency, have the potential to be deployed to the field to participate in the response, including personnel who are already assigned to a field location.Tier Four: Personnel who, in a public health emergency, are activated to Incident Management System leadership and liaison roles and are deployed to the field in leadership positions.

X X X X X X

Public Information Officer

X X X X X X X

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Disaster Planner X X X X X X X X X

Date of last revision: December 9th, 2013

The Toledo-Lucas County Health Department will provide new employees with information and direction on our disaster response and preparedness needs. The basic level trainings are:

ICS 100, 200 & 700a, 800b SNS plan All Hazards training on departmental plan MARCS Safety issues

All training for new employees will be accomplished within the first nine (9) months of employment.

1. Staff will be notified of mandatory annual training dates.2. Provisions for completing the annual training will be offered when unforeseen

circumstances prevent a staff member from attending a scheduled training.3. All staff is required to document participation in the training by signing the

appropriate sign-in sheets.4. Training may include completion of an evaluation or test to show knowledge.5. Participation in training will be noted in the staff member’s personnel file.

Ohio TRAIN TLCHD will use Ohio TRAIN to keep track of all required trainings for

employees. All employees will be instructed to sign up for an account. All trainings will be placed on OHIO Train. New staff will be given an orientation packet with instructions on how to

create an Ohio Train account and sign up for all required training and to whom/how to submit training certificates. Required trainings must be completed during probationary period.

To sign up for an Ohio Train account:Logon to https://oh.train.org/DesktopShell.aspxClick “Create Account” on the menu on the left side of screen.Write your password down and keep it in a safe place.

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Maintenance of Training Records Each employee shall have a file with hard copies of all training certificates

located in room 250B An excel spreadsheet shall be maintained by the disaster planner for all

required trainings. All employees shall be responsible for submitting training records to the

disaster planner Sign in sheets shall be kept for all in-person trainings along with the agenda

to serve as verification. Certificates shall be issued for all attendees.

All employees will be required to keep track of their own CEU’s for their disciplines. Upon receipt of their registration cards and/or license, they can submit paperwork to the agency for reimbursement of license costsRecommendation:

1. This should be added to new employee orientation. (Meet with person in charge of providing this section)

2. Committee recommends the training room to use for all required trainings for the new employees with the person in charge being present.

Tab 3. TLCHD Policies

1. All employees are expected to report to work in the event of a disaster. If the Erie Street location is damaged/ destroyed, all staff is to report to the Western Lucas County site. Likewise, if Western Lucas County site is damaged/ destroyed, all staff is to report to the Erie Street location.

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Tab 4. Concept of Operations

A. Incident Command System (ICS) and National Incident Management System (NIMS) – TLCHD Policy:

1. In order to maintain order and a smooth response to an event the Health Department will follow the NIMS/ICS management system. Incident command and control issues will involve a unified command system in order to properly coordinate the various agencies and authorities involved in responding to an incident.

2. All Health Department staff will receive yearly training on the ICS system. Emergency Preparedness Team members and Administrative Team members will complete NIMS training with yearly reviews and updates as deemed necessary by the Health Commissioner.

3. The Health Commissioner, or his designee, will assume or assign the Incident Command position at the onset of an event, with subsequent assignments and transfer(s) of command coming from/through the Incident Commander.

4. The Fire Department Chief Officer is the Incident Commander on the scene for crisis management unless the incident is biological. In a biological, the TLCHD will be the incident command, or will share ICS duties with local law enforcement.

5. The Emergency Management Agency is the lead agency for consequence management.

6. The Incident Commander will consult with the Sheriff’s department or other local law enforcement agencies in whose jurisdiction the event occurs in order to decide if and when the FBI should be notified.

7. If the FBI is involved, they become the lead agency for criminal investigation including evidence collection and custody. Until the FBI arrives on the scene, the Sheriff’s department or local law enforcement of the jurisdiction involved is the lead agency for securing the crime scene and further assisting the FBI.

8. The Ohio State Highway Patrol is the lead agency for crisis management in Ohio. The designation of the state's lead agency for consequence management is contingent upon the actual event and will be designated by the state Emergency Management Agency when there is a statewide event or an event large enough to open the state EOC.

9. In the event of nuclear and/or biological agents, the Ohio Department of Health is the lead agency.

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10. In the event of chemical agents, the state Environmental Protection Agency would be the lead agency assisted by the Ohio Department of Health for medical issues. Locally, Lucas County Hazmat would be the lead agency with the Health Department assisting.

11. Presidential Decision Directive 39 identifies the FBI as the lead federal agency for crisis management during terrorist incidents, and identifies FEMA (Federal Emergency Management Agency) as the lead agency for consequence management.

12. It is the policy of the TLCHD that all staff members will follow the ICS structure and the lead of the Incident Command. The Incident Commander, established by the Health Commissioner, will assign ICS positions – expanding or contracting the structure – as necessary

13. Transition of Incident Command: Initially, the incident commander for major terrorist incidents will likely be the Fire Chief on the scene. As state and federal assistance arrive and the scope of the response grows more complex, the need to transition Incident Command to a higher level may become necessary. The Health Department and all county officials must implement this transition and work together to determine ongoing incident command. Because of the methods used in the NIMS and ICS structures, local command will remain under local authority with federal command assisting and directing decision making processes. The Health Commissioner, or his designee, will participate in all ICS decision making sessions at the EOC when an event is occurring.

14. Delegation of Authority, Transfer of Authority and other command staff measures will be announced at regularly scheduled staff briefings during an event by the Incident Commander.

15. Regional Command and Control – The TLCHD will follow the NW Ohio Region Command and Control Policy for regional events/incidents. The TLCHD will fully participate with regional partners in all regional response and recovery efforts.

B. Activation of the TLCHD Emergency Response Plan

1. The Plan is activated in any emergency situation requiring public health resources and protective actions.

2. Public Health response is activated upon a major disaster, public health emergency or other event that exceeds the limits of normal response and requires assistance with resources and management.

3. Upon recognition and/or notification of an unusual occurrence, requiring an expanded response, the Health Commissioner will convene the Epidemiology

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Response Team meeting to determine the departmental response per the Emergency Operations Plan, and whether to open the DOC.

4. The TLCHD response to a disaster, bioterrorist threat or event, or any emergency potentially affecting the health of Lucas County residents will be either through the Emergency Operations Center (EOC) or the Departmental Operations Center (DOC).

5. In a public health emergency, the Health Commissioner contacts the EOC to request activation if the situation requires resources beyond the scope of the TLCHD.

6. The Health Commissioner may request assistance from the LCEMA and/or request a declaration of emergency and activation of the EOC (if not already done so by the County Commissioners).

7. The Health Commissioner, or his designee, will determine the level of response, the plans to activate, and who to deploy during initial emergency response.

8. Following the ICS, the Health Commissioner will assign individuals to those areas required, based on the scope of the response/size of the emergency. Following the basic ICS philosophy, the ICS structure and organization will expand and contract at the direction of the Incident Commander.

9. The TLCHD Health Commissioner, or his designee, functions as the Health Department’s Incident Commander until, or unless, he designates another person and transfers command to said person.

10. The EOC may be activated: Upon notification from an agency that assistance is needed to respond to a

multiple casualty incident(s). Upon declaration of a local emergency by a City government within the

County. In response to any local emergency (natural or man-made) affecting the

health and safety of employees or the public. In response to multiple local or regional incidents (natural or man-made)

occurring simultaneously and potentially affecting the health and safety of employees or the public.

Upon declaration, by the Governor for a state emergency, or the declaration of the President of the United States for a Federal disaster that may affect Lucas County.

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11. Emergency Operations Center:The Lucas County Sherriff maintains a call down list to contact TLCHD staff if the EOC were to open. The call down list in order is as follows:

-Eric Zgodzinski-Local Disaster Planner-Patti Fraker

Upon notification that the EOC will open, Eric Zgodzinski will assign the representative to report to the EOC from a list of trained individuals. This list can be found in the COOP plan.

12. Department Operations Center:The TLCHD Emergency Response Coordinator will be responsible for coordinating a response within the department in an emergency.

The Department Operations Center can be opened by the following:

Health CommissionerDeputy Health CommissionerDirector of Health ServicesDirector of Community Services and Environmental HealthEmergency Response Coordinator

13. The following TLCHD staff report to the EOC when it is activated: Health Commissioner EOC Liaison Other personnel as directed by the Health Commissioner

14. The Toledo-Lucas County Health Commissioner, or his designee, will activate the TLCHD Emergency Response Plan during any disaster or crisis event, as needed . The Health Commissioner will also function as the Health Department’s Incident Commander until, or unless, he designates another person and transfers command to said person.

15. The Department Operations Center may be activated, by the Health Commissioner, or his designee in response to:

A communicable disease outbreak, not requiring activation of the EOC. A suspected or actual bioterrorist event. Any local emergency incident (natural or man-made) that may affect the

health and safety of employees or the public. Multiple or regional incidents (natural or man-made) occurring at the same

time and potentially affecting the health and safety of employees and the public.

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A declaration of a local emergency by the Lucas County Emergency Management Agency and/or any County Executive.

A declaration by the Governor of a state emergency or a declaration by the President of the United States of a Federal disaster that may affect Lucas County.

16. The TLCHD Department of Operations will be housed at the health department (635 N. Erie Street, Toledo, Ohio 43604). Alternate locations, in case of building inaccessibility, will be determined by the Health Commissioner and announced via the TLCHD Communication Plan. (Annex 2)

17. The TLCHD Logistics Section Chief is responsible for setting up the DOC.

18. Reporting immediately upon activation of the DOC will be the following: Health Commissioner (if not active at the EOC) Public Information Liaison Planning Chief (Disaster Planner) Operations Chief (Director of Nursing) Logistics Chief (Environmental Health Director) Finance Chief (Director of Finance) Communicable Disease Coordinator/Epidemiologist Registrar

19. When activated, the Health Commissioner, or designee, will determine the hours of operation, shift(s) and when to deactivate.

Procedure, protocols and plans for disaster response activities are developed to govern staff operations at the Toledo Lucas County Health Department and in the field. These are in the form of Emergency Operations Plans and corresponding Appendixes. Incident Annexes, Support Annexes, and Standard Operating Guidelines, which describe public health capabilities. Periodic training and exercises are also conducted to enhance effectiveness.

C. Response Coordination

TLCHD will coordinate the medical/health response with: The EOC when it is activated. An individual city or village when the Operational Area EOC is NOT activated.

This type of activation involves response for a single affected jurisdiction. Hospital and/or EMS personnel during a mass casualty incident response. The Coroner during a mass fatality incident response. Other county departments.

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D. Lucas County Integrated Healthcare Preparedness Team

The Toledo-Lucas County Health Department and the Hospital Council of Northwest Ohio are co-chairs of the Lucas County Integrated Healthcare Preparedness Team. The Planning Team meets quarterly to discuss healthcare emergency planning. The focus of this group is to address gaps in healthcare emergency plans and work together to close those gaps. Local healthcare resources will be coordinated through this planning team.

E. Northwest Ohio Healthcare Emergency Management Coalition

The Toledo-Lucas County Health Department plays a support role for the steering committee of the Northwest Ohio Healthcare Emergency Management Coalition.The TLCHD and the Hospital Council of Northwest Ohio work with the Steering Committee to sustain coordination of disaster planning and preparedness capabilities with regional partners, ensure grant performance measure compliance, arrange coalition meeting dates and venues, finalize all meeting agendas (=3 per year), and gather and share information to assist the regional healthcare facilities during emergency responses.

F. Notifications

1. For Bioterrorist Incidents:

A report may be initiated by a concerned or threatened citizen, organization or employee.

911 Dispatch or any government agency may receive the initial notification from the affected individual organization.

If the 911 operator receives the initial call, the Local Law Enforcement agency, Fire and EMS are dispatched.

After the initial responders are dispatched, the 911 operator will notify the Health Department, County EMA and the regional FBI.

The Health Department will notify the Ohio Department of Health and establish a bridge telephone line. The Health Commissioner, or his designee, will consult with state and federal agencies regarding evacuation and isolation, risk of contagion, sheltering and subsequent re-opening of the site, decontamination of individuals and property, specimen collection, laboratory capabilities/time frames, special instructions to hospitals, diseased individuals, walking wounded, test result notification, use and supply of prophylaxis/vaccine, surveillance and Public Health Advisories.

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2. TLCHD will follow the TLCHD Communication Plan for unusual incidents/events. (Annex 2 Communications plan)

3. For incidents and/or events that involve the Strategic National Stockpile, TLCHD will follow the Mass Pharmaceutical Receipt and Distribution Plan. (Annex 4 SNS/ Mass Prophylaxis Plan)

4. For communicable disease outbreaks, the Health Department will notify the county EMA and county Hospital Emergency Departments on the status of cases on a basis to be determined at the onset of an event (i.e.: daily, weekly, hourly).

5. The County EMA will notify the State EMA, FBI, and other government agencies as an event develops. The TLCHD Communication Plan contains a Communication Flow Diagram for communications and notifications during a biological incident.

6. Regional Communications will follow the Northwest Ohio Regional Communications Plan.

7. Based on the first responder’s assessment of the situation, the county EMA may activate the Emergency Operation Center, in which case the TLCHD will coordinate communication from the Emergency Operation Center (EOC), with the Health Commissioner, or his designee, in attendance there.

8. Continuity of Operations (refer to COOP Plan, Annex 1)During a disaster, the health department’s role can shift and certain services that are not every day activities will become the responsibility of the health department. There are vital services that will need to be ongoing throughout an emergency. The COOP Plan (Annex 1) outlines health department’s roles to maintain and provide critical services in an emergency.

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Tab 5. INFECTIOUS DISEASES

A. Protocol

The TLCHD follows the protocols established by the Ohio Department of Health. These protocols are found within the Ohio Department of Health Infectious Disease Control Manual. In the event a case report is not for a class A infectious disease, but there is indication of epidemic spread or intentional infection, the Patient Contact Form is completed and the Ohio Department of Health's Bureau of Infectious Disease is notified immediately. Secondary contact would be the responsibility of ODH Disaster Response Team if deemed necessary by the Emergency Preparedness Team. The Northwest Ohio Regional Coordinator will be notified by the Communicable Disease Coordinator in the event that any infectious disease event may spread beyond the borders of Lucas County.

The ODH Emergency Response Team would be contacted by the Health Commissioner or the EMA if additional state resources are indicated.

B. Class A, B and C Diseases Reportable Class A, B, and C Diseases (especially Class A) are a major public health concern because of the severity of the disease and/or the potential for epidemic spread and are, by law, to be reported to the Health Department immediately upon recognition of a case, a suspected case, or a positive lab result. The Communicable Disease Coordinator, or other designated personnel, is then responsible for immediately contacting the Ohio Department of Health, Bureau of Infectious Disease. In cases of Class A 1 disease, the Communicable Disease Coordinator will notify the Director of Nursing and/or the Health Commissioner about the case(s) and provide updates as necessary. Health Department staff will follow the TLCHD Epidemiologic Response Plan which includes the Disease Outbreak Investigation Procedures for all investigations and the additional Biological Incident Policy and Procedure for the following specific biological agents: Anthrax, Botulism, Plague, Smallpox and Tularemia. (See Annex 5 Epidemiology and Surveillance)

C. Radiological Emergencies

In case of a nuclear power plant emergency, the TLCHD Davis Besse Standard Operating Procedure will be instituted, or in the case of other Radiological emergencies the Radiological Response Protocol will be instituted. The Environmental Health Director, or other designated personnel, is responsible for immediately notifying the Ohio Department of Health Radiation Protection Team (See Annex 3 Radiation Emergencies)

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D. Method of Identification

During any response to a crisis event, all health department staff members will be required to wear their photo identification badges while on duty whether at the health department or at another sites.

Volunteers will be required to wear a name badge with designation of services (IE: RN, clerk, etc.) at all times during their stay, or service to the health department. If available, and as time permits, photo identification badges may be provided utilizing the TLCHD/EMA badge machine.

All persons that are not directly employed by the health department will be required to sign in at the main reception desk of the health department or alternative care site. The individuals must have their identification and/or credentials verified by a health department staff member, and receive an identification badge prior to being dispatched anywhere in the building. Upon leaving the building, all non-health department employees will be required to surrender their identification badge. Volunteers and other non-health department employees will be validated and credentialed daily either at the health department or at an alternative Volunteer Management/Reception site.

E. Health Department Responsibilities

1. The Health Department will provide technical assistance to the ICS on scene with regard to decontamination, personnel protection equipment, identification of biological and/or chemicals, exposure assessment, risk assessment, drug/vaccine use, sample collection and shipping of diagnostic samples. The Health Department will act as a liaison between the Incident Commander and the Ohio Department of Health and/or the CDC.

2. The Health Department will maintain “Chain of Custody” when working with any samples involved in a potential or actual terrorist event. The TLCHD will utilize Lucas County Sheriff evidence tags for chain of custody per the Sheriff’s protocol.

3. During an event, the Health Department may support the local EMS at the triage site and will coordinate with local hospitals regarding treatment of victims that may be contaminated via contact with the hospital infectious disease control practitioners. The Health Department will act as a liaison between ODH, CDC and the local hospital(s) involved.

4. The Health Department may provide nursing assistance and guidance to the local hospitals and/or Red Cross sites if needed. However, all Health Department needs will be met first before assigning staff to non-Health Department sites. The Emergency Preparedness Team will review all decisions regarding staff placement.

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5. The TLCHD will report ODH Class A communicable diseases immediately to the ODH and will collect, pack and ship diagnostic samples to the ODH lab following protocols established by the ODH. Chain of custody will follow Sheriff’s protocol for any potential terrorist acts.

6. The TLCHD will receive sample analysis reports and implement the health protection and prevention guidelines provided by ODH and CDC.

7. The TLCHD Environmental Division will survey any incident sites for health threats and/or will inspect all shelter sites prior to occupancy.

8. The TLCHD will receive, store, distribute and/or administer any vaccine, prophylactic antibiotic or other medication/treatment (i.e., potassium iodide tablets) following Strategic National Stockpile guidelines.

9. The TLCHD will follow up with affected individuals, both exposed and potentially exposed individuals, conduct surveillance, coordinate surveillance reporting to ODH, provide education to the public on exposure related issues and monitor the immediate and long term effects of the event.

10. The TLCHD will coordinate with the health departments of contiguous counties, the Northwest Ohio Regional Coordinator and ODH to prepare public health advisories and announcements when individuals outside Lucas County are involved, in accordance with the NW Ohio Region Joint Information SOG.

11. The TLCHD will coordinate as necessary with the county coroner and local funeral homes. The Health Commissioner, or his designee, will communicate any specific risk to those working with exposed and deceased victims. The TLCHD will follow the Lucas County Mass Fatality Plan, coordinated through the Coroner’s office. In all Mass Fatality events, the Lucas County Coroner will be the Incident Command for mass fatality management.

12. The TLCHD will coordinate with the Red Cross as needed, including providing site surveys prior to opening shelters. The TLCHD will provide site surveys on any shelter opened by the Red Cross.

13. The TLCHD will work in conjunction with the Lucas County Special Needs Committee to provide sheltering for functional needs populations. Lucas County Special Needs Committee maintains a plan for special needs sheltering.

14. The TLCHD will provide staffing and coordination of health-related issues at the county Emergency Operation Center when the EOC is activated.

15. The TLCHD will arrange for and/or coordinate mental health services for public health staff members during and after a crisis event, as well as coordinate mental

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health services for the public at any treatment, distribution, or vaccination sites that the health department is providing.

16. The TLCHD will request assistance from ODH and CDC when appropriate.

17. The TLCHD will accumulate, maintain and report real time data on surveillance, occurrences, contacts, regions affected, threats to surrounding areas and any other data deemed appropriate by the Emergency Preparedness Team to local, regional, state and/or federal partners.

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Tab 6. Resource Coordination

A. Pharmaceuticals and Vaccinations

The Health Department is not equipped with the special pharmaceuticals and vaccines needed to respond to a bioterrorist attack. Vaccines that are needed for first responders and those exposed are only available on a limited basis to the CDC, US Public Health Service and the US military.

Supplies for mass treatment/vaccination are maintained by the Strategic National Stockpile (SNS) and will be distributed via governmental mandate following requests from local, state or federal officials on the scene of an event.

If the SNS is needed, the Health Commissioner, the Lucas County Emergency Management Agency Director or the Northwest Ohio Regional Coordinator may request assistance by contacting the Ohio Department of Health. The ODH will then coordinate a conference call with the Governor of Ohio, the Health Commissioner, county EMA and CDC. The CDC makes the final decision to deploy the SNS to an area or region. The Health Commissioner, as Incident Commander, will follow both the TLCHD SNS & Mass Prophylaxis Plan, as well as the Northwest Regional guidance documents for a regional event.

If the SNS is deployed, the Clinic Manager, as assigned, will oversee and coordinate the acceptance, storage and distribution of all SNS materials in Lucas County. Through prior Memorandums of Agreement, SNS acquisition, supply and distribution at the local level should not cause disruption in normal functioning of the TLCHD. Services may be geared down to essential services, if determined necessary by the Health Commissioner (See SNS/Mass Prophylaxis Plan Annex 4).

Clinic set up and distribution of SNS materials will be completed under the guidance of the TLCHD SNS and Mass Prophylaxis Plan.

(See Annex 4 TLCHD SNS and Mass Prophylaxis Plan)

The Lucas County EMA will assist in locating and preparing appropriate sites for distribution of any governmental supplies.

The Health Department will maintain all SNS vaccines at the distributions sites following CDC and ODH guidelines and protocols.

The Health Department Environmental Division will be responsible for evaluating/surveying all sites prior to the Health Department taking over control of the site, and will assure that the site is appropriate, suitable and safe.

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Distribution priority of primary drugs and vaccines to the public will be determined by the Health Commissioner following guidance issued by the Ohio Department of Health and the Centers for Disease Control.

The Health Commissioner or his designee will notify the Lucas County EMA, the Sheriff, Local Law Enforcement agency and the county EMS of any impending mass clinics.

The Health Department will maintain a list of local pharmacies and local analytical/clinical laboratories for support during emergencies as needed. The ODH Laboratories will be utilized as much as possible during outbreaks or unusual events.

B. Decontamination

While certain Health Department staff have received HazMat Awareness training, it is the Health Department policy that TLCHD staff are not First Responders. The Health Department will participate in local and regional HazMat events, as consultants, but will not function as First Responders.

The Health Department will assist in the coordination of disposal of decontamination run off as hazardous waste.

The Health Department will maintain a list of hazardous waste movers and will also develop memorandums of understanding, as needed, to support efforts during an emergency.

The Director of Environmental Health will be responsible for overseeing all decontamination activities, including documentation and follow up.

The Director of Environmental Health or his designee will work directly with HazMat in all decontamination activities.

C. Evacuation, Sheltering, and Quarantine

Sheltering activities will follow the order of the Lucas County Emergency Management Agency and the Lucas County Emergency Plan, this assumes that the EOC is open and functioning, with the Health Commissioner actively involved in the decision making process.

The Health Commissioner, with assistance from the Epi Response Team, will provide consultation to the Incident Commander for issues related to evacuation, sheltering, isolation and/or quarantine of exposed individuals, in conjunction with guidance provided by the CDC and ODH.

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If an event occurs that is biological in nature, the Health Commissioner will become the Incident Commander and has the Board of Health’s authority to institute isolation and quarantine orders following ODH guidelines.

The Environmental Health Director will dispatch sanitarians to inspect the safety of habitation in the designated shelters.

The Director of Nursing will dispatch public health nurses to the shelters to provide assistance in the distribution of medical aid as he/she deems appropriate.

The Operations Chief will have final say as to staff assignment of nurses during any mass vaccination or prophylaxis clinic.

The Health Commissioner, with the authority of the Board of Health, can institute an order of isolation and/or quarantine to any individual(s), organization(s) and /or entire entities located in Lucas County before, during, or after a potential biological incident.

The Environmental Health Director will be responsible for directing Registered Sanitarians in posting quarantine/isolation notices on private homes and/or businesses, and will maintain detailed records concerning any isolation or quarantine ruled necessary.

The Lucas County Sheriff and the local Police Chief will be notified by the Health Commissioner of any quarantine notices posted.

The Health Commissioner, in consultation with the Emergency Preparedness Team, will determine if there is public notification of any quarantine activity.

(See Annex 9 Quarantine, Isolation, and Social Distancing Plan)(See Annex 8 Shelter Inspections)

D. Coroner

The Health Department will coordinate with the County Coroner regarding deceased victims, body identification, preservation, prevention of spread of infection, disposal of potentially infectious body fluids and personnel safety following the LC Mass Fatality Plan.

The Health Department will maintain and protect all information concerning vital statistics and issues related to death certificates. The Health Department Office Manager/Registrar will act as the main liaison between the Coroner and the Health Department.

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E. Poison Control Center

The Health Department will notify the Poison Control Center (800-222-1222) when a nuclear, biologic or chemical event occurs with information related to the material used if this is known.

The Health Department will communicate with the Poison Control Center as they research data for personnel protection and emergency medical information.

All information provided about a nuclear, biologic or chemical agent will be shared by the Health Department, through the Communicable Disease Coordinator, with county hospitals, physicians and incident command as determined necessary by the Infrastructure Team.

F. Red Cross

The Health Department will assist in activities of rescue and relief with the American Red Cross, as needed, through the Lucas County Emergency Management Agency.

The TLCHD will coordinate with the American Red Cross and the Lucas County Special needs Committee to assure that all functional needs populations are sheltered appropriately when necessary.

G. Hospitals

The Health Department will collaborate with county hospital's Disaster Response Teams and Infection Control Practitioners during mass casualty incidents for clinical, investigational and surveillance support.

The Communicable Disease Coordinator will follow established protocols and state law for communicable disease reporting and surveillance with the local hospitals and Infection Control Practitioners.

(See Annex 5 TLCHD Epidemiology and Surveillance Plan)

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Tab 7. Special Teams

A. Epi Response Team

The Epi response team is comprised of individuals from different disciplines throughout the health department who are trained to respond to a disaster. The team meets monthly to discuss disease trends, outbreaks, and disaster planning. The team is actively involved with drills and exercises throughout the county and region.

B. Crisis Communication Team

The Crisis Communication Team is comprised of individuals from different disciplines within the health department who will act as spokespersons for different events. This team is trained in areas of public speaking and dealing with the media.

The team is responsible for the development and maintenance of the crisis communication plan. The plan outlines the dissemination of information to the public, hospitals and other lead ESF 8 agencies, county EOC, and regional health departments.

(See Annex 2 Communications Plan)

C. Safety Committee

The TLCHD Safety Committee will meet on a quarterly basis to discuss employee and building safety and security issues. The Safety Committee is composed of a cross section of employees from all divisions of the agency. The Safety Director will be the head of the Safety Committee. The role of the committee is to oversee employee safety and health issues.

(See Annex 14 Facility Safety Plan)

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Tab 8. Phases of Emergency Management MitigationActivities

Health Commissioner Reports to board of health

Administration Conducts regular review of standard operational procedures and

emergency operations guidelines Maintains current contact and emergency contact numbers for all

employees

All Staff Continues ongoing support of outlined preparedness actions Upgrades communications

Epidemiology Maintains an intelligence capability which provides for

early detection, evaluation, and prevention of epidemics or spread of other communicable disease

Monitors Epi-X for national surveillance and RODS for local surveillance

Monitors ODRS (Ohio Disease Reporting System) and oversees all activity related to this system

Acts as a liaison between area hospital Infection Control Practitioners and the Health Department

Environmental Health Provides for continuous health inspections within the community

Health Services Conducts effective immunization programs

Disaster Planning Attends any scheduled post-incident analysis sessions Identify errors and shortcomings in response and revise internal

plans accordingly Collect and analyze all incident related data for after-action review

to identify lessons learned Maintains communication with other ESF 8 agencies Annually review the Lucas County Emergency Operations plan to

include Emergency Support Function 8 and corresponding Incident Annexes

Medical Reserve Corps Coordinator Maintains a database of volunteers with current contact

information

Risk Communications Team Crafts PSA’s such as hand-washing, cover your cough,

and other public health related information

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Sends press releases about health topics

Preparedness Activities

All Staff Keeps current training on NIMS, ICS and MARCs radios Continues ongoing public health education

All ESF-8 agencies are expected to develop standard operating procedures to handle daily situations and larger scale events. This includes:

a. Developing and maintaining emergency call-out lists of personnel

b. Maintain and update listings of local private contractors who can provide support during emergencies

c. Participate in the development and exercising of the EOP for major emergencies and disasters

d. Development of mutual aid agreements between agencies, as appropriate

Administration Ensure personnel within your agency are trained and

certified in safety and health practices, including the use of Personal Protective Equipment (PPE) for designated personnel

Ensure that employees fully understand their obligation as emergency responders to report to work as soon as possible in the event of major emergency/disaster

Develop policies for overtime tracking and call out procedures during a disaster

Health Commissioner

Epidemiology Continue public health surveillance. Monitors Epi-X for national surveillance and RODS for

local surveillance Monitors ODRS (Ohio Disease Reporting System) and

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oversees all activity related to this system Acts as a liaison between area hospital Infection Control

Practitioners and the Health Department

Environmental Health Establishes good working relationship with epidemiologists Continuous training on food borne outbreaks

Health Services Maintain medical supplies at levels consistent with storage

capabilities, shelf life concerns, budgeted resources, and expected demand during emergency and non-emergency conditions

Medical Reserve Corps Coordinator Recruit and train disaster personnel and maintain rosters of

available volunteers

Disaster Planning Coordinate training and exercises for ESF8 primary and support

agency personnel Maintain liaison with support agencies. Maintain ongoing

communication with all ESF 8 agencies Engage in continuous cycle of homeland security planning, training,

and exercising to validate and improve existing plans Provide appropriate training to personnel on disaster response, self-

preservation techniques, the National Incident Management System (NIMS), and the incident command system (ICS) in disaster response

Participate in hazard and risk assessments for Lucas County

Conduct a capacity assessment defining the public health and medical resources available for your agency and those available through mutual-aid agreements

Develop other agreements (mutual aid) where appropriate with other governmental offices, nonprofits groups, and /or private companies/organizations which can provide support /supplies in an emergency/disaster

Conduct vulnerability analysis at critical facilities and make recommendations to improve the physical security

Maintain current information related to all nuclear, biological or chemical threats

Risk Communications Team Ensure all team members are fully trained in areas of public

speaking and media relations Develop and maintain relationships with local media Develop and maintain crisis communications plan Exercise crisis communications plan Develop Public Service Announcements ( PSA’s) and sample press

releases for different disasters/events preemptively

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Response Activities

All Staff Participates in alert, notification, and warning efforts. Verify communication procedures Provides pertinent information to the PIO to provide services to

special needs populations Promotes the health of everyone in Lucas County

Health Commissioner/ Medical Director Signs for receipt of SNS Acts as spokesperson for the health department Functions as the Incident Commander for the Health Department Opens the DOC at the health department Consults with Logistics, Planning, Operations and Finance on a

regular basis Instructs staff to shut down HVBAC system as warranted Determines if and when Health Department should be abandoned

for an alternate site Directs SNS activities and resources Functions in Unified Command at the EOC when it is activated; and

with RMAC when it is activated

Administration Activate emergency operation plans as warranted and

verify proper notifications to key staff members and appropriate agencies.

Coordinate the location, procurement, screening and allocation of health and medical supplies and resources.

Staff and operate a national Incident Management System with compliant command and control center (ICS) to assure that services and staff are provided to areas of needs.

Implement quarantine and social distancing policies as necessary to protect public health

Oversee disposal of mass casualties Evaluate the emergency situation, make strategic decisions, identify

resource needs and secure resources required for field operations Coordinate supplemental assistance in identifying and meeting the

health and medical needs of disaster victims Provide an ESF 8 representative to the EOC for coordination of

medical and health services Protect the health and safety of health department staff and clients Request and manage allocation of the SNS as needed Set up and manage the point of dispensing (pod) clinics as needed

throughout the community for prophylaxis Assist the Ohio Department of Health in providing assessments of

the public health impacts of large scale disasters or terrorist incidents.

Provide for the recording and preservation of death certificates Monitor, record, and maintain record of all expenses related to the

incident Complete all documentation for FEMA

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Liaison to FEMA

Epidemiology Maintain disease surveillance systems to detect disease outbreaks

and public health emergencies. Conduct analysis to determine cause, origin, and scope of epidemics and outbreaks

Establish disease surveillance and monitor environmental public health at public shelters

Monitor the public’s health as it relates to environmental contaminants such as chemical spills and provide advice to incident commanders and coordination entities regarding strategies for protecting human health

Coordinate the identification and treatment of zoonotic (animal to human) disease outbreaks with local veterinarians and Ohio Department of Agriculture or Ohio Department of Natural Resources as deemed necessary

Monitor Epi-X for national surveillance and RODS for local surveillance

Monitor ODRS (Ohio Disease Reporting System) and oversee all activity related to this system

Act as a liaison between area hospital Infection Control Practitioners and the Health Department

Coordinate investigation of communicable diseases with the ODH

Assist in the coordination of all investigation, surveillance and follow up activities related to nuclear, biological or chemical threats or events

Monitor statewide and regional events through surveillance

Environmental Health Provide guidance and oversight for the disposal of

animal carcasses to ensure public health is not at risk Coordinate with other agencies to ensure the safety of food and

water supply Examine food and water supplies (test as necessary) for

contamination Oversee vector and rodent control. Advise public on preventative

measures Ensure compliance of emergency sanitation standards for disposal

of garbage, sewage, and solid waste / debris Inspect shelters prior to opening and during operation to ensure that

minimum standards of sanitation are met

Health Services Assure provisions of immunizations, prophylaxis, and treatment as

necessary to prevent or control disease. Create a registry of exposed victims. Oversee decontamination procedures and provide the public with

relative information about contaminants and exposure.

Disaster Planning

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Ensure appropriate agency representatives are assigned to Incident Command post and/or EOC

Begin complete documentation stream to include phone, fax, and radio logs, as well as costs for overtime, materials, and supplies

Maintain contact/coordination with all agency emergency support functions, especially public safety

Maintain communications with the EOC and other agencies to provide for and / or seek support and assistance

Initiate and coordinate all health department activities related to Davis Besse SOP

Initiate and coordinate all health department events related to the Post Office Anthrax SOP

Medical Reserve Corps Coordinator Activate and deploy medically credentialed volunteers

once an emergency has been declared Coordinate volunteer management activities with community

organizations and implement systems for credentialing, training and tracking medical volunteers assigned to public health operations

Risk Communication Team Provide ongoing information regarding public health to other

agencies, staff, and general public Keep the public informed about public health issues and

recommend disease prevention and sanitation precautions to keep people healthy

Recovery Activities All Staff Return to mitigation/preparedness phase of emergency management Continue to provide support as required to facilitate recovery phase Re-stock supplies

Administration Initiate financial reimbursement process when such support is

available Demobilize staff and supplies as appropriate and return facilities and

equipment to pre emergency state of readiness Continue to oversee and maintain documentation stream. Prepare and/or review required reports on damage assessment and

health/environmental impacts.

Epidemiology Continue disease surveillance and investigation

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Environmental HealthCoordinate disposal of contaminated food itemsCoordinate disposal of dead animalsEnsure the quality and safety of septic systems and well water

Health Services Provide guidance for monitoring exposed victims for health concerns

Disaster Planning Participate in after-action review Coordinate with the EOC a re-entry plan for evacuees

Medical Reserve Corps Coordinator Add any new volunteers into the database Formally thank / recognize all volunteers Update contact information for volunteers Update database to enable volunteers to keep their

active status

Risk Communication Team Continue to provide the public with current information regarding the

health impacts of the incident

Tab 9. Organization of Responsibilities

A. Duties out of job classification

All health department staff members may be asked to perform a wide array of duties during an emergency or disaster situation. These duties may or may not pertain to an employee's day-to-day responsibilities. Below are descriptions of job

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responsibilities that may need to be performed during an emergency or disaster situation.

1. Shelter Operations (Annex 8)

Shelters may be utilized to house members of the public during an emergency or disaster. Prior to shelters opening, environmental health specialists are required to inspect each shelter to insure that the minimum standards of sanitation are met as further described in Annex 8.

2. Epidemiological Surveillance/Investigations (Annex 5)

In the event of an actual or potential disease outbreak, epidemiologists, nurses, and sanitarians may be asked to participate in administering epidemiological surveys or investigations. Epidemiological surveillance and investigation is discussed in detail in Annex 5.

The purpose of these investigations is to identify the cause/source of an agent by comparing the commonalities of cases compared to controls. This is done to determine the source of the exposure, which in conjunction with clinical and/or environmental specimens can lead to the identification of the responsible agent. Knowing the source of exposure and the agent also helps officials limit further exposure and aid clinicians in treatment of cases.

3. Point of Dispensing (POD) Setup/Management (Annex 4, SNS / Mass Prophylaxis Plan)

Employees with various knowledge, skills, and training will be asked to assist in the setup and management of PODS for the administration of immunization/prophylaxis (e.g., antibiotics, vaccinations) in the event of an actual or potential disease outbreak or bioterrorist attack. Mass immunization/prophylaxis and clinical setup is discussed in Annex 4.

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4. Environmental Surety (refer to Environmental Surety plan, Annex 7)

a. Vector/Rodent Control (Annex 7)

During certain emergency or disaster situations, it may be necessary to implement surveillance and control measures of environmental conditions that can result in increased insect, rodent, and/or other pest nuisance (e.g., flooding, solid waste issues at shelters). Therefore, surveillance and control measures will be important for limiting or preventing vector-borne and rodent transmitted diseases. These are discussed in Annex 7.

b. Waste/Debris Management ( Annex 7)

An increased need for management of solid waste may be required during some emergency or disaster situations. Proper storage, collection, and disposal of solid waste will be important at shelters and large clinics, which will need to be coordinated with the Lucas County Solid Waste District. It will also be important to disseminate information to the general public in disaster situations where water supply and regular trash pick-up are disrupted. Situations requiring environmental specialists for the management of solid, human, and infectious waste are discussed in Annex 7.

c. Water Supply (Annex 7)

In the event the potable water supply is disrupted, employees will be required to help disseminate information to the general public regarding the dangers of drinking contaminated water and proper water disinfection/purification methods. This issue is further discussed in Annex 7.

5. Community Reception Center 6. Medical Surge 7. Public Health Emergency

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Tab10. Responsibilities of State and Federal Agencies

State AgenciesOhio Department of

Health Conduct assessments and monitor health conditions in the

communities affected by the emergency and where possible, determine where health problems could occur.

Maintain ongoing epidemiological surveillance and investigation of affected communities in order to rapidly identify and address health related emergencies.

Support local health district emergency operations by coordinating health, medical and veterinary surge related services and supplies.

Coordinate and support inspections of food service sanitation programs and private water system and water hauling programs.

Provide consultation for household sewage disposal, housing sanitation, vector control, and health nuisances.

Coordinate state emergency response to health and medical problems through the State EOC for assessment, response and recovery.

Coordinate with local health districts in their emergency inspection programs.

Support the continued delivery of non-emergency health care programs by local health districts throughout the emergency.

Assist with the coordination of evacuation and sheltering-in-place hospital, long term care facilities, nursing homes and other affected communities.

Coordinate the supply of pharmaceuticals, medical equipment and supplies as needed during the emergency.

Provide health and medical advisories and news releases. Coordinate and support community containment, isolation

and quarantine strategies. Coordinate and support examinations and analyses of

possibly hazardous and contaminated substances throughout the emergency.

Coordinate and support mass fatality management. Provide health and medical-related information to the

public. Coordinate hospital bed and patient tracking. Support family re-unification programs. Perform laboratory testing and confirmation of samples. Coordinate and support mass prophylaxis, dispensing or

vaccination of the community. Maintain vital statistics and vital records. Monitor and inspect long-term care facilities. Locate and coordinate local, regional, state and federal

health and medical resources for response. Coordinate and support community environmental health

to include vector control, waste management, wells, food supplies and indoor/outdoor environment.

Conduct epidemiological follow up for exposed persons after radiation emergencies.

Ohio Department of Agriculture

Coordinate the inspection of retail food establishments with local health districts.

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Ensure the safety and efficacy of regulated foods, and conduct inspections of food processing establishments (e.g., food, dairy and meat) and distributors during emergencies.

Coordinate and collect food samples. Arrange for and oversee embargo, removal,

disposal, and/or destruction of contaminated products. Conduct sample analysis at the Consumer Analytical

Laboratory and/or the Animal Disease Diagnostic Laboratory; and provide laboratory support.

Conduct inspections, investigations and surveillance in the event of zoonotic diseases.

Ohio Environmental Protection Agency

Coordinate drinking water, waste disposal and environmental safety information with local health departments and ODH.

Provide a listing of laboratories offering microbiological, organic and inorganic analysis.

Ohio Funeral Director’s Association

Supply personnel and materials to support mass fatality response and expanded mortuary services in affected jurisdictions, including the set up and support of the State’s mobile morgue asset.

Federal AgenciesCenter for Disease

Control Provide guidance for all emergencies in the form

of fact sheets, FAQ’s, press releases , etc Monitor health of nation and look for trends with

diseases and for potential outbreaksFederal Emergency

Agency - FEMA Declare national emergencies Provide financial assistance to victims of natural

disasters

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Tab 11. Public Health Information

In addition to the information provided in the Health Department Emergency Response Plan (Annex H), the following special considerations would be taken during any crisis event:

The Lucas County Communication Plan (Annex 2) will be followed at all times. During events that are under the sole responsibility of the Health Department, the Health Commissioner, or his designee, will be the Public Information Officer and will pre-approve any information prior to dissemination by any Health Department employee.

The PIO will be responsible for coordinating the Health Department’s participation in any Joint Information Center activities.

In joint responses within the County EOC, all incident press releases or public information dissemination will be assigned to the Health Commissioner or his designee, who will work with the Public Information Officer assigned by the EOC and the incident commander.

The County Public Information Officer, assigned to the Incident Commander, will defer questions to the Health Commissioner, or his designee, regarding biological, chemical and radiological hazards as it relates to public health.

Fact sheets will be utilized for nuclear, biological and chemical agents, where concern exists about disease, immunization, communicability, exposure and health effects,

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personnel protection, including use of potassium iodide, risk factors, community resources, and other environmental issues. These fact sheets will be used to reach decisions on response activity.

Fact sheets on commonly used nuclear, biological and chemical agents, as well as treatment, prevention and surveillance procedure will be maintained at the Health Department.

The CDC and ODH updated information will be maintained and augment any Health Department standard operating guides if an actual event occurs.

(See Annex 2 Communication Plan)

Tab 12. Testing the Emergency Operations Plans:

Public health preparedness capabilities: The CDC identified the following 15 public health preparedness capabilities (shown in their corresponding domains) as the basis for state and local public health preparedness:

Bio-surveillance:- Public Health Laboratory Testing - Public Health Surveillance and Epidemiological Investigation

Information Management - Emergency Public Information and Warning - Information Sharing

Incident Management - Emergency Operations Coordination

Community Resilience - Community Preparedness - Community Recovery

Surge Management - Fatality Management - Mass Care- Medical Surge- Volunteer Management

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Countermeasures and Mitigation - Medical Countermeasure Dispensing - Medical Materiel Management and Distribution - Non-Pharmaceutical Interventions - Responder Safety and Health

The TLCHD will test all 15 capabilities within each 5 year period (starting in 2013). Tests of the EOP and these capabilities will be done by the following methods:

Response Exercises

Emergency response exercises allow emergency response personnel to become fully familiar with the procedures, facilities, and systems used during an actual emergency. The Emergency Operations Center (EOC) and the Departmental Operations Center (DOC) can be activated for a response exercise so employees can rehearse actions.

The following exercise formats are used:

Tabletop Exercise - A tabletop exercise (TTX) is an informal group discussion among senior staff, elected or appointed officials, or other key personnel centered on a hypothetical scenario. A TTX is typically used to identify strengths and shortfalls, understand new concepts or achieve a change in attitude. TTX characteristics include an in-depth discussion and slow-paced problem solving.

Tabletop exercises may be held for one ICS Section, Branch, Group or with all personnel participating.

Functional Exercise - A functional exercise (FE) is a single or multi-agency activity designed to evaluate capabilities and multiple functions using a simulated response. FE’s are typically used to evaluate management of Emergency Operations Centers, command posts, and headquarters, and assess adequacy of response plans and resources. The FE is characterized by a simulated deployment of resources and personnel, rapid problem solving and a highly stressful environment.

Full-Scale Exercise - A full-scale exercise (FSE) is a high-stress multi-agency, multi-jurisdictional activity involving actual deployment of resources in a coordinated response, as if a real incident had occurred. The FSE is typically used to assess plans and procedures under crisis conditions and assess coordinated response under crisis conditions. The characteristics of a FSE are mobilization of units, personnel, and equipment, stressful and realistic environment, and a scripted exercise scenario.

All Exercises will be HSEEP compliant. An After Action Report ( AAR) and Improvement Plan (IP) will be written for each exercise. The improvement plan items will be tracked by the disaster planner to make sure suggested improvements are implemented. The AAR/IP will be submitted to ODH 60 days after the end of the exercise and kept on file.

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Changes to current plans based on lessons learned from seminars, drills, and exercises will be adjusted or corrected as identified.

TLCHD will participate in regional drills and exercises as well as drills with partnering agencies in Lucas County.

Tab13. Debriefing Post Event

All Health Department employees and/or volunteers involved in responding to a crisis incident will participate in a critical incident stress debriefing conducted by the Health Department, coordinated by the Health Commissioner, in the department offices after termination of the incident.

Debriefing will include reflection on strengths and weaknesses of the response, recommendations for changes in the Emergency Response Plan, and recommendations for future trainings based on weaknesses noted during the event.

Mental Health personnel will be available during and after the post event debriefingfor stress debriefing of any and all employees requesting such services.

If another county agency has acted as Incident Command and conducts a debriefing session, all administrative Health Department employees taking part in the incident will participate.

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Tab14. After Action Review

An After Action Report provides a description and analysis of the department’s performance during an emergency operation, identifies issues that need to be addressed, and includes recommendations for corrective actions for future emergencies and disasters.

An AAR is to be completed when a communicable disease outbreak occurs, when anenvironmental public health risk has been identified, when a natural disaster occurs, and when any other significant event occurs that threatens the public’s health. An AAR will also be completed after drills and exercises.

All AAR’s must be maintained in room 250B in the printer/fax machine room.

AAR’s will be maintained on file for:

Drills and exercises: 10 years Real event: Indefinitely; Files can be archived and saved electronically.

The following table illustrates when a circumstance would require an AAR:Foodborne Illness

An AAR shall be completed whenever there is a confirmed Class A disease, a confirmed outbreak (other than Class A) with 25 or more ill individuals, or any outbreak when a death occurs. The AAR shall be submitted 90 days after the event has ended.

Waterborne IllnessCommunicable Disease

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OutbreaksNatural Disasters An AAR shall be completed after any natural disaster that deems

the opening of the county EOC. The AAR shall be submitted 60 days after the event has ended.

Environmental Public Health Hazards

An AAR shall be completed after any significant environmental health hazard (lives lost, suspect outbreak from environmental hazard, or other deemed as significant by health commissioner). The AAR shall be submitted 60 days after the event has ended.

Radiation Emergency

An AAR shall be completed after any radiation emergency. The AAR shall be submitted 60 days after the event has ended.

SNS Deployment An AAR shall be completed whenever the SNS is deployed. The AAR shall be submitted 60 days after the event has ended.

MRC Deployment

An AAR shall be completed whenever the MRC is deployed. The AAR shall be submitted 60 days after the event has ended.

Other Significant Public Health Emergency

An AAR shall be completed any time the Department Operations Center at the TLCHD opens. The AAR shall be submitted 60 days after the event has ended.

*****Submit AAR’s to ODH via GMIOS and send email a copy to Cathy Mockus at Cathy.Mockus@odh.ohio.gov.

Tab 15. Volunteer and Temporary Staff

Volunteers and Temporary Staff will be used to supplement staffing. Volunteers can be used to perform normal health department functions or perform duties related to the disaster such as staff a mass prophylaxis clinic or an alternate care center or functional needs shelter.

Temporary Paid Staff:

The following are temporary staffing agencies utilized in a disaster:

Type of Staff Medical Non-MedicalAgency name Medical Staffing Network

( MSN)Cardinal Staffing Services

Address 2515 Oregon Rd.Northwood, Ohio 43619

Office Phone toll free # 1-866-864-3462419-868-8536 419 666-8500 Ext 5104

Fax 419-868-8802 Fax 419 -661-2696

Contact person Angie Szymanski Jeanne Piotrowicz

Cell Phone 419-509-6053Email jpiotrowicz@cardinalstaffing.com

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All staff must complete a Temporary Paid Staff Registration Form, a HIPAA Employee Confidentiality Agreement, and sign a Code of Conduct form.

Credentials of medical staff will be checked by the Logistics chief or designee. Medical credentials can be checked at www.nursys.com .

Staff are subject to background checks. Criminal and Civil background checks can be performed at www.tmc-clerk.com .

Volunteers: All volunteers must register with the United Way and/or be sworn in by the Lucas

County EMA and go through training to be covered by liability. The Medical Reserve Corps can provide trained medical personnel. Currently, the

MRC is housed at the TLCHD. A disaster has to be declared for the volunteers to be covered under liability. If there is no disaster declaration, volunteers must register with the United Way.

All volunteers must complete a Volunteer Registration Form, a HIPAA Employee Confidentiality Agreement, and sign a Code of Conduct form.

Credentials of medical staff will be checked by the Logistics Chief or designee. Medical credentials can be checked at www.nursys.com .

Notification of MRC volunteers will be done via alerts through Ohio Responds. The MRC volunteers are also in the Athoc system as a backup.

Spontaneous/Unaffiliated Volunteers:Spontaneous volunteers should be convened in a separate location from registered Medication Center (POD) staff. Volunteers are accepted as POD staff based on skill set and need as determined by the POD leadership staff. These volunteers must be provided training and register with the United Way at a Volunteer Reception Center and/or county EMA to be covered under tort liability.

Volunteer Recruitment:

Prior to event: MRC Coordinator will recruit and train medical and non-medical volunteers through

the hospitals and medical college and nursing schools. Organizations such as Red Cross, United Way, and Cert will recruit and train

volunteers.

During Event: Lucas County EMA will recruit and swear in volunteers via local media “call out”.

Volunteers will be directed to a Volunteer Reception Center (VRC) operated by the United Way. The VRC can be virtual/web based or live at an area outside the hot zone.

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Tab 16. Personal Preparedness

The TLCHD administration believes that personal preparedness is an essential component of the Emergency Operations Plan. In order to respond to an emergency or disaster in a community, every individual must have a well-developed personal preparedness and response plan.

The TLCHD will support training and education to help employees better prepare their families during emergencies. All employees will be encouraged to maintain an emergency kit both at home and in personal vehicles, and be provided with educational items such as brochures which outline the items that should be kept in the kits.

A training component about personal safety will be added to each mandatory all-staff training day to help ensure personal preparedness.

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Tab 17. Plan Maintenance and Review The TLCHD Emergency Response Plan, at a minimum, will be reviewed yearly by the Emergency Response Coordinator. The plan will be reviewed by an internal plan review committee every 2 years. It will be reviewed externally by our partner agencies at the Lucas County Integrated Healthcare Planning Team every 2 years.

A. Internal Plan Review Schedule:

Quarter Even years Odd Years

1 January - March ESF 8

Base EOP

Quarantine , Isolation, and Social Distance Plan

Post Office Anthrax plan

2 April - June COOP EPI & Surveillance Plan

TLCHD Safety Plan

3 July - September Foodborne Illness Plan

Pandemic Influenza Plan

Demobilization and Recovery Plan

4 August- December SNS Plan

Antiviral Distribution

Environmental Surety Plan

Shelter Operations

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B. Internal Plan Review Process:

1. Send out a copy of the plan via email to plan review committee with instructions to submit changes, additions, and other comments to their supervisor.

2. Discuss plan at quarterly plan review committee meeting.3. Make corrections to plan.4. Have all Directors sign off on plan to approve it, add approval date and signature

to plan.5. Add date or revision to plan, and revision list to plan.6. Make changes to hard copy and plan on g-drive.7. Post on g-drive in common folder as PDF file, and send email to all staff

informing them that revised plan is on g-drive.Following any emergency response or training, the Emergency Response Coordinator, in conducting the After Action Review, will suggest and implement any changes needed to the Emergency Response Plan.

Hard copies of the Plan are maintained, at minimum, in the office of the Emergency Response Coordinator.

Electronic copies of the TLCHD Emergency Response Plans are on flash drives held offsite by:

Health Commissioner Deputy Health Commissioner Director of Community Services Emergency Response Coordinator

Electronic copies of the TLCHD Emergency Response Plan are maintained by the Emergency Response Coordinator, with copies available on the G-drive (shared drive for health department backed up daily by the county’s server).

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Tab 18. Annexes

Annex # NameAnnex 1 COOP Plan

Annex 2 Communications Plan

Annex 3 Radiation Emergency Plan

Annex 4 SNS / Mass Prophylaxis Plan

Annex 5 Epidemiology and Surveillance

Annex 6 Food- borne Illness Investigation Plan

Annex 7 Environmental Surety Plan

Annex 8 Shelter Operations Plan

Annex 9 Quarantine, Isolation, and Social Distancing Plan

Annex 10 Post Office Anthrax Plan

Annex 11 Antiviral Distribution Plan

Annex 12 Pandemic Flu Plan

Annex 13 Demobilization & Recovery Plan

Annex 14 Facility Safety Plan

Annex 15 5 Year Training and Exercise Plan

Tab 19. Appendixes

Appendix 1 MARCS Radios

Appendix 2 ICS and Job Action Sheets

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Appendix 3 SOP & SOG Binder

Appendix 4 Health Alert Network / HAN

Appendix 5 POD Supply Room

Appendix 6 POD Forms

Appendix 7 MOU’s

Appendix 8 OPHCS

Appendix 9 OPHAN

Appendix 10 atHoc

Appendix 11 EOC2Go

Appendix 12 Contacts

Appendix 13 Meetings

Appendix 14 Hazard Analysis

Tab 20. Authorities and Reference

A. Plans for Reference

Lucas County Emergency Operations Plan ESF 8 – Health and Medical portion of county EOP Transitional Medical Model

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