Instructions for use 6 cemp distribution List 8


ESF-8: HEALTH AND MEDICAL SERVICES



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ESF-8: HEALTH AND MEDICAL SERVICES



I. GENERAL:
A. Primary Agency: Levy County Health Department (LCHD)
B. Support Agencies: Levy County Emergency Medical Services (Fire/Rescue/EMS)
II. INTRODUCTION:
A. Purpose:
The purpose of this Emergency Support Function (ESF) is to coordinate the medical resources needed to supplement city/county resources in response to public health and medical care needs following a significant natural disaster or manmade event. Levy County Emergency Management and the Levy County Health Department (LCHD) direct assistance provided under ESF-8. Resources will be furnished when medical and or public health assistance is requested or deemed necessary by Levy County Emergency Management.
A significant natural disaster or manmade event that overwhelms the affected community or county would necessitate that county public health and medical assistance must be provided. In addition to direct assistance, the County would be required to provide leadership and coordination in carrying out emergency response efforts in the areas of health and medical issues.
B. Scope:
ESF-8 involves supplemental assistance to entities in identifying and meeting the health and medical needs of victims of a major emergency or disaster. This will include assessment of health/medical needs; disease control/epidemiology; health/medical care personnel, equipment and supplies; patient evacuation, coordination of hospital care; food/drug safety and emergency responder health and safety; radiological/ chemical/biological hazards; mental health and crisis counseling and public health information releases; vector control/monitoring; potability of water, wastewater and solid waste disposal; victim identification/mortuary services; medical command and control; and emergency medical services.
Hospitals, nursing homes, pharmacies and other medical/health facilities may be severely damaged or destroyed. Surviving facilities may be rendered unusable or only partially usable because of a lack of utilities and/or the inability of staff to report to work or patients to gain access to the facility. Medical facilities remaining in operation may be overwhelmed with minor injuries and seriously injured victims transported there in the immediate aftermath of the event. Massive increases in demand plus damage sustained may put medical supplies and equipment including pharmaceuticals in short supply. Disruption in local communications and transportation could prevent re-supply. Normal medication needs and supplies may be disrupted further taxing the system. Relocation or evacuation and specialized medical needs can further complicate patient care.
C. Planning Assumptions:
1. An incident has occurred of such magnitude that Levy County has implemented its CEMP and activated the Emergency Operations Center (EOC).
2. It may be a Mass Casualty Incident (MCI) with the potential of overwhelming the health and medical system in Levy County.
3. Neighboring counties might have been impacted and might not be able to furnish mutual aid.
4. Health care facilities may be overwhelmed, the target of an attack or otherwise affected.
5. Meridian maintains a 24-hour a day “Access Line” 1-800-330-5615 and TDD 1-800-955-8771.
6. The incident might involve pestilence or pandemic (disease) conditions.
7. Medical professionals might be suffering from the conditions of the incident and unable to perform.
8. The symptoms might be delayed in their appearance, and might take a few weeks to determine what they represent.
D. Priorities
The priorities might be required to change depending on the circumstances. The Levy County Emergency Management Director will consult with the Director of the LCHD in determining the priorities. Initially, the following priorities will be utilized:
III. CONCEPT OF OPERATIONS:
A. General:
ESF-8 will utilize locally available health and medical resources to the extent possible to meet the needs identified by county authorities. Throughout the response period, ESF-8 will evaluate and analyze medical and public health assistance requests and responses and develop and update assessments of medical and public health status. All requests from appropriate county response personnel for medical and public health assistance will be assumed valid. Upon receiving conflicting or questionable requests, ESF-8 will attempt to confirm the actual needs. ESF-8 will maintain accurate and extensive logs to support after action reports and other documentation of disaster conditions.


First Priority

Aid to those in life-threatening circumstances

Second Priority

Aid to ill or injured emergency responders and health

care professionals

Third Priority

Children, elderly, infirmed, or other special needs

group


Fourth Priority

General population




B. Organization:
ESF-8 is the primary source of all public health and medical response/information for all county officials involved with response operations. For field response operations, information will be coordinated with Levy County Emergency Management and LCHD. A representative of the LCHD will be designated and activated to the EOC upon notification or occurrence of a disaster. This representative will interact with the EOC Operations Officer and be responsible for activating Health Department resources upon request and maintaining contact with the State ESF-8 representative.
C. Notification:
1. Upon occurrence of a potential or actual major natural or manmade disaster event, the Levy County Sheriff’s Office Communications Center will notify Levy County Emergency Management.
2. Emergency Management will notify the ESF personnel of a pending event or activation as appropriate.
D. Direction and Control
ESF-8 will direct related countywide operations. This will include receiving and analyzing information for the following health related issues and directing support agencies in their management.
1. Monitoring the evacuation of health care facilities;

2. Monitoring shelters and congregate feeding sites;

3. Monitoring environmental issues;

4. Monitoring mental health issues;

5 Monitoring medical resources availability

6. Procuring need resources;

7. Monitoring evacuations and

8. Coordinating with ESF-14 regarding public and media informational needs.


E. Needs Assessment
Initial - Following a major incident a survey will be conducted to determine the immediate situation:
1. A survey of hospitals, nursing homes, assisted living facilities and doctors’ offices.

2 Reports from field responders, such as EMS crews and fire fighters.

3. SERT Reconnaissance Teams (RECON)

4. Initial Assessment Teams

5. Shelters

6. Calls for service


Continuing
1 Continue items listed in “Initial” immediately above

2. Agriculture Extension Service

3 Pharmacies and medical supply companies

4. Suwannee River Economic Council (for aging)

5. American Red Cross

6. Ministers

7. Long term shelters and congregate feeding sites

8. News Media reports

9. State and federal agencies
F. Health Care Facility Evacuation
Note: The State of Florida requires each health care facility to prepare an emergency plan that includes evacuation plans and procedures. ESF-8 will monitor evacuation progress by health care facilities.
1. Levy County does not have the capability of assisting the evacuation of health care facilities with the exception of “no-notice” emergencies (such as exposure to a nuclear accident), and whose patients and staff are in imminent danger. ESF-8 will:
a. Coordinate with ESF-16 regarding law enforcement escorts for evacuees.

b. Coordinate with EMS regarding transportation resources.

c. Coordinate mutual aid transportation requests through the State EOC.

d. Coordinate with Nature Coast Transit and the school district.

e. Advise ESF-14 of the situation for rumor control.
G. EMS Triage
Priorities will include:
1. Assistance to those in critical condition.
2. Assistance to those in less than critical condition, but are exposed to life threatening circumstances, such as rising floodwater.
3. Assistance to injured response and relief workers.
4. Assistance to injured or ill persons within the general public.
5. Transportation to persons with special needs who are not identified in item “4", immediately above.
6. Other calls for service.
H. Out-of-County Transportation
Levy County EMS will be responsible for coordinating out-of-country transport and determining when air transport is needed.
I. Resources
ESF-8 will coordinate resources requests with the EOC Duty Officer or State Liaison as appropriate. Mutual aid requests will be made in the following sequence:

1. Requesting mutual aid assistance from non-impacted counties.


2. Requesting assistance from American Red Cross.
3. Request assistance under provisions of the Statewide Mutual Aid Agreement.
J. Public Information
1. ESF-14 will provide support in reaching the public and the news media with pertinent information regarding health, mental health and environmental health issues.
2. Specific information, such as public warnings about contaminated water, may come from the Florida Department of Environmental Protection as well as the LCHD Administrator.
3. Should the incident be of such magnitude as to overwhelm county resources, the Levy County EOC may request a DMAT through the State EOC.
K. Disaster Mortuary Assistance Team (DMORT)
1. Should the incident overwhelm existing mortuary capabilities, the Levy County EOC may request a DMORT through the State EOC.
2. Identification will take place by the morticians, medical examiner and Sheriff.
3. ESF-16 will be responsible for next of kin notification.
L. Disaster Veterinary Assist Team (DVAT)
Should the incident overwhelm existing animal control capabilities and environmental health issues exist a DVAT may be request through the State EOC.
M. Special Needs
1. ESF-8 will use the Levy County data registration program and coordinate needs with:

  1. Levy County School District

  2. Levy County Emergency Medical Services

  3. Nature Coast Regional hospital

  4. Home Health Care agencies


IV. RESPONSIBILITIES:
A. Primary Agency: Levy County Health Department
Responsibilities:
1. Coordinate pre-incident planning.
2. Develop medical resource vendor contact information pre-incident.
3. Participating in training, drills and exercises.
4. Upon activation, assuring that the ESF-8/Branch position within the EOC can be staffed on a 24-hour a day basis if necessary.
5. Giving guidance and direction to support agencies.
6. Establishing priorities and serving as the principle health/medical advisor.
B. Support Agencies: Levy County Emergency Medical Services Nature Coast Regional Hospital
1. Support the primary agency in the performance of the ESF-8 activities.
2. Maintain vendor resource lists and contact information pre-incident.
3. Assist in staffing the ESF-8/Branch position in the Levy EOC.
C. Specific Functions
Levy County Health Department (LCHD)
The LCHD will serve as the primary agency for health, medical, mental health and environmental health issues. LCHD has primary responsibility for the operation of all Special Needs Shelters open in Levy County.
Levy County Emergency Medical Services (EMS)
Provide traditional services as well as incident related services. These may include, but not be limited to:


    1. Respond to public calls for assistance.




    1. Remaining on “standby” at incident scenes for response crews




    1. Involved in such activities as search and rescue and firefighting.




    1. When possible, remain on “standby” at shelters between calls.




    1. Assist with ground or air evacuation to hospitals in Ocala, Gainesville, Tampa and Orlando, when patient needs exceed those of local resources.


Nature Coast Regional Hospital
1. Provide customary services to the extent possible.
2. Provide overflow capacity for Special Needs Shelters.
VII. ACTIONS
A. Response Initial Actions:
1. Conduct initial assessment of health and medical needs and ascertain the need for health surveillance.
2. Determine need for additional personnel to include mass casualty incidents (MCI).
3. Determine coordination needs with ESF-6 regarding special needs shelters.
4. Examine need for medical equipment and supplies and identify in- hospital care resources.
5. Assist in dealing with hazardous materials, safety of food and drugs, radiological hazards, mental health problems of victims and responders, public health information, vector control, potable water, wastewater, solid waste and victim identification and mortuary services.
6. If advance warning of an impending disaster is available, resources may be pre-positioned, if necessary, for safety or in anticipation of the area of greatest need following the event.
7. No-notice incidents could result in medical and health resources being inaccessible or overwhelmed. ESF-8 will assess the need for non-local resources and request assistance through the Statewide Mutual Aid Agreement or other agreements.
8. Ascertain need for patient evacuation. Evacuation of residential health care facilities, if required, will be coordinated with ESF-1, ESF-5, ESF-6, ESF-13 and ESF-16.
B. Response Continuing Actions:
1. Monitor area of impact to assess potential hazards to public health and need for emergency medical response actions and resources.
2. Coordinate medical/patient transport requests.
3. Movement of supplies, equipment and support personnel to Staging Area or direct target sites.
4. Coordinate requests from hospitals/medical facilities and requests for medical evacuation.
5. Establish financial reimbursement policies and establish communications.
C. Recovery Actions:
1. All Primary Agencies during response will remain in place during the recovery phase, unless released. Support Agencies will be designated by the Primary Agency and may change to reflect available resources, area of impact and functional requirements.
2. ESF-8 will gather information regarding resources used, anticipated length of recovery activities and resources required.
3. Transportation of patients to facilities located outside of Levy County will be coordinated in the EOC with ESF-1, ESF-13 and ESF-16. Planning assumptions including airlifting may be required in some cases, ambulance capability will have to be enhanced from outside the county and multiple patients may be transported together.
4. Identification and mortuary services following a devastating disaster would require assistance of state and/or federal agencies. Response to “normal” events is within the capability of local health and medical professionals; a major disaster would stretch the capabilities of local resources and require mutual aid assistance. Notification of next of kin would take place using the accepted protocols used by County emergency response agencies following accidental deaths.
5. Primary and Support agencies will use appropriate state and federal rules, regulations, laws and guidance in maintaining records of staff utilization, obligations, expenditures and use of other resources. The public health unit will augment its normal level of accountability and business controls in order to do so.
6. Public advisories concerning food contamination will be coordinated with ESF-5 and released through ESF-14.
7. Primary and Support agencies will conduct after-action evaluations and present recommendations on health related mitigation opportunities.
V. ENVIRONMENTAL HEALTH
A. Inspections
Public Areas - Public shelters and congregate feeding sites will be inspected daily by an environmental health specialist. Food preparation areas, pantries, serving lines, food disposal systems, and public restrooms will be the area of emphasis on these inspections. Mutual aid may be requested.
Municipal Water Systems - The Florida Department of Environmental Protection will inspect municipal water systems.
Well Water System - The environmental health unit of the LCHD will obtain residential well samples and submit to the State Department of Health laboratories.
Waste Water Systems - Florida Department of Environmental Protection has jurisdiction.
Food Inspections (Levy County Health Department) – ESF-8 will not inspect food other than that utilized in congregate feeding areas i.e.

schools, jails and hospitals. Residents concerned about the safety of their own food stocks will be advised to dispose of questionable food.


Food Inspection (Commercial) – ESF-8 does not have the capability to inspect food inventories of grocery stores, nor does it have the responsibility or capability of inspecting restaurants. The Department of Business and Professional Regulation handles restaurant inspections. Inspections of commercial food products would require mutual aid from the appropriate state agencies.
Pharmaceutical Inspections – ESF-8 does not have qualified staff to conduct inspections of pharmaceutical products. Should such services be required, mutual aid will be requested.

B. Disposal Issues
1. The disposal of food from public shelters and congregate feeding locations will be done with guidance from ESF-8.
2. Commercial establishments will be responsible for disposing of spoiled or contaminated food stuffs through private vendors.
3. Residents will dispose of spoiled or contaminated food through normal disposal methods.
C. Pests / Animals
Following a disaster, there may be an increase in nuisances and health issues created by pests, such as rodents and insects. Few resources exist in Levy County to manage these concerns. Actions may include:
1. Guidance or mutual aid through the State EOC.
2. Guidance or assistance through the Levy County Agriculture Extension Agency, or the Institute of Food and Agriculture Science at the University of Florida.
3. Contract pest control services.
D. Potable Water
1. ESF-8 with ESF-14 will disseminate “boil water notices” to the public.
2. ESF-11 will request potable water if a shortage exists.

V. PUBLIC INFORMATION COORDINATION
A. Policy
The release of timely and accurate information pertaining to public health issues, crisis counseling and emergency medical needs will receive priority for public dissemination.
B. Authorities and Spokespersons
The LCHD staff is considered to be the local experts on health issues. The Director will be the spokesperson for ESF-8 activities and for issuing public warnings.
C. Concept of Information Operations
1. ESF’s 8 and 14 will maintain frequent coordination meetings to identify what information should be released and who should serve as spokesperson for the issue.
2. Health related rumors will be identified and countered with a joint effort by ESF’s 8 and 14.
3. Public health warnings and notices will be issued as necessary. The administrator of the LCHD, or their designated alternate, will be responsible for issuing public health warnings.
VI. RECOVERY
Many of the same health and medical needs may exist in recovery as exist in response. ESF-8 may be requested to remain operational during recovery. As appropriate, it will operate from the Health Department, EOC or Recovery Coordination Center, using the same primary / support structure.




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