CDPHE

Colorado Department of Public Health and Environment

EMERGENCY PREPAREDNESS AND RESPONSE

BE READY BE HEALTHY BE INFORMED

an EVENTful 2008

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mergency Preparedness and Response at the statehealth department has been involved in a wide range of events. Every emergency that is elevated to the state level is evaluated to determine what support is needed for the local response efforts.

CDPHE is the Emergency Support Function #8 lead agency, working closely with the Colorado Division of Emergency Management on incidents.

Fast action, efficient communication and the high level of cooperation among various agencies are all credited with significantly limiting the number of illnesses in Alamosa. The fact that Alamosa County staff had received incident command system training prior to the outbreak was critical to the success of the response. The regional trainer in the county’s public health nursing service has been personally lauded for encouraging other non-medical local partners to participate in the trainings as well, anticipating the need for multi-sector preparedness. At a statewide conference of county commissioners in June 2008, one of Alamosa’s county commissioners told an audience that he had never understood why his staff was spending so much time and money on trainings – but now, after the outbreak, he clearly sees the value in preparedness education.

The two most significant events for the division this year were the water system contamination in Alamosa and the Democratic National Convention.

Alamosa Salmonella Epidemic Alamosa declared a city-county emergency on March 19 when CDPHE issued a bottled water order for the town due to salmonella contamination in the city’s municipal water system. The sudden outbreak of salmonella in the municipal water supply in Alamosa tested the state’s ability to manage an epidemic and quickly mobilize key resources.

While a boost in federal funding in recent years has allowed Colorado to establish a statewide infrastructure to effectively respond to such disasters, the event in Alamosa underscores the importance of continued funding for emergency preparedness and the need to integrate public health activities with emergency management.

With the local public health nursing service as the lead agency in Alamosa, it was CDPHE that first was contacted for support. The regional planner and trainer, both funded by the Public Health Emergency Preparedness and Response Cooperative Grant, called on CDPHE’s EPR staff for guidance. While the infection control staff worked on identifying the salmonella cases, the lab identified the specific strain and the water team brought in experts to identify the problems and repair the water system. In the meantime, EPR had the job of helping a community of 10,000 cope with no water for drinking, food preparation or even bathing. :: EPR immediately contacted grocery, water and beverage bottling companies throughout the state.

Within two hours, trucks were en route to Alamosa with bottled water. :: EPR coordinated staff deployment to Alamosa, with the need for expertise in water quality, consumer protection, disease control, laboratory services and emergency response. EPR also helped coordinate volunteer efforts to support emergency responders. :: EPR managed the financial aspects of the state response, establishing a new cost center and requesting resources from other local public health agencies.

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Democratic National Convention The Democratic National Convention was designated a National Special Security Event, which authorizes the Secret Service to lead all security-related activities. From the beginning of the convention planning, the Emergency Preparedness and Response Division was an integral participant.

With Denver Public Health in the lead for ESF 8 response, CDPHE was on duty 24/7 to support the local efforts. It was the largest event ever in Denver, with projections of up to 100,000 protestors from multiple groups hoping to disrupt the convention. Just prior to the convention, the area experienced some of Denver’s summer extreme temperatures, adding to the public health concerns. communication among agencies, to maintain situational awareness by coordinating the various systems in use and to ensure public health had clear and decisive leadership 24 hours a day during the entire convention.

The department hosted about 100 staff from local and federal agencies at its operations center in Glendale. Emergency Preparedness and Response staff were assigned to one of several teams that staffed the Department Operations Center, the State Emergency Operations Center in Centennial and the Multi-Agency Coordination Center at the Federal Center in Lakewood. CDPHE’s objectives were to support redundant

A separate report on the BioWatch alarm during the DNC is available.

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Colorado Brings More Accountability to Emergency Preparedness and Response

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ocal governmental agencies are responsible for the coordination and management of disasters or emergency events affecting their jurisdictions. If the local jurisdiction’s resources are not sufficient for the increased level of need during a disaster or emergency, local governmental agencies may request assistance from the state. When a request is received, the Colorado Department of Public Health and Environment may be activated to mobilize resources, or to provide technical guidance and information to local governmental entities, other state departments and the public. The state health department also activates, with many other state agencies, when the State Emergency Operations Plan, managed by the Colorado Division of Emergency Management, is activated.

CDPHE also supports the Colorado Department of Human Services, the lead agency for ESF #8a – Mental Health and Substance Abuse.. CDHS is responsible for providing behavioral health crisis counseling during and after disaster response when necessary.

The Role of the Colorado Division of Emergency Management

When a disaster or emergency event exceeds local response capabilities, jurisdictions are likely to request common types of assistance from the state. The types of assistance have been grouped at the national level into 15 “emergency support functions,” or ESFs. The Colorado plan adopted the 15 ESFs and identified certain state departments as leads for each functional area. The Colorado Department of Public Health and Environment is the lead agency for ESF #8 – Public Health and Medical Services, and a support agency for nine of the remaining annexes.

The Colorado Division of Emergency Management (CDEM) is responsible for the management and coordination of all state emergency operations and, when necessary, federal resources. CDEM establishes the state government presence in the impacted jurisdiction in anticipation of the need for immediate and long-term assistance. CDEM supports all state departments and agencies during disasters and emergencies. This division assists with requests for and acquisition of resources during emergencies and coordinates the delivery of the needed resources.

In its role as the lead agency for ESF #8, CDPHE provides support to local and tribal governments in the assessment of public health/medical needs, including behavioral health and mortuary; public health surveillance and laboratory services; medical care personnel; and medical equipment and supplies. CDPHE helps identify and meet the public health and medical needs of victims of a disaster, including: • Disease surveillance and outbreak control measures • Indoor and outdoor air quality monitoring • Drinking water and wastewater assessments and recommendations • Food (except livestock) and dairy integrity evaluations and food safety guidelines • Hazardous materials, including radiological materials, assessments and recommendations • Waste management guidelines • Hospital resources and medical supply monitoring • Activation and deployment of the Strategic National Stockpile

CDEM is responsible for the organization and operation of the State Emergency Operations Center, daily and when activated for an emergency.

The center, also known as the Multi-agency Coordination Center or MACC, provides a central location for local, state and sometimes federal partners to work together in response to emergency events.

CDEM also is responsible for alerts and notification, deployment and staffing of designated emergency response teams, incident action planning, coordination of operations, logistics and material, direction and control, information management, facilitation of requests for federal assistance, resource acquisition and management, worker safety and health, facilities management, financial management and other support as required.

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In Their Own Words: Otero County

by Rick Ritter, Executive Director, Otero County Health Department, November 21, 2008

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tero County Health Department’s (OCHD) jurisdiction is Crowley and Otero counties in Southeast Colorado. Our counties are very low on the economic scale. The median annual income is significantly less than that of the state of Colorado.

Our main industry historically has been agriculture, which has been significantly impacted the last few years by diversion of irrigation water and a multipleyear drought. In addition, businesses have closed their doors, resulting in a significant job losses, which has a negative impact on the local economy and its tax base.

These resources have helped the Southeast Region immeasurably with preparedness and in addressing the 10 essential public health services.

This economic situation leads to several gaps and needs for public services, including preparedness.

Thanks to the grant, the state of our public health preparedness is good. This grant has undeniably changed our agency in a very positive way, with a state of readiness that allows us to respond effectively for local incidents. The grant supports emergency preparedness and response (EPR) staff training and exercises. Our EPR staff are on call 24/7 to respond to requests from the hospital, sheriff’s department, elected leaders and other response partners. Each month, we train on NIMS, weapons of mass destruction, communication devices, emergency risk communication, mental health issues in emergency response, Strategic National Stockpile, pandemic response, biological hazards and more.

:: OCHD responded to a major fire in Crowley County, and the mayor of Sugar City delegated the authority to serve as Incident Commander of the Sugar City Shelter to OCHD staff. Our go-kits, purchased with CDC grant funds, were an invaluable part of our response efforts. :: OCHD responded to a small out-building contaminated with organo-phosphate chemicals in Sugar City. We used personal protective equipment, or PPE, purchased with the CDC grant to protect us while we decontaminated the out-building.

In 2002, our state general fund support was eliminated. With the CDC grant supporting our preparedness activities, we had resources to support preparedness and readiness, including a regional public health epidemiologist, trainer and planner. These resources have helped the Southeast Region immeasurably with preparedness and in addressing the 10 essential public health services. Without the CDC grant, these positions would be cut, as the Southeast Region counties do not have the funds to support them. Not only have we had great successes with trainings and exercises, but also with real incidents: :: We responded to an issue involving great quantities of red, fuming nitric acid. We led the response with the Colorado Department of Public Health and Environment, U.S. Environmental Protection Agency, the Pentagon, Sheriff’s Department, hospital, local fire departments, Army Corps of Engineers, Colorado Attorney General’s Office and others.

:: We have responded to multiple incidents in chemical labs at our local public schools. We have assisted the schools in properly disposing of hazardous chemicals, thus making our children safer. :: We assisted when explosive material was found in the Crowley County Courthouse in Ordway. Once again, our incident command training proved very valuable.

In our jurisdiction, OCHD is respected as an incident response partner. This statement would not have been possible without the CDC grant funds supporting our preparedness efforts. This grant has made all the difference between being well prepared and not being prepared.

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In Their Own Words: Otero County Otero County Sheriff Chris Johnson

We absolutely need these funds to continue the important work of public health preparedness in our economically deprived area of the state.”

“By receiving these funds, the grants have enabled our health department to be an active participant in situations where they would have otherwise been unable to participate. These funds have made a positive impact between Otero County emergency management and our local health department. The loss of continued funding would critically hamper our efforts toward unified chain of command that includes public health as an essential and key component. The loss of these funds would also endanger our homeland security efforts as OCHD is a key player in this regard.”

Crowley County Emergency Manager Larry Reeves “The health department has been an invaluable partner in our emergency preparedness efforts through trainings, resources, etc. The loss of these funds would cripple our preparedness efforts and ability to respond.”

Otero County Administrator Jean Hinkle “With funding being cut at the federal and state levels for various programs it is becoming increasingly more difficult for local government to withstand the burden. The loss of funding would eliminate much needed full time positions including a regional training coordinator, an emergency preparedness response coordinator, a regional epidemiologist and others who are on call 24 hours a day for the safety of the public. These individuals are responsible for training the public and ensuring the necessary supplies are in place should a situation arise. Not only do these individuals assist locally but regionally as well.

Our Public Health Director is exceedingly fiscally responsible, maximizing every dollar and staying abreast of approaching issues. The Otero County Health Department and the Southeast Region would suffer greatly if funding is cut.”

Arkansas Valley Regional Medical Center Infection Control Officer Norm Finkner “The Southeast Colorado Region public health staff has been very instrumental in helping our hospital in the emergency preparedness arena. They have been excellent resources for planning and training, and in the development of training exercises. The grant money provided by Public Health has allowed the purchase of necessary preparedness equipment. The health department’s preparedness leadership has helped develop a strong partnership among the various entities in emergency response in Southeast Colorado.”

Crowley County Commissioner Tobe Allumbaugh “Due to the numerous emergency incidents we have had in the recent past, the preparedness funds and services through the local health department are invaluable to the citizens of Crowley County. They really do make a difference. Crowley County is the poorest county in Colorado, and if these funds were lost they absolutely could not be replaced locally.”

La Junta High School Principal Bud Ozzello “The health department has assisted us numerous times with hazardous chemical disposal. It is comforting to know they have the training and expertise to help when needed. I would hate to see their readiness funding disappear.”

Otero County Board of Health President Paul Yoder, M.D. “As president of the Board of Health, I see and hear first-hand how these grant dollars are being used to help the citizens of Crowley and Otero County.

Additionally, we have dispatched our EPR staff to other parts of the state when needed and requested for preparedness activities and emergency response.

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In Their Own Words: Jefferson County

by Jody Erwin, Emergency Response Coordinator, Jefferson County Department of Public Health and Environment, November 28, 2008

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ur number one priority is to make emergency preparedness a core public health program that enhances all other programs, supports the agency mission of protecting the health of the public, acts as a resource for the entire department and fully supports the Ten Essential Public Health Services.

trained, knowledgeable about and excited about their emergency response roles related to public health. We have our feet in the door and they have seen our value.

If we lose this ability to be flexible and creative we will lose every bit of momentum we have generated.

The key to this is continued funding of full-time staff that focus on integrating emergency preparedness into the daily activities of the department, while training staff and the public on what their role would be in preparedness and response. This works by making a connection to their daily activities and demonstrating value to other health programs. This does not mean that Jefferson County uses emergency preparedness money to fund other programs; rather, the funding enhances what staff does with emergency preparedness-related functions. This makes emergency preparedness a part of what they do every day.

An example of this is our ongoing Operation Artichoke exercises that test the regional/local distribution site positions and functions for the deployment of the Strategic National Stockpile. These were existing community events focused on providing fresh produce to underserved residents in Jefferson County. To be eligible for a small emergency preparedness grant, we required that they add several emergency preparedness objectives to these events. The functions that were

We have a lot left to do. We finally have an excellent set of fully developed plans. We are ready now to really get our staff into the details, and they are excited about it and committed to the program like never before, and now the funding is decreasing. We are on the verge of very exciting breakthroughs related to integrating the emergency preparedness culture and traditional public health culture but need to keep the momentum going.

"If we lose this ability to be flexible and creative we will lose every bit of momentum we have generated."

being done at the fairs closely resembled those of the Regional Distribution Siteand some portions of our local push-plans for mass prophylaxis dispensing. It was a perfect opportunity to make a connection between something these staff are excited about and committed to, and what their role would be in an emergency. We now have a group that might not have always embraced emergency preparedness fully

We are concerned when we hear that some states are being required to return funding because their preparedness activities were used to support public health programs. We are here to protect the health of the public. It is essential to maintain dedicated emergency preparedness staff and weave emergency preparedness into every public health project or program. We can find creative ways to use that leverage to train people and get them excited about what we need to do, but we need dedicated staff to carry on this process and ensure evenroutine events have an emergency preparedness component to them.

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More from Jefferson County

Jefferson County Department of Health and Environment serves approximately 535,000 people in both high-density urban areas and rural mountainous areas.

The Emergency Preparedness Program was established in 2002 and currently employs three FTEs dedicated to the program: a regional epidemiologist, regional planner and program coordinator. For this population size, an additional planner, epidemiologist, public information person and support staff would be ideal.

"Since day one our guidance has told us to break down the silos between emergency preparedness and other traditional programs. I believe that we are finally at a point where people accept us and want to keep us around long term and are really willing to work with us. The true disaster would be to stop or significantly reduce these programs now. I think there are ways that they could work better and more efficiently. I think the most important step that we can take is to integrate into traditional programs and continue to support the ten essential services. If we can’t use what folks do on a daily basis to teach them about their emergency preparedness role then they will never understand. I have said all along, you can force people to take an Incident Command System class or to participate in an exercise but you can’t force them to care. The only way to truly build preparedness is to weave emergency preparedness into the fabric of public health."

---Emergency Response Coordinator Jody Erwin

We are convinced that Incident Management Teams (IMTs) are the wave of the future for incident management. In Colorado I know that our state Division of Emergency Management is committed to deploying IMTs for big events. Since public health now has a presence on the first and most highly trained IMT in the state, we become a resource for the rest of the state.

As funding starts to drop for public health programs and smaller counties don’t maintain the regional positions, we can deploy to other parts of the state to help coordinate public health response. So there is still a need for local resources, but if they are not trained in emergency management it is ok because we can be there to act as that liaison between the IMT and the local public health staff.

Wow! These plans are great and just what is needed -- simple and direct. You guys from public health are GREAT! ---James Lancy, Arvada Emergency Manager

---Emergency Response Coordinator Jody Erwin

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Partnering with Business for Public Education

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ne of the Emergency Preparedness and Response Division’s accomplishments during 2008 involved the country’s first partnership between public health and a national private corporation targeting emergency preparedness.

The Wal-Mart Emergency Preparedness Campaign was developed with the corporate leadership for 79 Colorado Wal-Mart and Sam’s Club stores to encourage residents to prepare their own home, office and car emergency preparedness kits. This partnership was particularly important because it the Wal-Mart officials indicated that they considered the campaign to be a pilot project. Wal-Mart is considering repeating the campaign in other states, and perhaps nationwide.

This project was Wal-Mart’s first statewide private/ public partnership in the area of public health emergency preparedness.

The project was closely monitored by federal agencies as a potential model for future nationwide efforts. The state investment in the campaign was $32,000.

Some of the campaign successes documented included: Campaign reached the community statewide at 79 different Wal-Marts and Sam’s Clubs.

For eight days in March, 1.5 million Coloradans visited their local WalMart or Sam’s Club to view sample emergency preparedness kit items

Customers were open to taking brochures.

Display kits in the location at the entrances of the stores were very successful.

National Organization of Disabilities brochures were popular.

Volunteers were successful in groups.

People with children and families were very receptive and open to being prepared in the event of an emergency.

For eight days in March, 1.5 million Coloradans visited their local Wal-Mart or Sam’s Club to view sample emergency preparedness kit items on display and pick up an informational brochure, available in both English and Spanish. The brochure includes a checklist to help customers shop for their own emergency kit.

Wal-Mart and Sam’s Club staff who assist in community involvement and the training coordinators were very helpful. Some Wal-Mart stores had their own staff fill hours to staff the display if there were gaps.

Many of the Wal-Mart displays were staffed with close to 200 volunteers from the Colorado Public Health and Medical Volunteer System and other volunteer organizations to assist in distributing brochures and to answer questions from the public.

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Putting it into practice

Training and Exercises

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olorado state and local public health agencies coordinate emergency preparedness and re sponse training and exercise activities with other local, state and federal agencies.

... education and training opportunities are made available to adult and pediatric pre-hospital, hospital and outpatient healthcare personnel.

Colorado public health staff participate in allhazard planning meetings; information exchange; mutual aid; and collaborative training, exercises and drills to enhance multi-discipline and multi-jurisdictional preparedness and response.

Three-year Training and Exercise Cycle A three-year training and exercise plan serves as a guide for planning public health emergency preparedness training and exercises within the state of Colorado. The Colorado Department of Public Health and Environment (CDPHE) manages the state-coordinated exercises listed in the plan. The local and regional exercises listed in the plan are managed and implemented by public health staff at the regional and/or county level, with technical support from the state health department as needed. Colorado is in its second cycle, having completed its first three-year training and exercise cycle in 2008.

The CPDHE Emergency Preparedness and Response Division and its local partners include healthcare personnel and other response partners in all training and exercise events. The CDPHE Hospital Preparedness Program coordinates with hospitals and other healthcare partners, such as the Colorado Medical Society, the Colorado Hospital Association and Community and Rural Health Clinics to ensure that education and training opportunities are made available to

adult and pediatric pre-hospital, hospital and outpatient healthcare personnel. As a result, we can collectively enhance the abilities of all response partners to respond in a coordinated, effective and efficient manner, while minimizing duplication and filling gaps in knowledge, abilities and skills. By conducting joint exercises, state, regional and local response partners also meet multiple and varied grant requirements.

The goal for the training and exercise plan is to enhance and integrate state and local public health preparedness and response activities with federal, state, local and tribal governments, the private sector (including private healthcare industry partners) and nongovernmental organizations.

The three-year training and exercise plan is based on several sources: 1. Centers for Disease Control and Prevention Emergency Preparedness and Response Cooperative Agreement (federal grant requirements) 2. Assistant Secretary for Preparedness and Response Hospital Preparedness Program Cooperative Agreement (federal grant requirements) 3. 2008 needs assessment conducted by staff 4. Lessons learned from state, regional, and local exercise after-action reports and improvement plans Additionally, CDPHE encourages local public health and hospital response partners to develop training and exercise opportunities based on facility and community-level Hazard and Vulnerability Needs Assessments conducted throughout each of the nine all-hazards regions in the state.

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Training and Exercise Plan History In September 2005, CDPHE developed the first public health emergency preparedness three-year training and exercise plan. The 2005-2008 training and exercise plan reflected the requirements of the CDC Emergency Preparedness and Response Cooperative Grant and the results from a statewide training needs assessment survey conducted in March 2005. The goal for this plan was to provide standardized training to all public health staff and response partners on various topics: 1. Public health’s role in preparedness and response 2. Strategic National Stockpile 3. National Incident Management System and Incident Command Structure

exercises that incorporate a range of exercise activities with increasing complexity and interaction.

4. Personal Protective Equipment (PPE)

CDPHE exercises are designed so that each event increases in scope, scale and complexity. Theoretically, participants move from seminars to workshops to tabletop exercises to drills to functional exercises and, finally, to full-scale exercises.

5. Risk and tactical communications In addition to standardizing training, the 2005-08 training and exercise plan focused on mass prophylaxis.1 The plan called for each public health agency to participate in at least three drills the first year, and a statewide tabletop and functional exercise the second year (both of which used a pandemic influenza scenario). In late 2007, CDPHE coordinated a statewide full-scale mass prophylaxis exercise to test the Colorado’s ability to provide mass prophylaxis and medical supply management and distribution in the event of a flu pandemic. With this new three-year training and exercise cycle, the focus has shifted from mass prophylaxis to medical surge.2

CDPHE also uses a cyclical approach to exercise development. Once a plan, policy or procedure is developed, training staff create a process to deliver the necessary training. After training, the participants exercise the plan and document corrective actions and lessons learned. The cycle begins again as we update the plan, policy or procedure based upon the gaps identified in the exercise.

The building-block approach ensures successful progression in exercise complexity and allows for the appropriate training and preparation to occur prior to staff participation in emergency exercises.

Skillbuilding Process Establishing emergency preparedness plans and effectively training the public health and medical workforce is the first step towards preparedness.

With varied levels of experience among public health staff throughout the state, the training and exercise plan follows the Homeland Security Exercise and Evaluation Program (HSEEP) building-block approach in the design of the overall exercise program.

This approach requires a process of building the necessary skills to participate in public health and medical

Public health and medical exercises also are designed to meet specific target capabilities as defined by the Department of Homeland Security Target Capabilities List. The Target Capabilities List details 37 core capabilities that address specific prevention, protection, response and recovery capabilities, as wel l as common capabilities that support all missions, such as planning and communications.

1 Mass Prophylaxis is the capability to protect the health of the population through the administration of critical interventions in response to a public health emergency in order to prevent the development of disease among those who are exposed or are potentially exposed to public health threats. This capability includes the provision of appropriate follow-up and monitoring of adverse events, as well as risk communication messages to address the concerns of the public.

2 Medical Surge is the capability to rapidly expand the capacity of the existing healthcare system (long- term care facilities, community health agencies, acute care facilities, alternate care facilities and public health departments) in order to provide triage and subsequent medical care. This includes providing definitive care to individuals at the appropriate clinical level of care, within sufficient time to achieve recovery and minimize medical complications. The capability applies to an event resulting in a number or type of patients that overwhelm the day-to-day acute-care medical capacity. Planners must consider that medical resources are normally at or near capacity at any given time. Medical Surge is defined as rapid expansion of the capacity of the existing healthcare system in response to an event that results in increased need of personnel (clinical and non-clinical), support functions (laboratories and radiological), physical space (beds, alternate care facilities) and logistical support (clinical and non-clinical equipment and supplies).

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Three-year Training and Exercise Cycle Timeline 1. Create and disseminate a needs assessment survey (Completed April 1, 2008).

2. Analyze needs assessment data to identify performance gaps and training priorities (Completed June 30, 2008).

3. Develop draft exercise priorities, objectives and timelines for 2008-09 (Completed June 30, 2009).

4. Identify courses that address key performance gaps for each target audience at the state and local level (Completed August 31, 2009 and ongoing thereafter).

5. Market required and optional training opportunities using CO.TRAIN (Ongoing).

6. Update the Emergency Preparedness Course Catalog and link new courses to CO.TRAIN to allow public health employees to search for, register, and track their own learning (Completed September 2008 and ongoing).

7. Develop formal course evaluations and pre/post-tests to assess learner retention (Ongoing).

8. Develop local/regional multiyear training and exercise plans (Completed October 2008 and updated annually).

9. Evaluate the effectiveness of training through conducting tabletops, drills, and other exercises (Ongoing).

10. Analyze performance gaps identified in exercise after-action reports and exercise evaluations to develop a strategy for improving public health emergency preparedness training (Ongoing).

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Training and Exercises Resources for Partners

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he Emergency Preparedness and Response Division developed an electronic needs assessment survey, with the assistance of regional public health emergency preparedness staff. The survey was sent via email to all local public and environmental health employees throughout Colorado in April 2008.

This survey was designed to assess the ability of Colorado’s public health workforce to access information and perform tasks related to the various core competencies (“Emergency Preparedness Core Competencies for Public Health Workers” as defined by Columbia University and the Centers for Disease Control and Prevention). Our ability to perform each of these competencies will directly result in a stronger, more prepared public health workforce within the state of Colorado.

1. Training tools. With federal grant funds to support medical response to natural or man-made disasters, the EPR Division funded mass casualty and patient decontamination training tools for 72 acute-care hospitals across the state.

2. Decontamination training. EPRD staff conducted training for many rural hospitals to teach them how to set up a decontamination site and how to use decontamination personal protective equipment called powered air-purifying respirators, or PAPRs.3 3. Exercise technical assistance. Our staff also guide communities in exercises to activate and set-up medical surge caches intended to provide temporary hospital-bed sites. These could be needed in a disaster that involves serious damage to the local hospital, or it becomes overwhelmed with patients.

4. Coordination exercise assistance. EPRD staff designed and implemented mass casualty response exercises to test the communication and coordination of local law enforcement, fire, EMS and hospitals, and to evaluate their interactions with state and federal support response agencies, including the Colorado Division of Emergency Management, Colorado Department of Public Safety and the National Disaster Medical Response System. A large-scale exercise in two parts in 2006 and 2007,

known as Operation Mountain Move, tested medical response efforts in metropolitan and mountain communities.

5. Patient and inventory tracking tools training.

CDPHE developed a patient transport tool known as EMSystem for hospitals, EMS agencies and emergency response communication/ dispatch centers. EMSystem can play a powerful role in rapid movement of victims from the scene to hospitals during mass casualty incidents. A new tool known as HC Standard was introduced in 2008. This tool can help hospitals track both inventory and patient movement during large-scale mass casualty or community disasters.

6. Medical supplies training. Chempack and the Strategic National Stockpile are two critical medical resources for patient support. CDPHE trains local public health professionals as well as with local emergency managers, hospitals, EMS agencies and other first responders on the process for activation of these systems. CDPHE also offers physical, hands-on training for community responders to practice security, movement and distribution of the caches to the receiving locations.

7. Specialized training. CDPHE teaches its specialized community partners such as law enforcement and fire department hazardous materials teams on the protocol for suspicious powders and the submission of samples to the state laboratory.

8. University curriculum. EPRD staff present two lectures per semester at Colorado State University’s School of Environmental and Radiologic Health Sciences on public health’s role in emergency response.

9. Professional development for other CDPHE divisions. EPRD staff present information on CDPHE’s internal response plan for the 10 divisions of the department.

10. Department Operations Center orientation.

EPRD trains its internal partners on the department’s Operation Center (DOC), the use of the 800 MHz radios and risk communication.

3 An air-purifying respirator has an air-purifying filter, cartridge or canister that removes specific air contaminants by passing ambient air through the air-purifying element. A powered air-purifying respirator, or PAPR, uses a blower to force the ambient air through air-purifying elements to the inlet covering.

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SELECTED 2008 TrainingS Pandemic Influenza Department of Corrections Pandemic Influenza Workshop. Several CDPHE staff traveled to Canon City in April 2008 to conduct a two-day pandemic influenza workshop for approximately 100 members of the Colorado Department of Corrections. On the first day, participants were provided with presentations to describe the potential impacts a pandemic might have on correctional facilities, staff, and inmates. On the second day, participants were broken into regions to discuss planning considerations for how to address pandemic flu issues and implications.

Pandemic Preparedness. A staff member spoke at the 24th Graduate Student Symposium-Infectious Disease and Host-Pathogen Interactions hosted by the graduate students of the Molecular Cellular and Developmental Biology program at CU Boulder in October. EPRD addressed Colorado’s pandemic preparedness for the undergraduate and graduate students who attended the symposium.

Higher Education. More than 50 people from various higher education institutions and public health agencies participated in a one-day higher education workshop in July on pandemic preparedness, at the request of the Colorado Department of Higher Education. The chief medical officer and staff provided an overview of pandemic influenza and discussed planning tools, in addition to presentations from universities that have made great strides in pandemic planning.

Participants used checklists, templates and planning guidance to assist them in developing their own medical surge and Alternate Care Facility plans at the local and regional levels. Lessons learned from these seminars will be used to focus medical surge planning efforts and develop more advanced training and exercises in the future.

Nursing Surge Training. EPRD trainers co-taught Public Health Nursing Surge Training for the West Region’s nursing staff in July 2008.

Emergency Management NIMS. The Emergency Preparedness and Response Division taught two courses required by the National Incident Management System (ICS 100 and ICS 700) for the Tri-County Health Department’s Belleview site staff in July.

Intelligence. At the request of U.S. Department of Homeland Security (DHS), a presentation was given in October at a National Department of Homeland Security workshop. The workshop highlighted the role the division plays in intelligence sharing of public health and medical security issues through the Colorado Information Analysis Center in the Department of Public Safety Office of Preparedness and Security.

Medical and Nursing Surge Medical Surge Seminars. Emergency Preparedness and Response presented a total of six seminars throughout the state in April through September 2008. The purpose was to enhance medical surge planning with healthcare and emergency management partners throughout the state. The seminars provided information on alternate care facilities, pandemic influenza alternate standards of care, mobile medical caches, HC Standard, Strategic National Stockpileplanning, use of the Colorado Volunteer Mobilizer system, the Colorado Health Emergency Line for the Public (COHELP), Emergency Support Function #8’s draft “Guidance for Triaging and Altering Standards of Care During an Influenza Pandemic” and other topics of interest.

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Public Information and Risk Communication Crisis and Emergency Risk Communication. Staff presented for the Emergency Services Public Information Officers of Colorado (ESPIOC) at the organization’s annual conference. The workshop focused on crisis and risk communication during emergency situations, incorporating real-life examples and experiences from public health emergencies and other disasters. In July, the staff also went to Alamosa to teach a crisis and risk communication training to a group of public information officers and elected officials, including two county commissioners from the San Luis Valley Region. In October, EPRD provided risk communication training to public information officers in the Southeast All-Hazards Region. There were about 30 people who attended from a wide range of agencies, including public health hospitals, law enforcement, emergency management and county administration.

Joint Information Center. Staff gave a presentation about the Democratic National Convention to public information officers from county health agencies. The meeting, hosted by the Weld County Department of Health and Environment, provided an opportunity for public health information officers to discuss communication issues of mutual interest. The staff presentation focused on communications during the convention and the lessons to be learned from the experiences.

Colorado's Public Health Regional Trainers

Emergency Preparedness Core Competencies for all public health workers 1. Describe the role of public health in emergency response 2. Describe the agency chain of command 3. Identify and locate the agency emergency plan 4. Describe and demonstrate one’s functional emergency response role 5. Demonstrate use of communication equipment 6. Describe communication roles during emergency response 7. Identify limits to one’s own authority 8. Apply creative problem solving skills 9. Recognize deviations from the norm

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Emergency Preparedness Exercises

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onducting exercises is a critical component of planning to ensure that the anticipated actions during a State of Emergency are functional, practical and achievable. Through both the HHS Hospital Preparedness grant and the CDC Public Health Readiness grant, EPRD supports tabletop and functional exercises addressing medical and public health response to natural and man-made disasters.

• State and local staff are working on modifications and improvements to plans based on lessons learned from this exercise.

• Medical response exercises support hospital and community mass casualty incident response and medical surge response.

• Public health exercises support large-scale outbreaks, including pandemic influenza, and activation of the Strategic National Stockpile (SNS) for mass prophylaxis incidents and medical equipment for patient care.

In 2004 and 2005, Hospital Preparedness Program grant funds were given to many acute care hospitals across the state to support hospitals and communitybased mass patient decontamination exercises. These exercises tested the communication and coordination between fire departments, emergency medical services (EMS) transport agencies and acute care hospitals. The outcome was an enhanced ability to respond to chemical agent incidents, and to conduct ambulatory and non-ambulatory patient decontamination and hospital lock-down security to minimize contamination of the medical facilities and health care professionals.

Pandemic Influenza Surveillance and Reporting.

Disease Control and Environmental Epidemiology staff worked with regional epidemiologists and hospital infection control practitioners to conduct a pandemic influenza surveillance and reporting exercise in October 2008.

• The exercise tested the state’s plan for surveillance and reporting of pandemic influenza-related hospitalizations and hospital deaths.

• The goal was to recruit at least 75 percent of acutecare hospitals with more than 49 beds in the state to participate and encourage as many smaller hospitals as possible.

• Hospital infection control practitioners were provided with Colorado data from the 1918 pandemic to enter into CEDRS, Colorado’s disease tracking database.

Operation Mountain Move. EPRD developed and sponsored a two-year large scale mass casualty incident in the High Country to assess and enhance mass casualty response in areas of altitude and restricted road access. This exercise was known as Operation Mountain Move.

• Phase 1 of the exercise took place in the spring of 2006.

• Mountain Move examined communication between local law enforcement, emergency medical services, county emergency managers and acute care hospitals for incident activation and coordination, as well as patient triage issues and the exchange of securityrelated information related to the incident.

• Building from this initial response exercise, Phase 2 occurred in 2007, incorporating lessons learned in Phase 1 of the exercise.

• After the initial activation for an incident, the focus shifted to the next phase of medical response: activation of mutual aid; coordination of staging sites and patient movement between the scene responders, transport agencies and hospitals; and final destination patient tracking.

• Tools such as the Internet-based patient transport tool known as EMSystem and 800 MHz radios, which were purchased via the two grants for local response, were tested in both Phase 1 and Phase 2 of the exercise.

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• Fifty-two agencies in five counties plus three state agencies participated in Phase 1 of the exercise; 72 agencies in 19 counties plus three state agencies participated in Phase 2 of the exercise.

• Both exercises were considered successful for the testing of mass casualty response plans and coordination. Some jurisdictions participating opted to add additional challenges at the community-level by adding to the scenario, such as patient decontamination, to test medical surge capabilities.

Other Hospital Exercises. In 2008, individual hospitals continued to engage local partners to perform other mass casualty exercises. Highlights included:

• Fowl Play, which unfolded over two days, used an

• Mercy Regional Medical Center in Durango conducted an exercise called Operation Yellow Jacket that involved La Plata and Archuleta counties. It focused on incident management, patient transport, patient tracking and patient care. There were more than 30 participating agencies ranging from emergency medical resources, local and state law enforcement, fire departments, hospitals, search and rescue and dispatch centers.

• Keefe Memorial Hospital in Cheyenne Wells conducted a hazardous material and communication exercise. It involved both the testing of their communication and notification systems in Cheyenne County, but also the response and set-up of an offsite surge hospital at a local school. Ten agencies, including representatives from the neighboring state of Kansas and the National Weather Service, participated in the exercise.

• Melissa Memorial Hospital conducted a mass casualty incident exercise that involved implementing and testing the use of the hospital incident command system (HICS), the medical version of the National Incident Management System (NIMS).

This exercise was an internal hospital exercise to enhance staff knowledge and skills in operating within the incident management process.

The public health exercises funded by the CDC grant that EPRD developed or sponsored were equally all encompassing and successful in enhancing local and state plans for public health emergency response efforts.

Fowl Play. In the summer of 2005, EPRD worked with local public health agencies, federal and state law enforcement and CDC for the activation and movement of the Strategic National Stockpile (SNS) in a large-scale exercise known as ‘Fowl Play.’

avian influenza scenario to test CDPHE’s ability to activate and receive the SNS shipments, manage the inventory at a temporary warehouse and distribute the appropriate medication and supplies to local public health agencies. Activation was authorized by the Governor’s Expert Emergency Epidemic Response Committee, which initiates the request for the SNS. • A major focus of the exercise was the communication and the activation of a Joint Information Center at the local level for the development of consistent public information messages at the community level.

• The second day engaged local public health response in the Northeast and West Regions of Colorado.

EPRD tested communication using 800 MHz radios and the ability to receive requests from local public health agencies, process those requests and physically move the requested inventory to the regions.

The exercise then progressed to testing the local response to receiving the supplies and subsequently setting up points of distribution for the public.

• This successful exercise became the foundation for mass prophylaxis response. Eight county-level agencies, nine state agencies and three federal agencies participated. In addition to communication, coordination, logistics and transport capabilities outlined in the CDPHE and local public health SNS plans were evaluated.

Operation Iron Terminus. CDC approached EPRD in July 2006 and asked if Colorado would assist in a federal exercise that would test the CDC activation and mobilization steps of the federal SNS plan. This exercise, known as ‘Operation Iron Terminus,’ was a full-scale federal exercise involving seven federal agencies in three states: Washington, Colorado and Virginia.

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• EPRD led the Colorado component of the exercise, engaging two other state agencies, the Colorado Department of Public Safety and Colorado Division Emergency Management, the Governor’s Expert Emergency Epidemic Response Committee and the Regional Transportation District in Denver, as well as local public health agencies, county emergency managers and a select group of private businesses.

• CDC’s scenario involved the dispersal of aerosolized Bacillus anthracis (anthrax) throughout a metropolitan area and required CDPHE to play non-stop over a 48-hour period.

• EPRD tested the communication between CDPHE divisions and with state and local partners as well as with CDC’s emergency operations center and the federal partners outlined in the Colorado SNS plan, while CDC tested its communication with its federal partners and the state emergency operations centers.

• CDPHE successfully requested and distributed the SNS resources in a timely manner, ensuring the success of both the state and federal plan for Colorado. While other states participated in this federal exercise, Colorado was the first and only state to agree to open and operate an SNS receiving warehouse site in the middle of the night. CDC verbalized being impressed with EPRD and Colorado for our ability to adapt and adjust to changes, including delivery times and scenario changes as the exercise unfolded.

Squawk Talk. EPRD sponsored a large tabletop exercise in the fall of 2006 with local public health agencies that focused on interagency communication. This exercise, called ‘Squawk Talk,’ utilized an avian influenza scenario to test interagency communication, collaborative development and delivery of public information messages, and existing Joint Information

System (JIS) activation procedures. In addition to local public health agencies, four other state departments participated: 1. Department of Human Services – Division of Mental Health 2. Department of Public Safety 3. Department of Military and Veteran’s Affairs – Colorado National Guard 4. Colorado State University – Veterinary Diagnostic Laboratory

Pod Squad. EPRD then challenged itself and the local public health agencies as well as state partners by exercising four major areas of public health emergency response planning: 1. Mass Prophylaxis 2. Emergency Public Information and Warning 3. Medical Supplies Management and Distribution (SNS) 4. Emergency Operations Center Management

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Democratic National Convention Exercises Biowatch. The Colorado Department of Public Health and Environment, in conjunction with local, state and federal partners, held a tabletop exercise in May 2008 that tested the inter-agency response that would occur in the event of a BioWatch Actionable Result (BAR).

BioWatch is an early-warning system that can detect certain pathogens present in the air. The purpose of the exercise was to provide participants an opportunity to assess the current response concepts, plans, and capabilities. The exercise proved to be timely, as there was a BioWatch concern during the convention.

POD Squad took place over three days in the fall of 2007. The scenario was focused on a major influenza outbreak and administering the flu vaccine to a large population in the state. CDPHE provided a mass vaccination clinic to employees and first responders from agencies that have memoranda of agreement with the state health department. This allowed for EPRD to test a component of the department’s internal emergency response plan and the department’s continuity of business operations plan.

• The workshop was conducted as part of the Cities

• The second day of the exercise, EPRD tested the Department Operations Center’s ability to manage the full activation of the SNS plan.

• Participants moved influenza vaccine and other medical supplies to three distant regions in the state: the Southeast, South Central, and San Luis Valley regions.

• On the third day, all nine public health regions tested their mass immunization plans by distributing influenza vaccine to the public from 29 temporary clinic sites. Several county emergency operations centers and the State Emergency Operations Center (SEOC) were activated to coordinate exercise activities across the state.

• Public information staff successfully demonstrated its advancements in public health emergency response by working with the media, developing similar or joint messages and coordinating with multiple local agencies successfully.

CHEMPACK. CDPHE participated in a functional exercise with local partners in communication centers, at Emergency Medical Systems (EMS) agencies and in hospitals for the activation and movement of CHEMPACK to hospitals.

CHEMPACK is a cache of medications intended to support chemical exposures.

Public Information. Public Information Officers (PIOs) from nine counties representing eight local public and environmental health agencies in the North Central Region, including the PIOs from EPRD and CDPHE, held a tabletop exercise in January 2008 to discuss protocols and procedures for communicating with one another in the event of a public health emergency – in this case, an inhalational anthrax attack potentially affecting 2.8 million individuals throughout the entire region.

Readiness Initiative’s mass prophylaxis planning efforts to discuss and document how the region would establish a Joint Information System and how that system would coordinate with a state Joint Information Center.

• Participants were also to describe current state, regional and local notification systems; develop “pre-event” messages and press release templates; and how they would utilize existing resources for dissemination to the public.

• The intent of the workshop was to practice how to most effectively and efficiently communicate consistent information to the public when time is of the essence.

• The outcomes of the exercise were incorporated in the North Central Region’s Cities Readiness Initiative Mass Prophylaxis Plan.

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Colorado’s Learning Management System

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O.TRAIN, Colorado’s Public Health Learning Management System, is the primary method used by state and local health departments for emergency preparedness course marketing, training and exercise registration and data collection.

Colorado introduced the CO.TRAIN Learning Management System to the public health workforce in August 2004. There are more than 17,000 users and more than 900 local and online courses have been made available on CO.TRAIN since its inception. Every user has his or her own record, which contains information on their accounts and allows them to manage information about registered courses, completed courses and certificates. Users can create a transcript of their accomplishments to document requirements.

The CO.TRAIN reports feature allows the 95 different, registered course providers to create and view reports on users and courses. The Colorado Department of Public Health and Environment, for example, uses the system to track National Incident Management System training compliance for federal grant purposes.

The CO.TRAIN system can generate numerous reports to track emergency preparedness training and exercise participation, including:

• • • • • •

Number of course participants by course title Total number of course participants Number of participants by subject and/or topic area Number of trainings conducted or released Participant evaluation results for specific courses Pre-test and post-test scores for specific courses

CO.TRAIN by the numbers Total CO.TRAIN users – 17,093 Total CO.TRAIN course providers – 95 Total Colorado training registrations – 51,911 Total verified training completions – 34,529 Total Colorado course offerings – 985

• • • • •

On-site classroom trainings – 539 Web-based online trainings – 182 Conference sessions – 158 Exercises – 85 Satellite broadcasts – 21

Who uses CO.TRAIN? 95 Learning Management System Course Providers • Public health organizations • Emergency management and homeland security • Law enforcement • Non-profits, preschools, colleges and universities • Mental health service providers • Other state and local government agencies within Colorado

www.co.train.org

FEMA Incident Command System (ICS) Training Certifications Tracked by CO.TRAIN Course Name

Certifications

ICS-100 Introduction to ICS

3167

ICS-200 ICS for Single Resources and Initial Action Incidents

1058

ICS-300 Intermediate ICS for Expanding Incidents

758

ICS-400 Advanced ICS Command and General Staff—Complex Incidents

405

ICS-700 National Incident Management System (NIMS), An Introduction

3603

ICS-800 Introduction to the National Response Plan

565

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Hospital Preparedness Program Keeping Medical Systems Working

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he Hospital Preparedness Program (HPP) helps hospitals and health care systems to prepare for and respond to public health emergencies.

Hospitals, outpatient facilities, health centers, poison control centers, EMS and other healthcare partners work with their state or local health department to acquire funding and develop healthcare system preparedness through this program. Funding is distributed directly to state health departments or political subdivisions of a state, such as cities and counties.

Preparedness Program from the Health Resources and Services Administration to the Assistant Secretary for Preparedness and Response. The focus of the program now is all-hazards preparedness and not solely bioterrorism.

Program Priorities The HPP supports priorities established by the National Preparedness Goal established by the Department of Homeland Security (DHS) in 2005. The goal guides entities at all levels of government in the development and maintenance of capabilities to prevent, protect against, respond to and recover from major events, including incidents of national significance.

Additionally, the goal helps all levels of government develop and maintain the necessary capabilities to identify, prioritize and protect critical infrastructure.

• • • • • •

Current program priority areas include: Inter-operable communication systems Bed tracking Personnel management Fatality management planning Hospital evacuation planning

During the past five years, HPP funds have also improved bed and personnel surge capacity, decontamination capabilities, isolation capacity, pharmaceutical supplies, training, education, drills and exercises.

The Hospital Preparedness Program supports priorities established by the National Preparedness Goal established by the Department of Homeland Security (DHS) in 2005. The goal guides entities at all levels of government in the development and maintenance of capabilities to prevent, protect against, respond to and recover from major events, including incidents of national significance. Additionally, the goal helps all levels of government develop and maintain the necessary capabilities to identify, prioritize and protect critical infrastructure.

The Pandemic and All Hazards Preparedness Act of 2006 transferred the National Bioterrorism Hospital

Authorizing Legislation The Pandemic and All-Hazards Preparedness Act of 2006 (Public Law 109-417) amended section 319C-2 of the Public Health Service Act authorizing the secretary of the U.S. Department of Health and Human Services (HHS) to award competitive grants or cooperative agreements to enable eligible entities to improve surge capacity and enhance community and hospital preparedness for public health emergencies.

Program Options • • • • •

Alternate Care Sites (ACS) Mobile Medical Assets Pharmaceutical Caches Personal Protective Equipment Decontamination

Program Fundamentals The following components must be incorporated into the development and maintenance of all capabilities that are funded by the states and jurisdictions:

• National Incident Management System (NIMS) • Education and preparedness training • Exercises, evaluations and corrective actions

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The Colorado Department of Public Health and Environment awards competitive grants or cooperative agreements from HHS to eligible entities to improve surge capacity and enhance community and hospital preparedness for public health emergencies.

Surge capacity is defined as the ability of a healthcare system to adequately care for increased numbers of patients. In 2003, as a planning target HPP defined surge capacity for beds as 500 beds/million population. In 2006, the HPP expanded the definition of surge capacity to the ability of healthcare systems to treat the unusual or highly specialized medical needs produced as a result of surge capacity.

Project Assets

• HC Standard allows coalition partners to share

•

•

•

HC Standard Project Goal and Objectives: To provide a resourcetracking and communication tool to healthcare providers.

•

• Continue developing policy and procedures for the system • Continue to populate data fields • Continue to roll out the system • Continue to train personnel on proper use using drills and exercises HC Standard is a web-based emergency response tool and database that can be used to track internal resources and equipment, contact information, various reports and mapping features. It was added to ensure healthcare organizations would be able to integrate and coordinate with each other during an event.

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information related to their observations and supplies or needs. It provides real-time reporting on resource categories such as ventilators, staff, medications, supplies, patients, etc.

HC Standard has the ability to upload and share evacuation plans, floor plans, forms, pictures, etc. ∴ This is important in chemical and explosion/mass casualty as well as natural disaster incidents. ∴ The standardized communication foundation enhances the response capacity and overall coordination of medical resources. ∴ HC Standard also is a communication tool that can maximize medical surge capability by providing an efficient and rapid mechanism for transmitting critical information from the scene to all acute care hospitals. ∴ The overall communication between acute care hospitals, healthcare entities and EMS agencies through this web-based communication tool helps the organizations support each other, allowing for response integration and partnership during incidents. This has been demonstrated in community-based exercises.

HC Standard has the ability to track information of the deceased, their location, refrigerated storage capacity amongst facilities, availability of body bags, transportation information, death certificate status and disposition of the deceased.

Hospital evacuation plans can be stored in HC Standard. The plans may be downloaded and printed directly from HC Standard to ensure the safety of patients, visiting family members and staff in the hospital during an emergency.

Locations of Alternative Care Sites can be stored in HC Standard. ∴ GIS mapping, with real-time availability of equipment, supplies and personnel related to each ACS ∴ Plans, staffing, supply and re-supply information related to mobile medical capability ∴ Designation of emergency contacts that will have access to the cache ∴ Location of caches can be plotted out by authorized users only ∴ Real-time data on medications identified by location and availability ∴ Tracking of the locations, types and amounts of personal protective equipment (PPE)

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Finally, HC Standard supports the program fundamentals as required by HHS.

• Staffed vacant/available bed count ∴ ∴ ∴ ∴ ∴ ∴ ∴ ∴ ∴

• HC Standard offers an inventory of response assets (medical surge supplies, pharmaceuticals, personal protective equipment, staffing, patients, etc.).

• HC Standard exercises help participants practice using the system and building partnerships.

The Hospital Preparedness Program owns HC Standard, powered by two servers at a government data-hosting center in Colorado. A second location houses a back-up server, for system redundancy.

EMSystem Project Goal and Objectives: To provide medical entities a means of communicating alert information.

• Train users on proper use • Purchase Interface Bridge • Expand the NDMS bed poll drill to include other entities • Maintain and expand the system Colorado’s bed tracking system is EMSystem, a realtime communication and patient transport system that enhances preparedness and response to medical emergencies, mass casualty events and public health incidents. This system can provide the acute care hospital emergency department bed status, incident patient tracking, mass casualty incident support, hospital inpatient bed tracking and event alerting notifications with updates. The system is web-based, facilitating communication about regional emergency resources in real time and allowing for dispatch communication centers, local emergency managers and other administrators to rapidly query hospitals during an event for patient capacity, by triage category, and other available services.

Intensive Care Unit (ICU) Medical and Surgical Burn Care Pediatric ICU Pediatrics Psychiatric Emergency Department Negative Pressure Isolation Operating Rooms • Emergency Department Divert Status – Used daily for routine 911-response calls every day for hospitals’ divert status, with real-time information that is updated every three minutes. Hospitals list their divert status as ‘Green’ (fully open), ‘Advisory’ (certain limitations exists) or ‘Divert’ (divert status).

• Decontamination Facility Available – Used to query hospitals during an event to determine when each hospital decontamination facilities are fully functional and able to receive patients.

• Ventilators Available – Allows for queries any type of resource requested, including ventilator quantity and availability.

Part of the projected system costs include an interface for EMSystem and HC Standard. During an emergency incident, response time can be affected by having to operate two separate systems, switching from one to the other for pertinent information. This interface will allow HC Standard system users to pull data from EMSystem, populate a standardized form and access the needed information from one system instead of two.

EMSystem is used daily in Colorado to enhance user competency during actual events. The reporting function allows users to run various reports to analyze trends and manage hospital resources on a daily basis, which assists them in understanding their capabilities and capacity during surge events. The third party hosting allows for the system to be operational, independent of events occurring in Colorado, and in compliance with standards set at the national level.

EMSystem can query hospitals on the following categories as defined in the U.S. Department of Health and Human Services’ HAvBed system:

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Volunteers Supporting Preparedness The Colorado Department of Public Health and Environment has two programs to recruit and manage people who would like to volunteer to help their community prepare for and respond to emergencies. The Medical Reserve Corps and the Colorado Volunteer Mobilizer are managed through the Hospital Preparedness Program.

COLORADO'S Medical Reserve Corps Project Goal and Objectives: To improve the health and safety of communities in Colorado by organizing public health, medical and other volunteers.

• Integrate with existing programs and resources including the hospitals

• Identify, credential, train and prepare in advance for all hazards

• Bolster public health, medical and emergency response infrastructures Colorado added seven new units in the last grant year, bringing the state total to 21 units. Medical Reserve Corps units are community-based, though under the leadership of the U.S. Surgeon General. The community units provide a means of organizing local volunteers who want to donate their time and expertise to promote healthy living throughout the year, and to prepare for and respond to emergencies.

Colorado supports its units with technical assistance, training and grants. In the last complete grant year, CDPHE offered nearly $115,000 in grants, funding that goes right back to the communities in which each unit is based. In the current grant year, units are eligible for an additional $3,000 each to purchase 800 Mhz radios, the standard for public health emergency communications. And, the purchase of medical go-kits has helped to establish the MRC units as true mobile medical assets.

Among the 21 units are three with specialized functions:

The Medical Reserve Corps is a partner program of Citizen Corps, the national network of volunteers dedicated to ensuring hometown security. Medical Reserve Corps volunteers support local public health initiatives as well as the goals of the U.S. Department of Health and Human Services’ Healthy People 2010 and the priorities of the Surgeon General:

• • • •

The Colorado units respond and practice as frequently as needed. Recent efforts include:

• • • •

Alamosa salmonella outbreak Statewide points-of-dispensing exercise Sheltering CDPHE “WhatIf? Colorado” in Wal-Mart and Sam’s Club stores • Building explosion in Durango • Democratic National Convention

Upcoming MRC activities • Exercises with local, regional and/or state emergency • • • • •

• Joint MRC with a 2,500-resident gated community and the hospital in its area • MRC with volunteers who have backgrounds in both law enforcement and medical • Veterinarian unit

promoting disease prevention; improving health literacy; eliminating health disparities; and enhancing public health preparedness.

•

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response partners Participation in a state-standardized training schedule Volunteer recruitment More integration with public health and other emergency response agencies Expansion of the number of units within Colorado Implementation of 800 MHz radio system for redundant, inter-operable communication Purchasing and training with personal protective equipment, cardiopulmonary resuscitation, pulse ox machines, glucometers and triage tarps continued on following page

Colorado Volunteer Mobilizer CVM in Action

Project Goals and Objectives: To provide a volunteer management tool to be used by local partners and to recruit competent and credentialed volunteers.

CDPHE administers the CVM, contracting with the Colorado Association of Local Public Health Officials (CALPHO) to help manage marketing, training coordination, legal issues, system access and networking for the project. Global Secure, Inc., contracts with CDPHE to maintain the CVM system, including quarterly tests.

• Recruit volunteers and market to local, regional and statewide public health partners • Train and educate volunteers • Train regional and local administrators and volunteer managers • Integrate with Medical Reserve Corps The Colorado Volunteer Mobilizer is helping the state develop and maintain a cadre of competent and credentialed volunteers who can be activated at a moment’s notice to respond to any type of hazard. As a result, Colorado will have a confident volunteer workforce with the skills to sustain themselves and provide care to others very quickly upon mobilization, instead of just a list of possible medical volunteers.

The Colorado Volunteer Mobilizer (CVM) is a webbased system, first launched in November 2006. There currently are more than 1,400 volunteers within its public health and medical volunteer database, including members of the state’s Medical Reserve Corps units.

There are more than 30 local administrators who are trained to manage the system in their communities and activate volunteers as needed.

CVM was developed in accordance with the U.S. Department of Health and Human Services’ requirements for for each state to maintain an Emergency System for the Advanced Registration of Volunteer Health Professionals, or ESAR-VHP.

CDPHE conducts a background check and documents the credentials of each volunteer. This circumvents the problems of the past where well-intentioned volunteers want to help, but emergency management staff are not able to quickly verify their medical licenses. Individuals register themselves online, which triggers the credentialing process by Hospital Preparedness Program staff. After the credentials of the registered volunteers are confirmed, the program uses the Colorado Bureau of Investigation to complete background checks, at a cost of $7.00 per individual record.

CVM collaborates with the Department of Regulatory Agencies, which issues renewal notices to people with medical licenses. CVM registration is expected to increase significantly within the year, as 60,000 people with medical licenses that are up for renewal will receive information about CVM. Volunteers who are approved are required to have a basic understanding of the National Incident Management System (NIMS) by taking, at minimum, the Incident Command System 100 and 700 courses. Upon completion of the training regimen, these individuals are now considered “deployable” volunteers for the State of Colorado, and receive approved, standardized credentials developed at the local level.

Volunteers are encouraged to put their training to use in exercises. Exercises test protocols, confidentiality agreements and emergency and volunteer management principles. Future efforts will be geared to increasing the participation of mental health specialists.

Since the Colorado Volunteer Mobilizer coordinator and the State Medical Reserve Corps coordinator are both located at CDPHE, these programs are fully integrated, giving MRC coordinators ready access to their volunteers’ contact information and credentials.

https://covolunteers.state.co.US

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Colorado Medical Society Project Goal and Objectives: To inform, educate and integrate physicians regarding public health emergency response and medical surge. Colorado physicians will:

• Integrate with public health and hospital surge planning through regional partnerships and coalitions.

• Exercise to identify gaps in disaster planning including hospital surge, alternate care sites, fatality management, medical evacuation and communications.

• Register on CO.TRAIN and participate in volunteer training to respond better to an event.

• Prepare through continuity of operations planning.

• Understand what is needed to prepare themselves and their families for a disaster, understanding what will happen when a large-scale response is initiated.

∴ All hospitals participate in training or exercises

that incorporate NIMS and provide after-action reports that comply with federal requirements.

• Regional partnerships/coalitions: All hospitals work with their all-hazards region to develop an operational partnership/coalition and memoranda of understanding.

The Colorado Medical Society’s primary activities for CDPHE include:

The Colorado Medical Society, with its component and specialty societies, works closely with Colorado hospitals to help achieve specific benchmarks:

• Communications: All hospitals demonstrate dedicated, redundant communications capability during an exercise or incident.

• Volunteer Management ∴ 60% demonstrate the ability to query the Colorado Volunteer Mobilizer and generate a list of potential volunteers by discipline and credential level within two hours or less of request. ∴ 60% can compile an initial list of volunteers, by discipline and credential level, within 12 hours or less of request. ∴ 60% can report a verified list of available volunteers, by discipline and credential level, within 24 hours or less of request.

• Planning: All hospitals have written plans for mass fatality management and medical evacuation that include personnel, training, equipment and supplies, transportation, alternate facilities, standard operating procedures and senior management approval.

• National Incident Management System ∴ All hospitals have incorporated National Incident Management System (NIMS) concepts and principles for handling emergency events. ∴ All hospitals have had the appropriate personnel complete Incident Command System 100, 200, 700 and 800 courses.

• Integration – increase communication and coordination of the physician community to bridge the hospital-physician gap and improve hospital surge capacity.

• Exercising – integrate physicians into emergency response efforts through preparedness exercises with regional hospitals, local public health and emergency management. Exercises focus on topics including alternate care sites, communication and volunteering. With these exercises, physicians can help by identifying gaps in disaster planning, learn how to perform work under disaster conditions and build relationships with local emergency partners.

• Volunteer preparedness – CMS compiles lists of physicians interested in volunteer opportunities, targets interested physicians by encouraging and facilitating registration with the Colorado Volunteer Mobilizer and local Medical Reserve Corps, encourages physician volunteer attendance at training programs throughout the state, works with the state CVM coordinator to make required trainings accessible to physicians and works with the state Medical Reserve Corps coordinator to increase MRC capacity throughout the state.

• Business preparedness – distribute materials and offer education to medical practices without continuity of operations plans, tests existing plans and integrates plans into local and state emergency management planning.

• General emergency preparedness training – train Colorado physicians for disasters, including a pandemic; keep physicians informed about any potential disasters in the state, nation and world, and what local hospitals are currently doing to prepare for disasters including pandemics.

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Colorado Division oF behavioral Health Project Goal and Objectives: To increase networking, training and support for the hospital and medical response community through the recently developed Disaster Behavioral Health System.

• Continue the development of the “Resilience in the Workforce” training; provide the “Pandemic Influenza: Quarantine, Isolation and Social Distancing: Toolbox for Public Health and Public Behavioral Health Professionals” training at least three times.

• Complete the CoCERN plan for a statewide behavioral health network; educate the emergency/medical response community of its availability for support.

• Address gaps identified in the CoCERN tabletop exercise.

• Advance standardization for disaster behavioral health; register at least 350 individuals in the Colorado Volunteer Mobilizer.

• Collaborate with the North Central Regional Special Needs Committee and find better ways to respond to special needs populations.

Mental health aspects of a disaster and the needs of at-risk populations during emergencies continue to be felt as recovery continues from the Hurricane Katrina disaster. This recovery process has once again shown the importance of addressing the mental health needs of responders.

Disaster) and other identified behavioral health resource agencies.

Last May, CoCERN participants had a tabletop exercise with representatives from CDPHE, COVOAD, Tri-County Health Department, community mental health agencies, U.S. Veterans Affairs, police and security and the Colorado Division of Emergency Management. The goal was to put the CoCERN structure and the communication system to the test. Three needs arose during the tabletop exercise, which CDBH is addressing during the 2008-2009 grant cycle.

1) Regional training on CoCERN involving COVOAD, police, behavioral health and other local emergency management partners.

2) Continuing exercises and trainings using realistic scenarios emphasizing communications within and between CoCERN partner agencies.

3) A CoCERN job aid for field staff, including incident command structure and CoCERN structural/communication system job descriptions.

An important component of the CoCERN behavioral health network is communications. CoCERN’s basic communications and technology plan integrates behavioral health assets with the larger public health and emergency management disaster response system, for significant improvement regarding communication in a crisis for behavioral health.

The Colorado Department of Public Health and Environment’s Emergency Preparedness and Response Division contracts with the Colorado Division of Behavioral Health (formerly Mental Heatlh) for these services.

The Colorado Division of Behavioral Health (CDBH) is continuing its “Resilience in the Workforce” training. This year, this training and three others will be converted into electronic format for online training,resources permitting, including a podcast available on the CDPHE and CDBH websites. CDBH is marketing its training across the state, starting at each of the local public health agencies and expanding into the hospitals and the medical community.

In developing CoCERN, CDBH is collaborating with public health, hospitals, Colorado chapters of the American Red Cross, COVA (Victim Advocates), COVOAD (Colorado Volunteer Organizations Active in

CDBH has worked closely with the Colorado Volunteer Mobilizer (CVM) to develop trainings for volunteers and a post-deployment brief screening tool.

The goal is to have at least 350 individuals registered in CVM who have credentials in behavioral health fields.

Furthering CDBH’s work on a regional behavioral health response network, the agency has reached out to the 10 states from U.S. Regions VIII and VII. The other states are very interested in the CoCERN model, which helps all states strengthen their deployment and response capacity.

This year, the Colorado Division of Mental Health is expanding its connection with the North Central Regional Special Needs Committee to improve response to individuals and communities with special needs during a disaster.

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Colorado Hospital Association Project Goal and Objectives

providers and emergency management agencies to fill identified gaps in the North Central Region for the Democratic National Convention. The contract also funded video conferencing equipment to enable CHA to conduct trainings for hospitals throughout the state from its base in Denver.

To help hospitals integrate and improve emergency preparedness, which in turn will make Colorado’s healthcare systems function in a more efficient, resilient and coordinated manner.

• To integrate hospital response plans into the broader National Response Framework and National Incident Management System.

• To help hospitals comply with the requirements of the National Incident Management System.

• To support training and exercises for hospitals to increase their capacity to respond and manage surges in healthcare needs.

• To improve communications between hospitals and public health.

For one grant year, the Colorado Hospital Association focused on helping hospitals get training for NIMS compliance, contracting with nationally known subject-matter experts to develop a series of statewide regional training programs. The association also formed an advisory group to develop templates for a statewide memorandum of understanding. Hospitals did their part by identifying areas of agreement and resource-sharing within and between Colorado hospital systems.

CDPHE collaborated with the Colorado Hospital Association in a research study on hospital surge capabilities. The result, a final report entitled “Healthcare Preparedness and Surge Capacity Evaluation in Preparation for the Democratic National Convention,” offered recommendations for hospitals, EMS

This year, the association added special populations needs to its goals. CHA will work to improve crosscultural understanding and identify common ground for collaborative projects and efforts between local and state public health, emergency management and other specialty partners.

Colorado Rural Health Center Project Goal and Objectives: To provide Colorado a means to get needed funding to hospitals in rural areas.

• To provide the state a means of funding projects with numerous small hospitals and other rural healthcare providers.

• To help hospitals purchase equipment needed for surge capacity.

• To reimburse healthcare providers in rural areas for activities such as training or exercises.

The Colorado Rural Health Center (CRHC) contract was created to fund preparedness projects for rural hospitals and healthcare providers within very timerestrictive grant cycles. The level of complexity for training and exercises is increasing this year, following goals of the Hospital Preparedness Program to build

capabilities, in addition to increased capacity. Participation in healthcare coalitions, another grant requirement, will include planning for regional Alternate Care Facilities, in preparation for a statewide full-scale exercise. This collaboration creates the partnership needed for emergency response and medical surge capability.

The grant also expands 800MHz communications to new areas and for base stations and antennas. CRHC is improving the capacity to manage mass fatalities and and facility evacuation by funding planning, training, exercises and equipment needed for these purposes. In keeping with the projected needs associated with a pandemic, the CRHC also is helping hospitals develop their Strategic National Stockpile plans.

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Supply Coordination The Hospital Preparedness Program manages two projects that make sure that supplies are available throughout the state. These caches are vivid examples of the collaborative efforts of emergency preparedness and response staff throughout Colorado. Without these caches of medical supplies, “surge capacity” resources would be concentrated in the metropolitan area, making access difficult, if not impossible in some situations, for those responders in other areas.

Western Slope Cache

El Paso County Alternate Care Center Cache

Project Goal and Objectives: To maintain emergency equipment and supplies in a location prone to supply route disruption due to the geographic location.

• To develop deployment and distribution policy and procedures.

• To continue integrating regional medical response partners, expanding to the 21 counties west of the Continental Divide in Colorado.

• To develop just-in-time training for emergency warehouse operations.

• To design and execute one activation and training tabletop exercise in cooperation with area medical response partners.

Every winter, transportation and supply lines are paralyzed on Continental Divide passes. The Western Slope Cache is a pilot project that pre-positions emergency medical supplies in western Colorado, develops strategies for estimating needs, purchases and warehouses the supplies, develops inventory management methodologies and creates cache deployment protocols for the supplies.

Mesa County Health Department manages the project as the area’s ESF#8 lead agency. This year, Mesa County will:

Project Goal and Objectives: To establish a sustainable mobile and stationary cache of medical equipment to support the operations of alternate care centers in El Paso County.

• Purchase medical supplies to support the predetermined level of care for alternate care centers • Purchase medical supplies and equipment to support on-scene triage activities • Develop or purchase an inventory tracking system The El Paso County Alternate Care Center Plan was developed by a multi-agency coalition as a realistic plan for providing basic care to patients when an overwhelmed medical system would be unable to do so. Healthcare providers can offer the most good for the greatest number of people while using limited resources.

The stationary cache will support the operation of alternate care centers, when hospitals are at capacity or patients must be diverted from the hospitals for other reasons, such as infectious disease. The Alternate Care Center Plan describes the operational execution and considerations, and the logistical and staffing requirements associated with alternate care centers:

• Facility: location, size, characteristics, security needs, resources, supplies

• Expand from 16 counties to all 21 counties in the three all-hazards regions in western Colorado, including supply projections, product rotation, standard operating procedures, transportation plans, security and at least one activation exercise that includes volunteers.

• Expand the number of memoranda of understanding from 10 hospitals to all 20 in western Colorado, and develop memoranda of understanding with partners such as Red Cross, service clubs and retailers for emergency use of their durable goods.

• Update, standardize and coordinate the contents of medical surge trailers in the region with supplies that are in the main cache.

• Help CDPHE develop plan for stockpiling supplies throughout the state by creating guidance and a toolkit for establishing warehouses.

• Staffing: personnel needs, volunteers, credentialing • Philosophy of care: disaster care vs. non-disaster care, agent-specific care vs. generic care, altered standard of care in mass casualty environments • Command, control and communication: Incident Command System • Integration with federal and state response: framework of local response compatible with outside resources For planning purposes, the alternate care centers must care for patients until the local healthcare system recovers enough to absorb the extra patient load. El Paso County is evaluating current caches and supplies to ensure the most efficient use of funds.

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During recent emergencies in El Paso County involving multiple patients, such as the New Life Church shooting and the Castle West Apartment fire, rapid deployment of additional medical equipment and supplies was critical to reinforce pre-hospital care.

With this year’s grant, the Colorado Springs Fire Department will expand the treatment capacity of its trailer from 70 to 100 patients. Equipment may include a generator, a portable shelter, lighting and heating. In the event that a mass casualty incident occurred within a city, town or rural area, this trailer could provide an enclosed treatment area until victims can be transported to hospitals or alternate care centers. The Colorado Springs Fire Department will provide a truck capable of towing the trailer and the personnel re-

quired to transport the trailer when it is requested, from among its 119 personnel on-duty every day, for the most rapid deployment possible. The local agencies are responsible for replenishing supplies as needed.

Project Goal and Objectives: To help federally qualified health centers (FQHC) integrate and enhance preparednessto encourage Colorado’s healthcareto function in a more efficient, resilient and coordinated manner during emergency incidents.

on pandemic flu and all-hazards plan development, all based on a hazards vulnerability analysis.

• Help federally qualified health centers (FQHC) adopt NIMS-compliant emergency management plans, trainings and exercises.

• Integrate FQHC planning with regional partnerships and coalitions.

• Ensure that all FQHCs have redundant communications with emergency response partners.

• Assess FQHC role in supporting vulnerable patient populations in disaster.

The project began with a survey of Colorado’s 15 federally qualified health centers (FQHCs) to gauge their level of preparedness. The survey found that only one FQHC had an emergency management plan in place and only a few were involved in any kind of community emergency planning. The Colorado Community Health Network created a health center emergency management plan template, incorporating state bioterrorism and federal hospital requirements, for the FQHCs and the rural health clinics. The CCHN emergency preparedness manager worked with each FQHC

This project is coordinated with the Metropolitan Medical Response System to leverage funding. El Paso County is planning to have a full-scale exercise in the future to test the capabilities of the responding agencies, the alternate care centers and resource and supply management.

Each FQHC was provided with an 800 MHz radio and training, with quarterly communications exercises to test the equipment and users. NIMS training for CCHN and FQHCs allowed staff to participate in community-wide exercises. The benefit of the emergency preparedness program was demonstrated when one FQHC, Valley-Wide, activated its plan and used NIMS and incident command system principles to respond to the Alamosa salmonella outbreak. ValleyWide was able to keep open two family practice clinics, one dental clinic, a women, infants and children (WIC) office, a physical therapy practice and the administration building. They were able to continue serving the people in 14 counties without usable running water.

FQHCs play a crucial role in disaster and emergency preparedness, especially in the rural communities.

CCHN is committed to supporting the 118 fixed-clinic sites in their efforts to achieve high levels of readiness of people and resources in the event of a disaster or emergency incident. In year three, CCHN is working to develop and strengthen FQHC relationships with regional and local emergency partnerships and coalitions, for a more cohesive medical community response.

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Reaching people with limited english profiency The importance of outreach to populations with specific cultural needs or communication barriers is a vital, yet labor-intensive, component of preparing Colorado communities. The Hospital Preparedness Program issued two grants this year to help CDPHE help others prepare communities with limited English proficiency.

Project Goal and Objectives: To build Colorado’s capacity to address the needs of people with Limited English Proficiency during an emergency incident, particularly pertaining to Asian and Hispanic communities.

• To develop communications trainings for hospitals

Time and again, research shows that difficult messages are best delivered by someone who is trusted by the message recipients. For many groups, that means someone who understands their cultural background.

Working through local advocacy groups, Colorado is developing model programs for reaching communities with special needs. The Hospital Preparedness Program funds two agencies, Colorado Asian Health Education and Promotion and Hispanic Medical Health Organization, to build relationships between Asian and Hispanic communities and the Colorado Department of Public Health and Environment, and to teach two groups from the Denver area more about emergency preparedness and response.

that will help hospital staff assist Asian patients during an emergency incident.

• To help hospitals locate, exercise and begin using medical interpretation training and/or services.

• To help hospitals apply principles of Limited English Proficiency communications related to Asian and Spanish languages and cultures during an emergency incident.

Colorado Asian Health Education and Promotion the Hispanic Medical Health Organization have developed partnerships with the Colorado Hospital Association, Colorado Medical Society and the Colorado Department of Public Health and Environment to improve interactions with the Limited English Proficiency (LEP) population, designated as a special needs population, within Colorado hospitals.

• Assessment of LEP capacity in hospitals • Basic training for those with no current services • Resources related to medical interpretation for bilingual physicians and staff

• Exercises to acclimate hospitals to working through LEP issues in an incident

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Public Health Information Network Partner Communication and Alerting Certification The Public Health Information Network (PHIN) is a national initiative to promote the electronic exchange of information among public health agencies. The standards and technical requirements are determined by best practices related to efficient, effective and interoperable public health information systems that support both routine public health activities and emergency preparedness and response. The Center for Disease Control and Prevention (CDC) serves as the facilitator of the PHIN community and the steward for PHIN resources.

PHIN certification recognizes the ability of an application (or multiple applications, components or systems) to perform specific functions in compliance with the PHIN requirements and certification criteria.

There are several modules in which a health department can be certified.

PHIN Direct Alerting was one application for which Colorado sought certification in January 2009. Colorado was the first jurisdiction to achieve PHIN Certification in the area of direct alerting.

Public Health Information Network (PHIN) certification provides an objective assessment, designed to evaluate the compliance of public health information systems with PHIN Requirements Version 2.01. The goal of PHIN certification is to support the development and implementation of applications and information systems that comply with the PHIN requirements. This helps ensure that public health partners can securely, effectively and efficiently exchange data. PHIN certification is designed to provide meaningful and achievable targets, a consistent method to report capabilities and demonstrate progress. It also offers flexibility to support the evolving nature of PHIN and the Nationwide Health Information Network (NHIN).

Mission: to improve the capacity of public health to use and exchange information electronically by promoting the use of standards and defining technical requirements.

“Colorado’s efforts and willingness to be the first jurisdiction to successfully complete this task is noteworthy, and should be commended. While the PHIN Certification Criteria validated your ability to send a Direct Alert to the CDC using PHIN standards and security, this accomplishment has broader implications. It demonstrates Colorado’s commitment to implement PHIN standards and practices that improve your overall capacity to exchange electronic public health information across jurisdictional lines, a benefit during both emergency and day-to-day operations.” --Mark N. Winarsky, CDC1

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Mark N. Winarsky, MPA, IT Project Manager Team Lead, PHIN Support Team, Division of Alliance Management and Consultation, National Center for Public Health Informatics, Coordinating Center for Health Information and Service, Centers for Disease Control And Prevention

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In Their Own Words: Denver County

By Chuck Smedly, Emergency Preparedness and Response Program Manager, Denver Public Health

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hanks to funding from the Hospital Preparedness Program within the Emergency Preparedness and Response Division at Colorado Department of Public Health and Environment, Denver Health has been able to purchase close to $400,000 worth of equipment to strengthen the efforts of emergency preparedness at Denver Health. These are just a few examples of some of the things Denver Health has purchased and used. All of these items contributed to the overall preparedness of Denver Health by increasing the surge capacity, communication and decontamination capabilities.

1. 325 cots for increased surge capacity a Ten are stored outside the Emergency Department (ED) for quick access and to help the immediate ED surge. Twenty cots are stored in a closet for an initial surge into the hospital. The rest are stored on campus and can be accessed and distributed quickly. b, Ten cots were sent to Denver Cares for the DNC in anticipation of a surge. c. The cots were also used in disaster exercises: deploying in the ED, moving patients to inpatient units with cots and converting one of the nursing units into an alternate care site. d. Each inpatient unit used the cots to “practice” surge on their floors. Cots were set up in rooms to see which could be doubled up and some were placed in conference rooms and hallways. This allowed planners to project the maximum surge number for Denver Health.

b. Colors on the tags were hard to see and the tags all had to be thrown away after a single use. c. To replace these triage tags, a bracelet style was ordered. They can go around wrists or ankles, are reflective, and are more easily spotted and applied. d. The new tags were tested in another mass-casualty exercise and the feedback was very positive.

4. Decontamination a. One of the big initiatives this year has been decontamination. b. Decontamination supplies, including shampoo, sponges, squeegees, brushes and other supplies that are necessary for the decontamination process were purchased with funding from the Hospital Preparedness Program.

2. 800 MHz radio for effective communication a. Although the Emergency Department has several MACOM radios, those do not work with the other hospitals’ 800 MHz radios. b. Denver Health purchased an 800 MHz Motorola radio to be used in the hospital command center in emergencies. The radio has been used during exercises.

3. Triage tags a. New triage tags were purchased after it was discovered in an exercise that the older triage tag was not an effective tool for the Emergency Department.

No one was completing the information on the tag, and its parts were ripped off and discarded.

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Denver Health Colorarado’s Largest Safety-Net Healthcare System Denver Health is the state’s biggest provider of care for the uninsured, providing about $276 million last year in uncompensated care.

Approximately 25 percent of all Denver residents, or about 160,000 people, receive their health care at the hospital.

Denver Health is an essential healthcare provider and a major corporate contributor to the well being of Colorado. It is nationally recognized for its integrated health care system, contributing not only to personal, community and public health, but also in significant ways to the economic health of the community, the health care industry and the state.

WIPP transportation safety program Keeping Radiological Waste Shipments Safe and Secure

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he Waste Isolation Pilot Plant (WIPP), the nation’s repository for defense-related transuranic radiological wastes, is located 26 miles southeast of Carlsbad, New Mexico. The facility is built in a 250 million year-old salt formation 2,150 feet below the surface. Wastes generated from research, development and production of nuclear weapons at US Department of Energy sites across the country are transported by highway to the WIPP.

Regional Cooperation The State of Colorado has been working with the US Department of Energy for more than 22 years, both independently and with a coalition of 11 other western states through the Western Governors’ Association, to maintain a system for safe and uneventful transport of radioactive materials through western states. The WIPP Transportation Safety Program is a collaborative effort among the shipment-corridor states, tribes, local officials and the US Department of Energy. The program goes well beyond what is required by law. No other shipments on the road have undergone as much scrutiny by transportation safety specialists as WIPP shipments.

History of Radiological Waste Shipments The leaders and residents of Colorado are concerned about the transportation of radiological wastes through the state. The Colorado Waste Isolation Pilot Plant Program has accomplished a great deal in implementing and maintaining a rigorous preparedness and response program for shipping along the Interstate 25 corridor. Preparedness activities have been focused in the areas of accident prevention, planning, training, public education and collaboration between states and the regional coordinating groups across the nation.

Back in 1970, the US Department of Energy (DOE) stored transuranic wastes from the production of the nation’s nuclear weapons at the Rocky Flats Environmental Technology Site and at other facilities throughout the nation. By 1987, preparations for waste shipments to the Waste Isolation Pilot Plant were underway, and the transports to WIPP began in late March 1999. One month later, Colorado experienced its first shipment of transuranic waste shipments through the state. Over the almost 30-year life of WIPP, it has been

projected that 74.8 percent of all DOE transuranic waste in the United States will move through Colorado.

There are four main sites from which the waste is carried: 1. Idaho National Laboratory 2. Rocky Flats (completed in April 2006) 3. Hanford Site in Washington 4. Argonne East site in Illinois The conclusion of WIPP shipments is tied to the closure of Hanford Site., which is expected to be the last site to be completed. In addition, it is anticipated that there will be some site-to-site shipments. For instance, shipments are occasionally made to Idaho from Los Alamos National Laboratory or the Savannah River Site in South Carolina.

At the regional level, Colorado and other western states developed protocols in collaboration with the Western Governors’ Association (WGA), the US Department of Energy and other interested agencies for the safe transportation of transuranic waste to WIPP.

Radioactive Transuranic Waste Transuranic wastes are generated primarily during the research, development and production of nuclear weapons. The waste is contaminated with man-made radioactive materials and consists primarily of discarded items such as laboratory clothing, tools, plastics, rubber gloves, wood, metals, glassware, ash, and solidified waste. There are no free liquids in the drums.

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• Transuranic waste is contaminated with radioactive •

•

• •

•

materials that have atomic numbers greater than uranium, such as plutonium, americium and curium.

Transuranic waste is officially defined as waste contaminated with alpha-emitting radionuclides having atomic numbers greater than 92 and with half-lives greater than 20 years and in concentrations greater than 100 nanocuries per gram of waste.

Transuranic waste isotopes remain radioactive for a long period of time and must, therefore, be handled separately from other wastes.

Some of these wastes, known as “mixed” transuranic waste, also contain hazardous chemical constituents.

Most of these wastes are “contact-handled,” meaning that the radiation they emit does not require heavy lead shielding. The primary radiation hazard posed by this waste is through inhalation or ingestion.

The remaining waste is referred to as “remotehandled” because it requires heavy shielding and presents a much more significant external radiation hazard than contact-handled waste. About four percent of WIPP-bound waste by volume is classified as “remote-handled.”

All contact-handled transuranic wastes are transported in the Transuranic Packaging Transporter (TRUPACT-II), a reusable shipping package or “cask,” certified by the Nuclear Regulatory Commission.

Remote handled transuranic waste must be shipped in different containers that provide more shielding from penetrating gamma radiation.

Accident Prevention Most truck accidents can be avoided by alert, skilled drivers who avoid driving when road and weather conditions are particularly hazardous and who use high quality, well-maintained equipment. These preventive measures were used in developing the accident prevention portion of the program to reduce the risks associated with transporting hazardous materials.

• Driver and Carriers. The US Department of Transportation sets standards for drivers of trucks that carry hazardous cargo. The Department of Energy agreed to go beyond these requirements for its WIPP drivers and carriers. DOE has contracted with dedicated carriers whose drivers have extensive, accidentfree experience. WIPP drivers are subject to unannounced drug testing and are given no financial incentive to drive at excessive speeds. The states have a program to audit the shipping contractors for compliance with the vehicle and driver requirements. The Colorado State Patrol audits the Colorado-based WIPP motor carrier, CAST Transportation, on behalf of the Western States Governors’ Association.

• Independent Inspections. To identify and correct any mechanical defects in the vehicle and to ensure that radiation levels are within allowable limits, all shipments are subject to multiple inspections by state officials using safety standards that are much more stringent than those for other hazardous materials shipments. The uniform inspection procedures are called the “Commercial Vehicle Safety Alliance (CVSA) Enhanced North American Safety Inspections – Level VI.” CVSA inspections are conducted by specially trained state inspectors three times: prior to departure from the generator site, upon entry into Colorado and when the shipment reaches the WIPP site. In addition, in compliance with their contract with the Department of Energy, drivers are required to stop approximately every three hours or 150 miles to conduct a mechanical inspection of the vehicle.

Waste Transportation Containers All transuranic radioactive waste is transported to the WIPP in US Nuclear Regulatory Commissioncertified Type B containers, even though the highly secure containers are not required. Type B casks have been designed to withstand any conceivable traffic accident, with much stronger packaging than that which is used in the transport of other hazardous materials.

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• Bad Weather and Road Conditions. The states and the Department of Energy have agreed on procedures to monitor weather and road conditions so that shipments can avoid hazards. If unexpected bad weather or road conditions are encountered, preselected safe parking areas are available at specific military facilities or Department of Energy sites. No shipments are scheduled during rush hour traffic in major metropolitan areas in Colorado.

• Shipment Notification and Tracking. All transuranic waste shipments are monitored and tracked through a satellite-based system called TRANSCOM. The State of Colorado has direct access to this system, which provides shipping schedules and realtime tracking of shipments on the road. Colorado State Patrol, Port of Entry and the Colorado Department of Public Health and Environment monitor the system. TRANSCOM allows communications with drivers and immediate emergency response guidance information, if necessary. Satellite digital phones are available on each truck.

Transportation Preparedness Emergency preparedness is a significant part of the WIPP Transportation Safety Program. While the shipments are conducted in such a way as to prevent accidents from occurring, if one does take place, the state and local jurisdictions are prepared to respond quickly, safely and effectively.

• Emergency Response Plans and Procedures. A wellorganized and coordinated effort is necessary for a swift and effective response to an accident. Emergency responders along the route have plans and procedures in place to deal with transportation incidents involving the WIPP shipments. The State of Colorado has prepared several guidance documents that specify notification and response procedures for use in the event of a WIPP accident.

• Training. The Department of Energy has developed a training program, recognized by the US Department of Homeland Security and OSHA, called “Modular Emergency Response Radiological Transportation Training” (MERRTT). MERRTT has 16 concise and easy to understand modules that can be integrated into existing programs for hazardous material training. MERRTT exclusively covers Hazard Class 7 radioactive material and builds on information received in other hazardous material courses. The course covers awareness, operations and technicianlevel radiological training.

∴ The Colorado WIPP Program identified an unmet

need for medically-based radiological training.

While it is highly unlikely that a patient would be radiologically contaminated as the result of a WIPP accident, the Department of Energy now provides a training program for hospital and prehospital personnel. ∴ The Department of Energy recently partnered with FEMA in the revision of FEMA Course G-346, “Hospital Emergency Department Management of Radiation and Other Hazardous Materials Accident.” ∴ To meet the needs of medical examiners and coroners, and at the request of the Colorado WIPP Program, the Department of Energy developed a specialty course called, “Recovery, Acceptance, and Handling of Radiologically Contaminated Human Remains.”

• Exercises. Exercise programs are an integral part of a training program. The Department of Energy supports two full-scale exercise activities a year, called WIPPTREX, in the Western States. The exercises are done by the states on a rotating basis.

• Emergency Response Equipment. Radiation detection equipment has been provided to emergency responders and hospitals along Interstate 25, the WIPP transportation corridor through Colorado.

Responders have been trained to properly use this equipment in the event of any radiological incident.

Public Information Colorado WIPP developed a comprehensive website (www.cdphe.state.co.us/epr/rad.html) with links to key agencies, programs and topical information, including:

• Management of radioactive materials and radiation

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Radiological Waste Transportation Policy

• Radiological information for professionals (emer-

• • • • •

gency response personnel, public health and environment, medical personnel and clinicians, medical examiners, coroners and crime scene investigators) Radiological information for the general public Gubernatorial Radiological Waste Transportation Policy through the Western Governors’ Association National regional planning effort across the nation Training and education Fact sheet and additional resources

Colorado is a member state of the Western Governors’ Association as well as the Western Interstate Energy Board. The Western Governors’ Association addresses important policy and governance issues, advances the role of the Western States in the federal system and develops policy. The Western Interstate Energy Board serves as the energy arm of the Western Governors’ Association. Through both organizations, Western governors contribute to the federal effort to move defense-related waste and to anticipate program needs for shipments of commercial spent nuclear fuel to interim or permanent geologic storage.

Other Radiological Waste Campaigns Communication, collaboration, coordination and consultation are the keys to effective radiological transportation planning at a local, state, regional and national level. Regional planning for the shipment of nuclear waste began in the Western United States and has spread across the nation.

• Defense-Related Waste. In 1987, the Western Governors’ Association expanded its mission to include US Department of Energy radioactive waste transportation issues. A collaborative relationship was established with the US Department of Energy to develop a comprehensive transportation safety program for shipments of radioactive waste to interim and permanent storage sites across the nation. Since the majority of major storage sites are in the western United States, the WGA attends to all waste streams that are the result of cleanup of defense operations. WGA passed resolutions conveying the interests and policies of the Western governors: ∴ Policy Resolution 06-4: U.S. Department of Energy Waste Isolation Pilot Plant and Transportation of Transuranic Waste ∴ Policy Resolution 08-5: Department of Energy Facilities Cleanup Program

Through the Western Governors’ Association and the Western Interstate Energy Board, the Colorado WIPP Program works with other regional groups across the United States including the Midwestern Council of State Governments, Northeastern Council of State Governments and the Southern States Energy Board.

The regional groups work with the Department of Energy, the Nuclear Regulatory Commission and the US Navy on developing the transportation plans and public information outreach for other campaigns of radiological waste as well.

• Commercial Spent Nuclear Fuel and High-Level

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Waste. The Western Governors’ Association, through the efforts of the Western Interstate Energy Board, supports the objective of permanent, safe geologic disposal as the long-term national policy for managing and finally disposing of commercial spent nuclear fuel and high-level waste. In support of that effort, the WGA passed the following resolutions: ∴ Policy Resolution 08-6: Transportation of Spent Nuclear Fuel and High-Level Waste ∴ Policy Resolution 06-7: Private Storage and Transportation of Commercial Spent Nuclear Fuel ∴ Policy Resolution 07-2: Assessing the Risks of Terrorism and Sabotage Against High-Level Nuclear Waste Shipments to a Geologic Repository or Interim Storage Facility ∴ Policy Resolution 08-4: Enhancing Security During Transport of Radioactive Materials in Quantities of Concern (shipments of “product” rather than “waste”) continued on following page

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Shipments Transported through Colorado

In Their Own Words: san miguel County

By June Nepsky, RN, MN, Certified Family Nurse Practitioner; San Miguel County Director of Nursing and Administrator

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an Miguel County Nursing has been preparing for a major public health disaster since the fall of 2002 when the first purchase order for $5,000 was received from the Colorado Department of Public Health and Environment in order to upgrade our communication system.

Since that time SMCN has been training, exercising and preparing for all aspects of biological, nuclear, incendiary chemical and explosive attacks by working closely with our West Region partners from the Mesa County Health Department in Grand Junction. This staff of experts has provided the necessary training, educational preparation and opportunities in order to complete the important deliverables for each aspect of our contracts. San Miguel County has raised awareness within our community and has received support from our major stakeholders such as our local medical clinics, private physicians’ offices, schools, businesses, emergency manager and the County Sheriff’s and Marshall’s departments, as well as our County Commissioners, who serve as the Board of Health.

Jennifer Dinsmore, San Miguel County’s emergency manager, said, “The Emergency Operations Plan for the county never had a public health annex. The return has been huge as far as these grants making a difference.

Spending hours as a stakeholder and attending task force meetings for EPR and pandemic flu contracts, and developing our plan to address the ESF8 functions has greatly increased awareness within the public health infrastructure. Without additional funding, we may not be able to devote the necessary energy toward future planning for any public health disaster.”

Our Emergency Preparedness Response and Pandemic Flu Planning has been a collaborative effort demonstrated by financial support form the towns of Telluride and Mountain Village and the Board of County Commissioners. With their investment in our mission, we have built up our cache supplies and augmented our communications system.

However, by training our partners, community and staff in all aspects of emergency preparedness and response, the Public Health Emergency Preparedness and Response contracts have generated strong momentum, proving that our capabilities to respond to such disasters can be feasible, affordable and sustainable.

Exercising our ability to meet the goals and objectives of our contracts has been challenging. However, working with others in the West Region has allowed us the opportunity to expand beyond these road blocks despite decreasing funding.

San Miguel County’s 2008 Pandemic Influenza Exercise

“After attending many task force meetings, I can definitely state that San Miguel County Nursing has mobilized our stakeholders and raised awareness in preparation for any public health disasters in San Miguel County. I support the grants but we require much more funding to make it possible for our staff, stakeholders and community to continue to be educated, trained and prepared for a pandemic or major disasters so we can feel confident that we are prepared for future emergencies.”

-- Sheriff Bill Masters

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• Strengths Identified ∴ Community planning and knowledge of the ICS command structure for pandemic ∴ Readiness and ability to organize quickly into a functional command structure. ∴ Full community support for pandemic planning from San Miguel County and the three incorporated towns of Telluride, Norwood and Mountain Village • Areas for Improvement ∴ Interoperable communication during an incident ∴ More training for those who need it ∴ Surge capacity

supporting public health across Colorado

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he Division of Emergency Preparedness and Response has managed grant funding from the Centers for Disease Control and Prevention to help public health agencies prepare for and respond to emergencies since 1999. By 2002, the grant had increased, allowing the program to begin rebuilding the long under-funded public health system in Colorado with the placement of more epidemiologists, plus trainers and planners, in regions all over the state.

Today, there are 36 full-time equivalent positions in the nine all-hazards regions. It more than doubled the number of fully trained epidemiologists in our state, and brought hundreds of training opportunities in emergency preparedness and response to all public health staff in Colorado.

The division works closely with the Colorado Association of Local Public Health Officials, supporting its work on the reorganization of public health in Colorado, as a result of Colorado Senate Bill 07-094.

The organization hosts the Local Advisory Committee for the emergency preparedness and response grants, providing recommendations on funding allocations and establishing priorities.

Emergency Preparedness and Response supports public health education in the state as well, by staffing an informational exposition at the new UCHSC campus to show students the wide variety of careers that may be available in public health. It was the first time that CDPHE has promoted emergency preparedness and response as a public health career. The division is working with the school to develop effective placements for student interns, with the first appointments to begin in the spring of 2009.

Regional Staff Meetings With Emergency Preparedness and Response professional staff spread throughout the state in the nine all-hazards regions, CDPHE provides opportunities for collaboration at periodic regional staff meetings.

In October 2008, about 55 regional epidemiologists, planners and trainers attended a two-day meeting in Denver with both discussion and presentations delivered by state and local staff.

It was a packed agenda, with Denver’s preparedness for the Democratic National Convention, the role of public health on Incident Management Teams, Project Public Health Ready from a local health department perspective, and the Colorado Regional Model Survey findings presented by Colorado Association of Local Public Health Officials (CALPHO) in just the first day.

The second day, epidemiologists, planners and trainers separated into their respective groups to work on grant-specific activities and receive training to assist with performing their job tasks.

Epidemiologists focused on different types of disease outbreaks and how to respond; trainers learned about an online course building software application; and planners discussed strategies for identifying an Emergency Support Function #8 representative for each county. These periodic meetings allow the regional staff to collaborate with their peers in other regions, and work on projects of statewide significance. Technical assistance for the regional staff is always available from CDPHE.

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supporting public health across Colorado Urban Area Security Initiative “For the past three years, the Colorado Department of Public Health and Environment (CDPHE) has partnered with the Denver Urban Area Security Initiative (UASI) and the North Central Region (NCR) in providing and coordinating many training opportunities to the region. They have been proactive in hosting UASI/NCR sponsored NIMS/ICS training in support of Homeland Security Presidential Directive (HSPD-5) at all levels from basic NIMS/ ICS to advanced Unified Command and Area Command Training.

“CDPHE’s Training representatives have always been active participants in the Regional Training Committees and are a pleasure to work with, accommodating the needs of the instructor cadre as well as providing host agency assistance where needed.

“I look forward to a continued positive working relationship with the CDPHE as UASI/NCR moves forward with future training needs in the years to come.”

“CDPHE provides a well laid out classroom conducive to student learning with modern presentation equipment from computers, projectors and internet access to an Emergency Operations Center that provides the student with a typical layout for Incident Management Team training.

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-- Tom Witowski, Training Program Administrator Urban Area Security Initiative (UASI) November 25, 2008

in their own words: clear creek County

By Aaron Kissler, MPH, Clear Creek County Public Health Director

About Clear Creek County • • • • • • • •

C

lear Creek has participated in several public health emergency exercises both inside and outside the county. Public Health has had excellent coordination between emergency medical services, emergency management and law enforcement in conducting these exercises. Several real life emergencies have also tested Clear Creek’s readiness and coordination between the regional epidemiologist, public health nurses and environmental health.

The funding from the Emergency Preparedness and Response grants has helped us strengthen our relationships both inside and outside the agency, through increased coordination. Using emergency preparedness funding for dual purposes has also increased services to the community. Examples of this include immunizing the public through mass vaccination exercises, purchases of much-needed equipment and health education.

Before the grant, public health was not perceived as a piece of the emergency preparedness strategy and response. Now every emergency services agency understands that public health has a least some role in any conceivable county-wide emergency situation. This is a huge transformation, allowing public health personnel to become familiar with those personnel and agencies that they would be working with in small to large scale emergencies. An example of this is public health’s participation in Clear Creek’s monthly public safety meetings attended by the other emergency support function leads.

Population: 9, 400 Median age: 42.5 years Median household income: $57,000 - $62,000 Racial mix: Primarily white with about 4% Hispanic/Latino Largest employers: Henderson Mine, county government, public schools Designated as a Health Provider Shortage Area One primary care provider in Idaho Springs awaiting Rural Health Certification status Hospitals: none

Another important development for Clear Creek County is coordination in developing plans for residents with special needs. The special needs emergency preparedness discussion between traditional emergency groups and public health has lead to tabletop exercises and creation of a special needs registry.

Emergency Preparedness and Response Self Assessment Clear Creek Public Health’s Strengths • Cooperative political environment • Excellent reputation among county personnel and residents • Proactive emergency preparedness with excellent communication between emergency management and public health Clear Creek Public Health’s Gaps/Needs • Health care coverage • Socio-economic disparities • Lack of healthcare providers • Specific population health needs (dental, prenatal, substance abuse)

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in their own words: Prowers County

By Jacqueline Brown APRN, MSN,FNP, Prowers County Public Health Director and Health Officer

T

he level of emergency preparedness now for Prowers County as compared to eight years ago is a night-and-day difference. Public Health staff have worked hard over the past few years to train, exercise our new skills, develop emergency preparedness and response plans and inform the public.

Bringing partners together has been difficult at times. Public Health has been instrumental in gathering people from various disciplines together to use the funding, training, tools and other resources developed and supplied by the Colorado Department of Public Health and Environment’s Emergency Preparedness and Response Division effectively.

The state assistance has been invaluable to the process. We would not be where we are today -working as local leaders and being much better prepared -- if were not for the EPR funds, the leadership of CDPHE EPR staff and the partnerships that grew from these efforts. Prior to 2002, emergency management and other responders did not see us as partners, and they framed their preparedness efforts and exercises on explosions, crashes and other types of disasters. They did not understand us and we did not understand them. Now all of us have a better understanding of each others’ capabilities and abilities, and the benefits to all of our communities of partners working together.

March 2004 brought the first real test of our ability to respond. The Prowers County Annex Building was damaged by a large fire on a Friday morning, requiring evacuation of all county staff, including Public Health, and activating emergency plans.

Prowers County Public Health had received funds to assemble a “go-kit” with a computer, printer, fax and other supplies the year before. Staff immediately put it to use in another county building later that day as county administrators and department heads met to determine the next steps. Those EPR supplies certainly made the process much easier and demonstrated the need to plan for any and all hazards.

Prowers County has hosted two large-scale exercises. First, in October 2004, we spearheaded a nine-county mass vaccination clinic with 1,700 participants and more than 100 volunteers in Prowers County alone. The exercise helped us practice our pandemic response by practicing moving large numbers of people through vaccination clinics. Our November 2007 exercise was a drive-through mass vaccination clinic, vaccinating nearly 700 people, with over 60 volunteers. Both events were made possible through the leadership and assistance of the regional and state EPR staff, requiring many months of preparation, training and planning.

Prowers County also suffered from two major disasters in the last three years. A five-day, recordbreaking blizzard in late December 2006 kept us busy well into January 2007. Public Health’s work helped ensure that heathcare systems continued to operate in spite of enormous obstacles throughout Southeast Colorado.

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Not long after, on March 28, 2007, the town of Holly in eastern Prowers County was hit by a tornado that killed two people, devastated the town and destroyed over 65 homes.

About Prowers County

Both events required public health and environmental health staff and other partners to put into practice the skills and knowledge that we had developed through training, planning and exercises over the last few years, funded by the Emergency Preparedness and Response grant. While we won’t claim everything was perfect, if we had not trained, practiced and planned, there could have been even greater disasters.

The public saw first-hand the role that public health plays in these events. Prowers County residents were quite vocal in their great appreciation for our efforts.

Prowers County is a real example of what the EPR funding has accomplished. During 2002 the state was

“Public Health has taken a leadership role with emergency preparedness. They have been instrumental in expanding the beliefs about what is needed in an emergency or disaster situation and so has been able to include more agencies in the planning process for the community.”

--Deb Jones, Outpatient Program Director, Southeast Mental Health Services’ Lamar office

• • • • • •

Population: 13,100 (-7.4% in 10 years) Population density: <9 people per sq. mile Median age: 37.3 years Median household income: $34,000 Poverty: 19% below poverty level Racial mix: Primarily white with about 37% Hispanic/Latino • Largest employment sectors: retail, healthcare, schools, local government, agriculture • Designated as a Health Provider Shortage Area • Hospital: Prowers Medical Center experiencing a real down turn in the economy and many public health programs had experienced funding cuts, including Prowers County. The EPR funding made available through CDPHE, along with their leadership, brought public health into emergency preparedness and response incorporating the knowledge and skills learned into all aspects of public health, strengthening public health and weaving the EPR work into the day to day operations of each agency. Prowers County has been significantly impacted by this and has demonstrated the outcomes of EPR funding in real events and exercises planned and coordinated by public health.

These real events showcased the investment into local public health by the CDPHE EPR section and the local county funds used to augment those funds provided by the state.

I appreciate the Health Alert Network. CO.Train is easy to use and a good way to coordinate our efforts for trainings.

And I appreciate the informative quarterly EPR meetings.I place a high value on being able to utilize the regional staff and their expertise. I feel there is greater understanding of public health’s role in emergency response and planning in our communities, especially with staff at medical facilities and with our first responders. We need to keep the interest of all parties in order to plan, practice, evaluate and revise plans on a continuous basis so we will have the best possible coordinated response.

--Kelli Gaines, Director, Prowers County Environmental Health

“Prowers County Public Health has been very proactive with emergency preparedness. The staff is very knowledgeable, not only in public health, but also has a general understanding of other all-hazards partners and their experience. Prowers Public Health is very cognizant of the Incident Command System and other related systems. All the exercises that I have been involved with as a partner have displayed great coordination and planning on their part. In short, I feel that they display the knowledge within all scopes of emergency preparedness, beginning at the Emergency Operations Center and extending to the on-scene commander. Their outreach to the citizens of Prowers County has been great.”

-- Staffon Warn, Director, Prowers County Office of Emergency Management

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The 10 Essential Public Health Services and Emergency Preparedness and Response Prowers County Public Health Essential Service #1: Monitor Health Status to Identify Community Health Problems • Need -- To ensure that we maintain the level of skills, abilities and resources, both human and financial, to monitor health status for our county, region and state to identify threats either man-made or naturally occurring.

• Plan -- Continue to work with local public health agency components to ensure continued collaboration, utilizing the data and information to design plans and interventions and build partnerships.

Essential Service #2: Diagnose and Investigate Health Problems and Health Hazards in the Community • Need -- To ensure those epidemiological skills and abilities for investigations of disease outbreaks and patterns of infectious and chronic diseases and injuries, environmental hazards, and other health threats are maintained at each public health department, large or small.

• Plan -- Maintain access to the CDPHE public health laboratory for rapid screening and high-volume testing, which is imperative to preparedness and protection of the public. Ensure that qualified and trained regional epidemiologists are maintained to assist local public health agencies.

Essential Service #3: Inform, Educate and Empower People about Health Issues • Need -- To ensure that local and state public health officials continue to work together to develop messages and resources to inform, educate and empower people to be better prepared and ready in the event of any disaster, man-made or naturally occurring.

• Plan -- Providing ongoing, consistent training annually to ensure that we maintain current skill levels.

Essential Service #4: Mobilize Community Partnerships to Identify and Solve Health Problems • Need -- To maintain a high level of partnership and collaboration, in spite of limited resources, both people and money.

• Plan -- As counties struggle with funding and EPR funds decrease it will be even more imperative to mobilize community partnerships.

We have to figure out how to do it together, with less.

Essential Service #5: Develop Policies and Plans that Support Individual and Community Health Efforts • Need -- To maintain systematic community-level and state-level planning for emergency preparedness which will impact health in all jurisdictions.

• Plan -- Continue to align local public health resources and strategies with the local emergency preparedness and response planning.

Essential Service #6: Enforce Laws and Regulations that Protect Health and Ensure Safety • Need -- To ensure that we are knowledgeable and trained in emergency preparedness and response laws and regulations, ongoing training and exercises testing and evaluation of what is in place and what needs to be done different.

• Plan -- Include legal and regulatory issues in training.

Essential Service #7: Link People to Needed Personal Health Services; Assure the Provision of Health Care when Otherwise Unavailable • Need -- To ensure that special populations are pre-identified and included in emergency preparedness and response planning.

• Plan -- Invite representatives to participate in training and exercises.

Essential Service #8: Assure a Competent Public and Personal Health Care Workforce • Need -- To ensure that ongoing emergency preparedness and response training at all levels is maintained, with many avenues for access (face to face, web/internet, etc.).

• Plan -- Move toward accreditation for public health and tie that to outcomes and emergency preparedness and response work at the local level as it relates to essential and core services. Schools of Public Health and universities should include degree or certificate opportunities for emergency preparedness and response specialists who can be leaders at the state, federal and local levels.

Essential Service #9: Evaluate Effectiveness, Accessibility and Quality of Personal and Population-Based Health Services • Need -- To ensure that local and state emergency preparedness and response programs and deliverables are effective, accessible and of high quality.

• Plan -- Encourage CDPHE’s grant managers to enforce deliverables and not let grantees off the hook. Everyone in every county needs to be assured that their county is doing all that it can to be part of the big picture.

Essential Service #10: Research for New Insights and Innovative Solutions to Health Problems • Need -- To ensure that emergency preparedness and response programs participate in research and innovative solutions to make sure the work that we do is proven and will work.

• Plan -- Encourage program evaluation. When we find things that don’t work, let them go, move on and build on the successes.

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