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ESF 8 Presentation Webinar Version
Transcript of ESF 8 Presentation Webinar Version
An Emergency Manager’s greatest asset is the ability to facilitate a conversation amongst jurisdictions and partners for the safety of the community
Convener and Facilitator
Very little overall authority
Know the agencies, jurisdictions and partners needed to coordinate activities
Know the elected and key officials needed to make specific policy decisions
Know the resources within their jurisdiction, as well as mutual aid partners
Emergency Manager as Facilitator
EMS Special Districts
Private Ambulance Contracts
Air Ambulance Licensing and Support
Public Ambulance Systems
EMS Complexity in Colorado
ESF-8 is the public health and medical component of the overall Colorado emergency management system.
It includes public health, environmental health, behavioral health, fatality management and medical systems and facilities.
ESF 8: Public Health and Medical
Structure and Primary
Functions of an EOC
Emergency Management and Liaison (ESF 5)
Resource Coordination (ESF 7)
External Affairs (ESF 15)
Structure is Locally Driven
Command vs. Coordination
Clear away confusion regarding incident management and incident coordination concepts and terminology
Define the roles and responsibilities of federal, state and local public health and medical partners.
Establish understanding of Emergency Support Functions (ESFs), specifically ESF 8
Outline the roles and responsibilities of an EOC or DOC
Determine a process for resource support and incident coordination
Introduce the Unified Coordination System terminology
Develop the path forward for the local jurisdiction
Colorado Department of Public Health and Environment
Office of Emergency Preparedness and Response
PUBLIC HEALTH AND MEDICAL RESPONSE
Office of Preparedness and Response
Colorado Department of Public Health and Environment
Capturing Lessons Learned
Emergency / Disaster Review
After Action Meetings and Reports
Corrective Action Plan / Improvement Plan
Unified Coordination: After the Emergency
State ESF-8 Support to Local Partners
Food and Drug Safety
Potable Water / Wastewater
Solid Waste Disposal
Radiological and Chemical Hazards Consultation
Environmental Impact Assistance
Public Health and Medical Information Management
Behavioral / Mental Health Disaster Support
Biological Hazards Consultation
Pharmaceutical Supplies and Distribution
Assessment of Health and Medical Needs
Medical Care Personnel support
You don’t need to be an expert in all functions.
You just need to know who to call.
Public Health and Medical Support
at the Local Level
May be formed well before an incident occurs
Coordinate activities, agreements, policy issues and resources
Utilized for pre-planned events, large gatherings or other special events
Healthcare Coalitions can provide this support pre-emergency
Unified Coordination: Pre-Emergency
Differences in jurisdictional layouts can
change resource availability and demand for specific resources
Number of resources available to jurisdictions
Amount of mutual aid available
Amount of intra-county competition for resources
Time needed to get available resources
Why is this important?
Resource support examples
Colorado’s primary or lead agency with significant authorities, roles, resources and/or capabilities for public health and medical functions.
Colorado Department of Public Health and Environment (CDPHE)
Emergency Support Functions (ESFs) are groupings of governmental and certain private sector capabilities into an organizational structure to provide support, resources, program implementation, and services that are most likely needed to save lives, protect property and the environment, restore essential services and critical infrastructure, and help victims and communities return to normal following domestic incidents.
Department Operations Center (DOC)
What does it mean
to be a
Home Rule jurisdiction?
All Disasters Begin and End Locally
Are there any areas of concern or unanswered questions?
Where do we go from here?
State-Level Unified Coordination Process
Evaluating incidents based on the following factors:
Life Threatening Situations
Real Property Threatened
High Damage Potential
Potential for Timely Containment
Colorado State Authority
SEOC Support Entities
State Emergency Operations Center
Unified Coordination Center (currently called the MACC)
Federal Coordination through the JFO for larger scale events
Coordination has already occurred at the local level with priorities identified
Local and Mutual Aid Resources have been exhausted
The DOC and EOC will coordinate with regional partners for resource support
DOC to DOC Coordination
Utilization of State OEM Field Managers to gather information and facilitate coordination between multiple jurisdictions and partners
State OEM Field Manager sends regional considerations and decisions to the SEOC
Other partners may be involved in these conversations as needed
Public Health and Medical agencies may activate their Departmental Operations Center (DOC)
and / or ESF 8 leads may be activated to a multi-disciplinary Emergency Operations Center (EOC)
Unified Coordination: During the Emergency
From the local level on up
Unified Coordination System
From an ESF 8 Perspective
Colorado Volunteer Mobilizer (CVM) Support: Medical volunteers, Medical Reserve Corps (MRC), Red Cross, CERT, Fire Fighter Rehab teams
Air, Water Quality specialists
Ground and Air Ambulance Support
Hazardous Materials and Waste
Epi Surveillance & interventions
Health Facility Support
Fatality support (vital stats)
Coordinated through the local
emergency management organization
Development of policies and agreements
Commitment of funds as needed to support incident response and recovery
Commitment of jurisdiction / agency resources )
Knowledge of available resources and capabilities
Allocation of scarce resources based on resource requests and availability
Prioritization of scarce resources on one or more incidents
What does this mean
at the local level for
Who is involved and
what is their role?
ESF 8 – PUBLIC HEALTH AND MEDICAL
City and County Combined
Rural / Urban Mix
Types of local jurisdictions
Complex political environment
Media / Social Media
Critical issues in today’s emergency response environment
Emergency Operations Center (EOC)
This presentation has been developed to give Public Health and Medical partners information about what ESF 8 means at the State and Federal levels, and to provide guidance on the local Public Health and Medical responsibilities during and after a disaster or emergency.
We are seeing more complex incidents with a greater number of partners assisting in the response and recovery. Additionally, the recent trend shows more devastation when disasters occur, such as Hurricane Katrina, the Joplin Tornado, and Hurricane Sandy. Here in Colorado, we have seen the Windsor Tornado, 2008 SE Blizzard, Alamosa Salmonella water emergency, and the historic 2012 wildfire season.
Role Confusion and Unfamiliarity with Incident Command
Many do not understand their roles during and after emergencies, causing duplication of efforts, increased spending, and confusion amongst response agencies. Additionally, before EOCs were better established, multiple partners tried to coordinate within the ICS environment only to be left out or unable to function. Silos were common creating a further breakdown in communications.
There will always be outside influences affecting any emergency or disaster. In today’s environment, those influences may change the scope of the incident, change how response is managed or change the course of the recovery. For example, public pressure to elected officials will dramatically influence an event, so having people who can speak to the various issues is critical. Changing demographics, increased population density, technological risks and our aging population are all examples of changing social conditions that increase incident complexity.
Prior to 9/11, emergency management was not well known or understood, and many jurisdictions did not have an emergency manager or an Emergency Operations Center (EOC). Today, emergency management has become a professional field and EOCs are not only more common, they are expected in local communities. Some of the key reasons for this change include:
Complex Political Environment
There is no political environment more complex than here in Colorado. Not only do we have local, state, tribal and federal partners all with varying levels of authority, we also have special districts and special interests. On top of all of that, Colorado is a “Home Rule” state. See next slide for more information on Home Rule.
Home rule is the embodiment of the principle that the best government is the one that is the closest to the people. By empowering local citizens more directly, home rule enhances citizen control, interest, involvement and pride in their local government.
Home rule allows jurisdictions to respond more quickly to changed circumstances or emergency situations by allowing legislative solutions at the local level through resolutions, ordinances, or charter amendments, rather than waiting for action by the state legislature. Home rule municipalities are not required to follow state statutes in matters of local and municipal concern and therefore enjoy freedom from state interference regarding local and municipal matters. Jurisdictions lacking home rule status are limited to exercising those powers that have been granted by the state and subject to those provisions and limitations that have been imposed by the state.
Many have heard the term, “All incidents begin and end locally.” This means that the local jurisdiction, whether a special district (Water District, Fire District, Sanitation District, etc) or a local government, is responsible for the safety and security of their citizens and will be in charge of any incident in their jurisdiction. At no time will state or federal partners take over an incident from a local jurisdiction. Instead, they support incident activities and provide additional coordination as needed or requested.
In the words of Spiderman, “With great power comes great responsibility.”
Let's start with the beginning of response...
When an Incident occurs in any jurisdiction, local agencies and departments will respond and establish Incident Command. This happens every day on smaller-scale incidents and no one is better at handling local incidents than those who provide the service every day in that community.
If it is determined that the local jurisdiction is unable to manage the incident with available resources, they will call in mutual aid partners from around the area. These are departments and agencies they have agreements with to provide incident response activities. If there are still resource needs that cannot be met, the Emergency Manager may be called to begin coordination activities with regional partners or to activate an Emergency Operations Center (EOC).
Coordination occurs in a number of areas, but mainly the local Emergency Operations Center (EOC). Coordination entities provide support to incident operations. In addition to providing support to command for the area within the Incident Footprint, coordination entities also work through Consequence Management – everything affected by the incident within and around the community. For example, once people are evacuated from the incident footprint, they will need to be housed and fed. This is typically a coordination function from the Emergency Operations Center.
Incident Command or Unified Command occurs at the incident site or nearby. The Incident Commander(s) direct tactical operations directly related to the incident. This is often called the incident footprint.
Emergency Operations Center
The EOC is a coordination element of the incident response and recovery. It consists of local, state, and federal partners as needed for the incident, along with Non-Governmental Organizations (NGOs), Non-Profit Organizations (NPOs), volunteer agencies and the private sector. The activation of an EOC greatly enhances the jurisdiction’s ability to provide needed situational awareness and resource support for any escalating or large-scale incident.
Department Operations Center
For larger jurisdictions or agencies, a Department Operations Center may also be activated. The difference between an EOC and a DOC is that the DOC is focused specifically on one function/focus (i.e. Public Health and Medical support to the incident), where the EOC has all functions represented, including outside agencies, organizations and departments.
Primary Functions: Acquire, Assign and Track Resources
It is important that systems are in place to ensure there isn’t a duplication of efforts between on-scene incident command and the EOC. The EOC tracks availability of resources and assists incident command in finding resources that are not readily available within the jurisdiction.
The EOC works with the Policy Group and the Public Information Officers to ensure that public information is consistent and that the needs of the community are met. This is done in coordination with on-scene command. Additionally, the EOC helps to ensure there is a common operating picture. The IC may only have information on their incident, while multiple incidents may be occurring at the same time.
The EOC will set priorities that help to support the objectives outlined by the IC. Additionally, there may be additional priorities for the community as a whole, outside of the incident footprint.
Primary Functions: Providing Legal and Financial Support
The Agency Having Jurisdiction (AHJ) is responsible for all financial support for the incident. The Policy Group is a group of key elected and executive personnel who have the authority to expend funds and create legal documents for the emergency or disaster. The EOC works directly with the Policy Group to ensure these decisions are timely and effective.
Primary Functions: Liaison
One of the most important functions of an EOC is the development of inter-governmental relationships. The EOC should consist of governmental, non-governmental and private sector partners that have the ability to provide support to the incident. Additionally, the EOC personnel will communicate frequently with outside entities and other EOCs as needed.
There is no one structure for any EOC. It depends on the local needs and resources. The three most common layouts in any EOC include:
ICS – The EOC is structured around the Incident Command System structure with the same basic Command and General Staff positions: EOC Manager, PIO, Safety Officer, Operations, Planning, Logistics and Finance
Management Functions – The EOC is designed around the jurisdiction directors or managers. For example, they may have Road and Bridge assigned to take care of transportation and heavy equipment needs, or the Fire Chief take on firefighting and HazMat operations
Functional Layout – This design is based around the state and federal Emergency Support Functions (ESFs). See the next slide for more information on ESFs.
The majority of EOCs have a hybrid approach, designing their EOC with two or three of these models in mind. For example, many are based around the ICS structure with ESFs below each of the Section Chiefs.
In the National Response Framework, the federal government has outlined fifteen Emergency Support Functions (ESFs). These are federal agencies that will work together during an incident response at the EOC level. The ESFs provide the structure for coordinating Federal interagency support for a Federal response to an incident. They are mechanisms for grouping functions most frequently used to provide Federal support to States and Federal-to-Federal support, both for declared disasters and emergencies under the Stafford Act and for non-Stafford Act incidents.
At the Federal level, ESF-8 (Public Health and Medical) functions are the responsibility of the Department of Health and Human Services. Globally, the U.S. works with the World Health Organization on matters involving multiple countries, such as the Middle East respiratory syndrome coronavirus (MERS-CoV).
Primary ESF 8 Responsibilities
The primary ESF 8 responsibilities include:
Public and Environmental Health
Fatality Management (the County Coroner has statutory authority for fatality management. ESF 8 supports this role)
Each of these core areas has multiple sub-areas that need to be managed during and after any large-scale incident. All of these responsibilities must also be met at the local level, either through local policies and programs or through support from state and federal partners.
When a disaster occurs, it is the responsibility of the local government to determine their needs, fill them as appropriate, and call for support when necessary. It is the responsibility of the next level of government (state, federal) to lean forward and fill resource requests for the affected jurisdiction. There are multiple factors that play a part in resource requests at all levels.
Types of Jurisdictions
In Colorado, we have a range of jurisdiction types that will affect resource coordination activities. These include:
City and County Combined such as Broomfield or Denver
These are usually considered full service cities that have all the departments that are necessary to care for their citizens.
Mostly Urban such as the
City of Colorado Springs
This city is Home Rule as well, meaning they have specific authorities for their citizens including the responsibility for emergency management.
Mostly Rural such as
These counties typically cover a large amount of land with a smaller population and may require more assistance when a large-scale disaster occurs due to the lack of local services or support agencies.
Rural / Urban Mix such as Mesa County
These communities typically have one or two large cities or communities within the county, leading to varying levels of resource support opportunities.
Tribal Neighbors such as Montezuma and La Plata Counties
Each of these counties works closely with the Tribes that have land near their borders.
Special Districts such as Water, Sanitation, Fire and EMS
Special districts have specific authorities under Colorado State Statute and in the various communities they serve. ESF 8 works closely with many of these districts during emergencies and disasters.
In Colorado, we have multiple structures for Emergency Medical Services. This creates added complexity when supporting the management of any incident. How will the local jurisdiction handle the requests for support throughout the incident? This is where planning and coordination prior to an incident are so vital. The person sitting in the EOC must know who to call to get support when needed. They must know the local and state laws and regulations governing the use of EMS and ambulances within that area.
Unified Coordination System
The Unified Coordination System is a resource management process that has been implemented in the State of Colorado and is currently outlined in the Colorado Resource Mobilization Plan. It involves a combination of facilities, equipment, personnel, procedures, and communications integrated into a common system with responsibility for coordination of assisting agency resources and support to agency emergency operations. This is also commonly referred to as Multi-Agency Coordination (MAC).
As with everything else, this system begins at the local level.
The Public Health and Medical support function should work with all partners and agencies to ensure a coordinated and effective process. Healthcare Coalitions have been formed for this purpose. They allow Public Health, EMS, Hospitals, Health Facilities, Behavioral Health, Coroners and other partners to meet and prepare for emergencies or disasters. The Healthcare Coalition can then be a key asset to ESF 8 when an EOC is established.
During the Emergency
The key responsibilities of the Public Health and Medical function in the EOC include:
Providing technical assistance to the incident on issues affecting public health, behavioral health, fatality management and emergency pre-hospital and hospital care.
Providing resource support to the incident as needed and requested
Providing public information (in coordination with the incident) to ensure the safety and health of the public and responders
Providing overall situational awareness to varying partners and agencies assisting the disaster
In Colorado, it is up to the local jurisdiction to determine how they will respond to their citizens needs, and how they will support incident operations at the EOC level. In order to obtain support from the state and federal level, however, they must be able to understand the ESF process and how their local system fits in to the larger picture. CDPHE, as the lead agency for ESF 8 at the state level, must also be able to understand the local process to ensure adequate and effective support.
In order to best support the incident, the local jurisdiction should have a plan for Public Health and Medical support in the EOC, or a designated DOC. After looking at the vast amount of support activities necessary within this function, it is apparent that no one person or agency will have all of the answers that may be needed. Instead, the plan should involve other partners and agencies that can provide that support as needed. The person supporting the incident in the EOC should have the knowledge and expertise to obtain the needed support. It doesn’t mean they have to be able to provide the support through their agency/department. They merely need to understand who can help and how to get that help in a timely manner.
For example, a local Public Health director may be the designated lead for ESF 8 activities in the local EOC. If a resource request comes in for ambulance support, the ESF 8 desk needs to know who to contact to fill the request. They can always contact the state ESF 8 lead for assistance.
Within the Unified Coordination System, you may be dealing with more complex resource issues, such as:
Prioritization of multiple incidents – Widespread flu causing multiple hospitalizations or POD activities
Prioritization of scarce resources – Mass casualty incident requiring extrication and/or long-term pre-hospital treatment
Coordination with CDPHE on regulation restrictions – Asbestos mitigation following a wildfire, or EMS support to hospitals during large-scale evacuation
The ability to commit funds – Having the authority to expend funds to support Public Health and Medical activities
All of this should be done through the emergency management organization in place within the local jurisdiction. Emergency Managers rarely have authority, but they typically know all of the people in the community that do have authority so they can get them to the table and facilitate the conversation.
The emergency manager is often used to facilitate meetings or get people of varying backgrounds and disciplines together to make decisions. It is a logical progression to have the emergency management agency (or their designee) facilitate conversations about resource allocation and prioritization, policy decisions and commitment of funds.
Because emergency managers often work with the various emergency response and emergency management partners in and around their jurisdiction, they are a good choice to bring people with authority together. They also have their finger on the pulse of the community, allowing them to bring key partners and officials together to make decisions.
Many of the ESF 8 functions will require support from other ESFs. The emergency manager can assist with this support. Examples include:
Transportation assistance for pharmaceuticals or supplies
Security at PODs, mass-casualty scenes, or while transporting goods and supplies
Fire personnel to support EMS and hospitals during evacuation of facilities
Facility support for mass fatality incidents
Public Information management
Unified Coordination System
ESF 8 is a complex system of its own, coordinating activities amongst various Public Health and Medical partners on a daily basis.
Partners should therefore be well aware of all policies and procedures outlined in the Emergency Operations Plan, and should be a key player in any plans involving Public Health and Medical considerations. This is one of the greatest benefits of the Unified Coordination model – allowing subject-matter experts from various functions the ability to coordinate activities within the greater emergency management structure.
Ideally, conversations have occurred at the county / Tribal level to determine needs, gaps, and priorities. If multiple jurisdictions are vying for the same resource, regional coordination will help to prioritize needs and facilitate coordination. The State OEM Field Manager can then facilitate a conversation with the emergency managers for each of the affected or assisting areas to walk through each of these priorities and gaps. They can then facilitate a conversation between all jurisdictions to determine overall goals, priorities and gaps. This can then be sent up to the SEOC to fill requests according to priorities.
Response to Recovery
After the short-term recovery considerations are met, the jurisdiction will enter the long-term recovery process. It is during this phase that the DOC / EOC will shut down and all activities will be coordinated through local agencies and departments. Coordination between local and state Public Health and Medical entities will continue in a virtual environment with technical assistance, resource support, and policy guidance. The recovery process is typically managed by the jurisdictional emergency manager.
Planning for the transition between response and recovery with key partners is vital. Continuity of service, especially among health providers and services is critical, but though the event itself has ended, the surge of health related needs might still be pretty high, and it will be important that the local agencies and partners are ready to re-assume their responsibilities without the resources supplemented by response systems. For example, although the response to the Aurora Theatre Shooting was complete within the first 48 hours, the behavioral health component will have long-lasting effects for that community. Additionally, the Aurora Theatre Shooting, as well as the recent Boston Marathon Bombing, caused an influx of patients to hospitals. Many of those patients will remain in the hospital long after the response phase of the incident is over. Planning for these areas that span both response and recovery will assist the jurisdiction in the overall recovery from any incident.
Recovery after a large-scale emergency or disaster is often the most difficult piece for the local jurisdiction. It may last for a few days, to weeks, to multiple years. The Hayman burn area is still in recovery after ten years. Key areas where Public Health and Medical partners may be utilized during recovery include:
Hazardous Area Assessments
Disaster Recovery Center
Technical Assistance for Public / Environmental / Behavioral Health
Long-term recovery planning
Capturing Lessons Learned
After any emergency, there will be a process to evaluate plans and procedures. The Public Health and Medical function will be part of this process, but also may conduct After Action Reviews of their own, specifically if they were the lead agency for the emergency.
Media / Social Media
Information management has significantly changed since the advent of social media. Additionally, media has had to change dramatically to fit in this new, "instant information", environment. In Public Health and/or Medical emergencies of the past, the incident managers were able to coordinate all information to ensure the public received timely and accurate data and instructions. Now, this is no longer possible. Not only do the messages have to come out faster, the PIOs have to continually monitor social media to correct faulty information or to evaluate the incident expectations from the public.