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Emergency Support Function (ESF) # 8 Public Health Primary Agency Butte–Silver Bow Health Department Preface Emergencies have the potential to create widespread public health problems while resources and facilities may be in short supply. Major health problems may emerge, such as infectious diseases, sanitation problems, mental health, and contamination of food and water. Protecting the public from the public health impacts is vital in emergency re- sponse. The purpose of this support function is to establish a coor- dinated effort in providing and securing necessary public health services in response to actual or potential disaster situations. ---PAGE BREAK--- Butte–Silver Bow, Montana Emergency Operations Center ESF # 8 – Public Health Butte–Silver Bow Homeland Security and Emergency Management Agency Purpose: 1. Ensure comprehensive public health during an emergency, excluding the emergency medical services provided by the Hospital, Ambulance provider, and the Fire Department and coordinated in ESF # 11 (Hospital and Medical Services). Mass Fatality Management is addressed in ESF # 23. 2. Provide measures for communicable disease prevention and control (disease surveillance, investigation, containment and communication), including environmental health. Primary: • Butte–Silver Bow Health Department Support: • Butte–Silver Bow Public Schools • Fire Departments: Career and Volunteer • St. James Healthcare • Public Works Department • Animal Services • American Red Cross • Community Based Organizations: private, Non-profit, faith based • Community Mental Health Providers Likely Tasks: • Staff Health Group in the EOC Operations Section Human Services Branch. • Determine condition, status of City-County health resources. • Determine present and future need for health resources. • Obtain, coordinate health resources as requested by field incident commanders, to include Mass Care, Housing & Human Services and shelter sites. • Coordinate Medical Reserve Corp (MRC) activities, if available. Likely Tasks Continued: • Coordinate the assessment of general health needs of the affected population, including: – Provide for dissemination of emergency public health information. – Surveillance and monitoring of conditions that could impact general health. – Evaluation of food, drug or medical safety. – Assessment of worker health and safety. – Identification of biological, chemical, radiological or physiological hazards. – Evaluation of mental health of emergency workers and victims – Advice on potability of water sources and disposition of solid waste and wastewater. • Establish, maintain contact with State ECC through the Butte – Silver Bow EOC. – Provide information on damages, status of Butte – Silver Bow public health systems. – Request additional health resources, as needed. • Coordinate animal related advisories with the Public Health Department. – Provide information and/or services for the disposal of dead animals. State of Montana Primary • Public Health and Human Services Support • MT-VOAD • Montana Hospital Association • Department of Environmental Quality • MT National Guard (DMA) Actions: • Public health • Medical • Mental health services • Mass fatality management Federal Government Primary • Department of Health and Human Services Support • Federal agencies as required. Actions • Provides supplemental assistance in identifying and meeting the public health and medical needs of victims. • This support is categorized in the following core functional areas: – Assessment of public health/medical needs (including behavioral health). – Public health surveillance. – Medical care personnel. – Health/medical equipment and supplies. – Patient evacuation. Actions Continued – Patient care. – Safety and security of human drugs, biologics, medical devices, and veterinary drugs. – Blood and blood products. – Food safety and security. – Agriculture safety and security. – Worker health/safety. – All–hazard public health and medical consultation, technical assistance, and support. – Behavioral health care. – Public health and medical information. – Vector control. – Potable water/wastewater and solid waste disposal. – Victim identification/ mortuary services. – Protection of animal health. ---PAGE BREAK--- Annex III Emergency Support Function (ESF) # 8 PUBLIC HEALTH CEMP July 2011 8 - 3 Comprehensive Emergency Management Plan Emergency Support Function # 8 Public Health Primary Agency: Butte-Silver Public Health Department Primary Coordinator: Public Health Director Support Organizations: Butte–Silver Bow Public Schools Fire Departments: Career and Volunteer St. James Healthcare Butte-Silver Bow Animal Services Public Works Department American Red Cross Community Based Organizations: private, non- profit, and faith based Community Mental Health Providers I. INTRODUCTION. A. PURPOSE. 1. Ensure comprehensive public health care during an emergency, excluding the hospital and medical services provided by the Hospital and Medical Services ESF # 11. Fatality Management is addressed in ESF # 20. 2. Provide measures for communicable disease prevention and control (disease surveillance, investigation, containment and communication), including envi- ronmental health. B. SCOPE. This Public Health ESF organizes appropriate health care personnel to provide com- munity public health services, provides surveillance and monitoring of public health conditions, issues health warnings and information on preventative and treatment options, distributes prophylactic medicine and vaccines to the public as necessary, coordinates the provision of public health care services with, and advises on the sta- tus of potable water, waste water, solid waste, air monitoring and other environmen- tal health hazards. ---PAGE BREAK--- PUBLIC HEALTH City & County of Butte–Silver Bow, Montana 8 - 4 CEMP July 2011 C. SITUATION. 1. A major event would rapidly impact local and state government’s resources and abilities to provide public health services. Such an event would result in certain public health threats, including problems related to air and water quality, solid waste and physical and mental health. Health facilities may be severely damaged or destroyed resulting in a medical and pharmaceutical supplies/equipment shortage. Injuries and health conditions will be complicated by the impact of the emergency as well as in coordinating services of health care facilities and phar- macies. 2. Emergencies have the potential to raise stress levels in survivors and emergency responders, which may negatively affect their mental and emotional well being. 3. Situations with potential threat to health and safety of the community require coordination of public health and medical response. These could include natural disease outbreaks. D. POLICIES. 1. Continuation of public health functions and control of environmental factors re- lated to public health is essential following an emergency to prevent the out- break of disease and to monitor the spread of vectors associated with the emer- gency and its aftermath. 2. Expedient health services are provided by the staff of the public health and pri- vate health care facilities. 3. It is desired to provide the highest quality of care possible. In all likelihood, emergency measures to protect life and health during emergencies will be exclu- sively dependent upon those resources available at the local level during the first critical hours post event. Austere conditions may limit the amount and quality of care it is possible to deliver. E. PUBLIC HEALTH AREAS OF RESPONSIBILITY 1. Assessment of Public Health/Medical Needs: Mobilizes and deploys ESF #8 personnel to assess public health and medical needs, including the needs of at- risk population groups, such as language assistance services for limited English- proficient individuals and accommodations and services for individuals with dis- abilities. This function includes the assessment of the health care sys- tem/facility infrastructure. 2. Health Surveillance: In coordination with supporting departments and agen- cies, establishes or enhances existing surveillance systems to monitor the health of the general and medical needs population; carries out field studies and inves- tigations; monitors injury and disease patterns and potential disease outbreaks, blood and blood product biovigilance, and blood supply levels; and provides ---PAGE BREAK--- Annex III Emergency Support Function (ESF) # 8 PUBLIC HEALTH CEMP July 2011 8 - 5 technical assistance and consultations on disease and injury prevention and precautions. 3. Safety of Drugs, Food, Biologics, and Medical Devices: ESF #8 may task components to ensure the safety and efficacy of regulated foods, drugs, biologic products, and medical devices following a disaster. Coordinate the seizure, re- moval, or destruction of contaminated or unsafe products. 4. Agriculture Safety and Security: ESF may task components to ensure the health, safety, and security of food-producing animals, animal feed, and thera- peutics. 5. Vector Control: ESF #8 may task components and request assistance from oth- er ESF #8 partner organizations, as appropriate, in assessing the threat of vec- tor-borne diseases; conducting field investigations, including the collection and laboratory analysis of relevant samples; providing vector control equipment and supplies; providing technical assistance and consultation on protective actions regarding vector-borne diseases; and providing technical assistance and consul- tation on medical treatment of victims of vector-borne diseases. 6. Public Health Aspects of Potable Water/Wastewater and Solid Waste: Coor- dinate the assessment of potable water, wastewater, solid waste disposal, and other environmental health issues related to public health in establishments holding, preparing, and/or serving food, drugs, or medical devices at retail and medical facilities, as well as examining and responding to public health effects from contaminated water; conducting field investigations, including collection and laboratory analysis of relevant samples; providing equipment and supplies as needed; and providing technical assistance and consultation. 7. Public Health Information: ESF #8 provides public health, disease, and injury prevention information that can be transmitted to members of the general public who are located in or near areas affected in languages and formats that are un- derstandable to individuals with limited English proficiency and individuals with disabilities. 8. Behavioral Health Care: ESF #8 may task components and request assistance from other ESF #8 partner organizations in assessing mental health and sub- stance abuse needs, including emotional, first aid, behavioral, or cognitive limitations requiring assistance or supervision; providing disaster mental health training materials for workers; providing liaison with as- sessment, training, and program development activities undertaken by Federal, State, tribal, or local mental health and substance abuse officials; and providing additional consultation as needed. 9. Chemical and Biological Hazards Consultation: Will assist in assessing health and medical effects of chemical and biological exposures on the general popula- tion and on high-risk population groups; mobilize and deploy state resources to conduct field investigations, including collection and analysis of relevant sam- ---PAGE BREAK--- PUBLIC HEALTH City & County of Butte–Silver Bow, Montana 8 - 6 CEMP July 2011 ples; advise on protective actions related to direct human and animal exposure, and on indirect exposure through chemically or biologically contaminated food, drugs, water supply, etc.; and provide technical assistance and consultation on medical treatment and decontamination of chemically or biologically injured or contaminated victims. 10. Radiological Hazards Consultation: Will assist in assessing health and medical effects of radiological exposures on the general population and on high-risk pop- ulation groups. Will mobilize to conduct field investigations, including collection and analysis of relevant samples; advise on protective actions related to direct human and animal exposure, and on indirect exposure through radiological con- taminated food, drugs, water supply, etc.; and provide technical assistance and consultation on medical treatment and decontamination of radiologically injured or contaminated victims. II. CONCEPT OF OPERATIONS. A. GENERAL. 1. Emergency operations for public health services will be an extension of their normal duties. However, during widespread, multiple-site emergencies, health personnel, resources and facilities may be inundated by a surge in workload. 3. Existing mutual aid agreements may be able to augment and satisfy a temporary increase in local needs. If local capabilities are exceeded, support may be availa- ble from state and federal health service groups. 4. Coordination between public health service agencies is necessary to ensure emergency operational readiness. Each support agency must develop operating instructions and resource listings to support this plan. 5. A listing of available emergency public health service resources is maintained by the Butte – Silver Bow Public Health Department and shared with the EOC. B. TASKS AND RESPONSIBILITIES. 1. Pre–Emergency Tasks. a. Primary and support departments will coordinate with the Homeland Securi- ty and Emergency Management Agency to: • Maintain this Emergency Support Function (ESF). • Maintain inventories of resources and equipment. • Develop public education information concerning the use of untreated water, contaminated food, and other unsanitary practices following emergencies. • Develop format for preparing health–related public information for dis- tribution to the EOC PIO for release to the general public. • Develop procedures for deploying personnel into affected areas to pro- ---PAGE BREAK--- Annex III Emergency Support Function (ESF) # 8 PUBLIC HEALTH CEMP July 2011 8 - 7 vide surveillance and monitoring of public health following major emer- gencies. • Participate in training and exercises. • Develop emergency action checklists. • Maintain mutual aid agreements. • Develop and test methods for providing large scale prophylaxis in the community. 2. General Emergency Tasks. a. Primary and support agencies will: • When requested during an emergency situation, report to the Butte – Silver Bow EOC. • Provide guidance on personal protective equipment and other exposure precautions • Ascertain need for public health surveillance. 3. Specific Emergency Concepts and Responsibilities. a. Butte–Silver Bow Health Department is the primary department for ESF # 8 Public Health and will: • Assume the role of primary department for this ESF and assumes the position of Public Health Group Supervisor in the EOC Operations Sec- tion to carry out those functions within the EOC. • Provide personnel, equipment, supplies and other resources necessary to coordinate plans and programs for public health activities. • Inspect and advise on general food handling and sanitation matters. • Coordinate through the EOC Public Information Officer the dissemina- tion of emergency-related public health information to the public. • Coordinate with hospitals and other health providers regarding response to public health needs. • Provide investigation, surveillance, and take measures for containment of harmful health effects. • Provide coordination of laboratory services. • Consult with the Mass Care, Housing & Human Services Coordinator to identify shelters that may require public health services. • Coordinate air and water quality assurance activities. • Provide frequent updates to the EOC Operations Section Chief as to the status of the Public health function. • Coordinate behavioral health support agencies for requested services. • Support fatality management services by providing public health related disaster assessments and information. • Provide public health guidance to the private medical community. • Maintain records of cost and expenditures to accomplish this ESF and forward them to the EOC Finance/ Administration Section Chief. ---PAGE BREAK--- PUBLIC HEALTH City & County of Butte–Silver Bow, Montana 8 - 8 CEMP July 2011 b. American Red Cross: • Provide medical and mental health support personnel as requested. c. Fire Departments-Career and Volunteer: • Provide assistance with public health related assessments. • Record costs and expenditures and forward them to this ESF’s Group Supervisor. d. Butte – Silver Bow Public Schools: • Provide nursing personnel, equipment, supplies and other resources needed to assist in health care for victims of the effected emergency area. • Record costs and expenditures and forward them to this ESF’s Group Supervisor. e. St. James Healthcare: • Assist public health with community health issues. f. Mental Health Providers: Warm Springs State Hospital, Montana Mental Health, Butte Ministerial Association, Private Providers: • Provide behavioral health services. • Assess behavioral health needs following an emergency considering both the immediate and cumulative stress resulting from the emergency. • Provide State licensed medical and mental health support personnel as requested. • Coordinate through the EOC Public Information Officer the dissemina- tion of public education on critical incident stress and stress manage- ment techniques. • Provide outreach to serve identified behavioral health needs. g. Public Works Department: • Assist with water quality control. • Monitor sewerage treatment capabilities. • Record costs and expenditures and forward them to this ESF’s Group Supervisor. h. Animal Services: • Assist with the prevention and control of animal-borne diseases that have public health significance. • Record costs and expenditures and forward them to this ESF’s Group Supervisor. ---PAGE BREAK--- Annex III Emergency Support Function (ESF) # 8 PUBLIC HEALTH CEMP July 2011 8 - 9 C. ROLE OF BUTTE–SILVER BOW EOC. 1. When the EOC is activated, the EOC Manager may activate the Public Health ESF # 8 by assigning a representative of as Public Health Group Supervisor to coordinate public health services activities. The Public Health Group Supervisor is responsible for directing and coordinating emergency responses to situations relating to disease control, sanitation, and mental health. The Public Health Group Supervisor will make request to the state EOC through the EOC Com- mander for additional resources when all local public health services resources have been exhausted. 2. Public health personnel will be alerted according to prescribed departmen- tal/agency policy. The Public Health Group Supervisor will assign the operation- al priorities for personnel. All personnel will report to their pre–designated loca- tions unless otherwise directed by their supervisor at the time they are notified of the emergency. Pre–designation of duties and responsibilities will facilitate a reduction in response time. 3. Public Health Group Supervisor will establish and maintain lines of communica- tion in the EOC during major response operations to facilitate coordination of activities and resources. 4. Public Health ESF # 8 likely tasks are found in the City-County box on the tab page at the front of this section. D. LIFE SAFETY ASSESSMENT. An initial EOC priority is to gather as much intelligence about the extent of damage as soon as possible. As soon as possible, public health service personnel will submit situation and damage reports to the EOC. E. EVACUATION. Evacuation will be coordinated with the EOC to ensure the evacuees are moved to an appropriate shelter to provide for the needs of special populations and individuals. Public Health ESF # 8 will ensure appropriate public health service support. F. FIELD OPERATIONS. 1. Public Health Services emergency actions may include: • Immunizations and/or the distribution of prophylaxis. • Public Health inspections. • Public Health /Sanitation inspections of medical facilities, shelters, mass care centers, and food establishments impacted by disaster events. • Coordinate potable water testing. • Environmental health activities in regard to waste disposal, refuse, food, wa- ter control, environmental monitoring and vector control. ---PAGE BREAK--- PUBLIC HEALTH City & County of Butte–Silver Bow, Montana 8 - 10 CEMP July 2011 • Conduct or coordinate laboratory activities in regard to examination of food and water, and diagnostic tests. 2. Mental Health Services emergency actions may include: • Coordinating mental health programs and resources at incident sites. 3. Hazardous Materials Response. • Public health service units responding to a hazardous material incident will ensure that they have a full understanding of the Incident Commander’s as- sessment of the situation and that they take full and proper precautions to protect themselves. • Only personnel having proper training should be deployed to a hazardous material incident. 4. Multiple Death Operations. • The City-County Public Health Department gathers vital statistics during mass injury or fatality operations for the EOC situation reports as re- quested. III. ATTACHMENTS AND REFERENCES. A. ATTACHMENTS. 1. Public Health (ESF # 8) Checklist. B. REFERENCES. 1. Butte-Silver Bow Public Health Department Emergency Operations Plan. 2. Butte-Silver Bow Joint Information Center Plan. 3. Emergency Operations Center Operating Guide. C. PROVISO. This support annex has been prepared in accordance with the standards of the Na- tional Incident Management System and other Federal and State requirements and standards for emergency response plans applicable as of the date of the plan’s prep- aration. The plan provides guidance only; it is intended for use in further development for re- sponse capabilities, implementation of training and exercises, and defining the gen- eral approach to incident response. The actual response an incident is dependent on: 1. The specific conditions of the incident, including incident type, geographic ex- tent, severity, timing, and duration; 2. The availability of resources for response at the time of the incident; ---PAGE BREAK--- Annex III Emergency Support Function (ESF) # 8 PUBLIC HEALTH CEMP July 2011 8 - 11 3. Decisions of Incident Commanders and political leadership; and 4. Actions taken by neighboring jurisdictions, the State, and the Federal Govern- ment. These and other factors may result in unforeseen circumstances, prevent the implementa- tion of plan components, or require actions that are significantly different from those de- scribed in the plan. ---PAGE BREAK--- PUBLIC HEALTH City & County of Butte–Silver Bow, Montana 8 - 12 CEMP July 2011 This Page Is Blank Intentionally ---PAGE BREAK--- Annex III Emergency Support Function (ESF) # 8 PUBLIC HEALTH CEMP July 2011 8 - 13 Attachment 1 PUBLIC HEALTH (ESF # 8) CHECKLIST Pre–Emergency Coordinate with the Homeland Security and Emergency Management Agency to: Maintain this Emergency Support Function (ESF). Maintain inventories of resources and equipment. Develop public education information concerning the use of untreated water, contaminated food, and other unsanitary prac- tices following emergencies. Develop format for preparing health–related public information for distribution to the EOC PIO for release to the general public. Develop procedures for deploying personnel into affected areas to provide surveillance and monitoring of public health following major emergencies. Participate in trainings and exercises. Develop emergency action checklists. Maintain mutual aid agreements. Develop and test methods for providing large scale prophylaxis. Emergency When notified, report to the Butte – Silver Bow EOC. Monitor Public Health and well–being of emergency workers. Ascertain need for public health surveillance. Emergency Opera- tions Center (EOC) Perform Public Health ESF # 8 functions as the Public Health Group Supervisor within the Butte – Silver Bow EOC Operations Section. Determine condition, status of Butte – Silver Bow health re- sources. Determine present and future need for health resources. Obtain, coordinate Public Health resources as requested by field incident commanders. Sources for resources can include: – Mutual aid. – State ECC. – American Red Cross. Coordinate assessment of general health needs of the affected population, including: – Providing for dissemination of emergency public health in- formation. – Surveillance and monitoring of conditions that could impact general public health. – Coordinate the evaluation and dissemination of public heath alerts of food, drug or medical safety. – Assessment of worker health and safety. ---PAGE BREAK--- PUBLIC HEALTH City & County of Butte–Silver Bow, Montana 8 - 14 CEMP July 2011 – Assist with the identification of biological, chemical, radiolog- ical or physiological public health hazards. – Coordinate the evaluation of potential mental health issues of emergency workers and victims. – Advice on potability of water sources and disposition of solid waste and wastewater as it relates to public health issues. Establish, maintain contact with State EOC through the EOC Manager, as appropriate: – Provide information on damages, status of Butte – Silver Bow Public Health systems. – Request additional Public Health resources, as needed. Provide mutual aid if requested: – Do not commit mutual aid until it is determined that the City-County does not need the requested resources. Recovery Actions Continue to monitor the public and environment for adverse effects. Coordinate with and assist state and federal public health agen- cies as needed.