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Emergency Support Function (ESF) # 11 Hospital and Medical Services Primary Agencies St. James Healthcare A-1 Ambulance Preface Emergencies may cause medical emergencies. Providing pre-hospital and hospital emergency medical care to protect life is an integral part of the City-County’s emergency response system. The purpose of this support function is to identify, manage and organize the response of required emergency medical care resources. Act as the liaison between local, state and federal agencies and the private sector in the coordination of emergency response and emergency medical support. ---PAGE BREAK--- Silver Bow, Montana Emergency Operations Center ESF # 11 – Hospital and Medical Services Butte–Silver Bow Homeland Security and Emergency Management Agency Purpose: 1. Identify, manage and organize the response of required emergency medical care resources. Act as the liaison between local, state and federal agencies in the coordination of emergency response and emergency medical support. General community health is addressed in Public Health ESF # 8. Primary: • St. James Healthcare and A-1 Ambulance Support: • Law Enforcement Department • 911 Communications Center • Butte–Silver Bow Public Schools • Butte-Silver Bow Coroner’s Office • Butte–Silver Bow Public Health Department • Butte – Silver Bow Fire Department(s) • American Red Cross • Private Sector Medical Clinics Likely Tasks: • Staff EMS Group in the EOC Operations Section Public Safety. • Obtain, coordinate emergency medical resources as requested by field incident commanders, to include mass care and shelter sites. • Coordinate assistance to Medical Examiner in victim identification and mortuary services. • Coordinate with Public Health ESF # 8 in the team assessment of general health needs of the affected population, includes: – Assessment of worker health and safety. – Identification of biological, chemical, radiological or physiological hazards. • Assist with medical support for shelters. • Provide personnel at special needs shelters as requested. • Maintain a list of Emergency Medical resources. Likely Tasks Continued: • Establish, maintain contact with State ECC through the Butte – Silver Bow EOC. – Provide information on damages, status of City-County emergency medical systems. – Request additional emergency medical resources, as needed. • Activate the communications links between emergency medical responders and local hospitals. • Determine condition, status of City-County emergency medical resources. • Determine present and future need for emergency medical resources. – Determine need for additional personnel to include Multiple Casualty Incidents. – Determine coordination needed regarding special needs shelters. – Examine need for emergency medical equipment and supplies. – Ascertain need for patient evacuation. • Provide, coordinate the following resources: ambulance vehicles; Paramedics; EMT’s; emergency medical equipment and supplies; Infection Control Liaison and Information; logistical needs; administrative support; clerical support. • Obtain, coordinate medical resources as requested by field incident commanders, includes: – Provision for pre–hospital and hospital emergency medical care. – Assist in identification, coordination and mobilization of medical equipment, supplies and personnel. • Coordinate assistance to Medical Examiner in victim identification and mortuary services. • Determine condition, status of City-County health resources. • Determine present and future need for health resources. State of Montana Primary • Disaster & Emergency Services Division (DMA) • Public Health & Human Services Support • Agriculture • Livestock • • Fish, Wildlife & Parks • Natural Resources & Conservation • Environmental Quality • MT National Guard (DMA) Actions • Nutrition assistance • Animal and plant disease and pest response • Food safety and security • Natural and cultural resources and historic properties protection and restoration • Safety and well-being of household pets 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. – Patient care. Actions Continued – 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) # 11 HOSPITAL AND MEDICAL SERVICES (HMS) CEMP July 2011 11 - 3 Comprehensive Emergency Management Plan Emergency Support Function # 11 Hospital and Medical Services (HMS) Co-Primary Agencies: St. James Healthcare A-1 Ambulance Co-Primary Coordinators: St. James Healthcare Safety and Risk Manager A-1 Ambulance Medical Director Support Organizations: Law Enforcement Department 911 Communications Center Butte–Silver Bow Public Schools Butte-Silver Bow Coroner’s Office Butte – Silver Bow Fire Department(s) Public Health Department American Red Cross Private Sector Medical Clinics I. INTRODUCTION. A. PURPOSE. Identify, manage and organize the response of emergency medical care resources. Act as the liaison between local, state and federal agencies in the coordination of emergency response and emergency medical support. General community health is addressed in the Public Health ESF # 8. B. SCOPE. Provide pre–hospital emergency response, medical care and transport pre- and post emergency. Provide special medical needs evacuation of persons requiring transport by ambulance. Identify and coordinate emergency medical equipment and supplies, and support evacuation efforts from critical health care facilities if needed. C. SITUATION. A major event would rapidly impact local government’s resources and abilities to ---PAGE BREAK--- HOSPITAL AND MEDICAL SERVICES (HMS) City & County of Butte–Silver Bow, Montana 11 - 4 CEMP July 2011 provide medical services. Hospital and medical facilities may be severely damaged or destroyed resulting in a medical and pharmaceutical supplies/equipment shortage. Persons who are not injured, but require daily medication, would have difficulty in obtaining necessary medication due to the damage or destruction of supply locations. Injuries and health conditions will be complicated by the impact of the emergency as well as in coordinating services of health care facilities and pharmacies. D. POLICIES. 1. Butte – Silver Bow will endeavor to assure the quality of care given to its citizens will be at the highest level possible. However, measures to protect life and health during emergencies in all likelihood will be exclusively dependent upon local and area resources in the first hours and days after an emergency. Austere conditions may limit the amount and quality of care possible. 2. All emergency responders shall not release medical information on individual patients to the general public except as proscribed by law to ensure patient confidentiality protection. 3. Appropriate information on casualties/patients will be provided to the American Red Cross for inclusion in the Disaster Welfare Information System for access by the public according to established protocols. E. FUNCTIONAL AREAS OF RESPONSIBILITY AND DESCRIPTIONS 1. Patient Transport and Evacuation: ESF #11 is responsible for transporting ill or injured patients, and special medical needs populations from casualty collection points in the impacted area to designated reception facilities. ESF #11, in collaboration with the local EOC, coordinates State and/or Federal resource response in support of emergency triage and pre-hospital treatment, patient tracking, and distribution. 2. Patient Care: ESF #11 may task support components to provide available personnel to support pre-hospital triage and treatment, inpatient hospital care, outpatient services, pharmacy services, and dental care to victims who are seriously ill, injured, or suffer from chronic illnesses or who need evacuation assistance, regardless of location. 3. Blood, Organs, and Blood Tissue Supplies: ESF #11 may task support components and request assistance from other ESF #11 partner organizations to monitor and ensure the safety, availability, and logistical requirements of blood, organs, and tissues. This includes the ability of the existing supply chain resources to meet the manufacturing, testing, storage, and distribution of these products. ---PAGE BREAK--- Annex III Emergency Support Function (ESF) # 11 HOSPITAL AND MEDICAL SERVICES (HMS) CEMP July 2011 11 - 5 II. CONCEPT OF OPERATIONS. A. GENERAL. 1. Hospital and Medical Services (HMS) is an integral part of the first responder network providing emergency services (fire, rescue, medical, law enforcement) in Butte – Silver Bow. For many single site emergency situations, the function of emergency medical services will be an extension of normal duties. However, during widespread, multiple-site emergencies emergency medical personnel, resources and facilities may be in short supply. 2. 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 available from private sector, state and federal hospital or medical service groups. 3. Coordination between emergency medical services agencies is necessary to ensure emergency operational readiness. Each entity having responsibility for emergency medical services must develop operating instructions and resource listings to support this plan. B. TASKS AND RESPONSIBILITIES. 1. Pre–Emergency Tasks. a. Primary and support departments will coordinate with the Homeland Security and Emergency Management Agency to: • Maintain this Emergency Support Function (ESF). • Maintain inventories of resources and equipment. • Participate in drills, exercises. • Develop emergency action checklists. • Maintain mutual aid agreements. 2. General Emergency Tasks. a. Primary and support agencies will: • When notified of an emergency situation, may send a representative to the Butte – Silver Bow EOC, if appropriate. • Respond to the emergency scene with emergency medical personnel and equipment. • Upon arrival at the scene, assume appropriate role in the Incident Command System (ICS). If ICS has not been established, initiate in accordance with the Standard Operating Procedures and report implementation to the EOC. • Triage, stabilize, treat, and coordinate transport of the sick and injured with area hospitals. ---PAGE BREAK--- HOSPITAL AND MEDICAL SERVICES (HMS) City & County of Butte–Silver Bow, Montana 11 - 6 CEMP July 2011 • Establish and maintain field communications and coordination with other responding emergency teams (medical, fire, police, public works, etc.), and radio or telephone communications with area hospitals, as appropriate. – Provide early notification to the hospital radio net on potential mass casualty incidents. • Direct the activities of private, volunteer, and other emergency medical units, and of bystander volunteers as needed. 3. Specific Emergency Concepts and Responsibilities. a. St. James Healthcare and A-1 Ambulance are the primary agencies for ESF # 11 Hospital and Medical Services (HMS) and will: • Implement this Hospital and Medical Services ESF by assigning an individual to assume the position of the Hospital and Medical Group Supervisor within the EOC Operations Section. • Response to emergency scene(s) with emergency medical personnel and equipment. • Upon arrival at the scene, assume appropriate role in the Incident Command System (ICS). If ICS has not been established, initiate in accordance with the local emergency management plan and report implementation to the EOC. • Triage, stabilize, treat and transport the injured; ensure casualties are transported to the appropriate facilities. • Establish and maintain field communications and coordination with other responding emergency teams, and radio or telephone communications with medical centers, as appropriate. • Directing activities of private, volunteer, and other emergency medical units, and of emergent volunteers as needed. • Evacuate patients from affected hospital and nursing homes if necessary. • Isolate, decontaminate, and treat victims of hazardous chemical or infectious diseases, as needed. • Maintain records of cost and expenditures to accomplish this ESF and forward them to the EOC Finance/ Administration Section Chief. b. Butte – Silver Bow Fire Departments-Career and Volunteer: • Triage, stabilize, and treat the injured within capabilities. • Record costs and expenditures and forward them to this ESF’s Group Supervisor. c. Private Sector Medical Clinics: • Be prepared to provide medical care for injured or ill. • Coordinate with EMS and other health providers on patient care capacity. ---PAGE BREAK--- Annex III Emergency Support Function (ESF) # 11 HOSPITAL AND MEDICAL SERVICES (HMS) CEMP July 2011 11 - 7 d. 911 Communications Center: • Assure needed radio systems continue to function. • Provide dispatching capabilities. • Record costs and expenditures and forward them to this ESF’s Group Supervisor. e. Public Health Department: • Determine if emergency incidents have population-wide health implications. • Maintain ongoing human health and medical surveillance of affected populations in order to rapidly identify and address health-related issues. f. Law Enforcement Department: • Provide basic first-aid and scene security. • Maintain law and order through traffic and crowd control. • Provide security for vital facilities. • Record costs and expenditures and forward them to this ESF’s Group Supervisor. g. Butte-Silver Bow Coroner’s Office: • Coordinate with the EOC Hospital and Medical Group Supervisor and on-scene responders regarding disposition of deceased. • Record costs and expenditures and forward them to this ESF’s Group Supervisor. h. American Red Cross: • Provide first aid centers for non-critical injuries. • Assist with coordination of needed blood, blood products, and vaccines. • Provide supplementary medical and nursing care in shelters and other health services upon request and within capabilities. C. ROLE OF BUTTE–SILVER BOW EOC. 1. The Hospital and Medical Group Supervisor is responsible for implementing the Hospital and Medical Services ESF # 11 by directing and coordinating emergency programs relating to medical operations e.g., existing hospitals and hospital–type facilities, emergency treatment stations, first–aid stations, first– aid, litter and ambulance teams, blood banks, blood collecting centers, blood distribution and allocating medical personnel and equipment to reception areas. The Hospital and Medical Group Supervisor will make requests to the EOC Operations Section Chief for additional resources when it is apparent that all local medical resources have been exhausted. ---PAGE BREAK--- HOSPITAL AND MEDICAL SERVICES (HMS) City & County of Butte–Silver Bow, Montana 11 - 8 CEMP July 2011 2. Medical services personnel will be alerted according to prescribed departmental/agency policy. Operational priorities for personnel will be assigned by the assigned representative of the co-leading agencies or designee. Personnel will report to pre–designated locations 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. The Hospital and Medical Group Supervisor will establish and maintain lines of communication in the EOC during major response operations to facilitate coordination of activities and resources. 4. Hospital and Medical Services ESF # 11 likely tasks are found in the City- County box on the tab page at the front of this section. D. LIFE SAFETY ASSESSMENT. 1. 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. 2. An initial EOC priority is to gather as much intelligence about the extent of damage as soon as possible. The primary source for this will be Police and Fire dispatch centers. As soon as possible, HMS personnel will report need for rescue, numbers of dead or injured, damage to buildings, public facilities such as roads and bridges, and utilities. Reports will be compiled by dispatch and communicated to the EOC. E. EVACUATION. Evacuation will be coordinated with the EOC to ensure the evacuees are moved to an appropriate shelter, and the needs of special populations and individuals are provided for. The Hospital and Medical Services ESF # 11 will ensure appropriate medical support. F. FIELD OPERATIONS. 1. Incident Commanders will establish inner and outer perimeters to secure an emergency scene. A policy of limited access to the emergency area will be rigidly enforced to ensure safety and well being of the community. Movement into and out of area will be requested through established command posts. Additional details concerning response actions required are found in department standard operating guidelines (SOGs) published under separate cover. 2. Security will be provided for essential facilities if required, and law enforcement personnel will assist the Incident Commander in restricting access to unsafe buildings or areas. 3. Hazardous Materials Response. ---PAGE BREAK--- Annex III Emergency Support Function (ESF) # 11 HOSPITAL AND MEDICAL SERVICES (HMS) CEMP July 2011 11 - 9 • Hospital and medical units and personnel responding to a hazardous material incident will ensure they have a full understanding of the Incident Commander’s assessment of the situation and they take full and proper precautions to protect themselves. • Only personnel having proper training shall be deployed to a hazardous material incident. III. ATTACHMENTS AND REFERENCES. A. ATTACHMENTS. 1. Hospital and Medical Services (ESF # 11) Checklist. B. REFERENCES. 1. St. James Healthcare Emergency Operations Plan (October 2010). 2. Butte-Silver Bow Mass Casualty Plan (TBD). C. PROVISO. This support annex has been prepared in accordance with the standards of the National Incident Management System and other Federal and State requirements and standards for emergency plans applicable as of the date of the plan’s preparation. The plan provides guidance only; it is intended for use in further development for response capabilities, implementation of training and exercises, and defining the general approach to incident response. The actual response to an incident is dependent on: 1. The specific conditions of the incident, including incident type, geographic extent, severity, timing, and duration; 2. The availability of resources for response at the time of the incident; 3. Decisions of Incident Commanders and political leadership; and 4. Actions taken by neighboring jurisdictions, the State, and the Federal Government. These and other factors may result in unforeseen circumstances, prevent the implementation of plan components, or require actions that are significantly different from those described in the plan. ---PAGE BREAK--- HOSPITAL AND MEDICAL SERVICES (HMS) City & County of Butte–Silver Bow, Montana 11 - 10 CEMP July 2011 This Page Is Blank Intentionally ---PAGE BREAK--- Annex III Emergency Support Function (ESF) # 11 HOSPITAL AND MEDICAL SERVICES (HMS) CEMP July 2011 11 - 11 Attachment 1 HOSPITAL AND MEDICAL SERVICES (HMS) (ESF # 11) 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. Participate in drills, exercises. Develop emergency action checklists. Maintain mutual aid agreements. Become familiar with the National Disaster Medical System. Emergency Respond to the emergency scene with emergency medical personnel and equipment. Upon arrival at the scene, assume appropriate role in the Incident Command System (ICS). If ICS has not been established, initiate in accordance with the Butte – Silver Bow’s emergency management system and report implementation to the EOC. Triage, stabilize, treat, and coordinate transport of the sick and injured with area hospitals. Establish and maintain field communications and coordination with other responding emergency teams (medical, fire, police, public works, etc.), and radio or telephone communications with area hospitals, as appropriate. – Provide early notification to the hospital radio net on potential mass casualty incidents. Direct the activities of private, volunteer, and other emergency medical units, and of bystander volunteers as needed. When notified, report to the Butte – Silver Bow EOC. Emergency Operations Center (EOC) Implement this Hospital and Medical Services ESF by assigning an individual to assume the position of Hospital and Medical Group Supervisor within the EOC Operations Section. Activate the communications links between emergency medical responders and hospital. Determine condition, status of Butte – Silver Bow hospital and medical resources. Determine present and future need for hospital and medical resources. – Determine need for additional personnel to include Multiple Casualty Incidents. – Determine coordination needed regarding special needs shelters. – Examine need for medical equipment and supplies. – Ascertain need for patient evacuation. ---PAGE BREAK--- HOSPITAL AND MEDICAL SERVICES (HMS) City & County of Butte–Silver Bow, Montana 11 - 12 CEMP July 2011 Coordinate medical support for shelters. Provide medical personnel at special needs shelters as requested. Provide, coordinate the medical resources to include: – Ambulance vehicles and transportation. – Medical personnel. – Medical equipment and supplies. – Logistical support. – Administrative and clerical support. Obtain, coordinate medical resources as requested by field incident commanders, includes: – Provision for pre–hospital and hospital emergency medical care. – Assist in identification, coordination and mobilization of medical equipment, supplies and personnel. Sources for resources can include: – Mutual aid. – State EOC. – American Red Cross. – Hospital and clinics. – Military (disaster medical assistance teams). – Private sector physicians, nurses, hospitals, clinics. – National Disaster Medical System. Coordinate assistance to Coroner in victim identification and mortuary services. Establish, maintain contact with State EOC through the EOC Manager. – Provide information on damages, status of Butte – Silver Bow hospital and medical system. – Request additional medical resources as needed. Evaluate mutual aid requests and determine which can be filled. Recovery Actions Continue providing essential medical care services. Assist Recovery Operations; Identify barriers to recovery. Assist restoration of the area’s medical care delivery capacity. Support Operations to provide pre–hospital medical care and health services. Support USAR as needed. Support DMAT as needed. Maintain activity journal and documentation of labor, supplies and equipment. Document damaged apparatus and equipment. Maintain activity journal.