Jim Price, Tacoma-Pierce County Health Department

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Developing and Implementing an Approach to All
Hazards Emergency Response

• Jim Price, Tacoma-Pierce County Health
  Department

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Session Objectives

• Know the difference between a plan and a
  procedure
• Understand how to organize a set of Emergency
  Plan and Implementing Procedures (EPIPs)
• Know the steps to develop an EPIP
• Understand the need for a process for
  administrative review and approval

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Poll Question 1
In my opinion, the percent of staff in my health
department who understand the difference between
a plan and an implementing procedure is

1. 100
2. 50-99
3. 25-49
4. lt25

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Plan

• Document containing policies and response
  requirements
• Not a list of steps/job actions
• Includes all hazards
• Biologic
• Natural disaster
• Technologic

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What is an EPIP?
An EPIP is the collection of job task sheets and
associated information organized by Emergency
Response Organization Sections or Branches.
How policies and requirements are to be
implemented

• Includes
• Emergency response
• Program maintenance

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Emergency Plan Implementing Procedures
VS.
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Plan vs. EPIP Example

• Establish an EP program policy
• Elements of the EP program requirements
• How to accomplish requirements EPIP

• Who receives initial call
• How call triaged
• How event level determined
• Who/what/how is information communicated
• How ERO accomplishes their tasks

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Emergency Plan Implementing Procedures
(EPIP)
Emergency Ops (EPIP)
Normal Ops (SOP)
Standard Operating Procedure
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Poll Question 2
Do you now feel that you could describe the
difference between a plan and a procedure?

1. Yes
2. No

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Developing EPIPs
Review

• What are the established requirements and
  policies to be covered?
• What ERO positions are to be included?
• What are the logical steps (task analysis) to
  complete the identified task(s)?
• How can the EPIP be organized for ease of use?

Checklist

• Is the EPIP consistent with other EPIPs?
• Can the EPIP be understood by the user?

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Writing EPIPs
At TPCHD, divided incident types into categories
EPIP 1
Recognition of emergency conditions

• Biologic
• Natural disaster
• Technological

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EPIP Template
Operations Section Chief

• Position title
• Mission
• Location
• Chain of command
• Job task sheets

Mission Activates, coordinates, and provides
overall command and control of identified
operations support staff. This staff include the
Triage Unit, and the Field Facility Branch.
 
Located TPCHD Emergency Operations Facility (EOF)
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EPIP Example
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Poll Question 3
In my opinion, the following is most important in
recognizing an emergency condition

1. Having systems in place to recognize incident
2. Driving the response by determining the severity
   of the incident
3. Realizing that PH emergencies can emerge slowly
4. Early notification that PH emergencies can emerge
   slowly

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Incident Manager, EPIP 4
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Organizing the EPIPs
EPIP 1 Recognition of Emergency Conditions EPIP
2 Notification and Communication EPIP 3
Emergency Operations Facility EPIP 4 Biological
Incident EPIP 5 Natural Disaster EPIP 6
Technological Incident EPIP 7 Maintaining
Emergency Preparedness
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Poll Question 5
My PH jurisdiction has a formal system for
categorizing the severity of an incident.

1. Yes
2. No

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EPIP 1 Recognizing Emergency Conditions

• Public health emergencies begin slowly.
• System in place to recognize incident.
• Tie response to severity of incident.
• Recognition and notification are vital.

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Poll Question 6
My PH jurisdiction has a system for identifying
action levels based on the severity of an
incident.

1. Yes
2. No

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Recognizing Emergency Conditions (cont.)

• Identify levels of response for the LHJ
• Off-normal
• Low
• Medium
• High

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TPCHD Emergency Action Levels
Off-normal incidents involve no program resource
reallocation, but may have media or significant
public concerns. Inquiries are defined as
off-normal incidents.

• Response
• Notify other program on-call staff and Public
  Health Information Officer (PHIO).
• Enter data into incident tracking.

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TPCHD Emergency Action Levels (cont.)

• Low level incidents require a resource
  reallocation by a single department program to
  appropriately respond to the incident.

• Response
• Notify other program on-call staff, PHIO, and
  Emergency Operations Facility (EOF) manager.
• Enter data into incident tracking.
• Potential for limited activation of the EOF.

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TPCHD Emergency Action Levels (cont.)
Medium level incidents require resource
reallocation by more than one program within the
Health Department to appropriately respond to
the incident.

• Response
• Activate the EOF.
• Notify Pierce County Department of Emergency
  Management.
• Notify Washington Department of Health.

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TPCHD Emergency Action Levels (cont.)
High level events impact TPCHD as well as other
outside agencies.

• Response
• Activate the EOF.
• Notify Pierce County Department of Emergency
  Management.
• Notify Washington Department of Health.
• Request activation of the county EOC.

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EPIP 2 Notification and Communication

• Concept of Operations
• Declaring an Emergency
• Incident is off-normal
• Incident is low level
• Incident is medium level
• Incident is high level

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EPIP 2 Notification and Communication

• Attachments
• TPCHD Emergency Response Organization Activation
  List
• EOF Support Unit List
• TPCHD Emergency Response Facilities Telephone
  List
• Outside Agency Contact List
• TPCHD Safety Monitor Contact List
• Local Health Jurisdiction Contact List

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EPIP 2 Notification and Communication (cont.)

• Attachments (cont.)
• TPCHD Situation Report
• TPCHD GIS Unit
• TPCHD Language Unit
• Media Outlet Contact Lists
• Public Information Officer Contact List
• TPCHD Essential Services Functions Contact List
• Pierce County High School Contact List

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EPIP 3 EOF Command Staff

• EOC Policy Liaison
• EOF Incident Manager
• EOF Manager
• Safety Officer
• Liaison Officer
• Public Health Information Officer (PHIO)

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EPIP 3 EOF General Staff/Activities
3a Finance/Admin Section 3b PHIO Support
Units 3c Operations Section 3d Planning
Section 3e Logistics Section 3f Continuity of
Operations 3g Alternate Triage and Treatment
Sites 3h Recovery
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Event Based EPIPs

• EPIPs 4, 5, and 6 categories of incident types
• Biologic
• Natural disaster
• Technologic
• Provide information on general tasks for each
  category.
• Actions for specific types of incidents are
  included in the next level of EPIP.

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EPIP 4 Biologic
4a Response to a BDS Alarm 4b Small Pox 4c
Pandemic Influenza 4d Anthrax 4e Operating
Points of Dispensing 4f Containment Operations
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EPIP 5 Natural Disasters

• 5a Earthquake
• 5b Flood
• 5c Lahar

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EPIP 6 Technologic

• 6a Radiological
• 6b Chemical

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EPIP 7
Provide information on how the Public Health
Emergency Preparedness and Response Program is
being administered.

• Procedure development
• Training
• Drills and exercises

• Facilities and equipment
• Respiratory protection
• Quality improvement

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Questions?
Comments?