MFHCC Meeting

1. MFHCC Meeting February 7, 2017 Jefferson County Public Health Lakewood, CO

2. Welcome and Introductions

3. Agenda • Arrive, sign in, grab lunch • Welcome & Introductions – Janelle • Changes to HCCs and Healthcare Preparedness Program (HPP) – Dane Matthews, Director, CDPHE-OEPR • Agency Updates - All – Lisa • Upcoming Training and Events – Lisa and Janelle • Member Agency Spotlight – Colorado Coalition for the Homeless - Stan Eilert • Infectious Disease Update: Mumps & Measles – Carol McDonald • Health Alert Network (HAN) Overview – Lisa and Christine • Public Health Emergency Operations Plan (PHEOP) Summary - BOH Rule to have partners review the plan - Janelle and Christine • Influenza Update - Angel Anderson, JCPH and Lisa Miller, MD, MSPH, CDPHE • Inpatient Bed Tracking Discussion – Lisa and Janelle • Grant Funding - James Robinson, DHPD • Review New Action Items • Networking

4. Review previous action items Janelle Worthington

5. Review Previous Action Items

6. Healthcare Preparedness Program (HPP) and HCC ChangesFY 2017 – 2022 Dane Matthew, DirectorCDPHE - OEPRDane.Matthew@state.co.us(303) 692-2954

7. Hospital Preparedness Program • ASPR’s Hospital Preparedness Program (HPP) enables the health care delivery system to save lives during emergencies and disaster events that exceed the day-to-day capacity and capability of existing health and emergency response systems. • HPP is the only source of federal funding for health care delivery system readiness, intended to improve patient outcomes, minimize the need for federal and supplemental state resources during emergencies, and enable rapid recovery. • HPP prepares the health care delivery system to save lives through the development of health care coalitions (HCCs) that incentivize diverse and often competitive health care organizations with differing priorities and objectives to work together.

8. Hospital Preparedness Program The intended HCC participants include but not limited to:

9. Urban and rural HCCs Urban and rural HCCs may have different membership compositions based on population characteristics, geography, and types of hazards. For example, in rural and frontier areas—where the distance between hospitals may exceed 50 miles and where the next closest hospitals are also critical access hospitals with limited services—tribal health centers, referral centers, or support services may play a more prominent role in the HCC.

10. Hospital Preparedness Program • The 2017-2022 Health Care Preparedness and Response Capabilities • Draft came out in October…Identified significant HCC roles • Guidance describes what the health care delivery system, including HCCs, hospitals, and emergency medical services (EMS), have to do to effectively prepare for and respond to emergencies that impact the public’s health. • Capabilities may not be achieved solely with the funding provided by the HPP • Funding for 2017-2022 required to be directed to HCCs • Exceptions: Centrally procured services by state (ie. EMSystems, CHA, CCHN) • State administrative oversight capped at 18% for BP1 – down to 15% by BP5 • Goal, more HPP funding pushed to the regional/local level HCC to determine localized comprehensive health care preparedness priorities

11. HPP Capabilities • Capability 1: Foundation for Health Care and Medical Readiness • Goal of Capability 1: The community’s health care organizations and other stakeholders—coordinated through a sustainable HCC—have strong relationships, identify hazards and risks, and prioritize and address gaps through planning, training, exercising, and managing resources. • Capability 2: Health Care and Medical Response Coordination • Goal of Capability 2: Health care organizations, the HCC, their jurisdiction(s), and the ESF-8 lead agency plan and collaborate to share and analyze information, manage and share resources, and coordinate strategies to deliver medical care to all populations during emergencies and planned events. • Capability 3: Continuity of Health Care Service Delivery • Goal of Capability 3: Health care organizations, with support from the HCC and the ESF-8 lead agency, provide uninterrupted, optimal medical care to all populations in the face of damaged or disabled health care infrastructure. Health care workers are well-trained, well-educated, and well-equipped to care for patients during emergencies. Simultaneous response and recovery operations result in a return to normal or, ideally, improved operations. • Capability 4: Medical Surge • Goal of Capability 4: Health care organizations—including hospitals, EMS, and out-of-hospital providers—deliver timely and efficient care to their patients even when the demand for health care services exceeds available supply. The HCC, in collaboration with the ESF-8 lead agency, coordinates information and available resources for its members to maintain conventional surge response. When an emergency overwhelms the HCC’s collective resources, the HCC supports the health care delivery system’s transition to contingency and crisis surge response and promotes a timely return to conventional standards of care as soon as possible.

12. Colorado Specific HCC Challenges • OEPR sent letter to ASPR in November requesting concessions…denied. • We must submit a detailed plan with our grant application in March for how Colorado will comply with restructuring and funding HCCs. • Colorado currently has 34 HCCs…many single county entities • Many current HCCs do not meet core membership requirements • Many HCCs do not have members with multiple “like” organizations • Most HCCs are planning organizations only and have no operational roles identified to support ESF8 lead during response • Most HCCs do not have an identified fiscal agent able to receive funds from the state

13. Next Steps • HCC districts established; Goal is 9-15 total for the state (in progress) • Each district may have multiple sub-coalitions—preferably not geographically oriented but functionally oriented coalitions • Existing HCCs to align with one of the districts (not all HCCs will need to change) and adopt a governance structure • HCCs identify fiscal agents: • Fiscal agents may be: • HCC itself as a non-profit entity • A governmental agency • A non-profit agent (such as CHA, Colorado Rural Health Center, etc.) • When selecting a fiscal agent, HCCs should consider: • Cost of fiscal agent services • Agent’s policies for procurement, hiring, and spending • HCC’s Personnel costs to manage funds internally as a non-profit entity to ensure proper accounting, procurement, and tracking requirements • Provide Colorado Plan for implementation to ASPR

14. FIRST DRAFT of Proposed HCC Layout based upon existing HCCs, RETACs, and All Hazard Regions 7 1 5 12 8 9 2 10 3 13 6 11 4

15. OEPR Focus 2017 - 2022 Slogan: Prepared for when someday…is today VISION: Ensure Colorado’s communities are completely prepared to respond to and recover from, incidents adversely impacting health and our environment MISSION: Protect the health of Colorado’s people by collaborating with our community partners to provide preparedness support, skilled incident response, and expert recovery guidance whenever needed Priority Goals: Countermeasure Mitigation Information Management Recovery Management Training and Exercise HCC Establishment Response Support

16. OEPR Focus Roll-up to Domains and PHEP/HPP Capabilities Bio Surveillance Countermeasure & Mitigation Surge Management Information Management Incident Management Community Resilience Training and Exercise Recovery Management HCC Establishment Information Management Countermeasure Mitigation Response Support Community Recovery Fatality Management Community Preparedness Medical Countermeasure Dispensing Responder Safety and Health Information Sharing Community Preparedness Community Recovery Emergency Operations Coordination Emergency Operations Coordination Emergency Operations Coordination Volunteer Management Emergency Public Information and Warning Community Preparedness Medical Material Management and Distribution Community Preparedness EOC Activation Public Information Responder Health & Safety Foundations for Health Care & Medical Readiness Health Care & Medical Response & Recovery Coordination Medical Surge Health Care & Medical Response & Recovery Coordination Continuity of Health Care Service Delivery Health Care & Medical Response & Recovery Coordination Foundations for Health Care & Medical Readiness Health Care & Medical Response & Recovery Coordination

17. Solutions?

18. Agency updates Lisa

19. Agency Updates • Please mention brief updates you would like to share with the entire group • Include your name and agency name • High level reports applicable to various agencies • Updates requiring in depth discussions may transition into workgroups

20. Agency Updates • Epidemiology Update • Hospitals • Public/Environmental Health • EMS Provider • Emergency Management • Long Term Care • Mental/ Behavioral Health • Outpatient Medical Services (Example: community health center, clinic, dialysis, etc.) • Other HCC Partner (Example: education, private, federal entity, coroner, etc.).

21. Upcoming Trainings and Events Lisa and Janelle

22. Upcoming Events & Trainings • Networking Activity - Full Moon Snowshoe Event, February 11th • Idaho Springs area – Echo Lake or Bakerville to Loveland Trail (BLT) • 6pm food and drinks in Idaho Springs • Sign-in sheet – provide email and cell phone that we can contact on the weekend • Discuss need for PPE/Decontamination/HazMat trainings

23. MFHCC Website - 2017 Training and Exercise Opportunities in our Community • Throughout the year - Mental Health First Aid Trainings • Jan - June - Bridging The Gap Medical Interpreter Training by Asian Pacific Development Center • Feb 8&15 - ICS 100 & 700 In-Person Trainings, Clear Creek • March 1 & May 8 - Trauma Informed Care Workshops, Jefferson Center for Mental Health. July 25-26 - Public Information in an All-Hazards Incident • Sept. 19-20 - Pediatric Disaster Response and Emergency Preparedness

24. PHED EX • Public Health Emergency Dispensing Exercise (PHED EX) – June 2017 Workgroup divided into two groups: 1. Denver PHED EX Workgroup 2. Jefferson/Clear Creek/Gilpin PHED EX Workgroup Communications workgroup Will meet to review draft plan and eventually test it

25. Member agency spotlight – Colorado Coalition for the homeless Stan Eilert

26. Public Health Emergency Operations Plan (PHEOP) Review Janelle Worthington, JCPH

27. JCPH PHEOP • Board of Health Rule – PHEOP reviewed & updated at least every 3 years: • Submitted to CDPHE/OEPR • Submitted to local Board of Health • Copy made available to: OEM, Hospital(s), Rural Health Clinics, FQHC’s, RETAC’s • JCPH’s PHEOP Summary will be sent out with the meeting minutes • If you would like to review the full PHEOP or any of the Plan Annexes, please email Janelle at jworthin@jeffco.us • Please send feedback and questions to Janelle about either the PHEOP Summary or the full plan

28. JCPH PHEOP – Concept of Operations • Purpose:Describe the basic strategies and mechanisms by which JCPH will prepare, prevent, protect against, quickly respond to, and recover from all-hazard emergencies, particularly those whose scale, timing, or unpredictability threatens to overwhelm routine activities: • Infectious disease outbreaks, environmental public health hazards, natural disasters, and other threats that threaten the public’s health. • PHEOP is divided into two parts: • Concept of Operations, provides guidance based on the three operation phases: • Prepare, Prevent, Protect • Respond • Recover • Plan Annexes, consists of several support annexes that provide specific guidance for specific situations, such as mass care and public information communications.

29. JCPH PHEOP – Concept of Operations • Prepare, Prevent, Protect • Begins when a potential threat to public health has been identified • Hazard and Vulnerability Assessment (HVA): JCPH, JCSO EM, FHCC (2014) • Community Health Assessment (CHA) • On-going epidemiologic surveillance • Plans, vaccinations of public and JCPH staff • Caches - antibiotics, personal protective equipment (PPE) and communication equipment • Respond • 21 Steps: starting with incident identification, and ending with implementing the demobilization plan • Public Health Led Incident vs. Public Health Supported Incident • Recover • Identify recovery lead; conduct a community needs assessment (includes epidemiological surveillance); restore public health services; debrief and compile the After Action Report & Improvement Plan (AAR/IP); and mitigation

30. JCPH PHEOP – Roles & Responsibilities • Jefferson County Public Health • ESF#8b Lead • Advise the BCC and BoH • Conduct epidemiological surveillance and outbreak investigations • Etc. • Jefferson County Emergency Management • Emergency Operations Center (EOC) will provide resource support • Jefferson County Type III Incident Management Team (IMT) • May fill the Command and General Staff roles if the management of the incident exceeds the capacity of JCPH • Metro Foothills Healthcare Coalition Members • May utilize the members of the MFHCC for support of a public health incident • Participate in preparedness planning, represent their ESF in the County EOC, provide staff surge capacity for JCPH, and participate in information sharing

31. JCPH PHEOP – Plan Annexes Community Containment Annex Continuity of Operations Annex Epidemiological Investigation Annex Health Alert Network Annex Internal and External Emergency Contact Annex Internal Information and Communications Annex Mass Dispensing & Distribution Annex Medical Surge Annex Public Information and Communications Annex Training and Exercise Annex Volunteer Annex

32. Influenza Update Lisa Miller, MD, MSPH, CDPHE and Angel Anderson, JCPH

33. Influenza Update • CDPHE online influenza report: • https://www.colorado.gov/pacific/cdphe/influenza

34. Reported Outbreaks by Etiology in Jefferson County, CO in Healthcare and Residential Facility Settings, October 1, 2016 – February 3, 2017

35. Influenza outbreak in a long-term care facility Suspected influenza outbreak: Two cases of Influenza Like Illness (ILI) within a 1-week period without a positive test for influenza. During the time when influenza is circulating locally, the occurrence of acute febrile respiratory illness in several residents within a short time frame should be considered highly suspect for influenza until proven otherwise, regardless of whether the affected residents have been vaccinated. Confirmed influenza outbreak: at least one resident with a positive test for influenza among two or more residents with ILI. Please report all suspected and confirmed influenza outbreaks to your local health department. Outbreaks are reportable conditions in Colorado. https://www.colorado.gov/pacific/cdphe/flu-resources-health-professionals-and-schools Angel Anderson, MPH, REHS Regional Epidemiologist Jefferson County Public Health 800 Jefferson County Parkway, Golden, CO 80401 303.271.5742 office, 303.271.8390 fax aeanders@jeffco.us

36. Grant funding opportunities James Robinson, DHPD

37. Grant Funding Opportunities • We do not currently have a regional capability to treat multiple patients from MCI in a climate controlled environment • MCI in inclement weather present significant challenges • Hypothermia has demonstrated negative impacts on trauma survival and morbidity • Buses can serve as mobile treatment areas for MCI • We do not currently have a regional capability for transporting multiple supine patients • Unlikely that this would be an MCI transport resource from a scene • More likely a multiple patient transport resource for other contingencies • Evacuations- hospital, SNF, assisted living • Moving multiple patients to a climate controlled environment (i.e. apartment fire with AFN people, inclement weather MCI) • Regional plans to have EMS perform evacuations may conflict with incident management priorities • EMS capacity to perform evacuations may be limited by day-to-day capacity and the availability of resources at the time of need • This resource can be used as incident response support for fire and HazMat rehab

38. Grant Funding Opportunities • North Central All-Hazards Region/UASI Grant Applications is: • https://www.netciv.com/wp-content/ncrgrantsystem/public/index.html • State of Colorado Emergency Medical and Trauma Section grants is: • https://www.colorado.gov/pacific/cdphe/apply-ems-and-trauma-funds

39. Review New Action Items Lisa

40. Thank you!Networking