Virginia Department of Health

1. Virginia Department of Health • Emergency Support Function(ESF)-8 Public Health and Medical Services • Overview • Dr. S. Hughes Melton • Jeffery Walker • Andrew Slater

2. Virginia ESF-8 Overview • The ESF-8 Health and Medical Group’s mission is to coordinate the provision of critical services to protect the health of citizens and to provide medical, mental health and fatality management services as needed in disasters and large-scale emergencies. • ESF-8 provides assistance in identifying and meeting the public health and medical needs of those adversely affected by an emergency. 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 • Medical equipment and supplies • Emergency Medical Services • Environmental health monitoring and response • Mortality management • Support to Mass Care and Public Works emergency support functions

3. Local and Regional Public Health

4. Healthcare Coalitions and Regional Healthcare Coordinating Center

5. Commissioner’s Code Authority • §§ 32.1-42 / 32.1-13. authority to promulgate orders to meet any emergency. • §§ 32.1-48.01- 48.04 Isolation/Quarantine authority. • §§ 32.1-42.1 / 54.1-3408. authorizes persons not ordinarily authorized to do so to administer and dispense medications. • §§ 54.1-2506.1 / 54.1-2910.1 18VAC76-40-20. address the provision of emergency contact information by health care providers. • §§ 32.1-46.01 / 32.1-47 / 32.1-48. Immunization authority • § 32.1-283. Chief Medical Examiner authority to declare cause of death

6. Virginia Department of Health Functions • Office of Emergency Preparedness • Epidemiology • Surveillance and Investigation/Consultation • Risk Communications and Education • Emergency Medical Services • Radiological Health • Drinking Water • Environmental Health Services • Chief Medical Examiner • Family Health Services • Immunization • Health Equity • Pharmacy Services • Tuberculosis And Newcomer Health

7. VDH Service Areas • Scholarships • Financial Assistance for Non Profit EMS organizations and Localities • State Office of EMS • Anatomical Services • Medical Examiner Services • Health Statistics • Vital Records • Immunization Program • Tuberculosis Prevention and Control • Sexually Transmitted Disease Prevention and Control • Disease Investigation and Control Services • HIV/AIDS Prevention and Treatment Services • Pharmacy Services • Health Research, Planning and Coordination • Regulation of Health Care Facilities • Certificate of Public Need • Child and Adolescent Health Services • Women's and Infant's Health Services • Chronic Disease Prevention, Health Promotion, and Oral Heath • Injury and Violence Prevention • Women, Infants, and Children (WIC) and Community Nutrition Services • Local Dental Services • Restaurant and Food Safety, Well and Septic Permitting and Other Environmental Health Services • Local Family Planning Services • Support for Local Management, Business, and Facilities • Local Maternal and Child Health Services • Local Immunization Services • Local Communicable Disease Investigation, Treatment, and Control • Local Personal Care Services • Local Chronic Disease and Prevention Control • Local Nutrition Services • Payments to Human Services Organizations • Administrative and Support Services • Drinking Water Regulation • Drinking Water Construction Financing • Public Health Toxicology • State Office of Environmental Health Services • Shellfish Sanitation • Bedding and Upholstery Inspection • Radiological Health and Safety Regulation • Emergency Preparedness and Response

8. Office of Emergency PreparednessProgram Structure and Funding Public Health Emergency Preparedness Program (PHEP): Center for Disease Control and Prevention (CDC) Funds awarded through the United States Department of Health and Human Services through two cooperative agreements: Hospital Preparedness Program (HPP): Office of HHS Assistance Secretary for Preparedness and Response (ASPR)

9. HPP & PHEP Structure

10. Public Health & Healthcare Preparedness Funding Trend

11. Current Supplemental Funding • Hospital Preparedness Program (HPP) Ebola Funding • Public Health Emergency Preparedness Program (PHEP) Ebola Funding • PHEP Supplemental Zika Funding

12. Public Health Emergency Preparedness (PHEP) Capabilities • 1. Community Preparedness • 2. Community Recovery • 3. Emergency Operations Coordination • 4. Emergency Public Information / Warning • 5. Fatality Management • 6. Information Sharing • 7. Mass Care • 8. Medical Countermeasure Dispensing • 9. Medical Materiel Management / Distribution • 10. Medical Surge • 11. Non-Pharmaceutical Interventions • 12. Public Health Laboratory Testing • 13. Public Health Surveillance and Epidemiologic Investigation • 14. Responder Safety and Health • 15. Volunteer Management

13. Hospital Preparedness (HPP) Capabilities • Foundation for Healthcare and Medical Readiness • Healthcare and Medical Response Coordination • Continuity of Health Care Service Delivery • Medical Surge

14. ESF-8 Support Agencies • Secretary, Agriculture and Forestry • Department of Agriculture and Consumer Services • Secretary, Natural Resources • Department of Environmental Quality • Secretary, Administration • Department of General Services • Division of Consolidated Laboratory Services • Secretary, Public Safety and Homeland Security • Department of Emergency Management • Virginia State Police • Virginia National Guard • Secretary, Veterans’ and Defense Affairs • Secretary, Health and Human Resources • Department of Behavioral Health & Developmental Services • Department of Social Services • Virginia Hospital and Healthcare Association • VACO / VML • City, Town and County Governments

15. VDH Response To Addiction Epidemic • Completed • Primary: Declaration of a Public Health Emergency • Secondary: Addiction Disease Management Sessions • Tertiary: Naloxone Standing Order • In Progress • Establishment of VDH Incident Management Team • Develop Response Concept of Operations • Cross Agency Coordination • Surveillance of adverse health impacts of opioid addiction: Death, Injury due to Overdose, Hepatitis B and C infections, HIV • Identification of regional champions • Approved legislation establishing Syringe Services Programs as part of comprehensive harm reduction • Board of Medicine approved new emergency regulations that will give it authority to specifically regulate the prescribing of opioids for pain

16. Incident Commander Dr. Marissa Levine VDH Addiction IMT PIO Maribeth Brewster Liaison Officer Joe Hilbert Liaison – External Partners VSP, VDEM, DBHDS, VDSS Administration/Logistics/Finance Chief Richard Corrigan Planning Chief Bob Mauskapf Operations Chief Dr. Hughes Melton Data and Intelligence Branch Dr. Laurie Forlano Disease/ED Data Exercise Branch Suzi Silverstein CHS Branch Bob Hicks Finance Beth Franklin HR Rebecca Bynum Procurement/ General Services Steve VonCanon EMS/Naloxone Data OEMS Access/Functional Needs Planning Of of Health Equity (Dr. Adrienne McFadden) 35 Local Health District Directors IT Debbie Condrey Death Data OCME National Abstinence/ PMP Data OFHS Primary Prevention Branch Lead: OFHS (Dr. Vanessa Walker Harris) Secondary Prevention Branch Lead: EMS (Gary Brown) Tertiary Prevention Branch Lead: OEPI (TBD) Regional Response Branch Lead: CHS/OEP Hospital/Medical Community Kelly Parker DDP (Diana Jordan, RN) Training Lisa Wooten Education Carole Pratt

18. Virginia's Public Health Emergency Preparedness Regional and Local Discussion Jeffery Walker

19. How VDH Works • VDH Has worked in a regional construct since 2003 with Regional teams, similar to Regional VDEM current structure • We also work in a “Health District” format • Unlike local OEM because it may not represent a one to one county/political jurisdiction

20. VDH Regions/Districts

22. Potential Public Health Impacts from Disasters • Public Concern for Safety • Increased Pests & Vector • Damage to Healthcare Systems • Worsening of Chronic Illnesses • Toxic / Hazardous Exposure • Loss of Food/Med Supply(supply chain mgt) • Behavioral Health Impact • Death • Injuries • Loss of Clean Water • Loss of Shelter • Loss of Personal Property • Major Population Movements • Loss of Sanitation • Loss of Routine Hygiene • Loss of Electricity • Standing Surface Water • Disruption of Solid Waste Management

23. VDH Planning Initiatives • Situational Awareness (VHASS) • Continuity Plans (COOP) • Medical Countermeasure Distribution • CHEMPACK • Strategic National Stockpile (SNS) / Cities Readiness Initiative (CRI) • State and Local Operational Readiness Reviews (ORRs) • Annual Mass Vaccination Clinics (flu) • Surge Planning • Statewide Exercises • Bio-Watch, Guardian, +++ • USPS Bio Hazard Detection System (BDS) • Suspicious Substance Protocol • VDH Emergency Coordination Center (ECC) / ESF-8) • Medical Reserve Corps (MRCs) • All Needs Populations Planning • Shelters • Opioid • NACCHO Project Public Health Ready (PPHR)

24. Strategic National Stockpile (SNS) • “…maintain a national repository of life-saving pharmaceuticals and medical materiel that will be delivered to the site of a disaster in order to reduce morbidity and mortality...” • CHEMPACK: • “Forward placement of nerve agent antidotes, providing state and local governments a sustainable resource that increases their capability to respond quickly to a nerve agent event.”

25. Project Public Health Ready (PPHR) Project Public Health Ready (PPHR) is a collaborative program between the National Association of County and City Health Officials (NACCHO) and the Centers for Disease Control and Prevention (CDC). Vision Local health departments (LHDs) will be fully integrated into the response community and prepared to respond to any emergency. Mission To protect the public’s health and increase the public health infrastructure by building local health department preparedness capacity and capability. With assistance from state health departments, LHDs will use sustainable tools to plan, train, and exercise using a continuous quality improvement model.

26. PPHR Criteria • The PPHR Criteria are nationally-recognized standards for local public health preparedness. The Criteria are divided into three goals: all-hazards preparedness planning, workforce capacity development, and demonstration of readiness through exercises and real-events. The Criteria are updated annually to incorporate the most recent federal preparedness initiatives, including CDC Public Health Emergency Preparedness (PHEP) Capabilities and the ASPR Hospital Preparedness Program (HPP) metrics

27. Goal I: All-Hazards Response Plan • Local health departments must provide their all-hazards response plan as evidence for this goal. The plan must meet a number of standards, including describing the specific roles and responsibilities department or regional staff will have in a response. Sub-measures for this goal include Communications, Epidemiology, Mass Prophylaxis and Immunization, and Environmental Health.

28. Goal II: Workforce Capacity Development • Local Health Departments or regions must provide evidence of a training needs assessment and training plan based on this assessment. This training plan shall reflect the workforce capacity building goals within the department.

29. Goal III: Exercise/Real-Event • Local health departments or regions must provide evidence of an exercise they have conducted or a response to a real event they have participated in. This evidence is provided through either an after action report or an incident action plan.

31. PPHR • PPHR is a year + long application submission and national review process beginning in October (2017) and notification of successful recognition occurring January (2019). • Every single Health District in Virginia has received PPHR recognition and undergoes a re-recognition application process on a 5 year basis.

32. Conclusion • We have covered briefly how we (VDH) operate and are constructed at the regional and local level • We have covered some of our potential impacts to Public Health • We have covered some of our planning initiatives • And we have covered one way we use to assess our preparedness progress and ensure a baseline level across the Commonwealth to an established and recognized set of national criteria • Next, Andrew will come up and give you a more in depth look at the Healthcare Coalitions that we coordinate with. • Thank you for the opportunity to come here today and speak with you all • We have a common mission and skillset and it’s an honor to be able to work with so many talented and passionate emergency management professionals

34. Virginia’s Healthcare Coalitions & RHCCs Partners in preparednessAndrew Slater

35. Healthcare Coalitions Six Regional Coalitions

36. About the Coalition…. • Central Virginia Healthcare Coalition • Healthcare Emergency Management Alliance • 17 Acute Care Hospitals • 4 Free-standing Emergency Departments • Long Term Care Facilities • Fire/EMS/Emergency Management Stakeholders • Exists to organize a regional healthcare preparedness program • Response • Recovery

37. Central Region

38. Other Regional Coalitions

39. RHCC Model Overview • All six healthcare coalitions operate a primary & backup Regional Healthcare Coordination Center (RHCC) • Written into the COV EOP • Statewide Hospital Emergency Operations Plan • Statewide Health & Medical Surge Plan (Annex J) • Multi-agency coordination center. • Centralized POC for emergency coordination of healthcare facility assets in the region. • Responsible for activation of the Regional Hospital Emergency Operations Plan. • Hospital ICS is used for congruency with external partners.

40. RHCC Model Overview, cont. • RHCC facilitates emergency response, communication, and resource allocation for coalition members. • RHCC accomplishes this as the primary regional contact among: • Regional healthcare facilities (Hospitals and Long Term Care) • Other five RHCCs • State EOC through the ESF 8 (Public Health) annex. • Provide coalition stakeholders with: • Healthcare Intelligence • Incident coordination • Disaster resource management

41. What Responsibilities • Providing a single point of contact between Hospitals and the VDH Emergency Communications Center (ECC) & State. • Collection and dissemination of ongoing situational awareness updates and warnings, including the management of the current bed availability in Hospitals. • Establishing and managing the communication systems for the duration of the incident. • Serve as the single point of contact and collaboration point for Virginia Fire/EMS agencies for the purposes of hospital MCI management and movement of patients from an incident scene to receiving hospitals. • Secondary resource management to hospitals for fuel, food, and water. • Collection and dissemination of initial event notification to hospitals and public safety partners. • Establishing and managing the internet-based Virginia Healthcare Alerting and Status System (VHASS) for duration of incident. • Serve as the single point of contact and collaboration point for Virginia Fire/EMS agencies for the purposes of hospital MCI management and movement of patients from an incident scene to receiving hospitals. • Coordinating inter-hospital patient movement, transfers and tracking

42. Primary Central Virginia RHCC

43. RHCC Communications Capabilities • Telephone • IP based phone system • Hard Line • Satellite Phone • Cell Phone • Internet • Broadband • HotSpot • Satellite Internet • Virginia Hospital Alerting & Status System (VHASS) • WebEOC • Text Message Alerting System • Phone/Video Conferencing • PolyComm • WebEx • Radio • STARS Radio • Amateur Radio • Statewide Interoperability • CRISiS Radio • 3 site VHF & UHF repeater system • HEAR Radio • Hospital VHF System • COMLINC/RIOS • CVHC Primary & Backup Gateways

44. Alerting Mechanisms

45. Disaster Resource Mgmt. • Stabilization Treatment In Place (STIP) Tent Systems • Stockpiles • Regional/CVHC • Statewide • Infrastructure Resiliency Projects • Emergency Generators / Facility Quick Connects • Emergency Water Supply/Wells • Emergency Chillers / Facility Quick Connects (future) • Mutual Aid Program / Resource Mgmt. Tool • Clinical Supplies • Staff • Pharmaceuticals

46. What does the RHCC mean for Hospitals? • Emerging Incident Notifications • Intelligence/Information Sharing for better decision-making • Hospital Mutual Aid • Emergency Clinical Resources – Stockpile • Evacuation Coordination / No-Notice Emergency Patient Transfers • Assistance with local EOC requests • NDMS Coordination • Patient Tracking

47. Virginia’s Patient Tracking Program • Partnership between the regional coalitions & 2-1-1 Virginia. • During Mass Casualty Incidents, hospitals enter basic patient information into VHASS. • RHCC is responsible for requesting activation of the 2-1-1 Patient Locator Service. • Family members can call 2-1-1, and a trained operator searches the VHASS database for a patient “match”. • If a match is found, the caller is provided the hospital’s phone #.

48. Virginia’s Patient Tracking Program

49. Case Studies from Central Virginia Hospital Generator Failure • 6/16/2016 – Severe Thunderstorms in the late evening cause widespread power outages. • Catastrophic damage to electrical grid in Richmond area. • 7 hospitals are among >250,000 Dominion customers without commercial power. • 8AM on 6/17/2016… • Power not expected to be restored for another 10 hours. • Failure of backup generator is impacting care for high acuity patients in ICU (on ventilators) and ED. • Summertime, no HVAC in the facility. • Locality and other hospitals have limited ability to support an evacuation

50. Non-MCI Surge Event • Historic winter storm impacted Mid-Atlantic region on January 22-23, 2016. • Record snowfall, blizzard (or near-blizzard) conditions over much of the Commonwealth. • Throughput and staffing challenges at many central region hospitals due to weather and road conditions. • Extended storm: 2 full days • Friday & Saturday; • Storm made many roads impassable. • LogistiCare & other community transport services suspended operations starting Friday. • Most community dialysis clinics closed. • The few open clinics had alarming number of missed appointments. • Discharge difficulties at hospitals due to storm. • Sunday • Record-setting Emergency Medical Services (EMS) call volume. • “Breathing Problem”, “Chest Pain” and “Sick Person” were most common 911 call types. • RHCC notifies hospitals of regional surge event; continual monitoring of facility bed capacity & ED surge indicators in VHASS. • Emergency departments across metro-Richmond become saturated with patients