Santa Barbara County Disaster Healthcare Partners Disaster Training 2019

1. Santa Barbara County Disaster Healthcare Partners Disaster Training 2019 October 1st 2019 Santa Barbara

2. Santa Barbara County Public Health Department & Emergency Medical Services Agency Jan Koegler, MPH Program Manager Stacey Rosenberger, MPH Emergency Planner

3. “The last place I want to meet you for the first time is during a disaster.” Who’s your partner? Introductions

4. Training Objectives • Learn about potential vulnerabilities of our facilities and agencies to flooding and an extended power outage. • Review how partners and county and city emergency agencies work together in a disaster • Learn how to participate in the 2019 medical &health community based exercise • Identify ways to improve your response during flooding and a power outage • Draft your exercise plan objectives, scenario and schedule of events

5. Agenda

6. Exercise Training Schedule

7. Exercise Days: November 19th-21st

8. Scenario • Early morning on November 19 a winter storm causes flooding with road blockages in Santa Maria, Lompoc, and areas of southern Santa Barbara. • Freeway underpasses are flooded in some areas. • Rain continues through November 21st leaving roads and homes flooded for 3 days. • Santa Ynez River is close to overflowing its banks in Lompoc, and street flooding is reported around the Lompoc Skilled and Rehabilitation Facility and a large assisted living facility. • Ambulance access to Lompoc Hospital is delayed due to street flooding. • Santa Maria River is overtopping banks. Due to flooding, CHP has closed surface streets and Highway 101 bridge between North Broadway and Highway 166.

9. Scenario Cont. Road Closures: • Highway 101 at the county line between San Luis Obispo and Santa Maria • Hwy 1 between Lompoc and 101 closed due to rock falls • Hwy 154 closed below Painted Cave closed in both directions due to rock falls, flooded roads and extremely limited visibility Power Outages: • Power outages reported due to trees down on power lines • Large sections of cities are experiencing outages • SCE and PGE representatives are telling the public that power cannot be restored for at least 24 hours

10. Exercise Webpage http://www.countyofsb.org/phd/statewideexercise/2019.sbc

11. 2019 Disaster Exercise Participation Survey • Please complete the survey by October 31st • Let’s the PHD know what each facility/agency is planning on doing • Survey link: https://www.surveymonkey.com/r/2019DisasterExercise

12. CMS Emergency Preparedness Rule • Communications Plan • Complies with federal & state laws • Coordinate patients are within facility, across providers, and with state, local public health and emergency management • Annual update • Emergency Plan • Based on a risk assessment • Use an all-hazard approach to risk assessment • Update plan annually • Policies & Procedures • Develop based on risk assessment & emergency plan • Must address: subsistence of staff/patients, evacuation, shelter in place and tracking of patients • Review/update annually • Training & Exercise Program • Initial & annual training on policies & procedures • Conduct drills and exercises • Tabletop annually • Annual Full scale community based exercise

13. CMS Annual Exercise Requirements • Conduct one FULL SCALE EXERCISE annually • Must participate in a community based exercise if offered • The PHD annual medical and health exercise in November is a community based exercise • SNF/ICF’s have option to do PHD/ EMS Agency annual evacuation exercise as full scale • Conduct one additional exercise • Can be a tabletop exercise

14. Disaster Exercise Process

15. Need more information on exercise development? • http://www.countyofsb.org/phd/statewideexercise/2019-trainings.sbc

16. 2019 Flooding & Power Outage Exercise

17. Threats Flooding Electrical Outage Fire burning under transmission lines Fire – shut off for safety of responders Earthquake Public Safety Power Shut Down “PSPS” • Winter storms/ prolonged heavy rains • Dam break • Tsunami

18. How do you know if your facility or agency is at risk of flooding? • Past flooding experiences • Check flood maps: • http://myhazards.caloes.ca.gov/ - Select Flooding tab and put in address • https://msc.fema.gov/portal/search#searchresultsanchor

19. Carpinteria

20. Santa Barbara

21. Santa Barbara

22. Goleta

23. Buelton & Solvang

24. Santa Ynez

25. Flooding can cause….. • Staffing issues • Blocked roads due to standing water or trees/debris in the road • Damage to your building and/or campus

26. Ways to Exercise Flooding • Plan for housing staff on site • Evacuation • Alternate site to conduct operations • Continuity of Business • Identify staff that could be impacted by road closures • If access to your building is blocked, identify areas for ambulances and staff to park

27. Extended Power Outage

28. PGE Grid

29. SCE Grid

30. Key Health Challenges in Power Outage • Home medical equipment- including oxygen concentrators • Dialysis • Air conditioning • Health conditions exacerbated by heat • Food spoilage • Pharmaceuticals & Vaccines • Blood bank • Gasoline for home health and other workers

31. Public Safety Power Shutoff (PSPS)

32. Impacted Areas • PG & E in North County • SCE in South County

33. Notification from power companies When possible electrical companies will provide up to 48 hours of advance notice

34. Encourage clients/patients to…. • Update contact information with local power company • PG&E: www.pge.com/mywildfirealerts • SCE: www.sce.com/safety/wildfire/psps • Register for county alerts- www.readysbc.org • Sign-up as a medical baseline customer • Plan for where they will go, and who will assist them, in an extended outage

36. SCE Medical Baseline Program • QUALIFYING MEDICAL DEVICES • Aerosol Tent • Air Mattress/Hospital Bed • Apnea Monitor • Breather Machine (IPPB) • Compressor / Concentrator • Dialysis Machine • Electronic Nerve Stimulator • Electrostatic Nebulizer • Hemodialysis Machine • Infusion Pump • Inhalation Pulmonary Pressure • Iron Lung • Left Ventricular Assist Device (LVAD) • Motorized Wheelchair/Scooter • Oxygen Generator • Pressure Pad • Pressure Pump • Pulse Oximeter/Monitor • Respirator (all types) • Suction Machine • The Vest/Airway Clearance System • Total Artificial Heart (TAH-t) • Ultrasonic Nebulizer https://www.sce.com/residential/assistance/medical-baseline

37. How can we assist electricity dependent individuals? • Identify those individuals and facilities most at risk • Make sure individuals have a plan • Extra oxygen tank • Someone to check on them and transport if necessary • Plan for a destination with power • During large outages shelters for electrical dependent individuals • Note: If power outage is widespread few shelter sites have generators • Be aware that dispatch may be overwhelmed with calls • Activate EOC call centers, contact clients and facilities to determine status

38. Outreach Campaign to Prepare Individuals Dependent on Electricity • Request that agencies distribute this resource and encourage or assist individuals to fill it out http://www.countyofsb.org/phd/epp/poweroutages/

39. Additional Resources • https://prepareforpowerdown.com/ • http://prepareforpowerdown.com/wp-content/uploads/2019/06/Emergency-Power-Planning-Factsheet_revised-5.2018.pdf • www.readysbc.org • https://www.pge.com/en_US/safety/emergency-preparedness/natural-disaster/wildfires/public-safety-power-shutoff-faq.page • https://www.sce.com/safety/wildfire/psps • https://www.cpuc.ca.gov/deenergization/

40. Does my facility have priority for restoration? • Electricity providers are aware of buildings that are essential service providers • This may expedite restoration, but it may not • Depends on the area damaged and where you are located • The health department will advocate for early restoration of essential service providers • In a PSPS all facilities are at risk!

41. Will Phone and Internet Work in Power Outage? • As long as the fiber optic cables and other infrastructure is good, then internet should function. • HoweverWIFI modems and routers will not have power • Determine if your facility or agency phones work in a power outage • VOIP phones will not work without power

42. What are the threats to cell service from Power Outages? • Individuals cannot call 911 from cell phone if battery dies • Cell and internet availability is based on the battery backup or generator capability of each cell tower and internet data center feeding our area • Most towers have battery backup that should last a few hours • Others (longer range primary towers) have generators and can run indefinitely as long as they can be refueled

43. Tips to Keep your Phone Running During a Power Outage During a power outage: • Turn off phone’s location services, Wi-Fi, NFC, Bluetooth and any background apps to preserve battery power • Dim the screen to the lowest point that you can comfortably read it • Avoid using the phone unless necessary • If your phone supports “low power mode,” enable that feature as soon as the power goes out: • iPhone — go to Settings, scroll down to Battery and select Lower Power Mode. That will reduce power consumption by disabling Siri, background apps, mail fetching and other power hungry activities • Samsung Galaxy phones –Go to Settings and then Device and then Battery and select “ultra power saving mode” • Other phones — Use a search engine to search for “power saving mode” + the name of your phone to see if it is available • If you have access to a car, charge phone in car’s power plug • If the power comes back on, plug your phone back in. Power may not stay on.

44. Power Restoration and Surges Avoid damage to electronics due to voltage surges during power restoration When power goes out: • Unplug appliances with electronic components • Computers, refrigerators, microwaves, TV’s • Plug back in, waiting a few minutes, after power is restored • Good surge protector (Hi joules, low VPR) is an alternative

45. How will staff get gasoline? • Limited gas stations with generators in Santa Barbara County • Encourage staff to keep tanks at least half full if possible

46. County Emergency Operations Center In widespread and prolonged events: • Prioritize gasoline distribution for essential services • Bring in gasoline trucks for essential workers and essential generators

47. Ways to Exercise Power Outage Procedures and Training Exercise Activities Follow your procedure Put building on generator Print out records on battery power Activate downtime procedures Access/use paper charts Use vaccine and medication maintenance procedure Access patient schedules Provide meals without power • Do you have a power outage procedure? • Patient paper record procedure • Vaccine storage procedure • Are your staff trained in the power outage procedure? • Do you have exam room lanterns/batteries? • Generator/Fuel? • What is powered by generator?

48. Communication during Disasters • What communications systems might work? • Landlines/Fax line • Satellite Phones • Radios and walkie talkies • Texting/cell phones • What might not work? • Cell phones (initially overloaded-no battery) • Email/Internet: tied to electricity /routers and cables • Facility phones if VOIP or the system requires power

49. If Communication are Systems Out: • Do you have a disaster communication plan/procedure? • Are your staff trained? • How will your facility/agency report that you need assistance? • How will the City/County/PHD determine your status?

50. Disaster Communication Plan Template