Indian Health Service Federal Emergency Preparedness and Response Activities

1. Indian Health Service Federal Emergency Preparedness and Response Activities David Sprenger, M.D. Chief Medical Officer IHS/ California Area Office Partnership and Collaboration Summit for Emergency Management

2. Overview • History of emergency management in IHS • IHS role in NRF as Federal agency • IHS emergency response capacity and activation • Unmet needs and need for local collaboration • Quarantine authority and cooperative agreements in Indian country

3. History • Most emergency management decentralized and discipline specific • Hospital/ clinic emergency preparedness as required by accrediting bodies (JCAHO, AAAHC) • First responders, many times tribal, even when health system Federal

4. CAO Initiatives • Because of lack of direction nationally, felt need for local preparedness efforts • Developed partnership with Indian Health Council, SDSU, SD county, UCSD, Naval Hospital, Balboa to form Native American Alliance for Emergency Preparedness

5. Collaborations • NAAEP initially focused on training, then added needs assessment, resource linking • Evolved into current multi-agency workgroup which included State DHS- Indian Health Program, OES, OHS, Office of Governor

6. National IHS Office of Emergency Services • Created after the hurricanes of 2004 • Office of Emergency Services include following Divisions: Emergency Management, EMS, Children’s EMS, Security Protective Services and Trauma Services

7. Emergency Management Division Assets • Emergency Operations Centers: Equipped with large flat screens, computers, communications • Personnel: 2.5 FTE managers • Equipment: Two caches of equipment • Each consisting of 4 trailers of emergency medical response basics • Tents, cots, gurneys, communications, field medical equipment and supplies, pharmaceuticals • Located in Nashville, TN and Illinois

8. IHS Emergency Response Responsibilities • IHS could be involved in: • ESF #3 Public Works and Engineering • ESF #5 Emergency Management • ESF #6 Mass Shelter, Housing and Human Service • ESF #10 Oil and Hazardous Materials Response • ESF #11 Agriculture and Natural Resources • ESF #14 Long Term Recovery and Mitigation • ESF #15 External Affairs

9. Main ESF function • Consistent with DHHS, in which IHS is a part, ESF #8 is the primary ESF responsibility

10. National IHS OES functions • Preparedness: • Wrote IHS Concept of Operations (CONOPS) • Coordinate Continuity of Operations exercise • Conduct training • Support tribal events

11. Delineates emergency response responsibilities and functions IHS CONOPS

12. National IHS OES functions • Response: • Needs assessment • Can request IHS resources including personnel, equipment and supplies • During Oct 07 wildfires requested and received small response team incl 1 logs, 1 admin, 4 HC providers and a few boxes of pharmaceuticals • Can request National Disaster Medical System (NDMS) and Commissioned Corps assets • Received partial DMAT team during wildfires

13. Activation of IHS Emergency Assets • According to National Response Framework, Tribal Relations Annex request for declaration of Federal disaster can only come through state Governor on tribes’ behalf • But, tribe can work with Federal agencies through existing channels

14. Tribal Disaster Response Options • Also according to NRF, tribes have option of working with Federal government directly, or working with local and state governments

15. Need for local collaboration • Because of: • Limited IHS emergency response resources • Time delay in deploying assets We continue to stress local collaboration as the best method to ensure preparedness and effective response

16. NIMS Compliance • All Federal agencies are mandated to be NIMS compliant, including IHS

18. Quarantine authority 2 Federal laws TITLE 25 - INDIANS CHAPTER 5 - PROTECTION OF INDIANS -HEAD- Sec. 198. Contagious and infectious diseases; quarantine STATUTE- Whenever the Secretary of the Interior shall find any Indian afflicted with tuberculosis, trachoma, or other contagious or infectious diseases, he may, if in his judgment the health of the afflicted Indian or that of other persons require it, isolate or quarantine such afflicted Indian in a hospital or other place for treatment. The Secretary of the Interior may employ such means as may be necessary in the isolation, or quarantine, of such Indian, and it shall be the duty of such Indian so afflicted to obey any order or regulation made by the Secretary of the Interior in carrying out this provision.

19. Quarantine authority (cont’d) 25 USC Sec. 231                                             01/02/2006 EXPCITE-    TITLE 25 - INDIANS    CHAPTER 6 - GOVERNMENT OF INDIAN COUNTRY AND RESERVATIONS    SUBCHAPTER I – GENERALLY -HEAD-    Sec. 231. Enforcement of State laws affecting health and education;      entry of State employees on Indian lands -STATUTE-      The Secretary of the Interior, under such rules and regulations  as he may prescribe, shall permit the agents and employees of any State to enter upon Indian tribal lands, reservations, or allotments therein (1) for the purpose of making inspection of health and educational conditions and enforcing sanitation and quarantine regulations • Under separate authority (42USC Sec. 2001 ) the Secretary of the Interior’s authority is delegated to the Secretary DHHS, who in turn, directs the Director of the IHS

20. Interpretation • IHS can permit State agencies to declare quarantine on Indian land • IHS can permit state to isolate non-Indians on Indian land (isolation authority over Indians on Indian land definite for IHS, uncertain for state)

21. Proposed quarantine regulation • CDC is seeking regulations to acquire quarantine authority on Indian land • Part of regulation would be to require consultation with IHS and Tribal leaders

22. Consultation(Always a good decision) • Consultation generally requires trust, which is developed by relationship characterized my respect and mutual understanding • This process frequently requires time and patience

23. Memoranda of understanding • Some models exist Lummi Nation Mutual Aid Agreement between the Lummi Nation and the Whatcom County Health Department Relating to Disease and Contamination Control Measures (can google) • Others in draft form

24. Emergency credentialing guidance • The Indian Health manual provides guidance for temporary, streamlined privileging in the event of disasters • F. Disaster Privileges.  During disaster(s) in which the emergency management plan has been activated, the CEO or Clinical Director has the option to grant disaster privileges when the medical staff is unable to handle the immediate patient needs.  The CEO or Clinical Director may grant disaster privileges upon presentation of any of the following: a current picture hospital ID card; a current license to practice and a valid picture ID issued by a State, Federal, or regulatory agency; identification indicating the individual is a member of a Disaster Medical Assistance Team; identification indicating that the individual has been granted authority to render patient care in disaster circumstances (such as authority having been granted by a Federal, State, or municipal entity); or presentation by current hospital or medical staff member(s) with personal knowledge regarding the practitioner's identity.  As soon as the immediate situation is under control, the medical staff begins the verification process of the credentials of individuals who receive disaster privileges Indian Health Manual 3-1.3. F

25. Summary • Limitations in existing Federal emergency response structure and capacity make collaboration at the county level essential