As before it is important to understand the legal basis for the work that is being done.  How does a local health district know that a highly communicable disease is in the community.  The occurrence of the disease is usually observed when someone presents themselves to a medical practitioner.  The practitioner along with the lab services that are used are under certain obligations to report specific diseases within a given time frame.  Below are Idaho’s Reportable Disease Statutes.  Every state has such a list that is ultimately tied to the Centers for Disease Prevention.  Data is collected at the local level and then set up to the State level and from there to the Federal level.   This law is key to keeping your community healthy.

16.02.10– IDAHO REPORTABLE DISEASES 00.                LEGAL AUTHORITY.

Sections 39-605, 39-1003, 39-1603, and 56-1005, Idaho Code, grant authority to the Board of Health and Welfare to adopt rules protecting the health of the people of Idaho. Section 39-906, Idaho Code, provides for the Director to administer rules adopted by the Board of Health and Welfare. Section 39-4505(2), Idaho Code, gives the Director authority to promulgate rules regarding the identification of blood- or body fluid-transmitted viruses or diseases. Section 56-1003, Idaho Code, gives the Director the authority to adopt rules protecting the health of the people of Idaho and to recommend rules to the Board of Health and Welfare. Section 54-1119, Idaho Code, authorizes the Director to promulgate rules regarding the handling of dead human bodies as needed to preserve and protect the public health.                                                                                                                           (3-17-22)

01.                TITLE AND SCOPE.01.                Title. These rules are titled IDAPA 16.02.10, “Idaho Reportable Diseases.”                          (3-17-22)

02.                Scope. These rules contain the official requirements governing the reporting, control, and prevention of reportable diseases and conditions and requirements to prevent transmission of health hazards from dead human bodies. The purpose of these rules is to identify, control, and prevent the transmission of reportable diseases and conditions within Idaho.                                (3-17-22)

02.                DOCUMENTS INCORPORATED BY REFERENCE.The documents referenced in Subsections 004.01 through 004.07 of this rule are used as a means of further clarifying these rules. These documents are incorporated by reference and are available at the Idaho State Law Library or at the Department’s main office.                                                                                                                                                                                   (3-17-22)

01.                Guideline for Isolation Precautions in Hospitals. Siegel, J.D., et al., “Guideline for Isolation Precautions in Hospitals.” Health Care Infection Control Practices Advisory Committee, Atlanta, GA: Centers for Disease Control and Prevention, 2007. (3-17-22)

02.                National Notifiable Diseases Surveillance System – Case Definitions. http://wwwn.cdc.gov/ nndss/script/casedefDefault.aspx.                                                                                                                                    (3-17-22)

03.                Human Rabies Prevention — United States, 2008. Morbidity and Mortality Weekly Report, May 23, 2008, Vol. 57.RR-3. Centers for Disease Control and Prevention.                                                                                       (3-17-22)

04.                Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to Human Immunodeficiency Virus and Recommendations for Postexposure Prophylaxis. Infection Control and Hospital Epidemiology, September 2013, Vol. 34, 9. The Society for Healthcare Epidemiology of America. These guidelines are found online at http://www.jstor.org/stable/10.1086672271.                                                                            (3-17-22)

05.                Compendium of Animal Rabies Prevention and Control, 2016. National Association of State Public Health Veterinarians, Inc., Journal of American Veterinary Medical Association Vol. 248(5), March 1, 2016. This document is found online at http://nasphv.orgdocumentsCompendia.html.                                                                         (3-17-22)

06.                Standards for Cancer Registries, Volume II, Data Standards and Data Dictionary. North American Association of Central Cancer Registries, Eighteenth Edition, Record Layout Version 14, September 2013.          (3-17-22)

07.                Use of Reduced (4-Dose) Vaccine Schedule for Postexposure Prophylaxis to Prevent Human Rabies: Recommendations of the Advisory Committee on Immunization Practices, 2010. Morbidity and Mortality Weekly Report, Recommendations and Reports, March 19, 2010/59(RR02);1-9. This document is found online at https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5902a1.htm.                                                                                  (3-17-22)

03.                DISCLOSURE OF INFORMATION.No employee of the Department or Health District may disclose the identity of persons named in disease reports except to the extent necessary for the purpose of administering the public health laws of this state.                                                                                                                                                    (3-17-22)

04.     — 009.           (RESERVED)10.                DEFINITIONS A THROUGH K.

For the purposes of this chapter, the following definitions apply.                                                                             (3-17-22)

01.                Airborne Precautions. Methods used to prevent airborne transmission of infectious agents, asdescribed in “Guideline for Isolation Precautions in Hospitals,” incorporated in Section 004 of these rules.                      (3-17-22)

02.                Approved Fecal Specimens. Specimens of feces obtained from the designated person who has not taken any antibiotic orally or parenterally for two (2) days prior to the collection of the fecal specimen. The specimen must be collected and transported to the laboratory in a manner appropriate for the test to be performed.  (3-17-22)

03.                Bite or Other Exposure to Rabies. Bite or bitten means that the skin of the per son or animal has been nipped or gripped, or has been wounded or pierced, including scratches, and includes probable contact of saliva with a break or abrasion of the skin. The term “exposure” also includes contact of saliva with any mucous membrane. In the case of bats, even in the absence of an apparent bite, scratch, or mucous membrane contact, exposure may have occurred, as described in “Human Rabies Prevention — United States,” incorporated in Section 004 of these rules.                                                                                                                                                                                 (3-17-22)

04.                Board. The Idaho State Board of Health and Welfare as described in Section 56-1005, Idaho Code. (3-17-22)

05.                Cancer Data Registry of Idaho (CDRI). The agency performing cancer registry services under a contractual agreement with the Department as described in Section 57-1703, Idaho Code.                                                   (3-17-22)

 

06.                Cancers. Cancers that are designated reportable include the following as described in Section 57- 1703, Idaho Code:                                                                                                                                                                             (3-17-22)

 

a.                   In-situ or malignant neoplasms, but excluding basal cell and squamous cell carcinoma of the skin unless occurring on a mucous membrane and excluding in-situ neoplasms of the cervix.                             (3-17-22)

b.                   Benign tumors of the brain, meninges, pineal gland, or pituitary gland.                                  (3-17-22)

07.                Carrier. A carrier is a person who can transmit a communicable disease to another person, but may not have symptoms of the disease.                                                                                                                                            (3-17-22)

08.                Case.                                                                                                                                                                 (3-17-22)

 

a.                   A person, who has been diagnosed as having a specific disease or condition by a physician or other health care provider, is considered a case. The diagnosis may be based on clinical judgment, on laboratory evidence, or on both criteria. Individual case definitions are described in “National Notifiable Diseases Surveillance System Case Definitions,” incorporated in Section 004 of these rules.                                                              (3-17-22)

b.                   A laboratory detection of a disease or condition as listed in Section 050 of these rules and as further outlined in Sections 100 through 949 of these rules.                                                                                   (3-17-22)

 

09.                Cohort System. A communicable disease control mechanism in which cases having the same disease are temporarily segregated to continue to allow supervision and structured attendance in a daycare or health care facility.                                                                                                                                                                                                   (3-17-22)

10.                Communicable Disease. A disease that may be transmitted from one (1) person or an animal to another person either by direct contact or through an intermediate host, vector, inanimate object, or other means that may result in infection, illness, disability, or death.                                                                                                                    (3-17-22)

11.                Contact. A contact is a person who has been exposed to a case or a carrier of a communicable disease while the disease was communicable, or a person by whom a case or carrier of a communicable disease could have been exposed to the disease.                                                                                                                                          (3-17-22)

12.                Contact Precautions. Methods used to prevent contact transmission of infectious agents, as described in the “Guideline for Isolation Precautions in Hospitals,” incorporated in Section 004 of these rules.                      (3-17-22)

13.                Daycare. Care and supervision provided for compensation during part of a twenty-four (24) hour day, for a child or children not related by blood or marriage to the person or persons providing the care, in a place other than the child’s or children’s own home or homes as described by Section 39-1102, Idaho Code.                                   (3-17-22)

14.                Department. The Idaho Department of Health and Welfare or its designee.                                   (3-17-22)

15.                Director. The Director of the Idaho Department of Health and Welfare or their designee as described under Sections 56-1003 and 39-414(2), Idaho Code, and Section 950 of these rules.                                                  (3-17-22)

16.                Division of Public Health Administrator. A person appointed by the Director to oversee the administration of the Division of Public Health, Idaho Department of Health and Welfare, or their designee.                    (3-17-22)

17.                Droplet Precautions. Methods used to prevent droplet transmission of infectious agents, as described in the “Guideline for Isolation Precautions in Hospitals,” incorporated in Section 004 of these rules.                     (3-17-22)

18.                Exclusion. An exclusion for a food service facility means a person is prevented from working as a food employee or entering a food establishment except for those areas open to the general public as outlined in the IDAPA 16.02.19, “Idaho Food Code.”                                                                                                                                             (3-17-22)

19.                Extraordinary Occurrence of Illness Including Clusters. Rare diseases and unusual outbreaks of illness that may be a risk to the public are considered an extraordinary occurrence of illness. Illnesses related to drugs, foods, contaminated medical devices, contaminated medical products, illnesses related to environmental contamination by infectious or toxic agents, unusual syndromes, or illnesses associated with occupational exposure to physical or chemical agents may be included in this definition.                                                                                                                  (3-17-22)

20.                Fecal Incontinence. A condition in which temporarily, as with severe diarrhea, or long-term, as with a child or adult requiring diapers, there is an inability to hold feces in the rectum, resulting in involuntary voiding of stool.                                                                                                                                                                                       (3-17-22)

21.                Foodborne Disease Outbreak. An outbreak is when two (2) or more persons experience a similar illness after ingesting a common food.                                                                                                                                         (3-17-22)

22.                Food Employee. An individual working with unpackaged food, food equipment or utensils, or food-contact surfaces as defined in IDAPA 16.02.19, “Idaho Food Code.”                                                                              (3-17-22)

23.                Health Care Facility. An establishment organized and operated to provide health care to three (3) or more individuals who are not members of the immediate family. This definition includes hospitals, intermediate care facilities, residential care and assisted living facilities                                                                                                   (3-17-22)

24.                Health Care Provider. A person who has direct or supervisory responsibility for the delivery of health care or medical services. This includes: licensed physicians, nurse practitioners, physician assistants, nurses, dentists, chiropractors, and administrators, superintendents, and managers of clinics, hospitals, and licensed laboratories.                                                                                                                                                                                          (3-17-22)

25.                Health District. Any one (1) of the seven (7) public health districts as established by Section 39- 409, Idaho Code, and described in Section 030 of these rules.                                                                                             (3-17-22)

26.                Health District Director. Any one (1) of the public health districts’ directors appointed by the Health District’s Board as described in Section 39-413, Idaho Code, or their designee.                                                       (3-17-22)

27.                Idaho Food Code. Idaho Administrative Code that governs food safety, IDAPA 16.02.19, “Idaho Food Code.” These rules may be found online at http://adminrules.idaho.gov/rules/current/16/160219.pdf.                (3-17-22)

28.                Isolation. The separation of a person known or suspected to be infected with an infectious agent, or contaminated from chemical or biological agents, from other persons to such places, under such conditions, and for such time as will prevent transmission of the infectious agent or further contamination. The place of isolation will be designated by the Director under Section 56-1003(7), Idaho Code, and Section 065 of these rules.                  (3-17-22)

11.                DEFINITIONS L THROUGH Z.For the purposes of this chapter, the following definitions apply.      (3-17-22)

01.                Laboratory Director. A person who is directly responsible for the operation of a licensed laboratory or their designee.                                                                                                                                                                       (3-17-22)

02.                Laboratory. A medical diagnostic laboratory that is inspected, licensed, or approved by the Department or licensed according to the provisions of the Clinical Laboratory Improvement Act by the United States Health Care and Financing Administration. Laboratory may also refer to the Idaho State Public Health Laboratory, and to the United States Centers for Disease Control and Prevention.                                                                                        (3-17-22)

03.                Livestock. Livestock as defined by the Idaho Department of Agriculture in IDAPA 02.04.03, “Rules Governing Animal Industry.”                                                                                                                                            (3-17-22)

04.                Medical Record. Hospital or medical records are all those records compiled for the purpose of recording a medical history, diagnostic studies, laboratory tests, treatments, or rehabilitation. Access will be limited to those parts of the record that will provide a diagnosis, or will assist in identifying contacts to a reportable disease or condition. Records specifically exempted by statute are not reviewable.                                                                       (3-17-22)

05.                Outbreak. An outbreak is an unusual rise in the incidence of a disease. An outbreak may consist of a single case.                                                                                                                                                                               (3-17-22)

06.                Personal Care. The service provided by one (1) person to another for the purpose of feeding, bathing, dressing, assisting with personal hygiene, changing diapers, changing bedding, and other services involving direct physical contact.                                                                                                                                                                   (3-17-22)

07.                Physician. A person legally authorized to practice medicine and surgery, osteopathic medicine and surgery, or osteopathic medicine in Idaho as defined in Section 54-1803, Idaho Code.                                      (3-17-22)

08.                Quarantine. The restriction placed on the entrance to and exit from the place or premises where an infectious agent or hazardous material exists. The place of quarantine will be designated by the Director or Health District Board.                                                                                                                                                                   (3-17-22)

09.                Rabies Post-Exposure Prophylaxis (rPEP). The administration of a rabies vaccine series with or without the antirabies immune globulin, depending on pre-exposure vaccination status, following a documented or suspected rabies exposure, as described in “Use of Reduced (4-Dose) Vaccine Schedule for Postexposure Prophylaxis to Prevent Human Rabies: Recommendations of the Advisory Committee on Immunization Practices,” incorporated in Section 004 of these rules.                                                                                                                                             (3-17-22)

10.                Rabies-Susceptible Animal. Any animal capable of being infected with the rabies virus. (3-17-22)

11.                Residential Care Facility. A commercial or non-profit establishment organized and operated to provide a place of residence for three (3) or more individuals who are not members of the same family, but live within the same household. Any restriction for this type of facility is included under restrictions for a health care facility.    (3-17-22)

12.                Restriction.

(3-17-22)

a.                   To limit the activities of a person to reduce the risk of transmitting a communicable disease. Activities of individuals are restricted or limited to reduce the risk of disease transmission until such time that they are no longer considered a health risk to others.                                                                                    (3-17-22)

b.                   A food employee who is restricted must not work with exposed food, clean equipment, utensils, linens, and unwrapped single-service or single-use articles. A restricted employee may still work at a food establishment as outlined in the IDAPA 16.02.19, “Idaho Food Code.”                                                                   (3-17-22)

14.                Severe Reaction to Any Immunization. Any serious or life-threatening condition that results directly from the administration of any immunization against a communicable disease.                                                  (3-17-22)

15.                Significant Exposure to Blood or Body Fluids. Significant exposure is defined as a percutaneous injury, contact of mucous membrane or non-intact skin, or contact with intact skin when the duration of contact is prolonged or involves an extensive area, with blood, tissue, or other body fluids as defined in “Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Postexposure Prophylaxis,” incorporated in Section 004 of these rules.                                                                                              (3-17-22)

16.                Standard Precautions. Methods used to prevent transmission of all infectious agents, as described in the “Guideline for Isolation Precautions in Hospitals,” incorporated in Section 004 of these rules.                 (3-17-22)

17.                State Epidemiologist. A person employed by the Department to serve as a statewide epidemiologist or their designee.                                                                                                                                                                     (3-17-22)

18.                Suspected Case. A person diagnosed with or thought to have a particular disease or condition by a licensed physician or other health care provider. The suspected diagnosis may be based on signs and symptoms, or on laboratory evidence, or both criteria. Suspected cases of some diseases are reportable as described in Section 050 of these rules                                                                                                                                                                         (3-17-22)

19.                Vaccination of an Animal Against Rabies. Vaccination of an animal by a licensed veterinarian with a rabies vaccine licensed or approved for the animal species and administered according to the specifications on the product label or package insert as described in the “Compendium of Animal Rabies Prevention and Control,” incorporated in Section 004 of these rules.                                                                                                                                        (3-17-22)

20.                Veterinarian. Any licensed veterinarian as defined in Section 54-2103, Idaho Code.                  (3-17-22)

21.                Waterborne Outbreak. An outbreak is when two (2) or more persons experience a similar illness after exposure to water from a common source and an epidemiological analysis implicates the water as the source of the illness.                                                                                                                                                                                    (3-17-22)

22.                Working Day. A working day is from 8 a.m. to 5 p.m., Monday through Friday, excluding state holidays.                                                                                                                                                                                (3-17-22)

12.     — 019.           (RESERVED

)20.                PERSONS REQUIRED TO REPORT REPORTABLE DISEASES, CONDITIONS, AND SCHOOL CLOSURES.

 01.                Physician. A licensed physician who diagnoses, treats, or cares for a person with a reportable disease or condition must make a report of such disease or condition to the Department or Health District as described in these rules. The physician is also responsible for reporting diseases and conditions diagnosed or treated by physician assistants, nurse practitioners, or others under the physician’s supervision.                                                                  (3-17-22)

02.                Hospital or Health Care Facility Administrator. The hospital or health care facility administrator must report all persons who are diagnosed, treated, or receive care for a reportable disease or condition in their facility unless the attending physician has reported the disease or condition.                                                                       (3-17-22)

03.                Laboratory Director. The laboratory director must report to the Department or Health District the identification of, or laboratory findings suggestive of, the presence of the organisms, diseases, or conditions listed in Section 050 of these rules.                                                                                                                                            (3-17-22)

04.                School Administrator. A school administrator must report diseases and conditions to the Department or Health District as indicated in Section 050 of these rules. A school administrator must report the closure of any public, parochial, charter, or private school within one (1) working day when, in their opinion, such closing is related to a communicable disease.                                                                                                                                                     (3-17-22)

IDAHO REPORTABLE DISEASE LIST

Red Indicates Immediately

Blue Indicates within 1 day

Bacterial Diseases

Capability 13: Public Health Surveillance and Epidemiological Investigation^[2]

Definition: Public health surveillance and epidemiological investigation is the ability to create, maintain, support, and strengthen routine surveillance and detection systems and epidemiological investigation processes. It also includes the ability to expand these systems and processes in response to incidents of public health significance.

Functions: This capability consists of the ability to perform the functions listed below.

•        Function 1: Conduct or support public health surveillance

•        Function 2: Conduct public health and epidemiological investigations

•        Function 3: Recommend, monitor, and analyze mitigation actions

•        Function 4: Improve public health surveillance and epidemiological investigation systems

Summary of Changes: The updates align content with new national standards, updated science, and current public health priorities and strategies. Listed below are specific changes made to this capability.

•        Increases alignment to public health surveillance and data strategies

•        Strengthens surveillance systems for persons in isolation or quarantine and persons placed under monitoring and movement protocols

•        Emphasizes syndromic surveillance and data collection to improve situational awareness and responsiveness to hazardous events and disease outbreaks, for example, participation in the CDC’s National Syndromic Surveillance Program BioSense Platform

For the purposes of Capability 13, partners and stakeholders may include the following:

•        agricultural agencies

•        clinical laboratories

•        clinicians

•        community health centers

•        environmental health agencies

•        first responders

•        food safety agencies•        health care organizations

•        law enforcement agencies

•        medical examiner or coroner offices

•        poison control centers

•        public health officials

 

Function 1: Conduct or support public health surveillance

Function Definition: Conduct or support ongoing systematic collection, analysis, interpretation, and management of public health-related data to effectively detect, verify, characterize, and manage a threat, hazard, risk, or incident of public health concern throughout and following an incident.

Tasks

Task 1: Engage stakeholders to support public health surveillance and investigation . Coordinate activities with jurisdictional laboratories, partners, and stakeholders who can provide public health-related surveillance data to support routine and emergency responses requiring surveillance and epidemiological investigation.

Task 2: Conduct or support routine and incident-specific surveillance . Use data to conduct and support health-related surveillance. Data sources for surveillance may include

•      Case findings

•      Hospital discharge abstracts

•      Population-based surveys

•      Pre-hospital emergency medical services records

•      Registries

•      Reportable disease surveillance

•      Syndromic surveillance

•      Vital records

•      Other inputs

Task 3: Share surveillance findings . Share surveillance data and communicate statistical analyses of surveillance data to the jurisdictional public health agency and other applicable jurisdictional leaders, health care providers, and data providers to assist with the prompt identification of potentially affected populations at risk for adverse health outcomes and enable rapid decision making during a natural or human-caused public health threat or incident.

Task 4: Maintain and improve surveillance systems . Maintain, assess, and strengthen surveillance systems, and continuously support bi-directional information exchange to respond promptly to public health threats, hazards, and incidents.

Preparedness Resource Elements

P1: (Priority) Legal and procedural frameworks for jurisdiction personnel involved in surveillance and epidemiology to support mandated and voluntary information exchange with a wide variety of community partners and stakeholders, including tribal communities and populations at risk to be disproportionately impacted by the incident.

P2: (Priority) Procedures in place to gather and analyze data on a broad range of health indicators, such as indicators identified in novel or emerging public health threats, case definitions, and World Health Organization (WHO) public health emergencies of international concern (PHEIC) declarations.

Surveillance activities, ranging from passive to active, may include•      Reportable condition surveillance for conditions mandated for inclusion in case reporting to public health agencies, such as monitoring travelers from high-risk areas. Reportable condition surveillance activities may include

·  Electronic laboratory reporting (ELR)

·  Electronic case reporting (eCR) for reportable conditions from clinical laboratories and health care providers

·  Other notifiable disease and injury surveillance, such as non-electronic reporting and astute clinician notification

•      Environmental health surveillance

•      Incident-specific surveillance (sentinel surveillance)

•      Syndromic surveillance to improve situational awareness, which may include

·  CDC’s National Syndromic Surveillance Program BioSense Platform

·  Surveillance systems for pregnancy, infants, and birth defects

·  State or locally developed syndromic surveillance systems

•      Vital statistics surveillance, including birth and death registration

•      Animal-related surveillance and vector control Data to gather and analyze may include

•      Active case finding data, such as health care logs and record reviews

•      Background or baseline disease data

•      Chemical exposure assessment data, such as data from the Assessment of Chemical Exposure (ACE) Program

•      Environmental data, such as air quality, ground or surface water, water quality testing, and soil or sediment data

•      HazMat data, such as hazardous material spills

•      Hospital and other health care services data, such as discharge abstracts

•      Immunization data

•      Law enforcement data

•      Mental/behavioral health data

•      Poison control center data

•      Population-based survey data

•      Radiological exposure and dose reconstruction data

•      Responder monitoring data

•      Unusual incident of unexplained morbidity or mortality in humans or animals data

•      Workers compensation claims data

•      Work-related injuries and illnesses data, such as Occupational Safety and Health Administration (OSHA) 300 logs

•      Zoonotic disease or animal data

(See Capability 6: Information Sharing, Capability 14: Responder Safety and Health, and Capability 15: Volunteer Management)

P3: (Priority) Procedures specific to public health surveillance in place to access and share health-related information while following jurisdictional requirements and federal laws for protecting personal health information and personally identifiable information, such as institutional security and confidentiality policies.(See Capability 6: Information Sharing and Capability 12: Public Health Laboratory Testing)

P4: (Priority) Procedures in place for the jurisdictional public health agency to access, collect, analyze, interpret, and respond to reports of potential public health threats or incidents.

(See Capability 3: Emergency Operations Coordination)

P5: (Priority) Regularly updated and verified list(s) of identified stakeholders who will share, receive, and distribute surveillance reports.

(See Capability 6: Information Sharing)

P6: (Priority) Procedures in place to notify CDC of cases of diseases or conditions included in the National Notifiable Disease Surveillance System (NNDSS). Procedures also include immediate notifications concerning PHEICs.

(See Capability 6: Information Sharing)

P7: Procedures in place to ensure the electronic exchange of personal health information meets applicable patient privacy-related laws, standards, and jurisdictional requirements. Laws, standards, and requirements may include

•      Health Insurance Portability and Accountability Act (HIPAA)

•      Health Information Technology for Economic and Clinical Health Act

•      Standards from the National Institute of Standards and Technology and the Office of the National Coordinator for Health Information Technology of the U.S. Department of Health and Human Services (HHS)

•      Message mapping guides for Health Level 7 (HL7) case notifications

(See Capability 6: Information Sharing)

P8: Procedures in place to assess and improve systems to ensure continuity of surveillance operations if primary surveillance and detection systems are disrupted for example, due to power failure or compromise of electronic infrastructure.

Skills and Training Resource Elements

S/T1: (Priority) Public health personnel who participate in data collection, analysis, and reporting to support surveillance investigations trained, at a minimum, in the Tier 1 level Applied Epidemiology Competencies (AEC). Personnel skilled and able to use software systems to support data collection, reporting, management, and analysis. Consideration should be given to

•      Securing assistance (through coordination with academic institutions or state-level personnel) from individuals with Tier 2 level AECs when creating a new system or updating an existing system

•      The Public Health Informatics Institute Applied Public Health Informatics Competency Model

Equipment and Technology Resource ElementsE/T1: Systems to accept, process, analyze, exchange, and share surveillance and epidemiological data across multiple disciplines. These systems also may track and monitor known cases and exposed persons through disposition to enable short- and long-term follow-up. Systems may include

•      ELR systems

•      Electronic laboratory test order and reporting (ETOR) systems

•      eCR systems

•      Electronic death registration systems (EDRS)

•      Syndromic surveillance systems

•      Outbreak management systems

•      System for tracking investigation or monitoring of potential contacts to cases, meaning systems that track isolated and quarantined persons for direct active monitoring

•      Immunization registries or immunization information systems

•      Emergency management information sharing systems, such as WebEOC

•      Emergency Responder Health Monitoring and Surveillance™ (ERHMS™) and occupational registries

•      Zoonotic disease surveillance systems

•      HazMat reporting systems

•      National Poison Data System (NPDS)

•      Environmental public health tracking systems (EPHT)

(See Capability 6: Information Sharing, Capability 14: Responder Safety and Health, and Capability 15: Volunteer Management)

E/T2: Systems to ensure the electronic management and exchange of information, including laboratory test orders, samples, results, and other information, with jurisdictional partners and stakeholders. Systems should be capable of interfacing with pertinent databases and meet necessary computing power and technical specifications.

Function 2: Conduct public health and epidemiological investigations

Function Definition: Identify the source of a case or outbreak of disease, injury, or exposure and the associated determinants in a population, including time, place, person, vital status, or other indices, to report results and findings to cross-disciplinary jurisdictional and federal partners and stakeholders.

Tasks

Task 1:  Conduct public health and epidemiological investigations . Investigate diseases, injuries, and exposures in response to natural or human-caused threats or incidents in collaboration with jurisdictional stakeholders.

Task 2: Provide support to local public health and epidemiological investigations . Provide clinical and public health-related consultations to support public health agency investigations.

Task 3: Share public health and epidemiological investigation findings . Report investigation results to impacted communities and jurisdictional and federal partners, as applicable.

Preparedness Resource ElementsP1: (Priority) Templates for outbreak or multiple exposure investigation reports that may include

•      Context and background—Information to characterize the incident may include

·  Population(s) affected, including the estimated number of persons exposed, number of persons affected, and relevant demographic information, such as age, disability status, chronic health condition(s), and pregnancy or lactation status

·  Location(s), such as setting or venue

·  Geographical area(s) involved

·  Time frame(s)

·  Suspected or known etiology

·  Jurisdictional risks

•      Initiation of investigation—Information regarding receipt of the case report or notification and initiation of the investigation may include

·  Date and time initial notification was received by the agency

·  Date and time investigation was initiated by the agency

•      Investigation methods—Epidemiological or other investigative methods employed may include

·  Initial investigative activity, such as verified laboratory results

·  Interviews

·  Case definitions (as applicable)

·  Data collection and analysis methods , such as case-finding, cohort or case-control studies, and environmental data

·  Disaster epidemiology tools, such as the Community Assessment for Public Health Emergency Response (CASPER) toolkit and the Assessment of Chemical Exposures (ACE) Program toolkit

·  Data presentation and visualization, such as disaster epidemiology tools, epidemic curves, attack rate tables, and maps

·  Questionnaires

·  Exposure assessments and classifications

·  Radiation dose assessment or reconstruction

·  Review reports developed by first responders, laboratory testing of environmental samples, reviews of environmental testing records, and industrial hygiene assessments

•      Investigation findings and results—Applicable investigation results may include

·  Epidemiological results

·  Exposure assessment results

·  Laboratory results

·  Biomonitoring results

·  Clinical results

·  Other analytic findings

·  Record(s) of case notification(s)

•      Discussion and conclusions—Analysis and interpretation of investigation results and conclusions drawn as a result of performing the investigation

•      Recommendations—Suggested approaches for controlling spread of disease or preventing future outbreaks or preventing or mitigating the effects of an acute environmental hazard•      Key investigators and report authors—Names and titles to facilitate communication with partners, clinicians, and other stakeholders

P2: Procedures in place to support jurisdictional methods for conducting investigations of public health, environmental, and occupational threats, incidents, and hazards. Investigation considerations may include

•      Elements or instances that trigger the start of an investigation, including the initiation date and time of investigation

•      Identification of population(s) at risk to be disproportionately impacted by an incident

•      Identification of individual case or exposure status (confirmed, probable, and suspected cases)

•      Identification of jurisdictional risks, including jurisdictional risk assessment findings

•      Identification of exposed persons and contact tracing

•      Determination of source, exposure, and, as applicable, transmission mapping of identified and suspect cases, injuries, or exposures within the jurisdiction

P3: Procedures in place to establish partnerships, conduct investigations, and share information with other governmental agencies, partners, and organizations to support populations at risk of adverse health outcomes as a result of the incident.

P4: Written agreements, such as contracts or memoranda of understanding (MOUs), to authorize joint investigations and information exchange and to clarify agency roles between public health and other partners and stakeholders.

P5: Laws, statutes, policies, and procedures that ensure jurisdictional public health agencies have the authority to collect and share a uniform set of jurisdictional health-related data associated with diseases, exposures, or injury conditions of public health importance.

(See Capability 6: Information Sharing)

Skills and Training Resource Elements

S/T1: Personnel trained to manage and monitor routine surveillance and epidemiological investigation systems at the jurisdictional level and support surge requirements in response to natural and human- caused threats or incidents. Personnel skilled and able to use software systems to support data collection, reporting, management, and analysis. Specific jurisdictional needs may include

•      Personnel, including surge support personnel with Tier 1 level AECs

•      Access to individuals, such as academic or state-level personnel, with Tier 2 level AECs when creating a new or updating an existing system

Equipment and Technology Resource Elements

E/T1: Public health surveillance systems to monitor health status and exposure risks of individuals and groups, including criteria for reporting health events and criteria or processes for maintaining or contributing to population health surveillance registries.

E/T2: Information systems to aid in the development of public health investigation reports using available and relevant information, such as results from clinical, environmental, or forensic samples may include

•      Databases or registries with the capacity to both receive and transmit data cross-jurisdictionally using standards-based electronic messaging that adheres to relevant HHS standards for Certified Electronic Health Records, Meaningful Use, and other interoperability standards•      Databases and registries that include protocols to protect personal health information in conformity with jurisdictional requirements and federal law, such as privacy and cybersecurity policies

(See Capability 6: Information Sharing)

Function 3: Recommend, monitor, and analyze mitigation actions

Function Definition: Recommend, implement, and support public health interventions that contribute to the mitigation of a threat, hazard, risk, or incident, and monitor intervention effectiveness.

Tasks

Task 1: Identify public health guidance and recommendations . Determine appropriate clinical, epidemiological, and environmental-related public health actions to mitigate threats, hazards, risks, or incidents based on current public health science-based standards.

Task 2: Share appropriate public health guidance and recommendations . Communicate and coordinate guidance and recommendations with public health officials, partners, and stakeholders to support decision-making related to mitigation actions.

Task 3: Monitor and assess public health interventions . Evaluate public health mitigation actions throughout the duration of the public health response and recommend additional mitigation measures as appropriate.

Preparedness Resource Elements

P1: (Priority) Procedures in place, developed in consultation with appropriate public health officials, to initiate and sustain surveillance, exposure containment, control, and mitigation actions, such as

embargo, access restrictions, and isolation and quarantine in response to public health threats, hazards, risks and incidents. Procedures may include

•      Case definitions

•      Contact investigations

•      Clinical management of potential or actual cases

•      Provision of medical countermeasures

•      Processes for exercising relevant legal authorities

•      Provision of essential goods and services for isolated or quarantined persons

•      Consultation with the Council of State and Territorial Epidemiologists (CSTE)

(See Capability 1: Community Preparedness, Capability 6: Information Sharing, Capability 8: Medical Countermeasure  Dispensing and Administration, and Capability 11: Nonpharmaceutical Interventions)

P2: Procedures in place to use health-related data and statistics from partners, stakeholders,

and jurisdictional public health agency programs that support recommendations for populations at higher risk for adverse outcomes during a natural or human-caused threat, hazard, risk, or incident.

(See Capability 1: Community Preparedness and Capability 6: Information Sharing)

 P3: Procedures in place to track mitigation actions, monitor performance, and document and share outcomes using data instruments, such as data reports or statistical summaries consistent with recommended science-based standards and sources, which include

•      Control of Communicable Diseases Manual

•      Epidemic Information Exchange (Epi-X)

•      Health Alert Network (HAN) alerts

•      Morbidity and Mortality Weekly Report

•      Red Book of Infectious Diseases

•      State or CDC incident reports/annexes

(See Capability 2: Community Recovery, Capability 5: Fatality Management, Capability 7: Mass Care, Capability 8: Medical  Countermeasure Dispensing and Administration, Capability 11: Nonpharmaceutical Interventions, and Capability 14:  Responder Safety and Health)

Skills and Training Resource Elements

S/T1: Personnel trained to conduct epidemiological investigations, including radiation assessment and monitoring, public health informatics, and public health information systems. CDC recommends that personnel are trained on the specific information systems used within their jurisdiction.

(See Capability 1: Community Preparedness)

S/T2: Personnel trained on Homeland Security Exercise and Evaluation Program (HSEEP) processes for developing after-action reports (AARs) and improvement plans (IPs).

Function 4: Improve public health surveillance and epidemiological investigation systems

Function Definition: Assess internal agency surveillance and epidemiologic investigation systems and implement quality improvement measures within jurisdictional public health agency control.

Tasks

Task 1: Evaluate effectiveness of public health surveillance and epidemiological investigation processes and systems . Evaluate surveillance and epidemiological investigation outcomes to identify deficiencies encountered during responses to public health threats and incidents and recommend opportunities for improvement.

Task 2: Identify and prioritize corrective actions . Conduct post-incident or post-exercise agency evaluation meetings with response participants and relevant partners and stakeholders to identify procedures and organizational opportunities for improvement requiring corrective action.

Task 3: Establish an after-action process, share after-action report(s) and improvement plan(s), and implement and monitor corrective actions . Obtain feedback from after-action conferences, hot washes, and incident debriefings. Develop and share AARs and IPs, and implement corrective actions.

Medical Surge^[3]

Definition: Medical surge is the ability to provide adequate medical evaluation and care during events that exceed the limits of the normal medical infrastructure of an affected community. It encompasses the ability of the health care system to endure a hazard impact, maintain or rapidly recover operations that were compromised, and support the delivery of medical care and associated public health services, including disease surveillance, epidemiological inquiry, laboratory diagnostic services, and environmental health assessments.

Functions: This capability consists of the ability to perform the functions listed below.

•        Function 1: Assess the nature and scope of the incident

•        Function 2: Support activation of medical surge

•        Function 3: Support jurisdictional medical surge operations

•        Function 4: Support demobilization of medical surge operations

Summary of Changes: The updates align content with new national standards, updated science, and current public health priorities and strategies. Listed below are specific changes made to this capability.

•        Emphasizes the need to define public health agency lead and support roles within medical surge operations

•        Eliminates use of the term “HAvBED” because the term is no longer promoted by the Hospital Preparedness Program (HPP),8 and focuses instead on “situational awareness” and “health care systems tracking” as an overarching theme

•        Emphasizes the need to identify and clarify the jurisdictional Emergency Support Function (ESF) #8 response role in medical surge operations based on jurisdictional role and incident characteristics

For the purposes of Capability 10, partners and stakeholders may include the following:

•        ambulatory care providers

•        clinics

•        emergency management agencies

•        emergency medical services (EMS)

•        environmental health

•        fire departments

•        health care coalitions

•        health care organizations

•        health professional volunteer entities9

•        law enforcement agencies

•        long-term care agencies

•        mental/behavioral health pharmacies•        poison control centers

•        public health agencies

•        public works

•        social services

•        stand-alone emergency rooms

•        state hospital associations

•        tribes and native-serving organizations

•        urgent care

•        volunteer organizations10

1     Subject matter experts from the HHS Office of the Assistant Secretary for Preparedness and Response Hospital Preparedness Program made significant contributions to the updates for Capability 10: Medical Surge

2     For example, the National Voluntary Organizations Active In Disaster (NVOAD), and the National Disaster Medical System (NDMS)

10 For example, the Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP), and the Medical Reserve Corps (MRC)

Function 1: Assess the nature and scope of the incident

Function Definition: Coordinate with Emergency Support Function (ESF) #8 partners, the jurisdiction’s health care response, and other partners and stakeholders to define incident needs and available health care personnel and resources through the collection and analysis of data, including resource tracking data, data resulting from mutual aid agreements, such as the Emergency Management Assistance Compact (EMAC), disease surveillance data, and other applicable health data.

Tasks

Task 1: Define the role of the public health agency in medical surge . Identify jurisdictional public health medical surge lead or support roles and responsibilities in coordination with other jurisdictional authorities and partners.

Task 2: Evaluate the structural needs of the jurisdictional incident management system . Support the jurisdictional incident management system to determine the public health medical surge role within the Incident Command System (ICS).

Task 3: Complete incident assessments . Assess and document initial needs and availability of resources, including personnel, facilities, logistics, and other health care resources.

Task 4:  Exchange data with jurisdictional health care organizations or health care coalitions .

Provide public health data to jurisdictional health care organizations or health care coalitions to support activation of plans, if required, to maximize scarce resources and prepare for shifts into and out of conventional, contingency, and crisis standards of care.

Preparedness Resource Elements

P1: (Priority) Personnel trained and assigned to fill public health incident management roles, as applicable, to a medical surge response to include emergency operations center (EOC) staffing at agency, local, and state levels as necessary.

(See Capability 3: Emergency Operations Coordination)

P2: (Priority) Procedures in place to ensure coordination with jurisdictional partners and stakeholders for emergency incidents, exercises, and pre-planned (recurring or special) events in accordance with ICS organizational structures, doctrine, and procedures, as defined by the National Incident Management System (NIMS).

P3: Bidirectional situational awareness system between public health and health care organizations to assess and maintain visibility of emergency surge resources. Situational awareness system activities may include

•      Regularly assessing staffing surge across facilities and locations

•      Routinely tracking bed availability including specialty beds across facilities, as necessary

•      Continually tracking, allocating, and comprehensively managing medical materiel

•      Sharing ongoing epidemiological and surveillance data that may impact resource use

•      Sharing ongoing findings from community and environmental assessments

(See Capability 6: Information Sharing and Capability 9: Medical Materiel Management and Distribution)

P4: (Priority) Procedures in place for public health to engage the health care system and health care coalitions to collect, provide, and receive situational awareness in alignment with health care system institutional and jurisdictional expectations. Jurisdictional health care system or coalition responsibilities may include•      Including health care system emergency response planning into jurisdictional and state response plans

•      Preparing to address the needs of communities and at-risk individuals who may be disproportionately impacted by a public health incident or event, including children, pregnant women, older adults,

and others with access and functional needs, as defined by the Communication; Maintaining Health; Independence; Support, Safety and Self-determination; Transportation (CMIST) framework.

•      Minimizing duplication of effort by supporting coordination among federal, state, local, tribal, and territorial planning, preparedness, response, and demobilization activities

•      Coordinating with jurisdictional emergency management organizations and assisting the health care system at the level necessary to maintain continuity of operations if standard operations are overwhelmed and disaster operations become necessary

•      Supporting jurisdiction-wide situational awareness to ensure the maximum number of people requiring care receive safe and appropriate care, including facilitating triage and directing people to appropriate facilities and providing facility support

P5: Procedures in place to define when the jurisdiction’s health care system and health care coalitions transition into and out of conventional, contingency, and crisis standards of care during an incident based on the level of stress on the health care system. This may include assessing risks to formalize strategies that define transition processes and indicators in coordination partners and stakeholders.

(See Capability 1: Community Preparedness)

P6: Procedures in place for the inclusion of partners to assist in the effective management of medical surge needs, such as balanced use of population-based interventions.

P7: Ongoing communications, community messaging, and data sharing with the health care system, health care coalitions, public safety answering points, such as 911 emergency medical dispatch systems, poison control centers, and EMS organizations. This may include requesting and using National Emergency Medical Services Information System (NEMSIS) data elements.

(See Capability 1: Community Preparedness, Capability 3: Emergency Operations Coordination, Capability 4: Emergency  Public Information and Warning, Capability 6: Information Sharing, Capability 7: Mass Care, Capability 9: Medical Materiel  Management and Distribution, Capability 13: Public Health Surveillance and Epidemiological Investigation, and Capability 15:  Volunteer Management)

Skills and Training Resource Elements

S/T1: Personnel trained to use NEMSIS and 911 data.

S/T2: Personnel trained to use the jurisdictional bed-tracking system to obtain data for jurisdictional situational awareness activities.

S/T3: Personnel trained for the role of the public health agency programs in incident response requiring medical surge. Training materials may include

•      ESF #8—Public Health and Medical Services (IS-808)

•      Introduction to Incident Command System (IS-100.b)

•      Incident Command System for Single Resources and Initial Action Incidents (IS-200.b)

•      National Incident Management System, An Introduction (IS-700.a)•      National Response Framework, An Introduction (IS-800.b)

Equipment and Technology Resource Elements

E/T1: Primary and backup Internet connection to access local and state NEMSIS, 911 data, or access bed-tracking data.

E/T2: Jurisdictional situational awareness system coordinated with the health care system and health care coalitions as necessary.

Function 2: Support activation of medical surge

Function Definition: Convene subject matter experts to discuss incident-specific changes to clinical care in protracted incidents, such as pandemic influenza, and expand access to health care services, such as call centers, alternate care systems, EMS, inpatient services, pharmacies, and occupational health clinics, during a surge on the jurisdiction’s health care system from an incident or event. Support the health care system, health care coalitions, and response partners based on identified public health response role(s), including providing recommendations for allocation of scarce resources.

Tasks

Task 1: Mobilize medical surge personnel . Support mobilization of incident-specific medical and mental/behavioral treatment personnel, public health personnel, and support personnel.

Task 2: Activate alternate care facilities . Assist health care organizations and health care coalitions with monitoring and activating alternate care facilities, as requested.

Task 3: Support additional health care services . Assist with the surge of the health care system through coordination with health care coalitions, including hospitals and non-hospital entities.

Task 4: Ensure situational awareness . Support situational awareness by using real-time information exchange among response partners, the health care system, and health care coalitions.

Task 5: Coordinate public education opportunities . Provide information to educate the public regarding available health care services, and adapt messaging for populations that may be disproportionately impacted by the incident, including individuals with access and functional needs.

Preparedness Resource Elements

P1: (Priority) Procedures in place that indicate how the jurisdictional public health agency will access volunteer resources through ESAR-VHP, the MRC health professional volunteer entities, such as NVOAD, and other personnel resources.

(See Capability 15: Volunteer Management)

P2: (Priority) Procedures in place that indicate how the public health agency will engage with health care coalitions and other response partners in the development and execution of health and

medical response plans, integrating the access and functional needs of at-risk individuals who may be disproportionately impacted by a public health incident or event to meet incident and medical surge needs. Procedures may include

•      Written list of health care organizations, coalitions, and human services providers that can support the access and functional needs of at-risk individuals•      Communication strategies for coalitions, including health care organizations and human services providers, in advance of an event

•      Current (up-to-date) list of available human services organizations that provide support and services to address the access and functional needs of at-risk individuals

•      Pre-identified site(s) that have undergone an initial assessment to determine their adequacy to serve as an alternate care facility

P3: (Priority) Jurisdictional procedures in place to identify critical information sharing requirements (situational awareness information) for partners and stakeholders. Procedures for characterizing critical information requirements may include

•      Identifying, defining, and establishing essential information and requirements

•      Determining elements of information needed to establish a common operating picture

•      Identifying data owners

•      Validating data with stakeholders

(See Capability 6: Information Sharing)

P4: (Priority) Procedures in place to document participation from jurisdictional and regional pediatric and geriatric providers, trauma centers, and burn centers in a variety of settings, such as maternal and child health programs, clinic-based, hospital-based, long-term care, and rehabilitation within jurisdictional response planning. Recommended procedures may include

•      Identification of gaps in the provision of pediatric and geriatric care

•      Coordination of pediatric and geriatric care within the jurisdiction

•      Coordination with jurisdictional trauma and burn centers

(See Capability 1: Community Preparedness, Capability 2: Community Recovery, and Capability 4: Emergency Public  Information and Warning)

P5: Procedures in place to connect health care organizations and providers with additional volunteers or other personnel through volunteer or staffing programs, such as ESAR-VHP, MRC, and the National Disaster Medical System (NDMS), if necessary.

(See Capability 15: Volunteer Management)

P6: Procedures in place to provide support for the integration of MRC units with local, regional, and statewide infrastructure. Recommended procedures may include

•      Supporting MRC personnel or coordinators for the primary purpose of integrating the MRC structure with the state ESAR-VHP program or other volunteer management process

•      Including MRC volunteers in trainings and exercises that are integrated with other regional, state, local, tribal, territorial assets, health care systems, or volunteers through the ESAR-VHP program

(See Capability 15: Volunteer Management)

P7: Written agreements, such as contracts or memoranda of understanding MOUs, with partner agencies, if needed, to create formal and informal partnerships with jurisdictional volunteer sources.

(See Capability 15: Volunteer Management)

P8: Pre-identified potential locations for Federal Medical Stations (FMSs) and potential alternate care sites that have been assessed for environmental suitability in partnership with the applicable U.S. Department of Health and Human Services (HHS) Regional Emergency Coordinator(s) (RECs).P9: Partnership with the applicable HHS RECs to address the need for wrap-around services, such as facility security, biomedical, and medical waste disposal, or provide information regarding accessing other services, such as food service at projected FMS locations.

P10: Procedures in place to staff call centers with volunteer resources to manage increased call volumes at health care organizations and health care coalitions.

(See Capability 15: Volunteer Management)

P11: Procedures in place to create, clear or approve, and disseminate medical surge guidance to inform the population of where and when to seek care as well as the appropriate use of 911 and acute care health systems during an incident or event. Considerations for making messages accessible for individuals with access and functional needs may include

•      Developing translated materials or resources that are accessible for people with limited English proficiency and that are linguistically appropriate, culturally sensitive, and account for varied literacy levels

•      Developing materials or resources that are accessible for people who are blind, have low vision, are deafblind, or have other visual disabilities

•      Developing materials or resources that are accessible for people who are deaf, hard of hearing, deafblind, or have other hearing disabilities

(See Capability 1: Community Preparedness and Capability 4: Emergency Public Information and Warning)

P12: Procedures in place for the local EMS system to request additional resources, such as specialty equipment and personnel, for the needs of pediatric cases as part of the jurisdictional ESF #8 annex or other documentation.

P13: Legal and regulatory mechanisms to support surge activities at the jurisdictional level and identification and engagement of the health care workforce to execute the mechanisms. Recommended considerations may include

•      Liability protections for providers or facilities

•      Allowances and limitations for Health Insurance Portability and Accountability Act (HIPAA) compliance

•      Ability to commandeer resources

•      Ability to change regulations to support emergency and alternate systems of care

Skills and Training Resource Elements

S/T1: Personnel trained and knowledgeable on the Strategic National Stockpile (SNS) formulary and trained on FMS implementation.

S/T2: Personnel trained on providing care to pediatric patients and using pediatric equipment.

Equipment and Technology Resource Elements

E/T1: (Priority) Incorporation of equipment, communication, and data interoperability into the health care organizations’ acquisition programs.

(See Capability 6: Information Sharing)

Function 3: Support jurisdictional medical surge operations

Function Definition: Coordinate health care resources in conjunction with response partners, including the tracking of patients, medical personnel, equipment, and supplies from intra- or inter-state and federal partners, if necessary, in quantities needed to support medical response operations.

Tasks

Task 1: Maintain communications and continuity of services . Coordinate and maintain communications per jurisdictional authority or jurisdictional incident management structure with partners and stakeholders to maintain situational awareness, account for jurisdictional needs, and maintain continuity of medical response operations.

Task 2: Coordinate with partners to provide required resources . Assess resource requirements during each operational period and coordinate with partners, including those able to provide mental/behavioral health services for the community, to obtain necessary resources and to support medical surge.

Task 3: Track patients impacted by the incident . Coordinate with jurisdictional partners and stakeholders to facilitate patient tracking during the incident response and recovery.

Preparedness Resource Elements

P1: (Priority) Procedures in place to collect, communicate, and share situational awareness information, including number and types of patients seen by location, to partners and stakeholders through jurisdictional emergency management procedures.

(See Capability 6: Information Sharing and Capability 13: Public Health Surveillance and Epidemiological Investigation)

P2: (Priority) Procedures in place that detail jurisdictional public health agency participation in the development and execution of health and medical response and recovery plans that integrate the access and functional needs of populations at risk of being disproportionately impacted by the incident or event.

(See Capability 1: Community Preparedness and Capability 2: Community Recovery)

P3: (Priority) Procedures in place to support or implement family reunification.

P4: (Priority) Public health and health care system coordination procedures that account for public health and medical materiel management, inventory assessments, and personnel and equipment resource requests from jurisdictional and other ESF #8 partners as the incident evolves. Recommended considerations may include

•      Management of available medical supplies, medications, and vaccines

•      Use of jurisdictional medical caches

•      Processes for requesting additional supplies

•      Availability of ventilators (portable or otherwise) within the jurisdiction

•      Management of laboratory diagnostic services, for example equipment and supplies

•      Field- and facility-based epidemiological tracking

(See Capability 8: Medical Countermeasure Dispensing and Administration, Capability 9: Medical Materiel Management and  Distribution, Capability 12: Public Health Laboratory Testing, Capability 13: Public Health Surveillance and Epidemiological  Investigation, and Capability 15: Volunteer Management)

 
P5: Jurisdictional patient-tracking and disease surveillance systems operated in conjunction with state and local emergency management, EMS, health care organizations, and other jurisdictional partners. Recommended considerations for patient-tracking systems may include•      Close coordination with state government systems•      Interoperability with relevant state and national patient-tracking systems and registries•      Consistency with federal and state-approved privacy protection, regulations, and standards for patient-tracking systems and registries(See Capability 6: Information Sharing and Capability 13: Public Health Surveillance and Epidemiological Investigation)P6: Procedures in place to coordinate with the jurisdiction’s patient-tracking system, including immunization information systems (IISs), local and state EMS, and 911 authorities, as applicable.

(See Capability 6: Information Sharing)

Equipment and Technology Resource Elements

E/T1: Electronic or other data storage systems to inform situational awareness, such as the jurisdiction’s IIS and Joint Patient Assessment and Tracking System (JPATS), in accordance with national standards.

(See Capability 6: Information Sharing)

Function 4: Support demobilization of medical surge operations

Function Definition: In conjunction with jurisdictional partners, return the health care system to pre- incident operations by incrementally decreasing surge staffing, equipment needs, alternate care facilities, and other systems and transitioning patients from acute care services into their pre-incident medical environments or other applicable medical settings.

Tasks

Task 1: Assist in the return movement of patients . Assist or coordinate with partners to return patients to their pre-incident medical environments, such as prior medical care provider, skilled nursing facility, or place of residence, or other applicable medical settings.

Task 2: Assist the health care system in the demobilization of resources . Coordinate with partners to demobilize health care resources including facilities, personnel, and equipment according to incident needs. Ensure effective discharge planning for people with disabilities and other access and functional needs to avoid inappropriate placement, and maintain independent living in the least restrictive environment.

Task 3: Demobilize alternate care facilities and mutual aid resources . Coordinate with partners to demobilize alternate care facilities and resources obtained through mutual aid, EMAC, and other means of assistance, as appropriate for the incident.

Preparedness Resource Elements

P1: (Priority) Procedures in place to coordinate with state EMS to demobilize transportation assets used in the incident.