CJ: Week 8 Discussion Question
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ICS_Executives_NEMA.ppt*
Incident Command System
for Executives
Part I
NIMS/ICS Overview
presented by
The National Emergency Management Association
Harrisburg, Pennsylvania
April 2007
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Introductions
- Who are you?
- Who do you represent?
- Job title/function
- Years with your group
- NIMS/ICS experience – education
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Objectives
- Familiarization with the National Incident Management System
- Understand the Incident Command System
- Understand the Executives’ roles and responsibilities within the Incident Command System
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Objectives
- Understand the need to include non-traditional agencies in incident command and response during an event
- Become acquainted with the types of issues that are likely to surface during an event
- Understand the differences between on-scene Incident Command organizations, Emergency Operations Centers, Area Commands, and Multi-Agency Coordination Systems
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Agenda
- Overview of the National Incident Management System (NIMS)
- The Incident Command System (ICS) in the NIMS
- Executives’ roles within the framework of ICS
- The nature of Bioterrorism
- Managing Bioterrorism
- Summary
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Agenda
Day 1
- NIMS and ICS Basics
- Review of the National Incident Management System (NIMS)
- Incident Command System (ICS) as component of NIMS
- Explain ICS components in a major incident
- ICS in the NIMS
- Executive roles within the ICS framework
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Agenda
Day 1 (continued)
- Biological Terrorism (BT)
- Managing a biological event
- Pandemic Influenza vs. BT
- Potential issues-based scenario
- Summary
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Agenda
Day 2
- Facilitated Tabletop Exercise
- Scenario
- Discussion of roles
- After-action discussion
- What worked well – “Best Practices”
- What did not work?
- What do we need to improve?
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What Is an Incident?
- An incident is . . .
. . . an occurrence, caused by either human or natural phenomena, that requires response actions to prevent or minimize loss of life, or damage to property and/or the environment
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Incident Timeframes
We must understand incident time frames
- How long will a complex incident last?
- How long do we need to be self-sufficient?
- How will we know that the incident is over?
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National Incident Management System
(NIMS)
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Mandates
Background
Homeland Security Presidential Directives (HSPDs)
- Management of Domestic Incidents
HSPD-5
HSPD-8
National Incident Management System (NIMS)
National Response Plan (NRP)
- National Preparedness
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Background
NIMS and NRP
- NIMS: Standardizes incident management processes, protocols, and procedures for use by all responders. Mandates use of ICS
- NRP Establishes:
- Federal coordination structures/mechanisms
- Direction for incorporation of existing plans
- Consistent approach to managing incidents
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National Incident Management System
(NIMS)
Background
Relationship of NIMS and NRP
Local
Response
State
Response or Support
Federal
Response or Support
NIMS aligns command, control, organization structure, terminology, communication protocols, resources and resource-typing for synchronization of response efforts at all echelons of government
National Response Plan (NRP)
Incident
Activated for
incidents of national significance
Resources, knowledge,
and abilities from
Federal departments & agencies
DHS integrates
and applies Federal
resources both pre- and
post-incident
Used for all events
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NIMS
What It Is / What It’s Not
NIMS is…
- A core set of
- Doctrines
- Concepts
- Principles
- Terminologies
- Organizational Processes
- Applicable to all hazards
NIMS is not…
- An operational incident management plan
- A resource allocation plan
- A terrorism / WMD-specific plan
- Designed to address international events
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National Incident Management System
Why was NIMS established?
- To allow responders to focus on the response itself instead of organizing the response
- To provide for a better coordinated response
- Integrates existing best practices
- National approach
- Applicable at all jurisdictional levels
- Applicable across all functional disciplines
- All-hazards context
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National Incident Management System
NIMS provides
- A core set of concepts, principles, terminologies, technologies and organizational processes
- Incident Command System
- A multi-agency coordination system
- Unified command
- Training
- Identification and management of resources
- Qualifications and certification
- Collection, tracking, and reporting of incident information and incident resources
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Key Concepts
- Flexibility
- Government and private entities work together
- Applicable regardless of incident cause, size, location, or complexity
- Standardization
- Key to interoperability (processes/procedures/systems)
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NIMS Component Parts
- Command and Management
- Preparedness
- Resource Management
- Communications and Information Management
- Supporting Technologies
- On-going Management and Maintenance
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NIMS Components & ICS
Command and Management
Additional Information: www.fema.gov/NIMS
Preparedness
Resource Management
Communications and
Information Management
Supporting Technologies
Ongoing Management and
Maintenance
Incident
Command
System
Multi-Agency
Coordination
Systems
Public
Information
Systems
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NIMS Component Parts
- Command and Management
- Preparedness
- Resource Management
- Communications and Information Management
- Supporting Technologies
- On-going Management and Maintenance
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NIMS Component Parts
Command and Management
- Incident Command System
- Multi-Agency Coordination Systems
- Unified Command
- Public Information Systems
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NIMS Incident Management
| Incident Command System | Multi-Agency Coordination System (MACS) | Unified Command (UC) | Public Information System |
| The management system used to direct all operations at the incident scene. The IC is located at an Incident Command Post (ICP) at the incident scene. | An activity or a formal system used to coordinate resources and support between agencies or Jurisdictions. MACs are useful for regional situations. (MAC Groups are normally composed of Agency Executives) | UC provides guidelines to enable agencies with different legal, geographic, and functional responsibilities to coordinate, plan, and interact effectively. | Public Information Systems will establish protocols for communicating timely and accurate information to the public during a crisis or emergency situation. |
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Command and Management
Public Information Systems Principles
- Systems and protocols for communicating timely and accurate information to the public are critical during crisis or emergency situations.
- Public Information Systems Components
- Joint Information System (a mechanism)
- Joint Information Center (a location)
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Command and Management
Public Information Systems Principles
- Public Information Officer supports the Incident Command
- Public information functions must be coordinated and integrated
- Across jurisdictions
- Across functional agencies
- Among Federal, State, local, and tribal partners
- With private sector organizations
- With nongovernmental organizations
- Participating organizations retain their independence
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Command and Management
Public Information Systems
Joint Information System (JIS)
- Interagency coordination and integration
- Develops and delivers coordinated messages
- Clear and consistent
- Supports decision makers
- Characterized by
- Flexibility
- Modularity
- Adaptability
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Command and Management
Public Information Systems
Joint Information Center (JIC)
- Must include representatives from
- Each jurisdiction
- Each agency
- May include representatives from
- The private sector
- Nongovernmental organizations
- A single JIC location is preferable
- Must communicate and coordinate with
- Other JICs
- Other components of the ICS organization
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Command and Management
Public Information Systems
Joint Information Center (JIC)
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NIMS Component Parts
- Command and Management
- Preparedness
- Resource Management
- Communications and Information Management
- Supporting Technologies
- On-going Management and Maintenance
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NIMS Component Parts
Preparedness
- Planning
- Training
- Exercises
- Qualification and Certification
- Equipment Certification
- Publications Management
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Preparedness
Concepts & Principles
- Continuous cycle of
- Planning
- Training
- Equipping
- Exercising
- Evaluating
- Taking action to correct and mitigate
- Requires a unified approach
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Preparedness
Concepts & Principles
- Processes for providing
- Guidelines
- Protocols
- Standards for planning, training, qualifications, and certification
- Publication management
- “National-level preparedness standards related to the NIMS will be maintained and managed through a multijurisdictional, multidiscipline center, using a collaborative process”
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Preparedness
Concepts & Principles
- Mitigation activities are important elements of preparedness
- Mitigation activities include
- Ongoing public education and outreach activities designed to reduce loss of life and destruction of property
- Structural refitting
- Code enforcement
- Flood insurance and buy-out of properties subjected to frequent flooding
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Preparedness
Concepts & Principles
- Who is responsible for implementing the preparedness cycle in advance of an incident and appropriately including private sector and nongovernmental organizations in such implementation?
- What about other groups of people?
- Committees, planning groups, and others
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Preparedness
Planning
- Emergency Operations Plan (EOP)
- Organizational structures
- Roles / responsibilities
- Policies
- Procedures
- Standard Operating Procedures (SOPs)
- Field Operations Guide / Handbook
- Job Aids
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Preparedness
Planning
- Preparedness Plans
- Identifying and meeting training needs
(based on expectations the EOP has outlined) - Corrective Action and Mitigation Plans
- Lessons learned
- Recovery Plans
- Long and short term
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Preparedness
Training and Exercises
- Appropriate training is required for organizations and personnel
- All levels of government
- Private sector
- Nongovernmental organizations
- NIMS Integration Center is key to training and training standards
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Preparedness
Qualification and Certification
- National standards for emergency response personnel are the basis for national preparedness
- Personnel who support interstate incidents must meet national qualification and certification standards
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Preparedness
Equipment Certification
- Equipment must perform to specific standards, including interoperability
- National equipment standards, guidelines, and protocols and reviews of certified equipment lists in coordination with
- Federal, State, local, tribal, private sector, and nongovernmental agencies
- Standards-making, certifying, and accrediting organizations
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- Means for one jurisdiction to provide resources, facilities, services, and other required support to another jurisdiction during an incident
Preparedness
Mutual Aid Agreements
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Preparedness
Mutual Aid Agreements
- Should include
- Definitions
- Roles and responsibilities
- Procedures for requesting and providing assistance
- Procedures, authorities, and rules for payment and cost issues
- Notification procedures
- Communications protocols
- Relationships with other jurisdictional agreements
- Workers compensation, liability, and immunity treatments
- Recognition of qualifications and certifications
- Sharing agreements
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Preparedness
Publications Management
- Naming and numbering conventions
- Review and certification of publications
- Publications control
- Identification of sources and suppliers
- Publication distribution
- Efforts managed by NIMS Integration Center
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NIMS Component Parts
- Command and Management
- Preparedness
- Resource Management
- Communications and Information Management
- Supporting Technologies
- On-going Management and Maintenance
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Resource Management
Four Primary Tasks
- Establishing systems for describing, inventorying, requesting, and tracking resources
- Activating those systems prior to, during, and after an incident
- Dispatching resources prior to, during, and after an incident
- Deactivating or recalling resources during or after incidents
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Resource Management
Processes
- Identifying and typing resources
- Certifying and credentialing personnel
- Inventorying resources
- Identifying resource requirements
- Ordering and acquiring resources
- Tracking and reporting resources
- Mobilizing resources
- Recovering resources
- Reimbursing
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NIMS Component Parts
- Command and Management
- Preparedness
- Resource Management
- Communications and Information Management
- Supporting Technologies
- On-going Management and Maintenance
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Communications & Information Management
Concepts & Principles
- Common operating picture accessible across
jurisdictions and functional agencies - Allows incident managers at all levels to make effective, consistent decisions expeditiously
- Ensures consistency at all levels of incident management
- Common communications and data standards to assure accessibility and interoperability
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Communications & Information Management
Incident Management Communications
- Jurisdictions must comply with national interoperable communications standards
- Incident communications
- Follow ICS standards
- Managed by IC
- Common communications plan
- Common terminology
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Communications & Information Management
Incident Management Communications
- Policies
- Pre-incident information (preparedness organizations)
- Information management
- Networks
- Technology (computers / networks)
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NIMS Component Parts
- Command and Management
- Preparedness
- Resource Management
- Communications and Information Management
- Supporting Technologies
- On-going Management and Maintenance
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Supporting Technologies
Concepts & Principles
- Interoperability and compatibility
- Technology support (R&D)
- Technology standards
- Broad-based requirements
- Strategic planning for research and development
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Supporting Technologies
Supporting Incident Management
- Operational scientific support
- Technical standards
- Performance measurement
- Consensus-based performance standards
- Testing and evaluation
- Technical guidelines for equipment training
- Solving operational problems through research and development
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NIMS Component Parts
- Command and Management
- Preparedness
- Resource Management
- Communications and Information Management
- Supporting Technologies
- On-going Management and Maintenance
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Ongoing Management & Maintenance
Concepts and Principles
- All users and stakeholders participate in NIMS Integration Center activities
- Various levels of government
- Functional disciplines
- Private entities
- Process relies on
- Lessons learned from actual incidents and exercises
- Best practices across jurisdictions and functional disciplines
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The NIMS Integration Center
Mission
“To provide strategic direction for and oversight of the NIMS, supporting … routine maintenance and the continuous refinement of the system and its components over the long term”—HSPD-5
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Ongoing Management & Maintenance
NIMS Integration Center Responsibilities
- National program for NIMS education and awareness
- General training requirements and national-level training standards and course curricula
- National standards, guidelines, and protocols for qualification and certification of emergency responder and incident management personnel
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Ongoing Management & Maintenance
NIMS Integration Center Responsibilities
- Standards for performance, compatibility, and interoperability of incident management equipment
- National standards for resource typing
- Materials and standardized templates to support NIMS implementation and continuous refinement
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NIMS & Institutionalizing ICS
- Governmental officials must
- Adopt the ICS through executive order, proclamation, or legislation as the jurisdiction’s official incident response system
- Direct that incident managers and response organizations in their jurisdictions to train, exercise, and use the ICS
- Integrate ICS into functional and system-wide emergency operations policies, plans, and procedures
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NIMS & Institutionalizing ICS
- Governmental officials must
- Conduct ICS training for responders, supervisors, and command-level officers
- Conduct coordinating ICS-oriented exercises that involve responders from multiple disciplines and jurisdictions
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NIMS Conclusion
- Incorporates best practices of current incident management (e.g., ICS, Joint, Multi-Agency, Unified Incident Management)
- Consistent, nationwide approach
- Applicable
- To all jurisdictional levels
- Across functional disciplines
- In all-hazards context
- Recognizes the need to integrate Crisis and Consequence management
- Recognizes the need to establish standards and common operating systems
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Incident Command System
(ICS)
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What is ICS?
- A standardized, on-scene, all-hazard incident management concept
- A process management tool
- A flexible organizational structure
- The standard for managing emergency incidents
- Easily adapted to large- or small-scale incidents
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ICS Purposes
- Allows its users to adopt an integrated organizational structure to match the complexities and demands of single or multiple incidents without being hindered by jurisdictional boundaries
- Using management best practices, ICS helps to ensure the
- Safety of responders and others.
- Achievement of tactical objectives.
- Efficient use of resources
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ICS Benefits
- Meets the needs of incidents of any kind or size
- User friendly
- Enables personnel from diverse organizations to work together
- Provides logistical and administrative support to operational staff
- Minimal disruption
- Cost effective
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ICS Characteristics
- Flexible
- Modular
- Scalable
- Interactive management components
- Management by Objectives
- Reliance on Incident Action Plan (IAP)
- Resource Management
- Integrated Communications using common terminology
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Management by Objectives
- ICS is managed by objectives
- Objectives are communicated throughout the entire ICS organization
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- Incident objectives are established based on the following priorities:
- #1 Life Safety
- #2 Incident Stabilization
- #3 Property/Environmental Conservation
Management by Objectives
Overall Incident Objectives
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Reliance on an Incident Action Plan
- The Incident Commander creates an Incident Action Plan that:
- Specifies the incident objectives
- States the activities to be completed
- Covers a specified timeframe, called an operational period
- May be oral or written—except for hazardous materials incidents, which require a written IAP
- Takes into account legal and policy considerations and direction
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Resource Management
- Resource management includes processes for:
- Categorizing resources
- Ordering resources
- Dispatching resources
- Tracking resources
- Recovering resources
- Reimbursement for resources, as appropriate
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Before an incident, it is critical to develop an integrated voice and data communications system (equipment, systems, and protocols)
Integrated Communications
- Incident communications are facilitated through:
- The development and use of a common communications plan
- The interoperability of communication equipment, procedures, and systems
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Common Terminology
- ICS requires use
- Helps to define
- Organizational functions
- Incident facilities
- Resource descriptions
- Position titles
This is Unit 1, we have a 10-37, Code 2.
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Incident Command System
Management Characteristics
- Reliance on Incident Action Plan (IAP)
- Manageable Span of Control
- Pre-designated Incident Locations and Facilities
- Comprehensive Resource Management
- Integrated Communications
NIMS requires that field command and management functions be performed in accordance with a standard set of ICS organizations, doctrines, and procedures
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ICS Organization
The Incident Command System
Organizational Structure
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Modular Organization
- Develops in a top-down, modular fashion
- Is based on the size and complexity of the incident
- Is based on the hazard environment created by the incident
- Incident objectives determine the organizational size
- Only functions/positions that are necessary will be filled
- Each element must have a person in charge
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ICS Organization
Command Staff
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ICS Organization
General Staff
Incident
Commander
Operations
Section
Planning
Section
Logistics
Section
Finance/Admin
Section
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Who Does What?
Incident
Commander
Operations
Section
Planning
Section
Logistics
Section
Finance/Admin
Section
Command: Overall responsibility for the incident. Sets objectives.
Operations: Develops the tactical organization and directs all resources to carry out the Incident Action Plan
Planning: Develops the Incident Action Plan to accomplish the objectives
Finance/Admin: Monitors costs related to the incident. Provides overall fiscal guidance
Logistics: Provides resources and all other services needed to support the incident
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ICS Organization
Command and General Staff
Span of control
3 – 7 personnel
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ICS Organization
Operations Section
The Operations Section develops the tactical organization and directs all resources to carry out the Incident Action Plan
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Divisions and Groups are established when the number of resources exceeds the Operations Section Chief’s manageable span of control
ICS Organization
Operations Section: Divisions and Groups
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The best way to create geographical
divisions is to divide an area according to
natural terrain separations or other prominent
geographical features
ICS Organization
Operations Section: Geographical Divisions
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Functional groups can best be used to describe
areas of like activity, e.g., rescue, evacuation,
Medical, etc.
ICS Organization
Operations Section: Functional Groups
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In the case of a multijurisdictional incident,
resources are best managed under the
agencies that normally control them
ICS Organization
Operations Section: Multi-Jurisdictional
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ICS Organization
Planning Section
Planning develops the Incident Action Plan to
accomplish the objectives, collects and
evaluates information, and maintains
the status of assigned resources
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ICS Organization
Logistics Section
Logistics provides the resources and all other
services needed to support the organization
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ICS Organization
Finance/Administration Section
Finance/Administration monitors costs
related to the incident, and provides accounting,
procurement, time recording, cost analysis,
and fiscal guidance
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Incident Complexity and Resource Needs
Incident Complexity
Resource Needs
ICS Structure
Complexity
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Complexity Analysis Factors
- Impacts to life, property, and the economy
- Community and responder safety
- Potential hazardous materials
- Weather and other environmental influences
- Likelihood of cascading events
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Complexity Analysis Factors
- Potential crime scene (including terrorism)
- Political sensitivity, external influences, and media relations
- Area involved, jurisdictional boundaries
- Availability of resources
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Incident Typing: Overview
- Incidents are categorized by type based on complexity
- Type 5 incidents are the least complex and Type 1 the most complex
- Incident typing may be used to ensure that Incident Commanders or Incident Management Teams (IMTs) are qualified to manage the incident
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Incident Typing: Overview
Typically, Types 1 & 2 are incidents of national significance.
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Incident Management Teams (IMTs)
- An IMT may be used to respond to an incident.
IMTs include Command and General Staff members - IMT types correspond to incident type and include
- Type 1: National and State Level (Type 1 Incident)
- Type 2: National and State Level
- Type 3: State or Metropolitan Area Level
- Type 4: City, County, or Fire District Level
- Type 5: Local Village, Town, Township, or Lowest Level of
Government (if applicable) - Team members must have training and experience to fulfill IMT positions
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ICS Command and Management
Command Function
- Unified Command
- Multi-jurisdictional and/or multi-agency event
- Includes all agencies with legal or jurisdictional authority or functional responsibilities
- No agency’s legal authorities compromised or neglected
- All agencies with responsibility for the incident understand priorities and restrictions
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ICS Organization and Operations
Command Function
- Unified Command
- Single planning process; single management structure
- Jurisdictional authorities jointly determine
- Single set of objectives, plans, and strategies
- Work together to execute integrated operations optimizing performance
- Improved information flow and coordination
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Unified Command Applications
- Incidents that affect more than one political jurisdiction
- Incidents involving multiple agencies within a jurisdiction
- Incidents that impact multiple geographic and functional agencies
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Unified Management Structure
Command Staff
Jurisdiction
A
Jurisdiction
B
Jurisdiction
C
Unified Objectives
Operations
Section
Planning
Section
Logistics
Section
Finance/
Administration
Section
Unified Command Example
Multi-Jurisdiction
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Unified Management Structure
Command Staff
Law Enforcement
Fire
Health
Unified Objectives
Operations
Section
Planning
Section
Logistics
Section
Finance/
Administration
Section
Unified Command Example
Multi-Department
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Area Command
- Oversees the management of multiple incidents
- Oversees the management of large or multiple incidents to which several Incident Management Teams have been assigned
- Develops overall strategy and priorities
Area Command becomes Unified Area Command when an incident becomes
multijurisdictional
ICS Organization and Operations
Command Function
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Area Command
- Allocates resources according to priorities
- Ensures proper management of incidents
- Ensures objectives are met and strategies are followed
- Ensures effective communications
Area Command becomes Unified Area Command when an incident becomes
multijurisdictional
ICS Organization and Operations
Command Function
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When Should Area Command
be Established?
- Several active incidents are in close proximity
- Critical human or property values are at risk due to incidents
- Incidents will continue into the next operational period
- Incidents are using similar and limited critical resources
- Difficulties are encountered with inter-incident resource allocation and coordination
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Area Command
- Established by an Agency Executive
- Given written, delegated authority
- Best qualified and experienced personnel
- Patterned after ICS Command/General Staff
- Operates under same principles as ICS
- Should be kept to a small organization
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Area Command Organization
Area
Commander
Information Officer
Liaison Officer
Planning Chief
Logistics Chief
Incident A
Incident B
Incident C
Agency
Administrator
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Multi-Agency Coordination Systems
(MACS)
- What are MACS?
- Mechanisms for combining the following into a common operating system
- Facilities
- Equipment
- Personnel
- Procedures
- Communications
- Coordinates and supports domestic incident management
- Agency/Jurisdictional Chain of Command does not change
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Multi-Agency Coordination Systems
- Who Can Activate MACS ?
- Agencies within a single political subdivision
- The Jurisdiction’s Chief Executive Officer
- Multiple political subdivisions
- The consensus of involved jurisdictions’ executives
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MACS Elements
- Emergency Operations Center (EOC)
- The physical location for the coordination of
- Information
- Resources
- On activation, communication and coordination must be established between the EOC and the IC/UC
- Multi-Agency Coordinating Entities
- Principals of Agencies or organizations with
- Direct incident management responsibility or
- Significant incident management support or resource responsibilities
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MACS Locations
MACS can be set up
- At a jurisdictional EOC
- At a regional facility
- At a State or Federal facility
- Wherever it is needed
MACS is a system . . .
Not a facility
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ICS
Summary
- Five basic functions
- The IC has both a command staff and a general staff
- Modular and Scalable
- Not all sections need to be activated
- ICS is highly adaptive
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ICS
Summary
- An integral element of NIMS
- A process management system
- Utilized throughout the United States
- Flexible in its approach to incidents
- A common structure
- A common terminology
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The Executive
What YOU need to know
Approach to resolve incidents
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Issues of Concern
In the context of ICS, you – the Executive –
need to ask:
- What are the implications of an incident to you and your organization?
- What do existing plans and authorities mandate?
- How do you maintain control when an incident occurs?
- Where do you fit in the incident management process?
- What are the goals and priorities you’ll give to the IC?
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Lines of Authority
- Political Authority
- Agency Director
- Incident Commander
- Assigned Resources
The lines of authority vary from state to state, and these variances are one of the reasons for the creation of NIMS
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Chain of Command
- Chain of command is an orderly line of authority within the ranks of the incident management organization
- Unity of command means that every individual has a designated supervisor to whom he or she reports at the scene of the incident
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Incident Commander
Upon arriving at an incident, the higher ranking person will either assume command, maintain command as is, or transfer command to a third party
The most qualified person is designated as the Incident Commander independent of rank
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Incident Commander’s Role
- Provides overall leadership for incident response
- Takes policy direction from the Executive/Senior Official
- Delegates authority to others
- Ensures incident safety
- Provides information to internal and external stakeholders
- Establishes and maintains liaison with other
agencies participating in the incident - Establishes incident objectives
- Directs the development of the Incident Action Plan
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What the Executive Provides
- Policy
- The Agency’s or Jurisdiction’s policy to manage the incident
- Mission
- Setting goals for accomplishment
- Direction
- The Agency’s goals and priorities
- Authority
- Delegated to allow incident responders to accomplish the incident objectives
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Executive/Senior Officials’
Role & Responsibilities
- Clearly state and provide policy guidance through the IAP development process based on situational needs and the Emergency Operations Plan
- Support a multi-agency approach to the response
- Oversee resource coordination and support to the on-scene command from the Emergency Operations Center or through dispatch
- Evaluate the effectiveness of the response and correct deficiencies
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Executives/Senior Officials Delegate Command Authority
- Executives/Senior Officials delegate authority to the designated Incident Commander for on-scene operations.
- The Incident Commander has direct tactical and operational responsibility for conducting incident management activities.
Incident Commander
Senior Official
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Delegation of Authority
- May be in writing (established in advance) or verbal, and include:
- Legal authorities and restrictions
- Financial authorities and restrictions
- Goals, priorities, and
expected timetables - Reporting requirements
- Demographic issues
- Political and social implications
- Agency or jurisdictional priorities
- Plan for public information management
- Process for communications
- Plan for ongoing incident evaluation
Authority can be
delegated
Responsibility can
never be delegated
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Assess Effectiveness
The Incident Commander must
- Understand agency policy and direction
- Be proactive
- Provide clear objectives
- Match objectives and strategy
- Staff the organization to meet workload
- Monitor span of control
- Identify problem areas and work to overcome them
- Meet the responsibilities of NIMS, EOPs, and written SOPs
*
*
“The last place I want to meet you for the first time is at an incident site.”—Unknown
Support Multi-Agency Approaches
The Executive must plan for an Area Command approach prior to an incident by
- Holding planning meetings and preparing mutual aid agreements
- Involving other agencies’ personnel in his/her ICS organization
- Advocating the use of “Area” and/or “Unified Command”
- Conducting inter-agency training and exercises
- Revising plans based on findings of exercises and training events
*
*
Executive/Incident Commander Relationship
Executive/Senior Official
- Provides the Incident Commander with:
- Policy
- Mission
- Direction
- Authority
Incident Commander
- Manages the incident at
the scene - Keeps Executive
informed on all important
matters pertaining to the
incident
To maintain the unity of command and
safety of responders, the chain of command must NOT be bypassed
*
*
Steps to Accomplish Incident Objectives
| Activity | Responsibility |
| Agency policy, direction and support, goals and priorities | Executive/Senior Official |
| Incident objectives | Incident Commander |
| Strategy to achieve objectives | Incident Commander |
| Tactical direction | Operations Section Chief in support of the IC’s objectives |
*
*
Executive – IC Briefing
Items That Should Be Covered
- Overall situation
- What is occurring
- Resources required
- Resource availability
- Approach – What’s in the IAP
- Jurisdictional authority over the incident(s)
*
*
Executive – IC Briefing
Items That Should Be Covered (cont.)
- Executive’s Issues
- Goals
- Priorities
- Expectations
- Policies
- Political factors
- Other constraints
*
*
Executive – IC Briefing
Items That Should Be Covered (cont.)
- Status of communications systems
- Media interaction
- Information needs
- Review of priorities
- Supporting plans, mutual support agreements, and directories
*
*
Evaluating the IC’s Effectiveness
- Sample criteria to use
- Followed agencies’ policies and direction?
- Proactive vs. reactive?
- Matched agencies’ objectives and strategies with goals and priorities?
- Ensured sufficient staffing?
- Maintained an effective span of control?
*
*
Evaluating the IC’s Effectiveness
- Sample criteria to use
- Utilized deputies?
- Integrated other agencies’ personnel?
- Ensured organizational effectiveness?
- Delegated authority?
- Identified problems and solutions?
*
*
After-Action Review
- Ensure an after-action review is conducted and answers the following questions:
- What did we set out to do?
- What actually happened?
- Why did it happen?
- What are we going to do better next time?
- Are there lessons learned that should be shared?
- What followup is needed?
*
*
Conclusion
- Most importantly Executives/Senior Officials provide leadership
Leadership means . . .
- Motivating and supporting trained, on-scene responders so that they can accomplish difficult tasks under dangerous, stressful circumstances
- Instilling confidence in the public that
the incident is being managed effectively
*
*
Incident Command System
for Executives
Part II
Biological Terrorism/Pandemic Influenza
presented by
The National Emergency Management Association
Harrisburg, Pennsylvania
April 2007
*
*
Agenda
- Introduction to Biological terrorism
- The nature of Biological terrorism
- Pandemic Influenza / Bird Influenza
- Response to a Biological event
- Containing a Biological event
- Community recovery from a Biological event
*
*
Objectives
- Understand the nature of bioterrorism and the evolving threat of pandemic influenza
- Describe the history and unique nature of biological terrorism and warfare
- Describe and explain the special nature of the evolving pandemic influenza threat
- Describe and explain the likely targets and time of year for a biological terrorism event
*
*
Terrorism Definition
- Terrorism (FBI definition): “The unlawful use of force or violence against persons or property to intimidate or coerce a government, the civilian population, or any segment of it, in furtherance of political or social objectives”
*
*
- The intentional use of micro-organisms or toxins derived from living organisms to produce death or disease in humans, animals, or plants
- The goal of bioterrorism is to produce fear in the population with subsequent disruption of society
Bioterrorism Definition
*
*
History of Bioterrorism/Biowarfare
- 6th century BC
- Assyrians poison the wells of their enemies with rye ergot
- Solon of Athens poisons the water supply with hellebore (skunk cabbage) an herb purgative, during the siege of Krissa
- 184 BC – Hannibal forces hurled earthen pots filled with serpents upon enemy
- 1346 – Tatars catapulted corpses with bubonic plague over walls into Kaffa (modern Crimea)
*
*
History of Bioterrorism/Biowarfare
- 1422 – Battle of Carolstein (Czech Republic), bodies of slain soldiers plus 2,000 cartloads of excrement are hurled at the enemy
- 15th Century – Pizarro presented native South Americans with smallpox-contaminated clothing
- 1710 – Russian troops hurl the corpses of plague victims over the city wall in war with Sweden
- 1763 – British army provided Delaware Native Americans with blankets and handkerchiefs taken from smallpox hospitals
*
*
History of Bioterrorism/Biowarfare
- 19th and 20th century – Livestock contaminated with anthrax and glanders
- 1925 – Geneva Protocol prohibits use of chemical and biological weapons
- 1937-1945 – Japan’s “Unit 731” among other activities dropped plague-infected fleas over Manchuria & China
- 1943 – U.S. launches biological warfare research
- 1953 – U.S. defensive program was launched in response to Russian aggression
*
*
History of Bioterrorism/Biowarfare
- 1969 – President Nixon disbands offensive program
- 1975 – President Ford signs prohibition on the development, production and stockpiling of biological and toxin weapons
- 1984 – Rajneeshee Cult contaminated restaurant salad bars with Salmonella typhimurium in Oregon
- 1991 – Minnesota, ricin toxin (hoax)
- 1995 – Arkansas, ricin toxin (hoax)
*
*
History of Bioterrorism/Biowarfare
- 1995 –Aum Shinrikyo cult attempted to disperse BW agents in aerosol form; sarin gas attack in Tokyo
- 1995 – Ohio, Yersinia pestis sent in mail
- 1997 – Washington, DC: “Anthrax” (hoax)
- 1998 – Nevada, non-lethal strain of B. anthracis
- 1998 – Multiple “Anthrax” hoaxes
- 2001 – Anthrax-contaminated letters sent to
U.S. media and government offices
*
*
- May be easier, faster to produce and more cost-effective than other weapons
- Potential for dissemination over large geographic area
- High morbidity and mortality
- Creates panic
- Person-to-person transmission possible
- Difficult to diagnose and/or treat
Advantages of Biologicals As Weapons
*
*
Preparation
~5 years
Execution
1 day
Diagnosed case(s)
3+ days
First Death
Multiple deaths
Days to months
Terrorism takes much time and planning
Timeline for a Bioterrorist Attack
*
*
The Nature of Biological Terrorism
Does Biological Terrorism present
any different challenges than
Conventional Terrorism?
*
*
The Nature of Biological Terrorism
- Unique
- Insidious
- There is no “incident site” with BT
- Infected individuals may become carriers
- Symptoms delayed in presentation
- May have greater mortality than chemical agents
*
*
The Nature of Biological Terrorism
- Most likely targets for a biological attack
- Large conventions
- Large indoor gatherings (concerts, sports events)
- Large hotels (international/out-of-state visitors)
- Large office buildings
- International/domestic airports
All buildings with ventilation systems are
potential targets
*
*
The Nature of Biological Terrorism
- Time of the year Biological Attacks possess the greatest potential threat
- Winter
- Cold / Flu Season
- Effects of a Biological Attack may appear but not be identified as such
- Family physician’s office – first “wave”
- How will we know it has occurred?
*
*
Ideal Characteristics for Potential Biological Terrorism Agent
- Inexpensive and easy to produce
- Can be aerosolized (1-5 µm)
- Survives sunlight, drying, heat
- Cause lethal or disabling disease
- Person-to-person transmission
- No effective treatment or prophylaxis
*
*
Category A Agents
- Pose a risk to national security
- Easily disseminated or transmitted from
person to person - High mortality rates
- Potential for major public health impact
- Panic and social disruption
- Require special action
*
*
Category A Agents
*
*
Summary of Biological Terrorism
- Unique challenges
- Potential to escalate
- Target = large concentrations of people
- “Discovered” after the fact
*
*
Pandemic Influenza/Avian Influenza
Types of Influenza
- Type A
- Epidemics and pandemics
- Animals and humans
- All ages
- Type B
- Milder epidemics
- Humans only
- Primarily affects children
*
*
Recent Pandemic Influenza Outbreaks
- 1918 – Spanish flu (H1N1)
- 500,000 in United States
- 40,000,000 worldwide
- 1957 – Asian flu (H2N2)
- 70,000 deaths in United States
- 1-2,000,000 worldwide
- 1968 – Hong Kong flu (H3N2)
- 34,000 deaths in United States
- 700,000 worldwide
- 1976 Swine flu (H1N1)
- 1977 Russian flu (H1N1)
*
*
Influenza Deaths Compared
to War Deaths
*
*
I had a little bird / Its name was “Enza” / I opened up the window/ and in-flew-enza!
– Popular children’s rhyme, 1918
*
*
Recent Avian Influenza Outbreaks
Affecting Humans
- 1997 – H5N1 Hong Kong
- 1999 – H9N2 Hong Kong
- 2003 – H7N7 Netherlands
- 2004 – H7N3 Canada
- 2004 – H5N1 Southeast Asia
*
*
Animal Reservoirs
- All influenza A subtypes recognized to date are found in wild birds
- Fecal transmission common among wild birds
- Usually, infections occur without illness
- Other animal species
- Domestic poultry (chickens, ducks, and quail)
- Humans, swine, horses, seals, whales
- Humans usually infected by human influenza viruses
*
*
Response to a Biological Event
How do we respond?
*
*
Planning Issues
- Detection and Tracking
- Care for Isolated and Ill
- Vaccines and Antivirals
- Food and Other Support
- Basic Services and Economic Impact
- Communication
- Quarantine and Isolation
- Family plan (Family health records/ immunizations)
- Travel
- Attendance at schools
*
*
Business as Usual?
- Can government or business be operated from a remote site?
- Private business strategy?
*
*
Response to a Biological Event
- Primary tools
- Organism identification
- Disease surveillance
- Who and where are victims?
- Local or widespread outbreak?
- Commonality of victims?
- Contact evaluation
- Family Members?
- Acquaintances/co-workers?
- Event?
- Travel?
*
*
Response to a Biological Event
Other Control Measures
- Vaccines
- Antibiotics/antivirals
- Education to encourage prompt self-diagnosis
- Public health information (risks, risk avoidance, advice on universal hygiene behavior)
- Hand hygiene
- Face masks for symptomatic persons
- School closures (?)
- Deferring travel to involved areas
*
*
Response to a Biological Event
Other Control Measures
- Isolation precautions
- Private room or with other similar patient(s)
- Negative air pressure room, or placed with other suspected influenza cases in area of hospital with independent air supply
- Masks for HCW entering room
- Standard droplet precautions (hand washing, gloves, gown and eye protection)
*
*
Response to a Biological Event
Other Control Measures
- Feasibility of these measures in a pandemic setting is questionable, priorities should include:
- Droplet transmission precautions (use of masks and hand hygiene)
- Cohorting of influenza-infected patients
*
*
Response to a Biological Event
Even after answering these questions, are we sure it’s an act of biological terrorism?
*
*
Response to a Biological Event
- Right agency to lead response?
- Addressed in State’s EOP?
- State Code?
- Prior coordination?
- All response agencies notified?
*
*
Response to a Biological Event
- When assigning an Incident Commander to manage a Bioterrorism Incident, identify some of the qualifications you consider essential
- The Incident Commander may not be a representative of the lead agency
- Why?
*
*
Response to a Biological Event
Others considered for inclusion in the Incident Management Group (not all inclusive)
All these groups can likely make
a valuable contribution
- Department of Labor and Industry
- Department of Public Welfare
- Non-Governmental Organizations
- Office of Administration
- Private Sector
- Department of Agriculture
- Department of Aging
- Department of Conservation and Natural Resources
- Department of Transportation
- Department of Mental Health
- National Guard
- Department of Health
*
*
Response to a Biological Event
- Response nontraditional and Public Health facilitated
- Different types of information
- Short time frame
- Patient focused
- Coordinating agencies
- Subject Matter Expert agency: PADOH
- Qualifications for Incident Commander
- Support agencies
*
*
Containing a Biological Event
We know we’ve been attacked with a
biological agent…
Now what?
*
*
Containing a Biological Event
- What elements or options of ICS should be employed?
- Single Command
- Incident does not exceed local SOP
- Incident does not generate extraordinary activities or concerns
- Unified Command
- More than one agency involved
- Only one jurisdiction involved?
Is this incident stand alone, or part of a more complex series of incidents that may include more than one jurisdiction?
*
*
Containing a Biological Event
- What elements or options of ICS should be employed?
- Area Command (Unified Area Command)
- More than one agency involved
- More than one jurisdiction involved
- A region involved
- Multi-Agency Coordination (MACs)
- Do you need to interact with agencies/jurisdictions?
- Multiple dispatch centers (911 centers)?
- Multiple EOCs or a large geographical area?
*
*
Containing a Biological Event
- Status of health care facilities
- Stretched to breaking?
- Expandable?
- Necessary resources?
- Where will you treat the overflow of patients?
- School Gyms
- Community Centers
- Churches/Synagogues
- Tents
- How will you re-supply medications?
- Private companies
- Emergency contracting
- Strategic National Stockpile
*
*
Containing a Biological Event
- Will you recommend
- A state of emergency?
- Isolation of outbreak areas?
- Enforcement?
- Mass Prophylaxis?
- Time?
- Persons who refuse?
*
*
Containing a Biological Event
- Personal consequences of your recommendations?
- Political consequences of your recommendations?
- Presidential Declaration?
*
*
Containing a Biological Event
- Remains of the deceased?
- Storage?
- Concerns and return to family?
- Mass cremation/burial?
- Personal/political consequences?
What resources are available from outside your state? DMAT? DMORT? How do you get those resources and who pays?
*
*
Recovering from a Biological Event
- Now that the disease is on the decline, how do you go about recovering?
- You may have lost personnel
- You’ve exceeded the State’s budget
- Do you still need all sections of ICS?
- How quickly do you try to capture and analyze the large amount of information you’ve just accumulated?
- One month?
- Six months?
*
*
Recovering from a Biological Event
- Or, do you determine the answers to these and many other issues before a Biological event?
Food for Thought:
These same issues will come up if Pandemic flu hits your area (The pandemic of 1918/1919 caused 40 million deaths worldwide)
*
*
Conclusions
- There are no quick or easy fixes to these issues
- Open the dialogue process with other agencies
- Revise your preparedness plans based on lessons learned
- A plan is a living document
- It evolves based on your collective experiences and evolving best practices
*
*
Conclusions
- Deploy your personnel to the appropriate EOCs
- Half the battle is maintaining good
communications - Now is the time to develop your agency’s goals, priorities, and policies
- Develop multiple scenarios based on different biological agents
*
*
Parting Thoughts
- Interoperability
- Common Operating Picture
- My Plans compared to
- NRP
- NIMS
- ICS
*
*
We have only one enemy, and that, is complacency
– Julie Gerberding, MD, MPH; Director, CDC
*
*
Questions?
*
*
Incident Command System
for Executives
Part III
Bioterrorism Tabletop Exercise
presented by
The National Emergency Management Association
Harrisburg, Pennsylvania
April 2007
*
*
Purpose of Exercise
- Assure mechanisms for effective communications and public information are in place
- Implement necessary control measures
- Identify critical issues and alternative courses of action
- Refine Emergency Operations Plans based on the issues you address here today
*
*
Exercise Goals
Preface: The events during this exercise are oriented to the State Emergency Operations Center and the exercise will be framed within the context of a Unified Command (UC)
- Correlate the Executives’ ability to provide guidance objectives to Incident Command
- Develop a prioritized list of issues to take back to your agency
- Identify issues that may be seen with a bioterrorism event
*
*
Exercise Objectives
Within the Context of UC
- Demonstrate the need to clearly articulate the agency’s policies
- Articulate the criteria for evaluating an effective response using ICS
- Understand the need to support a Multi-Agency Command response to a large-scale Biological Terrorism incident
*
*
Exercise Participants
- American Red Cross, Pennsylvania Southeastern Chapter
- Chester County Emergency Management Agency
- City of Harrisburg Fire Department
- Easttown Township Police Department
- Department of Agriculture
- Department of Corrections
- Department of Economic Development
- Department of Education
*
*
Exercise Participants
- Department of Environmental Protection
- Department of General Services
- Department of Health
- Department of Military & Veteran Affairs
- Department of Public Welfare
- Department of Transportation
- Emergency Management Agency
*
*
Exercise Participants
- State Police
- Office of Administration
- Office of Homeland Security
- Office of the State Fire Commissioner
*
*
- Background information
- Five events
- Questions follow each event
- Identify requirements for future plans
Exercise Organization
*
*
- Active participation is encouraged
- Bring issues affecting your agency to discussion
- Discuss your agency’s role within ICS and response to the event
Roles of Participants
*
*
Framework for Discussion
- What can we do, given the existing resources?
- What should we do if resources are not available?
- How do we need to modify existing Emergency Operations Plans?
- How do we incorporate NIMS into the management and operational strategy for this event?
*
*
Background…
*
*
World Headlines
London, August
- Terrorist Organization Threatens Security
- Suspected Terrorists Identified by Video Cameras in Subways
- Arrested Terrorists Have Links to Al-Qaeda
*
*
National News
November
- Reports of “Bird Flu” Reaching Europe; Infected Birds Tested
- DHS Reports High “Chatter” Levels
- National Threat Level Not Raised
- Shortage of Influenza Vaccine
*
*
Pennsylvania
January
*
*
Pennsylvania
January
- State Health Officials See No Letup in Influenza Cases
- School Absentee Rates Highest in Decade
- Flu Epidemic Hits Area Services Hard
*
*
Hershey/Harrisburg Area Hospitals
25-mile Radius1
*Assume 80% occupancy
1 Data source: The American Hospital Directory (www.ahd.com) and PinnacleHealth
| # Hospitals | # Beds | # Open beds* |
| 10 | 3,175 | 635 |
*
*
Event 1
Outbreak…
*
*
Hershey Medical Center
Wednesday, Day 1
*
*
Twenty-four Year Old Male
Becomes Sick
- Guest Roger Smith staying at Holiday Inn - Grantville
- Complains of chills, fever, cough, and chest pain
- Contacts hotel front desk for assistance
- Hotel employee calls 911
- EMS takes him to ER at Hershey Medical Center
Wednesday, Day 1, 2 p.m.
*
*
Patient Examined in the
Emergency Room
- Disoriented
- Temperature 103o F
- Difficulty breathing
- Abnormal physical exam
- Chest X-ray obtained
Wednesday, Day 1
*
*
Patient Admitted to Hospital
- Diagnosis: “community acquired pneumonia” (CAP)
- Begins coughing blood
- Increased difficulty with breathing
- Transferred to ICU
- Placed on “life support” (ventilator)
Wednesday, Day 1, 7 p.m.
*
*
Twenty-nine Year Old Male
Develops Fever
- Works as general maintenance mechanic
- Felt tired on the job
- Had sleepless night
- Difficulty breathing
- Progressively worsened throughout day
Wednesday, Day 1, 7:30 p.m.
*
*
EMS Transports
Male Patient (Second Patient)
- Patient with fever, difficulty breathing
- Elevated white blood count
- Pneumonia on X-ray
- Admitted and started on antibiotics
Wednesday, Day 1, 7:30 p.m.
*
*
Three Additional People
Become Sick
- Patient complaints: Fever and respiratory symptoms
- Transported via EMS and private car
- Diagnoses
- Two patients
- “Viral pneumonia”
- Discharged
- One patient
- Community acquired pneumonia (CAP)
- Prescribed antibiotics
- Discharged
Thursday, Day 2, 3 p.m.
*
*
Hospitals Treating Patients
Thursday, Day 2, 3 p.m.
- Community General Hospital
- Good Samaritan Hospital
- Harrisburg Hospital
- Hershey Medical Center
- Holy Spirit Hospital
- Lancaster General
- Lancaster Regional Medical Center
- York Hospital
*
*
One Hundred More Sick Patients
- During day 3 an additional 100 patients with a presumptive diagnosis of Community Acquired Pneumonia (CAP) are treated and released at area hospitals
- Patients range from 8 to 39 years old
- Fever and respiratory symptoms
- Mr. Smith (24-year-old male patient #1) dies of respiratory failure at Hershey Medical Center
Friday, Day 3
*
*
End of First Event
*
*
Questions
Event 1: Outbreak
*
*
Event 2
Detection & Diagnosis…
*
*
Male Patient Arrives at
Hershey Medical Center
(Patient # 107)
Symptoms began yesterday
- Fever
- Chest pain
- Coughing blood
Saturday, Day 4, 7:45 a.m.
*
*
Hershey Medical Center Laboratory
- Preliminary results of cultures on Mr. Smith are now available
Saturday, Day 4, 8 a.m.
*
*
Gram Stain of Mr. Smith’s
Blood Culture
Saturday, Day 4
*
*
Hershey Medical Center Laboratory
- Gram stain: gram-negative rods
- Hospital pathologist has participated in CDC satellite courses
- Suspects Yersinia pestis
Saturday, Day 4, 8 a.m.
*
*
Hershey Medical Center Laboratory
- Performs Wright’s stain on specimen
- Sees “safety pins”
- Notifies health department
- Notifies infectious
disease consultant and medical examiner
Saturday, Day 4, 8 a.m.
*
*
Infectious Disease Physician Reviews Case
- Patient #1 - Mr. Smith
- From out of state
- No history of exposure to animals
- Clinical course suggests pneumonic plague
- Requests autopsy
Saturday, Day 4, 9:45 a.m.
*
*
Harrisburg Hospital
- Patient transported by EMS
- Nine-year-old female with fever and difficulty breathing
Saturday, Day 4, 11 a.m.
*
*
Office of the Dauphin County Coroner
Saturday, Day 4, 3 p.m.
*
*
Office of the Medical Examiner
Autopsy findings for Mr. Smith
- Heavy, congested lungs with evidence of bleeding
- Swelling of lymph glands
- Evidence of low blood pressure
Saturday, Day 4, 3 p.m.
*
*
Office of the Medical Examiner
Microscopic examination
- Gram-negative coccobacilli with safety pin bipolar staining
Preliminary Findings
- Pneumonic plague
Saturday, Day 4, 3 p.m.
*
*
PADOH
- Local health officials seek assistance from PADOH
- PADOH notifies the CDC
Saturday, Day 4, 3:15 p.m.
*
*
Facts About Plague
- Rare, only 10-15 cases in United States
per year - Usual transmission via bite of infected flea
- Incubation period 1-7 days
- Three clinical forms
- Bubonic
- Septicemic
- Pneumonic
*
*
Facts About Plague
- Pneumonic plague
- Can be transmitted from person to person (most credible exposure range - 6 ft.)
- Mortality near 100% if untreated
- Antibiotics effective if started early (12 to 24 hours following onset of symptoms)
- Vaccine available, efficacy not well tested
*
*
End of Second Event
*
*
Questions
Event 2: Detection & Diagnosis
*
*
Event 3
Communications
Event 3: Communications
*
*
WGAL Channel 8
- Rumors of “rat-bite fever” on a local talk show
- TV reporter begins investigation
- Reporter calls hospitals
- Reporter calls Governor’s Office and
Pennsylvania Department of Health
Saturday, Day 4, 4:15 p.m.
*
*
Outside Hershey Medical Center
- WGAL leads with Hershey Medical Center feed
- Reporter speculates about mystery illness
- Describes symptoms
- Sore throat
- Headache
- Cough
Saturday, Day 4, 5:30 p.m.
*
*
Outside Hershey Medical Center
- On-site reporter notes that illness (plague) is highly unusual
- Speculates that event could be intentional, with hundreds or thousands sick
Saturday, Day 4, 5:33 p.m.
*
*
WGAL News Center
- Anchorman thanks reporter for story
- Comments, “Well, maybe if people are feeling these symptoms, it would be best to seek the advice of their family doctor”
Saturday, Day 4, 5:34 p.m.
*
*
Outside Hershey Medical Center
Emergency Room
- Hundreds descend on local hospitals
- Persons interfere with hospital operations
- Families begin pulling relatives out of hospitals
Saturday, Day 4, 6:15 p.m.
*
*
End of Third Event
*
*
Questions
Event 3: Communications
*
*
Event 4
Investigation…
*
*
Emergency Rooms at
Local Hospitals
- Hundreds of additional persons with fever and cough seek treatment
- Scores of people who think they are sick seek treatment
- Since the onset of the event 29 people have died
Sunday, Day 5, 10:30 a.m.
*
*
Joint Information Center
Harrisburg
- National reporters flock to the capital region
- Media devotes continuous airtime
- Reporters question why source of outbreak not identified
- Public spokespersons give assurances
- Public health and law enforcement seeking source of infection
Sunday, Day 5, 12 p.m.
*
*
Public Information Lines
- Rumor Control Lines established
- Callers complain about busy signals
- Staff note many callers not sick but worried
- Some callers speculate about illness source
- Lines have become inundated with non-medical requests for information
Sunday, Day 5, 4 p.m.
*
*
PADOH
Public Health Laboratory
- Lab begins to receive additional clinical specimens
- Lab personnel on leave and travel status contacted
Sunday, Day 5, 4 p.m.
*
*
PADOH
- Health officials develop “case definition” for suspected plague illness
- Area hospitals canvassed
- Patients and families interviewed
Monday, Day 5, 9 a.m.
*
*
Number of Cases of Confirmed or Suspected Plague by Date of Arrival at Hospitals
Capital Region – January 11-14
Monday, Day 6, 9 a.m.
*
*
End of Fourth Event
*
*
Questions
Event 4: Investigation
*
*
Personnel Needed for Mass Prophylaxis
# days to
prophylax
Metro area
3 shifts/day
2 shifts/day
core support total
core support total
*Weill/Cornell Mass Prophylaxis/Vaccination Model