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MFHCC Meeting February 7, 2017 Jefferson County Public Health Lakewood, CO Welcome and Introductions Agenda Arrive, sign in, grab lunch Welcome & Introductions Janelle Changes to HCCs and Healthcare Preparedness Program (HPP) Dane

Matthews, Director, CDPHE-OEPR Agency Updates - All Lisa Upcoming Training and Events Lisa and Janelle Member Agency Spotlight Colorado Coalition for the Homeless - Stan Eilert Infectious Disease Update: Mumps & Measles Carol McDonald Health Alert Network (HAN) Overview Lisa and Christine Public Health Emergency Operations Plan (PHEOP) Summary - BOH Rule to have partners review the plan - Janelle and Christine Influenza Update - Angel Anderson, JCPH and Lisa Miller, MD, MSPH, CDPHE Inpatient Bed Tracking Discussion Lisa and Janelle Grant Funding - James Robinson, DHPD Review New Action Items Networking REVIEW PREVIOUS ACTION ITEMS Janelle Worthington

Review Previous Action Items ACTION ITEMS PERSON RESPONSIBLE DEADLINE Contact Christine/Cali if interested in becoming a JCPH or Denver Closed POD. All On-going Email Janelle or Lisa to sign up for workgroups of interest, including the PHED EX workgroup. All On-going

Member Spotlight - email Janelle and Lisa if you would like to be featured on the website. ALL ON-GOING Cali Zimmerman TBD Cali will e-mail the Inventory Management System Excel form to all Denver Closed POD partners for confirmation and for POD site records. HEALTHCARE PREPAREDNESS PROGRAM (HPP) AND HCC CHANGES FY 2017 2022 Dane Matthew, Director

CDPHE - OEPR [email protected] (303) 692-2954 Hospital Preparedness Program ASPRs Hospital Preparedness Program (HPP) enables the health care delivery system to save lives during emergencies and disaster events that exceed the day-to-day capacity and capability of existing health and emergency response systems. HPP is the only source of federal funding for health care delivery system readiness, intended to improve patient outcomes, minimize the need for federal and supplemental state resources during emergencies, and enable rapid recovery. HPP prepares the health care delivery system to save lives through the development of health care coalitions (HCCs) that incentivize diverse and often competitive health care organizations with differing priorities and objectives to

work together. Hospital Preparedness Program The intended HCC participants include but not Hospitals EMS (including interEmergency limited to: Management Public Health Agencies facility and other non-EMS Organizations patient transport systems) Behavioral health services and organizations Child care providers (e.g., daycare centers) Community Emergency Response Teams (CERT)1 and Medical

Reserve Corps (MRC)2 Dialysis centers and regional Centers for Medicare & Medicaid Services (CMS)-funded end-stage renal disease (ESRD) networks3 Faith-based organizations Federal facilities (e.g., U.S. Department of Veterans Affairs (VA) Medical Centers, Indian Health Service facilities, military treatment facilities Home health agencies, including home and community-based services 1 Community Emergency Response Teams. Infrastructure companies (e.g.,

utility and communication companies) Jurisdictional partners including Cities, counties, and tribes Local chapters of health care professional organizations (e.g., medical societies, professional societies, hospital associations) Local public safety agencies (e.g., law enforcement and fire services) Medical and device manufacturers and distributors Non-governmental organizations (e.g., American Red Cross, voluntary organizations active in disasters, amateur radio

operators, etc.) Outpatient health care delivery (e.g., ambulatory care, clinics, community and tribal health centers, Federally Qualified Health Centers (FQHCs), 4 urgent care centers, freestanding emergency rooms, stand-alone surgery centers) Primary care providers, including pediatric and womens health care providers Schools and universities, including academic medical centers Skilled nursing, nursing, and longterm care facilities

Support service providers (e.g., clinical laboratories, pharmacies, radiology, blood banks, poison control centers) Other (e.g., child care services, dental clinics, social work services, faith-based organizations) Specialty patient referral centers (e.g., pediatric, burn, trauma, and psychiatric centers) should ideally be HCC members within their Urban and rural HCCs Urban and rural HCCs may have different membership compositions based on population characteristics, geography, and types of hazards. For example, in rural and frontier areas where the distance between hospitals may exceed 50 miles and where the next closest hospitals are also critical access

hospitals with limited servicestribal health centers, referral centers, or support services may play a more prominent role in the HCC. Hospital Preparedness Program The 2017-2022 Health Care Preparedness and Response Capabilities Draft came out in OctoberIdentified significant HCC roles Guidance describes what the health care delivery system, including HCCs, hospitals, and emergency medical services (EMS), have to do to effectively prepare for and respond to emergencies that impact the publics health. Capabilities may not be achieved solely with the funding provided by the HPP Funding for 2017-2022 required to be directed to HCCs Exceptions: Centrally procured services by state (ie. EMSystems, CHA, CCHN) State administrative oversight capped at 18% for BP1 down to

15% by BP5 Goal, more HPP funding pushed to the regional/local level HCC to determine localized comprehensive health care preparedness priorities HPP Capabilities Capability 1: Foundation for Health Care and Medical Readiness Goal of Capability 1: The communitys health care organizations and other stakeholderscoordinated through a sustainable HCChave strong relationships, identify hazards and risks, and prioritize and address gaps through planning, training, exercising, and managing resources. Capability 2: Health Care and Medical Response Coordination Goal of Capability 2: Health care organizations, the HCC, their jurisdiction(s), and the ESF-8 lead agency plan and collaborate to share and analyze information, manage and share resources, and coordinate strategies to deliver medical care to all populations during emergencies and planned events. Capability 3: Continuity of Health Care Service Delivery

Goal of Capability 3: Health care organizations, with support from the HCC and the ESF-8 lead agency, provide uninterrupted, optimal medical care to all populations in the face of damaged or disabled health care infrastructure. Health care workers are well-trained, well-educated, and well-equipped to care for patients during emergencies. Simultaneous response and recovery operations result in a return to normal or, ideally, improved operations. Capability 4: Medical Surge Goal of Capability 4: Health care organizationsincluding hospitals, EMS, and out-ofhospital providersdeliver timely and efficient care to their patients even when the demand for health care services exceeds available supply. The HCC, in collaboration with the ESF-8 lead agency, coordinates information and available resources for its members to maintain conventional surge response. When an emergency overwhelms the HCCs collective resources, the HCC supports the health care delivery systems transition to contingency and crisis surge response and promotes a timely return to conventional standards of care as soon as possible. Colorado Specific HCC Challenges OEPR sent letter to ASPR in November requesting concessionsdenied.

We must submit a detailed plan with our grant application in March for how Colorado will comply with restructuring and funding HCCs. Colorado currently has 34 HCCsmany single county entities Many current HCCs do not meet core membership requirements Many HCCs do not have members with multiple like organizations Most HCCs are planning organizations only and have no operational roles identified to support ESF8 lead during response Most HCCs do not have an identified fiscal agent able to

receive funds from the state Next Steps HCC districts established; Goal is 9-15 total for the state (in progress) Each district may have multiple sub-coalitionspreferably not geographically oriented but functionally oriented coalitions Existing HCCs to align with one of the districts (not all HCCs will need to change) and adopt a governance structure HCCs identify fiscal agents: Fiscal agents may be: HCC itself as a non-profit entity A governmental agency A non-profit agent (such as CHA, Colorado Rural Health Center, etc.) When selecting a fiscal agent, HCCs should consider: Cost of fiscal agent services

Agents policies for procurement, hiring, and spending HCCs Personnel costs to manage funds internally as a non-profit entity to ensure proper accounting, procurement, and tracking requirements Provide Colorado Plan for implementation to ASPR FIRST DRAFT of Proposed HCC Layout based upon existing HCCs, RETACs, and All Hazard Regions 7 1 5 8 2 1 0

3 4 9 6 1 1 1 2 1 3 OEPR Focus 2017 2022 Slogan: Prepared for when somedayis today VISION: Ensure Colorados communities are completely prepared to respond to and recover

from, incidents adversely impacting health and our environment MISSION: Protect the health of Colorados people by collaborating with our community partners to provide preparedness support, skilled incident response, and expert recovery guidance whenever needed Priority Goals: Countermeasure Mitigation Information Management Recovery Management Training and Exercise HCC Establishment Response Support OEPR Focus Roll-up to Domains and PHEP/HPP Capabilities Community Resilience Recovery Management

Incident Management Surge Management Countermea sure & Mitigation Training and Exercise Countermeas Response ure Support Mitigation Information Management

Information Management Bio Surveillance HCC Establishment Community Recovery Fatality Management Community Preparedness Foundations for Health Care & Medical Readiness Health Care & Medical Response & Recovery Coordination

Responder SafetyOperations and Emergency Coordination Health Community Preparedness Medical Surge Health Care & Medical Response & Recovery Coordination Continuity of Health Care Service Delivery Informatio n Sharing Emergency Operations Volunteer Management

Medical Countermeasur MedicaleMaterial Management and Distribution Dispensing Community Preparedness EOC Activation Public Information Responder Health & Safety Coordination Community Preparedness Emergency Operations Coordination Community Recovery

Emergency Public Information and Warning Health Care & Medical Response & Recovery Coordination Foundations for Health Care & Medical Readiness Health Care & Medical Response & Recovery Coordination Solutions? AGENCY UPDATES Lisa Agency Updates Please mention brief updates you would like to

share with the entire group Include your name and agency name High level reports applicable to various agencies Updates requiring in depth discussions may transition into workgroups Agency Updates Epidemiology Update Hospitals Public/Environmental Health EMS Provider Emergency Management Long Term Care Mental/ Behavioral Health Outpatient Medical Services (Example: community health center, clinic, dialysis, etc.) Other HCC Partner (Example: education, private, federal

entity, coroner, etc.). UPCOMING TRAININGS AND EVENTS Lisa and Janelle Upcoming Events & Trainings Networking Activity - Full Moon Snowshoe Event, February 11 th Idaho Springs area Echo Lake or Bakerville to Loveland Trail (BLT) 6pm food and drinks in Idaho Springs Sign-in sheet provide email and cell phone that we can contact on the weekend Discuss need for PPE/Decontamination/HazMat trainings MFHCC Website - 2017 Training and Exercise Opportunities in our Community Throughout the year - Mental Health First Aid Trainings Jan - June - Bridging The Gap Medical Interpreter Training by Asian Pacific Development Center

Feb 8 & 15 - ICS 100 & 700 In-Person Trainings, Clear Creek March 1 & May 8 - Trauma Informed Care Workshops, Jefferson Center for Mental Health. July 25-26 - Public Information in an AllHazards Incident Sept. 19-20 - Pediatric Disaster Response and Emergency Preparedness PHED EX Public Health Emergency Dispensing Exercise (PHED EX) June 2017 Workgroup divided into two groups: 1. Denver PHED EX Workgroup 2. Jefferson/Clear Creek/Gilpin PHED EX Workgroup Communications workgroup Will meet to review draft plan and eventually test it MEMBER AGENCY SPOTLIGHT COLORADO COALITION FOR THE

HOMELESS Stan Eilert PUBLIC HEALTH EMERGENCY OPERATIONS PLAN (PHEOP) REVIEW Janelle Worthington, JCPH JCPH PHEOP Board of Health Rule PHEOP reviewed & updated at least every 3 years: Submitted to CDPHE/OEPR Submitted to local Board of Health Copy made available to: OEM, Hospital(s), Rural Health Clinics, FQHCs, RETACs JCPHs PHEOP Summary will be sent out with the meeting minutes If you would like to review the full PHEOP or any of the Plan Annexes, please email Janelle at [email protected] Please send feedback and questions to Janelle about either the PHEOP

Summary or the full plan JCPH PHEOP Concept of Operations Purpose: Describe the basic strategies and mechanisms by which JCPH will prepare, prevent, protect against, quickly respond to, and recover from allhazard emergencies, particularly those whose scale, timing, or unpredictability threatens to overwhelm routine activities: Infectious disease outbreaks, environmental public health hazards, natural disasters, and other threats that threaten the publics health. PHEOP is divided into two parts: Concept of Operations, provides guidance based on the three operation phases: Prepare, Prevent, Protect Respond Recover Plan Annexes, consists of several support annexes that provide specific

guidance for specific situations, such as mass care and public information communications. JCPH PHEOP Concept of Operations Prepare, Prevent, Protect Begins when a potential threat to public health has been identified Hazard and Vulnerability Assessment (HVA): JCPH, JCSO EM, FHCC (2014) Community Health Assessment (CHA) On-going epidemiologic surveillance Plans, vaccinations of public and JCPH staff Caches - antibiotics, personal protective equipment (PPE) and communication equipment

Respond 21 Steps: starting with incident identification, and ending with implementing the demobilization plan Public Health Led Incident vs. Public Health Supported Incident Recover Identify recovery lead; conduct a community needs assessment (includes epidemiological surveillance); restore public health services; debrief and compile the After Action Report & Improvement Plan (AAR/IP); and mitigation JCPH PHEOP Roles & Responsibilities Jefferson County Public Health ESF#8b Lead

Advise the BCC and BoH Conduct epidemiological surveillance and outbreak investigations Etc. Jefferson County Emergency Management Emergency Operations Center (EOC) will provide resource support Jefferson County Type III Incident Management Team (IMT) May fill the Command and General Staff roles if the management of the incident exceeds the capacity of JCPH Metro Foothills Healthcare Coalition Members May utilize the members of the MFHCC for support of a public health incident Participate in preparedness planning, represent their ESF in the County EOC, provide staff surge capacity for JCPH, and participate in information sharing JCPH PHEOP Plan Annexes

Community Containment Annex Continuity of Operations Annex Epidemiological Investigation Annex Health Alert Network Annex Internal and External Emergency Contact Annex Internal Information and Communications Annex Mass Dispensing & Distribution Annex Medical Surge Annex Public Information and Communications Annex Training and Exercise Annex Volunteer Annex

INFLUENZA UPDATE Lisa Miller, MD, MSPH, CDPHE and Angel Anderson, JCPH Influenza Update CDPHE online influenza report: https://www.colorado.gov/pacific/cdphe/influenza Reported Outbreaks by Etiology in Jefferson County, CO in Healthcare and Residential Facility Settings, October 1, 2016 February 3, 2017 Month of Report Influenz Confirme Suspect a d Noro Noro Grand Total

October 2016 0 0 1 1 November 2016 1 1 1 3

December 2016 1 0 0 1 January 2017 8 0 2 10 February 2017

1 1 0 2 11 2 4 17 Grand Total Influenza outbreak in a long-term care facility Suspected influenza outbreak: Two cases of Influenza Like Illness

(ILI) within a 1-week period without a positive test for influenza. During the time when influenza is circulating locally, the occurrence of acute febrile respiratory illness in several residents within a short time frame should be considered highly suspect for influenza until proven otherwise, regardless of whether the affected residents have been vaccinated. Confirmed influenza outbreak: at least one resident with a positive test for influenza among two or more residents with ILI. Please report all suspected and confirmed influenza outbreaks to your local health department. Outbreaks are reportable conditions in Colorado. https://www.colorado.gov/pacific/cdphe/flu-resources-health-professio nals-and-schools Angel Anderson, MPH, REHS Regional Epidemiologist Jefferson County Public Health 800 Jefferson County Parkway, Golden, CO 80401 303.271.5742 office, 303.271.8390 fax [email protected] GRANT FUNDING

OPPORTUNITIES James Robinson, DHPD Grant Funding Opportunities We do not currently have a regional capability to treat multiple patients from MCI in a climate controlled environment MCI in inclement weather present significant challenges Hypothermia has demonstrated negative impacts on trauma survival and morbidity Buses can serve as mobile treatment areas for MCI We do not currently have a regional capability for transporting multiple supine patients Unlikely that this would be an MCI transport resource from a scene More likely a multiple patient transport resource for other contingencies Evacuations- hospital, SNF, assisted living Moving multiple patients to a climate controlled environment (i.e. apartment fire with AFN people, inclement weather MCI) Regional plans to have EMS perform evacuations may conflict with incident

management priorities EMS capacity to perform evacuations may be limited by day-to-day capacity and the availability of resources at the time of need This resource can be used as incident response support for fire and HazMat rehab Grant Funding Opportunities North Central All-Hazards Region/UASI Grant Applications is: https://www.netciv.com/wp-content/ncrgrantsyste m/public/index.html State of Colorado Emergency Medical and Trauma Section grants is: https://www.colorado.gov/pacific/cdphe/apply-emsand-trauma-funds Review New Action Items Lisa

Thank you! Networking

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