Health and Medical Services |
A. Purpose
To provide guidance and coordination of emergency medical, health, ministerial, and mortuary services in Pierce County.
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B. Scope
1. This ESF addresses the identification and coordination of the county's medical, health, ministerial, and mortuary needs during an emergency or disaster.
2. Planning for every health and medical contingency is beyond the scope of this ESF.
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A. It is the policy of Pierce County that Emergency Medical Technicians (EMTs), Paramedics or other first responders, who provide emergency medical assistance in Pierce County, shall operate under Pierce County procedures and protocols. The provision of basic and advanced life support services shall be provided as per existing standing operating procedures, patient care guidelines, and treatment and transfer protocols as promulgated or coordinated by the Emergency Medical Services (EMS) Division of the Pierce County Department of Emergency Management (DEM).
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B. It is the policy of Pierce County that a Disaster Medical Control Center (DMCC) to provide coordination among hospitals in a disaster and appropriate alternates be designated among hospitals in the county (see Tab 1 to this ESF).
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C. It is the policy of Pierce County that a mass casualty incident (MCI) may be declared to allow EMS personnel to follow established written emergency protocols without base station contact.
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D. It is the policy of Pierce County that the Sheriff's Chaplaincy and the Pierce County Critical Incident Stress Management Program will provide and coordinate on-scene defusing and support to emergency workers. This is done in coordination with the Pierce County Emergency Operations Center (EOC). Outside agencies or persons who offer to assist in this area will be referred to, screened and coordinated by Chaplaincy members. The Chaplaincy shall establish a liaison in the EOC during disaster operations, when requested.
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E. It is the policy of Pierce County that spiritual support and assistance from churches to persons affected by disaster be coordinated by the Associated Ministries of Tacoma-Pierce County (AM), in cooperation with the American Red Cross Tacoma-Pierce County Chapter (ARC-TPC Chapter).
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F. It is the policy of the Tacoma-Pierce County Health Department to provide guidance to political jurisdictions, agencies and individuals on basic public health principles involving safe drinking water, home and office air quality, food sanitation, personal hygiene, and proper disposal of human waste, garbage and infectious or hazardous waste spills.
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G. It is the policy of the Medical Examiner that remains should only be moved if authorized by the Medical Examiner or designee. It is further the policy of the Medical Examiner that commissioned Deputy Sheriffs may act as Deputy Coroners in the event of a situation wherein medical investigators from the Medical Examiners Office are unable to respond to the scene of a death.
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A. Emergency/Disaster Conditions and Hazards
Refer to the Pierce County Hazard Identification and Vulnerability Analysis.
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B. Planning Assumptions
1. A significant natural or technological emergency or disaster could overwhelm county medical facilities and services requiring emergency coordination of casualties.
2. County hospitals, clinics, nursing homes, pharmacies, and other medical and health care facilities may be severely damaged, destroyed, or rendered unusable.
3. An emergency or disaster can pose public health threats to food, water, and personal health.
4. Damage to manufacturing facilities, waste processing and disposal facilities, sewer lines, and water distribution systems and secondary hazards such as fires could result in toxic environmental and public health hazards to the surviving population and response personnel.
5. The damage and destruction of a catastrophic disaster will produce urgent needs for mental health crisis counseling and spiritual support for disaster victims and response personnel.
6. Disruption of sanitation services and facilities, loss of power, and massing of people in shelters may increase the potential for disease and injury.
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A. Emergency Medical Services
1. The EMS Division of the DEM is the lead agency for the coordination of EMS disaster planning under the scope of this plan. The chain of command for the EMS Division coordination is as follows:
a. Medical Program Director (MPD).
b. EMS Coordinator.
Any of the chain of command, when acting on behalf of the MPD, has the authority of the MPD in matters of coordination. In matters of medical control, designated physicians at respective base stations and receiving centers will be responsible for medical control in the absence of the MPD.
2. Upon request, or upon the occurrence of a disaster, the EMS Division staff shall report to the EOC. Appropriate staffing will be determined, depending upon the situation, to cover 24-hour operations if needed. Assistance in the EOC may be provided from other EMS providers. The EMS Division staff will initiate coordination with the DMCC.
3. Pierce County is divided into three base station zones for day-to-day EMS operations. Good Samaritan Hospital is the Base Station for the East Zone, Madigan Army Medical Center is Base Station for the South Zone. The Northwest Zone is temporarily in a Receiving Center mode of on-line medical control, where the closest hospital is contacted by the field units to provide medical control. Mary Bridge Children's Hospital is the Base Station for all patients under 16 years of age. As much as possible, this base station concept will be maintained for on-line medical control for out-of-hospital care during disaster operations.
4. Good Samaritan Hospital also functions as the primary Pierce County DMCC. The Director of the Emergency Department at Good Samaritan Hospital is the Coordinator of the DMCC. The alternate DMCC is Madigan Army Medical Center.
5. Direction and control of emergency medical functions at hospitals will be the responsibility of each facility's manager and staff. Upon the occurrence of an emergency or disaster, each hospital in Pierce County shall assess what has happened, what can be done about it with their own resources, and what is needed. This assessment shall include damages to the facility, condition and availability of staff, condition of patients, resource inventory information including pharmaceutical supplies, communications capabilities, and bed space. This information shall be relayed as soon as possible to the DMCC, and periodically updated. The DMCC shall provide this information and coordinate EMS needs with the EOC.
6. In the event normal communications are disrupted, doctors and nurses should report to the hospital where they practice the most for an assignment. Doctors and nurses who do not practice at a hospital should either go to their normal place of business to handle walk-in patients or report to the nearest hospital and offer assistance. Additional reporting points for physicians may be established to meet local community needs (such as in the Peninsula area).
7. The Medical Society of Pierce County is responsible for informing member physicians of current emergency policy and procedures through their regular publications. The Medical Society may also assist with coordinating physician services.
8. During major events, hospitals may resupply field units (ambulances, rescue units, etc.) with consumable medical supplies, to the extent practical. Non-consumable items will be procured through normal resupply procedures or through coordination with the EOC. Hospitals normally stock oral and injectable pharmaceutical supplies. Private drug stores primarily stock oral pharmaceutical supplies. Community needs for additional pharmaceutical supplies will be coordinated by the DMCC with information received from different hospitals when capability assessments are reported.
9. Emergency medical staffing and supplies not available in Pierce County may be requested from the Washington Department of Health through the state Emergency Operations Center or other jurisdictions through mutual aid coordinated with the DMCC and the EOC. The ARC-TPC Chapter and other Disaster Assistance Council agencies may support the EMS response with additional resources. Requests for additional out-of-hospital EMS resources may be coordinated by the DEM or the EOC.
10. Private ambulance organizations may provide the nucleus for emergency medical transportation. Transportation needs may be coordinated by the EOC. Fire services may provide the nucleus of emergency medical responders. Each fire agency would respond to their capability level.
11. Several hospitals in Pierce County participate in the National Disaster Medical System (NDMS) (see Tab 2 to this ESF).
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B. Health Services
1. The Tacoma-Pierce County Health Department is the lead agency for the coordination of public health services including, but not limited to sanitation services and basic hygiene; identification and control of communicable diseases; vector control; examination of food and water supplies for contamination; emergency sanitation standards for disposal of garbage, sewage and debris; assessment of environmental contamination, and public health risk from hazardous materials spills.
2. The chain of command for the Health Department is as follows:
a. Director of Health.
b. Public Health Manager.
c. Business Office Manager.
Any of the chain of command, when acting as the lead for the Health Department, has the authority of the Director of Health in matters of operations and departmental policy.
3. Upon the occurrence of a major event, Health Department staff shall report to their offices to do a situation assessment. General information needed includes what has happened, what can be done about it with existing staff, and what is needed. Specific information needed includes status of Health Department facilities, employees, and the capability to carry on Health Department responsibilities and programs. Also needed is information on Health Department clients and status of public health issues caused or affected by the event. This information shall be reported, and periodically updated, to the EOC.
4. The Director of Health is responsible for establishing liaison with the EOC. The level of coordination (operations, supervisory, policy, etc.) and whether the Health Department should be represented at the EOC will depend upon the situation. If the threat to public health is of such magnitude that supplemental assistance is necessary, supplemental assistance may be requested by the Director of Health to the state Health Officer. This request may be done directly by the Director of Health, or through the EOC, or the state Emergency Operations Center. The Health Department Public Information Officer (PIO) will coordinate with the Pierce County Emergency Public Information Officer (EPIO) media releases, concerning public health issues, through the EOC.
5. If a major event occurs during non-working hours, Health Department employees are advised to secure themselves and their families first; then, if possible, report to work for assignment. If phone access allows, employees may also contact the Health Department's emergency voice mailbox in Spokane (1-800-326-6959) where work instructions or other messages will be left for employees.
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C. Pierce County Sheriff's Department
1. Emotional support for emergency workers, disaster victims and relatives is coordinated on-scene by the Pierce County Sheriff's Chaplaincy and the Pierce County Critical Incident Stress Management (CISM) Team, with assistance from mental health care providers from the community. Long range mental health care may be provided after a Presidential Declaration of Disaster by the 'Crisis Counseling' program of the National Institute of Mental Health, which is delivered through local providers.
2. The Pierce County Sheriff's Department is the sponsor of the CISM Program. The program, via the team, provides assistance and support to law enforcement, fire and EMS personnel, and other emergency workers. The CISM Team shall be activated, upon request, after any incident where emergency workers need assistance dealing with critical incident stress. The team is activated through the DEM duty officer.
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D. Associated Ministries of Tacoma-Pierce County
1. To facilitate coordination among Pierce County congregations involved with AM, the county has been divided into 11 zones. Each zone has a lead person or congregation which acts as a coordinator for training, response, assessment and coordination.
2. The AM will appoint an Emergency Coordinator who will be responsible for the establishment of the AM Emergency Response Plan for Pierce County.
3. The AM Emergency Coordinator will maintain contact with the DEM on its progress, needs and assistance. The AM will make the initial contact with the EOC in the event of an emergency or disaster.
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E. Mortuary Services
1. The Pierce County Medical Examiner's Office is the lead agency for activities concerning the deceased as a result of an emergency or disaster. This includes identification and disposition of the dead, and documenting the number of confirmed dead. The chain of command for the Medical Examiner's Office is as follows:
a. Medical Examiner.
b. Deputy Medical Examiner.
c. Chief Medical Investigator.
d. Lead Medical Investigator.
Any of the chain of command, when acting as the lead for the Medical Examiner, has the authority of the Medical Examiner in matters of operations and departmental policy.
2. Upon the occurrence of a major event, the Medical Examiner and staff shall report to their offices to do a situation assessment. General information needed includes what has happened, what can be done about it with existing staff, and what is needed. Specific information needed includes status of the facility, employees, and the capability to carry on Medical Examiner responsibilities. This information shall be reported, and periodically updated, to the EOC.
3. If a major event occurs during non-working hours, Medical Examiner staff are advised to report to work for assignment. If they cannot get to work, they should report to the closest county facility, fire station or public facility and offer assistance.
4. The Medical Examiner may designate temporary morgues if the normally established morgues are overwhelmed and may coordinate with local funeral directors to identify staff to support these temporary morgues. The Medical Examiner is responsible for notifying local agencies of the locations of morgues and coordinating transportation of the deceased to these sites. This may be done through the EOC.
5. If, due to the circumstances of the event, no authorized Medical Examiner staff are available, remains should be covered, removed to a secure location, chilled, if possible, and the circumstances of death documented. If appropriate, care should be given to not disturb the death scene for later documentation of evidence.
6. The Tacoma-Pierce County Health Department is the lead agency for providing death certificates and coordination with the Medical Examiner and funeral homes to assure vital data is recorded and burial-transit permits are appropriately issued. The Pierce County Sheriff's Identification Unit may assist in the identification of the deceased. Forensic dentists of the Washington State Dental Association may assist with the identification of the deceased using dental records.
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F. Interaction with family members on-scene will be coordinated by the Pierce County Sheriff's Chaplaincy. The Chaplaincy assists relatives and friends relieve emotions, encourage expression of their feelings, provide support and comfort, and encourage funeral planning. The assistance of outside persons who are trained in support activities shall be coordinated by the chaplains.
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G. The ARC-TPC Chapter may assist in the notification of next of kin following mass casualty disasters.
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H. The Federal Bureau of Investigation may assume identification responsibilities in accidents involving interstate commercial carriers, hostage situations or citizens killed in acts of terrorism.
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A. Joint Primary Agencies-Pierce County Departments
1. Emergency Medical Services Division, DEM
a. lead agency to ensure basic and advanced life support systems are organized and coordinated to provide prompt and continuous emergency medical care to disaster victims.
b. assess county wide EMS needs and make logistical recommendations.
c. provide liaison from the EOC with hospitals and out-of-hospital care providers.
d. work in the EOC upon request.
2. Tacoma-Pierce County Health Department
a. coordinate emergency health support and control of communicable diseases.
b. coordinate emergency sanitation support.
c. monitor and assure sanitation of food and food preparation at the point of consumption.
d. monitor and assure safe drinking water supply.
e. coordinate the collection of vital statistics relative to births and deaths.
3. Medical Examiner's Office
a. provide for the identification, storage and disposition of the deceased.
b. provide notification to local agencies of the locations of any temporary morgues.
c. coordinate transportation of the deceased to these sites in coordination with the EOC.
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B. Support Agencies
1. Pierce County Departments
a. Emergency Management
1. provide guidance and support in the response and recovery activities of the joint primary agencies.
2. support and coordinate with the CISM Program.
3. support and coordinate with the AM.
b. Sheriff's Department
1. participate on the CISM Team.
2. provide limited first aid capability.
3. Identification Unit assists the Medical Examiner with the identification of the dead.
4. commissioned deputies may act as Deputy Coroners in the absence of the Medical Examiner.
5. Sheriff's Chaplaincy
a. provide and coordinate on-scene defusing and support to emergency workers using members of the CISM Program, when requested.
b. provide coordination for victim and relative counseling and comfort on scene at major incidents.
2. Fire Services
a. establish Incident Command for on scene emergency operations.
b. provide first aid, EMT and paramedic services in response to injured persons.
c. provide limited emergency medical transportation capability.
3. Hospitals
a. provide medical care.
b. resupply field units with consumable medical supplies.
c. provide assessments of hospital capabilities and damages to the DMCC to be reported to the EOC.
d. may mobilize staff to provide teams to respond to field treatment and triage sites.
e. assist in blood procurement for community needs.
4. Medical Society of Pierce County
a. may assist in the procurement of physician services.
b. provide information to member physicians on current emergency response policy and procedures.
5. Private Ambulance Providers
Provide emergency medical transportation resources and support in the EOC.
6. Washington State Dental Association
a. forensic dentists may assist with the identification of the deceased using dental records.
b. provide information to member forensic dentists on current emergency response policy and procedures.
7. Volunteer Organizations
a. American Red Cross Tacoma-Pierce County Chapter
1. provide supplementary medical, nursing aid and other health services upon request and within capabilities.
2. establish procedures whereby names of victims will be obtained for health and welfare communications by appropriate agencies and immediate family.
3. assist disaster victims with replacement of personal medical supplies, glasses, dentures, hearing aids, wheelchairs, prosthesis, etc.
4. assist with the notification of next of kin at the request of the Medical Examiner.
b. Radio Amateur Civil Emergency Services
1. provide emergency communications support to hospitals.
2. provide emergency communications support to military units during the activation of the National Disaster Medical System (NDMS).
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Tab 1-DMCC Guidelines
Tab 2-National Disaster Medical System (NDMS) Activation
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