Biowatch Annex

Version .7 March 3, 2016

OCHCA BioWatch Plan

WARNING: This document is FOR OFFICIAL USE ONLY (FOUO). It contains information that may be exempt from public release under the Freedom of Information Act (5 U.S.C. 552). It is to be controlled, stored, handled, transmitted, distributed, and disposed of in accordance with Department of Homeland Security policy relating to FOUO information and is not to be released to the public or other personnel who do not have a valid “need-to-know” without prior approval of an authorized DHS official.

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Table of Contents

I. Purpose...... 3 II. Scope...... 3 III. Background ...... 3 IV. Detection of Aerosolized Biological Agents ...... 4 V. Daily Testing of Samples ...... 5 VI. Concept of Operations ...... 5 VII. Federal BioWatch Resources ...... 7 VIII. Communication Systems ...... 7 IX. Ongoing Response and Recovery ...... 8 X. Roles and Responsibilities ...... 8 XI. Planning, Increased Readiness, and Response ...... 11 XII. Plan Development and Maintenance ...... 16 XIII. References and Authorities ...... 16 IV. Acronyms……………………………………………………...………………………...18 Appendix A: Notification Process for a BioWatch Actionable Result ...... 20 Appendix B: Control One Notification Procedures ...... 27 Appendix C: Health Disaster Management Duty Officer Notification Procedures ...... 33 Appendix D: Local SCBAC Conference Call ...... 34 Appendix E: Operational Area Cities Conference Call Script ...... 47 Appendix F: National Conference Call Script ...... 60 Appendix G: Public Health Decision Making Matrix ...... 68 Appendix H: BioWatch Fact Sheet ...... 70 Appendix I: Risk Communication Protocol ...... 72 Appendix J: BioWatch Site Information Guide ...... 82 Appendix K: Orange County BioWatch Phase I Environmental Sampling Plan ...... 83 Appendix L: HCA Epidemiology and Assessment Phase-Specific Activities ...... 87 Appendix M: Orange County Profile for BioWatch Disease Agents ...... 90

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I. Purpose

This plan addresses actions to take in the event of a BioWatch Actionable Result (BAR) at any of the BioWatch collector sites in Orange County.

The disclosure of information in this plan could compromise the security of essential equipment, personnel, services, and systems of the Orange County Health Care Agency, or the many partners required to carry out essential emergency responsibilities throughout the county. BioWatch and its associated activities are classified as SENSITIVE BUT UNCLASSIFIED (SBU) and FOR OFFICIAL USE ONLY (FOUO). This plan contains information that may be exempt from public release under the Freedom of Information Act (5 U.S.C. 552). It is to be controlled, stored, handled, transmitted, distributed, and disposed of in accordance with Department of Homeland Security policy relating to FOUO information and is not to be released to the public or other personnel who do not have a valid “need-to- know” without prior approval of an authorized DHS official.

II. Scope

This BioWatch Plan addresses the Orange County response to a BioWatch Actionable Result (BAR). The plan should in no way encompass the full range of necessary activities which would be required upon the notification of a BAR. The scope of this plan is only to formulate initial actions and guidelines to assist the Orange County BioWatch Advisory Committee (OCBAC) and public health response within the county upon notification. It does not alter existing Standard Operating Procedures (SOPs) or any roles and responsibilities under the Operational Area Emergency Operations Plan (EOP) and Annexes including the Weapons of Mass Destruction, Disease Outbreak Response Annex (DORA), Medical Countermeasure Distribution, and Point of Distribution (POD) plans. The expectation is that the Standardized Emergency Management System (SEMS) and the National Incident Management System (NIMS) will be followed.

III. Background

BioWatch is a United States Department of Homeland Security (DHS) program and is currently managed by the Office of Health Affairs within DHS. DHS provides oversight for the BioWatch program, while city, county, and state governments operate the system. BioWatch serves as an early warning system that can detect trace amounts of pathogen- specific nucleic acid in the air whether intentionally released or naturally present in the environment. BioWatch currently tests for five pathogens.

The system is designed to assist public health experts in determining the presence and geographic extent of a biological agent release. This in turn will enable local, state, and federal officials to quickly assess risk to the public’s health and implement appropriate emergency response and medical care to mitigate the impact on the population.

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The County of Orange is a jurisdictional member of the South Coast BioWatch Advisory Committee (SCBAC). The other SCBAC members include Los Angeles, Riverside, and San Bernardino Counties, and the Cities of Pasadena and Long Beach, Federal Bureau of Investigation (FBI), South Coast Air Quality Management District (AQMD), US Environmental Protection Agency Region 9 (EPA), California Department of Public Health (CDPH), and the California Emergency Management Agency (CalEMA)/California Office of Emergency Services (OES), Los Angeles World Airports, and the Los Angeles County Metropolitan Transportation Authority.

When there is an incident associated with BioWatch in Orange County, the County Health Officer will serve as the Decision Maker during the Local SCBAC, OC OA City, and National Conference Calls. The SCBAC, state and federal partners are available on the Local SCBAC and National Conference Calls to provide assistance and subject matter expertise to the Orange County Health Officer. If more than one county is affected, a unified approach will be taken. In areas outside of the Health Officer’s scope (i.e. law enforcement), decisions may be made by the appropriate agency, but communicated to the Health Officer or designee. Information regarding the SCBAC Local, OC OA City, State, and National calls is detailed in Appendix A.

IV. Detection of Aerosolized Biological Agents

The detection of an aerosolized biological agent by the BioWatch system is referred to as a BioWatch Actionable Result or a BAR. A BAR is defined as:

• A Polymerase Chain Reaction (PCR) verified positive result from a BioWatch collector or;

• Other PCR results from a BioWatch collector (or multiple collectors) that public health officials, in consultation with the Centers for Disease Control and Prevention (CDC) Bioterrorism Rapid Response and Advanced Technology (BRRAT) laboratory, believe warrant some type of response, such as further investigation or other public health action. (An example would be if more than one BioWatch collector has multiple signatures that are reactive, but the overall pattern does not meet the algorithm for a verified positive.)

When laboratory PCR screening of one or more filter quadrants indicates the presence of a biological agent, a second PCR analysis is conducted to confirm the initial results. If both PCR tests return positive results, then the laboratory declares a BioWatch Actionable Result, and initiates notifications.

Note: A BAR indicates that BioWatch agent DNA has been detected on a filter. A BAR does not necessarily mean that a terrorist attack has occurred, that a viable biological agent was released, or that people have been exposed to a viable agent. Additional analysis (e.g. environmental sampling, intelligence information, discussion of wind patterns, etc.) is required to make those determinations.

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A BAR will trigger the need for coordination between local, county, state, and/or federal agencies to quickly assess the risk to the public and implement appropriate actions to respond, mitigate, and recover from a biological agent release.

V. Daily Testing of Samples

Filters are collected daily in the morning from BioWatch Portable Sampling Units (PSUs) in the South Coast BioWatch Region network for testing at the South Coast BioWatch Lab located at the Los Angeles County Public Health Laboratory (LAC-PHL). Laboratory test results (indicating whether the sample triggers a BAR or not) are typically completed in the late afternoon or early evening of the same day the samples are taken.

PSUs collect 24 hours of environmental information. By the time laboratory tests indicate a BAR, the actual release of the biological agent may have occurred 12 to 36 hours before a declaration of a BAR and the initiation of the SCBAC Local OC OA City, State, and National calls.

A. Non-Reactive Test Results

If laboratory results are non-reactive, the BioWatch Lab sends an email to the BioWatch Jurisdictional Coordinator (JC), who in turn forwards the email to the local health jurisdictions in the SCBAC notifying that all samples tested were non-reactive. Note: the absence of this email does not indicate that a BAR has occurred.

B. Reactive Test Results

If laboratory results are reactive, the BioWatch Lab will conduct confirmatory testing and consult with the CDC BRRAT laboratory experts to make a determination of a BAR. A reactive result will trigger a number of responses, conference calls and actions as detailed in the Concept of Operations.

VI. Concept of Operations

The Concept of Operations addresses actions to be followed in the event of a BAR at any of the BioWatch collector sites in Orange County. It further clarifies the coordination between local, state, and federal governmental and other agencies during a BAR. Orange County involvement with BARs in the SCBAC outside of Orange County will be advisory and support only. Below is a summary of the eight components of operations. For detailed information on the responsibilities of the responding agencies during different phases of operations, please refer to section XI titled, “Planning, Increased Readiness, and Response.”

A. Notification: The determination of a BAR triggers a predetermined set of BioWatch jurisdictional and federal notifications. Following the notifications, BioWatch conference calls are scheduled as appropriate. (See Appendix A: Notification Process for a BAR)

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B. Situational Assessment: Situational assessment activities provide additional data to determine the potential public health risk represented by a BAR. Initially, this includes a review of data from the following sources: BioWatch agent testing results from the BioWatch approved laboratory, BioWatch jurisdictional profile, disease surveillance, and available intelligence information. Information from the situational assessment will be reviewed on an ongoing basis; additional data, such as from environmental sampling, modeling, and enhanced surveillance, will be obtained and assessed through ongoing BioWatch Local SCBAC and National Conference Calls, as needed.

C. Bioterrorism Assessment: If facts and circumstances indicate a BAR may be a result of an intentional release, the FBI will open a criminal investigation, focusing its efforts on identifying the source of release and possible suspects. This may include a broad array of investigative actions, such as conducting interviews and searches, criminal background checks, review of related investigations and current intelligence, and sampling operations to collect evidence.

D. Public Health Risk Assessment: Appropriate public health response is based on results of the situational assessment and incorporates new information as it becomes available. Therefore, the assessment of whether or not a BAR represents a potential risk to the public’s health may change over time depending on available data. Additionally, Appendix G titled, “Public Health Decision Making Matrix” provides specific information on decision making regarding select biological agents.

E. Environmental Sampling: If directed by the Orange County Health Officer, environmental sampling will be conducted by HCA’s Environmental Health Hazardous Material Team (EH HAZMAT) in accordance with the “Orange County BioWatch Phase I Environmental Sampling Plan,” (Appendix K) and the US Environmental Protection Agency’s site‐specific “Phase I Environmental Sample Collection Plan.” If more than one collector is positive, the Health HazMat Team will convene a conference call to discuss a strategy for the particular situation. The FBI may be available to provide additional field support. Other jurisdictions may also provide additional assistance through mutual aid. In the event that local resources are exhausted, the California National Guard, Civil Support Team may be requested through the Orange County Operational Area Emergency Operations Center.

F. Deployment of Additional BioWatch Collectors: Additional sample collection units are available through AQMD. If requested by the SCBAC, these units can be deployed to enhance air sampling following a BAR by Environmental Health HAZMAT.

G. Sampling Frequency: While BioWatch filters are routinely retrieved every 24 hours, during a BAR response, the Orange County Health Officer may request that the Field Collection Team collect the filters every 12 hours which may improve time resolution but decrease sensitivity. Laboratory and Field staffing and surge capacity must be taken into account when deciding to change the sampling frequency.

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H. Risk Communication: The Health Care Agency’s Public Information Officer will coordinate messaging and risk communications jointly with the other local health jurisdictions within the SCBAC, as appropriate. See Appendix I titled “Risk Communication Protocol.” Additionally, the Health Care Agency Public Information Officer (PIO) will assume the role of the Public Information Officer at the OA EOC. The PIO will recommend activation of the Joint Information System Annex and possibly a Joint Information Center (JIC) to work in conjunction with the local impacted jurisdictions.

VII. Federal BioWatch Resources Federal event reconstruction, reach back and outreach resources are available to the SCBAC. The affected health jurisdictions may discuss the request for resources on the National Conference Call with federal partners.

A. BioWatch Event Reconstruction Team (BERT): Support for estimating impact of an event on a local area; analysis of potential source scenarios following a positive BAR; response time (deployed and operational) within two hours of initial notification; and may provide first results within approximately 6 hours of initial notification.

B. BioWatch Indoor Reach Back Center (BIRC): Indoor modeling and positioning

C. Chemical and Biological Operations Support Center (CBOSC): Supplies common operating picture for day-to-day, special event and incident operations.

VIII. Communication Systems

The following communication systems are used by the SCBAC before, during, and after a BAR.

A. BioWatch Portal: A single, central point for finding, creating, and sharing BioWatch information managed by Tauri Group, a Department of Homeland Security contractor and updated by the Jurisdictional Coordinator.

B. California Health Alert Network (CAHAN): The emergency preparation and notification system operated by CDPH Emergency Preparedness Office. It serves as the redundant notification system for alerting local and state officials and as the back-up portal for the SCBAC.

C. California State Warning Center (CSWC): Operated by CalEMA, this system alerts appropriate key senior officials and staff in State agencies such as CDPH, CalEMA and California Department of Food and Agriculture.

D. Los Angeles Health Alert Network (LAHAN): Automatic notification system operated by Los Angeles County Public Health Department. It is the primary notification systems for alerting the SCBAC of a BAR. Notifications to Orange County may be received by the

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Orange County Communications Control One or directly to the Orange County Health Care Agency Health Disaster Management Duty Officer.

E. AlertHCA: Automatic notification system operated by the Orange County Health Care Agency. It is the backup notification systems for alerting Orange County of a BAR.

F. Orange County Conference Call System: Conference Call Bridge maintained and operated by the Orange County Sheriff’s Department Emergency Management Division providing communications to members within the Operational Area.

G. Control One: The coordinated communications center for Orange County. Operated by the Orange County Sheriff’s Department, Control One’s function is to provide a communications service and teletype system to all law enforcement and public service agencies within Orange County.

H. A detailed communications plan is outlined in the Operational Area BioWatch Response Annex.

IX. Ongoing Response and Recovery

Once a BAR has been classified as probable or possible, the Health Officer will request activation of the OA Emergency Operations Center and recommend response activities be implemented as required by the complexity of the event. This may include activation of the OA BioWatch Response Annex, the OA Emergency Operations Plan, Medical Countermeasures Annex, Disease Outbreak Response Annex, and other Annexes as required.

X. Roles and Responsibilities

The roles and responsibilities outlined in this section provide a general overview of the various responding agencies. For specific tasks, please refer to section XI titled “Preparedness, Increased Readiness, and Response.”

A. Local

1. OCHCA – Health Disaster Preparedness (HDP): Activates local BioWatch Response Plan and notification, convenes conference calls with local, state, and federal partners, and oversees the HCA Health Emergency Operations Center (HEOC) activities, assists with other activated HCA programs, and coordinates the Medical Counter Measures (MCM) reception and distribution utilizing the Point of Distribution (POD) plans.

2. OCHCA – Emergency Medical Services (EMS): Facilitates and coordinates response activities in EMS including coordination with hospitals and ambulance providers.

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3. OCHCA – Public Health Services (PHS): Oversees public health response activities, works to monitor the potentially exposed population for signs/symptoms of disease from the agent released, and institutes control measures and protective actions.

 Epidemiology and Assessment (EPI): Conducts syndromic surveillance, reviews historical disease outbreak patterns, surveillance and reportable disease data. Makes treatment, prophylaxis, and/or infection control recommendations as needed following available CDC and CDPH guidance; assesses public health risk, and provides input to the overall response strategy.

 Environmental Health (EH) HAZMAT: Mobilizes the field sampling team to collect additional filters, conducts secondary sampling operations, decontaminates and coordinates transport of samples under chain of custody with assistance from the Orange County Sheriff’s Department Hazard Devices Section to the Orange County Public Health Laboratory and/or Los Angeles Public Health Laboratory.

 Public Health Laboratory: Processes environmental samples taken from surrounding areas, not the collector filter samples.

4. OCHCA – Public Information Office (PIO): Coordinates messaging and risk communications jointly with the other local health jurisdictions within the SCBAC, as appropriate. Additionally, the Health Care Agency Public Information Officer (PIO) will assume the role of the Public Information Officer at the OA EOC. The PIO will recommend activation of the Joint Information System Annex and possibly a Joint Information Center (JIC) to work in conjunction with the local impacted jurisdictions.

5. Orange County Fire Authority (OCFA): Coordinates with EH HAZMAT and provides trained personnel to assist with sampling operations and decontamination, coordinates fire mutual aid, and deploys fire resources. Provides decontamination for the Hazmat Sampling Teams and supports HCA EMS with EMS missions.

6. Orange County Sheriff’s Department Emergency Management Division alerts and notifies appropriate jurisdictions and agencies, activates and operates the County Operational Area (OA) Emergency Operations Center (EOC), provides consequence management by coordinating with responding agencies, ensures availability of adequate resources, coordinates Conference Calls with the local jurisdiction impacted, and requests additional outside resources in the event of a major disaster within the Operational Area.

7. Orange County Sheriff’s Department, Hazardous Devices Section: Coordinates with EH HAZMAT and provides chain of custody and transportation of samples to the Public Health Laboratory. The EH HAZMAT team will provide transportation for any samples being processed with the Orange County Public Health Laboratory.

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8. Orange County Sheriff’s Department, Law Enforcement Mutual Aid Coordinator: Coordinates the requests and deployment of mobile field force teams to support the law enforcement agency where the incident is occurring, coordinates security for the medical countermeasures, and deploys law enforcement resources.

9. Orange County Intelligence Assessment Center (OCIAC): Gathers, investigates, and disseminates intelligence collected pertaining to the BAR received. Coordinates with the FBI on assessing threat and investigation.

10. South Coast Air Quality Management District (AQMD): Maintains collector units; collects and transports samples to the South Coast BioWatch Lab daily; and coordinates requests to install temporary BioWatch sampling units for special events. Upon notification of a BAR, makes recommendations based on initial meteorological data, plume modeling, and the location of the sensor on which counties/cities are affected (to determine which Health Officers may need to manage the incident).

11. Los Angeles County Public Health Laboratory (LAC-PHL): Los Angeles County facility with authority to make direct notification to the local Public Health Officers in the six South Coast Region BioWatch health jurisdictions. The South Coast BioWatch Lab co-located with LAC-PHL accepts and processes filter samples, secondary filter sampling, and analysis verification. Upon determination of a BAR, LAC-PHL activates its BioWatch Response Plan; notifies affected health jurisdiction(s), Centers for Disease Control and Prevention, Department of Homeland Security, and FBI; participates in the SCBAC Local, OC OA City, State, and National Conference Calls.

12. South Coast BioWatch Jurisdictional Coordinator (JC): Serves as a liaison between DHS and the SCBAC. Ensures notification to appropriate federal agencies, including the local FBI WMD Coordinator. Participates in SCBAC Local. OC OA City, State and National Conference Calls. Posts BioWatch event information to the BioWatch Portal and/or CAHAN.

13. South Coast BioWatch Advisory Committee (SCBAC): Serves in advisory capacity in determining the nature of a BAR and any needed actions to ensure the health and safety of the public. Comprised of the following six health jurisdictions: Counties of Orange, Los Angeles, Riverside, and San Bernardino, and the cities of Long Beach, and Pasadena. Other members include FBI, AQMD, EPA Region 9, CDPH, CalEMA/OES, Los Angeles World Airports, and Los Angeles County Metropolitan Transportation Authority.

B. State

1. California Department of Public Health (CDPH): Operates CAHAN, provides support to the local public health jurisdictions during a BAR, and coordinates the state-level public health response and State Call, if needed.

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2. California Emergency Management Agency (CalEMA)/California Office of Emergency (OES): Lead state organization for coordinating emergency response and recovery. Alerts appropriate senior officials and affected Regional and County EOCs through the California State Warning Center, coordinates responding agencies, ensures availability of adequate resources, and requests additional outside resources in the event of a major disaster.

C. Federal

1. Federal Bureau of Investigation (FBI): Leads the criminal investigation of acts of bioterrorism, with state and local law enforcement assistance. Provides updates on threats that may be related to the incident.

2. United States Centers for Disease Control and Prevention (CDC): Primary federal point of contact for information from local laboratories, hospitals, and city and state governments by established protocols to provide a “health risk assessment.” Oversees the Laboratory Response Network (LRN) that analyzes collected samples.

3. United States Department of Homeland Security (DHS): Facilitating federal agency for the BioWatch program. DHS funds BioWatch daily monitoring and sample collection and analysis, issues guidance to local BACs, and holds additional technical assets which might be employed during a response to a BioWatch event or for a special event. DHS must be notified via the Office of Health Affairs (OHA) Desk within the National Operation Center immediately upon the LAC-PHL determining a BioWatch Actionable Result for the South Coast BioWatch region. DHS will join the National Conference Call to provide coordination and assets, as needed. Provides overall public information guidance on releasing information to the public about a BAR. DHS also serves as the primary reference point for state and local PIOs for addressing specific programmatic issues and sensitive but unclassified information with the media.

4. United States Environmental Protection Agency (EPA): Serves as the primary contact for the state and local environmental monitoring agencies. The EPA Superfund Technical Assistant and Response Team (START) assists the primary sampling team in conducting environmental sampling. Provides expertise in environmental cleanup actions and messages that would be necessary if a biological attack occurred.

XI. Planning, Increased Readiness, and Response

For the purposes of the BioWatch program, there are three phases of operations: A. Phase I Planning B. Phase II Increased Readiness C. Phase III Response

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A. Phase I – Planning

During this phase, the County of Orange has no information indicating the presence of a BAR. Samples have been reported non-reactive by the South Coast BioWatch Lab and risk to public health is considered to be unlikely.

1. All Agencies and Jurisdictions: Review and enhance standard operating procedures (SOPs), update and maintain phone rosters, review and update emergency notification procedures and interagency checklists and/or procedures.

2. Air Quality Management District: Picks up and delivers samples to the South Coast BioWatch Lab (located at LAC-PHL) daily and maintains PSUs.

3. South Coast BioWatch Lab: Performs daily analysis of BioWatch samples. Maintains team of microbiologists competent in molecular analysis of selected BioWatch agents from daily PSU filter samples.

4. Orange County Health Care Agency: Conducts routine surveillance of reportable diseases and evaluates increases in baseline reports. Inventories and updates communications gear, sampling equipment, and consumable supplies. Reviews sampling protocols. Trains Hazmat staff and other agencies in proper sampling methodology. Ensures readiness of Department Operation Center (DOC) and the Health Emergency Operations Center (HEOC) and develops proposed staffing patterns. Ensures risk communications coordination with local response partner agencies and prepares generic press releases and fact sheets.

5. Orange County Sheriff's Department Emergency Management Division: Ensures readiness of the OA EOC evaluates and tests OA EOC equipment and procedures, develops proposed staffing patterns, and develops response plans and procedure.

6. Orange County Intelligence Assessment Center: Coordinates and shares relevant threat information with HCA, Terrorism Liaison Officers in BioWatch jurisdictions, and OCSD EMD.

7. Federal Bureau of Investigation: Coordinates and shares relevant threat information as appropriate with OCIAC and OCHCA.

8. Jurisdictional Coordinator (JC): Supports SCBAC planning efforts including facilitation of BAC meetings, coordination of preparedness activities, and communication of federal guidance.

B. Phase II – Increased Readiness

During this phase, the County of Orange has been notified by the South Coast BioWatch lab that a sample is reactive and a select agent is present on the filter. The risk to the public health has been increased to “possible.”

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1. Notification: A number of Conference Calls may occur in accordance to procedures described in Appendix A.

2. Southern California Air Quality Management District: Obtains information on which samples were operating on the platform during the last 24 hours. Obtains any relevant meteorological information regarding weather patterns for the past 24 hours and advises SCBAC on which jurisdictions are affected so the appropriate Health Officers can manage the incident. Works with law enforcement and environmental sampling teams to provide necessary access and/or information on local conditions before they are on scene with the collector.

3. LAC-PHL: Notifies the Jurisdictional Coordinator, Health Officer and 24/7 contact at affected jurisdiction. Also, participates in the SCBAC Local Conference Call, State, and National Conference Call. Reviews laboratory results and provides subject matter expertise.

4. Jurisdictional Coordinator (JC): Ensures that BAR declaration requirements have been met, the Health Officer is notified, the OCBAC Chair is notified, and that the 24/7 contact is notified. Participates in SCBAC Local, OC OA City, State, and National Conference Calls.

5. OCHCA Health Disaster Management Duty Officer and/or OCBAC Chair: Notifies OCHCA Administration. Participates in SCBAC Local, OC OA City, and National Conference Calls. Notifies CDPH to ensure notification to the California State Warning Center. Coordinates with the MHOAC to provide a status report and prepare a resource request if needed. Activates the HEOC as directed.

6. OCHCA Health Officer: Serves as the Decision Maker for County of Orange during the Local SCBAC, OC OA City, and National Conference Calls. Determines need for additional environmental sampling, protective actions for first responders, and transition to MCM plan. Makes determination to activate the HEOC.

7. OCHCA EMS: Participates in SCBAC Local, OC OA City, and National Conference Calls. Prepares to activate and staff the EMS DOC if necessary.

8. OCHCA Epidemiology and Assessment: Participates in SCBAC Local, OC OA City, and National Conference Calls. Provides updated information for local profile. Reviews laboratory results, recent syndromic surveillance reports, and veterinary data and enhances surveillance. Consults with and recommends course of action to Health Officer. See Appendix L for details.

9. OCHCA Environmental Health: Participates in SCBAC Local, OC OA City, and National Conference Calls. Deploys collection teams. Selects appropriate rally point(s) and decontamination station(s) to use for sampling operations according to the Orange County Phase I Environmental Sampling Plan.

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10. OCHCA Public Information Officer (PIO): Remains on standby status and prepares key messages, talking points, fact sheets, and Q&A, in anticipation of media and public inquiries. Participates on Risk Communications Conference Call, following the BioWatch National Conference Call.

11. Orange County Sheriff's Department Emergency Management Division: Participates in SCBAC Local, OC OA City, and National Conference Calls. Activates the OA EOC as required. Coordinates a Conference Call with the impacted jurisdiction(s), OCSD, and HCA. Facilitates activation of required OA/OC EOP Annexes to respond.

12. Orange County Sheriff’s Department, Law Enforcement Mutual Aid Coordinator: Coordinates with impacted jurisdiction (law) on potential needs. Begins identification of field mobile force units. Establishes a staging area. Coordinates with HCA HDM if Medical Counter Measures will be expected.

13. Orange County Fire Authority Fire Mutual Aid Coordinator: Activates fire service Hazardous Materials Response Team(s) in support of HCA EH collection teams and prepares for first responder point of dispensing operations.

14. Orange County Intelligence Assessment Center: Participates in Local SCBAC and National Conference Calls. Queries and shares relevant threat information as appropriate.

15. Director of Orange County (OC) Animal Care: Participates in Local SCBAC and National Conference Calls. Provides local veterinary data and information.

16. Federal Bureau of Investigation: Participates in Local SCBAC and State, and National Conference Calls. Initiates a possible joint bioterrorism investigation with affected County/City public health department. Queries national, state, and local assets for intelligence and disseminates applicable intelligence.

C. Phase III - Response

During this phase, the County of Orange has been notified that supplemental environmental sampling has tested positive for an agent (is a positive BAR), there is information for a credible source that positive findings have occurred in other jurisdictions, or there are large concentrations of agent in the quadrant tested. The risk to the public health has been increased to “probable.”

1. Information Sharing: All city and county agencies are to utilize the Operational Area’s WebEOC as the primary method for information sharing.

2. All Agencies: Determination is made to place key staff on standby status.

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3. OCHCA Health Officer: Coordinates with HCA HDM, Epi and Assessment, EH, EMS, and PIO to issue protective actions for first responders, activates the medical countermeasures plan, and provides recommendations for post-exposure prophylaxis. Coordinates with OCSD EMD to request a proclamation of an emergency and works through OCSD EMD to advise cities to activate Point-of-Dispensing (POD) plans. May issue quarantine and isolation orders as appropriate.

4. OCHCA Health Disaster Preparedness (HDP): Activates the Health Emergency Operations Center (HEOC) and the Local Distribution Center. Coordinates with MHOAC to update status reports and request pharmaceuticals and/or other medical supplies from CDPH. Coordinates with cities to activate POD plans. Coordinates with OCSD Mutual Aid Division for transportation and security needs for pharmaceuticals.

5. OCHCA EMS: Activates the EMS DOC. Sends ReddiNet messages and coordinates communications with hospital infection control practitioners, hospital disaster coordinators, HEOC, and HCA Public Health Services. Communicates with the Regional Disaster Medical Health Coordinator (RDMHC) Region 1, State EMSA and CDPH, and other health care partners.

6. OCHCA Epidemiology and Assessment: Initiates communications with hospitals through infection preventionists and community health care providers. Evaluates appropriateness of prophylaxis for first responders and persons potentially exposed. Continues enhanced disease surveillance and recommends appropriate public health response. Advises the Health Officer on need for mass prophylaxis and community mitigation measures as appropriate. See Appendix K for details.

7. OCHCA Environmental Health: Coordinates HAZMAT sampling team and resources.

8. OCHCA Public Information Officer: Responds to inquiries from media and public. Prepares key messages, talking points, and fact sheets. Coordinates with local, state and federal agency PIOs. Responsible for activating a Joint Information Center (JIC) as necessary.

9. Orange County Sheriff's Department Emergency Management Division: Activates the OA EOC in accordance to Operational Area Emergency Operations Plan. Coordinates with impacted jurisdiction and OCHCA HDM in implementing the POD plan. Consults with affected jurisdiction and OCHCA to develop and send messages through AlertOC or the Emergency Alert System to notify and provide information to the affected public. Establishes the Operational Area EOC hotline (if requested) and contacts 2-1-1 Orange County for Rumor Control/Public Inquiry Assistance, if appropriate. Coordinates resource requests from the Operational Area.

10. Orange County Sheriff’s Department, Law Enforcement Mutual Aid Coordinator: Activates DOC at appropriate level. Provides local law enforcement and dispatch

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centers with recommended protective measures. Coordinates with impacted jurisdiction on potential needs. Plans and coordinates with HCA HEOC (if activated) on transportation and security of Medical Counter Measures to POD locations, hospitals, and/or clinics.

11. Orange County Fire Authority, Fire Mutual Aid Coordinator: Activates the DOC at appropriate level, initiates first responder POD operations, deploys HazMat Response Team(s) to support HCA EH sampling team(s) and supports HCA EMS in EMS missions.

12. Orange County Intelligence Assessment Center: Queries and shares relevant threat information as appropriate.

13. Federal Bureau of Investigation: Coordinates biological evidence collection and response. Continues joint investigation with HCA and/or other public health departments. Consults with Health Officer and other agencies to consider standing up a Joint Field Officer and/or Joint Operations Center to assist in managing resources for the evidence collection and joint bioterrorism investigation.

XII. Plan Development and Maintenance A. Plan Updates: The plan revision process will be coordinated by HCA HDM every two (2) years at a minimum. Items needing immediate correction will be identified and changed annually, if warranted.

B. After Action Reports/Improvement Plan (AAR/IP): The AAR will be written after BioWatch drills, exercises and real events. Corrective actions identified in the AAR will be reviewed during the revision process and an Improvement Plan will be drafted outlining needed corrective actions.

C. Plan Distribution: Copies of the plan will be maintained at the OCSD EMD and HCA HDM office. Distribution of this plan will be controlled. This document is FOR OFFICIAL USE ONLY (FOUO). It contains information that may be exempt from public release under the Freedom of Information Act (5 U.S.C. 552). It is to be controlled, stored, handled, transmitted, distributed, and disposed of in accordance with Department of Homeland Security policy relating to FOUO information and is not to be released to the public or other personnel who do not have a valid “need-to-know” without prior approval of an authorized DHS official.

XIII. References and Authorities Orange County Operational Area Emergency Operations Plan, 2015 County of Orange Emergency Operations Plan, 2015 Orange County Operational Area Weapons of Mass Destruction Annex, 2007 Orange County Strategic National Stockpile Annex, 2007 Orange County City Readiness Initiative Plan, 2007

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Orange County HazMat Plan, 1997South Coast BioWatch Advisory Committee, “South Coast BioWatch Charter,” adopted March 29, 2006, revised January 22, 2008. United States Department of Homeland Security, Office of Health Affairs, “BioWatch 101 Presentation,” May 2009. United States Department of Homeland Security, “Interim Guidance Document: BioWatch Outdoor Program Guidance Document for BioWatch Jurisdictions, August 11, 2010, Revised June 2015 United States Environmental Protection Agency, “South Coast BioWatch Environmental Sampling Plan,” July 2009.

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IV. Acronyms

ACRONYM DEFINITION AAR AFTER ACTION REPORT AQMD SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT ASPR ASSISTANT SECRETARY OF PREPAREDNESS AND RESPONSE BAC BIOWATCH ADVISORY COMMITTEE BAR BIOWATCH ACTIONABLE RESULT BERT BIOWATCH EVENT RECONSTRUCTION TEAM BIRC BIOWATCH INDOOR REACH BACK CENTER BWNCC BIOWATCH NATIONAL CONFERENCE CALL CAHAN CALIFORNIA HEALTH ALERT NETWORK CALOES CALIFORNIA GOVERNOR’S OFFICE OF EMERGENCY SERVICES CBRNE CHEMICAL BIOLOGICAL RADIOLOGICAL NUCLEAR EXPLOSIVE CBOSC CHEMICAL AND BIOLOGICAL OPERATIONS SUPPORT CENTER CDC CENTERS FOR DISEASE CONTROL AND PREVENTION CDC BRRAT CENTERS FOR DISEASE CONTROL AND PREVENTION BIOTERRORISM RAPID RESPONSE AND ADVANCED TECHNOLOGY CDFA CALIFORNIA DEPARTMENT OF FOOD AND AGRICULTURE CDPH CALIFORNIA DEPARTMENT OF PUBLIC HEALTH CF CALL FACILITATOR CID CENTER FOR INFECTIOUS DISEASE CST CIVIL SUPPORT TEAM CSWC CALIFORNIA STATE WARNING CENTER Ct CYCLE THRESHOLD DCDC DIVISION OF COMMUNICABLE DISEASE CONTROL DHS DEPARTMENT OF HEALTH SERVICES DOC DEPARTMENT OPERATION CENTER DORA DISEASE OUTBREAK RESPONSE ANNEX EH ENVIROMENTAL HEALTH EH HAZMAT ENVIROMENTAL HEALTH HAZARDOUS MATERIAL TEAM EMD EMERGENCY MANAGEMENT DIVISION EOM EMERGENCY OPERATIONS MANUAL EMS EMERGENCY MANAGEMENT SYSTEM EMSA EMERGENCY MEDICAL SERVICES AUTHORITY EOP EMERGENCY OPERATION PLAN EPA ENVIROMENTAL PROTECTION AGENCY EPI EMERGENCY PREPAREDNESS INITIATIVE FBI FEDERAL BUREAU OF INVESTIGATION FOUO FOR OFFICIAL USE ONLY HCA HEALTH CARE AGENCY HDM HEALTH DISASTER MANAGEMENT 18 FOR OFFICIAL USE ONLY

HDP HEALTH DISASTER PREPAREDNESS HHS/ASPR HEALTH AND HUMAN SERVICES/ASSISTANT SECRETARY OF PREPAREDNESS AND RESPONSE HEOC HEALTH EMERGENCY OPERATION CENTER JC JURISDICTIONAL COORDINATOR JIC JOINT INFORMATION CENTER JIS JOINT INFORMATION SYSTEM LAHAN LOS ANGELES HEALTH ALERT NETWORK LA-PHL LOS ANGELES PUBLIC HEALTH LABORATORY LIRG LOCAL INCIDENT RESPONSE GROUP LOCAL SBAC CC LOCAL ORANGE COUNTY SOUTH COAST CONFERENCE CALL MCM MEDICAL COUNTER MEASURES MHOAC MEDICAL HEALTH OPERATIONAL AREA COORDINATOR NOC NATIONAL OPERATIONS CENTER OA OPERATIONAL AREA OCBAC ORANGE COUTNY BIOWATCH ADVISORY COMMITTEE OCIAC OC INTELLIGENCE ACCESSMENT CENTER OCOA ORANGE COUNTY OPERATIONAL AREA OC OA CCC ORANGE COUNTY OPERATIONAL AREA CITY CONFERENCE CALL OCSD ORANGE COUNTY SHERIFF DEPARTMENT OES OFFICE OF EXECUTIVE SERVICES OHA OFFICE OF HEALTH AFFAIRS PHO PUBLIC HEALTH OFFICER PBACC POST-BAR AWARENESS CONFERENCE CALL PCR POLYMERASE CHAIN REACTION PHEP PUBLIC HEALTH EMERGENCY PREPAREDNESS PHS PUBLIC HEALTH SERVICES PIO PUBLIC INFORMATION OFFICER POD POINT OF DISPENSING RDL RAPIDLY DEPLOYABLE LABORATORY RDMHS/C REGIONAL DISASTER MEDICAL HEALTH SPECIALIST/COORDINATOR REC REGIONAL EMERGENCY COORDINATOR SBU SENSATIVE BUT UNCLASSIFIED SC AQMD SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT SCBAC SOUTHCOAST BIOWATCH ADVISORY COMMITTEE SEMS STANDARDIZED EMERGENCY MANAGEMENT SYSTEM SNS STRATEGIC NATIONAL STOCKPILE STAC STATE THREAT ASSESSMENT CENTER START SUPERFUND TECHNICAL ASSISTANT AND RESPONSE TEAM TLCC TECHNICAL LAB CONSULT CALL

19 FOR OFFICIAL USE ONLY DRAFT Appendix A Notification Process for a BAR

Appendix A: Notification Process for a BioWatch Actionable Result

Background: The BioWatch program consists of a network of continuous air sampling collectors throughout the country. Filters from the collectors in Orange County are picked up every 24 hours by the South Coast Air Quality Management District (SC AQMD) and taken to the South Coast BioWatch Laboratory (located within Los Angeles County Public Health Laboratory (LAC-PHL)) to be analyzed for select bioterrorism agents.

The laboratory tests the filters and, provides same day results by late afternoon or early evening. Laboratory personnel under the direction of the LAC-PHL laboratory director will determine if the test results indicate a BioWatch Actionable Result (BAR). If there is no BAR, normal operations continue and an “all clear” email is sent to the South Coast BioWatch Advisory Committee’s (SCBAC) health jurisdictions by the South Coast Jurisdictional BioWatch Coordinator (JC). If the laboratory determines there is a BAR in Orange County, immediate notifications and Conference Calls will begin to determine the public health risk and possible actions to be taken.

Local SCBAC Conference Call When LAC-PHL laboratory director determines there is a BAR in Orange County, immediate notifications will be made to the OC Health Officer, Control One, SCBAC Chair and the JC. The Local SCBAC Conference Call is to begin 45 minutes after notification from LAC-PHL. (N + 45)

Control One will then notify the HDM Duty Officer, Health Officer, JC, OCIAC, and OCBAC Chair of the time of the SCBAC Local Conference Call, telephone number and access code. See Appendix B: Control One Notification Procedure.

The HDM Duty Officer sends AlertHCA notification to: (alphabetical list)  OCHCA Health Officer  OCHCA Public Health Deputy Agency Director  OCHCA Public Health Chief of Operations  OCHCA Public Information Officer  OCHCA Environmental Health Division Manager  OCHCA EH HAZMAT Supervisor  OCHCA Epidemiology Medical Director  OCHCA Epidemiology Deputy Medical Director  OCHCA HDM Division Manager  OCHCA EMS Program Manager  OC BAC Chair  OCHCA HDM PHEP Coordinator  OC Veterinarian

20 FOR OFFICIAL USE ONLY DRAFT Appendix A Notification Process for a BAR

 South Coast Jurisdictional Coordinator (JC)  LA FBI WMD Coordinator  LA-PHL Director  Regional Disaster Medical Health Specialist (RDMHS)  California Department of Public Health Duty Officer

The purpose of the Local SCBAC Conference Call is to discuss and evaluate the BAR and determine the next course of action. The Local SCBAC Conference Call is facilitated by the OCHCA Duty Officer or OCBAC Chair. See Appendix C: Local SCBAC Conference Call Script.

Orange County Operational Area (OC OA) City Conference Call and National Conference Call Within 90 minutes of notification of the BAR (N + 90), the Orange County Health Officer will make the decision to conduct an OC OA City Conference Call and a National Conference Call. A BAR alone does not indicate the presence of a public health threat. The decision to act on the BAR results is determined by the Orange County Health Officer in conjunction with other senior Public Health officials.

OC OA City Conference Call 1. If the Orange County Health Officer determines the BAR is environmental and there is no need for an OC OA City or National Conference Call, then the HDM OCBAC Chair will send an email to the Jurisdictional Coordinator, other BAC representatives, and CDPH Duty Officer that the Orange County Health Officer has determined that no medical countermeasures are required.

2. If the Orange County Health Officer determines a need to hold an OC OA City Conference Call, it is to begin 90 minutes after the initial notification from LAC- PHL. (N + 90)

a) HDM OCBAC Chair will request the Jurisdictional Coordinator notify the National Operation Center (NOC) Health Desk and establish a time for the national call. This information will be communicated in automatic notifications described below.

The purpose of the OC OA City Conference Call is to relay critical information regarding the BAR. This is done using a scripted protocol (Appendix D). b) Notification for the OC OA City Call will be initiated through Control One at the Orange County Sheriff’s Department Emergency Management Division to the following:

 HCA Public Information Officer  HDM Division Manager

21 FOR OFFICIAL USE ONLY DRAFT Appendix A Notification Process for a BAR

 MetroNet  OC BAC Chair  OC Sheriff’s Department Emergency Management Division  OC Sheriff’s Department Commander/Mutual Aid Coordinator  OC Sheriff’s Department Hazardous Devices  Orange County Intelligence Assessment Center  South Coast Jurisdictional Coordinator  Anaheim BioWatch Representative  Brea BioWatch Representative  Fullerton BioWatch Representative  Santa Ana BioWatch Representative  Yorba Linda BioWatch Representative

c) The OC OA City Call will be facilitated by a member of the Orange County Sheriff’s Department Emergency Management Division.

National Conference Call

The purpose of the BioWatch National Conference Call (BWNCC) is for information sharing and situational assessment following a BioWatch Actionable Result (BAR) in order to develop a common operating picture. This framework guides that discussion.

The National Conference Call occurs after the OC OA City Call, and within the two (2) hour time limit after the NOC becomes aware of the BAR (N + 180). It is facilitated by BioWatch Special Projects Office. The National Conference Call includes all the participants of the Local (OA) Conference Call, plus additional state and federal agencies. The National Conference Call allows the state and federal partners to exchange information and learn of potential resource requests. If it is determined that no action is necessary, the BioWatch response is complete. (N + 180)

If it is determined that further response action is warranted, Orange County will coordinate appropriate response, mitigation, and recovery operations, using existing Emergency Operations Plans and Standard Operating Procedures.

Unified Command between the Orange County Health Care Agency, Orange County Sheriff’s Department and Orange County Fire Authority will be established for a BioWatch incident.

State Conference Call The State may decide to add a State Conference Call. This conference call will be hosted and facilitated by CDPH. The OC BAC Chair will ensure OC BAC participation on this call. Prior to this call the California State BioWatch Actionable Results (BAR)

22 FOR OFFICIAL USE ONLY DRAFT Appendix A Notification Process for a BAR

Data Form will be distributed, completed, and submitted to the California State Warning Center at [email protected] with a follow-up call to (916) 845-8911 to confirm receipt.

Following a BAR declaration by the LAC-PHL, the CSWC will have a form submitted to them from the affected OA by email ([email protected]). Upon receiving the initial form, the CSWC will email the form to the South Coast JC, the CDPH EPO Duty Officer (DO), and the Cal OES BioWatch Advisor. Should a state and or national call be convened, the CSWC will notify the individuals listed below either with an updated form or a new notification with the relevant information. Notifications Made By: CSWC A. State Conference Call a. California Department of Food and Agriculture (CDFA) i. CDFA Duty Officer (DO) 1. Notifications Made By: CDFA Duty Officer b. CDPH i. CDPH EPO DO 1. Notifications Made By: CDPH EPO Duty Officer a. DCDC DO i. Notifications Made By: DCDC Duty Officer: 1. DCDC BioWatch subject matter experts (SME) 2. Bioterrorism SME 3. Disease specific SME b. Senior CDPH leadership – list maintained by EPO c. CDPH Duty Officer d. EMSA Duty Officer e. RDMHC Program f. Local BAC representatives through the MHOAC ii. Cal OES 1. Executive Duty Officer (EDO) 2. Regional Duty Officer 3. Law Duty Officer 4. Fire & Rescue Duty Officer 5. BioWatch Advisor 6. State Threat Assessment Center (STAC) a. Deputy Director b. Duty Analyst 7. Environmental Protection Agency Region IX Duty Officer

23 FOR OFFICIAL USE ONLY DRAFT Appendix A Notification Process for a BAR

8. Federal Emergency Management Agency Region IX Watch Desk 9. ***Note – the CSTs could be notified by Fire or Law with the approval from the Cal OES Director, or they could be notified by the CSWC through and with the approval of the Joint Operations Committee.*** c. California BioWatch Jurisdictional Coordinators (JCs) B. National Conference Call a. All listed above b. Cal OES Senior Executive leadership - list maintained by Cal OES c. California BioWatch Jurisdictional Coordinators (JCs)

Multiple BARs CDPH EPO is responsible for recognizing that BARs have occurred in multiple OAs and notifying relevant parties (identified in this plan) so that a state call can be convened after the end of the local conference calls.

Non-BioWatch Operational Area Notifications: The CDPH EPO is responsible for notifying non-BioWatch Operational Areas of a BAR. Following the BWNCC, CDPH, in conjunction with Cal OES, will send out a CAHAN Alert to all 61 Operational Areas with the BAR details and response actions. When appropriate, a conference call will be scheduled, coordinated, and co-facilitated by CDPH EPO and Cal OES to answer questions about the BAR and provide additional details. In some cases, non-BioWatch Operational Areas or Mutual-Aid Regions are included in local jurisdictional-specific notification procedures.

Inter-State Notifications: The CDPH will take the responsibility for notifying neighboring State Health Departments, in collaboration with the Region IX Health and Human Services/Assistant Secretary for Preparedness and Response (HHS/ASPR) Regional Emergency Coordinators (RECs), of a BAR in California. Simultaneously Cal OES will notify neighboring state’s OES thru the Federal Emergency Management Agency (FEMA) Regional Emergency Centers. Following the BWNCC, the DHS BioWatch Program will be notifying all BioWatch jurisdictions nation-wide and will be hosting a Post-BAR Awareness Conference Call (PBACC). Inter-State notifications should take place immediately after the PBACC, and the following information should be relayed: Agent, Location, and Response Actions.

International Notifications: Following a BAR with a threat to the public’s health, Cal OES and CDPH will work with the Federal Partners to ensure that international notifications are made when appropriate. This notification and communication should be coordinated with Region IX HHS/ASPR

24 FOR OFFICIAL USE ONLY DRAFT Appendix A Notification Process for a BAR and FEMA, as well as the DHS BioWatch Program Office. Ultimately the Department of State will make the notification to foreign countries if necessary.

Notification alert examples: CAHAN advisory for BioWatch state call participants: There has been a BioWatch Actionable Result for {organism} in {Operational Area/Mutual-aid Region}. A Local SCBAC Conference Call was conducted at XXXX hours. The following actions have been implemented: {list response actions}. A State Conference Call is scheduled for XXXX hours; please call X- XXX-XXX-XXXX PASSCODE XXXXXX.

CAHAN advisory for BioWatch and non-BioWatch OAs: There has been a BioWatch Actionable Result for {organism} in {Operational Area/Mutual-aid Region}. A Conference Call was conducted at XXXX hours with local, state, and federal partners. The following actions have been implemented: {list response actions}. A State Conference Call is scheduled for non-impacted OA’s to receive additional information. If interested, please call X- XXX-XXX-XXXX PASSCODE XXXXXX at XXXX hours.

Dialogic text message (limited to 140 characters): This is a {Jurisdiction} BioWatch Alert. Please check email for conference call information. Type YES to confirm receipt.

CSWC alert: THIS IS A {Jurisdiction} BIOWATCH ACTIONABLE RESULT (BAR) FOR A {Regional/State/National} CALL AT XXXX. THERE HAS BEEN A DETECTION OF ORGANISIM {two letter code}. PLEASE CALL X-XXX- XXX-XXXXPASSCODE XXXXXX FOR A “BIOWATCH ALERT CONFERENCE CALL AT XXXX HOURS

25 FOR OFFICIAL USE ONLY DRAFT Appendix A Notification Process for a BAR

OCBAC Chair contacts the JC

1) To notify NOC for National Call time

2) Sends a LAHAN alert regarding OC OA City Call and National Call LA-PHL determines there LA-PHL Lab Director information to pre-determined OC is a BAR in OC and notifies positive BAR Notification List, FBI, OCIAC, AQMD, US- initiates notification to OC Health Officer, EPA, CDPH, LA-PHL, and representatives N+90 Minutes N Control One, and JC from other SCBAC Counties OC OA City Call YES 3) Control One notifies: HCA Public Information Officer, HDM Division Manager, MetroNet, OCBAC Chair, Control One sends date/time OCSD Emergency Management information re: Local SCBAC Call to Division, OCSD Commander/Mutual Aid OC Health Officer, JC, OCIAC and Coordinator, OCSD Hazardous Devices, N+180 Minutes HDM Duty Officer. HDM Duty OCIAC, South Coast JC, Anaheim BW National Call which Officer sends Alert HCA notification Representative, Brea BW includes Local SCBAC, to: representative, Fullerton BW OC OA City Call representative, Santa Ana BW participants & State & representative, Yorba Linda BW Federal representative OC OA City Call Representatives N+75 Minutes  OC Health Officer OC Health Officer  LA-PHL Director determines need for  OC Public Health Deputy Agency Director OC OA City & National NO  OC Public Health Chief of Operations Calls If directed, the  OC Epidemiology Medical Director State will host a  OC Epidemiology Deputy Medical Director State Call  Director, OC Public Health Lab  Chief of Operations, Medical Services  Health Disaster Management Division Manager OCBAC Chair emails JC  HCA HAZMAT Supervisor representatives from other  Division Manager, Environmental Health SCBAC Counties and CDPH  HDM Duty Officer Duty Officer of decision  HDM PHEP Coordinator N+45 Minutes  EMS Program Manager Local SCBAC Call  OCSD Emergency Management Division  HCA Public Information Officer  South Coast JC  CDPH Duty Officer  EPA  LA FBI WMA Coordinator N Initial Notification by LAC-PHL to Orange County  National Weather Service LAC-PHL Los Angeles County Public Health Lab  OC BAC Chair BAR BioWatch Actionable Result BW BioWatch  OC Veterinarian JC BioWatch Jurisdictional Coordinator  RDMHS LAHAN Los Angeles Health Alert Network  Santa Ana FBI NOC National Operations Center  WMD Coordinator SCBAC South Coast BioWatch Advisory Committee  SC AQMD PHEP Public Health Emergency Preparedness

26 FOR OFFICIAL USE ONLY DRAFT Appendix B Control One Notification Procedures

Appendix B: Control One Notification Procedures

 THIS IS A DRILL  THIS IS A REAL EMERGENCY

Date: Notification received by: ______

Time initial message received: ______

Message received from: ______

Time follow-up message(s) received: ______

Background: The BioWatch System is a network of air sampling stations throughout the country. Filter samples are collected every 24 hours and analyzed for bioterrorism agents at designated Public Health Labs. Los Angeles County Public Health Lab (LAC-PHL) is the designated lab for Orange County’s Filter Samples.

LAC-PHL Request for HCA/Orange County Notifications: If a BioWatch filter sample in Orange County tests positive for a Bioterrorism (BT) agent, Control One will be contacted by the LAC-PHL or the BioWatch Jurisdictional Coordinator (Federal-DHS).

Control One Responsibilities:

[ ] Will receive notification from LAC-PHL, or the BioWatch Jurisdictional Coordinator (Federal-DHS).

[ ] Control One should obtain the following information from the LAC PHL or Coordinator.

“BioWatch Alert. The Los Angeles County Public Health Laboratory has a detected a positive BAR for a site in Orange County as of ______(time).”

[ ] Control One will add 45 minutes to the initial time call was received. This will be the start time of the Local SCBAC Call (N + 45).

[ ] Make notifications as indicated on back side of this form.

27 FOR OFFICIAL USE ONLY DRAFT Appendix B Control One Notification Procedures

"Control One" shall notify the positions listed on this form, in order, and state:  THIS IS A DRILL  THIS IS A REAL EMERGENCY

Control One will state the following to each person notified:

“Today the Los Angeles County Public Health Laboratory detected a positive BAR for a site in Orange County. A Local SCBAC BioWatch Conference Call has been scheduled. Here is the phone call information.”

Time: ______(Control One add 30 minutes to initial notification time)

Phone Number: 714-437-5766 Agency Code: 39

Access Code: 365412#

Please make appropriate notifications to those pre-identified to be on the call.

Primary Contact 1 Position: HDM Duty Business Home Cell Time Follow-up Follow-up Officer Phone Phone Phone/Pager/e contacted message message #2 mail #1 time time Rotating list 714-415- HDMDutyOffic 8980 [email protected]

Primary Contact 2 Position: OC Health Business Home Cell Time Follow-up Follow-up Officer Phone Phone Phone/Pager/e contacted message message #2 mail #1 time time Eric Handler 714-834- 949-836- 714-620-4913 3155 7079 EHandler@ochc a.com Alternate: Deputy 714-834- 562-508- 714-615-6958 County Health 5518 0696 HCalvet@ochca Officer Helene Calvet .com

Primary Contact 3 Position: HDM Business Home Cell Phone/ Time Follow-up Follow-up Division Manager Phone Phone Pager/email contacted message message #2 #1 time time Mary Massey 714-720- 949-858- 714-315-0572 1069 4873

Primary Contact 4 Position: OC BAC Business Home Cell Phone/ Time Follow-up Follow-up Chair Phone Phone Pager/email contacted message message #1 time #2 time Mary Massey 714-720- 949-858- 714-315-0572

28 FOR OFFICIAL USE ONLY DRAFT Appendix B Control One Notification Procedures

1069 4873 mmassey@och ca.com

Primary Contact 5 Position: OC Public Business Home Cell Phone/ Time Follow-up Follow-up Health Deputy Phone Phone Pager/email contacted message message Agency Director #1 time #2 time David Souleles 714-834- 949-887- 714-720-1334 3882 4151 DSouleles@och ca.com

Primary Contact 6

Position: Public Business Home Cell Phone/ Time Follow-up Follow-up Health Laboratory Phone Phone Pager/email contacted message message Division Manager #1 time #2 time Richard Alexander 714-834- 714-693-5357 8379 RAlexander@oc hca.com

Primary Contact 7 Position: HCA Business Home Cell Phone/ Time Follow-up Follow-up HAZMAT Phone Phone Pager/email contacted message message Supervisor #1 time #2 time Darwin Cheng 714-433- 310-869- 714-936-4346 6250 3250 DCheng@ochca .com

Primary Contact 8 Position: OC Business Home Cell Phone/ Time Follow-up Follow-up Environmental Phone Phone Pager/email contacted message message Health Division #1 time #2 time Manager Denise Fennessy 714-834- 714-720-1343 4099 dfennessy@oc hca.com

Primary Contact 9 Position: EMS Business Home Cell Phone/ Time Follow-up Follow-up Program Manager Phone Phone Pager/email contacted message message #1 time #2 time Tammi McConnell 714-834- 714-402- 714-720-1514 2791 1069 TMcConnell@o chca.com

Primary Contact 11 Position: OCSD Business Home Cell Time Follow-up Follow-up Emergency Phone Phone Phone/Pager/e contacted message message Management mail #1 time #2 time Division Assistant Emergency Manager

29 FOR OFFICIAL USE ONLY DRAFT Appendix B Control One Notification Procedures

Victoria Osborn 714-628- 714-628- 714-448-1197 7019 7054 vosborn@ocsd .org

Primary Contact 12 Position: HCA Public Business Home Cell Phone/ Time Follow-up Follow-up Information Officer Phone Phone Pager/email contacted message message #1 time #2 time Jessica Good 714-834- 714-834-2178 7649

Primary Contact 13 Position: OC Epi Business Home Cell Phone/ Time Follow-up Follow-up Medical Director Phone Phone Pager/email contacted message message #1 time #2 time Matthew Zahn 714-834- 714-720-1323 8024 MZahn@ochca. com

Primary Contact 14 Position: OC Epi Business Home Cell Phone/ Time Follow-up Follow-up Deputy Medical Phone Phone Pager/email contacted message message Director #1 time #2 time 714-834- 949-654- 714-720- Dr. Michele Cheung 7729 0325 147/mcheung@ ochca.com

Primary Contact 15 Position: US Business Home Cell Phone/ Time Follow-up Follow-up Environmental Phone Phone Pager/email contacted message message Protection Agency #1 time #2 time OSC Jason Musante

Primary Contact 16 Position: SC AQMD Business Home Cell Phone/ Time Follow-up Follow-up Phone Phone Pager/email contacted message message #1 time #2 time Rene Bermudez 909-396- 909-485-8762 2136 rbermudez@a qmd.gov

Primary Contact 17 Position OC Business Home Cell Phone/ Time Follow-up Follow-up Veterinarian Phone Phone Pager/email contacted message message #1 time #2 time Jennifer Hawkins 714-796- Jennifer.hawki 6417 [email protected]

30 FOR OFFICIAL USE ONLY DRAFT Appendix B Control One Notification Procedures

v.com

Primary Contact 18 Position: Santa Ana Business Home Cell Time Follow-up Follow-up FBI WMD Phone Phone Phone/Pager/e contacted message message Coordinator mail #1 time #2 time Leah Greeves 213-407- 213-407-9638 9638 leah.greeves@ ic.fbi.gov

Primary Contact 19 Position National Business Home Cell Phone/ Time Follow-up Follow-up Weather Service Phone Phone Pager/email contacted message message #1 time #2 time

Primary Contact 20 Position LA FBI Business Home Cell Phone/ Time Follow-up Follow-up WMD Coordinator Phone Phone Pager/email person message message contacted #1 time #2 time James Peaco 310-996- 24 h duty 310-261-9118 3428 desk: james.peaco@i 310-996- c.fbi.gov 3622

Primary Contact 21 Position: LA PHL Business Home Cell Time Follow-up Follow-up Director Phone Phone Phone/Pager/e person message message mail contacted #1 time #2 time Robert Tran [email protected] county.gov

Primary Contact 22 Position RDMHS Business Home Cell Time Follow-up Follow-up Phone Phone Phone/Pager/e person message message mail contacted #1 time #2 time Michael Noone 562-347- Satellite 213-587-3034 1505 #254- [email protected] 241-9962 acounty.gov

Primary Contact 23 Position CDPH Duty Business Home Cell Time Follow-up Follow-up Officer Phone Phone Phone/Pager/ person message message email contacted #1 time #2 time

31 FOR OFFICIAL USE ONLY DRAFT Appendix B Control One Notification Procedures

Primary Contact 24 Position SCBAC Business Home Cell Time Follow-up Follow-up BioWatch Phone Phone Phone/Pager/ person message message Jurisdictional email contacted #1 time #2 time Coordinator Steven Medley (for 213-434- Alternate 213-422-7930 additional alternates 8928 571-338- see below) 3403

Primary Jurisdictional Coordinator Alternate: Larissa Chiari-Keith, San Diego JC 619-755-7914 619-823-6451 310-748-4283 [email protected]

Secondary Jurisdictional Coordinator Alternate: Brendan Manning, Bay Area JC 415-271-9209 415-603-1511 [email protected]

Tertiary Jurisdictional Coordinator Alternate: Ted Cowan, National JC Supervisor 301-351-7106 301-854-2078 [email protected] [email protected]

COMMENTS:

32 FOR OFFICIAL USE ONLY DRAFT Appendix C HDM Duty Officer Notification Procedures

Appendix C: HDM Duty Officer Notification Procedures

1. Go to www.blackboardconnect.com and click “Sign in Here” located in the top right corner of the screen. 2. Enter Username and Password, and click “Sign In” 3. Under the HOME tab, click “Priority Communication” 4. Click “Create New Message” 5. Enter a title for the message, for future reference (e.g. “BioWatch Alert”) 6. Select Phone, Text-to-Speech, email, SMS and click NEXT 7. Type a short script:

“BioWatch Alert. A Local SCBAC Call will be held at time XX:XX a.m./p.m. today. Dial 877-336-1828 and access code 5180323 to join the BioWatch Local SCBAC Call.”

8. Click “Next” 9. Click “Next” upon seeing a preview of your message 10. Verify the email message is the same as your phone message, and then click “Next” 11. Under the “Create SMS” tab, right dropdown menu, select “email script,” click “Copy” 12. Abbreviate the message for text messaging, if necessary, then click “Next” 13. Verify the messages are correct and proceed to “Select Contacts” 14. Filter or Search for the contacts and select HCA BioWatch group, then click “Next” 15. Select your time zone, enter the date and time you want the message sent, and click “Next” 16. Verify your delivery settings, then click “Confirm”

33 FOR OFFICIAL USE ONLY DRAFT Appendix D LOCAL SCBAC CONFERENCE CALL SCRIPT

Appendix D: Local SCBAC Conference Call Script

The Local SCBAC Conference Call is to begin 45 minutes after notification from LAC- PHL. (N + 45)

Local Conference Call Form Time Initiated: Time Completed: Date:

Telephone Number: 877-336-1828 Access Code: 5180323

Facilitator: (Name, Agency) Decision Maker: (County Health Officer, Agency) Note taker: (Name, Agency)

 This is (Name of Facilitator) from the Orange County Health Care Agency and I will be facilitating the BioWatch Local SCBAC Conference Call.

 We have received notification of a BioWatch Actionable Result (BAR) for (name agent(s)) in (name city) at the street location(s) of (name street intersection(s)).

 The purpose of this conference call is to discuss and evaluate the BAR and determine the next course of action and whether a Local and/or National Conference Call are necessary.

 Please keep background noise to a minimum and mute your phones while listening. Also, remember to unmute while you speak.

 I will now conduct a roll call. When I call the name of your position, please respond with your name and “present.”

Required HCA Participants:  Orange County Health Officer  Deputy Orange County Health Officer  OC BAC Chair  Deputy Agency Director, Public Health Services  Chief, Public Health Services  Medical Director, Epidemiology  Deputy Medical Director, Epidemiology

34 FOR OFFICIAL USE ONLY DRAFT Appendix D LOCAL SCBAC CONFERENCE CALL SCRIPT

 Director, Public Health Lab  Chief, Medical Services  Division Manager, Health Disaster Management  HCA Environmental Health Hazmat Supervisor  Division Manager, Environmental Health  OCHCA PIO  HDM Duty Officer  OCBAC Chair  EMS Program Manager

Other Participants:

 California Department of Public Health  EMS Duty Officer  EMS Program Manager  Environmental Protection Agency  HCA HAZMAT Supervisor  HCA Public Information Officer  Health Disaster Management Division Manager  HDM PHEP Coordinator  LA FBI WMD Coordinator  LA-PHL Director  National Weather Service  Regional Disaster Medical Health Specialist (RDMHS)  Orange County Intelligence Assessment Center  OCSD Emergency Management Division  Southern California AQMD  Santa Ana FBI WMD Coordinator

 If you have joined the call since I started the roll call or your name was not mentioned please let me know now______

 To anyone’s knowledge, are we missing any key personnel who are expected to join or who are unable to attend?

Other:

SITUATION BRIEFING

35 FOR OFFICIAL USE ONLY DRAFT Appendix D LOCAL SCBAC CONFERENCE CALL SCRIPT

 We will begin with a situation briefing from the laboratory. When the report is completed, participants will be given the opportunity to ask questions.

Los Angeles County Public Health Lab Answer BAR results

Organism(s) detected and average Ct values

Location(s) and exposure window of positive collectors

Will organism isolation be attempted/initiated? If so, when?

When will the strain/subtype of organisms available?

What is the status of additional lab testing?

What is the range for the Ct values detected?

Has a previous BAR for this agent ever occurred in the jurisdiction?

Quality control:

Has the laboratory processed any other samples (i.e. QA samples) in the past week in which this agent was tested for or results were generated for? Did any work with this organism recently occur in the laboratory space where BioWatch samples are processed?

Did any other collector filters under analysis generate reactive results not meeting the algorithm in the screening or verification panels to the agent?

Has laboratory contamination been ruled out?

36 FOR OFFICIAL USE ONLY DRAFT Appendix D LOCAL SCBAC CONFERENCE CALL SCRIPT

Is any additional lab testing being conducted to rule out contamination or cross-contamination?

Have positive and negative assay controls worked as expected?

What are yesterday’s BioWatch results

History of BioWatch positive results in the jurisdiction.

Is there any background agent and surveillance information from OC Public Health: Is there any animal surveillance information from the OC Veterinarian? Is there any information or threat assessment from Law Enforcement? Additional information or unusual circumstances regarding:

 What is the Health Care Agency’s assessment of public health risk at this time?

□ Unlikely risk to the public’s health □ Possible risk to the public’s health □ Probable risk to the public’s health

 Should the Health Care Agency conduct environmental sampling actions, additional filter retrieval, or any other actions?

 At this point, a decision is required from the County Health Officer regarding the need for an OC OA City Conference Call. Should the County of Orange conduct an OC OA City Conference Call?

If a determination is made that an OC OA City call will be conducted, the facilitator will relay said call information to participants. If the call is deemed not necessary, the Facilitator will instruct the OCBAC Chair to follow the notification protocol as listed in appendix A.

37 FOR OFFICIAL USE ONLY DRAFT Appendix D LOCAL SCBAC CONFERENCE CALL SCRIPT

 To summarize, based on current evidence and our discussion, we believe there to be an (unlikely/possible/probable) risk to the public’s health. This group (recommends/does not recommend) an OC OA City Conference Call.

Final discussion regarding the following actions: (See Appendix G: Public Health Decision Making Matrix)

Specific Actions Assigned to: Health Surveillance (e.g., Active, passive, alerts) Veterinary Surveillance

HEOC Activation

EMS DOC Activation

POD Activation

Mass Prophylaxis Deployment

Protective Actions: Emergency Responders (e.g., PPE, MCM) Protective Actions: Local Community e.g., Shelter-in-Place, MCM)

 Final discussion regarding Public Information Actions:

Actions Assigned to: Information sheets available for responders and public A press release prepared

A press conference scheduled

If a State Conference Call is requested by the California Department of Public Health, complete the California State BioWatch Actionable Results (BAR) Data Form and submit to [email protected] and call (916) 845-8911 to confirm receipt.

If an OC OA City call is decided, read the following:

38 FOR OFFICIAL USE ONLY DRAFT Appendix D LOCAL SCBAC CONFERENCE CALL SCRIPT

Purpose of an Orange County Operational (OC OA) City Call: This guide is designed to facilitate communication among jurisdictions for a BioWatch incident. This guide may be used under any of the following conditions:

 To establish communications among jurisdictions.

 To facilitate protective action decision-making.

Initiating an OC OA City Call: The following jurisdictions/agencies should participate on BioWatch call as indicated below:

Jurisdiction/Agency  City of Anaheim  City of Brea  City of Fullerton  City of Santa Ana  City of Yorba Linda  Orange County Intelligence Assessment Center (OCIAC)  Orange County Fire Authority  Orange County Health Care Agency  Orange County Sheriff’s Department Mutual Aid and/or Department Commander  Orange County Sheriff’s Emergency Management Division

Conference Call Lines and Back-up Systems for the OC OA City Call:

Primary conference call line: Conference Call Phone Number: 877-336-1828 Access Code: 5180323 (this is the code provided to those calling in) Host Code: 3486  The conference may consist of up to 100 members.

 All Conferees will dial the phone number and access code only. Only OCSD Emergency Management Division will utilize the host code 3486. This should not be disseminated to other agencies.

 As conferees enter or leave the call, a confirmation tone will be received by all conferees to confirm that there has been a change in the number of participants.

39 FOR OFFICIAL USE ONLY DRAFT Appendix D LOCAL SCBAC CONFERENCE CALL SCRIPT

 When the conference call is completed, conferees simply hang up.

In the event the primary conference call line fails, the OCSD Emergency Management Division has the capabilities to provide back-up modes of communications including:

Secondary back up conference call line: Conference Call Phone Number: 877-336-1829 Access Code: 3753246(this is the code provided to those calling in) Host Code: 4361  The conference may consist of up to 100 members.

 All Conferees will dial the phone number and access code only. Only OCSD EM will utilize the host code 4361. This should not be disseminated to other agencies.

 As conferees enter or leave the call, a confirmation tone will be received by all conferees to confirm that there has been a change in the number of participants.

 When the conference call is completed, conferees simply hang up.

Orange County, “MEET ME” Conference Call Line: Allows agencies to host conference calls by using the Orange County Telecommunications Network (OCTNET) system. Conference Call phone number: 714-834-7400 Agency ID: 22 Passcode: 164422# The conference may consist of up to 30 members.  All Conferees will dial the phone number, Agency ID and Pass Code to activate the conference bridge.

 The first person to call will hear a ringing only, until the next party connects. As conferees are added a confirmation tone will sound to all parties but the new arrival. This allows any conferee to check the “roll call” and ensure that only desired parties are involved in the conference call and maintain an orderly list of participants.

 As conferees leave the bridge, a confirmation tone will be received by all conferees to confirm that there has been a change in the number of participants.

40 FOR OFFICIAL USE ONLY DRAFT Appendix D LOCAL SCBAC CONFERENCE CALL SCRIPT

 When the conference call is completed, conferees simply hang up.

 Are there any additional questions and issues?

 Thank you for your participation. This concludes the call.

41 FOR OFFICIAL USE ONLY DRAFT Appendix D REGIONAL CONFERENCE CALL SCRIPT

CONTACT LIST NUMBERS FOR ALL CALLS (Notify only those involved with each call)

Primary Contact 3 Position: HDM Business Home Cell Phone/ Time Follow-up Follow-up Division Manager Phone Phone Pager/email contacted message message #2 #1 time time

Primary Contact 6 Position: OC Public Business Home Cell Phone/ Time Follow-up Follow-up Health Chief of Phone Phone Pager/email contacted message message Operations #1 time #2 time

42 FOR OFFICIAL USE ONLY DRAFT Appendix D REGIONAL CONFERENCE CALL SCRIPT

Primary Contact 7 Position: Public Business Home Cell Phone/ Time Follow-up Follow-up Health Laboratory Phone Phone Pager/email contacted message message Division Manager #1 time #2 time Richard Alexander 714-834- 714-693-5357 8379 RAlexander@oc hca.com

Primary Contact 8 Position: HCA Business Home Cell Phone/ Time Follow-up Follow-up HAZMAT Phone Phone Pager/email contacted message message Supervisor #1 time #2 time Darwin Cheng 714-433- 310-869- 714-936-4346 6250 3250 DCheng@ochca .com

Primary Contact 9 Position: OC Business Home Cell Phone/ Time Follow-up Follow-up Environmental Phone Phone Pager/email contacted message message Health Division #1 time #2 time Manager

Primary Contact 10 Position: EMS Business Home Cell Phone/ Time Follow-up Follow-up Program Manager Phone Phone Pager/email contacted message message #1 time #2 time Tammi McConnell 714-834- 714-402- 714-720-1514 2791 1069 TMcConnell@o chca.com

Primary Contact 13

43 FOR OFFICIAL USE ONLY DRAFT Appendix D REGIONAL CONFERENCE CALL SCRIPT

Position: OC Epi Business Home Cell Phone/ Time Follow-up Follow-up Medical Director Phone Phone Pager/email contacted message message #1 time #2 time Matthew Zahn 714-834- 714-720-1323 8024 MZahn@ochca. com

Primary Contact 15 Position: US Business Home Cell Phone/ Time Follow-up Follow-up Environmental Phone Phone Pager/email contacted message message Protection Agency #1 time #2 time OSC Jason Musante

Primary Contact 17 Position: OC Business Home Cell Phone/ Time Follow-up Follow-up Veterinarian Phone Phone Pager/email contacted message message #1 time #2 time Jennifer Hawkins 714-796- Jennifer.hawki 6417 [email protected] v.com

Primary Contact 19 Position: National Business Home Cell Phone/ Time Follow-up Follow-up Weather Service Phone Phone Pager/email contacted message message

44 FOR OFFICIAL USE ONLY DRAFT Appendix D REGIONAL CONFERENCE CALL SCRIPT

#1 time #2 time

Primary Contact 20 Position: LA FBI Business Home Cell Phone/ Time Follow-up Follow-up WMD Coordinator Phone Phone Pager/email person message message contacted #1 time #2 time James Peaco 310-996- 24 h duty 310-261-9118 3428 desk: james.peaco@i 310-996- c.fbi.gov 3622

Primary Contact 22 Position: RDMHS Business Home Cell Time Follow-up Follow-up Phone Phone Phone/Pager/e person message message mail contacted #1 time #2 time Michael Noone 562-347- Satellite 213-587-3034 1505 #254- [email protected] 241-9962 acounty.gov

Primary Contact 23 Position: CDPH Duty Business Home Cell Time Follow-up Follow-up Officer Phone Phone Phone/Pager/ person message message email contacted #1 time #2 time

Primary Contact 24 Position: SCBAC Business Home Cell Time Follow-up Follow-up BioWatch Phone Phone Phone/Pager/ person message message Jurisdictional email contacted #1 time #2 time Coordinator Steven Medley (for 213-434- Alternate 213-422-7930 additional alternates 8928 571-338- see below) 3403

Primary Jurisdictional Coordinator Alternate: Larissa Chiari-Keith, San Diego JC 619-755-7914 619-823-6451 310-748-4283 [email protected]

45 FOR OFFICIAL USE ONLY DRAFT Appendix D REGIONAL CONFERENCE CALL SCRIPT

Secondary Jurisdictional Coordinator Alternate: Brendan Manning, Bay Area JC 415-271-9209 415-603-1511 [email protected]

Tertiary Jurisdictional Coordinator Alternate: Ted Cowan, National JC Supervisor 301-351-7106 301-854-2078 [email protected] [email protected]

Primary Contact 25 Position: Business Home Cell Time Follow-up Follow-up Fullerton/Brea Fire Phone Phone Phone/Pager/ person message message email contacted #1 time #2 time Rhonda Rosah 714-671- 714-336-9681 6365 rhondar@city ofbrea.net

Primary Contact 26 Position: Santa Ana Business Home Cell Time Follow-up Follow-up Police Department Phone Phone Phone/Pager/ person message message email contacted #1 time #2 time Steve Rhyner 714-647- 949-525- 714-418-7449 5315 8417 srhyner@sant a-ana.org

Primary Contact 27 Position: Anaheim Business Home Cell Time Follow-up Follow-up Fire Department Phone Phone Phone/Pager/ person message message email contacted #1 time #2 time Jeff Duvall 714-765- 310-560- 714-296-5161 4051 2316 jduvall@anah eim.net

Primary Contact 28 Position: City of Business Home Cell Time Follow-up Follow-up Yorba Linda Phone Phone Phone/Pager/ person message message email contacted #1 time #2 time Mike Ferdig 714-961- 949-858- 714-349-9671 7104 8625 mferdig@yor balinda.org

46 FOR OFFICIAL USE ONLY DRAFT Appendix E OC OA CITY CONFERENC CALL

Appendix E: OC OA City Conference Call Script

The OC OA City Conference Call is to begin 90 minutes after notification from LAC-PHL (N + 90).

Time Initiated: Time Completed: Date:

Telephone Number: 888-232-0362 Participant Code: 831470

Facilitator: Name, Orange County Sheriff’s Department Emergency Management Division (Name, Agency) Decision Maker: (County Health Officer, Health Care Agency) Note taker: (Name, Agency)

 This is (Name of Facilitator) from the Orange County Sheriff’s Department Emergency Management Division and I will be facilitating the BioWatch OC OA City Conference Call.

 We have received notification of a BioWatch Actionable Result for (name agent(s)) in (name city) at the street location(s) of (name street intersection(s)).

 The purpose of this Conference Call is to provide a situational assessment to the BioWatch cities.

 Please keep background noise to a minimum and mute your phones while listening. Do not put your phone on hold if it activates background music. Also, remember to unmute while you speak. Finally, please do not speak unless you have been specifically asked for a response or have received a verbal prompt for questions.

Date: Time:

Event Name:

County/OA EOC Facilitator:

The OC OA City Conference Call is to begin 90 minutes after initial notification from Control One to OCSD EMD.

Control One Notification to OCSD EMD: ______OC OA City Conference Call time: ______

Conference Call Number: Conference Call Phone Number: 877-336-1828

47 FOR OFFICIAL USE ONLY DRAFT Appendix E OC OA CITY CONFERENC CALL

Access Code: 5180323 (this is the code provided to those calling in)

LEGEND: CF= Call Facilitator CF= SAY IT CF = indicates actions or items to complete

Critical Information required for the Conference Call: CF should have the information below ready prior to initiating the conference call OCHCA Representative confirmed to be on the call Name: BioWatch Phase (Circle One) Phase 2 Phase 3 (Stage 1 -- Stage 2 – Stage 3)

Weather outlook for the next 72 hours CF can obtain this information from the NWS Website Organism(s) DNA detected (two letter code) (BA, YP, FT, BU, VM)CF can obtain this information from the NTWC Bulletin

CF This is (name of facilitator) from the Operational Area Emergency Operations Center and I will be facilitating the OA BioWatch conference call.

Reminder - please mute your phones during this call in order to keep background noise to a minimum. Please do not place this call on hold – some phone systems have music and it is a disruption.

The Orange County Health Care Agency has notified us of a BAR occurring at the collector located in circle one (Anaheim – Brea – Fullerton – Santa Ana – Yorba Linda).

This conference call has been initiated to provide a briefing on the current situation and discuss if any protective actions need to be implemented. Each agency with public safety authority for their jurisdiction is expected to have a Decision Maker on the Conference Call for this event.

I will conduct a roll call; jurisdictions included in the BioWatch program will be called first, then additional agencies.

48 FOR OFFICIAL USE ONLY DRAFT Appendix E OC OA CITY CONFERENC CALL

When prompted, please respond if your Decision Maker is present, and provide the Decision Maker’s name and phone number.

CF The following jurisdictions are required participants who have decision making authority for this event:

“Is your Jurisdiction or Agency “Decision Maker Name and Agency Decision Maker on Name Contact Number” line?”

Anaheim YES NO

Brea YES NO

Fullerton YES NO

Santa Ana YES NO

Yorba Linda YES NO

Seal Beach YES NO

CF I will now call other assisting agencies who are on this call. Please provide the name of the primary point of contact.

CF will conduct roll call of the agencies listed below. If any agency is not listed, indicate in the others column.

Other Participants: “Please list your conference call participant’s name”

OC Fire Authority

OCIAC OCSD – Mutual Aid/DC

OCSD-EMD

OC HCA Rep.

Others:

49 FOR OFFICIAL USE ONLY DRAFT Appendix E OC OA CITY CONFERENC CALL

SITUATION BRIEFING

CCF We will begin with a situation briefing from the Orange County Health Care Agency. When the report is completed, participants will be given the opportunity to ask questions.

CF, If OCHCA is unable to be on the conference call, the CF will provide the current situation update provided on the LOCAL SCBAC Conference Call preceding this call.

OC Health Care Agency Briefing:

 General Information:

 Review of symptoms, incubation period, and any reported epi cases:

 Actions being taken by HCA (i.e. Environmental sampling)

CF Does anyone have any questions for the Health Care Agency?

CF Capture any question asked by the members on the call. CCF We will begin with a situation briefing from the Orange County Intelligence Assessment Center. When the report is completed, participants will be given the opportunity to ask questions.

CF If OCIAC is unable to be on the conference call, the CF will provide the current situation update provided on the LOCAL SCBAC Conference Call preceding this call.

50 FOR OFFICIAL USE ONLY DRAFT Appendix E OC OA CITY CONFERENC CALL

OCIAC Briefing:

 Any credible threats to Orange County

 Any special events/circumstances in the area (VIPs, events with animals, large gatherings, etc.)

CF Does anyone have any questions for the OCIAC? CF Capture any question asked by the members on the call.

CF Based on the information receive we are current at: (Phase 2, Phase 3) and will now talk about operational actions

CF: If time allows, summarize facts for those who may have joined call late and take any questions to clarify the above situation report before moving on.

CF The next discussions will vary based on which phase we are in. Please go to the appropriate sections attached.

INITIAL INFORMATIONAL/COORDINATION CALL/ACTIONS:

CF Based on the information receive so far, we will begin to discuss initial actions the cities should be taking

51 FOR OFFICIAL USE ONLY DRAFT Appendix E OC OA CITY CONFERENC CALL

CF: Health Care Agency, what is the Personal Protective Equipment for First Responders: Yes – what is it?

No- Why not?

CF OC HCA – Has the Has the Strategic National Stockpile been requested?

If yes, what is the eta?

If No – Will this decision be made in the next Operational Period?

CF Is there a recommendation to begin planning for establishment of POD sites:

If Yes – Is there set time to begin distribution to the POD locations and what time should PODs be available for the public

If No – Will this decision be made in the next Operational Period?

CF When I call your jurisdiction or agency, please provide the following information:  Will you be activating you EOC and to what level

 Current status update/city activities

 Do you have any special events scheduled in your jurisdiction

 Road closures or construction

 Any other pertinent information which may impact decision making

52 FOR OFFICIAL USE ONLY DRAFT Appendix E OC OA CITY CONFERENC CALL

Current Status Report From: (EOC, Special Events scheduled, Road impediments, beach status, etc.)

Anaheim

Brea

Fullerton

Santa Ana

Yorba Linda

OCHCA

OCSD EMD

Others

53 FOR OFFICIAL USE ONLY DRAFT Appendix E OC OA CITY CONFERENC CALL

BioWatch Response: (Initial Call) ** If not the initial call skip to page 12)

CF For a BioWatch Response, our response plans will transition to the OA Emergency Operations Plan, City Emergency Operations Plan, WMD Annex and other supporting annexes as needed.

For this initial call, there are:  No Protective Actions  No AlertOC  No Point-of-Distribution (POD) Activation Orders  Jurisdictions will continue to Monitor Situation

CF Is there any discussion, comments or questions before we continue? CF shall capture additional comments here, if any:

CF When I call your jurisdiction, state your concurrence with the protective action recommendations. Please state yes or no to the following:

CF will call each jurisdiction then read the header of each column and indicate yes or no.

BioWatch Concurrence Table No AlertOC No POD Activation Continue to Monitor Orders Situation

YES NO YES NO YES NO

Anaheim

Brea

Fullerton

Santa Ana

Yorba Linda

OC HCA

OCSD

54 FOR OFFICIAL USE ONLY DRAFT Appendix E OC OA CITY CONFERENC CALL

CF will recap if a concurrence has been received. If there is not a concurrence, discussion to come to a resolution will take place until a concurrence or reasonable solution is agreed upon.

CF Just a reminder, public information will be coordinated with the Orange County Health Care Agency Public Information Officer. Press Releases and information will be coordinated with ______(insert name of PIO) at OCHCA.

CF Is there any jurisdiction with any needs or requests at this time or do any jurisdictions have any further questions?

CF will capture any needs or requests from jurisdictions, including mutual aid, OA EOC support, etc.

Anaheim

Brea

Fullerton

Santa Ana

Yorba Linda

OC HCA

OCSD

Others:

55 FOR OFFICIAL USE ONLY DRAFT Appendix E OC OA CITY CONFERENC CALL

CF Prior to ending the conference call, facilitator should provide a summary of the final decision on protective actions to be taken or not taken.

CF will determine if there is the need for additional coordinating conference calls with the Operations Area.

CF Our next conference call will be held at ______time on ______date an email reminder with the time and conference call information will be sent out to the jurisdictions.

CF This concludes this conference call. Thank you.

CF Immediately send out next scheduled conference call date and time information via email and AlertOC.

CF should indicated time call ended here: ______

56 FOR OFFICIAL USE ONLY

Appendix E: OC OA CITY CONFERENC CALL

BioWatch Response: (Follow up Coordination OA Conference Calls Call)

CF For this continued response, the OCHCA Public Health Officer is making the following protective actions for responders and the community members. OC HCA, please provide an update on these recommendations

CF Will write the recommendations below

 ______ ______ ______ ______

CF Is there any discussion, comments or questions before we continue? CF shall capture additional comments here, if any, if not recap the information above.

CF When I call your jurisdiction, state your concurrence with the protective action recommendations. Please state yes or no:

CF will call each jurisdiction then read the header of each column and indicate yes

Protective Action Recommendations

Concurrence

YES NO

Anaheim

Brea

Fullerton

Santa Ana

Yorba Linda

OC HCA

OCSD

57 FOR OFFICIAL USE ONLY

Appendix E: OC OA CITY CONFERENC CALL

CF will recap if a concurrence has been received. If there is not a concurrence, discussion to come to a resolution will take place until a concurrence or reasonable solution is agreed upon.

CF Is there any jurisdiction with any needs or requests at this time or do any jurisdictions have any further questions?

CF will capture any needs or requests from jurisdictions, including mutual aid, OA EOC support, etc.

Anaheim

Brea

Fullerton

Santa Ana

Yorba Linda

OC HCA

OCSD

Others:

CF Prior to ending the conference call, facilitator should provide a summary of the final decision on protective actions to be taken or not taken.

58 FOR OFFICIAL USE ONLY

Appendix E: OC OA CITY CONFERENC CALL

CF will determine if there is the need for additional coordinating conference calls with the Operations Area.

CF Our next conference call will be held at ______time on ______date an email reminder with the time and conference call information will be sent out to the jurisdictions.

CF This concludes this conference call. Thank you.

CF Immediately send out next scheduled conference call date and time information via email and AlertOC.

CF should indicated time call ended here: ______

CONCLUSION:

 Are there any additional questions or issues?

Facilitator: Follow established rotation to allow agencies to raise issues regarding resource utilization and incident priorities, followed by questions from other conference call participants.

Summarize situation report and action plan.

Provide information regarding the National Conference Call (below).

NATIONAL CONFERENCE CALL Date: Time: Telephone Number: Participant Code:

 Thank you for your participation. This concludes the call.

59 FOR OFFICIAL USE ONLY DRAFT Appendix F National Conference Call Script

Appendix F: National Conference Call Script (N + 180)

BioWatch National Conference Call (BWNCC) Facilitator:  Hello everyone and welcome to this BioWatch National Conference Call. The current time is now ______(Pacific). The Department of Homeland Security National Operations Center (NOC) is recording this call for documentation and archival purposes. To limit background noise and feedback, please mute your phone now and remember to unmute before you speak.

 My name is ______, I am the ______( Title ), of the BioWatch Program, Office of Health Affairs (OHA), Department of Homeland Security and I am the facilitator of this call. Information discussed on this call is sensitive to United States national security. Parties who are not affiliated with this subject matter must leave now. (Pause to allow people to leave)

 The purpose of this call is for information sharing and situational assessment following a BioWatch Actionable Result (BAR) in order to develop a common operating picture. Participants in the BWNCC are federal, state, and local government subject matter experts from a multitude of disciplines and emergency support functions (ESFs). The discussion we have today using the BWNCC Framework will help to ensure a robust common operating picture at an early stage in this BioWatch Incident.  As a reminder, this call does not constitute a formal declaration of emergency by the local, state, or federal government nor is it a forum to request federal emergency response resources. However, BioWatch specific reachback resources are available and will be addressed later in this call. Please mute your phone now and remember to unmute before you speak.

 We will begin the roll call with state and local representatives, including locally deployed federal representatives in the field offices. The Jurisdictional Coordinator will conduct this portion of the roll call based on local roll call preferences, and I will conduct the roll call for federal representatives at national headquarters following the jurisdictional roll call.

 Each representative who will be responding to the roll call on behalf of the jurisdiction, please identify yourself and your agency. Use the emergency support functions (ESF) as appropriate to ensure all agencies on the call are identified. In the interest of time, please identify a single representative to speak on behalf of each agency.

While I recognize that there may be a number of important participants on this call, for purposes of the roll call, I intend only to highlight corresponding emergency

60 FOR OFFICIAL USE ONLY DRAFT Appendix F National Conference Call Script support function areas that align with this BAR assessment. I will now turn it over to the JC to start the roll call:

State Officials □ State Public Health Official □ State Emergency Management □ State Law Enforcement □ Other State Agency (e.g. National Guard/CST)

Federal field officials □ BioWatch Jurisdictional Coordinator □ FBI WMD Coordinator □ EPA On-Scene Coordinator □ Other (e.g. US Military, DoD, installations)

Federal headquarters □ DHS National Operations Center (NOC) □ DHS OHA – BioWatch Program Office □ DHS OHA – National Biosurveillance Integration Center (NBIC) □ DHS Intelligence and Analysis (I&A) □ HHS Office of Assistant Secretary of Preparedness and Response (ASPR) □ HHS Centers for Disease Control and Prevention □ EPA Office of Emergency Management □ FBI WMD Operations Unit (WMDOU) □ Other

 To anyone’s knowledge, are we missing any key personnel who are expected to join or who are unable to attend?

2) Introduction, purpose and scope of the BioWatch National Conference Call

 Again, this is , , of the <agency>. I will be the moderator of this BioWatch National Conference Call. The purpose of this call is to:  Receive a BAR incident brief from local/State officials  Receive a report of national threat, intelligence, and surveillance information  Determine if there is a threat to the public  Determine a need for BioWatch resources  Discuss immediate jurisdictional and Federal activities  Determine the time and date for the next BioWatch National Conference Call, if necessary  Please keep in mind this BioWatch National Conference Call does not constitute a formal declaration of emergency by the local or state 61 FOR OFFICIAL USE ONLY DRAFT Appendix F National Conference Call Script government and is not a forum in which to request National response assets such as the Strategic National Stockpile. However, certain BioWatch resources for situational awareness are available for modeling, laboratory support, and environmental sampling. Those resources will be discussed later in this call.  Before we hear from <the jurisdiction> please mute your phone while you are listening, and be sure to unmute as you speak. We will now begin with a situation brief from<the jurisdiction>. 3) Situation brief (Jurisdiction: local or State health official) BWNCC Facilitator: We will now discuss key findings from ( Jurisdiction Representative ) regarding laboratory and field data. Laboratory Information: • Did a Technical Laboratory Consultation Call (TLCC) occur? • What is the range for the Ct values detected? • (Note: A Ct (cycle threshold) is the number of Polymerase Chain Reaction (PCR) cycles necessary to reach a detection threshold. Ct values are inversely proportional to the amount of DNA, a lower value indicates more DNA.) • Have there been previous BAR(s) for this ( Agent )? • Has the laboratory processed any other samples (i.e., QA samples) in the past week in which this agent was tested for or results were generated for? • Did any work with this ( Agent ) recently occur in the laboratory space where BioWatch samples are processed? • Did any other collector filters under analysis generate reactive results not meeting the algorithm in the screening or verification panels to ( Agent )? (Note: The BioWatch Laboratory Director determined laboratory data met the algorithm for a BAR Declaration. This means the verification panel met the algorithm for the DNA of ( Agent ), and the quality control processes worked as expected, which provides extremely high confidence that the results represent a genuine detection of the agent DNA. The BioWatch QA program and the daily quality control testing ensure a high level of confidence in the testing procedures and the results of the screening and verification panels. This allows for extremely high confidence in the results reported. More information about the BioWatch QA program and laboratory operations can be found in the BioWatch Outdoor Guidance.) Field Information: • What was the sampling period for the collector(s) that reported the BAR? • How many ___outdoor and ___indoor collectors are in the network? • Did your team report any unusual activity around these collector(s)? 62 FOR OFFICIAL USE ONLY DRAFT Appendix F National Conference Call Script • Did the collector(s) have any mechanical problems that may have compromised sampling capacity? • Can you briefly describe approximately where each collector that tested positive is located to provide us with a general understanding of the area? • What were the weather conditions during the sampling period? • What are the weather conditions today? • Do you have any other relevant environmental information to share? Are there any questions or comments from the jurisdictional or federal partners regarding this information? Law Enforcement and Intelligence Summary: BWNCC Facilitator: We will now discuss key local law enforcement and intelligence findings from ( Jurisdiction Representative ). • Are you aware of any credible threats to the jurisdiction or intelligence about potential threats? • Have there been any recent applicable criminal or suspicious activities near or relevant to the area in question that you are free to discuss? • Have there been any special events, large gatherings, VIP visits, etc.? • Does the local Fusion Center have anything to add? • Does the Local FBI WMD Coordinator have anything to add? • Any other items for discussion? BWNCC Facilitator: We will now discuss key law enforcement and intelligence findings from federal representatives. • Does FBI HQ have anything to add about their threat credibility evaluation at this stage? • Does DHS Intelligence and Analysis have any information to share? • Does the DHS National Operations Center have any information to share? Are there any questions or additional comments from the jurisdictional or federal partners regarding the law enforcement and intelligence information provided? Public Health Summary: BWNCC Facilitator: We will now discuss key findings from ( Jurisdiction Representative ) regarding human and animal health surveillance data. • Has there been any recent human health surveillance data that could be related to the disease caused by ( Agent )? 63 FOR OFFICIAL USE ONLY DRAFT Appendix F National Conference Call Script • Has there been any recent animal health surveillance data that could be related to the disease caused by (Agent)? • Any other relevant public health information for discussion? BWNCC Facilitator: We will now discuss key findings from the federal representatives regarding human and animal health surveillance data. • Does HHS/CDC have anything to add? • Does HHS/ASPR have anything to add? • Does the DHS National Biosurveillance Integration Center have anything to add? BWNCC Facilitator: Now I will ask the (Lead National Laboratory) to provide an overview of the reachback modeling results. BWNCC Facilitator: Are there any questions about these results? Is there any other agency on the call with information to share? This concludes the situation briefing portion of the call. Are there any questions or comments regarding the information we have so far? Before we move on to the risk assessment portion, has anyone else joined the Conference Call? < Pause> We will now continue to discuss the situational assessment. Assessment of Current Situation: BWNCC Facilitator: We just heard four summary briefings regarding the conditions in (Insert Jurisdiction) at the present time, and now must assess the available information about the BioWatch Incident to direct initial actions. We recognize that this is a rapidly evolving incident and thus the assessment may change as new information becomes available. Public Health Assessment: (Note for BWNCC Facilitator: These questions are for the group to discuss. You may need to call on respective agencies to share feedback on the assessment if nothing is provided when the questions is posed to the group.) • Do the circumstances of the incident warrant a public health investigation? • Has the jurisdiction already begun a public health investigation? If Yes − What steps are being taken? • Do the circumstances of the incident warrant additional public health responses, beyond an investigation? • If no, what additional information is needed to make a decision on whether to initiate a public health investigation? 64 FOR OFFICIAL USE ONLY DRAFT Appendix F National Conference Call Script • Has the jurisdiction already taken additional public health response actions? If yes, what steps are being taken? If no, what additional information is needed to make a decision on whether to initiate additional public health response actions? • Does a public health risk exist based on what was discussed so far on the BWNCC? Law Enforcement Assessment: • Do the current conditions discussed about the detection warrant a law enforcement investigation due to the possibility of an intentional release? • If so, has the jurisdiction already begun a law enforcement investigation, and what steps are being taken? • If no, what additional information is needed to make a decision on whether to initiate a law enforcement investigation? • Does the intelligence discussed create a credible threat to the jurisdiction? • Does any other state, local, and federal participants on this call have any additional perspectives to add? (Note: Participants that support this initial assessment are encouraged to share their perspectives. If there are alternative assessments of the situation, those alternatives should be shared now.) To summarize we are concluding on this BWNCC that ( a/no ) public health risk exists and that ( a/no ) public health response will be conducted. (A/No) threat exists and ( an/no ) active investigation will be conducted. BWNCC Facilitator Follow Up BWNCC Facilitator: Given the assessment of the situation, ( Jurisdiction Representative ) please highlight your jurisdiction’s actions / next steps. (Note: Jurisdictional Representatives can use the list below as an example of activities that could be discussed and reported during this section of the call. If the jurisdiction does not have a next steps identified, the BWNCC Facilitator may ask the jurisdiction about some steps.) • No actions are being considered or • BioWatch Specific • Changing filter retrieval frequencies • Modifying collector array (additional collectors) • Phase I/II (who is performing sampling / receiving samples for testing?) • Emergency management operations • Transition to response framework to include emergency declaration 65 FOR OFFICIAL USE ONLY DRAFT Appendix F National Conference Call Script • Requests for Federal assistance (e.g., anticipating, in progress) • Activate and staff emergency operations center • Risk communication activities • Risk Communication Conference Call • Media and / or public inquiries • Press releases • Public health operations • Enhanced passive surveillance • Active surveillance • Continued syndromic surveillance • Joint public health/law enforcement investigation of Agent-related disease • Requested / not requested / considering request of SNS • Activated / not activated / considering activation of PODs • Briefings made or planned to be made to elected political leadership BWNCC Facilitator: Given the assessment of the situation (and the request for resources we just heard), I will ask our Federal Representatives to highlight your agencies actions / next steps. I will call you by agency for your response. (Note: Federal Representatives are encouraged to describe the current status of their EOCs, their operational activities (including actions taken under their own authority based on a BAR), the status of resource requests they may have received already or anticipate receiving based on this call, and how they will help address the jurisdictions unmet needs.) OHA (BWNCC Facilitator will call on participating component, directorates and offices based on the roll call) (Note: OHA Public Affairs will introduce the BioWatch Public Affairs Liaison Officer: They will provide their contact info and any pertinent information about public affairs coordination) Assistant Secretary of Preparedness and Response (ASPR) Centers for Disease Control and Prevention (CDC) Federal Bureau of Investigation (FBI) Environmental Protection Agency (EPA) Do any other federal representatives on the call have anything to report? Given the considered actions, would you ( Jurisdiction Representative ) wish to receive/continue to receive the following BioWatch Program managed resources? • Rapidly Deployable Laboratory (RDL) (or elements of) consumables, reagents, or surge laboratory staff • Environmental sampling supplies 66 FOR OFFICIAL USE ONLY DRAFT Appendix F National Conference Call Script • DHS / OHA Public Affairs risk communication / messaging support The BioWatch Program will coordinate the delivery of the BioWatch resources as well as any on-site control / access issues through the Jurisdictional Coordinators following this conference call. Are there any additional comments at this time before we close this conference call? Is there a need for another BWNCC? (Option, as needed: The date and time for the next BioWatch National Conference Call will be at: (Date/Time/Number/Access Code)) Thank you everyone for your contributions to this BioWatch National Conference Call. The time is now ______( Pacific ) and this call is adjourned. 67 FOR OFFICIAL USE ONLY Appendix G PUBLIC HEALTH DECISION MAKING MATRIX Appendix G: Public Health Decision Making Matrix A Agents/Action F. tularensis B. mallei Y. pestis B. anthracis Variola Major Acti Incubation period 3 – 5 days [1-14d] 1 – 21 days 1 – 4 days 2 – 7 days 7 – 19 days Human Transmissible Not communicable Possible Yes. Latent 1 – 8 d Not communicable Yes. Latent 7 – 21 d Local environ reservoir Yes No Yes Limited No Likelihood of Organisms in Unlikely Possible Probable Possible Probable Possible Probable Possible Probable Possible Probable Environment Pre-Conference Call Initial Notifications BAC BAC BAC, E BAC BAC, E BAC,E BAC, E BAC, E BAC, E BAC, E BAC, E Conference Calls Local National All National All All All All All All All Command Center N N EOC DOC EOC EOC EOC EOC EOC EOC EOC Environmental Environmental Sampling N N Y Y Y Y Y Y Y Y Y Filter Retrieval Frequency q24hr q24hr q24hr q24hr q24hr q24hr q24hr q24hr q24hr q24hr q24hr Staff Retrieving Filter(s) Routine Routine EPA EPA EPA EPA EPA EPA EPA EPA EPA Public Health Health Surveillance R R RSEA RSEA RSEA RSEA RSEA RSEA RSEA RSEA RSEA Veterinary Surveillance R R RSEA RSEA RSEA RSEA RSEA RSEA RSEA N/A N/A Mass Prophylaxis Deployment None None Alert Alert Request Alert Request Alert Request Request Request POD Activation None None Alert Alert Ready Alert Ready Alert Ready Ready* Ready* PEP: Emergency Responders N N N N Y N Y Y Y Y* Y* PEP: Retrieval N Y Y Y Y Y Y Y Y Y* Y* Press Statement By JIC** Prepare Prepare Release Release Release Release Release Release Release Release Release Other Event Recon. Modeling N Y Y Y Y Y Y Y Y Y Y * If available **After consultation with Health Office68 FOR OFFICIAL USE ONLY Appendix G PUBLIC HEALTH DECISION MAKING MATRIX General: R = Review existing surveillance data BAR = BioWatch Actionable Result S = Syndromic surveillance enhancement (if available) Ct Values = Cycle threshold value, laboratory measurement (inversely related to E = Enhanced passive surveillance (health alert) concentration) A = Active surveillance (public health calls or site visits – health alert) Local environmental reservoir Y=Yes; Evidence that agent is present in humans or animals in BAC jurisdiction Veterinary Surveillance: N=No; No evidence that agent is present in humans or animals in BAC R = Review existing surveillance data jurisdiction S = Syndromic surveillance enhancement (if available) Limited= Historical cases but no recent cases E = Enhanced passive surveillance (health alert) A = Active surveillance (public health calls or site visits – health alert) Pre-conference call activities: Mass Prophylaxis Deployment: Initial Notifications None = no action at this time BAC = BioWatch Advisory Committee members notified Alert = notify that a request may be forthcoming E = Emergency Response Agencies within health jurisdiction notified according Request = initiate request for SNS to local health jurisdiction internal BioWatch Public Health response plan. Point Of Distribution (POD) Activation: None = no action at this time Conference Call: Alert = notify individuals that activation may be forthcoming Local SCBAC = BAC Members only Ready = activate and staff PODs National = “Local” + 2nd call with Fed and State partners PEP Emergency Responders: All = “National” + 3rd call – internal emergency response Referring to local police and fire/other city officials with defined exposure without appropriate PPE or bio-safety procedures Command Center: Y=Yes EOC = Emergency Operations Center (Operational Area) N=No HEOC = Health Emergency Operations Center PEP Retrieval Staff: DOC = Department Operations Center Referring to personnel who collected or handled positive sample(s) which includes daily filter collection staff, environmental sampling team, and/or Environmental Activities: laboratory personnel with defined exposure without appropriate PPE or bio- Environmental Sampling safety procedures. Will phase I samples be collected Y=Yes Y=Yes N=No N=No Press Statement by JIC: Filter Retrieval Frequency Prepare = begin preparation of statement Q 24 hr. = samples will be taken every 24 hours Release = prepare and release statement Staff Retrieving Filter(s) EPA = Environmental Protection Agency Other: Routine = SCAQMD Event Reconstruction Modeling Request event reconstruction modeling resources from DHS/National Labs Public Health Recommendations: Y=Yes Health Surveillance N=No69 FOR OFFICIAL USE ONLY DRAFT Appendix H BioWatch Fact Sheet Appendix H: BioWatch Fact Sheet 70 FOR OFFICIAL USE ONLY DRAFT Appendix H BioWatch Fact Sheet 71 FOR OFFICIAL USE ONLY Appendix I Risk Communication Protocol Appendix I: Risk Communication Protocol The South Coast BioWatch Advisory Committee has drafted this Risk Communication Protocol to be used in the event of a BioWatch Actionable Result (BAR). The purpose of this protocol is to identify the specific actions that would occur related to crisis and emergency risk communication, as well as designated communication roles and responsibilities that would be activated to ensure coordinated and consistent communication with the public and partners on issues related to health and safety during an emergency. The purpose of Attachment G in this plan is to provide local impacted jurisdictions the understanding of what is being coordinated by the South Coast BAC region. It should be recognized that in the event of an intentional release in the South Coast Area, the demands for information to secure the public’s health and safety would be great and involve the response and involvement by all affected partners to address. This document will be reviewed and updated annually to ensure its accuracy and also to provide an opportunity for improvement. This protocol also emphasizes the importance of immediately establishing a communication link with anticipated partners including Orange County Health Care Agency, the California Department of Public Health, California Emergency Management Agency, Federal Bureau of Investigation, United States Centers for Disease Control and Prevention, United States Department of Homeland Security, United States Environmental Protection Agency, and the impacted local jurisdiction(s) impacted by a positive BioWatch test result. Essential attachments to this protocol are draft messages for consideration in the event of a positive BioWatch test result. UNIQUE RISK COMMUNICATION CONSIDERATIONS FOR A BAR TYPES OF BARS There are two types of BARs: those attributed to naturally occurring sources and those indicating a public health risk and/or high probability of an intentional release. Unlikely Public Health/Terrorism Threat‐‐ A BAR that is attributed to naturally occurring sources is typically absent of indicators that suggest suspicious activity and usually is considered a low public health risk. Although a proactive operational response is necessary, a measured series of actions are more appropriate for public information officials, as the decision for releasing information to the public should be based on established triggers or consensus from the local jurisdictions responding to the BAR. Possible or Probable Public Health/Terrorism Threat‐‐ If indicators are present that suggest an increased threat or risk, such as an intentional release or other act of terrorism, the need to quickly inform the public and engage stakeholders will be necessary. Rather than a reactive public information strategy, a proactive campaign will be required and must parallel the operational response. LEAD PUBLIC INFORMATION OFFICER The Health Care Agency (HCA) Public Information Officer (PIO) will act as the lead PIO for Orange County. It is the responsibility of the HCA PIO to coordinate and interact with the impacted Orange County City(ies). If needed, an Orange County Conference Call will be held 72 FOR OFFICIAL USE ONLY Appendix I Risk Communication Protocol during or immediately after the National Conference Call. The HCA PIO should be able to assist a coordinated effort with the impacted jurisdictions to ensure a unified message is being disseminated to the public. A physical or virtual Joint Information Center should be established to share and deliver these messages to the media and the public. UNIFIED RESPONSE WITH FEDERAL PARTNERS For a suspected act of terrorism identified, the Assistant Secretary for Public Affairs at DHS will activate ESF 15 and a national JIC will be established by DHS to coordinate activities among the federal interagency partners, White House Communications and the affected state or local municipality. If a terrorism nexus has been identified, or is suspected, and conveyed during the national BioWatch Conference Call, the DHS Secretary will conduct a press conference and address the American public within one hour. This protocol also calls for the Attorney General and/or FBI Director, as well as the HHS Secretary, to participate in this national‐level media briefing. Other federal agencies may also be required to participate. In the days following the initial announcement of the incident, a field level ESF 15 structure will be established to support local and state PIOs and provide information on the actions the federal government is taking. ESF 15 ensures sufficient federal assets are deployed to the field during a major national‐level incident to provide accurate, coordinated, and timely information to affected audiences, including governments, media, the private sector, and the local populace. Providing the availability of space, an effort will be made to co‐locate with state or local partners. In the event co‐location is not feasible, the ESF 15 cadre will look to establish its field operation near the incident site. RISK COMMUNICATION PRODUCTS Depending on information needs identified during Conference Calls, the Orange County HCA PIO drafts initial public messages for review by Orange County Health Officer and the BioWatch Advisory Committee, in coordination with local, state and federal partners, and issues messages following needed approvals via the virtual or physical JIC. Initial and on‐going communications may include, but are not limited to:  Press releases  Health alerts/advisories  Telephone hotline scripts and messages  Internet postings  Fact sheets  Information for individuals in neighboring jurisdictions  Templates or messages for use by field personnel  Press conferences TRIGGER POINTS FOR RELEASING INFORMATION Events that may indicate the need to develop and/or disseminate press release(s) and other risk communication actions:  Determination of possible or probable likelihood of organisms in the environment after a BioWatch Actionable Result (BAR). 73 FOR OFFICIAL USE ONLY Appendix I Risk Communication Protocol  Assessment of credibility that there is a terrorism threat and assessment of public health risk (unlikely, possible, or probable) established during the local South Coast BAC and/or national Conference Calls or the Orange County Conference Call.  Activation of LHD Department Operations Center (DOC), City/County Emergency Operations Center (EOC), or Joint Information Center (JIC)  Request by Health Care Agency or local jurisdictions impacted.  Media Inquiries  Broadcasts on media outlets (TV, Radio, Internet or social media)  A BAR involving multiple collector locations and/or multiple jurisdictions  Dissemination of health alerts by CDC, State, neighboring County Health Department, or a facility  Multiple public inquiries  Human cases (dependent on agents) likely associated with the BAR findings.  Launch of an epidemiological investigation by affected LHD or neighboring jurisdiction  A BAR associated with a special event COORDINATION OF RISK COMMUNICATION ACTIONS All affected jurisdictional, state, and federal agencies should coordinate the development of press releases, talking points, and health alerts via the Virtual or Physical JIC to ensure consistent messaging. In addition, it is advised that all jurisdictions and agencies coordinate the timing of press releases, alerts, or advisories so that they are issued at the same exact time (e.g., 9 p.m.) The non‐affected jurisdictions may also coordinate a press release as a neighboring jurisdiction but if one jurisdiction issues a press release, then the remaining jurisdictions should issue a similar press release for consistency. If a jurisdiction decides to issue health alerts, hotline scripts, fact sheets, advisories via intelligence fusion centers, or upload event information to their City Website, HCA Website and the OA website; then the jurisdiction or agency should coordinate the content and timing with the press release. For example, a health alert and JRIC advisory should contain the same essential information as the press release and be released at the same time or immediately following the press release. If there is no press release, then the aforementioned risk communications actions are not advised. ACTION STEPS FOR THE PUBLIC INFORMATION OFFICERS DURING THE ORANGE COUNTY CONFERENCE CALL The following steps summarize key risk communication activities that would be expected to occur during the response to a BAR.  If the BAR is determined by the Health Officer to be an unlikely public health threat go to Step #1 and skip Step #2. If a trigger occurs that prompts a risk communication response, proceed to Step #2.  If the BAR is determined to be a possible or probable public health threat, skip #1 and go to Step #2. 1. In the event that the BAR is determined to be from a naturally occurring organism in the environment that represents an unlikely public health threat, the following actions may be advised on the local, regional, and/or national conference calls (see Appendix A):  Activate Virtual Joint Information Center within BAR Workbench on BioWatch Portal.[JC] 74 FOR OFFICIAL USE ONLY Appendix I Risk Communication Protocol o Upload risk communication templates and resources.[HCA PIO] o Monitor Virtual JIC. [HCA PIO]  Begin briefing other local government agencies and response partners.  Monitor media coverage and Internet throughout event. [JIC, HCA PIO]  Standby and prepare to engage in the following risk communication actions in the event of a trigger: o Set up press conference o Identify spokesperson o Prepare talking points o Prepare and review current press release templates in coordination with HCA PIO and Health Officer. o Prepare and review Health Alerts or other advisories in coordination with Orange County Health Officer. o Prepare and review fact sheets on BioWatch and agent detected. o Prepare and review hotline script and messages. o Prepare to upload event information to the local health department website. o Prepare to notify other Local Health Department PIOs in the region of BAR. o Collaborate with Orange County Intelligence Assessment Center (OCIAC) on advisory. 2. In the event that the BAR is determined to be a possible or probable public health threat, the following actions may be advised during the local, regional and/or national conference calls (see Appendix A)  Activate Virtual Joint Information Center within BAR Workbench on BioWatch Portal.[JC] o Upload risk communication templates and resources.[HCA PIO] o Monitor Virtual JIC. [HCA PIO]  Begin briefing other local government agencies and response partners.  Monitor media coverage and Internet throughout event. [JIC, HCA PIO]  Standby and prepare to engage in the following risk communication actions in the event of a trigger: o Set up press conference o Identify spokesperson o Prepare talking points o Prepare and review current press release templates in coordination with HCA PIO and Health Officer. o Prepare and review Health Alerts or other advisories in coordination with Orange County Health Officer. o Prepare and review fact sheets on BioWatch and agent detected. o Prepare and review hotline script and messages. o Prepare to upload event information to the local health department website. o Prepare to notify other LHD PIOs in the region of BAR. o Collaborate with Orange County Intelligence Assessment Center (OCIAC) on advisory.  Communicate with potential partners/stakeholders (health care providers, Orange County Department of Education/schools, trade or tourism organizations, community‐based organizations, etc.) 75 FOR OFFICIAL USE ONLY Appendix I Risk Communication Protocol Risk Communication Matrix The following are the minimum recommended actions based on the potential BioWatch Actionable Result scenario: Action/Scenario Unlikely Possible Probable Risk Communication Call (N+3) No Yes Yes NICCL No Maybe Yes Press Release Standby Yes Yes (prepare press (coordinate with (coordinate with release templates) BAC, State, and BAC, State, and Federal partners) Federal partners) Health Alerts* No Yes Yes Hotline* No Yes Yes Upload Event Info to No Yes Yes HCA/OA/CITY Website* Advisories via OCIAC* No Yes Yes Press Conference Standby Local Local, State, and Federal Provide situation briefings to media† No Yes Yes Notify and update other LHD PIOs No Yes Yes in region of current status and events Joint Information Center Virtual Virtual & Maybe Virtual & Physical Physical Brief other local government Maybe Yes Yes agencies and response partners Monitor media coverage and internet Yes Yes Yes PRESS RELEASES AND MESSAGING Pre-established press release templates, fact sheets and FAQ’s for a BioWatch incident are available at the BioWatch Portal (https://www.biowatchportal.org) and on the Bioterrorism Shared Drive (Z:\BIOWATCH\BW Risk Communication Tools and Templates). Template messages for specific agents, both long and short versions, and messaging regarding the environmental sampling that occurs during a BAR are available on the BioWatch Portal and Bioterrorism Shared Drive as well. In addition, social media template messaging for specific agents is available for both Facebook and Twitter on the BioWatch Portal and the Bioterrorism Shared Drive. Press releases and messaging should be coordinated with the Orange County Health Care Agency Public Information Officer and other affected jurisdictions as the BioWatch event permits. See BioWatch Communications Timeline and Public Affairs Guidance below for further guidance on public messaging before, during and after a BAR. 76 FOR OFFICIAL USE ONLY Appendix I Risk Communication Protocol BIOWATCH COMMUNICATIONS TIMELINE 77 FOR OFFICIAL USE ONLY Appendix I Risk Communication Protocol PUBLIC AFFAIRS GUIDANCE 78 FOR OFFICIAL USE ONLY Appendix I Risk Communication Protocol 79 FOR OFFICIAL USE ONLY Appendix I Risk Communication Protocol 80 FOR OFFICIAL USE ONLY Appendix I Risk Communication Protocol 81 FOR OFFICIAL USE ONLY Appendix J BioWatch Site Information Guide Appendix J: BioWatch Site Information Guide (See separate plan for each city) BioWatch Site Information Guide Orange County Health Care Agency Table of Contents A. Site Name/Address...... B. Site Point of Contact ...... C. Primary Emergency Responders ...... D. Additional Notifications...... E. Other County Contacts ...... F Hazard Analysis ...... G Environmental Sampling ...... H Public Health Response ...... I Purpose ...... J Off-Site Facility Plan Distribution ...... Attachment 1: Site Location Map Attachment 2: Special Facilities Map Attachment 3: Staging Area Map Attachment 4: Sampling (Phase 1) Map Attachment 5: Field Collection Route Map 82 FOR OFFICIAL USE ONLY Appendix K Orange County BioWatch Phase I Environmental Sampling Plan Appendix K: Orange County BioWatch Phase I Environmental Sampling Plan I. INTRODUCTION The Orange County Environmental Health Hazardous Materials Team (Health HazMat Team) is the primary response unit to conduct the BioWatch Phase I environmental sampling for a BioWatch Actionable Result (BAR) in the Orange County Operational Area (OCOA). This plan describes the procedures of a Phase I environmental sampling. II. OBJECTIVES The objectives of Phase I sampling are as follows: 1. Confirm the presence of the identified biological agent(s) in the vicinity of the affected collector(s). 2. Assess the concentration of contamination in the vicinity of the affected collector(s). 3. Collect, secure and decontaminate samples for transportation to the Los Angeles County Public Health Laboratory and the Orange County Public Health Laboratory. III. ROLES AND DUTIES a. The Health HazMat Team is deployed to conduct the Phase I sampling activities. The Health HazMat Team may be deployed via Control One or by the County of Orange Health Officer during the BioWatch Conference Calls. b. The Health HazMat Team will lead the sampling collection with local law enforcement agency (LEA) and/or the Orange County Fire Services Hazardous Materials Response Team (Fire HazMat). 1. The Health HazMat Team will perform the sample collection and photo/written documentation. 2. The LEA or the Orange County Sheriff’s Department Hazardous Devices Squad will provide site safety/force protection. 3. When necessary, the Fire HazMat Team(s) will provide technical decontamination. IV. STAGING 83 FOR OFFICIAL USE ONLY UNCLASSIFIED//FOR OFFICIAL USE ONLY Appendix K Orange County BioWatch Phase I Environmental Sampling Plan The primary staging area will be at the Joint Powers North Net Training Center at 2400 East Orangewood Avenue, Anaheim, CA 92805. The alternate staging area will be at the Health Emergency Operational Center at 2228 Ritchey Street, Santa Ana, CA 92705. V. COMMUNICATION The Health HazMat Team will use cell phones to communicate with the Orange County Health Disaster Management Division (HDM), and the Health Officer. The Health HazMat Team will use encrypted 800 megahertz radios for tactical operations with law and fire. The Health HazMat Team will request an encrypted channel from Control One. VI. PERSONAL PROTECTIVE EQUIPMENT AND SAMPLING KITS a. At a minimum, level C personal protection is used to conduct the sampling. b. The Health HazMat Team will use sampling kits prepared by the Orange County Public Health Laboratory. VII. PROPHYLAXIS a. All personnel responding to the sampling activity will receive appropriate prophylaxis under the authority of the County of Orange Health Officer or his/her designee. b. At the direction of the County of Orange Health Officer or his/her designee, the prophylaxis will be dispensed by authorized HCA personnel. VIII. SAMPLE COLLECTION a. The Health HazMat Team will collect at least 12 samples including 1 PSU filter, 1 blank, 1 wetting agent blank and at least 9 samples from surfaces in the immediate vicinity (0-100 feet) of each affected collector. b. The Health HazMat Team will select sampling areas by the following criteria. 1. Visible of dust and deposit surfaces. 2. Shaded or not in direct sunlight surfaces. 3. Undisturbed surfaces. 4. Horizontal non-porous surfaces. c. Best practices for sampling techniques will be used to minimize contamination. 84 FOR OFFICIAL USE ONLY UNCLASSIFIED//FOR OFFICIAL USE ONLY Appendix K Orange County BioWatch Phase I Environmental Sampling Plan d. All samples will be sealed, labeled, decontaminated, and double contained in plastic bags. e. All samples will be logged in the BioWatch Sampling Log (See Attachment I). f. Photographs will be taken and logged in the BioWatch Photo Log. IX. DECONTAMINATION a. All sample containers will be decontaminated with 0.5% bleach solution (a 1:10 dilution using 1 part of 5% household bleach and 9 parts water). b. In most circumstances, the Health HazMat Team will perform dry decontamination upon the completion of the sampling activity. c. Fire HazMat Team may be requested to provide technical decontamination depending on the totality of circumstances including, but not limited to, the identified biological agent(s), duration of the sampling, the locations of samples collected, or any other information or intelligence pertinent to the safety of the responders. d. The vehicle(s) used for the sampling will be quarantined at the decontamination zone until further laboratory testing results and evaluation are completed. The Health HazMat Team will secure the contaminated vehicle(s). X. SAMPLES TRANSPORTATION The Health Hazmat Team will transport the collected samples under a chain of custody to the designated public health laboratories for analysis. 85 FOR OFFICIAL USE ONLY Appendix L Epidemiology and Assessment Phase-Specific Activities BIOWATCH SAMPLING LOG DATE: ______NAME: ______LOCATION: ______NAME: ______SAMPLE ID TYPE (wipe, TIME SAMPLE liquid, etc.) LOCATION/DESCRIPTION PSU FILTER FILTER AT THE PSU COLLECTION BLANK SAMPLE #1 SAMPLE #2 SAMPLE #3 SAMPLE #4 SAMPLE #5 SAMPLE #6 SAMPLE #7 SAMPLE #8 SAMPLE #9 SAMPLE #10 86 FOR OFFICIAL USE ONLY Appendix L Epidemiology and Assessment Phase-Specific Activities Appendix L: HCA Epidemiology & Assessment Phase-Specific Activities Phase I. Initial Planning/Preparedness  Conducts surveillance and evaluates increases in baseline reports. o Reportable diseases; unusual diseases o Orange County Animal Care data for animal intakes and deaths o ReddiNet data for emergency department (ED) diversions (for saturation) o Influenza-like illness surveillance through sentinel provider network o Pneumonia and influenza deaths o Outbreak investigations  Evaluates new surveillance and reporting tools and applies to BioWatch when applicable (in progress) o Uses aberration detection methods for monitoring diversions, pneumonia and influenza deaths, animal intake and death data o Develops reports to evaluate OC-MEDS dispatch data when available o Maintains on-line reporting tools for schools o Drafts on-line reporting tools for businesses and hospitals o Adapts surveillance tools into automatic form processing specifications.  Creates databases and maps with Geographic Information Systems (GIS) to better characterize affected population and perform surveillance (includes location and contact information): o Includes the following layers: o Collector sites o Potential bioterrorism targets (landmarks, transportation centers) o Hospitals o Urgent Care Centers o Long Term Care Facilities o Schools (includes enrollment information) o Child care facilities o Universities o Large businesses (>1000 employees; contact information for employee/occupational health if available) o Fire stations o Population o Creates 3, 5, 7 mile radius buffers on above maps around potential targets so as to better assess population at risk in neighborhood of a positive sensor. o Automates extraction of data on affected groups in the buffer zones and with importation of plume data into the model.  Prepares draft ReddiNet messages for each potential agent detectable by BioWatch sensors to notify local EDs for use when enhanced surveillance is indicated.  Prepares draft assessment polls for each potential agent detectable by BioWatch sensors to administer as needed through ReddiNet to local hospitals 87 FOR OFFICIAL USE ONLY Appendix L Epidemiology and Assessment Phase-Specific Activities  Develops surveillance tools for reporting and tracking illness from schools, businesses, and other non-traditional reporting sources.  Educates community health care providers about reporting of diseases through frequent Grand Rounds presentations at local hospitals Phase II. Increased Readiness/Information Gathering  Reviews results and available information on agent in question, consults with subject matter experts, State and CDC, to make recommendations about public health actions  Updates fact sheet drafts with latest information about potential agent, diagnosis, treatment, prophylaxis and infection control precautions.  Conducts surveillance (see South Coast BioWatch Regional Response Plan – Public Health Decision Making Matrix) depending on agent/situation. Potential activities include: o R=Reviews existing public health surveillance data o Reportable diseases; unusual diseases o Orange County Animal Care data for animal intakes and deaths o ReddiNet data for ED diversions (for saturation) o Influenza-like illness surveillance through sentinel provider network o Pneumonia and influenza deaths o Any veterinary information from CDPH, CDFA, and/or OC Animal Care. o Modifies template case (and contact) tracking databases to incorporate event-specific information. o S=Syndromic surveillance enhancement o Increases frequency of receipt and analysis of OC Animal Care data to daily o Increases frequency of analysis of ReddiNet ED diversions (for saturation) to daily o Finalizes surveillance tools specific to the agent in question to be used in next phase to assess illness in potentially affected areas (identified by buffer zones or plume modeling). o E=Enhanced Passive Surveillance o Finalizes surveillance case definition and coordinates any laboratory testing needs. o Alerts specific medical provider groups (such as infectious diseases physicians, emergency room physicians, infection control professionals), depending on agent/situation, to enhance detection of initial human cases, if any. o Alerts all licensed physicians in Orange County for whom contact information is available. o A=Active Surveillance o Institutes active case finding in clinics, hospitals, laboratories, and/or with coroner. o Finalizes surveillance tools specific to the agent in question to be used in next phase to assess illness in potentially affected areas (identified by buffer zones or plume modeling).  Makes recommendation to Health Officer about need for vaccination/prophylaxis of first responders, including HazMat and filter collection/sampling team.  Makes recommendation to Health Officer when event reconstruction and plume modeling is needed to help in assessing potentially exposed population. 88 FOR OFFICIAL USE ONLY Appendix L Epidemiology and Assessment Phase-Specific Activities  Begins defining potential population at risk using GIS buffers as described above, in conjunction with information provided re: location of sensor and any plume modeling. Phase III: Response  Finalizes alerts with preliminary information about disease, diagnosis, treatment, and infection control precautions (for dissemination to first responders and health care providers via CAHAN, broadcast fax and email distribution lists)  Updates prepared fact sheets for public and health care providers; prepares scripts for public and medical provider hotlines  Provides updated clinical information and recommendations to health care providers, first responders, and hospitals as necessary.  Further defines population at risk  Makes recommendations to Health Officer about need for ongoing vaccination/prophylaxis of first responders, and of general population at risk.  Continues R, S, E, A surveillance activities as per above depending on agent/situation. Potential additional activities include: o A (Active), S (Syndromic): o Contacts schools, urgent cares, hospitals, large businesses in potentially affected areas (using buffers or any plume modeling) to assess increases in illnesses o Finalizes tracking databases for cases and contacts, if indicated. o Once human cases are identified, transitions into HCA Epidemiology Emergency Operations Plan. Activities may include daily case updates, mapping of cases, if indicated, using GIS, and tracking of cases and contacts, if indicated.  Advises Health Officer on need, if any, for quarantine and isolation orders as appropriate.  Assesses need for surge capacity staff and provides information/training to surge capacity staff.89 FOR OFFICIAL USE ONLY Appendix N California State BioWatch Actionable Results Data Form Appendix M: Orange County Profile for BioWatch Disease Agents To assist in the Orange County Health Officer response to: South Coast BioWatch OC OA City and National Conference Call Question 1 Orange County Health Care Agency Briefing. To be updated by Epidemiology at time of event. AGENT: <a href="/tags/Anthrax/" rel="tag">ANTHRAX</a> (Bacillus anthracis) Local Affected Public Health Jurisdiction(s): □ General information about the agent: Spore-forming. 3 clinical forms: inhalational, oropharyngeal/GI, cutaneous. Transmission through inhalation of spores, ingestion of contaminated food, contact with spores/infected material through non-intact skin. o Incubation period: 1-7 days, up to 60 days (up to 12 days for cutaneous or oropharyngeal/GI forms) o Latent period o Pathogenicity: Inhalational rapidly progresses to respiratory failure, sepsis, shock, and death if untreated. The other 2 forms can also progress to sepsis, shock, death. Antibiotics available for treatment and post-exposure prophylaxis. Vaccine available for post-exposure prophylaxis. □ Regional Profile (affected health jurisdiction) o Review of historical patterns for endemic disease outbreaks: . HUMAN: 1 human case in 1928; none since in OC. . ANIMAL: No records of any positive testing able to be identified. □ Review of syndromic surveillance data, reportable disease data, and other relevant data sources o Recent human cases and average number of cases: NONE o Recent veterinary cases and average number of cases: NONE. Animal Care Services intake and death data for the past (timeframe) shows: ______90 FOR OFFICIAL USE ONLY Appendix N California State BioWatch Actionable Results Data Form AGENT: BURKHOLDERIA (GLANDERS/MELIOIDOSIS) Local Affected Public Health Jurisdiction(s): □ General information about the agent: Glanders (B. mallei), melioidosis (B. psuedomallei). Several clinical forms including acute localized, acute pulmonary, acute bloodstream, chronic. Transmission through direct contact of mucosa or non-intact skin with infected animals, water, soil; inhalation of contaminated aerosols/dust; ingestion of contaminated water (melioidosis) o Incubation period: Glanders 1-14 days (1-5 for cutaneous); melioidosis not clearly defined (2 days to many years) o Latent period o Pathogenicity: Glanders fatality rate >50%; melioidosis not usually fatal unless bacteremic. Antibiotics available for treatment; no prophylaxis or vaccine. □ Regional Profile (affected health jurisdiction) o Review of historical patterns for endemic disease outbreaks: . HUMAN: not a reportable disease. Glanders: No human cases known in OC. No cases in US since 1945. Melioidosis: Last case in OC in 2008 (immigrant from endemic area); 0-5 cases/year in U.S. . ANIMAL: No records of any positive testing able to be identified. □ Review of syndromic surveillance data, reportable disease data, and other relevant data sources o Recent human cases and average number of cases: NONE o Recent veterinary cases and average number of cases: NONE. Animal Care Services intake and death data for the past (timeframe) shows: ______91 FOR OFFICIAL USE ONLY Appendix N California State BioWatch Actionable Results Data Form AGENT: PLAGUE (<a href="/tags/Yersinia_pestis/" rel="tag">Yersinia pestis</a>) Local Affected Public Health Jurisdiction(s): □ General information about the agent: 3 clinical forms: pneumonic, bubonic, septicemic; another form can develop secondary to first. Transmission through inhalation of droplets from infected animal/human or bite of infected fleas/direct contact with infected material. o Incubation period: 2-8 days, depending on form; pneumonic usually 2-4 days (range 1-6) o Latent period o Pathogenicity: Pneumonic form 100% fatal if untreated within 12-24 hours. Antibiotics available for treatment and post-exposure prophylaxis. □ Regional Profile (affected health jurisdiction) o Review of historical patterns for endemic disease outbreaks: . HUMAN: No records of any human cases in OC able to be identified. . ANIMAL: Last known positives: 1982 2 ground squirrels antibody positive Anaheim Hills 1998 Rattus rattus antibody positive Orange squirrel Irvine Park 2007 bobcat antibody positive Lake Forest (near 241) Source: OCVCD; ongoing testing year-round throughout county. □ Review of syndromic surveillance data, reportable disease data, and other relevant data sources o Recent human cases and average number of cases: NONE o Recent veterinary cases and average number of cases: NONE. Animal Care Services intake and death data for the past (timeframe) shows: ______92 FOR OFFICIAL USE ONLY Appendix N California State BioWatch Actionable Results Data Form AGENT: <a href="/tags/Smallpox/" rel="tag">SMALLPOX</a> (Variola virus) Local Affected Public Health Jurisdiction(s): □ General information about the agent: transmission primarily through inhalation of droplets or aerosols from infected person; less commonly direct contact with skin lesion/contaminated material. o Incubation period: usually 12-14 days; range 7-17 o Latent period o Pathogenicity: No specific antiviral treatment. Vaccine available for pre- and post-exposure use. □ Regional Profile (affected health jurisdiction) o Review of historical patterns for endemic disease outbreaks: . HUMAN: No human cases since 1945 in OC. . ANIMAL: N/A □ Review of syndromic surveillance data, reportable disease data, and other relevant data sources o Recent human cases and average number of cases: NONE o Recent veterinary cases and average number of cases: NONE. Animal Care Services intake and death data for the past (timeframe) shows: ______93 FOR OFFICIAL USE ONLY Appendix N California State BioWatch Actionable Results Data Form AGENT: <a href="/tags/Tularemia/" rel="tag">TULAREMIA</a> (<a href="/tags/Francisella_tularensis/" rel="tag">Francisella tularensis</a>) Local Affected Public Health Jurisdiction(s): □ General information about the agent: Several clinical forms; pneumonic, oropharyngeal/GI, ulceroglandular/oculoglandular, typhoidal. Transmission through infected ticks, deerflies; contact with/ingestion of contaminated animals/food/water; rarely inhalation of contaminated aerosols. o Incubation period: usually 3-5 days, range 1-14 o Latent period o Pathogenicity: Typhoidal form most severe with mortality rates 30-60% if untreated; pneumonic also can be severe. Antibiotics available for treatment and post-exposure prophylaxis. □ Regional Profile (affected health jurisdiction) o Review of historical patterns for endemic disease outbreaks: . HUMAN: No human cases in OC since 1981. . ANIMAL: No records of any positive testing able to be identified. No seropositive rabbits for F. tularensis up to 1993. Source: OCVCD reports, last dated 1993. No testing done since 1993. □ Review of syndromic surveillance data, reportable disease data, and other relevant data sources o Recent human cases and average number of cases: NONE o Recent veterinary cases and average number of cases: NONE. Animal Care Services intake and death data for the past (timeframe) shows: ______94 FOR OFFICIAL USE ONLY Appendix N California State BioWatch Actionable Results Data Form Appendix N – Form submitted by OA to CSWC (warning.center@oes.ca.gov) by Orange County; after submission call the CSWC at 916-845-8911 to confirm receipt. California State BioWatch Actionable Result (BAR) Data Form 1. Incident Name (Format: 2015JAN01_BAR_CITY) = identical to federal nomenclature Date of Submission Time of Submission (PST) 2. Caller Information 2.1 Operational Area (i.e. specific city or county) Reporting a BAR 2.2 Caller Name 2.3 Caller Title 2.4 Caller Phone Number 2.5 Caller Email 2.6 Alternate Point of Contact Name 2.7 Alternate Point of Contact Phone 3. BAR Information 3.1 Organism(s) DNA detected (two letter code) (BA, YP, FT, BU, VM) 3.2 Number of positive collectors 3.3 Relative Concentration (High: Ct < 30; Med: Ct = 30-35; Low: Ct >35) 4. Additional Information Alerts for Calls Time Bridge Line Passcode and Facilitator Bridge *BAC - provide or Access Requested Line information that is Code (y/n) Requested available at the time of (y/n) submission. This form may be sent back out with updated information. Local Call* State Call* National Call* x x Risk Communications Call* Other Calls?* Name of CSWC Duty Officer:______95 FOR OFFICIAL USE ONLY </div> </article> </div> </div> </div> <script src="https://cdnjs.cloudflare.com/ajax/libs/jquery/3.6.1/jquery.min.js" crossorigin="anonymous" referrerpolicy="no-referrer"></script> <script> var docId = '94477d07d9ca18bb4aee9a819015d442'; var endPage = 1; var totalPage = 95; var pfLoading = false; window.addEventListener('scroll', function () { if (pfLoading) return; var $now = $('.article-imgview .pf').eq(endPage - 1); if (document.documentElement.scrollTop + $(window).height() > $now.offset().top) { pfLoading = true; endPage++; if (endPage > totalPage) return; var imgEle = new Image(); var imgsrc = "//data.docslib.org/img/94477d07d9ca18bb4aee9a819015d442-" + endPage + (endPage > 3 ? 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