Meeting Agenda: Mohawk Area Public Health Coalition Date August 18, 2020 Location CONFERENCE CALL Facilitators Carolyn Shores Ness & Norene Pease, Time 4:30 – 6 p.m. Call-In # (425) 436-6370 Co-Chairs
Access 372022 Cancellation 413-774-3167 x 155 Code Notice https://www.freeconferencecall. Video com/wall/trogers35
Agenda Items Point Person(s) Time Action Required
1. Welcoming remarks; offer necessary 4:30 p.m. Co-Chairs introductions; review agenda. (5 minutes)
2. Review/approval of August 8, 2020 4:35 p.m. Co-Chairs Vote to approve or amend. minutes (5 minutes)
3. Old business. a. EDS equipment/supplies allocations a. Address any outstanding for BP2. questions on application b. Drive-thru annex for EDS plans. and acceptable fund use. c. Q1 outstanding tasks. b. Open discussion on a. EPP staff. i. Each EDS decide upon drill or TTX by development of annex b. EPP staff. 4:40 p.m. 9/30. and next steps. c. EPP staff. (50 minutes) ii. Last year’s AAR/IP reviewed in light c. Rewview grant d. EPP staff. of making two plan improvements. deliverable decision 1. Drive-thru annex points that must be 2. TBD. concluded prior to 9/30. d. Update on school opening criteria d. Update. alignment.
4. New business. a. Emrgency Preparedness Program (EPP) a. Update/discuss. a. EPP staff. 5:30 p.m. Multi-Year Training and Exercise b. Identify messaging for b. Committee. (25 minutes) Program (MYTEP) development. next period. b. Risk communication messaging needs.
5. Business not reasonably anticipated 48 5:55 p.m.
hours prior to the meeting (5 minutes)
6. Wrap up and adjourn Co-chairs 6:00 p.m.
Meeting Documents: 8.18 agenda 8.4 draft minutes EDS TTX AAR/IP Draft drive thru annex 1
Meeting Minutes: Mohawk Area Public Health Coalition Steering Committee Date August 4, 2020 Location CONFERENCE CALL Facilitator: Carolyn Shores Ness ONLY! & Norene Pease, Call-In (425) 436-6370 Co-Chairs Number Access Code 372022 Time 4:30-6:00 p.m.
ATTENDEES: GUESTS: Valerie Bird, Greenfield Health Director Gail Bienvenue, MA DPH OPEM Donna Gibson, Williamsburg BOH Meg Burch; Nurse Lead, Frontier Regional School Union John Hillman, Leverett BOH Marie Iken, Conway BOH Betsy Kovacs, Heath BOH Nina Martin-Anzuoni, Colrain BOH Carolyn Shores Ness, Deerfield BOH Norene Pease, Shutesbury BOH Sandra Aronson, CTC Supervisor Team 6 Dan Wasiuk, Montague Health Director Kirstin Lewis, Resource Coordinator Manager
ABSENT: FRCOG STAFF: Duncan Colter, Ashfield BOH Mark Maloni; Lisa White; Randy Crochier; Liz Jacobson- Mike Friedlander, Colrain BOH Carroll Deb Coutinho, Shelburne
Agenda Items
1. Welcoming Shores Ness called the meeting to order at 4:30 p.m., then introduced remarks/agenda/ Burch, whose work for FRSU #38 may serve as a model for other introductions districts in the MAPHCO region.
2. Review/approval of July 21, Pease moved to accept the July 21, 2020 minutes, Hillman seconded 2020 minutes the motion, and the motion passed unanimously.
3. Guest presentations/ a. Burch reviewed they key points of FRSU #38’s draft COVID-19 discussions response document, developed upon request of the School a. Updates on school Committee. These include: opening criteria 1. Responsibility to close schools rests with the LBOHs b. CTC updates 2. Pre-determined data points measuring community spread will be used as criteria for closing 3. Specific procedures to be followed upon the identification of a positive case within the school community
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4. Procedures for contact tracing to be conducted with the partnership between LBOHs, public health nurses/agents, and the school district She noted that further guidance from the Dept. of Elementary and Secondary Education and the Dept. of Public Health are forthcoming and may spur revision of the plan. Burch foresees reciprocal sharing of plans with nurse leaders of other area school districts, aiming for consistency in the region. In response to a question from Hillman, Burch indicated her willingness to research the justification for the closure benchmark of 50/100,000 cases rather than the 25/100,000 seven-day rolling average proposed by CT.
With the goals of collaboration and consistency of policies and procedures for the start of the semester, Maloni will facilitate discussion between MAPHCO staff and chairs, CPHS staff, public health nurses, school nurses and school leaders prior to the next meeting. b. Aaronson updated attendees on recent restructuring and staff changes within the CTC. These enable closer contact with LBOHs, and include the establishment of an epidemic intelligence unit to better identify emerging clusters, and the formation of team focused on K-12 and higher education. Lewis explained the Care Resource Coordination team’s goal of facilitating the comfortable quarantine of individuals, thus relieving some pressure on local public health nurses. White and Aaronson expressed their mutual confidence in CTC’s ability to scale-up their staffing and response in a surge following the opening of schools and return of college students to the region. Lewis noted dramatic investment and improvement in CTC’s preparedness since the launch in April.
4. Old business After noting that he is awaiting guidance and an update regarding funds from the MA Bureau of Infectious Disease and Laboratory Science -- so has no further information to share -- he updated members on the EDS equipment/supplies allocation process for MAPHCO BP2: applications for funding are due August 14th allowable expenses are for EDS planning purposes only: clinic drills and supplies, including directional signs for drive-through clinic drills. Maloni will distribute Frontier EDS’s sign inventory and prototypes, and will re-send the memo/application form and the EDS clinic planning guide.
5. New business After discussion regarding the risks presented by out-of-state vacationers, and of the MA travel order, Maloni indicated that he will craft a flyer to de-mystify the latter. An additional piece will affirm that vigilance should be maintained as cases rise in the Commonwealth.
6. Business not reasonably None. anticipated 48 hours prior to the meeting
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7. Wrap up and adjourn Gibson moved to adjourn the meeting, Hillman seconded the motion, and the meeting adjourned at 5:45 p.m.
Documents Distributed / Agenda Presentations Viewed: DRAFT Minutes of July 21, 2020 Meeting Managing COVID-19 Response in Schools_Draft language from FRSU #38
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Drive-Through Dispensing Planning Considerations
Page 1 of 39 5 Table of Contents
Scope/Disclaimer ...... 4 Record of Changes ...... 4 Drive-through Dispensing Concept of Operations ...... 5 Advantages of a Drive-thru EDS: ...... 5 Disadvantages of a Drive-thru EDS: ...... 5 General Process Flow of a Drive-thru: ...... 5 Stations ...... 7 General Recommendations ...... 7 Site Selection ...... 9 General Recommendations ...... 9 Space and Layout Recommendations ...... 9 Site Selection Tool ...... 10 Traffic and Safety ...... 11 General Recommendations ...... 11 Managing Traffic ...... 11 Air Quality ...... 12 Monitoring Carbon Monoxide Levels ...... 13 Communications ...... 14 General Recommendations ...... 14 Onsite Communication and Signage ...... 14 Radio Drive-Through Instructions ...... 14 Equipment Needs ...... 15 General recommendations ...... 15 Staffing ...... 16 General Recommendations ...... 16 Staff Training and Support ...... 16 Staff Roles ...... 16 Incident Command System Structure ...... 16 Job Descriptions - Non-Medical ...... 18 Job Descriptions - Medical ...... 18 Infection Control ...... 20 Infection Control Measures: ...... 20 Attendee PPE: ...... 20
Page 2 of 39 6 Staff PPE: ...... 20 OTHER CONSIDERATIONS FOR INFECTION CONTROL ...... 20 Signs ...... 21 General Recommendations ...... 21 Frontier EDS Sign Inventory ...... 21 Appendices ...... 25 Appendix 1: Sample setup diagrams/maps ...... 26 Appendix 2: Sample Drive-thru Planning Guide ...... 29 Appendix 3: Equipment and Supply Planning Sheets ...... 32 Frontier EDS Equipment Sheet by Station ...... 33 Recommended Supplies from NACCHO Drive-thru Planning Guide ...... 34 Equipment and Supply Planning Tool by Function ...... 36
Page 3 of 39 7 Scope/Disclaimer
This annex is intended to facilitate development of operational plans for drive-thru dispensing capabilities. When complete, the operational document should contain all information necessary for drive-thru EDS management, including point-of-contact information, maps, and flow charts.
A drive-thru EDS plan for mass prophylaxis/clinic response should not be a stand-alone plan but should be incorporated in the EDS base plan and attached to the jurisdictional emergency operation plan(s).
Because an agency’s drive-thru EDS plan for mass prophylaxis/ clinic response should not be a stand- alone plan, planning issues relating to SNS triggers and requests, security, communication, public information, distribution, inventory control, epidemiology/ surveillance, legal issues, hospital coordination, regional coordination, training, exercises, and post-event improvement planning will not be dealt with in any detail in this guide except for in instances that are unique to drive-thru EDSs.
Record of Changes
Description of Change Edited By (Name:) Edit Date:
Page 4 of 39 8 Drive-through Dispensing Concept of Operations
Advantages of a Drive-thru EDS:
Infection Control Eliminates a crowd of people standing in close proximity in the case of a contagious agent Retaining participants in separate vehicles may reduce their fear about contracting a contagious agent
Crowd control: Law Enforcement's main concern is traffic control instead of crowd control Reduces parking problems Less “damage to property” liability than indoor PODs.
Mobility: Mobility issues might be mitigated for non-ambulatory clients Easier to keep families together. Vehicle environment adds temperature control, music or videos for kids, and avoids taking children in/out of car seats Protects individuals from long periods of standing, being exposed to heat, cold, weather
Disadvantages of a Drive-thru EDS:
Greater Dependency on Weather Considerations Severe and/or ongoing inclement weather can impact operations
Traffic Safety Greater need to focus on staff safety and traffic flow management
General Process Flow of a Drive-thru:
The drive-thru EDS will have 2 main types of vehicle lanes: The "Adult Medication Lane” to serve those vehicles containing only adults, and the "Children with Adult Medication Lane”, to serve vehicles with children. These types could also be considered “expedited lanes” and “special considerations” lanes. The primary goal is to create lanes for more straightforward pass-through, and lanes that will be expected to have further considerations based on the registration and perhaps move a little slower.
If there are too many cars in the cue in one type of lane, those cars may be redirected to other less populated lanes, regardless of type.
Page 5 of 39 9 All vehicles will proceed through a 4-step process:
Step Objective Fundamental Tasks
Distribution of Registration forms, VIS sheets, and Getting attendees into the information about EDS flow 1: Registration most appropriate lane Completion of any
paperwork Routing the vehicle to the appropriate lane
Provide medical assessment of Checking of forms for 2: Triage appropriateness of legibility, accuracy, and vaccine/medication completeness distribution to the participant
Reviewing of completed form to check for
contraindications 3: Vaccine/Medication Actual dispensing of Preparation and dispensing Distribution vaccine/medication of vaccine/medication
Routing vehicle to Form Collection
Final review of form for accuracy and completeness Final processing, form Collect participant's form 4: Form Collection collection, addressing Distribute any follow-up outstanding questions, and information and directing to wait area if willing educational materials Involves moving traffic to "Wait Area"
Page 6 of 39 10 Stations Organize your staffing and equipment planning based on stations; recommendations on stations and responsibilities of each are included below.
Forms Station Reviews registration forms Provides disease, POD, and instructional information Ascertains ability to fill out forms Labels cars needing the additional assistance lane Runners can walk down line and hand out forms and information ahead of station Give all drug information to all patients, which will allow for standardized information packets
Primary Traffic Control Station Routes vehicles coming from forms distribution into the next available dispensing lane Communicates with other traffic control staff on restricting traffic flow Gives recommendations to POD manager on reconfiguration of lanes May use many staff to cover each lane entrance and manually direct cars
Dispensing Station Provides medication in the correct dose and quantity Forms collection, bar code labeling (or other recording method) from each regimen dispensed May distribute information sheet regarding the specific medication(s) dispensed and pediatric suspension instructions if forms station does not do so.
Staff Rehab Houses the site support unit Provides rest area for staff Provides meals through coordination between the site support unit and the food unit in the logistics section at the EOC (ICS titles may vary).
First Aid Provides medical assistance and referral to POD staff Performs triage of severely symptomatic or ill individuals at POD (if staffing is available) Does not interface with the public except when referred by other stations Should be a “reserve” station and will be underused if public messaging is adequate
General Recommendations
Designate best customer service individuals to forms distribution. This station does not require medical knowledge and is the first point of contact for the public in a very stressful situation Drive-thru PODs typically accommodate a larger number of people than indoor PODs, requiring fewer POD sites If the LHD’s continued planning leads to a greater number of drive-thru PODs, staffing burdens will be reduced— especially in the area of greeters and triage. Consider transitioning the
Page 7 of 39 11 personnel savings of greeters into runners (floaters), carrying supplies to different stations and directing oncoming staff to their station at very large PODs Job action sheets should be similar to those used for other POD types. Job action sheet examples are available at www.naccho.org/toolbox A common best practice is to miniaturize the job action sheet and put it along with pertinent information (radio channels, etc.) on the back of the individual’s badge It is important to direct staff that are feeling unwell or have been working for long periods to use the staff support area, especially in harsh (hot, cold) weather conditions Staff the dispensing station with personnel that show superior attention to detail (non-medical) Ensure that the first aid station is staffed by a person with the medical training level of an EMT or higher. Also ensure that communication is available with medical staff as needed through the EOC Plan to station the lead traffic control operator at the entrance to the dispensing lanes. Vehicles being evenly distributed between all dispensing lanes and not allowed to back up unnecessarily in any of the lanes will be critical to the flow of the POD Secure a temperature controlled area (or vehicle) with chairs, tables, and cots for the rehab area. This area should also have snacks and beverages that can be used by individuals on break or distributed by runners to stations
Page 8 of 39 12 Site Selection
General Recommendations
Keep in mind that low-income neighborhoods with limited access to transportation cannot be adequately covered by a drive-thru EDS.
Some of the most ideal location types for a drive-thru model include; Large parking lot venues: stadiums, amusement parks, large businesses Drive-thru accessible buildings: pharmacies, banks, fast food Easily modifiable areas: toll booths, interstate underpasses, parks/fairgrounds
Space and Layout Recommendations
Assess the number of lanes that can be arranged. A minimum width of 13 feet per lane and a radius of 18 feet for turns is recommended.
Decide on suitable locations for entrance and exit points that can accommodate traffic control and security personnel and will not block external traffic patterns.
Develop sensible areas to be used as stations: forms distribution, command and control, dispensing, supply depot, first aid station, and staff support/rehab
Plan to use one end lane closest to staff tents to be used for special needs (help with forms completion, first aid, security risk, etc.).
In planning the number of lanes to be used at a POD, it is important to consider that access to an exit lane from each operational lane will be necessary to accommodate people that are recommended to other medical care and for whom the queue wait time is too long. Therefore, parking areas without concrete barriers are usually the preferred design for layout optimization.
Exit lanes will solve most issues, but it is important to consider having a towing company on standby for immediate removal of cars with mechanical failure or no gas
Leave space for crosswalks for providing medications to dispensing lanes by the re-supply unit leader and for reporting of dispensing numbers back to the emergency operations center (EOC)/area command
Place command and control and staff rehab areas away from traffic to remove interaction with the public and exposure to fumes
It is easier to secure an MOU if the LHD staff only use the outdoor parts of a facility, which means that many of the stations will have to be tented.
Page 9 of 39 13 Site Selection Tool
Drive-Through Site Assessment Checklist
Infrastructure Roof Space for portable toilets Ventilation Total Space and Layout Equipment/supply storage area Patient observation area Pharmacy area Staff rehab area No. of traffic lanes (capability) Utilities Electrical power Emergency power Heating Lighting Refrigeration Water Communication Landline Two-way radio capability to main facility Cell phone signal strength Other Services Security of equipment and supplies Biohazard & other waste disposal Proximity to main hospital Access control Total Rating/Ranking (Largest # indicates best site)
Rating System 1 = Positive attribute 0 = Neither positive nor negative -1 = Negative attribute
Page 10 of 39 14 Traffic and Safety
Providing a safe and secure environment for patients and staff is a prime consideration when conducting Drive-thru dispensing. The structure must be inspected, approved and signed off by the local authority having jurisdiction.
General Recommendations
Inform local police of operation dates and times of Drive-Through Triage and participate in advance planning to reduce traffic concerns including: o Traffic control at intersections near the EDS o Guidance in and approval of controlled public street lanes such as cones in curb lanes funneling patients’ vehicles into barricaded lanes o Recommendations for appropriate signage including ideal locations for the signage to have maximum impact o Police availability for help; a minimum one sworn officers per EDS is highly recommended.
Work local Public Works and Highway Departments to discuss: o Loan of cones if available through Public Works Department o Temporary closure of public parking spaces/meters on EDS days, if necessary for traffic control
Managing Traffic
If non-police/security staff are in traffic control roles, security should work with traffic control. Security should be located at outside and inside the Drive-thru EDS to direct the flow of traffic, including the entrance, exit, special needs lane, and have a representative in the command center as available.
It is important to avoid gridlocking traffic outside of the EDS during a disaster. Exercising should reveal whether a drive-thru EDS site has enough space to accommodate all traffic queuing. o When entrance traffic begins to pile into surrounding streets, an LHD should consider the use of pre-planned alternate methods such as ticket and return, traffic bypass/street re-routing, or increased dispensing limits (i.e. one person picking up for 20).
To avoid collisions and protect pedestrians, Signs are used to designate lanes and stopping points. Drivers are instructed to turn off their engines before staff approach the vehicle and reversing is not permitted (unless directed by traffic control).
Pedestrians should not be allowed through but should be directed to transportation the nearest indoor EDS
Page 11 of 39 15 Avoid walking behind or in front of parked vehicles or in between lanes, as much as possible; exercise extreme caution at all times.
Security oversees traffic and parking in the Parking Area and Drive-Through Triage Area. Security personnel will: Set up marker cones, barricades, tape off designated areas, post signs Direct flow of traffic; permit vehicles to move when stations are available and prevent vehicles from backing up (unless instructed to do so by Traffic Control Unit Leader) Instruct drivers at Entrance to Drive-Through Triage to proceed to Registration Station, stop and turn off engine Direct flow of traffic into appropriate dispensing lane or direct to Bypass Track to immediately exit Remove (tow or push) stalled or broken-down vehicles
Instruct drivers to turn off engines when stopped at each station in Drive-Through Triage; instruct drivers to set the parking brake
Post signs indicating speed limit outside Drive-Through Triage Area (5 mph) and inside Drive- Through Triage Area (3 mph)
Post sign for vehicle height clearance and divert over-height vehicles prior to entry point
Report damage to vehicles, buildings or equipment to the Security Branch Director.
Air Quality
Carbon monoxide (CO) toxicity was not found to be a hazard in a Drive-Through Triage simulation exercise (over a 4-hour period), during which a random sample of 19 people was tested for carboxyhemoglobin levels using the Masimo Rad-57.2
However, since CO is one of the most abundant airborne contaminants in parking structures and poses significant risks to human health, emission of CO is monitored, controlled and ventilated before CO concentration reaches unsafe levels.
Signs of CO toxicity include headache, tiredness, dizziness and nausea.
To mitigate CO buildup in the Parking Area and Drive-Through Triage Area: Instruct drivers to turn off their engines when parked. Vehicles are only turned on when driving from the Parking Area to the Drive-Through Triage AND when driving from station to station within the Drive-Through Triage Monitor all parked vehicles to ensure compliance Place fans in Drive-Through Triage Area to move maximum amount of contaminants (including CO) out of treatment area Visually monitor patients/staff for signs or reports of possible CO toxicity symptoms and report to medical staff for evaluation
Page 12 of 39 16 Monitoring Carbon Monoxide Levels
Technology offers easy-to-use handheld devices to monitor carbon monoxide (CO) levels in human blood and in the atmosphere. For example:
CO levels in a patient or staff member is monitored with the handheld Rad-57 which measures carboxyhemoglobin (SpCO). www.masimd.com/rad-57/index.html CO levels in the atmosphere is measured with the handheld Vulcain Safety Palm. www.topac.com
Page 13 of 39 17 Communications
In a Drive-Through Triage, where waiting patients are confined to their cars without easy access to staff, communication becomes of prime importance
General Recommendations
Onsite Communication and Signage
The signage at each POD site should include directions, wait times, and warnings/situational information Signs at large venues with multiple lanes should be made for every lane (numbers and arrows) Each sign should be at least 18 by 24 inches in large block font, secured to the ground or post, and made from weather resistant material For directional signage, there must be a sign placed at every entrance, exit, and choice to turn Signage does not replace the need for greeters and traffic control staff If the health department is employing public hotlines or public radio communications, directions to use these should be included in signage (at the entrance).
Radio Drive-Through Instructions
A simple, but highly effective way to communicate with patients in real time is by activating a temporary AM radio station through which information can be transmitted on patients’ car radios. This requires a portable broadcast system, available from various manufacturers in a “box” kit. The box includes everything needed to start broadcasting – transmitter, antenna, media players and microphones. The system can be installed, programmed and in use within hours, even in remote locations. Most systems allow for origination and control for both live and recorded broadcasts. On average, the broadcast can reach listeners within 5 miles of the antenna.
Signs placed at the entrance (and other strategic points) of the Parking Area advise patients to tune their vehicle radios to the appropriate AM station. These instructions are included in the Drive-Through Patient Information sheet distributed to all vehicles in the Parking Area.
This system is used to broadcast regular updates on patient wait times, healthcare advisories, vehicle safety and other information and instructions. The regular radio updates keep patients informed and alleviate possible frustration and impatience with long wait times. Consider updates in languages besides English as appropriate to your population.
Page 14 of 39 18 Equipment Needs
General recommendations
Page 15 of 39 19 Staffing
General Recommendations
Staff require the following: Staff Break and Nutrition Area (outside of, but convenient to, Drive-Through Triage Area) Appropriate Personal Protective Equipment (PPE) (including reflective vests for traffic control staff) Food and water and/or other refreshments Regulated shift times and breaks (Drive-Through Triage conditions require shorter shift times and more frequent breaks). Access to bathroom facilities/port-a-potties, and appropriate sanitation including hand sanitizer Appropriate clothing for weather conditions (i.e., sweatshirt or sweater to wear under uniform in cold weather, wind parka, rain poncho, etc.) Rubber mats to stand on (to counteract stress to feet, legs and back from standing for prolonged periods on concrete) Training and/or written handouts on back health, including lifting and bending (some staff members will be bending/leaning into cars to talk to patients) Provision of emotional or spiritual support, if needed Security provisions, especially if hostile or other dangerous situation arises (including escorts from the area, if necessary) Available resources to assist with issues related to childcare or other family needs (e.g., access to communication including phones, cell phones, email, etc.).
Staff Training and Support
Look for regional or state provided training opportunities Make sure that your jurisdiction has accurate job action sheets for all roles, including roles that are specific to drive-thru clinics, and that these are incorporated into planned and JITT Practice JITT through smaller and more frequent drills and functional exercises Exercise using real cars to simulate the importance of safety and awareness with traffic Include training issues in exercise evaluations and improvement planning to conform to the Homeland Security Exercise and Evaluation Program (HSEEP).
Staff Roles
Incident Command System Structure
Incident Command Establish the Incident Command Post Set priorities, and determine incident objectives and strategies to be followed Establish the Incident Command System Approve resource requests and use of volunteers and auxiliary personnel
Page 16 of 39 20 Authorize information release to the media Ensure after-action reports are completed.
Public Information Officer Develop accurate and timely information for use in press/media briefings according to direction from Incident Command Conduct periodic media briefing Arrange for tours and other interviews or briefings that may be required Implement methods to monitor rumor control Participate in planning meetings.
Safety Officer Identify and mitigate hazardous situations Ensure safety messages and briefings are made Assign assistants qualified to evaluate special hazards Initiate preliminary investigation of accidents within the Incident Area.
Security Officer Meet supply vehicle with medications and supplies, and provide security to site location Secure all entrances and exits Direct participants to EDS Flow starting Area Maintain order and security within and outside the facility, and respond as needed to events In deactivation phase, ensure facility is empty of participants, and provide security for remaining medications and supplies until returned.
Finance Section Chief Manage all financial aspects of an incident Provide financial and cost analysis information as requested Ensure compensation and claims functions are being addressed relative to the incident Ensure that personnel time records are completed accurately and transmitted to proper agency
Operations Section Chief Manage tactical operations Request additional resources to support tactical operations Maintain close contact with the Incident Command, subordinate Operations personnel, and other agencies involved in the incident Conduct volunteer training
Logistics Section Chief Identify anticipated and known incident service and support requirements Manage all incident logistics Assess in-stock supplies and identify items needed to purchase; maintain inventory of supplies Coordinate pick up of medication. Coordinate all activity in relation to proper handling, distribution, and storage of medication including all necessary paperwork Return all medication/supplies to appropriate agency
Page 17 of 39 21 Participate in volunteer training.
Planning Section Chief Collect and manage all EDS relevant data Establish information requirements and reporting schedules Coordinates and collects information from the various Section Chiefs
Job Descriptions - Non-Medical
Greeters Welcome and greet the public Orient the public to the EDS flow pattern Answer any non-medical questions Direct vehicle to "Registration" area.
Registration Distributes EDS paperwork to participants. (Registration Form and VIS) Assists in the completion of forms Keeps count of number of cars and number of people in each car. This number will be reported every half hour Assures that the participant has readied their arm to receive their injection Directs the participant to the Triage Area.
Line Monitors Ensures a continuous supply of EDS paperwork and facilitates the moving of clipboards/pens from vehicles back to the "Registration" area Assists in directing the public through the EDS May help keep count of number of cars/people in the "Registration", "Vaccination", and "Form Collection" area Assists "Form Collection" area in monitoring "Wait Time".
Form Collection Collects all completed forms and checks for their completeness Monitors the vehicle's "Wait Time" Directs participant to Wait/Exit
Job Descriptions - Medical
Triage These medical staff will review completed registration forms and will ask the appropriate questions to the participant to determine if the vaccination/medication may be given
Vaccinators Reviews the registration form Prepares injection site and administers vaccination
Page 18 of 39 22 Documents time on registration form Directs participant to Form Collection/Wait Area
Behavioral Health Addresses any unusual emotions and behavior of the participants.
Pharmacy/Medical Supply Staff Provide each vaccination station with vaccine and supplies Keeps accurate count of the number of doses available for dispensing.
Medical Exit Evaluator Ensures that participants exiting the EDS are not experiencing any side effects.
EMT Responds to medical emergencies throughout the EDS and responsible for transport of participants should they be in need of transfer to a medical facility Asks post-vaccination questions to participants to screen for any adverse effects at "Form Collection"
Page 19 of 39 23 Infection Control
Infection control is of prime concern in the Drive-Through Triage.
Infection Control Measures:
Wear appropriate Personal Protective Equipment (PPE) during assigned shift Use anti-microbial solution provided at each station o Perform hand hygiene frequently, including before and after patient contact and before putting on or taking off Personal Protective Equipment (PPE). Instruct drivers and passengers to stay in their cars
Attendee PPE:
Surgical masks/ear loop face masks o Consider if attendees will be asked to bring their own masks; consider if your site will have some available for distribution if needed
Staff PPE:
See “Equipment and Supply Planning Tool by Function” in the Appendices for a listing of likely recommended PPE for staff. Work with your clinicians on your planning team to arrive at a final listing and quantities needed.
OTHER CONSIDERATIONS FOR INFECTION CONTROL
Cleaning equipment and supplies to deal with emesis or other body fluids in or outside of vehicles Fans to move contaminants, including carbon monoxide fumes from cars, out of treatment area
Page 20 of 39 24 Signs
General Recommendations
Consider the need for, and amount of, the following signs:
Arrow signs (pointing to the left, right and top/forward) “Dispensing” “Entrance/Enter” “Exit” “Incident Command Post” “Observation Area” “Park Car – Keep Windows Up – Stay in Car” “Restroom” “Screening” “Speed Limit 3 MPH” “Speed Limit 5 MPH” “Staff Parking” “Start Here” “Stop” “Tune Radio to: ___” “Turn Off Your Engine” “Vehicle Height Clearance ___ ft.”
Frontier EDS Sign Inventory
The Frontier EDS has run flu clinics as EDS drills for several years; the following inventory has been built up over time; not all signs cited in the following inventory are drive-thru specific; consider your existing sign inventory as you identify drive-thru signage needs.
As you consider your sign needs, bear in mind that locations for your dispensing may change over time, and some signs may be more immediately essential than others.
Frontier has used Hale Custom Signs to print many of their signs; references to “Hale signs” indicates those signs that have been professionally printed as opposed to hand-drawn or handwritten.
The following tables indicate the Frontier EDS sign type, quantity, and samples.
Page 21 of 39 25 “Hale” Signs – With Stands Sign Text Qty. Sample Triage 1
Put Car in Park 3 Vaccination 1
Registration 2
Child with Adult Medication 1
Turn Here (with arrow pointing right) 2
Turn Here (with arrow pointing left) 1
Stay in Car 1
Arrow pointing to right 1
Arrow pointing to left 1
E.D.S./Clinic 1
(No text, just:) thee arrows pointing up 2
Enter EDS/Clinic 1
Exit 3
Wait Area 1
Adult Medication 1
Volunteer Parking 1
Stay in Lane 1
Form Collection 1
Enter Here 1
Extra Large ENTER sign 1
Page 22 of 39 26 “Hale” Signs – Smaller, with no grommets for hanging Sign Text Qty. Sample (no text, just directional arrows – 2 sided signs, 3 arrow pointing left on one side, right on the other) E.D.S. Parking (with directional arrow, 2 sided signs, 3 arrow pointing left on one side, right on the other)
Volunteer Parking (two sided) 1
Large Heavy Cardboard signs (one sided) with grommets for hanging Sign Text Qty. Sample Four Simple Steps (see sample to right) 1
Entrance (2 sided in several languages) 3 Prohibited – photography, smoking, weapons, pets, 1 video/sound recording Thank You for your Cooperation 1 This is a medical services facility: • Patient Privacy is protected by State and Federal law. • Authorized personnel and patients only. 1 • The procedures inside this facility are private; no video/sound recording and no photography are allowed.
Page 23 of 39 27 Small Heavy Cardboard Signs With Grommets (one sided) Sign Text Qty. Sample Medical Evaluation 1
Counselor 1
Language Assistance 1
Please Wait 3
Adult Line 1
Family Line 1
First Aid 1
Exit 1
Kids 1
Small Laminated Thin Signs with Grommets(1 sided, English/Spanish) Sign Text Qty. Sample Exit 1 Black Arrows (grommets on top & bottom so arrow 10 can go in either direction)
Special Assistance 1
Page 24 of 39 28
Appendices
Page 25 of 39 29
Appendix 1: Sample setup diagrams/maps
Page 26 of 39 30
Page 27 of 39 31
Page 28 of 39 32
Appendix 2: Sample Drive-thru Planning Guide
Page 29 of 39 33 ITEM TASK ASSIGNED TO COMPLETE
Agree on section head selections
Recruit section heads and primary leaders 1. Organization Finalize job descriptions
Set possible dates
Review site options
2. Site Selection Select Site
Implement agreement with site authorities
Define stations & location for each Design traffic flow control points & staff
placement Identify necessary traffic control items; (e.g.,
cones, signage) Accommodation for emergency lanes, parking 3. Site Plan Consideration of all planning and operations partners:
i. Fire ii. EMS iii. Police iv. DPW/Highway v. EMDs vi. FRCOG vii. Private non-profits Define all radio needs, numbers and types
Identify who will have what equipment
Inventory and obtain equipment 4. Communications Identify pre-event information to be communicated (e.g. EDS objectives, if pre- registration is available, traffic notices, safety rules re; pets, smoking, weapons, etc.) Define all publicity plans i. Radio, web sites, newsletters, cable, etc. 5. Publicity ii. Dates for various releases iii. Telephone number to call for questions iv. Get politicians involved
Page 30 of 39 34 6. Equip. & Supplies Identify medical and non-medical equipment and supply needs for all stations Develop staffing plan i. How many stations and people per
7. Staffing station? ii. How many shifts? Develop recruitment plan
Develop plans for JIT training of all staff
Acquisition plan development 8. Vaccine Cold chain management plan development 9. Pre-registration Define process and forms i. Determine need and capacity for online registration ii. Determine if forms will be available in other venues, such as web site Site layout and instructions for each car
Safety guidelines
Registration 10. Forms/Paperwork Client expectations
Frequently asked questions
Releases of liability Make plans for visitors i. Press 11. Visitors ii. Dignitaries; state & local iii. Exercise reviewers Plan for table top exercise in advance 12. Pre-event drills Conduct review meeting week before drill
Weather 13. Alternate Plans Vaccines supply chain/availability
Physical distancing protocols and messaging 14. Miscellaneous Food/refreshments for staff Identify all necessary/potential funding 15. Finance sources Apply for funding as required
Page 31 of 39 35
Appendix 3: Equipment and Supply Planning Sheets
Page 32 of 39 36 Frontier EDS Equipment Sheet by Station
GREETERS Injectable screening Chairs Table tool Plastic storage Chairs Radio container Plastic storage Cell phone number Radio container list Cell phone number "Welcome to EDS Trash bag list Handout" Number of cars per 1/2 hour form VACCINATION FORM COLLECTION Radio Gloves Table Cell phone number 3cc syringe with 1" Chairs list needle Plastic storage Trash bag 3cc syringe with 11/2" container needle Pens Sharps container Amount of REGISTRATION Band aids Vaccine/Flumist per Table 2"x2" sterile gauze 1/2 form Chairs Hand sanitizer Educational handout Clipboards Trash bags - Irg. & Radio Pens small Cell phone number Plastic storage Tablecloths list container VIS FluMist forms VIS FluMist forms VIS Injectable forms VIS Injectable forms FluMist screening ADDITIONAL SUPPLIES FluMist screening form EDS Plan forms Parent second dose ICS Flowchart Injectable screening Flumist info. Form EDS signs forms Injectable screening Vests Random EDS station form Sign-in sheets time cards Standing orders Cones Radio Emergency meds Food area table & Cell phone number Ammonia inhalant chairs list Vaccination recording Tape Trash bag form Scissors Proof of vaccination Paper form Duct tape TRIAGE Vaccine Tents Table FluMist Medical supply area Chairs Tissues table & chairs Clipboards Cooler & ice packs Stethoscope Pens Thermometer Blood pressure VIS FluMist forms Clipboards manometer VIS Injectable forms Pens Personal Protective FluMist screening tool Table Equipment (PPE)
Page 33 of 39 37
Recommended Supplies from NACCHO Drive-thru Planning Guide
IN IN QUANTITY STILL ITEMS SECURED GENERAL COMMENTS NEEDED NEEDED STOCK SUPPLIES
PHP plan binder SNS operations plan
Station tents Extension cables and power sources Lighting source (floodlight, etc.) for 24/7 operations Station tables
Station chairs
Traffic cones, tape, wands, etc. DVD player and JITT video (if needed) Temperature-controlled storage area Coolers for food items
Labeled vests
ID badges for staff Radio/TV for situational awareness Phones (satellite, cell) Transport vehicles (golf carts, etc.) Cooling fans or space heaters
Cots
Ambulance and supplies
Portable toilets (if needed)
Garbage bags and containers
Water and cups
Yellow Book directory
List of phone contacts
English signage Alternate language signage and pictograms
Page 34 of 39 38 Medical screening forms Informational packets (in all necessary languages) Paper
Staplers and staples Pens (check at one year and rotate if needed) Manila envelopes
Large Post-it notes
Legal pads
Rubber bands
Clip boards
Duct tape Sharpies (check every six months and rotate if needed) Highlighter (check every six months and rotate if needed) Scissors Boxes for transporting forms, etc. Flashlights Flashlight batteries (check monthly and rotate out as needed) Walkie talkies (check monthly and recharge as needed) Megaphones (six batteries per unit) Anti-bacterial washing solution
First aid boxes
Tissues/paper towels Computers, printers, and internet hookup as needed
Page 35 of 39 39
Equipment and Supply Planning Tool by Function
OPERATIONAL EQUIPMENT
Item Quantity Comments General Clipboards Clerical Scissors Pens Paperclips Tables Ideally has surface that is easy to wipe clean Chairs Trash Bins Non-Biohazard bins for regular trash Bin Liners Non-Biohazard trash bags 2-Way Radios (and batteries) Consider plan for charging radios Wheelchairs Flashlights Lights as needed Area Lighting/Generator* If Drive-Through area not illuminated, generators and lighting will need to be installed *Caution: Due to CO poisoning risk, generators should not be placed indoors. Extension Cords Megaphone (with batteries) For announcements Tent or coverage for outside screening RN If raining Patient Amenities
Port-a-Potties Preferably one that is handicap accessible Hand-washing facilities/hand sanitizer As required to meet patient needs Emesis Bags/Basins Manila Envelopes Allows patients to keep paperwork together Blankets Bedpan Spare Infant diapers Tissue Boxes Screens Provide patient privacy during physician exams
Page 36 of 39 40 Heating lamps Fans to move exhaust out of parking structure Documentation Medical Record Folders Registration Forms Triage Form Medical Screening Exam Forms Discharge Form Order Sheet Influenza Information Sheet Medication Information Maps and Directions to Emergency Dept. Green Post-it Notes Yellow Post-it Notes Traffic Control
Traffic Vests Reflective vests for Traffic Control staff Traffic Cones Barricades Barricade Tape Traffic Light Wands For night-time traffic control Rubber Mats Signage Butcher Paper 1 roll To make expedited signs Marker Pens 2 To make expedited signs Arrow signs Discharge & Dispensing Entrance Exit Incident Command Post Medical Screening Exam Observation Area Park Car – Keep Windows Up – Stay in Car Restroom
Page 37 of 39 41 Screening Speed Limit 3 MPH Speed Limit 5 MPH Staff Parking Staging Area Start HERE Stop Tune Radio to Turn Off Your Engine Vehicle Height Clearance ___ ft.
PERSONAL PROTECTIVE EQUIPMENT (PPE)
Item Quantity Comments
General Personal Protective Equipment (PPE)/Cleaning
N95 Respirators (Respiratory Protection) Need at least 1/staff/shift Surgical Masks/Earloop Facemask Need at least 1/staff/shift Gloves, Nitrile Need at least 1/staff/shift Eye shields or Safety Glasses Yellow Isolation Gowns (droplet Need at least 1/staff/shift protection of clothing) Masks with Face Shield Place over N95 to protect mask and eyes Booties Hand Sanitizer Bottles Sani-Cloth Type Disinfecting Wipes Paper Towels Biohazard Bags Biohazard Bins Carbon Monoxide Monitor-Rad 57 Monitor CO levels
Page 38 of 39 42 CLINICAL EQUIPMENT
Item Quantity Comments
Patient Assessment Stethoscopes BP Cuffs (Manual or Automated) Consider pediatric sizes as well Pulse Oximeters Vital signs Glucometer Lancets Sharps Container Disposal of any sharp objects RAD-57 CO-oximeter For non-invasive CO monitoring Thermometers Consider disposable style Thermometer Probe Covers Tape Alcohol wipes Cleaning of probes and minor equipment
Page 39 of 39 43
Operation Hold the Line
After-Action Report/Improvement Plan April 27, 2020
The After-Action Report/Improvement Plan (AAR/IP) aligns exercise objectives with prepared- ness doctrine to include the National Preparedness Goal and related frameworks and guidance. Exercise information required for preparedness reporting and trend analysis is included; users are encouraged to add additional sections as needed to support their own organizational needs.
44 After-Action Report/ Operation Hold the Line Improvement Plan (AAR/IP)
EXERCISE OVERVIEW
Exercise Name Operation Hold the Line: MAPHCO All EDS Tabletop Exercise (TTX)
Exercise Dates March 2, 2020
Operation Hold the Line is a TTX to evaluate procedures and identify new planning considerations for early pandemic influenza responses, prior to vaccine administration. The exercise is planned for 3 hours and will be conducted at the John W. Olver Transit Center, 12 Olive St., Greenfield, MA. Participating local Boards of Health and Health Departments in Re- gion 1B will recruit other local agencies that are identified as EDS staff in Scope their plans to participate in the exercise. Early pandemic response procedures will be evaluated through discussion and in the context of a scenario that requires EDS teams to determine ef- fective means to prevent the spread of infection and to prepare for vaccine administration.
Mission Area(s) Prevention, Protection, and Response
PHEP Capability 3 : Emergency Operations Coordination PHEP Capability 4 : Emergency Public Information and Warning Core Capabili- PHEP Capability 6 : Information Sharing ties PHEP Capability 8 : Medical Countermeasure Dispensing PHEP Capability 9 : Medical Materiel Management and Distribution PHEP Capability 14: Responder Safety and Health, Information
1. Conduct preliminary assessment to determine the need to activate public health emergency operations. 2. Assess procedures for notifying and assembling response team mem- bers for initial briefing and early objectives development. 3. Define key messages and processes for disseminating information to the public. 4. Demonstrate knowledge of regional and state agencies for information Objectives and resource requests. 5. Determine populations and essential personnel for priority treatment. 6. Assess EDS plan for adequate contact information for local organiza- tions serving populations with access and functional needs. 7. Identify protocols for maintaining cold chain management of vac- cines, and issues related to storage/distribution. 8. Evaluate sufficiency of current supplies of personal protective equip- ment (PPE) in EDS inventory.
Exercise Overview 1 Mohawk Area Public Health Coalition FOUO 45 After-Action Report/ Operation Hold the Line Improvement Plan (AAR/IP)
Threat or Haz- Pandemic influenza ard
For the next 12 months, a highly pathogenic and novel influenza strain will spread worldwide. While a vaccine is in development, local EDS Scenario groups will need to focus their efforts on internal organization, preventing new cases, and readying for their receipt of an initial delivery of limited doses for priority populations and essential personnel.
Mohawk Area Public Health Coalition (MAPHCO); Franklin Regional Council of Governments (FRCOG). Funding for this exercise was made possible (in whole or in part) by the Centers for Disease Control and Pre- vention and/or the Assistant Secretary for Preparedness and Response. Sponsor The views expressed in written materials or publications and by speakers and moderators do not necessarily reflect the official policies of the De- partment of Health and Human Services, nor does the mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.
State agencies: 2 Participating Regional agencies: 4 Organizations Local agencies: 31
Tracy Rogers Emergency Preparedness Program Manager Point of Con- Franklin Regional Council of Governments tact 413-774-3167 x118 [email protected]
Exercise Overview 2 Mohawk Area Public Health Coalition FOUO 46 After-Action Report/ Operation Hold the Line Improvement Plan (AAR/IP)
ANALYSIS OF CORE CAPABILITIES Aligning exercise objectives and core capabilities provides a consistent taxonomy for evaluation that transcends individual exercises to support preparedness reporting and trend analysis. Table 1 includes the exercise objectives, aligned core capabilities, and performance ratings for each core capability as observed during the exercise and determined by the evaluation team.
Performed Performed Performed Unable to Core Capabil- without with Some with Major Objective be Per- ity Challenges Challenges Challenges formed (U) (P) (S) (M) 1. Conduct preliminary assess- #3: Emergency ment to determine the need to Operations Co- X activate public health emer- ordination gency operations. 2. Assess procedures for notify- #3: Emergency ing and assembling response Operations Co- X team members for initial brief- ordination ing. 3. Define key messages and pro- #4: Emergency cesses for disseminating infor- Public Infor- X mation to the public. mation and Warning 4. Assess EDS plan for adequate #4: Emergency contact information for local Public Infor- organizations serving popula- mation and X tions with access and func- Warning tional needs. 5. Demonstrate knowledge of re- #6: Information gional and state agencies for Sharing X information and resource re- quests. 6. Determine populations and es- #8: Medical sential personnel for priority Countermeasure X treatment. Dispensing and Administration 7. Identify protocols for main- #9: Medical taining cold chain management Materiel Man- X of vaccines, and issues related agement and to storage/distribution. Distribution 8. Evaluate sufficiency of current #14: Responder supplies of personal protective Safety and X equipment (PPE) in EDS in- Health ventory.
Table 1. Summary of Core Capability Performance
The following sections provide an overview of the performance related to each exercise objec- tive and associated core capability, highlighting strengths and areas for improvement.
Analysis of Core Capabilities 3 Mohawk Area Public Health Coalition FOUO 47 After-Action Report/ Operation Hold the Line Improvement Plan (AAR/IP)
Objective 1: Conduct preliminary assessment to determine the need to activate public health emergency operations. The strengths and areas for improvement for each core capability aligned to this objective are de- scribed in this section.
PHEP Capability 3: Emergency Operations Coordination
Strengths The partial capability level can be attributed to the following strengths: Strength 1: Towns quickly recognized that regional coordination would be necessary, including the possibility of area or unified command.
Areas for Improvement The following areas require improvement to achieve the full capability level: Area for Improvement 1: While necessary information was generally in the regional EDS plan, it was not easy to locate quickly. Reference: Regional EDS plans Analysis: Since this kind of scenario doesn’t occur very often, local boards of health don’t have any muscle memory available when they need to respond. This creates a feeling that everything one needs to know for a response must be included in the written plan, making it cumbersome. Area for Improvement 2: Towns were unclear about who had the authority to activate an EDS team. Reference: Regional EDS plans Analysis: The regional EDS plans explain how an EDS team would activate the plan, but not whether a single town or individual can activate the team. Area for Improvement 3: Some EDS’ have several plans: one for each different scenario, mak- ing it hard to find all of the information at once and to keep all of it up to date. Reference: Regional EDS plans Analysis: When plans become too big, they become overwhelming to read, leading to the need for chunking the information into smaller pieces.
Objective 2: Assess procedures for notifying and assembling re- sponse team members for initial briefing. The strengths and areas for improvement for each core capability aligned to this objective are de- scribed in this section.
Analysis of Core Capabilities 4 Mohawk Area Public Health Coalition FOUO 48 After-Action Report/ Operation Hold the Line Improvement Plan (AAR/IP)
PHEP Capability 3: Emergency Operations Coordination
Areas for Improvement The following areas require improvement to achieve the full capability level: Area for Improvement 1: EDS team rosters are out of date. Reference: Regional EDS plans Analysis: Because local boards are comprised of volunteers, they have little time to focus on small tasks such as keeping rosters up to date. They need to prioritize their limited time. Area for Improvement 2: Many teams didn’t know how to access teleconferencing platforms. Reference: Regional EDS plans Analysis: Because we haven’t had such a virulent virus to respond to within our lifetimes, we’ve never considered how we’d have to work using social distancing practices.
Objective 3: Define key messages and processes for disseminating information to the public. The strengths and areas for improvement for each core capability aligned to this objective are de- scribed in this section.
PHEP Capability 4: Emergency Public Information and Warning
Strengths The partial capability level can be attributed to the following strengths: Strength 1: EDS teams recognized the importance of spreading information provided by trusted sources at the state and national level. Strength 2: Some EDS teams already have sample messages ready to use.
Areas for Improvement The following areas require improvement to achieve the full capability level: Area for Improvement 1: Teams identified other resources for getting messaging out that aren’t reflected in the plans, such as faith-based leaders, TRIAD, and neighborhood leaders. Reference: Regional EDS plans Analysis: n/a Area for Improvement 2: Plans don’t currently include information on how to locate translators or interpreters. These resources are particularly needed to aide in communication with migrant agricultural workers.
Analysis of Core Capabilities 5 Mohawk Area Public Health Coalition FOUO 49 After-Action Report/ Operation Hold the Line Improvement Plan (AAR/IP)
Reference: Regional EDS plans Analysis: According to the 2014 American Community Survey conducted by the U.S. Census Bureau, only 2% of the population in Franklin County (which contains 24 of MAPHCO’s 26 towns) speak English less than “very well.” This leads planners not to highly prioritize inclusion of translation and interpretation services.
Objective 4: Assess EDS plan for adequate contact information for lo- cal organizations serving populations with access and functional needs. The strengths and areas for improvement for each core capability aligned to this objective are de- scribed in this section.
PHEP Capability 4: Emergency Public Information and Warning
Strengths The partial capability level can be attributed to the following strengths: Strength 1: EDS team members had many creative ideas of community organizations to which they could reach out and ways in which those organizations could assist with messaging.
Areas for Improvement The following areas require improvement to achieve the full capability level: Area for Improvement 1: Many EDS teams did not consider creating or participating in a joint information system. Reference: n/a Analysis: Most board of health members have not been trained on the existence or use of joint information systems.
Objective 5: Demonstrate knowledge of regional and state agencies for information and resource requests. The strengths and areas for improvement for each core capability aligned to this objective are de- scribed in this section.
PHEP Capability 6: Information Sharing
Strengths The partial capability level can be attributed to the following strengths: Strength 1: All EDS teams were aware of MEMA as a resource.
Analysis of Core Capabilities 6 Mohawk Area Public Health Coalition FOUO 50 After-Action Report/ Operation Hold the Line Improvement Plan (AAR/IP)
Areas for Improvement The following areas require improvement to achieve the full capability level: Area for Improvement 1: Many EDS team members did not know what the HMCC was and how it could help during such a scenario. Reference: Western MA HMCC Emergency Response Plan Analysis: Because most boards of health are comprised of volunteers, they don’t have the time or bandwidth to keep up with all of the information sent to them by other organizations, such as the HMCC.
Objective 6: Determine populations and essential personnel for prior- ity treatment. The strengths and areas for improvement for each core capability aligned to this objective are de- scribed in this section.
PHEP Capability 8: Medical Countermeasure Dispensing
Strengths The partial capability level can be attributed to the following strengths: Strength 1: EDS team members have many contacts within their towns or the region that can help them identify those in the target population. Strength 2: EDS team members were able to find the list of essential personnel in their EDS plans.
Areas for Improvement The following areas require improvement to achieve the full capability level: Area for Improvement 1: Not all essential personnel are included in the EDS plans. Reference: Regional EDS plans Analysis: Many people have trouble grasping that a public health emergency of this magnitude will ever happen, so not all disciplines prioritize participation in planning, causing their person- nel to be left out of plans. Area for Improvement 2: There is currently no plan for requesting enough doses for essential personnel at a regional level. Reference: Regional EDS plans Analysis: Because of Massachusetts home rule, each town’s board of health has its own com- mand and control authority. Several towns belong to a regional health district that could make a purchase on their behalf, but there is also more than one regional health district covering the 26
Analysis of Core Capabilities 7 Mohawk Area Public Health Coalition FOUO 51 After-Action Report/ Operation Hold the Line Improvement Plan (AAR/IP) towns in MAPHCO’s catchment area. There is not one entity with regional command and control that covers all 26 towns.
Objective 7: Identify protocols for maintaining cold chain manage- ment of vaccines, and issues related to storage/distribution. The strengths and areas for improvement for each core capability aligned to this objective are de- scribed in this section.
PHEP Capability 9: Medical Materiel Management and Distribution
Strengths The partial capability level can be attributed to the following strengths: Strength 1: EDS team members were able to locate information in their plans describing what temperature range was necessary to maintain vaccine efficacy.
Areas for Improvement The following areas require improvement to achieve the full capability level: Area for Improvement 1: Though the regional EDS plans describe a process for cold chain management, they do not make reference to the use of regional refrigerators, which MAPHCO purchased in 2019. Reference: Regional EDS plans Analysis: n/a
Objective 8: Evaluate sufficiency of current supplies of personal pro- tective equipment (PPE) in EDS inventory. The strengths and areas for improvement for each core capability aligned to this objective are de- scribed in this section.
PHEP Capability 14: Responder Safety and Health
Strengths The partial capability level can be attributed to the following strengths: Strength 1: Many EDS team members knew where to obtain needed PPE, including from re- gional and state entities, as well as local businesses and universities. Strength 2: Many towns have multi-disciplinary emergency management teams in existence, which allows for better resource coordination.
Analysis of Core Capabilities 8 Mohawk Area Public Health Coalition FOUO 52 After-Action Report/ Operation Hold the Line Improvement Plan (AAR/IP)
Areas for Improvement The following areas require improvement to achieve the full capability level: Area for Improvement 1: None of the EDS teams had a complete inventory of PPE that they own or have access to. Reference: Regional EDS plans Analysis: The responsibility for inventory management rests with local boards of health and EDS team comprised mainly of volunteers. Area for Improvement 2: The plans include tables to indicate how much PPE is necessary, but the tables are blank. Reference: Regional EDS plans Analysis: n/a
Analysis of Core Capabilities 9 Mohawk Area Public Health Coalition FOUO 53 After-Action Report/ Operation Hold the Line Improvement Plan (AAR/IP)
APPENDIX A: IMPROVEMENT PLAN This IP has been developed specifically for the Mohawk Area Public Health Coalition as a result of Operation Hold the Line con- ducted on March 2, 2020.
Primary Re- Capability sponsible Organiza- Start Comple- Core Capability Issue/Area for Improvement Corrective Action Element1 Organiza- tion POC Date tion Date tion Core Capability 1. While necessary information The plans should be stream- Planning EDS PHEP 7/1/20 6/30/21 1: Emergency was generally in the regional lined and operationalized. teams planner Operations Co- EDS plan, it was not easy to lo- FRCOG ordination cate quickly. 2. Towns were unclear about Those EDS teams that are not Organi- EDS Local 9/1/20 6/30/21 who had the authority to acti- multi-disciplinary should con- zation teams boards of vate an EDS team. sider becoming so, so all re- health sponders are on the same page. EDS teams should discuss Planning EDS 7/1/20 12/31/20 who has the authority to acti- teams PHEP vate the entire team and this FRCOG planner should be written into the re- gional EDS plans. Towns should investigate how Planning EDS Local 9/1/20 6/30/21 EDS plans and CEMPs are re- teams boards of lated and ensure they don’t Local health contain conflicting information. EMDs and EMDs As towns explore creating Organi- MAPHCO MAPHCO 7/1/20 4/1/21 multi-disciplinary teams, so zation REPC and should the region; specifically REPC how MAPHCO and the REPC leader- could work more closely to- ship gether, or even merge.
1 Capability Elements are: Planning, Organization, Equipment, Training, or Exercise.
Appendix A: Improvement Plan A-1 Mohawk Area Public Health Coalition FOUO 54 After-Action Report/ Operation Hold the Line Improvement Plan (AAR/IP)
Primary Re- Capability sponsible Organiza- Start Comple- Core Capability Issue/Area for Improvement Corrective Action Element1 Organiza- tion POC Date tion Date tion FRCOG Emer- gency Prepar- edness Program staff 3. Some EDS’ have several Additional plans should be in- Planning EDS Local 7/1/20 6/30/21 plans: one for each different corporated into a main plan teams boards of scenario, making it hard to find with annexes. health all of the information at once and to keep all of it up to date. 4. EDS team rosters are out of Rosters should be updated at Planning EDS Ongoing date. least annually. teams PHEP FRCOG planner Plans should include position Planning FRCOG PHEP 7/1/20 6/30/21 names, not names of specific planner personnel. 5. Many teams didn’t know how A teleconferencing line should Planning FRCOG PHEP 7/1/20 8/31/20 to access teleconferencing plat- be established for each EDS planner forms. team and its credentials written into the regional EDS plan. Core Capability 1. Teams identified other re- Teams should brainstorm re- Planning EDS 7/1/20 6/30/21 4: Emergency sources for getting messaging sources and document those, teams PHEP Public Infor- out that aren’t reflected in the along with contact information, FRCOG planner mation and plans, such as faith-based lead- in the plans. Warning ers, TRIAD, and neighborhood leaders. 2. Plans don’t currently include Contact information for inter- Planning FRCOG PHEP 7/1/20 6/30/21 information on how to locate preters and translators should planner translators or interpreters. be included in the plans.
Appendix A: Improvement Plan A-2 Mohawk Area Public Health Coalition FOUO 55 After-Action Report/ Operation Hold the Line Improvement Plan (AAR/IP)
Primary Re- Capability sponsible Organiza- Start Comple- Core Capability Issue/Area for Improvement Corrective Action Element1 Organiza- tion POC Date tion Date tion These resources are particu- EDS teams should attend a Training FRCOG HMCC 5/1/20 9/30/20 larly needed to aide in commu- training on how to work with in- manager nication with migrant agricul- terpreters and translators. tural workers. 3. Many EDS teams did not Use of a joint information sys- Planning MAPHCO Emer- 7/1/20 6/30/22 consider creating or participat- tem should be added to all re- and REPC gency ing in a joint information sys- gional response plans (not just leadership Prepar- tem. EDS plans). edness Program staff Core Capability 1. Many EDS team members A diagram of regional, state, Planning FRCOG Emer- 7/1/20 6/30/21 6: Information did not know what the HMCC and federal agencies available gency Sharing was and how it could help dur- to assist during a response, in- Prepar- ing such a scenario. cluding what services they pro- edness vide and their contact infor- Program mation, should be created and staff offered to all towns to add to all response plans. Core Capability 1. Not all essential personnel Towns should consider adding Planning Towns EMDs 7/1/20 6/30/21 8: Medical are included in the EDS plans. senior center and town hall em- Countermeas- ployees to response plans (not ure Dispensing just EDS plans) as essential personnel. 2. There is currently no plan for MAPHCO should consider Planning MAPHCO PHEP 71/20 6/30/21 requesting enough doses for whether it wants to act as a su- Steering planner essential personnel at a re- per-regional coordinating body, Committee gional level. or if there is another entity that could fulfill that role. Core Capability 1. Though the regional EDS The MAPHCO Steering Com- Planning MAPHCO PHEP 71/20 6/30/21 9: Medical Ma- plans describe a process for mittee should discuss how use Steering planner teriel Manage- cold chain management, they of regional refrigerators will oc- Committee ment and Distri- do not make reference to the cur and write those procedures bution use of regional refrigerators, into the regional EDS plans.
Appendix A: Improvement Plan A-3 Mohawk Area Public Health Coalition FOUO 56 After-Action Report/ Operation Hold the Line Improvement Plan (AAR/IP)
Primary Re- Capability sponsible Organiza- Start Comple- Core Capability Issue/Area for Improvement Corrective Action Element1 Organiza- tion POC Date tion Date tion which MAPHCO purchased in 2019. Core Capability 1. None of the EDS teams had The coalition-wide cache of Planning FRCOG PHEP 7/1/20 9/30/20 14: Responder a complete inventory of PPE PPE in a storage locker in planner Safety and that they own or have access Greenfield should be aug- Health to. mented. If there is one cache, the Coalition could count on the paid staff to maintain the in- ventory. 2. The plans include tables to The tables should be filled in, Planning FRCOG PHEP 7/1/20 6/30/21 indicate how much PPE is nec- customized for each EDS loca- planner essary, but the tables are blank. tion.
Appendix A: Improvement Plan A-4 Mohawk Area Public Health Coalition FOUO 57 After-Action Report/ Operation Hold the Line Improvement Plan (AAR/IP)
APPENDIX B: EXERCISE PARTICIPANTS
Participating Organizations State MA Dept. of Public Health MA Emergency Management Agency
Regional Berkshire Regional Planning Commission (Franklin County MRC) Franklin Regional Council of Governments (CPHS, HMCC, MAPHCO) Pioneer Valley Planning Commission South County Emergency Medical Services
Local Ashfield BOH Buckland BOH Conway BOH Deerfield (BOH, Board of Selectmen, Dept. of Public Works, EMD, Police Dept.) Goshen BOH, EMD Greenfield (BOH, Council on Aging, Fire Dept., Health Dept.) Hawley (BOH, Board of Selectmen) Heath BOH Leverett BOH Leyden BOH Montague (BOH, Board of Selectmen, Health Dept.) Rowe BOH Shelburne (BOH, Emergency Management) Shutesbury (BOH, Board of Selectmen, EMD, Fire Dept., Town Administration) Sunderland BOH Turners Falls Fire Dept. Wendell (BOH, Emergency Management) Whately BOH Williamsburg (BOH, Board of Selectmen, Town Administration)
All organizations above were registered to participate. Those who attended are printed in bold.
Appendix B: Exercise Participants B-1 Mohawk Area Public Health Coalition FOUO 58 After-Action Report/ Operation Hold the Line Improvement Plan (AAR/IP)
APPENDIX C: ACRONYMS
Acronym Term AAR After Action Report BOH Board of Health CDC Centers for Disease Control and Prevention CEMP Comprehensive Emergency Management Plan CPHS Cooperative Public Health Service EDS Emergency Dispensing Site EEG Exercise Evaluation Guide EID Emerging Infectious Disease EMD Emergency Management Director EOC Emergency Operations Center HMCC Health and Medical Coordinating Coalition HSEEP Homeland Security Exercise and Evaluation Program IC Incident Commander ICS Incident Command System IP Improvement Plan JITT Just-in-Time Training LHD Local Health Department MAPHCO Mohawk Area Public Health Coalition MCM Medical Countermeasures MDPH Massachusetts Department of Public Health MEMA Massachusetts Emergency Management Agency MRC Medical Reserve Corps NIMS National Incident Management System OPEM Office of Preparedness and Emergency Management (MDPH) PHEP Public Health Emergency Preparedness PIO Public Information Officer PPE Personal Protective Equipment SNS Strategic National Stockpile TTX Tabletop Exercise
Appendix C: Acronyms C-1 Mohawk Area Public Health Coalition FOUO 59