A Tale of Many towns - cross-discipline health and medical

preparedness 

Sean M. O’Brien, Coordinator Barnstable County Regional Emergency Planning Committee

Terence Hayes, DirectorDennis Health Department

October 2015

Building Our Foundation

The Formation of the

Barnstable County Regional Emergency Planning Committee

First, A Little Geography

• Cape Cod is peninsula in Southeast MA.

• Barnstable County encompasses Cape Cod

• We have fifteen communities in the County

• Martha's Vineyard is Dukes County • Nantucket is Nantucket County

A Little More Geography

• We are “Geographically Connected”

• Year round population of 218,000• Summer population 800K+• Surrounded by water on all sides• Limited ingress and egress.

Cape Cod Towns• Provincetown• Truro• Wellfleet• Eastham• Orleans• Brewster• Chatham• Harwich• Dennis• Yarmouth• Barnstable• Mashpee• Sandwich• Falmouth• Bourne

Next, A little History• The Barnstable County Department

of Health and Environment (BCDH&E)was established by act of Massachusetts Legislature in 1926.

• BCDH&E provides support to the 15 communities in Barnstable County.

October 12, 2001, Our Start in EP

• September 11th • Public

Health/HAZMAT Event

• Anthrax at press outlets/The U.S. Capital

• Over 100 HAZMAT Calls in SE MA

What is an LEPC?• Local Emergency Planning Committee• Regional Emergency Planning Committee (REPC)• 1986• Superfund Amendments and Reauthorization Act

(SARA Title III)• Emergency Protection and Community Right to

Know Act (EPCRA)• An LEPC is a group of first responders et al in a

community to plan, train and prepare for hazardous materials emergencies in that community.

Emergency Planning and Community Right to Know Act.

• Our vehicle for regionalizing emergency preparedness efforts for Cape Cod

• First established to address EPCRA compliance for the communities that participate.

• The structure outlined a multi-disciplined and multi-jurisdictional format.

• We knew we could use this as a foundation for and “All Hazard” approach to emergency preparedness efforts for our region.

• As a region we prepare to be on our own for emergencies for 48-72 hours before support arrives.

Membership• 15 communities on Cape Cod and Nantucket• SARA Title III mandates we have the following 13 disciplines

o Public Healtho Environmentalo Police, Law Enforcemento Fireo Emergency Medical Serviceso Health Care/Hospitalo Local Politicalo Emergency Managemento Community Groupso Broadcast/Print Mediao HAZMAT Facility Operatorso Disaster Relief Agencieso Transportation Agencies

• We addedo Regional Communication Centers

The Players on Cape Cod

• 15 Health Departments and Boards of Health• 15 Police Departments• 20 Fire Departments with EMS services• 1 Regional EMS support agency.• 1 Regional Planning Agency• 2 Hospitals• 5 Community Health Centers• 1 Power Company• 1 Sheriff’s Department (Communication)• 15 Departments of Public Works• 1 Regional Transportation Agency• 1 Chapter American Red Cross• 2 Medical Reserve Corps (Until 2008)• Etc.…

SARA Title III Structure helped bring the groups

together.• BCDH&E was chosen for this task because we were

not a public safety agency. “Neutral”• We built the committee on existing associations and

by working with a progressive multi-disciplined steering committee.o NEXTEL

• By regulation, SARA Title III requires a cross disciplined group to do the emergency planning, so it seemed fitting to use the structure to plan for other types of emergencies as well.

• Each Discipline had a role for the project and Program.• “All Hazard “ The REPC has served as a foundation for

emergency planning activities on Cape Cod.

SARA Title III Structure

• SARA encourages Multi-disciplined Collaboration.

• Title III has 4 Major Sectionso Emergency Planningo Emergency Notificationo Community Right to

Know Reporting Requirements

o Toxic Chemical Release and Emissions Inventory Reporting

What is the BCREPC?

• The Barnstable County Regional Emergency Planning Committee is a Regional “All Hazard” Multi-disciplined Emergency Planning Organization.

• We are a Support Function for the Participating Communities and Agencies.

• 15 Towns in Barnstable County and Nantucket

• Map from www.capecodfds.com

Development of a Regional Hazardous Materials Response

Plan

• A regional Hazardous Materials Response Plan was developed for the 16 Communities.o The response would be from a regional Hazardous Materials

Response Teamo There is a strong mutual aid plan in place with the fire

departments

• We established a Planning and Readiness Subcommittee to draft the Plan.o “Too Many Cooks Spoil the Broth”o Written by 2 peopleo Modeled after Military Plano It was written in a Health Department

• Job Action Sheets Were developed for the plan.o Will aid jurisdictions with responsibilities

“All Hazard” Emergency

Preparedness• A Multi-

disciplined “ All Hazard” approach is a must for the four phases of disaster management.

Mitigation• How do we minimize the

effects of an emergency event?obuilding codes and zoningovulnerability analysesopublic educationoPre-disaster mitigation program

Preparedness

• How do we plan to respond to emergency events?oEmergency Response PlansoExercises, Drills and TrainingoUtilization of Warning SystemsoMulti-disciplined planning

committees

Response

• What are the efforts to minimize the hazards created by a disaster?oEvacuation/Search and RescueoEmergency Relief• Sheltering

oMACC/EOCs

Recovery

• How do we bring the community back to a normal state?oTemporary Housing/ShelteringoGrants/Financial SupportoMedical Support

How We Built the Structure

Formation of the

Cape and Islands Health Agents Coalition

Establishment of a Health Agents Coalition

• In 2006 we were asked to serve as the fiduciary agent for the a regional Health Agents Coalition.

• BCDH&E would be coordinating a regional public health emergency preparedness program with 23 communities on Cape Cod, Martha’s Vineyard and Nantucket.

• Each BCDH&E staff member was assigned communities to serve as a liaison with developing response plans

• 3 public health nurses were hired to serve as planners and were assigned regions to assist the communities with plan development

Public Health Emergency Planning on the Cape and Islands

• Emergency Planners and Liaisons were tasked with helping each of the 23 communities develop emergency response plans

• It was determined that individual community plans may be more appropriate than 1 regional plan.o There are differences in how each health department operateso Contracts with visiting nurse associationso Martha’s Vineyard developed a regional plan

• The plans developed were also used to build and strengthen relationships with the other agencies in the community.

• Mutual Aid with All of our 23 Communities.

Increase Communications

Capabilities

• Our Public Safety Component allowed us to expand into radio communications

• One of the first tasks of the coalition was to increase communication capabilities.

• As part of a Homeland Security Grant, each fire and police chief received a new 800 MHz radio.

• The chief’s had to provide a functioning Radio to the Health Agent

State Police Radio System

• A talk group for the health agents was established on the State Police 800 MHz system.

• Used Grant $$ to purchase additional radios. Each town has 2 or 3 radios.

• Conducted weekly drills

Hospital Surge• In 2006 The HAC

Cape Cod Health Care and the REPC began the development of a hospital surge plan for a potential influenza pandemic.

• This plan was regional.

Cape Cod Medical Reserve Corps

• Dennis Church of the Nazarene established. Great Foundation and successful.

• Falmouth Hospital established a chapter as well

• In 2007 the MRC chapters were absorbed by the Cape and Islands Health Agent’s Coalition

MRC 2009 H1N1 Influenza

Response

• MRC Volunteers supported the 15 communities on Cape Cod with vaccine clinics.

• The labor hours of the volunteers were able to offset costs to the communities.

• MRC Coordinator identified supplies and equipment needed for response.

• Cape and Islands Coalition returned almost 300K of PHER funding to Commonwealth.

• Event was a successful test of the local response plans.

How the Cape and Islands Health Agents

Coalition and BCREPC Supported

Local Planning Efforts

Terence Hayes, DirectorDennis Health Department

Cape Cod Medical Reserve Corps

• Cape & Islands Health Agents Coalition took responsibility for the MRC in 2007.

• Provide medical and non-medical volunteers for emergencies and on-going public health initiatives.

Community Emergency

Response Team• Trained in basic

disaster response skillso fire safetyo light search and rescueo team organizationo disaster medical

operations.

• CERT members are encouraged to take an active role in emergency preparedness projects

Barnstable County Incident Management

Team• Follows FEMA Incident

Command and Incident Management standards

• Uses ICS standard operating procedures within the framework of the National Incident Management System (NIMS).

• Either augments ongoing operations through provision of infrastructure support or, when requested, transitions to an incident management function

Multi Agency Coordinating Center

Regional Shelters

Better Prepared

2006 PODS Drill

2009 Drive-thru PODS Drill

Less Stressed!

Overview of the Barnstable County

Regional Sheltering Plan and the

Barnstable County MACC

Multi-disciplined and Multi-Jurisdictional Emergency Planning Effort

Health and Medical Coordinating Coalitions• There has been quite a bit of

discussion across the Commonwealth of using the Multi Agency Coordination Center (MACC) concept for emergencies.

• Here is why we use it on Cape Cod

The Benchmark Event• On December 9,

2005, a tropo-pause fold struck Cape Cod.o Temperature Drop o Power Outageso Shelters Openedo Lack of Cotso Lack of Supplieso Lack of volunteers

2005 Shelter Conditions

• 31 Shelters across Cape Cod

• Total 600 cots in the region

• Red Cross only NGO agency supporting effort

Consolidation and Regionalization of Shelter

Operations

• After the December 9, 2005 storm, BCREPC as instructed to…

• Develop a regional shelter program for the 15 Towns on Cape Codo Consolidate number of shelterso Expand NGO Participation (More Volunteers)o Expand Shelter Capabilitieso Funding Protocols

• Develop a resource mechanism to centralize resource requestso MACC Concept usedo Regional Situational Awareness

Regional Sheltering Initiative

• Locationso Nauset Regional HS, Easthamo Cape Cod Technical HS, Harwicho Dennis Yarmouth Regional HSo Barnstable ISo Falmouth HSo Sandwich HS

• Veterans School Provincetown. (Satellite)• Bournedale School. (Satellite)

• Each Shelter is supported with a CONNEX Box of Supplies. 5000 cots and sleeping pads across the Cape.

• Shelters have been opened for many weather events since 2008.

• A small county budget and grants are used to support the program.

• Full Service Partner Shelterso MRC, ARC, CERT, DART, ARES

Regional Sheltering Case Study: NEMO

• February 2013 Blizzard • 12 Operational Periods• 3 Shelters Opened

o Sandwicho Nauseto Dennis Yarmouth

• Shifted Upper Cape Shelter to Falmouth• Issues

o Volunteerso Facilities and Generatorso Feedingo Transportationo Cape Cod Hospitalo Nursing Homes/Facility Drop Offs

Regional Sheltering Initiative ReviewReadjustment of the Plan

oMOUs with Medical Supply CompaniesoMOUs with Nursing Agencies• Will address Hospital Issues• Nursing Homes

oMOUs with Additional Volunteer Agencies

oAll Shelters Now Openo Look at Generators at SheltersoCentralized Kitchen

Barnstable County Type 3Incident Management Team

• Multi Disciplined teamed formed to support command structure during a major event.

• Extensive FEMA and MEMA ICS Training and Position Specific Training in ICS Roles.

• They never take over an incident, Support with ICS

• On Cape Codo Supports Planned and

Emergency Eventso Supports a Multi Agency

Coordination Center (MACC)

Multi Agency CoordinationCenter

• The MACC is operated to assist our region with resource management and support of regional plans (Sheltering)

• BCREPC Executive Committee determines if shelters open and to make MACC operational.

• Maintain contact with ESF 8 desk at MEMA for sheltering issues.

• MACC is staffed by the BCIMT. It most often provides support to the communities with storm response. Ex. NSTAR, Shelter, MEMA

Multi Agency CoordinationCenter

• The MACC would be used for “All Hazard Response”

• In certain responses it may be mobile.

• The community maintains the Incident Commander Role.

• The MACC provides the region with one voice with regional coordination

MACC During January 2015 Blizzard

The MACC Concept has been very successful for our region. It is in 24-7 operation and provides constant situational awareness.

MACC During February 2015 Blizzard

This concept can be used successfully for all types of emergencies.

MACC Concerns

• The MACC is not an Emergency Operations Center, Operations for the emergency are done at the local level. (Except Sheltering) We are not taking over the event.

• Our MACC is run primarily by volunteers. Personnel issues may arise for long term events.

• Communities working outside of the MACC structure for resource requests.

Projects for Collaboration in an HMCC

• Determine if a regional approach is warranted for Specific Response Plans

• Subject Specific Response Planso Shelteringo Ebola

• Development of Medical Reserve Corps for your Region

Projects for Collaboration in an HMCC

• Develop a Volunteer Reception Center Plan.o Process Just in Time

Volunteerso 3 VRCs Across The Cape

• Develop an Incident Management Team for Your Area.

• Initiate a Multi-disciplined Training and Exercise Program

The End

• Any Questions?• Terence Hayes Email:

o thayes@town.dennis.ma.us

• Phoneo 508-760 6158

• Sean M. O’Brien Email: o bcrepc@barnstablecounty

.org• Phone:

(508)-375-6618• Website:

o www.bcrepc.org