adhs npi playbook june13 - arizona department of health … · 2018-04-27 · adhs...
TRANSCRIPT
Non-PharmaceuticalInterventionsBureauofEpidemiologyandDiseaseControlOfficeofInfectiousDiseaseServices
January2016
ADHSNon-PharmaceuticalInterventionsPlaybook i
TableofContentsIntroduction...................................................................................................................................................1
Purpose..........................................................................................................................................................1
Assumptions...................................................................................................................................................2
ConceptofOperations...................................................................................................................................2
TypesofNon-PharmaceuticalInterventions..............................................................................................3
UseofNPIsbyHazardTypes......................................................................................................................4
ProcedureforIsolation&Quarantine........................................................................................................7
PublicHealthRiskCommunication................................................................................................................8
Triggers/SeverityIndex................................................................................................................................11
LegalAuthorities..........................................................................................................................................12
FederalLaw..............................................................................................................................................12
ArizonaRevisedStatutes(A.R.S.).............................................................................................................12
Roles&Responsibilities...............................................................................................................................17
CountyHealthDepartments....................................................................................................................17
ArizonaDepartmentofHealthServices(ADHS).......................................................................................18
CentersforDiseaseControlandPrevention(CDC)..................................................................................18
OtherOrganizations.................................................................................................................................19
NPIPlaybookMaintenance..........................................................................................................................20
Appendices...................................................................................................................................................21
Definitions................................................................................................................................................21
NPIDecisionMatrix..................................................................................................................................22
ADHSOfficeofInfectiousDiseaseServicesOrganizationChart...............................................................23
EducationalMaterials...............................................................................................................................24
MessagingTemplates...............................................................................................................................26
Resources.................................................................................................................................................29
ADHSNon-PharmaceuticalInterventionsPlaybook 1
IntroductionPublichealthemergencies,suchasmonsoonfloodingandcommunicablediseaseoutbreaks,areunpredictableintermsoftiming,onset,andseverity.Implementationofbothpharmaceuticalandnon-pharmaceuticalinterventions(NPIs)iscriticalinreducingmorbidityandmortalitycausedbytheseevents.Inadisease-relatedemergency,anovelvirusmaybeinvolved,decreasingthelikelihoodthatawell-matchedstrainvaccineisavailable.Inaddition,currentlyavailablemedicationsmaybeineffectiveagainstanovelpathogen.Asaresult,NPIsbecomecriticalinpreventingfurtherdiseasespread.NPIsareactionsseparatefromtheutilizationofmedicaltherapies(suchasvaccination,chemoprophylaxis,antibioticsandantivirals),whichpeopleandcommunitiescantaketohelppreventorlimitthespreadofillnesses.AlthoughNPIsareusuallyrelatedtodiseasemitigation,theseinterventionsmayalsobeimplementedtoprotectthepublicfrominjuryandexposureduringanaturaldisaster,biological,chemical,orradiologicalincident.
TheStateofArizonaispreparedtoimplementthelayereduseofNPIsasoutlinedinthisplan;however,thedecisiontoimplementvariousNPIsandcommunitymitigationstrategiesbeginsatthelocallevel.EachArizonacountyhealthdepartmentisresponsibleforpreparingandmaintainingacounty-specificNPIplan.
Decisionsaboutwhatinterventionsshouldbeusedduringanemergencyeventshouldbebasedontheobservedseverityoftheevent,itsimpactonspecificsubpopulations,theexpectedbenefitoftheinterventions,thefeasibilityofsuccess,thedirectandindirectcosts,andtheconsequencesoncriticalinfrastructure,healthcaredelivery,andsociety.Themostcontroversialelements(e.g.,prolongeddismissalofstudentsfromschoolsandclosureofchildcareprograms)arenotlikelyneededinlesssevereemergencies,butcouldsavelivesduringsevereevents.
TheNon-PharmaceuticalInterventionsPlaybookdefinesArizonaDepartmentofHealthServices’expectedrolesandresponsibilitiesforimplementingandsustainingNPIsinthecommunityinresponsetoanemergencyeventaffectingpublichealth.Thisplanisbasedonpublichealthpracticeandexperience,lessonslearned,andsupportedbystateandfederallaw.
PurposeThepurposeoftheNon-PharmaceuticalInterventionsPlaybookistoprovideguidancetotheArizonaDepartmentofHealthServices(ADHS),localhealthjurisdictions,andsupportingagenciesregardingidentification,implementation,andde-escalationofnon-pharmaceuticalinterventionsinresponsetoanemergencyeventinArizona.Theplandescribesthecircumstancesandeventsinwhichresponseactionsandmeasuresmaybenecessary,leadershipprotocols,supportinglegalauthorities,andemergencyriskcommunicationmechanisms.
Specifically,thepurposeofthisplanisto:• Establishthedecision-makingcriteriausedbytheADHSDirectorordesigneetodeterminewhencertainnon-pharmaceuticalinterventionsarenecessary.
• Definetheauthorities,rolesandresponsibilitiesofADHS,localhealthjurisdictions,andsupportingagenciesintheeventofapublichealthemergencyrequiringimplementationofNPIs.
• Describetheprocessforimplementingisolationandquarantine,bothvoluntaryandinvoluntary.
• Describetheprocessforimplementinginterventionsimpactingvulnerablepopulations(e.g.,
ADHSNon-PharmaceuticalInterventionsPlaybook 2
infectioninpersonswithdisabilities,personswithspecialmedicalneeds,homelesspersons,andtheelderly).
• DelineatecommunicationandcoordinationmechanismstooccuramongADHS,local,stateandtribalentitiesduringanemergencyeventaccordingtothecommunicationproceduresintheADHSCrisis&EmergencyRiskCommunication(CERC)Plan.
• AssistADHSandresponsepartnersinlimitingthespreadofinfectiousdiseasesandreducingillnessanddeath.
TheNon-PharmaceuticalInterventionsPlaybookwillbecoordinatedwithotherADHSpublichealthemergencypreparednessplansandactivities,aswellaswithplansoflocal,stateandfederalpartners.
AssumptionsThisplanassumesthefollowing:• Non-pharmaceuticalinterventionplanningandimplementationeffortsmustincorporateandaddresstheuniqueneedsandcircumstancesofvulnerablepopulationsincludingthehomeless,limitedEnglishspeakingpopulations,personswithspecialmedicalneeds,etc.
• Interventionsmaybenecessarywithintribalnations;ADHSwillcoordinatewithcountyhealthdepartments,IndianHealthServices,andtribalauthoritiesinthecaseofapublichealthemergency,toformulateresponsestrategiesthatrespectjurisdictionalauthority.
• Allpoliciesandprocedurestoassurethecareofprotectedhealthinformationshallapply.PoliciesandproceduresrecognizethatADHSmaymakenecessarydisclosurestoprotectpublichealthwhenitisactingasthepublichealthauthority.
• Largescaleinterventionswillrequiretheparticipationofmanypublichealthresourcesaswellascoordinationwithmultiplecommunity,healthcare,andfirstresponderagencies.
• ADHSmayutilizeisolationandquarantineasoneofseveraltoolstoreducethespreadofcommunicablediseasesandwillfocusongainingvoluntarycompliancefromillorexposedpersonsandimplementingtheleastrestrictivemeanspossibletoreducethespreadofillness.
• Aneffectivepublichealthcommunicationsprogramisessentialtoachievingvoluntarycompliancewithalldiseasecontrolstrategies.
• Isolationandquarantinemayrequiretheinvoluntarydetentionofindividualswhomayposeathreattothepublic’shealthanddonotcooperatewithrequestsfromtheADHSDirector,MedicalDirector,ordesignee.
• Non-pharmaceuticalinterventionsraisesocial,legal,financial,andlogisticalchallengesthatshouldbeanticipatedandaddressed.Social,financial,andpsychologicalneedsofinfectedorexposedpersonsandtheircontactsmustbemetinordertosuccessfullyimplementinterventions.
• Socialmediaoutletsmayplayanimportantroleinthedisseminationofinformationtothepublic.
• Dependingonthecrisisorevent,theADHSHealthEmergencyOperationsCenter(HEOC)maybeactivatedandwouldbetheleadentityonallNPIdecisionsandexecutionofthose.
ConceptofOperationsTheNPIPlaybookconceptofoperationsaddressestheNPIstrategicapproachpublichealthagenciesmayconsiderfortheiroverallpre-eventplanning.ThisplaybookprovidesaframeworkortemplateforthemanagementofNPIs,promotingaunifiedapproachtoallmitigation,
ADHSNon-PharmaceuticalInterventionsPlaybook 3
preparedness,response,andrecoveryactivitiescarriedoutinthestateofArizona.Implementationofinterventionsmayneedtobeimplementedrapidly,canbecomplicatedandresourceintensive,andcanbedifficultforaffectedpersonstoendure.NPIscanincludemeasuresthataffectindividuals(e.g.handhygiene)andmeasuresthataffectgroupsorwholecommunities(e.g.cancellationofmassgatherings).Forthemajorityofemergencyincidents,individual-basedinterventionsarerecommendedandeasiertoimplement.However,duringsevereevents,community-wideinterventionsneedtobeconsideredandmaybeimplementedtoprotectpublichealth.Commonlyusedinterventionsincludeisolation,quarantine,socialdistancing,restrictionsonmovement,externaldecontamination,hygiene,andprecautionaryprotectivebehaviors.SomeNPIssuchasisolationandquarantinecanbeconsideredindividualaswellasimplementedcommunity-wide.Isolationisdefinedasseparatingandrestrictingthemovementofillpeoplewithacontagiousdiseasetopreventtransmissiontoothers.Quarantineisdefinedasseparatingandrestrictingthemovementofwellpeoplewhowereexposedtoacontagiousdiseasetopreventtransmissiontoothers.Quarantinetypicallylastsaslongastheincubationperiodoftheinfectiousagent.SocialDistancingisdefinedasreducinginteractionsandincreasingthedistancebetweenpeopleinsettingswhereindividualscomeintoclosecontactwithoneanother.TypesofNon-PharmaceuticalInterventions–IndividualNPIscaninclude:• Stayinghomewhenyouaresick.• Stayinghomeifyouhavebeenexposedtoafamilyorhouseholdmemberwhoissick.• Coveringcoughsandsneezeswithatissue.• Washinghandsorusinghandsanitizer.• Coveringyournoseandmouthwithamaskorclothifyouaresickandaroundpeopleoratamassgatheringinacommunitywhereothersaresick.
• Wearinglongsleeveshirtsandpantstopreventmosquitobites.• Externaldecontaminationsuchasremovingclothingorwashinghairafterradiologicalevent.
CommunityNPIscaninclude:• Patientcohorting(e.g.illpatientsawayfromwellpatientsinlong-termcarefacility)• Shelteringinplace(canbeduetobiological,chemicalorradiologicalevent)• Haltingpublictransportation• Restrictingtravel(e.g.air,train,car,walking)• Evacuation/relocation• Facilityclosures(e.g.schools,childcarecenters,theatres)• Massgatheringcancellations(e.g.concerts,festivals,conferences)
EnvironmentalNPIscaninclude:• Routinesurfacecleaning• Wastemanagement• Creationofphysicalbarriers(e.g.sandbags)• Debrisclearing• Creationoffirebreaks• Roadclearance
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UseofNPIsbyHazardTypes–Thefollowingscenariosareprovidedasexamples,NPIrecommendationsmayvary,dependingontheseverityoftheevent.Notethatthefirstrespondersinanincident/emergencyeventareusuallycomprisedoflocalhealthemergencyservices,supplementedbystateandvolunteerorganizations;intheseinstances,thefocusandlegalresponsibilityofthemedicalandhealthcoordinationeffortisatthelocaljurisdictionallevel(LocalHealthOfficer)andafterthoseresourceshavebeenexhausted,upwardtotheArizonaStateHealthDepartmentforfurthercoordination,legalguidanceandsupport.BiologicalorInfectiousDiseaseOutbreakIfthepublichealthemergencyiscategorizedasbiological,alocalhealthdepartmentorentitymustfirstdetermineifitwasintentional(human-caused)oranaturallyoccurringepidemic.Interventionsthatmaybeconsideredforbiologicalorinfectiousdiseaseoutbreaksinclude:• Isolation&Quarantine• Restrictionsonmovement(e.g.cohorting,shelterinplace)• Traveladvisories/warnings• Haltingpublictransportation• Evacuation/relocation(includingpatientrelocation)• School&childcareclosures• Massgatheringpostponement/cancellation• Recommendationstoavoidcrowdedplaces• Externaldecontamination• Environmentaldecontamination
BioterrorismIncidentAbioterrorismeventisdefinedasterrorisminvolvingtheintentionalreleaseordisseminationofbiologicalagentstocauseillnessordeathinpeople.Theseagentsarebacteria,viruses,ortoxins,andmaybeinanaturallyoccurringorahuman-modifiedform.Biologicalagentscanbespreadthroughtheair,water,orinfood.Terroriststendtousebiologicalagentsbecausetheyareextremelydifficulttodetectanddonotcauseillnessforseveralhourstoseveraldays.Duetothisdelayindetection,diseasespreadoccursrapidlyandnon-pharmaceuticalinterventionsneedtobeimplementedtorestrictfurtherspread.
MeaslesMeaslesvirusishighlycontagiousandcanbetransmittedbydirectcontactwithinfectiousdropletsorbyairbornespreadwhenaninfectedpersonbreathes,coughs,orsneezes.Measlesviruscanalsoremaininfectiousintheairforuptotwohoursafteraninfectedpersonleavesanarea.In2000,measleswasdeclaredeliminatedfromtheUnitedStates;however,measlescasesandoutbreaksstilloccureveryyearintheUnitedStatesduetomeaslesstillbeingcommonlytransmittedinmanypartsoftheworld.In2014,theU.S.experienced23measlesoutbreaks,includingonelargeoutbreakof383cases,occurringprimarilyamongunvaccinatedAmishcommunitiesinOhio.In2015,theU.S.experiencedalarge,multi-statemeaslesoutbreaklinkedtoanamusementparkinCalifornia.
ADHSNon-PharmaceuticalInterventionsPlaybook 5
Duetotheunavailabilityofaspecifictreatmentformeasles,non-pharmaceuticalinterventionsplayamajorroleinreducingdiseasespread.EbolaVirusDisease(EVD)Ebolaisarareanddeadlydiseaseandistransmittedthroughdirectcontact(throughbrokenskinormucousmembranesintheeyes,nose,ormouth)with:- bloodorbodyfluidsofapersonwhoissickwithorhasdiedfromEbola,- objects(likeneedlesandsyringes)thathavebeencontaminatedwithbodyfluidsfromapersonwhoissickwithorhasdiedfromEbola,and
- infectedfruitbatsorprimatesSinceMarch2014,WestAfricahasexperiencedthelargestoutbreakofEbolainhistory,withmultiplecountriesaffected,andapproximately28,600cases.DuetoexperimentalvaccinesandtreatmentsforEbolabeingunderdevelopment,butnotfullytestedforsafetyoreffectiveness,non-pharmaceuticalinterventionsarecrucialinreducingspread.NaturalDisastersNaturaldisasterssuchasflood,tornados,fires,earthquakes,andhurricanesaffectthousandsofpeopleeveryyear.Communitiesshouldconductthreatassessmentstomaintainawarenessofthemostcommonnaturaldisasterthreatsintheirregionandbebetterpreparedtoprotecttheircitizensforthoseimpendinghazards.Interventionsthatmaybeconsideredfornaturaldisastersinclude:• Restrictionsonmovement(e.g.cohorting,shelterinplace)• Traveladvisories/warnings• Haltingpublictransportation• Evacuation/relocation(includingpatientrelocation)• School&childcareclosures• Massgatheringpostponement/cancellation• Creationofphysicalbarriers(e.g.sandbags)• Debrisclearing• Roadclearance• Cooling/heatingcenters• Creationoffirebreaks
HeatWaveHeatcankillbypushingthehumanbodybeyonditslimits.Mostheatdisordersoccurbecausethevictimhasbeenoverexposedtoheatorhasover-exercisedforhisorherageandphysicalcondition.Olderadults,youngchildrenandthosewhoaresickoroverweightaremorelikelytosuccumbtoextremeheat.Between2000and2012,1535deathsfromexposuretoexcessivenaturalheatoccurredinArizona;inPhoenix,Arizona,normaldailymaximumtemperaturesreach>100°FinearlyJuneandcanremainatthatleveluntilmid-SeptemberorOctober.Byrecognizingaheatwaveinitsearlystages,localagenciescantakeactionsthatwillenablethepublictopreventaheatrelated
ADHSNon-PharmaceuticalInterventionsPlaybook 6
illnessordeath.(re:ADHSHeatPlan,dtd2014).Heat-relatedillnessesarelargelypreventable;timelyandpropermessagingaboutpracticingheatsafetymeasuresiskeytoprotectingthosemostvulnerabletoextremeheatconditions.SevereMonsoon/FloodingFloodsareamongthemostfrequentandcostlynaturaldisasters.Conditionsthatcausefloodsincludeheavyorsteadyrainforseveralhoursordaysthatsaturatetheground.Flashfloodsoccursuddenlyduetorapidlyrisingwateralongastreamorlow-lyingarea.Eachyear,avarietyofstorm-relateddangersaffectArizona,particularlyfromlatespringintoearlyautumn,althoughlightningstrikes,highwinds,andflashfloodingcanoccurduringanyseasoninArizona.June15ththroughSeptember30thhasbeendefinedas“MonsoonSeason”;thisisaperiodofongoingextremeheatwhichisfollowedbyaninfluxofmoistureleadingtodailyroundsofthunderstormsthatcanstrikesuddenlyandwithviolentforce.September2014broughtrecord-breakingrainstoArizonathataffectedcommunitiesinthecentralvalleyallthewaytoTucson;schoolsclosed,highwayswerefloodedandlitteredwithabandonedvehicles(requiringmultiplewaterrescues),approximately200homeswerefloodedandthestormledtotwofatalities.TheheavyrainswerecharacterizedinanArizonaRepublicheadlineasa“slow-movingdisaster”.Flashfloodsaretheprimarythunderstorm-relatedkillerandmostflashflooddeathsoccurinvehicles.Priorityshouldbeplacedonthoseactionsandmessagingthatprovidethehighestlikelihoodforlife-savinginterventions.Considerthatfloodingcanoccurslowly(rainfallformanydays);canberapid(developingwithinhoursordays);orcanbeconsidered“flashfloods”thatoccurveryquicklywithlittleornowarning.Allinterventionsshouldbeconsideredandplannedforinthecaseofeachofthesetypesoffloods.WildfiresAwildfireorwildlandfireisdefinedasanuncontrolledfireinanareaofcombustiblevegetationthatoccursinacountrysidearea.Dependingonthetypeofvegetationthatisburned,awildfirecanalsobeclassifiedasabrushfire,forestfire,desertfire,grassfire,hillfire,oravegetationfire.Awildfirediffersfromotherfiresbyitsextensivesize,thespeedatwhichitcanspreadoutfromitsoriginalsource,itspotentialtochangedirectionunexpectedly,anditsabilitytojumpgapssuchasroads,riversandfirebreaks.Arizonahasexperiencednumerouswildlandfiresovertheyears,fromthe2002Rodeo-ChediskiFirethatburnedover460,000acrestothelargestinhistoryWallowFirein2011thatsweptthrough530,000acres.ThemostrecentYarnellHillFirein2013burnedover8,400acresandkilled19CityofPrescottfirefighters,membersoftheGraniteMountainhotshots.Since2002,wildfireshaveburnedover4millionacresinArizona.Winds,prolongeddroughtandhightemperatureshavecombinedtomakeArizonaforestsanddesertareasextremelydryeveryyear;that,coupledwithincreasedhumanactivityandlightningstrikes,predictably,everyyearcanbeabusyfireyearinourstate.ThestateofArizonaisnostrangertowildfires.Withahot,dryclimate,wildfiresarepossibleyear-roundacrossthestate.AlthoughthemostimportantissueiskeepingtheArizonacitizenssafeandoutofharm’sway,otherpublichealthimpactsincludeair,waterquality,andwaste
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disposalpost-wildfireevents.Well-plannedcommunicationsplanswithmessagingdevelopedinadvancearekeytokeepingresidentsinformedbothbeforeandafterwildfireevents.ProcedureforIsolation&Quarantine–WhenastateofemergencyisdeclaredwheretheArizonaDepartmentofHealthServices(theDepartment)iscoordinatingallmatterspertainingtothepublichealthemergencyresponseofthestate,theDepartmenthastheauthoritytoisolateandquarantinepersonswhenthereisanimminentinfectiousdiseasethreat(ArizonaRevisedStatutes[A.R.S.]§36-787).TherearethreesourcesofauthorityanddirectionforIsolationandQuarantineinArizona:
A.R.S.§36-624Givescountiestheauthoritytoconductisolationandquarantinemeasures.MustbeconsistentwiththedueprocessrequirementsthatarespecifiedunderA.R.S.§36-788and36-789.A.R.S.§36-787through36-789Providesthegovernor–inconsultationwiththeDepartment,theDepartment,andthelocalhealthauthority–withisolationandquarantineauthorityduringastateofemergencyorstateofwaremergency.ArizonaAdministrativeCode(A.A.C.)R9-6-303Theserulesgivethelocalhealthagencyaprocessfromwhichtoissueisolationand/orquarantineordersthatarecongruentwithA.R.S.§36-624,A.R.S.§36-788andA.R.S.§36-789.Additionally,therulesrequirespecificcontrolmeasuresforcertaindiseases(e.g.,A.A.C.R9-6-390-viralhemorrhagicfever).
FormoredetailsontheArizonaRevisedStatuteslisted,seetheLegalAuthoritiessection.IftheDepartmentorlocalhealthauthorityfindsitnecessarytoisolateorquarantineapersonorgroupofpersonsforadiseaseotherthantuberculosis,itmustadheretotheprocessdescribedbelow.DuringaGovernor-declaredstateofwarorstateofemergency,theArizonaDepartmentofHealthServicesorcountyhealthdepartmentmustfollowtheprocessbelowwhenisolatingorquarantiningapersonorgroupofpersons:
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PublicHealthRiskCommunicationDuringaresponseorevent,itisimportanttoestablishclearandconsistentlinesofcommunication.Effectivepublichealthriskcommunicationisnecessarytoinformthepublicnotonlyofthespecificinterventionsbeingimplemented(e.g.whichschools/businesses/eventsareclosed)buttherationalebehindthesemeasures.Wheneveracrisisoccurs,communicatorsmustbereadytoprovideinformationtohelppeoplemakethebestpossibledecisionsfortheirhealthandwell-being.Notethatthismayneedtobedoneinarapidtimeframeandwithoutknowingalldetailsaboutthecrisis.
StateofDeclaredEmergencyorStateofDeclaredWarEmergency
DepartmentDirectivetoIndividualorGroup
PetitionforaCourtOrderisfiledwithSwornAffidavit
Notificationtoperson(s)identifiedinPetition
CourtHearing
CourtOrder
TheGovernormustfirstsignanemergencydeclaration.
Ifadelaywouldposeathreattopublichealth,theDepartmentmayissueadirectivetoanindividualorgroupandspecifytheisolationorquarantinerequirementsthatmustbefollowed.
Within10daysafterissuingthedirective,theDepartmentmustpetitionthecourtforacourtordertocontinueisolationorquarantine.
Individualorgroupmustbenotifiedwithin24hoursafterfilingpetition.
Ahearingmustbeheldonthepetitionwithin5daysafterthepetitionisfiled.Itmaybecontinuedfor10daysunderextraordinarycircumstances.
Thecourtorderiseffectiveforupto30days.Ifneeded,theDepartmentmaymovetoextendtheorderforanadditional30days.
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ADHShaspublishedaCrisis&EmergencyRiskCommunicationPlan(CERC)thatidentifiescommunicationprotocolsandprocedurestobefollowedintheeventofacrisisoremergencywithpublichealthconsequences.Theultimategoalistoprovideaframeworkforcommunicatingwiththepublic,media,ADHSstaff,governmentagenciesandallotherstakeholdersduringacrisisoremergency.Dependingonthescopeoftheevent,ADHSwillworkwithintheJointInformationSystem(JIS)forminorincidentsorwithintheactivationofaJointInformationCenter(JIC)foramajorresponse.Throughongoingexercises,trainings,real-worldresponsesandhabitualinter-agencyrelationships,Arizonaispreparedtoeffectivelyandefficientlyrespondtoawidevarietyofemergencysituations.OncetheADHScommunicationprocessandproceduresareputinplace,itwillbeimportanttoconsiderwhatthepublicexpectationswillbefromapublichealthperspective.Thefollowingareafewcommunicationgoalstoconsiderforapublicaudience:
• Providewantedfacts;• Empowerthemasdecisionmakers;• Involvethemasparticipants,notspectators;• Providewatchguardoverresourceallocation;• Recoverorpreservewell-beingandnormalcy.
Communicationfailuresthatmayhamperoperationsandrecoveryefforts:
• Mixedmessagesfrommultipleexperts;• Informationreleasedlate;• Paternalisticattitudes;• Notcounteringrumorsandmythsinreal-time;• Publicpowerstrugglesandconfusion.
TheJIS/JICstaffwillidentifywaystoexpediteinformationtothepublicwhileworkingtocoordinatemediafunctionswithstakeholdersstatewide.Duringtheevent,communicationtothepublicmayincludemediareleases,websitecontent,talkingpointsforspokespersons,interviews,socialmedia,publicserviceannouncements,andadvertising.“JustincaseArizona”isastatewideemergencyanddisasterpreparednesscampaignsponsoredbytheArizonaDepartmentofHealthServices(http://www.justincasearizona.com/).Itsimplifiesthepreparednessmessagebybreakingallemergenciesdownintooneoftwotypes;thoseforwhichyouneedtobe“preparedtostay”(orshelterinplace),andthoseforwhichyouneedtobe“preparedtogo”(orevacuate)whenthetimecomes.Awealthofinformation,includingchecklistsandfamilyplans,isalsoavailablethroughtheArizonaEmergencyInformationNetwork(AzEIN)(https://ein.az.gov/).AzEINhelpsArizonansfindinformationaboutlocalemergenciesandhealthandhumanservicesandistheofficialsourceoftimelyinformationduringnaturalorman-madeemergenciessuchaspandemicinfluenza,wildfires,floods,utilityoutages,andevacuations.Inanticipationofincreasedtelephonecallsandotherinquiriesfromthegeneralpublic,apublichealthinformationlinecurrentlyexistsandcanbecoordinated,scriptedandactivatedbytheArizonaDepartmentofHealthServices.Thebi-lingual,24/7menu-driveninformationlinecanbeaccessedthroughoutArizona(MetropolitanPhoenix602-364-4500andstatewide800-314-9243).Inaddition,acallcentermaybeactivatedattheprivatesector,local,orstatelevel.Inthis
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case,ADHSstaffwillworkwithaffectedlocalhealthdepartments,emergencymanagement,andhealthcaresystempartnerstodevelopcallcentermessagingandmaterials.MoredetailedcallcenterinformationcanbeobtainedviatheCERC.Inapandemicevent,ADHShastheleadinpublicinformationfunctions.SincenumerousagencieswillpotentiallyworkinsupportoftheADHSpublicinformationfunction,aJointInformationCenter(JIC)maybeestablishedasrequiredbythenatureandscaleoftheevent.TheJICwillperformthefollowing:
• ProvideguidanceandproceduresfordisseminatingEmergencyPublicInformation(EPI)insupportofthestate’sresponseandrecoverytoanemergency/disaster.
• Providefortheeffectivecollection,monitoring,managementanddisseminationofaccurate,usefulandtimelyinformationtomediaoutletsduringemergencies/disasters.
• Disseminateemergencyinstructionsandprotectiveactionstothepublic.• Maintainprocedurestodisseminatepublicinformationandinstructionsforobtainingdisasterassistance.
• Provideprocedurestodevelopanddisseminatepublicinformationregardinggovernmentalresponseandrecoveryoperations.
• CoordinateEPItoavoidpanic,fearandconfusionresultingfromrumorsandhearsay.• Providelong-termpubliceducationeffortsrelatedtohazardawareness,familyprotectionplanningandemergencyself-help.
Additionally,localpublicserviceannouncementscanbeusedtopromotethefollowinginformation:
• Educatethepublictorecognizethesignsandsymptomsofcommunicablediseases.• Encouragethepublictovoluntarilyself-isolateorself-quarantineandforhowlong.• Notifybusinessesthatillindividualsshouldnotgotowork.• Informthepublicofhotlinephonenumbersandwebsitesforeventupdates.• Informthepublicofwheretoobtaineducationalmaterials.• Announcethecancellationoflargepublicgatherings(concerts,sportingevents,etc.)
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Triggers/SeverityIndex
PotentialInterventionOptions ExtremeHeat Fire Severe
Monsoon/Flooding BiologicalAgent Radiation
ú PrecautionaryBehaviors
ú Traveladvisories/warnings
ú Establishmentofcoolingcenters
Riskforextremeheatatexpectedlevelsforsummer;Severityindexcategory1-2
Containedfireinareaswhereeventsareoccurring;noevacuationneeded
Precipitationatexpectedlevelsduringmonsoonseason;floodwatchissued
Agentwithknownmeansofspread,orlowmorbidity/mortality
Radiologicalincidentoccurred;noreleaseorreleasecontained
ú CancellationsofMassGatherings
ú Closures(school,daycare,etc.)
ú Physicalbarriers(e.g.sandbags)
Severityindexcategories3-4maybeapplicable;cancellationofeventsneededtoensurepublicsafety
Uncontainedfireinareaswhereeventsareoccurring;cancellationofeventsneededtoensurepublicsafety
Severefloodinginareaswhereeventsareoccurring;cancellationofeventsneededtoensurepublicsafety
Agentwithknownmeansofspreadinareaswhereeventsareoccurring;cancellationofeventsneededtoensurepublicsafety
Radiologicalincidentoccurredwhereeventsareoccurring;cancellationofeventsneededtoensurepublicsafety
ú Isolationú Quarantineú Evacuation/relocation
ú Decontamination(external,environmental,etc.)
Severityindexcategory5;poweroutageduringmonsoonseason
Large,complexincidentinvolvingmulti-agencyresponse;uncontainedfireinresidentialareas;evacuationneeded
Floodwarningissued;severefloodinginresidentialareas;evacuationordered
Agentwithunknownmeansofspread,orhighmorbidity/mortality
Radiologicalincidentaffectingresidentialareas;exposuretodangerouslevelsofradiation;decontaminationand/ortreatmentneeded
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LegalAuthorities
FederalLaw–ThefederalgovernmentderivesitsauthorityforisolationandquarantinefromtheCommerceClauseoftheU.S.Constitution.Undersection361ofthePublicHealthServiceAct(42UnitedStatesCode[U.S.C.]§264),theU.S.SecretaryofHealthandHumanServicesisauthorizedtotakemeasurestopreventtheentryandspreadofcommunicablediseasesfromforeigncountriesintotheUnitedStatesandbetweenstates.FederalisolationandquarantineareauthorizedbyExecutiveOrderofthePresident.ThePresidentcanrevisethislistbyExecutiveOrder.TheauthorityforcarryingoutthesefunctionsonadailybasishasbeendelegatedtotheCentersforDiseaseControlandPrevention(CDC).Federalisolationandquarantineareauthorizedforthesecommunicablediseases:• Cholera • Yellowfever• Diphtheria • Viralhemorrhagicfevers• Infectioustuberculosis • Severeacuterespiratorysyndromes• Plague • Fluthatcancauseapandemic• Smallpox
UnderTitle42CodeofFederalRegulations(CFR)parts70and71,CDCisauthorizedtodetain,medicallyexamine,andreleasepersonsarrivingintotheUnitedStatesandtravelingbetweenstatesthataresuspectedofcarryingthesecommunicablediseases.
ArizonaRevisedStatutes(A.R.S.)–Title3:AgricultureTitle36:PublicHealthandSafety
Statute Description3-1205-Controlofanimaldiseases
Whenadvisedoftheoccurrenceofadiseaseofanimalsorpoultrywhichconstitutesathreattothelivestockorpoultryindustries,thedirectormayissuelawfulordersandadoptruleshedeemsnecessary.Thestateveterinarianmayenteranyplacewhereasuspectedanimalorpoultrymaybeandtakecustodyoftheanimalorpoultryforthepurposeofdeterminingthepresenceofacontagious,infectiousorcommunicabledisease.Thedirectormaydirectthestateveterinarianandagencyemployeesto:1. Establishquarantinesanddefinetheirboundaries.2. Destroyanimalsorpoultrywhennecessarytopreventthespreadofanyinfectious,
contagiousorcommunicabledisease.3. Appointappraisersforthepurposeofindemnifyingownersofanimalsorpoultry
destroyed.4. Controlthemovementofanimalsorpoultry,animalorpoultryproductsandagricultural
productswhichmaybedirectlyrelatedtodisseminationofdiseasesaffectingthelivestockorpoultryindustries.
Anypersonwhoviolatesanylawfulorderorruleissuedpursuanttotheprovisionsabove,orbreaksanyquarantineestablishedbythestateveterinarianforthepreventionandcontrolofdiseaseamonglivestockorpoultry,isguiltyofaclass2misdemeanor.
36-136-Powers Thedirectormayenter,examineandsurveyanysourceandmeansofwatersupply,sewage
ADHSNon-PharmaceuticalInterventionsPlaybook 13
anddutiesofdirector(Publicworks/WaterSupply)
disposalplant,seweragesystem,prison,publicorprivateplaceofdetention,asylum,hospital,school,publicbuilding,privateinstitution,factory,workshop,tenement,publicwashroom,publicrestroom,publictoiletandtoiletfacility,publiceatingroomandrestaurant,dairy,milkplantorfoodmanufacturingorprocessingplant,andanypremisesinwhichthedirectorhasreasontobelievethereexistsaviolationofanyhealthlaworruleofthestatethatthedirectorhasthedutytoadminister.
36-621-Reportofcontagiousdiseases
Apersonwholearnsthatacontagious,epidemicorinfectiousdiseaseexistsshallimmediatelyreportittothehealthdepartment.
36-623-Reportbyphysicianofdeathfromcontagiousdisease
Physiciansshallreportthedeathofpatientsdyingfromcontagious,infectiousorepidemicdiseasestothelocalhealthdepartmentwithinitsjurisdiction.Thereportshallbemadewithin24hoursafterdeath,andshallincludethespecificnameandcharacterofthedisease.
36-624-Quarantineandsanitarymeasurestopreventcontagion
Whenacountyhealthdepartmentisapprisedthatinfectiousorcontagiousdiseaseexistswithinitsjurisdiction,itshallimmediatelymakeaninvestigation.Iftheinvestigationdisclosesthatthediseasedoesexist,thecountyhealthdepartmentmayadoptquarantineandsanitarymeasuresconsistentwithdepartmentrulesandsections36-788and36-789topreventthespreadofthedisease.ThecountyhealthdepartmentshallimmediatelynotifyADHSoftheexistenceandnatureofthediseaseandmeasurestakenconcerningit.
36-630-Violation;classification
Guiltyofaclass3misdemeanorunlessanotherclassificationisspecificallyprescribedinthisarticle:
- Apersonwhoknowinglysecreteshimselforothersknowntohaveacontagiousorinfectiousdisease
- Amemberofaboardofhealthoranofficerofalocalhealthdepartmentwhowithcriminalnegligencefailsorrefusestoperformaduty
- Apersonwhoviolatesaprovisionofthisarticleorarule,regulation,order,instructionormeasureadoptedandgiventherequiredpublicitybyaboardofhealth
36-631-Violation;classification
Guiltyofaclass2misdemeanor:- Apersonwhoknowinglyexposeshimselforanotherafflictedwithacontagiousorinfectiousdiseaseinapublicplaceorthoroughfare,exceptinthenecessaryremovalofsuchpersoninamannerleastdangeroustothepublichealth.
36-787-Publichealthauthorityduringstateofemergencyorstateofwaremergency
Duringastateofemergencyorstateofwaremergencydeclaredbythegovernorinwhichthereisanoccurrenceorimminentthreatofanillnessorhealthconditioncausedbybioterrorism,anepidemicorpandemicdiseaseorahighlyfatalinfectiousagentorbiologicaltoxinandthatposesasubstantialriskofasignificantnumberofhumanfatalitiesorincidentsofpermanentorlong-termdisability,thedepartmentshallcoordinateallmatterspertainingtothepublichealthemergencyresponseofthestate.Thedepartmenthasprimaryjurisdiction,responsibilityandauthorityfor:1. Planningandexecutingpublichealthemergencyassessment,mitigation,preparedness
responseandrecoveryforthisstate.2. Coordinatingpublichealthemergencyresponseamongstate,localandtribalauthorities.3. Collaboratingwithrelevantfederalgovernmentauthorities,electedofficialsofother
states,privateorganizationsandprivatesectorcompanies.4. Coordinatingrecoveryoperationsandmitigationinitiativessubsequenttopublichealth
emergencies.5. Organizingpublicinformationactivitiesregardingstatepublichealthemergency
responseoperations.6. Establishing,inconjunctionwithapplicableprofessionallicensingboards,aprocessfor
temporarywaiveroftheprofessionallicensurerequirementsnecessaryfortheimplementationofanymeasuresrequiredtoadequatelyaddressthestateofemergencyorstateofwaremergency.
7. Grantingtemporarywaiversofhealthcareinstitutionlicensurerequirementsnecessaryforimplementationofanymeasuresrequiredtoadequatelyaddressthestateof
ADHSNon-PharmaceuticalInterventionsPlaybook 14
emergencyorstateofwaremergency.Inadditiontotheauthorityprovidedabove,duringastateofemergencyorstateofwaremergency,thegovernor,inconsultationwiththedirectorofthedepartmentofhealthservices,mayissueordersthat:1. Mandatemedicalexaminationsforexposedpersons.2. Rationmedicineandvaccines.3. Providefortransportationofmedicalsupportpersonnelandillandexposedpersons.4. Provideforprocurementofmedicinesandvaccines.
Inadditiontotheauthorityprovidedabove,duringastateofemergencyorstateofwaremergencyinwhichthereisanoccurrenceortheimminentthreatofsmallpox,plague,viralhemorrhagicfeversorahighlycontagiousandhighlyfataldiseasewithtransmissioncharacteristicssimilartosmallpox,thegovernor,inconsultationwiththedirectorofthedepartmentofhealthservices,mayissueordersthat:1. Mandatetreatmentorvaccinationofpersonswhoarediagnosedwithillnessresulting
fromexposureorwhoarereasonablybelievedtohavebeenexposedorwhomayreasonablybeexpectedtobeexposed.
2. Isolateandquarantinepersons.LawenforcementofficialsofthisstateandtheNationalGuardshallenforceordersissuedbythegovernorunderthissection.Diseasessubjecttothissectiondonotincludeacquiredimmunedeficiencysyndromeorotherinfectioncausedbythehumanimmunodeficiencyvirus.Ifduringastateofemergencyorstateofwaremergencythepublichealthisnotendangerednothinginthistitleshallauthorizethedepartmentoranyofitsofficersorrepresentativestoimposeonanypersonagainsttheperson'swillanymodeoftreatment,providedthatsanitaryorpreventivemeasuresandquarantinelawsarecompliedwithbytheperson.Nothinginthistitleshallauthorizethedepartmentoranyofitsofficersorrepresentativestoimposeonanypersoncontrarytohisreligiousconceptsanymodeoftreatment,providedthatsanitaryorpreventivemeasuresandquarantinelawsarecompliedwithbytheperson.Atthegovernor'sdirection,thedepartmentmayusereasonableeffortstoassistthepersonsandinstitutionsaffectedbythestateofemergencyorstateofwaremergencydeclaredpursuanttothissectioninseekingreimbursementofcostsincurredasaresultofprovidingservicesrelatedtotheimplementationofisolationandquarantineunderthisarticletotheextenttheseservicesarenototherwisesubjecttoreimbursement.
36-788-Isolationandquarantineduringastateofemergencyorstateofwaremergency
Duringastateofemergencyorstateofwaremergencyasdeclaredpursuanttosection36-787,thedepartmentorlocalhealthauthoritymustinitiateaninvestigationifthatagencyhasreasonablecausetobelievethatahighlycontagiousandfataldiseaseexistswithinitsjurisdiction.Subjecttotheprovisionsofthisarticle,personswhohavecontractedthediseaseorwhohavebeenexposedtothediseasemaybesubjecttoisolationandquarantineifthedirectordeterminesthatquarantineistheleastrestrictivemeansbywhichthepubliccanbeprotectedfromtransmissionofthedisease,duetothenatureofthediseaseandavailablepreventivemeasures,orrefusalbyanindividualtoacceptlessrestrictivemeasurestopreventdiseasetransmission.Diseasesforwhichisolationandquarantinemaybeordereddonotincludeacquiredimmunedeficiencysyndromeorotherinfectioncausedbythehumanimmunodeficiencyvirus.Thedepartmentorlocalhealthauthoritymay,duringthestateofemergencyorstateofwaremergencydeclaredbythegovernor,dothefollowing:
ADHSNon-PharmaceuticalInterventionsPlaybook 15
1. Establishandmaintainplacesofisolationandquarantine,whichmayincludetheresidenceofthepersonquarantined.
2. Requireisolationorquarantineofanypersonbytheleastrestrictivemeansnecessarytoprotectthepublichealth.Thedepartmentorlocalhealthauthorityshalluseallreasonablemeanstopreventthetransmissionofdiseaseamongtheisolatedorquarantinedpersons.
Thedepartment,acountyhealthdepartmentorapublichealthservicesdistrictshallensure,totheextentpossible,thatthepremisesinwhichapersonisisolatedorquarantinedismaintainedinasafeandhygienicmannerandisdesignedtominimizethelikelihoodoffurthertransmissionofdiseaseorotherharmtoapersonsubjecttoisolationorquarantine.Adequatefood,clothing,medicationandothernecessities,competentmedicalcareandmeansofcommunicatingwiththoseinandoutsidethesesettingsshallbemadeavailable.Apersonsubjecttoisolationorquarantineshallcomplywiththedepartment'sorlocalhealthauthority'srulesandorders,shallnotgobeyondtheisolationorquarantinepremisesandshallnotcomeincontactwithanypersonnotsubjecttoisolationorquarantineotherthanaphysicianorotherhealthcareprovider,departmentorlocalhealthauthorityorpersonauthorizedtoenteranisolationorquarantinepremisesbythedepartmentorlocalhealthauthority.Otherthanapersonauthorizedbythedepartmentorlocalhealthauthority,apersonshallnotenteranisolationorquarantinepremises.If,byreasonofanunauthorizedentryintoanisolationorquarantinepremises,thepersonposesadangertopublichealth,thedepartment,orlocalhealthauthoritymayplacethepersoninisolationorquarantinepursuanttothissectionorsection36-789.Thedepartmentorlocalhealthauthoritymustterminateisolationorquarantineofapersonifitdeterminesthattheisolationorquarantineisnolongernecessarytoprotectthepublichealth.
36-789-Dueprocessforisolationandquarantineduringastateofemergencyorstateofwaremergency
A. Thedepartmentorlocalhealthauthoritymayisolateorquarantineapersonorgroupofpersonsthroughawrittendirectivewithoutfirstobtainingawrittenorderfromthecourtifanydelayintheisolationorquarantineofthepersonwouldposeanimmediateandseriousthreattothepublichealth.Thedirectiveshall:1. Specifytheidentityofthepersonorpersonssubjecttoisolationorquarantine,thepremisessubjecttoisolationorquarantine,thedateandtimeatwhichisolationorquarantinecommences,thesuspectedhighlycontagiousandfataldisease,ifknown,andthatastateofemergencyhasbeendeclaredbythegovernor.
2. Begiventothepersonorpersonstobeisolatedorquarantined.Ifthedirectiveappliestogroupsofpersonsanditisimpracticaltoprovideindividualcopies,itmaybepostedinaconspicuousplaceintheisolationorquarantinepremises.
B. Withintendaysafterissuingthewrittendirective,orwhenanydelayintheisolationor
quarantineofapersonorgroupofpersonswillnotposeanimmediateandseriousthreattothepublichealth,thedepartmentorlocalhealthauthorityshallfileapetitionforacourtorderauthorizingtheinitialorcontinuedisolationorquarantineofapersonorgroupofpersons.Thepetitionshallspecifythefollowing:1. Theidentityofthepersonorgroupofpersonssubjecttoisolationorquarantine.2. Thepremisessubjecttoisolationorquarantine.3. Thedateandtimeatwhichisolationorquarantinecommences.4. Thesuspectedcontagiousdisease,ifknown.5. Astatementofcompliancewiththeconditionsandprinciplesforisolationand
ADHSNon-PharmaceuticalInterventionsPlaybook 16
quarantine.6. Astatementofthebasisonwhichisolationorquarantineisjustifiedpursuanttothisarticle.
C. Thepetitionmustbeaccompaniedbytheswornaffidavitofthedepartmentorlocalhealth
authorityattestingtothefactsassertedinthepetition,togetherwithanyfurtherinformationthatmayberelevantandmaterialtothecourt'sconsideration.
D. Noticetoapersonorgroupofpersonsidentifiedinapetitionfiledpursuanttosubsection
Bofthissectionmustbecompletedwithintwenty-fourhoursafterfilingthepetitionandinaccordancewiththerulesofcivilprocedure.
E. Ahearingmustbeheldonapetitionfiledpursuanttothissectionwithinfivedaysafter
filingofthepetition.Inextraordinarycircumstancesandforgoodcauseshown,thedepartmentorlocalhealthauthoritymayapplytocontinuethehearingdateonapetitionfornotmorethantendays.Ifthecourtgrantsacontinuanceitmustgivedueregardtotherightsoftheaffectedpersons,theprotectionofthepublic'shealth,theseverityoftheemergencyandtheavailabilityofnecessarywitnessesandevidence.
F. Thecourtshallgrantthepetitionif,byapreponderanceoftheevidence,isolationor
quarantineisshowntobereasonablynecessarytoprotectthepublichealth.G. Acourtorderauthorizingisolationorquarantinemaydosoforaperiodnottoexceed
thirtydays.Theordermust:1. Identifytheisolatedorquarantinedpersonorgroupofpersonsbynameorsharedorsimilarcharacteristicsorcircumstances.
2. Specifyfactualfindingswarrantingisolationorquarantinepursuanttothisarticle,includinganyconditionsnecessarytoensurethatisolationorquarantineiscarriedoutwithinthestatedpurposesandrestrictionsofthisarticle.
3. Beservedonanaffectedpersonorgroupofpersonsinaccordancewiththerulesofcivilprocedure.
H. Beforeanisolationorquarantineorderexpires,thedepartmentorlocalhealthauthority
maymovetocontinuetheisolationorquarantineforanadditionalperiodnottoexceedthirtydays.Thecourtshallgrantthemotionif,byapreponderanceoftheevidence,isolationorquarantineisshowntobereasonablynecessarytoprotectthepublichealth.
I. Apersonorgroupofpersonsisolatedorquarantinedpursuanttothissectionmayapplyto
thecourtforanordertoshowcausewhythepersonorgroupofpersonsshouldnotbereleased.Thecourtmustruleontheapplicationtoshowcausewithinforty-eighthoursafteritisfiled.Ifthecourtgrantstheapplication,thecourtmustscheduleahearingontheordertoshowcausewithintwenty-fourhoursafteritissuestheordertoshowcause.Theissuanceofanordertoshowcausedoesnotstayorenjoinanisolationorquarantineorder.
J. Apersonisolatedorquarantinedpursuanttothissectionmayrequestacourthearing
regardingtheperson'streatmentandtheconditionsofthequarantineorisolation.K. OnreceivingarequestforahearingpursuanttosubsectionJofthissection,thecourtmust
setadateforahearing.Thehearingmusttakeplacewithintendaysafterthecourtreceivestherequest.Therequestforahearingdoesnotaltertheorderofisolationorquarantine.Ifthecourtfindsthattheisolationorquarantineofthepersonorgroupofpersonsdoesnotcomplywiththerequirementsofthissectionorsection36-788,thecourt
ADHSNon-PharmaceuticalInterventionsPlaybook 17
mayprovideremediesappropriatetothecircumstancesofthestateofemergency,therightsoftheindividualandinkeepingwiththeprovisionsofthisarticle.
L. Arecordoftheproceedingspursuanttothissectionshallbemadeandretained.If,
becauseofastateofemergencyorstateofwaremergencydeclaredpursuanttosection36-787,partiescannotpersonallyappearbeforethecourt,theproceedingsmaybeconductedbytheauthorizedrepresentativesofthepartiesandheldbyanymeansthatallowsallpartiestofullyparticipate.
M. Thecourtshallappointcounselatstateexpensetorepresentapersonorgroupofpersons
whoissubjecttoisolationorquarantinepursuanttothisarticleandwhoisnototherwiserepresentedbycounsel.Representationbyappointedcounselcontinuesthroughoutthedurationoftheisolationorquarantineofthepersonorgroupofpersons.Thedepartmentorlocalhealthauthoritymustprovideadequatemeansofcommunicationbetweentheisolatedorquarantinedpersonsandtheircounsel.
N. Inanyproceedingsbroughtpursuanttothissection,topromotethefairandefficient
operationofjusticeandhavinggivendueregardtotherightsoftheaffectedpersons,theprotectionofthepublic'shealth,theseverityoftheemergencyandtheavailabilityofnecessarywitnessesandevidence,thecourtmayordertheconsolidationofindividualclaimsintogroupsofclaimsif:1. Thenumberofpersonsinvolvedortobeaffectedissolargeastorenderindividualparticipationimpractical.
2. Therearequestionsoflaworfactcommontotheindividualclaimsorrightstobedetermined.
3. Thegroupclaimsorrightstobedeterminedaretypicaloftheaffectedperson'sclaimsorrights.
4. Theentiregroupwillbeadequatelyrepresentedintheconsolidation.36-910-Seizure(Food)
Allowsthehealthdepartmenttodetainorembargoanyfoodthat“issuspectedofbeingadulteratedormisbrandedwithinthemeaningofthisarticleastobedangerousorfraudulent.”
Roles&Responsibilities
CountyHealthDepartments–• Leadagencyinepidemiologicalinvestigationsandmanagementofcommunicableoutbreakswithincountyjurisdiction.
• Assesspublichealththreat,potentialconsequences,anddeterminewhetherisolationandquarantinearenecessaryfortheincident.
• Seekcooperationandcomplianceofinfectedorexposedpersonsforisolationandquarantinerequests.Ifnecessary,mayneedtoimmediatelyrequestacourtordertodetaininfectedorexposedpersonsandplacetheminisolationorquarantine.
• AnalyzeinformationgatheredduringtheinvestigationonanongoingbasisincollaborationwithADHStoevaluatetheeffectivenessoftheintervention.Itiscriticalindeterminingtheneedforbroaderapplicationofquarantineandthetimingofwithdrawalofcontainmentmeasures.
• Identifyfacilitieswithinjurisdictionalboundariesthatmayqualifyasisolationandquarantinedetentioncentersforbothvoluntaryandcompulsorycontacts.
• Coordinatewithlocallawenforcementagenciesto:
ADHSNon-PharmaceuticalInterventionsPlaybook 18
ú Tracethewhereaboutsofpersonswhohaveviolatedrestrictions,ifneeded.ú Provideescortforpersonsrequiringtransportationforpurposesofinvoluntaryisolationofquarantine,ifneeded.
ú Executearrestwarrantsrelatedtoisolationandquarantinecases.ú Providesecurityforrestrictedfacilitiesorhomes.
NOTE:TransportationofinfectiouspersonswillbemanagedbylocalEmergencyMedicalServiceprovidersthroughcoordinationwiththecountyhealthdepartment.
• Coordinatewithlocalcommunity-basedorganizationstoaddressbasicneedsoftheindividual(s)placedinisolationandquarantine,including,butnotlimitedto:food,clothing,shelter,medicalcare,communicationwithfamilymembers,legalcounsel,accesstomentalhealthandotherpsychologicalsupport.
• CoordinatewithArizonaDepartmentofEconomicSecurity(ADES)andlocalsourcestoprovidetemporaryfinancialassistanceforpersonsisolatedorquarantined,ifneeded.
ArizonaDepartmentofHealthServices(ADHS)–• Providetechnicalassistanceandguidancetocountyhealthdepartmentsregardingnon-pharmaceuticalinterventionsandpreparednessactivitiesincludingplanning,legaldocumentation,isolationandquarantineimplementation,andrelease.
• PrepareandsubmittimelyrequestsforGovernor’sDeclarationofStateofEmergency,asrequired.
• Ifneeded,activateADHSEmergencyOperationsCenterand/orJointInformationCenterforcoordinatingallpublicinformationrelease,mediarequests,andresponseactivities.
• CoordinatewithcountyhealthdepartmentandIndianHealthServicesoninterventionsaffectingtribalnationsanditsmemberswithincountyjurisdictionalborders.
• Actasaliaisonwithothercounty,stateandfederalagencies,includingCentersforDiseaseControlandPrevention,ifneeded.
NOTE:CountyhealthdepartmentswillcoordinatewithStateEmergencyMedicalServicesiflocalEMSorcountyhealthrequiresassistancewithtransportationofinfectiouspersons.
CentersforDiseaseControlandPrevention(CDC)–• Providetechnicalassistanceandguidanceonallhealthmattersrelatingtoisolationand/orquarantine.
• AssumeleadershipinallcaseswhereinfectedpersonsenterArizonaviainterstateorinternationaltransportationmeansunderfederalauthoritieslistedabove.SeeLegalAuthorities.
• Assumecontrolandauthorizeactionintheeventthatmeasurestakenbylocalandstatehealthauthoritiesareinsufficienttopreventthespreadtootherstates.
Arizona-MexicoBorderCoordinationDuringapublichealthemergency,includinganinfectiousdiseaseoutbreak,theArizona-Sonoraborderregionmaybehighlyaffected.ArizonaandSonorasharea370mile(595km)borderthatincludesfiveinternationalportsofentry(POE)alongtheinternationalU.S.-Mexicoborder.ThePOEsaresituatedinfourArizonabordercounties,theTohonoO’odhamNation,andtwoSonoranjurisdictionsthatencompasssixbordermunicipalities.Onadailybasis,tensofthousandsofresidentsoftheborderregioncrosstheborderbothnorthandsouthbound.
ADHSNon-PharmaceuticalInterventionsPlaybook 19
ToincreasetheefficacyofcoordinatedactivitiesbetweentheArizonaDepartmentofHealthServices(ADHS)andtheSecretaríadeSaludPúblicadeSonora(SSP)duringallpublichealthemergenciesaffectingArizonaandSonora,theArizona-SonoraRegionalPandemicandEmergencyResponsePlanwasdeveloped.TheADHSOfficeofBorderHealth(OBH)servesastheprimaryconduitforpublichealthcommunicationandcoordinationbetweenADHSandtheSSP.IntheeventofapublichealthemergencyaffectingtheArizona-Sonoraborderregion,orbothstates,theSSPwillcoordinatewiththeADHSthroughtheOBH,orotherappointedpersonnelatthestatelevel,tomaintainbinationalcommunicationandcollaborationbetweenbothstate-levelpublichealthagencies.Cross-bordercoordinationbetweenADHSandtheSSPpertainsto,butisnotlimitedto,thefollowingareas:communication,publicinformation(media),sharingofpublichealthinformationincludingepidemiology,infectiousdiseasesurveillance&laboratorysurveillancedata,andisolationandquarantine.TheSSPandADHSwillcollaborateandexchangepublichealthinformationtoemploypreventivemeasurestoattempttominimizethenumberofaffectedpeopleduringaninfectiousdiseaseoutbreakorpublichealthemergency.TheOBHservesastheprimaryconduitforbinationalcommunicationandcoordinationforcross-borderpublichealthactivitiesandincidentsofpublichealthconcern.Intheeventofapublichealthemergency,theOBHstaffwillmaintaincommunicationwiththeSecretariatofHealth(SSP)inHermosillo,Sonora.Initialcontactwillbeestablishedviaatelephonecall.AcalldownlistismaintainedandroutinelyupdatedbytheOBHandSSP.Allpertinentinformation,dataandinfectiousdiseasecaseinformation,andlaboratorytestingprotocolsandresultswillbesharedviatheSecureIntegratedResponseElectronicNotification(SIREN)system:Email,CurrentResponseportal,ortheBorderHealthportal.IfSIRENisunavailable,telephonesandfaxmachineswillbeusedtoshareinformation.TheOBHOfficeChiefandBorderSurveillanceEpidemiologist(s)areresponsibleformaintainingcommunicationwiththeSonoraSecretariatofHealth.IfOBHpersonnelarenotavailabletoinitiateandmaintaincommunicationwiththeSSP,anidentifiedbackupteamofSpanish-speakingADHSpersonnelwillbeestablished.TheOBHwillestablishroutineconferencecallsbetweentheADHSandtheSSP,andmayincluderepresentationfromtheGovernors’OfficesofArizonaandSonora,andanyotherlocal,stateandfederalagencyasdeemednecessary.ParticipantsontheteleconferencecallwillbedeterminedbyADHSandSSPand/orGovernor’sofficeofeachrespectivestate.TheSSPpersonnelatthelocal-levelbordermunicipalitieswillfirstestablishcommunicationwiththeSonorastate-levelandotherSonoraborderregionhealthentitiesintheeventofasuspectorprobablecaseofaninfectiousdiseaseoutbreak.State-levelpersonnelfromtheSSPwillthenbegincommunicationwiththeADHSviatheOBHOfficeChief,ordesignee.OtherOrganizations–Inmanypublichealthemergencies,otherstate,federal,andlocalagenciesmayneedtobeinvolved.Theseagenciesmayincludelawenforcement,fireandotherfirstresponders,correctionalfacilities,agriculture,education,andotherorganizations.
ADHSNon-PharmaceuticalInterventionsPlaybook 20
U.S.CustomsandBorderProtectionForArizonacountiesborderingwithMexico(Yuma,Pima,SantaCruzandCochise),partnershipsbetweenlocalhealthdepartmentsandrespectiveBorderPatrolofficesareextremelyimportant.Currently,allfourcountieshaveworkingrelationshipswiththeU.S.CustomsandBorderProtectionofficestoensureopen,habituallinesofcommunicationnowandgoingforward.Specificpartnershipshaveincludedcollaborationoninfectiousdiseaseplans,jointplanningonworkshopsandtable-topexercisesthathaveassistedinoutliningagencyrolesandresponsibilities.Countyhealthdepartmentsareproactiveinensuringallcriticalcontactinformationisavailableandsharedwithborderpatrol,whentheneedtocommunicatearises.Countiesalsoprovideborderpatrolincidentmanagementteamswithnotesandupdatesregardingseasonalandemergingdiseases(Zikaisthemostrecentexample).ArizonaDepartmentofCorrectionsArizonaDepartmentofCorrections(ADOC)hascontractedwithCorizonCorrectionalHealthcaretoprovidefullservicemedical,mentalhealthanddentalcaretotheinmateshousedatthefollowingprisoncomplexes:ArizonaStatePrisonComplex(ASPC)-Lewis,Phoenix,Perryville,Winslow,Douglas,Safford,Florence,Eyman,Tucson,andYuma.Dependingonthedisease/condition,theyfollowtheestablishedreportablediseaseguidelinessetforthbyADHSandisolation/treatmentguidelinessetforthbyCDC.InmatesarescreenedforcommunicablediseasesuponintaketotheAlhambraReceptionUnitinPhoenixwheremostnewintakesarereceivedfortheirintakescreening.Oncethescreeningisconductedandtheyare"cleared"fortransporttoafacilityappropriatetomeettheircustodyclassificationandmedicalneedstheyreceiveanotherscreeningbyanursetoassuretheyarefreefromcommunicablediseases,andmajorhealthneedsareidentified.Nurselineisconducteddailytoofferinmatestheopportunitytoreportanysymptomsofconcern;providerlinesareconductedroutinelyaswell.Ifacommunicablediseaseisnotedatanyoftheseencountersinmatesareimmediatelyisolatedaspertheestablishedprotocolforthedisease/condition.Theyarethenassessedbyaphysiciantodetermineanappropriatetreatmentplan.Ifthecondition/diseasemeetsreportableguidelinesasestablishedbyADHS,areportablediseaseformiscompletedbytheFacilityHealthAdministratororDirectorofNursingandissubmittedtoADHS.Incasesofoutbreaks,theRegionalDirectorofNursingandRegionalMedicalDirectoraretobenotifiedbytheFHAandDONtohelpcoordinateserviceswiththeDOCandADHS.
NPIPlaybookMaintenance
TheNPIPlaybookandallsupportingdocumentswillbereviewedonanannualbasisorasneeded;theADHSOfficeofInfectiousDiseaseServices(OIDS)istheleadentity.Revisionswillreflectchangesinstatutes,rules,regulations,implementationprocedures,improvedcapabilities,andcorrectionofgapsidentifiedinexercisesandactualincidentsorresponses.PleasesubmitanycommentsorsuggestededitstoADHSOIDS,PublicHealthEmergencyPreparednessEpidemiology(PHEPE)Program.
ADHSNon-PharmaceuticalInterventionsPlaybook 21
Appendices
Definitions–Isolation Separatingandrestrictingthemovementofillpeoplewithacontagious
diseasetopreventtransmissiontoothers.Quarantine Separatingandrestrictingthemovementofwellpeoplewhowere
exposedtoacontagiousdiseasetopreventtransmissiontoothers.Quarantinetypicallylastsaslongastheincubationperiodoftheinfectiousagent.
SocialDistancing Reducinginteractionsandincreasingthedistancebetweenpeopleinsettingswhereindividualscomeintoclosecontactwithoneanother.
JointInformationSystem(JIS)
AnIncidentCommandSystem(ICS)concept,theJISprovidesthemechanismtoorganize,integrate,andcoordinateinformationtoensuretimely,accurate,accessibleandconsistentmessagingacrossmultiplejurisdictionsand/ordisciplineswithnongovernmentalorganizationsandtheprivatesector.MinorincidentsoreventswouldnormallycallfortheactivationoftheJIS.InaccordancewiththeArizonaStateEmergencyResponse&RecoveryPlan(SERRP),theArizonaDivisionofEmergencyManagement(ADEM)willactivatetheJIStosupportgeneral(non-publichealthspecific)emergencyresponseactivitiesinthestate.InthiscaseADHSwillsupportADEMJISbyprovidingpublicinformationtoassistwiththedevelopment,coordination,anddisseminationofpublichealthmessaging.
JointInformationCenter(JIC)
AnIncidentCommandSystem(ICS)concept,theJICisestablishedtocoordinateallincident-relatedpublicinformationactivities.Itisthecentralpointofcontactforallnewsmediaresponsetoanevent.Publicinformationofficialsfromallparticipatingagenciesshouldco-locateattheJIC.Majorresponsesmaycallforactivationofaphysical(facility)JIC.
EmergencyOperationsCenter(EOC)
AspartoftheIncidentCommandSystem(ICS),theEmergencyOperationsCenter(EOC)supportstheon-sceneIncidentCommandTeamwithinformationandcoordinationofresources.TheEOCisacentralizedfacilitythathasinformationmanagementandcommunicationsystems,andsupportstheincident/responsewithplanning,operations,logisticsandfinance.ADHSactivatesits’HealthEmergencyOperationsCenter(HEOC)whichisresponsibleforcoordinatinghealth-specificprogramresponseactivities,implementinghealthpolicydirectives,determiningthemissionandprioritiesoftheresponse,engaginginlong-rangeplanning,coordinatingwithexternalpartnersandagencies,andprovidingdirectionandauthoritytoact.
IncidentCommandSystem(ICS)
Thecombinationoffacilities,equipment,personnel,procedures,andcommunicationsoperatingwithinacommonorganizationalstructure,designedtoaidinthemanagementofresourcesforemergencyincidents.Itmaybeusedforallemergencies,andhasbeensuccessfullyemployedbymultipleresponsedisciplines.ICSisusedatalllevelsofgovernment(local,State,Tribal,andFederal)toorganizefieldleveloperations.
ADHSNon-PharmaceuticalInterventionsPlaybook22
NPIDecisionMatrix–
ADHSNon-PharmaceuticalInterventionsPlaybook23
ADHSOfficeofInfectiousDiseaseServicesOrganizationChart–
ADHSNon-PharmaceuticalInterventionsPlaybook 24
EducationalMaterials–
ADHSNon-PharmaceuticalInterventionsPlaybook 25
ADHSNon-PharmaceuticalInterventionsPlaybook 26
MessagingTemplates–Influenza(FirstFluCase)HealthAlertNetworkTemplate
DearHealthCareProvider:
TheArizonaDepartmentofHealthServiceshasconfirmedthefirstinfluenzacaseinArizonaforthe20xx-20xxinfluenzaseason.
Westronglyrecommendvaccinatingyourpatientsandstaffagainstinfluenzathroughoutthefluseason.Alleligibleindividualsaged6monthsoroldershouldbevaccinated.
Pleaseremindyourpatientsthebestwaytopreventfluandotherrespiratorydiseases,include:
• Getvaccinatedagainsttheflu• Washhandsoften• Avoidtouchingyourfacewithunwashedhands• Coveryourcoughandsneezes• Cleananddisinfectsurfacesfrequently• Avoidclosecontactwithsickpeople• Stayathomeifyouaresick
Forquestionsregardingthe2015-2016fluvaccine,callyourlocalhealthagencyortheArizonaImmunizationProgramOfficeat(602)364-3630.Influenzavaccinerecommendationsareavailableatcdc.gov/vaccines/hcp/acip-recs/index.html.Formoreinformation,visitazdhs.gov/fluorcdc.gov/flu.EnterovirusD68AssociatedwithSevereRespiratoryIllnessinChildren
InlateAugust,theCentersforDiseaseControlandPrevention(CDC)wasnotifiedbytwostatesofanincreaseinchildrenhospitalizedwithsevererespiratoryillness.EnterovirusD68(EV-D68)wasidentifiedinmanyofthesepatients.Therearenowseveralotherstatesreportingincreasesinadmissionsforsevererespiratoryillness.ItispossiblethatthesearealsoassociatedwithEV-D68.EV-D68appearstospreadviaclosecontact(e.g.,saliva,sputum,feces)withinfectedindividuals.Currently,thereisnovaccinetopreventEV-D68andnospecificantiviraltreatmentrecommended.However,patientscanhelpprotectthemselvesandothersfromrespiratoryillnessesby:• avoidingclosecontactwithpeoplewhoaresick;• avoidingtouchingeyes,nose,andmouthwithunwashedhands;• washinghandsoftenwithsoapandwater,especiallyafterchangingdiapers;• cleaning/disinfectingfrequentlytouchedsurfaces,suchastoysanddoorknobs,especiallyifsomeoneissick;
• ensuringvaccinations,includingtheinfluenzavaccine,areuptodate.CliniciansshouldbeawareofEV-D68asoneofmanycausesofviralrespiratorydiseaseandshouldreportclustersofunexplainedrespiratoryillnesstotheirlocalpublichealthagency.PleaserefertothisMMWRformoredetailedinformation:www._______________
ADHSNon-PharmaceuticalInterventionsPlaybook 27
NoticetoOutdoorSpecialEvents(RadiologicalHazard)
Staytunedtolocalradio.Specificinstructionswillbegivenbyauthorities.Localinstructionsalwaystakeprecedencetoanythingwritteninthispressrelease.Evacuateifyouareadvisedtodoso.Keepcarwindowsandventsclosed;usere-circulatedair.Whenyouhavereachedshelter,remainindoorsand:•Closedoorsandwindows•Turnofftheairconditioner,ventilationfans,furnaceandotherairintakes•Gotoaroomwithasfewwindowsaspossibleorabasement•Ifyoumustgooutdoors,coveryournoseandmouthwithahandkerchief
Ifyouhavejustbeenoutdoors,takeathoroughshowerand:•Changeyourclothesandshoes•Puttheitemsyouwerewearinginaplasticbag•Sealthebagandstoreitoutoftheway•Clothescanlaterbewashedasyounormallywouldinthewashingmachine.Anycontaminationwouldremaininthewaterandnotcontaminatethewashingmachine.
Putfoodincoveredcontainersorintherefrigerator.Foodnotpreviouslyincoveredcontainersshouldbewashedfirst.Washingshouldbedoneinaplaceotherthaninthekitchentopreventcontaminationoffoodsanddishes.Donotsellorconsumeanyfoodstuffsuntiltheyhavebeentestedforcontamination.Youmightbetoldtowashyouroutdoorequipmentwithsoapandwater.Cleaningdoesnotdestroyradioactivity.However,cleaningisusefulinmovingradioactivematerialstoaplacewheretheireffectswouldbelessharmful.Youshouldwearprotectiveclothingduringcleaningactivities.ExtremeHeatHealthAlertNetworkTemplate
NationalWeatherServicehasdeclaredanExcessiveHeatWarningbeginningatxxA.M.today,month,day,20xxuntil8P.M.tonightforxxxCounties.Daytimehighsareexpectedtobeinthe110to113degreerange.Residentsareadvisedtostaycool,stayhydrated,andstayinformed.Inareaswithanexcessiveheatwarning,itisrecommendedforschoolstokeepstudentsindoorsforphysicalactivityandrecess.Ifstudentsaregoingoutdoorsforrecess,itisrecommendedthatschoolsprovidewater(8gulpsevery15minutes),provideshade,encouragestudentstowearhats,sunscreenandlightcoloredclothingandprovidefrequentbreaks;ifstudentsshowsignsandsymptomsofheatillnessorwanttogoinside,itisadvisedtogetthemtoacoolenvironmentimmediately,suchasinsidetheschoolbuilding;additionally,itisveryimportantthatstudentsbehydratedbefore,duringandafterbeingoutsideforphysicalactivityand/orrecess.Extremelyhighorunusuallyhottemperaturescanaffectyourhealth.Onaverage,675deathsfromextremeheateventsoccureachyearintheUnitedStates.Mostvulnerableareadultsage65andolder,thosewhoworkorexerciseoutdoors,infantsandchildren,thehomelessorpoor,andpeoplewithachronicmedicalconditionorpeopleoncertainmedications.Takethenecessaryprecautionstopreventserioushealtheffectssuchasheatexhaustionorheatstroke.
ADHSNon-PharmaceuticalInterventionsPlaybook 28
Staycool• Stayinair-conditionedbuildings• ContacttheArizonaDepartmentofHealthServicesat602-364-3118orlocateanair-conditionedrefugestationinyourarea
• Donotrelyonafanasyourprimarycoolingdevice• Limitoutdooractivity,especiallymiddaywhenitisthehottestpartoftheday,andavoiddirectsunlight
• Wearloose,lightweight,light-coloredclothing• Takecoolshowersorbathstoloweryourbodytemperature• Checkonat-riskfriends,familyandneighborsatleasttwiceaday
Stayhydrated• Drinkmorethanusualanddon’twaituntilyou’rethirstytodrink• Drinkfromtwotofourcupsofwatereveryhourwhileworkingorexercisingoutside• Avoidalcoholorliquidscontaininghighamountsofsugar• Makesureyourfamily,friendsandneighborsaredrinkingenoughwater
Stayinformed• Checkyourlocalnewsforextremeheatwarningsandsafetytips• Visitthexxx.countywebsitetofindlocalinformationandtipsforpreventingheatsickness• Signupforfreeweatheralertstoyourphoneore-mail• Keepyourfriends,familyandneighborsawareofweatherandheatsafetyinformation
Additionally,theArizonaDepartmentofHealthServicesencouragesallresidentstolearnthesignsandfirstaidresponseforheat-relatedillness.Warningsignsandsymptomsvarybutmayinclude:HeatExhaustion–Symptoms• Heavysweating• Weakness• Skincold,pale,andclammy• Weakpulse• Faintingandvomiting
WhatYouShouldDo• Movetoacoolerlocation.• Liedownandloosenyourclothing.• Applycool,wetclothstoasmuchofyourbodyaspossible.• Sipwater.• Ifyouhavevomitedanditcontinues,seekmedicalattentionimmediately.
HeatStroke–Symptoms• Highbodytemperature(above103°F)• Hot,red,dryormoistskin• Rapidandstrongpulse• Possibleunconsciousness
WhatYouShouldDo• Call911immediately—thisisamedicalemergency.• Movethepersontoacoolerenvironment.• Reducetheperson'sbodytemperaturewithcoolclothsorevenabath.• DoNOTgivefluids.
ADHSNon-PharmaceuticalInterventionsPlaybook 29
EmergencycoolingcentersandhydrationstationswillbeopenthroughoutMaricopaCounty.Eachcenterwillprovidecoolairandwaterfreetothepublic.
Formoreinformationonextremeheat,call602-364-3118orvisit:ADHSHeatSafety
ADHSExtremeWeather&PublicHealth
Wantdailyhealthupdates?FollowtheArizonaDepartmentofHealthServicesonFacebookandTwitter
Sanitation&HygieneinaFlood
Itiscriticalforyoutoremembertopracticebasichygieneduringtheemergencyperiod.Alwayswashyourhandswithsoapandwaterthathasbeenboiledordisinfected:•Beforepreparingoreatingfood;•Aftertoiletuse;•Afterparticipatinginfloodcleanupactivities;and•Afterhandlingarticlescontaminatedwithfloodwaterorsewage.
Whencleanwaterisnotavailable,youcanusealcohol-basedproductsmadeforwashinghands.Floodwatersmaycontainfecalmaterialfromoverflowingsewagesystems,andagriculturalandindustrialbyproducts.Althoughskincontactwithfloodwaterdoesnot,byitself,poseaserioushealthrisk,thereissomeriskofdiseasefromeatingordrinkinganythingcontaminatedwithfloodwater.Ifyouhaveanyopencutsorsoresthatwillbeexposedtofloodwater,keepthemascleanaspossiblebywashingwellwithsoaptocontrolinfection.Ifawounddevelopsredness,swelling,ordrainage,seekimmediatemedicalattention.Inaddition,parentsneedtohelpchildrenavoidwaterborneillness.Donotallowchildrentoplayinfloodwaterareas,washchildren'shandsfrequently(alwaysbeforemeals),anddonotallowchildrentoplaywithflood-watercontaminatedtoysthathavenotbeendisinfected.Youcandisinfecttoysusingasolutionofonecupofbleachin5gallonsofwater.Formoreinformationabouthealthandsafetyduringaflood,pleasevisittheArizonaDepartmentofHealthServices’Websiteatwww.azdhs.govorcalltheStatePublicHealthInformationlineat(602)364-4500orstatewidetoll-freeat(800)314-9243.Resources–AdditionalNPIResources:CDCNonpharmaceuticalInterventions(NPIs)
NationalAssociationofCountyandCityHealthOfficers(NACCHO):Capability11:Non-PharmaceuticalInterventions
TRACIE–HealthcareEmergencyPreparednessInformationGateway:TopicCollection:NPI/TechnicalResources