Health Care Du rin g

Disa st e rsWhat You Can DoWhat DHEC Can Do

Planning for a Disa st e rRoles of Public Health and Health Care Providers

Is this an outbreak?

What is the potential impact?

Epidemiological investigation and on-going surveillance for cases

What controls can beplaced to

prevent spread of disease, reduce injury and

promote restoration of health?

Quarantine & monitor exposed

Provide preventive treatment

Isolate ill persons

Inform, educate & coordinate with healthcare community, first responders, officials & public

Assistance with sheltering; mortuary support; mass care

Environmental health monitoring & controls

Could t his be biot er ror ism ?

Healthcare facility monitoring

Coordination of volunteers

Source: MMWR 48(29);621

Category 5

Category 4

Category 3

Category 2Category 1Category 1

Case Fatality Ratio

>2.0%

1.0 - <2.0%

0.5 - <1.0%

0.1 - <0.5%<0.1%

Pandemic Severity Index

Projected NumberOf Deaths

(Based on U.S. Population, 2006)

>1,800,000

900,000 - <1,800,000

450,000 - <900,000

90,000 - <450,000<90,000

Assumes 30% Illness Rate and Unmitigated Pandemic

Category 4/5 Pandem ic FluSouth Carolina Projections (CDC FluAID Models –15% - 35% Attack Rate)

• 371,000 - 867,000 outpatient visits• 8,467 – 19,756 hospitalizations

• Surge capacity needed during peak (week 5 of 8-week pandemic wave) to manage additional:

• 486 hospitalization admissions per day• 688 ICU beds• 344 patients requiring mechanical ventilation

Earthquake Consistent w ith Su m m e rville , 1886

South Carolina Projections (U.S. Geo Survey & SC Hazards Vulnerability Lab – 2 PM Event)

• 31,250 outpatient visits• 9,537 hospitalizations

• 14 of 108 hospitals with moderate damage

• 92,000 households displaced• 62,500 seeking temporary shelter

Challenges During Disasters• Damage to facilit ies and utilit ies • Disrupted communication channels• Transportation disrupted• Quantity of and severity of cases• Insufficient quantity of resources

• Absenteeism

• Altered standards of care• Social distancing, isolation, quarantine

Before the Disaster• Identify community partners

• Emergency contact information

• Establish communication systems • Routine coordination and collaboration

• Shared data systems

• Joint planning and exercises• Decontamination

• Isolation and quarantine

• Surge capacity

• Altered standards of care

Coord inat ion• Disease Reporting• Infection Control Committee• Hospital Emergency Preparedness• Community Coalitions• Communications

• HAN

During Disaster• Establish communication channels ASAP

• ICS - Liaison Officers

• Establish protocols• Clinical/Surge

• Reporting and tracking

• PPE

• Consistent communications to the public• ICS – JIC

• Designated spokespersons

• Message maps and talking points

Roles for Clin icians

• Medication Distribution• Mass Vaccinations• Community Triage• Mass Care• Crisis Counseling

• Medical Reserve Corps

Pub lic Health Authorit ies Du rin g Em e rg e n c ie s

GOVERNOR’S POWERS

• SECTION 1-3-420. Proclamation of emergency by Governor• SECTION 1-3-430. Orders to prevent danger• SECTION 1-3-440. Further powers of Governor• SECTION 1-3-450. Intervention by Governor in situations of

violence or public disorder• SECTION 1-3-460. Governor’s powers under article shall be

supplemental to powers granted by other laws • SECTION 25-1-440. Additional powers and duties of Governor

during declared emergency• SECTION 44-4-100 Emergency Health Powers Act

DHEC: State Public Health Agency

• Duties and powers of Board regarding communicable or epidemic diseases

• Duties of Department regarding public health, in general

• Department may promulgate and enforce rules and regulations for public health

DHEC: Traditional Public Health Powers • Authority to require reporting cases and deaths from

contagious, infectious diseases, chemical or other terrorism; • Authority to require reporting of increased prescription rates

of drugs for diseases caused by chemical terrorism or infectious agents

• Physicians, licensed nurses and public health employees participating in mass immunization projects exempt from liability; exceptions

• Authority to request assistance from peace and health officers and the National Guard to enforce isolation and quarantine orders

DHEC Powers Expand under Declaration of Public Health Emergency

• Only in effect after the Governor, with consultation from the Public Health Emergency Committee if possible, declares a Public Health Emergency (PHE).

• (“Emergency Health Powers Act,” SC Code Sections 44-4-100, et seq)

Public Health Emergency "Public health emergency" (PHE) means the occurrence or imminent risk of a qualifying health condition.

• “Qualifying Health Condition” means:• (1) a natural disaster; or• (2) an illness or health condition that may be caused by

terrorism, epidemic or pandemic disease, or a novel infectious agent or biological or chemical agent and that poses a substantial risk of a significant number of human fatalities, widespread illness, or serious economic impact to the agricultural sector, including food supply.

Control of Persons during PHE

• DHEC must use every means to prevent transmission of infectious disease and ensure all cases are subject to proper control and treatment.

• DHEC may perform voluntary physical examinations or tests as necessary for the diagnosis or treatment of individuals.

• DHEC may isolate or quarantine any person who refuses examination or testing.

• Physical exams or tests may be performed by any qualified person authorized to do so by DHEC and must not be reasonably likely to result in serious harm.

Vaccinations and Treatment

• During a PHE, DHEC may use powers to:• (1) vaccinate persons;• (2) treat persons exposed to or infected with disease; and• (3) to prevent spread of contagious or possibly contagious

disease. DHEC, upon provision of due process outlined in statute, may isolate or quarantine persons who are unable or unwilling for any reason (including, but not limited to, health, religion, or conscience) to undergo vaccination or treatment pursuant to this section.

Vaccinations and Treatment

• Vaccinations or treatment must be provided only to those who agree to the vaccinations or treatment.

• Vaccinations or treatment may be administered by any qualified person authorized by DHEC. DHEC works closely with LLR on PHE issues.

• To be administered pursuant to this section, a vaccine or treatment must not be such as is reasonably likely to lead to serious harm to the affected individual.

Isolation and Quarantine• DHEC may isolate infected individuals and quarantine

exposed individuals. Includes those who have not been vaccinated, treated, tested, or examined.

• Must be least restrictive means necessary to prevent the spread of disease (may include confinement to private and public premises.)

• Health status of isolated and quarantined individuals must be monitored regularly.

• Must be immediately released when pose no substantial risk of transmitting disease.

• Must comply with DHEC's rules and orders. Failure to comply constitutes a felony.

Isolation and Quarantine

• DHEC may authorize access of physicians, health care workers, or others to individuals in isolation or quarantine as necessary to meet needs.

• Law enforcement officers may arrest, isolate, or quarantine an individual who is acting in violation of an isolation or quarantine order.

• Jobs of isolated or quarantined individuals protected.

Emergency Licensing Issues

• DHEC with the Department of Labor, Licensing and Regulation (LLR), may exercise the following emergency powers regarding licensing of health personnel:

• (1) to require in-state health care providers to assist in the performance of vaccination, treatment, examination, or testing of any individual as a condition of licensure, authorization, or the ability to continue to function as a health care provider in this State;

• (2) to accept the volunteer services of in-state and out-of-state health care providers, to appoint such health care providers as emergency support function volunteers, and to prescribe the duties as may be reasonable and necessary for emergency response; and

Licensing – cont’d

• The appointment of in-state and out-of-state health care providers must not exceed the termination of the PHE. DHEC may terminate in-state and out-of-state appointments at any time or for any reason provided that termination will not jeopardize health, safety, and welfare of the people of this State.

• The licensing authority may waive any or all licensing requirements, permits, or fees required by law and applicable orders, rules or regulations for health care providers from other jurisdictions to practice in this State.

Immunity from Liability

• Any health care provider appointed pursuant to this section must not be held liable for any civil damages as a result of medical care or treatment including, but not limited to, trauma care and triage assessment, related to the appointment of the health care provider and the prescribed duties, unless the damages result from providing, or failing to provide, medical care or treatment under circumstances demonstrating a reckless disregard for the consequences so as to affect the life or health of the patient.

Immunity from Liability– cont’d

• Applies if health care provider does not receive payment from the State other than as allowed in Section 8-25-40 for the services and duties.

• Applies whether health care provider was paid, should have been paid, or expected to be paid for the services at the time of rendering the services from sources including, but not limited to, Medicaid, Medicare, reimbursement under the Stafford Act, 42 U.S.C. Section 512, et seq., or private health insurance.

Crisis Standards of Care• During a wide-reaching catastrophic public health

emergency or disaster, existing surge capacity plans may not be sufficient to enable health care providers to continue to adhere to normal treatment procedures and follow usual standards of care. This is a particular concern for emergencies that may severely strain resources across a large geographic area, such as a pandemic influenza or the detonation of a nuclear device. Under these circumstances, it may be impossible to provide care according to the standards of care used in non-disaster situations, and, under the most extreme circumstances, it may not even be possible to provide basic life sustaining interventions to all patients who need them. Institute of Medicine, “Crisis Standards of Care,” 2010.

Crisis Standards of Care - SC

During the H1N1 pandemic, the SCHA began a series of meetings to discuss Crisis Standards of Care in SC.While this effort did not result in a final determination of CSCs, the effort was very educational. Why is it difficult to pre-determine CSCs?

Purchase and Distribution of Pharmaceuticals

• DHEC may purchase and distribute antitoxins, serums, vaccines, immunizing agents, antibiotics, and other pharmaceutical agents or medical supplies in the interest of preparing for or controlling a public health emergency, without any additional legislative authorization.

Cont’d• If shortage of such a product results, whether or not the

product has been purchased by DHEC, DHEC may control, restrict, and regulate by rationing and using quotas, prohibitions on shipments, price fixing, allocation or other means, the use, sale, dispensing, distribution, or transportation of the relevant product necessary to protect the health, safety, and welfare of the people of the State. In making rationing or other supply and distribution decisions, DHEC must give preference to health care providers, disaster response personnel, and mortuary staff.

DHEC may procure products across state

• During PHE, DHEC may procure, store, or distribute any antitoxins, serums, vaccines, immunizing agents, antibiotics, and other pharmaceutical agents or medical supplies located within the State as may be reasonable and necessary for emergency response, with the right to take immediate possession thereof.

Control of Property during PHE

• With other agencies, DHEC handles dangerous facilities and materials.

• Power to close, direct evacuation of or decontaminate facility or material.

• Purchase and distribution of pharmaceutical agents or medical supplies.

• Destruction of property; civil proceedings.

Control of Healthcare Facility

• Use of health care facility or services in response to public health emergency.

• DHEC may require a health care facility to provide services, as condition of licensure, authorization, or ability to continue doing business.

• Facility may be used to isolate or quarantine individuals during PHE. Management and supervision of the health care facility must be coordinated with DHEC to ensure protection of existing patients and compliance with the terms of this act.

Thank you!Thank you for all you do for the people of the State and your interest in Public Health Preparedness. While no one wants a public health emergency to occur, being informed about the program structure and laws is very important for everyone.

Lil ian Peake, M.D.Director of Health Services

Questions?