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Disaster Medical Services Division — Health Agency Services Disaster Plan: 1997

SAN MATEO COUNTY HEALTH SERVICES AGENCY DISASTER PLAN

This Plan describes how disaster health and medical operations will be conducted.

AGENCY DIVISIONS:

• Aging & Adult Services
• Business Administration
• Emergency Medical Services
• Environmental Health
• Financial Services
• Food & Nutrition Services
• Hospital & Clinics
• Health Information/Technology
• Public Health Nursing
• Mental Health

COOPERATING AGENCIES:

• Amateur Radio
• Contract Ambulance Provider
• San Mateo County Sheriff's OES

Please send any additions or corrections to:

San Mateo County Emergency Medical Services
Health Services Agency
San Mateo, CA 94403
(415) 573-2564
(415) 573-2029 [FAX]

HEALTH SERVICES AGENCY DISASTER PLAN TABLE OF CONTENTS

1. Introduction
2. Objectives
3. General
4. Authorities and References
5. Concept of Operations
6. Responsibilities
   1. County Sheriff's Office of Emergency Services
   2. Operational Area Disaster Medical Health Coordinator (OADMHC)
   3. Environmental Services
   4. Human Services
   5. Public Works
   6. American Red Cross
7. Health Services Divisions
   1. Aging and Adult Services
   2. Business Administration
   3. Emergency Medical Services
   4. Financial Services
   5. Food and Nutrition
   6. Hospital and Clinics
   7. Health Information Technology (HIT)
   8. Mental Health
   9. Public and Environmental Health
8. Activation of Plan
9. Standardized Emergency Management System (SEMS)/ Incident Command System (ICS)
10. Checklists

SAN MATEO COUNTY HEALTH SERVICES AGENCY DISASTER PLAN

1. Introduction

   The Health Services Agency (HS Agency) has nine Divisions providing diverse services and functions. The HS Agency's mission is:

   "The Health Agency protects the public health of all citizens; ensures a healthy environment and rapid, compassionate emergency medical response; provides medial care, mental health, health education, and protective services for vulnerable people, regardless of ability to pay; and cooperates with concerned citizens and committed volunteers."

   This disaster plan describes the basic concepts, policies, and procedures for providing emergent and recovery disaster medical care to persons during natural disasters, chemical, biological, and/or nuclear related incidents, terrorism, and national defense emergencies. This plan applies primarily to major area-wide disasters creating sufficient casualties to overwhelm local disaster medical response capabilities. This plan supplements the Medical Annex (Annex D) of the San Mateo County Area OES Emergency Plan.

2. Objectives

   The overall objectives of disaster medical care operations will be to:

   • Minimize loss of life, subsequent disability, and human suffering by ensuring timely and coordinated medical assistance, to include evacuation of severely ill and injured patients.
   • Coordinate the application of medical facilities and the procurement, allocation, and distribution of medical personnel, supplies, communications, and other resources.
   • Provide a system for receipt and dissemination of information required for effective response to and recovery from the effects of a major disaster.
   • Provide for the potential long term health care needs of displaced individuals. Prevent the initiation and spread of communicable diseases.
   • Ensure the safety of water and food supplies to the public.
3. General

   This plan is designed to provide coordination of the Divisions of the Health Services Agency in disaster response. It utilizes the Standardized Emergency Managment System (SEMS) and is based on the Incident Command System (ICS) model. The concepts and procedures outlined in this plan will be utilized in the event of, but are not limited to, the following situations: Fire, explosion, building collapse, transportation accident, hazardous materials accident, or other emergency in which there are casualties or potential casualties sufficient to overload routine medical response.

4. Authorities and References

   This plan was developed in accordance with the San Mateo Area/County Emergency Plan Volume 1, Basic Plan / Management Annex, and therefore recognizes the authorities and laws sited in Enclosure 1-1, page 1, in addition to Government Code Section 8607, the "Standardized Emergency Management System (SEMS)," and Government Code Section 3100.

   Requirements for employee response:

   Government Code Section 3100 states "It is hereby declared that the protection of the health and safety and preservation of the lives and property of the people of the state from the effects of natural, manmade, or war-caused emergencies which result in conditions of disaster or in extreme peril to life, property, and resources is of paramount state importance requiring the responsible efforts of public and private agencies and individual citizens. In furtherance of the exercise of the police power of the state in protection of its citizens and resources, all public employees (defined in Government Code Section 3101 as "...all persons employed by the state or any county, city, city and county, state agency or public district...") are hereby declared to be disaster service workers subject to such disaster service activities as may be assigned to them by their supervisors or by law."

5. Concept of Operations

   Disaster medical care activities during peacetime and national defense emergencies will usually be associated with the periods and phases indicated below.

   1. Pre-Emergency Period

      The Pre-Emergency Period is divided into two phases as follows:

      Normal Preparedness Phase

      During this phase, emphasis will be placed on preparing supporting plans, Standard Operating Procedures (SOP) and checklists detailing the disposition of public and private health and medical resources in an emergency. Such plans and procedures will provide for coordination and communication channels with public and private agencies and individuals that normally operate independently. Resource listings will also be prepared and maintained current.

      Increased Readiness Phase

      This phase could begin upon receipt of an accredited earthquake prediction, the forecast of a flood which could impact the jurisdiction, or a rapidly deteriorating international situation which could lead to a possible attack upon the United States. Increased readiness actions will include reviewing and updating plans, SOPs and resource information, ensuring that facilities and equipment are in a state of readiness, alerting of resource suppliers and emergency personnel, and other measures to increase capabilities to accomplish emergency missions.

   2. Emergency Period

      The Emergency Period is divided into three phases as follows:

      Pre-Impact Phase

      Most actions to be accomplished during this phase would be precautionary and would be centered around taking appropriate countermeasures to protect people should the jurisdiction be impacted by an event such as a slow-rise flood situation, a health-endangering hazardous material incident, or terrorist activity. If local plans for moving persons from threatened areas are placed into effect, medical personnel will implement plans for moving patients in hospitals and nursing homes within the threatened area to facilities in reception areas. Hospitals will consider discharging ambulatory patients to facilitate an evacuation of the facility and will seek to ensure the safety of patients whose illnesses and injuries preclude evacuation.

      Immediate Impact Phase

      Actions taken during this phase will be concentrated on the well-being of people impacted by an event such as a major earthquake, a release of hazardous materials, or terrorist activity. Priority activities will include providing disaster medical care to injured persons and/or continuing medical care to patients relocated to other facilities.

      Persons requiring medical assistance will be treated at local facilities insofar as possible. Medical personnel and supplies will be transported to the affected area as rapidly as feasible to provide assistance. If local facilities are unable to adequately accommodate patients due to the large number of casualties or damage to local facilities, it will be necessary to move patients to suitable facilities elsewhere. This phase requires emergency medical services to function in a priority role.

      Sustained Emergency Phase

      As early lifesaving and property-protecting actions continue, attention can be given to other priority activities during this phase, such as assuring that hospital and nursing home patients receive continuing care, that other persons relocated to congregate care facilities receive medical care, and that continuing day-to-day medical emergencies are met. The role of emergency medical services in the traditional sense will have ended by this point. Public and environmental health concerns will begin to surface, if they haven't already. Public and environmental health response activities will be the priority.

   3. Post-Emergency Period (Recovery)

      Priorities during this period will be focused on continuing to provide essential medical/health care services, and assisting in recovery operations and restoration of the area's medical/health care delivery capacity. Public and environmental health will function on an on-going basis until the recovery period is complete. This may be for several weeks, or months, depending upon the nature of the incident.

6. Responsibilities

   To ensure meeting the goals of the Health Services Agency mission through coordination with the County Sheriff's Office of Emergency Services, Operational Area Disaster Medical Health Coordinator, and other County Departments.

   1. County Sheriff's Office of Emergency Services

      The San Mateo County Sheriff's Office of Emergency Services Operational Area is a joint powers agreement between the County of San Mateo and its 20 cities. The OES exercises overall management and coordination of the jurisdiction's response to emergency situations. Area Emergency Services Coordinators advise and assist County and city emergency organizations in managing and coordinating disaster response efforts.

   2. Operational Area Disaster Medical Health Coordinator(OADMHC)

      The OADMHC directs the countywide disaster medical care program. In the event of disaster, the OADMHC will be located in the Medical Branch of the County EOC. Responsibilities at the Operational Area level include, but are not limited to:

      • Coordinating disaster medical care operations within the county area.
      • Coordinating with Mental Health and Public Health response activities.
      • Coordinating the procurement and allocation of critical public and private medical and other resources required to support disaster medical care operations in affected areas.
      • Coordinating means of transporting casualties and medical resources to health care facilities including Casualty Collection Points (CCPs) within the area and to, or from, other areas as requested.
      • Responding to requests from the Regional Disaster Medical/Health Coordinator (RDMHC) to provide disaster medical care assistance, as conditions permit.
      • Developing and maintaining a capability for identifying medical resources, transportation, and communication services within the county.
      • Maintaining liaison with the American Red Cross Bay Area, volunteer service agencies, and such sub-area representatives within the county as may be designated.
      • Maintaining liaison with the Operational Area Coordinators of other relevant emergency functions such as: communications, fire and rescue, health, law enforcement and traffic control, transportation, care and shelter, etc.
      • Ensuring that the existing county medical care system for day-to-day emergencies is augmented in the event of a disaster requiring utilization of medical mutual aid resources.
      • Communicating with the Regional Disaster Medical Health Coordinator on matters requiring assistance from other counties, state or federal governments.
      • Coordinating the activities of his/her staff or agents who perform these duties on a sub-area/district/municipal basis.
   3. Environmental Services - Provides building inspection and damage assessment during the incident. Environmental Services also plays a key role in Situation/Status Management.
   4. Human Services - Provides shelter and housing to the public and County employees during the disaster.
   5. Public Works - Handles coordination of vehicles and debris removal, monitors condition of roadways, and acts as the primary link to utility providers during a disaster response.
   6. American Red Cross

      Under its charter, the ARC provides supplementary first aid, minor medical and nursing care in Red Cross shelters and other health services upon request and within limited capabilities. The Red Cross can also provide outreach and crisis intervention in support of County Mental Health and Public Health.

7. Health Services Divisions
   1. 1. Introduction

         Aging and Adult Services ensures the safety of at-risk older adults and people with disabilities and provides access to services to support independence and maintain dignity by providing information and assistance, case management, advocacy, planning, coordination and public education in a client-centered, compassionate and fiscally responsible manner.@

         This Division has a staff of over 100 including managers, social workers, deputy Public Guardians, accounting staff, and nurses. The Division offers a variety of services to adults with special needs. The Protective and Supportive Services Section of the Division provides adult protective services, in-home supportive services for the elderly and disabled persons, case management for the frail elderly, at-risk adults, and persons with AIDS. The Conservatorship/Representative Payee/Veterans Services Section carries out the court-appointed duties of the Public Guardian, provides money management services to frail elderly/at-risk adult clients/HIV clients who are unable to manage their own finances, but do not require conservatorship, and advocates for and assists military veterans and their widows and orphans in all benefit claims. The Commissions and Provider Services Section manages and monitors contracts for a variety of community services for seniors and people with disabilities.

         In the event of a disaster, this Division=s clients will have many special needs. Examples include ensuring access to shelters for persons with physical disabilities and ensuring immediate response and rescue to at risk adults in their own homes as well as to skilled nursing facilities.

      2. Responsibilities
         1. Law Enforcement - Law enforcement officers work with AAS to protect safety of our clients and to identify adults in need. The prime responsibilities are the investigation and reporting of adult abuse.
         2. Fire Services - Primary responsibilities are to provide pre-hospital emergency medical care for older and dependent adults, and the reporting of adult abuse.
         3. County Communications - Primary responsibilities are to identify adults in need of AAS services.
         4. Public Authority - Monitor status of care providers and thereby receive information regarding the needs of IHSS clients.
         5. RCF/SNF - Monitor the health and custodial needs of older adults and identify adults in need of AAS services.
         6. Senior Centers - Provide congregate nutrition meals and transportation services and collaborate with AAS in the provision of services.
         7. Meals On Wheels - Provide nutritional services and identify nutritional services to homebound older adults and to collaborate with AAS in the provision of services.
         8. Adult Day Programs - Provide custodial/rehabilitative care to incapacitated adults and collaborate with AAS in the provision of services.
         9. CARD Collaborative Agencies - To identify adults in need and triage their response and collaborate with AAS in the provision of services.
      3. Response

         Respond to Health Services DOC and report to DOC Commander. Assume the Incident Command System role of Aging and Adult Services Unit Leader, unless otherwise assigned by DOC Director. Refer to the ICS Section of this document for the definition of this role and corresponding checklist.

         1. Aging and Adult Services Unit Leader - Responsibility: To carry out the mission of the division by helping to maintain the independence of AAS clients. Establish and maintain contact with facilities: senior housing, skilled nursing facilities, senior centers, adult day health centers, board and care facilities, and the Regional Center. Monitor and facilitate the needs and status of AAS associated facilities, employees, and clients throughout duration of the disaster.
   2. BUSINESS ADMINISTRATION
      1. Introduction

         "The Health Services Administration provides overall direction, analysis, financial management and automation services to the Health Services Divisions to foster innovative program planning and policy development."

         The Business Administration Staff of approximately eighteen provides overall direction, analysis, financial management and automation services to the HS Agency.

         The County Health Officer is based in Business Administration. He has broad responsibilities that involve clients of all Divisions. The Health Officer is a key participant in disaster planning, especially related to public health issues.

         An optimal medical and health response to a disaster requires the services of each division of the Health Services Agency in a standardized and integrated manner. Each division should be prepared to deliver those services most appropriately provided by that division, and all divisions should use a standard approach to the delivery of those services.

      2. Responsibilities
         1. Department of Health Services - Supervise Department's top management.
         2. Other County Departments - All County Departments have specific responsibilities during a disaster. The Department of Health Services is responsible for the health care response to the disaster.
         3. Provision of In-County Health Care - Monitor status of in-county health care (including county and non-county facilities and personnel). Communicate community health care needs and available resources, including requests for mutual aid, to the Department of Health Services'representatives at the County Emergency Operations Center (Operations Branch).
         4. Financial Services - See specific section.
         5. Health Information/Technology - See specific section.
      3. Response

         Respond to DOC where the following roles are optimally managed by Health Services Business Administration personnel: Health Services DOC Director, Liaison Officer, Information Officer, Safety Officer. The Incident Commander will assign roles, including Section Chiefs. Report to DOC Director, and assume roles as assigned. Refer to the ICS Section of this document for definitions of each role and corresponding checklists.

         1. Department Operations Center Director - Responsibility: Manage the incident activities including the development and implementation of DOC positions, strategic decisions, and approve the ordering and releasing of resources. The DOC Director is from the health services division having overall responsibility for the department, Business Administration.
         2. Liaison Officer - Responsiblity: A member of the Command Staff, the Liaison Officer is responsible for interacting (by providing a point of contact) with the assisting and cooperating agencies.
         3. Information Officer - Responsibility: A member of the Command Staff, the Information Officer is responsible for the information and release of information about the incident to the news media and other appropriate agencies and organizations.
         4. Safety Officer - Responsibility: A member of the Command Staff, the Safety Officer is responsible for monitoring and assessing hazardous and unsafe situations and developing measures for assuring personnel safety. The Safety Officer will correct unsafe acts or conditions through the regular line of authority, although the officer may exercise emergency authority to stop or prevent unsafe acts when immediate attention is required. The Safety Officer Maintains awareness of active and developing situations, approves the medical plan, and includes safety messages in each incident action plan.
         5. Medical Officer - Responsibility: A member of the Command Staff, the Medical Officer position is ad hoc, and utilized as needed. The responsibilities of the Medical Officer are to provide consultation to the Command Staff, make recommendations as appropriate, and participate in and support Command Staff activities.
   3. EMERGENCY MEDICAL SERVICES
      1. Introduction

         The Emergency Medical Services Agency Mission is:

         "To ensure the highest quality emergency medical care to the people of San Mateo County through an integrated and coordinated system of services."

         The EMS Agency is programmatically based in Business Administration. The EMS program has a small staff of four full time personnel and a part-time EMS medical director.

         The EMS Agency provides oversight and coordination for all aspects of emergency medical services including emergency medical dispatch, fire service first response, emergency and non-emergency ambulance services, and air ambulance services. The EMS Agency coordinates interfaces between prehospital care services and hospitals. The EMS Agency procures services through requests for proposals and written agreements. The Agency plans and evaluates the EMS system as a whole, including its service providers.

         The EMS Agency provides leadership to the Health Services Agency for all aspects of disaster planning as well as serving the entity responsible for planning and coordinating the immediate emergency medical response in a disaster. A representative of the EMS Agency is a member of the Operations Section of the County Emergency Operations Center.

      2. Responsibilities
         1. Medical Services -Medical Services personnel have primary responsibility for medical care on the scene to include liaison with the incident commander.
         2. Law Enforcement - Law enforcement officers may render immediate first aid but their primary responsibilities are for investigation, crowd and traffic control.
         3. Fire Services - Primary responsibilities are rescue, fire prevention, fire fighting, extrication, and medical care.
         4. County Communications - County Communications will contact the hospitals to determine their receiving capabilities. The Medical Transportation Supervisor will then assign destination(s).
         5. Receiving Hospitals - Each hospital shall determine their receiving capabilities and prepare for victims. Ambulance personnel will contact receiving hospital with appropriate patient information.
      3. Response

         Respond to Health Services DOC and report to DOC Director. Assume the Incident Command System role of Emergency Medical Services Unit Leader, unless otherwise assigned by DOC Director. Refer to the ICS Section of this document for definitions of the role and corresponding checklist.

         1. Emergency Medical Services Unit Leader - Responsibilities: To monitor the status and needs of specified health care facilities in San Mateo County. Monitor status and needs of Casualty Collection Points. Plan for extended medical care needs related to specified facilities. Provide information and support as requested by the OADMHC and Planning Section Chief.
   4. FINANCIAL SERVICES
      1. Introduction

         Financial Services is part of Health Services Business Administration. The staff handles the financial management of the Health Services Department. The unit provides full range and accounting services which include: fiscal monitoring of Division's budgets, bookkeeping for general, enterprise and trust funds, reimbursement activities for state and federal grants, coordination and review of audtis, processing of claims and collections, and liaison function with the County Controller's Offfice.

      2. Responsibilities

         Financial Services does not coordinate the services it provides with any agency outside of its department. All services are coordinated in-house.

      3. Response

         Respond to Health Services DOC and report to DOC Director. Assume the Incident Command System role of Finance Section Chief, Time Unit Leader, Cost Unit Leader, or Claims Unit Leader (in said order), unless otherwise assigned by DOC Director. Refer to the ICS Section of this document for definitions of each role and corresponding checklists.

         1. Finance Section Chief - Responsibility: Provide advice and support to Department Operations Center Director regarding financial issues; insure that adequate records are maintained to support requests for state and federal assistance; track time worked by all emergency personnel involved in the incident; provide cost analysis and projections.
         2. Time Unit Leader - Responsibility: The Time Unit maintains records of all personnel time worked at the emergency which includes all volunteers that may or may not be previously registered as Disaster Service Workers.
         3. Cost Unit Leader - Responsibility: The Cost Unit leader is responsible for collecting all cost data, performing cost effectiveness analyses, providing cost estimates, and cost saving recommendations for the incident.
         4. Claims Unit Leader - Responsibility: The Claims Unit manages all legal claims for compensation filed against the Health Services Agency. It advises the Department Operations Center Director in areas of claims for bodily injury and property damage compensation presented to the Health Services Agency.
   5. FOOD & NUTRITION
      1. Introduction

         Food and Nutrition Services provides nutritious meals to County patients, residents, detainees, inmates, senior citizens, and the frail elderly in a cost-effective manner.

         This program has a staff of approximately 70 including dietitians, cooks, drivers, and food service workers. The program provides food services for the County hospital, all correctional facilities, and the Meals-On-Wheels program.

      2. Response

         Respond to DOC, report to DOC Director, and assume role of Food and Nutrition Services Unit Leader, unless otherwise assigned by DOC Director or Logistics Section Chief. Refer to the ICS Section of this document for the definition of this role and corresponding checklist.

         1. Food and Nutrition Services Unit Leader - Responsibilities: Provides the direction in the procurement of food and supplies to food services operated by the County. Coordinate supply needs as requested by each location and determine level of assistance required by food service operations. Plan and direct any additional food services required as a result of the emergency in progress.
   6. HOSPITAL AND CLINICS
      1. Introduction

         San Mateo County General Hospital and Clinics guarantees access to medical care for the San Mateo County community by delivering quality inpatient and outpatient care with compassion and respect for the dignity, comfort and privacy of the individual, regardless of ability to pay.

         Crystal Springs Rehabilitation Center provides high quality nursing care for difficult-to-place county residents in a professional, dignified, and caring environment regardless of ability to pay.

         The County operates a 145 bed general acute care hospital and a 124 bed skilled nursing facility. In addition, this Division has several clinics operated at the acute care hospital and 3 clinics located off site.

         San Mateo County General Hospital's Disaster Plan is based on the Hospital Emergency Incident Command System (HEICS). However, neither the skilled nursing facilities nor the off-site clinics have a HEICS disaster plan.

         North County Health Center

         This new clinic provides medical and social services to North County residents. The Center is staffed by physicians, nurses, community health workers, and mental health professionals. This center, as well as all county operated-clinics throughout the county need to be addressed within the Department's Disaster Plan.

      2. Responsibilities
         1. North County Health Center - This clinic provides medical and social services to north county residents. The Center is staffed by physicians, nurses, community health workers, and mental health professionals. Works with City of Daly City Police and Fire Departments, and Daly City Youth. Provides primary care, pediatrics, dental, family planning, TB, infectious disease, mental health servioces and public health field services.
         2. Fair Oaks Family Health Center - This clinic provides medical services to south county residents. The Center is staffed by physicians, nurses and community health workers. Works with Redwood City Fire Department and San Mateo County Sheriff's Department. Provides primary care, pediatrics, and dental services.
         3. Belle Haven Community Health Center - This clinic provides medical services to East Menlo Park residents. The Clinic is staffed by physicians, nurses and health workers. Works with the Menlo Park Police and Fire Departments.
         4. Willow Clinic - This Clinic provides medical services to south county residents. The clinic is staffed by physicians, nurses and health workers. Works with the Menlo Park Police and Fire Departments.
         5. Crystal Springs Rehabilitation Center (CRSC) - The CSRC provides high quality nursing care for gero-psychiatric and rehabilitation patients. The CSRC is staffed by physicians, nurses, social services staff and mental health workers. Works with California Division of Forestry or fire services and the San Mateo County Sheriff's Department.
         6. San Mateo County General Hospital - Works with the City of San Mateo Police and Fire Departments, Emergency Medical Services, Office of Emergency Services, and the American Red Corss.
      3. Response

         Respond to Health Services DOC and report to DOC Director. Assume the Hospital and Clinics Unit Leader role, unless otherwise assigned by DOC Director or the Operations Section Chief. Refer to the ICS Section of this document for definitions of each role and corresponding checklists.

         1. Hospitals and Clinics Unit Leader - Responsibilities: Maintain communication with Operational Area Disaster Medical Health Coordinator (OADMHC), located in the Area EOC Medical/Health Branch. Assess and activate responses to County hospital and clinic issues. Coordinate with Health Services DOC Team and San Mateo County General Hospital Operations Center.
   7. HEALTH INFORMATION TECHNOLOGY (HIT)
      1. Introduction

         "To provide full access to information and seamless systems support and enabling HS Agency staff to provide quality health care to the community."

         The hardware, software and network connectivity supported "by HIT staff benefits 700+ system users throughout five HS Agency Divisions at 29 sites. These Divisions provide inpatient, clinic and in-home support for the mental, physical and social support needs of San Mateo County citizens of all ages.

      2. Responsibilities

         The HIT Department does not coordinate the services it provides with any agency outside of its department. All services related to the hardware, software, and network connectivity are coordinated in-house.

      3. Response

         Respond to Health Services DOC and report to DOC Director. Assume the HIT Officer role, unless otherwise assigned by DOC Director or the Logistics Section Chief. Refer to the ICS Section of this document for definitions of each role and corresponding checklists.

         1. HIT Officer - Responsiblities: Rapid restoration of network system functionality to all HS Agency end-users responding to disaster. Ongoing and clear reporting of systems' status to Services Unit Leader and HIT staff.
   8. MENTAL HEALTH
      1. Introduction

         "To provide excellent mental health services to enable residents of San Mateo Coutny to live successfully in their communities.

         This division has a staff of 194 including clinicians, administrators, and support staff. It provides sub-acute care, residential care, outpatient therapy, case management, and medication management to mental health clients in all age groups. These services are provided at five primary sites throughout San Mateo County.

      2. Responsibilities
         1. Mental Health - Ensure continuation of care, treatment and housing for those clients currently open to the Mental Health System. Mitigate when possible the impact of the disaster and provide crisis support services for those clients and their community.
         2. American Red Cross - Works with Mental Health to assess and coordinate a plan to provide mental health services and assessments of needs at disaster sites, shelters, evacuation centers, and other casualty collection points. Primary role is to provide shelter and basic care needs to displaced individuals.
         3. California Department of Mental Health (CDMH) - A mental health liaison is assigned to work with the CDMH and the County OADMHC to assess needs and, if necessary, request mutual aid. The Disaster Office at the CDMH communicates with Federal and State disaster relief agencies.
         4. California Medical Mutual Aid Region II - Via the OADMHC, the Region provides Public and Environmental Health resources that are not available at the local level.
         5. First Response Team - A Mental Health team of specialists trained in disaster response and in critical incident stress debriefing that can be activated by contacting San Mateo County General Hospital Psychiatric Emergency Services (PES).
      3. Response

         Respond to Health Services DOC and report to DOC Director. Assume the Mental Health Services Unit Leader role, unless otherwise assigned by DOC Director or the Operations Section Chief. Refer to the ICS Section of this document for definitions of each role and corresponding checklists.

         1. Mental Health Services Unit Leader - Responsibilities: Maintain communication with Operational Area Disaster Medical Health Coordinator (OADMHC), located in the Area EOC Medical/Health Branch; assess and activate responses to mental health issues; coordinate with Health Services DOC Team and Division Operations Centers.
   9. PUBLIC AND ENVIRONMENTAL HEALTH
      1. Introduction

         "The Division of Public Health and Environmental Protection provides services designed to monitor and assess as well as protect, promote and maintain the public and environmental health of San Mateo County and its residents."

         The Public Health Division has a staff of approximately 140 including physicians, public health nurses, laboratory workers, health educators, communicable disease investigators, dietitians, and community program specialists. The Community Health Section provides a variety of services including public health nursing field services, nutrition programs, maternal child health programs, and health education. The Clinic Services Section operates five fixed location clinics and one mobile clinic. Additionally, this section provides epidemiology surveillance for the community. Public health problems are numerous and critical in all types of disasters.

         The Environmental Health Division has a staff of approximately 65 including hazardous materials and environmental health specialists. The Consumer Health Protection Section manages a wide variety of environmental public health activities for food, housing, vector control, water and recreational facilities including inspections, permitting and enforcement activities. The Hazardous Material Management Section monitors and inspects underground storage tanks, solid/medical waste, hazardous materials and hazardous waste generation. Hazardous materials specialists from this Section respond to all hazardous materials incidents (HazMats) within the County.

         These Divisions have a combined role in the Health Services DOC and are critical players in a disaster. The Environmental Health Director is a member of the Operations Section of the County's EOC.

      2. Responsibilities
         1. Public and Environmental Health - Coordinate health services with other local health care providers; respond to issues related to consumer and environmental health protection.
         2. American Red Cross - Primary role is to provide shelter and basic care needs to displaced individuals.
         3. Association of Bay Area Public Health Nursing Directors - Offers a Public Health Nursing resource available through Region II.
         4. California Medical Mutual Aid Region II - Provides Public and Environmental Health resources that are not available at the local level.
      3. Response

         Respond to Health Services DOC and report to DOC Director. Assume the Public and Environmental Health Services Unit Leader role, unless otherwise assigned by DOC Director or the Operations Section Chief. Refer to the ICS Section of this document for definitions of each role and corresponding checklists.

         1. Public and Environmental Health Services Unit Leader - Responsibilities: Maintain communication with Operational Area Disaster Medical Health Coordinator (OADMHC), located in the Area EOC Medical/Health Branch. Assess and activate responses to public and environmental health issues. Coordinate with Health Services DOC Team and Division Operations Centers.
8. Activation of Plan

   This plan is based upon the Incident Command System (see 8.1, below). This plan may be activated by the Operational Area Disaster Medical Health Coordinator (OADMHC), on-call Health Services Agency Manager, or Director of Public Health/Environmental Health, upon receipt of information that an incident as described above (section 3 General) has occurred. Activation shall be via notification of all Division Managers.

   1. Initial Notification - At the time of notification, all Division Managers will be given an assessment of the situation:
      • Type of incident
      • Location of incident
      • Approximate number of victims
9. Standardized Emergency Management System (SEMS)/Incident Command System (ICS)

   The Incident Command System (ICS) is an organized approach to any type of emergency. It is easily adaptable from a single agency to multi-agency/multi-jurisdiction response. It is capable of expanding in a logical manner. ICS provides standardization of organizational structure, terminology, areas of responsibility, and operational procedures. Each Division in the Health Services Agency has Incident Command System (ICS) assignments. Refer to the ICS Section of this document for definitions of each role and corresponding checklists.

   The Standardized Emergency Management System (SEMS) utilizes the structure of ICS to create standardization and avenues for communication/coordination amoung agencies and jurisdictions.

   1. Implementation of the Standardized Emergency Management System

      Health Services Department Operations Center (DOC)

      • The first Health Services representative to respond to disaster establishes a DOC and advises all appropriate individuals.
      • The Health Services DOC=s primary location is in the Health Services Department building, 225 W. 37th Avenue, San Mateo. It is located in Multi-purpose Rooms A & B. Equipment and supplies for the DOC are located in a secured and clearly marked closet. The radio room adjoins Room B and is equipped with packet radio capabilities. Keys for this area are located with the Health Services Administrative Secretaries and/or the EMS Agency.
      • If the location is safe and secure, it shall be utilized. If the DOC is uninhabitable, the DOC should be moved and established at the best location for coordination with other agencies and divisions. The decision to move the DOC will be made by the management team on site at the time the DOC is declared uninhabitable. The DOC shall be established outside any potential danger zones, near an adjacent telephone and if possible, a clear parking area.
   2. STANDARDIZED EMERGENCY MANAGEMENT SYSTEM (SEMS)/ INCIDENT COMMAND SYSTEM (ICS)
      1. General

         The Incident Command System (ICS), because of its standardized organizational structure and common organizational and operational terminology, provides a useful and flexible management system that is particularly adaptable to incidents involving multi-jurisdictional response. The ICS provides the flexibility to rapidly activate and establish an organizational form around the functions that need to be performed.

         The Standardized Emergency Management System (SEMS) utilizes the organizational structure of ICS to facilitate communication and coordination within an organization, as well as with agencies outside of the organization, during disaster response. The purpose and scope of SEMS is stated in the California Code of Regulations Title 19, Division 2, Chapter 1, Article 1, §2401 Purpose and Scope, as: "SEMS is intended to standardize response to emergencies involving multiple jurisdictions or multiple agencies. SEMS is intended to be flexible and adaptable to the needs of all emergency responders in California. SEMS requires emergency response agencies use basic principles and components of emergency management including ICS, multi-agency or inter-agency coordination, the operational area concept, and established mutual aid systems. State agencies must use SEMS. Local government must use SEMS..."

         The ICS basic organizational (here is a sample of San Mateo Count's ICS Chart) structure within SEMS consists of five principal Sections: Command, Operations, Planning, Logistics and Finance. Depending upon the nature and size of the incident, all or some of these Sections would normally be activated. By nature, the ICS allows the flexibility to utilize those positions most appropriate for the incident at hand. Therefore, not all positions are activated for every crisis. It is the responsibility of the Health Services Department Operations Center (HS DOC) Director and prospective Command Staff to determine the level of activation. Additionally, each role in the Sections is designed to be occupied by the most appropriate individual available at the time. For example, the DOC Director would ideally be the Health Services Agency Director; however, if she cannot get to the DOC or is not on site at the time of the incident, the most appropriate person available will assume the role. Once an individual that is more capable of performing the duties of the DOC Director is available, he or she should assume the DOC Director position, if necessary.

      2. Organization
         1. Command

            Includes the Department Operations Center (DOC) Director, who has overall management responsibility for the health services disaster response. A Command Staff element is

            provided for handling such matters as Public Information, Safety, interagency Liaison, and Medical Officer (if needed).

            Multidivisional incidents will involve a Unified Command element. A Unified Command brings together officials from affected divisions to form an integrated and unified element to develop a common and consistent action plan. This process is utilized to ensure the best use of all available resources. The person with the greatest qualifications and experience should be selected to assume the role of DOC Director and oversee these operations.

         2. Operations Section

            This Section is headed by an Operations Section Chief, who is responsible for the management of all disaster response activities that are operational in nature. The Operations Section is subdivided into the following Units:

            • Aging and Adult Services
            • Public and Environmental Health Services
            • Mental Health Services
            • Hospital and Clinics Services
         3. Planning Section

            The Planning Section is under supervision of the Planning Section Chief. The Planning Section is responsible for the collection, analysis, and dissemination of information regarding the incident and the assigned resources, the development of the jurisdiction’s action plan in coordination with other functions; and the collection and maintenance of response documentation. The Planning Section maintains an incident log and DOC display maps and charts. In addition, the Planning Section is also responsible for preparing situation reports, conducting the planning meetings, documenting all DOC activities, and preparation of the Incident Action Plan. The Planning Section consists of the following positions, although not all of the positions may be filled, depending on the nature or extent of the emergency situation. The Planning Chief assumes the responsibilities of those positions which are vacant.

            • Situation/Status Unit
            • Documentation Unit
            • Emergency Medical Services Unit
            • Message Unit
            • Resource Status Unit
            • Action Plan Unit
         4. Logistics Section

            The Logistics Section is under the supervision of the Logistics Section Chief, and provides all emergency support needs. The Logistics Section orders all resources, manages volunteers and personnel, and provides communications, facilities, transportation, supplies, equipment, and food as required. The Logistics Section is made up of the following Units:

            Services Unit Leader

            • Communications Officer
            • Health Information Technology (HIT) Officer
            • Food/Nutritional Officer

            Support Unit Leader

            • Human Resources Officer
            • Facilities Officer
            • Materials and Supplies Officer
            • Transportation Officer
         5. Finance Section

            The Finance Section provides for the tracking of the time worked by all emergency personnel involved in the incident, provides cost analysis and projections, and records any and all injury claims for compensation. The Finance Section is managed by the Finance Director. The following units are established as necessary in the Finance Section:

            • Time Unit
            • Cost Unit
            • Claims Unit
10. CHECKLISTS
    • Command Section
    • Operations Section
    • Planning Section
    • Logistics Section
    • Finance Section