The Framework of Emergency PreparednessPatricia Frank, RN, Director of Emergency Preparedness and Response, Duval County Health Department; Chip Patterson, Chief, Duval County Emergency Operation CenterClick here for the City of Jacksonville Emergency Preparedness webpage
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| This is the first of several articles to appear in the Duval County Medical Society Journal related to Emergency
Preparedness and Response plans for our community. This first installment will present an overview of the framework of the local,
regional, state and national Comprehensive Emergency Management Plan. As you will see, it is quite comprehensive in scope.
Subsequent articles will detail aspects of our local plans and present the critical roles to be played by physicians and other
health care providers. To be sure, our response will rely on the participation of all physicians and the Medical Society. Our
challenge, as a community, will be to ensure that all physicians are educated and prepared to respond as individuals and as part of a
fully integrated system. We must acknowledge the leadership that has already been provided by the DCMS in this regard. Our
success depends on this continuous leadership and our ability to work together to meet the needs of our community in the event of
any incident whether it is a natural or man-made disaster.
Emergency management is composed of four distinct phases. They are preparing for, responding to, recovering from and mitigation of local disasters. Local capabilities and resources determine the methodology and procedures used by emergency managers. Emergency management has only one rule, that is, meet the needs of the victims. Emergency management has only one goal, which is reducing the number of victims. Each Florida County has a Comprehensive Emergency Management Plan (CEMP). The Florida Division of Emergency Management, Department of Community Affairs, as required by Florida Statute, must approve each County CEMP to be in compliance with published criteria. Each CEMP uses an all-hazards approach tailored to the uniqueness of each county. Among the items included in each CEMP are alert and notification procedures to the general public, medical community, private sector and government agencies. Each CEMP must contain a local hazards analysis and concept of operations. Each Florida County uses the Emergency Support Function concept in emergency management operations. Emergency management procedures are based on the four phases of emergency management. That entails conducting an inventory of local resources, understanding local capabilities and building relationships with local agencies to integrate all parties into one organization should disasters threaten or strike. Grouping local agencies into a cohesive organization based on functionality has proven to be the optimum method for response and recovery operations. Local emergency management offices have prepared and routinely use protocols and procedures for local operations. The State of Florida requires each CEMP to identify normal management and local jurisdictions, identify local officials, provide for continuity of government and line of succession and name the lead and support agencies used within the emergency management organization. Further, additional plans are required that address coastal oil spills, hazardous materials incidents, mass immigration, airports and others. The State Division of Emergency management requires each County plan for major and minor catastrophic events, host and impact sheltering, develop plans/procedures to support regional evacuation, develop/maintain procedures/plans for re-entry activities, develop and maintain a critical facilities database, and develop and maintain a mitigation plan. Each County is required to prepare Standard Operating Procedures for damage assessment operations, selection and operation of Disaster Recovery Centers, infrastructure/public assistance activities, recovery projects, debris management operation, community relation's activities. The City of Jacksonville/Duval County's Comprehensive Emergency Management Plan is comprised of eighteen (18) Emergency Support Functions that address the unique challenges disaster poses to our community. The eighteen Emergency Support Functions address issues in four general areas; 1) damaged or destroyed infrastructure (water, wastewater, electrical, communications, etc.), 2) impaired ability to provide service (police, fire, social services, etc.), 3) isolated or displaced persons and 4) mass casualty and/or death. Our State law, local emergency management ordinances and executive ordinances are the bedrock. The Comprehensive Emergency Management Plan is the cornerstone for all other disaster management planning in the county. Building up from the cornerstone of the Comprehensive Emergency Management Plan is an interagency disaster plan for Mass Casualty Incidents. This interagency disaster plan describes the roles and responsibilities various organizations have in a mass casualty disaster. Because of some unique characteristics of responding to a weapon of mass destruction (nuclear, biological, chemical, incendiary or explosive); a Metropolitan Medical Response System (MMRS) plan has been developed for Jacksonville. The MMRS development has been preparing and equipping police, fire, hospitals and public health with the tools to detect exotic chemicals, conduct mass decontamination, personal protective equipment and purchase a supply of pharmaceuticals for chemical attack. Each agency involved in the MMRS then takes the MMRS coordination plan and builds specific procedures, checklists and protocols for response. Recent work in the MMRS Task Force has been to complete a Biological Terrorism Response Plan that is currently under review by the United States Public Health Service. The Comprehensive Emergency Management Plan and Metropolitan Medical Response System are integrated with State and Federal disaster plans. As with all jurisdictions in the country; Jacksonville/Duval County works with the National Disaster Medical System (NDMS) to prepare for state and federal deployment of Disaster Medical Assistance Teams (DMATs) and Disaster Mortuary Teams (DMORTs) that would respond to a national disaster. Specific to a WMD event; the federal government has developed "PUSH" packages that consists of equipment and supplies, including pharmaceuticals, to be deployed into an area within 12 hours. In accordance with the National Defense Authorization Act for Fiscal Year 1997, Title XIV, Defense Against Weapons of Mass Destruction, the Public Health Service and the U.S. Department of Health and Human Services are charged with helping local governments develop and implement plans to respond to weapons of mass destruction/nuclear, biological, and chemical incidents. In 1997, Jacksonville-Duval County submitted a plan for implementing a Metropolitan Medical Response System. The MMRS interfaces with existing Jacksonville-Duval County Comprehensive Emergency Management Plan and the Mass-Casualty Response Plan. Following the guidelines set forth by the U.S. Department of Health and Human Services, the MMRS provides a very general set of guidelines that can be utilized regardless of whether radiological, biological, or chemical agents are present. Given current concerns, it will be helpful to further examine special concerns regarding the release of a biological agent. Unlike nuclear or chemical incidents, biological releases may not be immediately apparent. Depending on the nature of the exposure, patients may not present symptoms for days or even weeks. In addition, the contagious nature of a biological agent creates added danger and makes it extremely difficult to identify the exposed population. Surveillance and Early RecognitionA rapid escalation of similar sickness patterns or symptoms presented to health-care centers will likely prompt the public health community (EMS Agency or healthcare facilities) to suspect possible contamination or intentional release of a causative agent. Such an event will trigger a full epidemiological and law enforcement investigation to determine the probable cause, site, exposed population, and public health risk. Due to the nature of biological incidents, Incident Command will be established at the EOC. Surveillance is an essential in order to detect an intentional release of an infectious disease in our community. Surveillance is a continuous operational process that occurs before, during, and following a disease outbreak. Early recognition of a suspect bioterrorist event can reduce the number of casualties. The bioterrorism surveillance system for the City of Jacksonville, Duval County, has as part of the MMRS:
Mass Patient Care/TreatmentAn effective medical and public health response to a biological incident/terrorism event depends upon anticipating the various medical and health problems that will result from such an event, and then providing appropriate therapeutic interventions in as timely and effective a manner as possible. The number of casualties resulting from a biological incident will determine the response of the medical community to either address the incident with existing resources or to deploy alternate care facilities to manage large numbers of casualties. Jacksonville Medicine / November, 2001What's New
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